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IFS vs. CBT for Trauma in Driven Women: A Therapist’s Honest Comparison
Morning light over a quiet harbor — Annie Wright trauma therapy for driven women

IFS vs. CBT for Trauma in Driven Women: A Therapist’s Honest Comparison

SUMMARY

IFS and CBT are both legitimate, evidence-supported approaches to therapy — but for driven women with relational trauma, they work at completely different levels and suit very different presentations. This post explains what each one actually does, where each one has limits, and how to make an intelligent clinical decision about which belongs in your treatment.

The Loop She Can’t Think Her Way Out Of

Dimension Internal Family Systems (IFS) Cognitive Behavioral Therapy (CBT)
Foundational model The psyche is understood as multiple ‘parts’ — protective parts, exiled wounded parts, and a core Self — and healing involves helping these parts relate differently to each other and to the Self. The interaction of thoughts, feelings, and behaviors — CBT understands distress as maintained by cognitive distortions and behavioral patterns that can be identified, challenged, and changed.
How trauma is addressed IFS directly engages the exiled parts carrying the traumatic material — healing involves accessing the wounded part, unburdening it, and integrating it into the larger system with the Self’s care. CBT addresses the cognitive patterns that trauma installed — challenging negative automatic thoughts, building tolerance for avoided situations, and restructuring the beliefs that trauma activated.
What the client is doing in session Attending inward — noticing internal parts, curiosity about their roles and fears, and developing a relationship with the different aspects of the self that CBT doesn’t explicitly attend to. Engaging cognitively — identifying thoughts, examining evidence, building cognitive flexibility, and completing behavioral assignments between sessions.
For driven women specifically IFS often resonates because it makes sense of the internal conflict driven women frequently experience — the part that performs, the part that wants to rest, the part that fears failure; the model is immediately recognizable. CBT’s structured, evidence-based framework often appeals to driven women — the cognitive engagement, the homework, and the measurable progress match a goal-oriented operating style.
What each doesn’t address IFS doesn’t explicitly target behavioral patterns or provide the skills-based structure that CBT offers — for some presentations, the lack of concrete skill-building is a limitation. CBT doesn’t directly address the somatic and parts-level complexity that deep trauma often requires — the cognitive framework may not reach the most entrenched traumatic material.
In my practice I find IFS invaluable for complex trauma — particularly when clients are in conflict with themselves, when there’s significant internal fragmentation, or when standard approaches keep hitting the same parts-level resistance. CBT provides useful structure, particularly early in treatment or for anxiety and depression presentations — I integrate specific CBT strategies within a broader trauma-informed frame.

Miriam is 39, a senior attorney at a large litigation firm. She’s been in CBT for two years with a therapist she genuinely likes. She can identify cognitive distortions with the proficiency of someone who’s read the workbooks. She knows her catastrophizing is irrational. She can construct a more balanced alternative thought in the time it takes most people to name the feeling.

She still spirals every time her managing partner sends a terse email. The alternative thought doesn’t touch it. The thought record fills itself out correctly. The dread arrives anyway, right on schedule.

In my work with clients like Miriam, this moment — when cognitive tools are being deployed competently and the pattern still isn’t shifting — is a significant clinical signal. It means the presenting problem isn’t primarily cognitive. The thoughts are symptoms. The root is somewhere else, and CBT’s tools, as useful as they are, are aimed at the wrong level.

This post is for the driven woman who has tried CBT, gained useful skills, and still has the sense that the deeper thing hasn’t moved. It’s also for the woman who is trying to choose between CBT and IFS — Internal Family Systems — and wants a clinician’s honest account of what each one actually does and what each one can’t reach.

What Is CBT — and What Does It Actually Treat?

Cognitive Behavioral Therapy was developed primarily by Aaron T. Beck, MD, psychiatrist and professor emeritus at the University of Pennsylvania, who pioneered the cognitive model of depression in the 1960s and 70s. CBT is built on the premise that distorted or unhelpful thoughts drive distressing emotions and dysfunctional behaviors — and that systematically identifying and restructuring those thoughts produces symptomatic improvement.

CBT is the most extensively researched psychotherapy modality in existence. Its evidence base for depression, anxiety disorders, specific phobias, OCD, and acute PTSD is robust. It’s structured, time-limited, and teachable — which makes it the modality most readily delivered in insurance-covered, session-limited contexts. For what it was designed to treat, it works well.

