Sunday, December 27, 2009

What Kind of Patients Do Parts Psychology

Many people have asked about the kinds of patients who do Parts Psychology. My answer is that any one who is capable of carrying on a converstion with another person can do this sort of work. Here is an excerpt from one of the chapters of my book. It describes one such patient.

Richard was 38 and feeling that he could barely function when he first came to therapy. He had panic attacks “out of the blue” that felt like he was having heart attacks. His everyday anxiety left him wide awake at bedtime, unable to sleep for an hour or more after going to bed. He was depressed and cried for no reason, sometimes four or five days in a row, although his longer term pattern was to cry only about 10 days in any given month. He had been on antidepressant medications for 10 years. He was currently taking nefazodone (formerly marketed as Serzone) and bupropion (Wellbutrin) for depression. For his panic attacks and generalized anxiety his psychiatrist had prescribed lorazepam (Ativan) and risperidone (Risperdal), a medication generally used for schizophrenia and bipolar disorder. He was seriously overmedicated and still not receiving significant relief. One of our first session's stated goals was to wean him off of his medications. With proper psychotherapy, most people do not need such a soup of psychoactive substances circulating in their blood.

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Sunday, December 20, 2009

Twinning in the Development of Subpersonalities

In the course of normal development all humans develop subpersonalities to help them adjust to new and, especially, difficult life situations. These subpersonalities are the parts we are talking about when we say “a part of me wants to ask for the promotion but another part tells me to keep my head down.” Talking about how different parts affect us is common in everyday language. Sometimes, two parts are created in the same difficult circumstance. For example, in one case an adolescent girl was punished in a demeaning way by a teacher in front her classmates. The experience was so embarrassing that two internal parts developed to handle the humiliation However, they functioned in different ways. First, there was the part who experienced the embarrassment. She remained trapped in the memory and served as a reminder whenever the person considered doing something socially risky in the future. The result was that as an adult the woman was socially conservative in dress and outlook, and generally expected to fail whenever she tried anything that exposed her to public view. In addition to the part trapped in the memory, another part developed at the same time. This part reinforced the message that the person was socially clumsy, unlikeable, and generally inept. The second part became the person’s critical self (Most of us probably have critical selves). In another case an adolescent girl felt rejected by her mother when her mother chose to leave her with her father when the mother left with another man. The experience brought about the creation of one part who stayed trapped in the memory of terrible sadness and rejection, while a second part was created to keep smiling at the world. The second part influenced the woman to be bubbly and to smile frequently as she dressed stylishly at all times. The result was that the adult woman was hugely popular with friends and family and did well in her career in sales and marketing. The process of creating two new selves in a difficult social circumstance, with a second part opposed in some way to the felt emotions of the first, is what I am calling twinning. It occurs in the normal adjustment to life situations as we grow up, and it occurs as well in the extreme development of parts found in Dissociative Identity Disorder (Multiple Personality Disorder).
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Sunday, December 13, 2009

Treating DID (MPD): Getting Rid of Alters

Most approaches in the psychotherapy of Dissociative Identity Disorder (DID), also called Multiple Personality Disorder (MPD), aim to somehow get rid of the annoying presence of multiple minds—that is, the alter personalities. The most na├»ve of these approaches just want these multiple selves to go away. Religious and other simplistic approaches which treat alter personalities as if they were demons or unwanted stepchildren are like this. But there are no demons in Dissociative Identity Disorder. More sophisticated approaches want to fuse the multiple selves into a unified entity. This is the current mainstream system for treating multiple selves. In a certain sense these approaches are just as wrongheaded as the idea that internal parts are demons. These approaches may attempt to fuse the many voices into one and then continue to work with the person’s life traumas, or they might process the trauma first and then try to do the fusion. But why is the attempt to fuse many into one wrongheaded? Because we are all multiple in the sense that we have unconscious internal parts with their own senses of self with their own agendas. These parts also have their own limited consciousness. If a therapist succeeds in fusing the many into one then that therapist creates something new, something nature did not create in the building of what becomes a human being. Rather than continue to try to fuse the many into one, what therapists and researchers should be doing is to figure out what causes the normal internal parts of some people to become energized enough that they switch into control of a person and that person cannot remember what happened during the time of control. And yet for 95 to 98 percent of people that kind of switching never happens. Now that is a good research question!

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Sunday, December 6, 2009

Publishing Parts Psychology

I have just about decided to start my own publishing company. I don’t want to wait the two years it might take to see my book in print by a traditional publisher. Parts Psychology is a subject that needs to be available immediately. I have purchased a couple of domain names and begun researching the process for a start-up publishing corporation—probably as an LLC. The two alternative corporate names I’m thinking of are NewUniversityPress and FreeUniversityPress. I would love to hear from any of you who read this blog as to which name you like best. Or any other suggestions for names would also be appreciated. Just click the comment button.

