Sunday, December 28, 2008

Parts Psychology and Trauma Therapy

"Parts Psychology" is the label I use for psychotherapy with the part-selves that underlie all psychological functioning. The moods, attitudes, beliefs, and tendencies that characterize a person's "personality" are based in these normally unconscious parts of the mind. These parts were called "sides" by Morton Prince, founder of the Journal of Abnormal Psychology. Prince discovered these internal parts of normal people through hypnosis nearly a century ago, but his observations were soon replaced on the larger stage by the rise of Freudian psychoanalysis. The concepts of parts, sides, or subpersonalities were rarely utilized in American psychology for half a century. Then, John and Helen Watkins developed their theory of "Ego States" beginning in the early 1970s, and Richard C. Schwartz developed his "Internal Family Systems" model of internal parts during the 1980s. The Watkinses emphasized hypnosis as the means for becoming acquainted with internal parts, but Schwartz showed us that hypnosis is unnecessary. In my own work I rarely use hypnosis.

"Parts Psychology" is also the name of my book on the subject and should be in press in 2009. I have so far written 11 of the 15 chapters. In the book I write about the treatment of a large variety of problems experienced by fairly normal people, including issues of jealousy, rage, sexual swinging, binge eating, panic, low sexual drive, body image distortion, pornography addiction, and grief. These and other issues are carried by internal part-selves and expressed in the external world by normal people. In order to sidestep potential criticism alleging that the people I write about are "multiples," I used tests of dissociation to rule out persons for the book unless their scores were in the "normal" range. Dissociation in the extreme range is characteristic of multiple personality disorder. The book demonstrates that treatment of the above problems moves quickly and results in healing rather than mere coping with the problems.

Parts Psychology emphasizes trauma therapy for the healing of emotional issues. More and more research shows significant trauma in the histories of people suffering from depression, anxiety disorders, and compulsive problems of many kinds. One implication of these findings is that trauma therapy rather than drug therapy may be the most helpful treatment. Advertisments by the drug industry that suggest that the problem is a "chemical imbalance" treatable simply by taking a pill are seriously misleading. Instead, true healing may require the neutralization of the psychological trauma that underlies the mental problem.

Trauma therapy is a different kind of psychotherapy from the usual supportive therapy which focuses on the here and now in the therapy office. Trauma therapy might focus on the here and now if the trauma is recent. But most mental health problems have their roots years or decades in the past. Trauma includes the obvious such as rape or exposure to near death as a victim or a witness. But it also includes childhood experiences that are less obviously traumatic, such as watching your parents scream at each other and threaten divorce, losing a best friend as the result of moving to another city, and attending the funeral of a close relative. Probably the childhood experiences that are most damaging are those of physical, sexual or emotional abuse. Many adult problems are due to these childhood traumas.

Sunday, December 21, 2008

Normal and Abnormal Dissociation

This weeks blog might border on being too technical for some readers. If so, and you just want to connect to last week, then skip to the final paragraph. I will get away from definitions and experts next week.

I think most experts in dissociation studies would accept a definition something like this: dissociation is the abnormal separation of psychic processes or contents where these processes or contents would normally be integrated. Thus, memory should be integrated with action so that we remember putting a note on the table, deleting phone numbers from a cell phone, or ruining dinner if we did these things. Or, we should have sufficient control over our self states such that we can refrain from actions that our self states might tempt us to take if we choose to do so. Self states should be integrated into a cohesive whole such that they do not represent semi-independent or autonomous entities capable of taking action on their own. Otherwise they represent the alter personalities of multiple personality disorder.

Using this definition people who behave in starkly different ways depending upon the context, such as work versus home, or the athletic field versus a barbeque, are not dissociating unless they *feel* like they are different people in those differing contexts. This conclusion would seem to follow from the standard definition of dissociation. However, I want to suggest that this definition needs revision so as to account for "normal dissociation."

Normal dissociation in the sense I want to use the term would include the differing ways we experience ourselves in the many different contexts where we participate. I want to suggest that it is in these varying contexts that we see the influence of our normal internal parts (self states) on our thinking and behavior. Generally speaking our parts do not compel us to act in particular ways; rather they influence us without controlling us. We have a degree of choice. With Parts Psychology we work in the therapy room to differentiate these parts and engage them in therapeutic conversations. We work to heal them of the painful life experiences that lead them to influence us in ways that are not helpful. We work with them in ways not unlike work with alter personalities, except that normal parts have much less autonomy and a much better understanding that they are not independent entities, but parts of the whole person.