What it was designed to treat matters. CBT was built to address what Beck called the cognitive triad: negative automatic thoughts about the self, the world, and the future. It’s most effective when the presenting problem is primarily maintained by thought patterns — when thinking differently would actually produce different feeling and behaving.

DEFINITION COGNITIVE BEHAVIORAL THERAPY (CBT)

A structured, evidence-based psychotherapy developed by Aaron T. Beck, MD, psychiatrist and professor emeritus at the University of Pennsylvania, and expanded by Albert Ellis, PhD, and others. Based on the cognitive model: distorted or unhelpful thoughts drive distressing emotions and problematic behaviors. Treatment involves identifying automatic negative thoughts, evaluating their accuracy, and restructuring them into more adaptive cognitions. The most researched psychotherapy modality, with strong evidence for depression, anxiety, OCD, specific phobias, and acute PTSD.

In plain terms: CBT works on the premise that what you think shapes how you feel and behave. If you can change the thought, the feeling and behavior follow. This works — for problems that are primarily cognitively organized. For trauma rooted in early relational experience, it often addresses symptoms without touching the root.

The Neurobiology: Why Cognitive Restructuring Hits a Wall

To understand where CBT reaches its limit — particularly for complex relational trauma — requires a brief look at how the brain processes threat and encodes early experience.

Bessel van der Kolk, MD, psychiatrist and trauma researcher, author of The Body Keeps the Score, has documented extensively that trauma disrupts the integration between the prefrontal cortex — the brain’s executive reasoning center, where CBT operates — and the subcortical structures that encode threat responses: primarily the amygdala and the brainstem. When early relational trauma has shaped a person’s nervous system organization, the threat response patterns aren’t stored as thoughts. They’re encoded as implicit memory — body-level, subcortical, automatic.

When Miriam’s managing partner sends a terse email, what fires is not a thought. It’s a subcortical threat signal — activated in the amygdala, experienced in the body as dread before her conscious mind has registered the content of the email. The cognitive restructuring that CBT offers is aimed at the prefrontal cortex. But the problem is originating three floors below that.

Daniel Siegel, MD, clinical professor of psychiatry at UCLA and author of The Developing Mind, describes integration — the linkage of differentiated parts of the nervous system into a coherent, flexible whole — as the core task of both development and healing. When early attachment experiences have been inadequate or harmful, certain parts of the nervous system develop in isolation from the integrative, narrative-making centers of the brain. Those isolated parts don’t respond to reasoning. They respond to relational experiences, to body-level approaches, and to modalities that work at the level where they’re actually organized.

This is where CBT, for all its genuine strengths, runs into a structural limit with complex relational trauma: cognitive restructuring assumes the problem is cognitively organized. For early attachment wounding, it isn’t.

Richard Schwartz, PhD, psychologist and founder of Internal Family Systems therapy, recognized this clinical gap in the 1990s. IFS developed out of his observation that clients had internal experiences of being composed of “parts” — sub-personalities that held different emotions, memories, beliefs, and survival strategies — and that these parts, particularly those that carried historical pain and those that developed to protect against it, weren’t reliably responsive to cognitive intervention. They needed a different kind of relationship.

DEFINITION INTERNAL FAMILY SYSTEMS (IFS)

A psychotherapy model developed by Richard Schwartz, PhD, psychologist and clinical faculty member at Harvard Medical School, based on the premise that the mind is naturally multiple — composed of sub-personalities or “parts” — and that psychological suffering results from parts that became burdened with historical pain and protective strategies that are no longer serving the whole system. IFS works by developing the client’s relationship with their parts through a non-pathologizing, compassionate internal stance (the Self), rather than seeking to eliminate or override them. Increasingly supported by clinical research, including a 2013 RCT by Shadick et al. demonstrating efficacy for rheumatoid arthritis-related depression and quality of life.

In plain terms: IFS doesn’t try to change the part of you that’s afraid, ashamed, or self-critical. It tries to get the rest of you into a compassionate relationship with that part — so the part can finally update. This is the work that reaches where CBT can’t.