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Sunday, November 29, 2009

Childhood Experiences and Parts Psychology

Parts Psychology is a psychotherapy approach which works with the internal parts that make up the total of a complete personality. These are the parts we are talking about when we say things like, “A part of me wants to get up and clean the house, but another part wants to sleep all day.” We see these parts also in statements such as “A part of me wants to watch football all day, but another part of me will feel guilty if I do.” Doing therapy with these parts means identifying them and then talking with them about what is stressing them out. Whatever a part’s problem is, it is only partly about the current issue. It is also about past history. And that is the subject of today’s blog.

We are the product of our experiences. Our experiences are recorded in our brains as memories. These memories continue to affect the way we experience our lives. For example, many of us will visit our parents over the holidays. When we do a large number of us will be unhappy when our parents treat us as if we were still children. For example, our mothers might remind us to wipe our feet when we come in the door, just as they did when we were 8 years old. We are annoyed because the memories of our mothers’ scoldings still bother the child parts of us who got in trouble when we were kids. Or our fathers may ask us if we finished the backyard landscaping we were planning. We are annoyed because the question triggers memories of our fathers checking to se if our homework was finished. We become just as annoyed, or feel just as guilty, as when we were 12. It’s pretty obvious that our childhood experiences continue to affect us in a multitude of ways.

Because the connections between our childhoods and our adult lives are so obvious, it is distressing when psychiatrists such as Joel Paris, author of Prescriptions for the Mind, suggest that therapy should be about current issues and rarely about childhood. He argues that because many people have horrible childhoods and grow up to be fully functioning adults, this proves that bad childhoods do not cause psychological problems. But this is like arguing that the fact that some people can smoke for 50 years and never get lung cancer proves that smoking is not bad for your health. Focusing entirely on current issues during the therapy hour will often help patients to cope with life’s stresses. But permanent healing only comes from neutralizing the continuing power of childhood memories.

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Sunday, November 22, 2009

Parent Introjects in Normal Dissociation

Normal dissociation is the normal multiplicity of self states in the average person. These self states, parts, or subpersonalities (all synonyms) influence the self from within. These are the parts we are talking about when we say things like “A part of me wants to tell my boss to shove it, but another part of me reminds me that I need a job and it’s a tough market out there.” Abnormal dissociation is present when internal parts take executive control from the Self, and then the Self doesn’t remember what happened during that period of control by a part. If this happens it is likely that the person has DID (Dissociative Identity Disorder).

Parental introjects are internal parts, usually formed in childhood, who represent a person’s understanding of the point of view of a particular parent—especially an abusive parent. When doing Parts Psychology and the therapist discovers a parental introject, the procedure for working with the part is largely the same as working with other parts. The difference is that the therapist must take the time to ally with the introject. Often the therapist will want to suggest that the part “take off” its parent costume and just be the child underneath the costume. But this scene has to be carefully set up.

Here is an illustration from an actual case of a hostile mother introject during the getting acquainted stage of working with a part. The patient is a 45 year old woman. The mother introject internally visualized by the patient appears to be in her mid 30s, as she was when the patient was about five years old. Both the patient and the mother are named Maria. During a recent session, Maria spoke inwardly to the mother introject and found that she claimed to know Maria’s name. She demanded of Maria, “What do you want!” When Maria asked for the name of the introject, the response was brutal: “Don’t you fucking know my name? What fucking name you want to call me? ‘Maria,’ you asshole!” An introject typically functioned, when the patient was a child, to remind the patient of the power of the parent even when the parent was not physically present.

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Sunday, November 15, 2009

Treating Rejection in Normal Dissociation (Subpersonalities)

This week’s blog focuses on work with an internal part which we could not have worked with early in therapy because there were too many other extreme parts that required attention. At the later stage of therapy, however, we could work with the Little Girl part without interference.