Last week's blog referred to cases of abnormal behavior by, apparently, dissociatively normal people. The man who did not remember slipping a note from his lover underneath his wife's keys was victimized by an internal part who wanted his wife to find out about his affair and divorce him. The woman who deleted numbers from her fiancé's cell phone was momentarily controlled by a jealous part of herself who wanted to protect her from competition with other women. The woman who ruined dinner for a guest was temporarily dominated by a part who wanted to discourage a guest with a "shady character" from associating with her husband. All of these actions were abnormal because none of the people remembered the actions taken by the internal parts. If they remembered then we might say they were conniving or deceitful people, but their actions would not be considered as dissociative according to the standard definition. I believe, however, that our definition of dissociation should be expanded so as to include cases of strong influence, but short of control, by internal parts.

Sunday, December 14, 2008

Pathological Dissociation in Normal People

The question of what is normal and abnormal is always a tricky subject in psychology. Here are some examples of abnormal dissociation. A woman who experiences herself as if she were standing outside herself. A man who experiences the world around him as if he were watching a movie. A man who is so overcome by rage that when he returns to a normal state he doesn't remember what he said or did. A woman who is caught up in the binge-purge cycle and who doesn't remember parts of her binging or her purging. Failing to remember what you said or did during an altered state of consciousness is a defining feature of Dissociative Identity Disorder. In this condition, characteristically, internal self states referred to as alter personalities take executive control of a person, and then the person later has no memories for what happened during the takeovers. Few would disagree that this pattern of takeover plus amnesia is abnormal.

Normal people—that is, people without a dissociative disorder—sometimes have these experiences of amnesia for actions taken while in an altered state. Here are some case examples of such phenomena. In couples therapy a man said his wife cursed him in the parking lot of a grocery store the previous evening. The wife said it didn't happen, but all she remembered was their arrival in the parking lot and then a discussion about what brand of toilet paper to buy after they were inside the store. In individual therapy a man struggled with what to do with his adult life now that his kids were almost grown. He was having an affair but not ready to divorce his wife. One morning the wife discovered a note addressed to the man from his lover. The note was lying underneath the wife's keys on the kitchen counter. The man had no idea how the note, which he had been carrying in his personal notebook, got under his wife's keys. In couples therapy a man was angry with his fiancĂ© and threatening to cancel the planned wedding because three important phone numbers of women disappeared from his cell phone directory. The woman swore she didn't delete the numbers. In individual therapy a woman talked about a "horrible" dinner she had made a couple of years previously. Although she was a good cook she had somehow ruined the meat sauce, the mashed potatoes, and the dessert of a dinner she had prepared for her husband and a new friend of his. She didn't like the new friend and suspected he was a drug addict, but she had no memory of doing anything differently in her preparation of the meal. In each one of these cases work with each patient's inner world of subpersonalities revealed that usually normal internal parts took brief executive control of the person and then left the person with no memory for the actions taken.

Sunday, December 7, 2008

Normal Parts, Normal Self States

Looking back over the last few blog entries I see that I have had some unusual topics. However, my aim with this blog is to explain and develop ideas about normal parts of self. We all have internal parts, or self states. Also called subpersonalities, ego states, and a host of other things. In trying to show how having such states is normal the greatest obstacle is convincing the reader that it is possible to have internal conversations with such states. It is fairly easy to show that we act differently in different situations, and that our access to our memories is dependent to some extent upon the situation. For example, if we are enjoying a sporting event and someone asks us a question about problems we or our children are having in school, it may be difficult to recall the details of the school problems. That is because our memories are to some extent state-dependent, meaning that memory is partly dependent upon the self state we are experiencing at the moment. Another example: if we have been drinking and put something away while in an inebriated state, we may not remember where we put the object once we have sobered up. However, if we have a drink or two we may then remember where we put it. This is state dependent memory.

We can understand that our memories are state dependent and still not accept that we have partially independent internal self states. So here are a couple of pointers to help readers understand how to discover their internal parts. Suppose you have just been jilted by a lover. You will likely be experiencing a lot of rejection pain. One way to reduce that pain temporarily is to pretend the pain is a person and say to it something like, "Step back, please." Or you could try to bargain, as in, "If you will step back from me and let me go to work, I will give your pain full attention for an hour tonight after I get home." You can try the same technique with any strong emotion: anger, anxiety, embarrassment, etc. Most of the time the part of self that carries the emotion will temporarily respond to your request, although it will not likely respond to a demand. Especially if you get a positive response to your request that an emotion step back, you could then address the part that carries the pain and try to develop a dialog with it. for example, you might address the emotion and ask "How old are you?" or, Do you have a name?" or, "Do you know who I am?" If you get an answer you could expand the conversation from there.

Another means of establishing a dialog with internal parts is available to those who have vivid dreams and who can recall the characters in the dream the next day. In such a case you could isolate on a prominent dream character as you recall the dream and ask questions such as "What do you want me to know?" Or, you could ask about the meaning of particular actions in the dream, such as "Why are you chasing me? or, "Is hurting me what you want or don't want?" You could attempt to develop a continuing dialog with this dream character just as you might want to develop a continuing friendship with an outside person.