Allan Schore, PhD, clinical faculty member at UCLA David Geffen School of Medicine and author of The Science of the Art of Psychotherapy, has spent three decades mapping the neuroscience of right-brain-to-right-brain communication in early attachment — the implicit, nonverbal, affect-regulating attunement between caregiver and child that shapes the developing nervous system. Schore’s work makes a compelling case that the mechanisms through which early relational trauma is encoded are primarily right-hemisphere, subcortical, and implicit. They are not stored as narrative memory or accessible through verbal reasoning. CBT’s cognitive model, which operates primarily through language and explicit cognition, is therefore engaging the left hemisphere’s processing — while the trauma lives in the right hemisphere’s implicit, procedural, body-level memory. This is not a failure of CBT. It’s a mismatch of modality to mechanism. IFS, with its capacity to work with parts through imagery, sensation, and felt sense, accesses that right-hemisphere territory more directly.

In my clinical work, this theoretical distinction has a very clear practical expression. When a driven woman in CBT says, “I know the thought is irrational, but I feel it anyway” — she is describing exactly this mismatch. The knowing is left-hemisphere, verbal, explicit. The feeling is right-hemisphere, subcortical, older. Cognitive restructuring is speaking to the knowing. IFS is capable of speaking to the feeling.

How Each Modality Shows Up for Driven Women

What I see consistently in my clinical work is that driven women often arrive already skilled at using CBT-style tools. They’re analytical, self-reflective, and good at applying frameworks. They’ve often done genuine, productive cognitive work. They’ve gotten better at catching distorted thinking. They’ve built real skills for managing acute anxiety.

And then there’s the part that hasn’t moved. The one that still believes, at some cellular level, that her worth is entirely contingent on her performance. The one that will burn herself out rather than risk disappointing someone she respects. The one that has carried a specific shame since she was nine years old and her father said something she still can’t quite repeat.

Consider Talia, 44, a partner at a venture capital firm. She’s been in therapy, on and off, since her mid-twenties. She’s articulate about her perfectionism — she knows where it came from, she can name the cognitive distortions, she’s even done meaningful CBT work on her presentation anxiety. But every year, she is still working 80-hour weeks because she can’t tolerate the possibility of being seen as inadequate. She has a part that runs her professional life on high alert, and a part underneath it that holds a terror she has never been able to name in words.

CBT addresses Talia’s thought content. IFS goes toward the parts. It asks: what is the anxious, overdriving part of Talia trying to protect her from? And when that part can be approached with curiosity rather than shame or frustration — when Talia can sit with it and hear its story — the possibility of something shifting opens up.

This is not a rejection of CBT. For specific presentations — work-performance anxiety, specific phobias, acute depression with primarily cognitive features — CBT can be highly effective and often sufficient. The clinical question is always: what is actually driving the presentation? If the answer is “a thought pattern,” CBT is often the right tool. If the answer is “a part of me that developed in response to early relational pain,” you need a modality that can work with parts.

What Is IFS — and What Can It Reach That CBT Can’t?

Richard Schwartz, PhD, psychologist and clinical faculty at Harvard Medical School, developed IFS from a foundational observation: clients naturally described their inner experiences in terms of parts — “a part of me wants to quit, but another part is terrified to.” Rather than treating this multiplicity as pathological, Schwartz worked with it as an accurate map of how the psyche organizes experience.

In IFS, the internal system is understood to include managers (parts that try to control the environment to prevent pain), firefighters (parts that react when the pain breaks through anyway — often with addictive, self-harming, or dissociative behaviors), and exiles (parts that carry the actual historical pain — the childhood experiences, the attachment wounds, the shame — and have been banished from conscious awareness by the protective parts). At the center of the system is what Schwartz calls the Self — a state of calm, curious, compassionate presence that is not a part but the person’s essential nature.

IFS therapy works by building the client’s capacity to access Self and from that grounded place, approach the protective parts with curiosity rather than combat, and eventually, carefully, reach the exiles — the parts that carry the original wound — so they can be witnessed, unburdened, and updated.

“I felt a Cleaving in my Mind — As if my Brain had split — I tried to match it — Seam by Seam — But could not make them fit.”

EMILY DICKINSON, poet, c. 1864

I use that Dickinson poem in my work because it describes, with eerie accuracy, what many driven women experience — this sense of internal fracture that no amount of intellectual effort can suture. IFS is, in some ways, the clinical answer to that poem. It doesn’t try to make the seams fit by force. It builds a different kind of internal relationship — one where the split parts can be known rather than managed, witnessed rather than overridden.

Consider Gabriela, 41, a pediatric surgeon. She came to therapy because she couldn’t stop working. Not wouldn’t — genuinely couldn’t. If she took a day off, she experienced what she described as “a crawling wrongness” that no amount of rationally knowing she deserved rest could touch. CBT told her the rest was rational. The crawling wrongness didn’t care about the thought record.

In IFS work, what became clear was that Gabriela had a manager part — the driven, relentless worker — whose entire job was to prevent a very young exile part from being felt. That exile carried the experience of a childhood in which she was only acceptable when she was achieving. Her worth had been conditional for so long that idleness didn’t feel like rest — it felt like annihilation.

CBT couldn’t reach this because the manager wasn’t running cognitive distortions. It was running a survival strategy. IFS could approach the manager with genuine curiosity — not trying to eliminate it, but asking what it was afraid would happen if Gabriela rested. And from there, the deeper work became possible.

This is also where Fixing the Foundations does meaningful work — helping driven women identify the foundational relational patterns that drive the loops CBT can’t quite reach.

Both/And: CBT Has Real Strengths AND IFS Has Real Strengths

The clinical picture is almost never either/or. And in practice, the most effective treatment for driven women with complex relational trauma often sequences or integrates both.

CBT is genuinely useful for:

Acute symptom management. When anxiety is spiking or depressive symptoms are severe, CBT skills — breathing techniques, behavioral activation, thought records — provide concrete stabilization tools. They don’t address the root, but they help the client stay functional enough to do the deeper work.

Specific, circumscribed problems. A specific phobia. A circumscribed work-performance anxiety around a particular context. Presentation anxiety. For these targeted presentations, CBT is often sufficient and can work efficiently.

Building metacognitive awareness. CBT builds the capacity to notice thoughts as thoughts rather than as facts — a skill that actually supports IFS work by developing the observational capacity that facilitates Self access.

IFS is most indicated for:

Complex relational trauma and attachment wounds. Early experiences of emotional neglect, parentification, conditional worth, or chronic misattunement. These aren’t thought patterns. They’re parts that carry historical pain.

Self-critical patterns that don’t respond to reframing. When the inner critic is so entrenched that alternative thoughts feel false — because they are to the part running the critic — IFS’s approach of working with the part rather than against it often reaches further.

The driven woman who has already done CBT and hit a wall. If insight and cognitive tools are in place and the deeper pattern hasn’t shifted, the clinical signal is that the root is below the cognitive level.

What I often recommend in practice: build the cognitive skills with CBT first, especially for managing acute symptoms. Then, when the client has enough stabilization, shift to parts work — approaching the underlying relational wounds that the cognitive patterns are protecting. The modalities serve each other.

You can learn more about individual therapy with Annie, which integrates approaches based on what your specific presentation requires, or explore executive coaching for the organizational and leadership dimensions of these patterns.

The Systemic Lens: Why Driven Women Are Overprescribed CBT

Here is the systemic reality: CBT is the modality most covered by insurance, most easily delivered in session-limited contexts, and most straightforwardly manualized — meaning it can be delivered with reasonable fidelity by practitioners who haven’t had years of specialist training. These are not criticisms of CBT. They’re accurate descriptions of why it has become the default intervention in almost every mental health system.

The consequence for driven women with complex relational trauma is that CBT is often what they receive, not because it’s the best fit for their presentation, but because it’s what the system can deliver. An EAP covers six sessions. Insurance authorizes twelve. In that context, a focused, structured, symptom-targeted modality is what gets offered — and CBT fits that container better than IFS, which requires relationship development and parts-system mapping that rarely fits in a session-limited authorization.

This creates a pattern I see regularly: driven women who have had multiple rounds of CBT, each of which produced real but partial benefit, and who have come to believe they’re simply resistant to treatment or not trying hard enough. What they’re actually experiencing is the right tool applied to the wrong level of the problem.

There’s also a subtler dynamic worth naming. Driven women often find CBT comfortable precisely because it’s structured and cognitive — it plays to the strengths that have made them successful professionally. A parts-based model that asks you to slow down, be curious about internal states, and approach a scared eight-year-old exile with compassion is doing something very different from running a thought record. It asks for a different kind of engagement, and it can feel vulnerable in ways that feel less efficient and less controllable.

The systemic message — use the protocol, fill out the worksheet, demonstrate measurable improvement in six sessions — often reinforces exactly the achievement-orientation that is part of what’s driving the driven woman toward therapy in the first place.

True healing for relational trauma doesn’t fit a protocol. It requires the right modality, the right relational container, and enough time. This is one reason why private-pay, non-insurance therapy often serves driven women better — it allows for the kind of sustained, flexible, clinician-directed work that complex presentations require.

There’s a subtler gender dimension worth naming here. The CBT model’s emphasis on cognitive control, rationality, and measurable outcomes maps cleanly onto the professional qualities that got many driven women where they are. Thought records feel like deliverables. Challenge-and-replace exercises feel like problem-solving. The structure of CBT affirms the very capabilities these women have cultivated and valorized. IFS, which asks them to approach a frightened, young, or hurt part of themselves with tenderness and curiosity rather than rational analysis, can feel profoundly foreign and even threatening to the part of them that has kept a lid on vulnerability for twenty years. The irony is that the modality that asks for something more is often the one that delivers more. But the asking requires a willingness to relinquish the cognitive control that has been both the driven woman’s professional asset and her internal survival strategy.

How to Choose the Right Modality for Your Presentation

Here’s the framework I use with clients who are trying to make this decision:

What’s the primary driver of the presenting problem? If distorted thoughts are the primary driver — if you can identify the thought, challenge it, and the emotional response shifts — CBT is likely a strong fit. If you’ve tried this and the pattern is impervious to correct cognitions, the driver is likely below the cognitive level.

Is there an internal critic that doesn’t respond to reframing? A self-critical voice that you can rationally argue with and that simply doesn’t care what the argument says is a parts signal. That voice isn’t a thought pattern. It’s a part. IFS is built to work with it.

Is there a sense of internal fragmentation? If you experience what feels like internal conflict — one part that desperately wants to change, another that sabotages every attempt — IFS’s parts framework often provides a map that makes sense of the experience and opens up a different way of working with it.

What does your clinical history tell you? If you’ve had productive CBT and arrived at its limit, IFS (often combined with body-based approaches like somatic therapy) is often the next step. If you haven’t had any structured therapy, CBT’s skill-building may be an appropriate entry point — particularly for managing acute symptoms while longer-term relational work is undertaken.

Whatever modality you pursue, make sure the practitioner is specifically trained in it — not just informed about it. For IFS, look for practitioners trained by the IFS Institute or certified by the IFS Level 1–3 training program. For CBT, look for practitioners trained in specific CBT protocols relevant to your presentation (Trauma-Focused CBT if there’s a trauma component, for instance).

And if you’re unsure where to start, a consultation can help clarify what your presentation actually calls for. The goal is not to find the most popular modality. It’s to find the right level of intervention for what’s actually driving your experience.

FREQUENTLY ASKED QUESTIONS

Q: Is IFS evidence-based?

A: IFS has a growing evidence base, including a 2013 randomized controlled trial by Shadick et al. demonstrating efficacy for rheumatoid arthritis-related depression and quality of life, and it’s included on SAMHSA’s National Registry of Evidence-Based Programs and Practices. Its evidence base is less extensive than CBT’s — CBT has had decades and hundreds of trials — but IFS is gaining research support and is considered a legitimate evidence-informed approach by mainstream clinical organizations.

Q: I’ve tried CBT and it helped with skills but hasn’t touched the deeper pattern. What does that mean?

A: It’s a strong clinical signal that the root of the pattern isn’t cognitively organized. CBT is excellent for what it’s designed to treat — cognitive patterns, specific phobias, acute symptoms. When the deeper pattern persists despite competent cognitive work, the driving mechanism is typically at the parts level (relational and attachment wounds) or the somatic level (nervous system encoding). IFS and/or body-based approaches typically serve this presentation better.

Q: How long does IFS therapy take?

A: IFS for complex relational trauma is typically medium-to-long-term work — often one to three years of regular sessions. The first phase involves learning the IFS framework and developing the capacity to access Self. The second phase involves working with protective parts. The third phase — approaching and unburdening exiles — requires significant relational safety and internal capacity. This work can’t be rushed, and insurance-covered session limits are rarely sufficient.

Q: Can I do IFS and CBT simultaneously?

A: Yes, and this is often clinically appropriate. Many skilled therapists integrate CBT tools for acute symptom management and stabilization while doing IFS-oriented parts work for the deeper relational material. The two can operate in parallel within a single therapeutic relationship if the clinician is trained in both. The sequencing and integration depend on where you are in treatment and what your nervous system can hold at any given time.

Q: What’s a “part” in IFS? Is this just a metaphor?

A: Richard Schwartz describes parts as both a useful clinical metaphor and a description of something neurologically real — the brain’s tendency to organize experience into differentiated sub-systems with their own emotional signatures, memories, and behavioral propensities. Whether you understand parts as literal or metaphorical, what matters clinically is that working with them as if they’re real — approaching them with curiosity and compassion rather than trying to override them — consistently produces different results than cognitive restructuring alone.

Q: Why does my inner critic not respond to positive self-talk or thought records?

A: Because your inner critic isn’t a thought pattern. In IFS terms, it’s a manager part — one that developed a specific job, usually to prevent humiliation or rejection by criticizing you before anyone else can. When you apply positive self-talk to it, you’re trying to override a parts system. In IFS, the approach is to get curious about the critic — what is it afraid would happen if it stopped? That question opens the work that cognitive restructuring can’t reach.

Q: My insurance covers CBT but not IFS. What do I do?

A: Many IFS practitioners bill under a diagnosis and use standard procedure codes, which insurance will cover regardless of the modality label — because modality isn’t typically what insurance authorizes, a diagnosis is. If your IFS therapist is also trained in evidence-based approaches for your diagnosis, the work may be covered. That said, private-pay therapy with an IFS specialist may ultimately serve you better than session-limited insurance-authorized care for complex relational trauma. The clinical question is whether what insurance covers is sufficient for what you actually need.

Related Reading

Schwartz, R. C. No Bad Parts: Healing Trauma and Restoring Wholeness with the Internal Family Systems Model. Boulder: Sounds True, 2021.

Beck, A. T., Rush, A. J., Shaw, B. F., and Emery, G. Cognitive Therapy of Depression. New York: Guilford Press, 1979.

Shadick, N. A., et al. “A Randomized Controlled Trial of an Internal Family Systems-Based Psychotherapeutic Intervention on Outcomes in Rheumatoid Arthritis.” Journal of Rheumatology 40, no. 11 (2013): 1831–1841.

References

Peer-Reviewed Research (Vancouver)

  1. van der Kolk BA, Wang JB, Yehuda R, Bedrosian L, Coker AR, Harrison C, et al. Effects of MDMA-assisted therapy for PTSD on self-experience. PLoS One. 2024;19(1):e0295926. doi:10.1371/journal.pone.0295926. PMID: 38198456.
  2. Reisz S, Duschinsky R, Siegel DJ. Disorganized attachment and defense: exploring John Bowlby's unpublished reflections. Attach Hum Dev. 2018;20(2):107-134. doi:10.1080/14616734.2017.1380055. PMID: 28952412.
  3. Schore AN. The Interpersonal Neurobiology of Intersubjectivity. Front Psychol. 2021;12:648616. doi:10.3389/fpsyg.2021.648616. PMID: 33959077.
  4. Brenner EG, Schwartz RC, Becker C. Development of the internal family systems model: Honoring contributions from family systems therapies. Fam Process. 2023;62(4):1290-1306. doi:10.1111/famp.12943. PMID: 37924221.

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About the Author

Annie Wright, LMFT

LMFT · Relational Trauma Specialist · W.W. Norton Author

Helping ambitious women finally feel as good as their résumé looks.

Annie Wright is a licensed psychotherapist (LMFT #95719) and trauma-informed executive coach with over 15,000 clinical hours. She works with driven, ambitious women — including Silicon Valley leaders, physicians, and entrepreneurs — in repairing the psychological foundations beneath their impressive lives. Annie is the founder and former CEO of Evergreen Counseling, a multimillion-dollar trauma-informed therapy center she built, scaled, and successfully exited. A regular contributor to Psychology Today, her expert commentary has appeared in Forbes, Business Insider, Inc., NBC, and The Information. She is currently writing her first book with W.W. Norton.

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