The problem became apparent when the adult female patient became angry when her husband told her to go home with the kids (they were tired) while he took care of a drop-in social obligation. When she objected and insisted that they should both go, her husband said he should take care of the obligation because the hosts were his friends and not hers. She became incensed. As the result of the intense argument which followed, neither went to the social event. Later, the patient agreed that she had overreacted to the rejection she felt. When she focused inward in search the part of herself who experienced the rejection, she found a miniature image of her adult self. This part’s earliest memories were of being excluded in elementary school from the clique of popular girls there. Later, she experienced exclusion from similar cliques in junior high and high school. Most recently, the Little Girl part was triggered when the adult patient and her husband were not immediately accepted into an exclusive country club. All of these events had in common the theme of rejection by a group of others. When her husband had wanted her to stay away from the social event because the hosts were his friends, the Little Girl was triggered and the patient felt all of her previous rejections again. Treatment was straightforward: neutralize the set of memories of rejection felt by the Little Girl. At the conclusion of the session the miniature version of the patient had grown to a mid-size version of her; she identified the image as a child of junior high school age. The patient now explained that she understood that the original image of herself in miniature was because she was a child, although the image she had was of herself as a tiny adult. The important part of the story, though, is that by healing the child part, the adult healed herself of her intense response to the perception of rejection.

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Sunday, November 8, 2009

Parts Managers in Normal Dissociation

This will be another short blog because I am still recovering from a hand injury.

My patient is Ariel, a 38-year-old mother of two who came to therapy for marital issues. What is interesting about Ariel is the unusual way her internal world of parts is organized. It is the most highly structured system I have seen. In all, there are nine parts, or subpersonalities. The center of this internal world is Sarah, a part who carries Ariel’s mother’s name. Sarah conceives of herself as the center of this internal world with eight tentacles extending outward from her to the eight other parts she attempts to control. Although Sarah is Ariel’s mother’s name, Sarah does not resemble Ariel’s mother in appearance, even without her tentacles. According to Ariel, Sarah as a part is similar to her mother in that she conceives of herself as a typical “Jewish mother”. This manager Sarah says that it is her job to look after and care for the eight parts she attempts to control. She is especially concerned to look out for Ariel, the Self. Most internal systems have more freestanding parts than this one and there is usually no single manager part with control over all other parts. Most frequently there may be two or three parts that claim to be managers.

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Sunday, November 1, 2009

Myths in the Study of Dissociative Disorders

I am continuing to recover from a hand injury and so this is another cut-and-paste from my files.

Top 10 myths in the Study of Dissociative Disorders.

10) That is there is a significant discontinuity in the distribution of dissociative symptoms such that pathological dissociation as found in DID stands in sharp contrast (as a Taxon) to the experiences of normal individuals.

9) That there is a consensus in the field acknowledging a continuum of dissociation ranging from normal dissociative symptoms at one pole to pathological dissociation at the other pole, as represented by DID.

8) That healing of dissociative disorders necessarily involves extended periods of painful abreactions.

7) That ego states are artifacts of hypnosis.

6) That the vast majority of DID cases require a phased approach to treatment whereby processing of trauma must be delayed until after an extensive period of therapy devoted to “stabilization.”

5) That the differentiation of and interaction with ego states (including naming) poses a danger of reification of such states such that healing is compromised.

4) That neither host nor any of the internal self states of a DID diagnosed person has a greater claim to self priority than any other.

3) That the ego states of normal individuals lack a sense of self, an enduring self representation, a sense of ownership of some but not all of a person’s experiences, and their own set of autobiographical memories.

2) That the presence of a multiplicity of selves necessarily signals pathology.

1) That the best solution to DID is a state of fusion of selves into a single, unitary self.

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Sunday, October 25, 2009

Parts Psychology Book Summary

I injured my hand this week and so today's blog is merely a cut and paste of the summary of the book that I am sending to a potential publisher.

While the natural division of the personality into parts, or subpersonalities, has been recognized for nearly a century in the works of early American scholars such as William James and Morton Prince, the “Parts Psychology” of this book draws heavily upon recent theorists such as John and Helen Watkins (Ego States: Theory and Practice, 1997, WW Norton) and Richard C. Schwartz (Internal Family Systems Therapy, 1995, Guilford Press). However, the present book goes beyond these works by drawing upon their insights and combining them with innovations from the last 12 years of my clinical practice. The result is a contemporary theory of personality dynamics that recognizes subpersonalities as responses to a universal developmental process which is activated whenever people confront novel, and, generally, painful life situations. Once created, each internal part selectively attends to life experiences according to the emotional themes that organize a part’s content. In the book, case narratives describe the process of psychotherapy through painstaking elicitation and resolution of each part’s unique set of problem memories. In the great majority of cases therapeutic issues are resolved within a few months. However, three chapters describe therapy with the same female attorney, illustrating that while Parts Psychology work is generally short-term, it is also suitable for more complex, long-term, work.

The case descriptions are written in an engaging style which holds the reader’s attention as each story unfolds. Each chapter presents a success story. A woman overcomes her debilitating jealousy and anger with her husband. A man overcomes his addiction to sexual swinging. A woman overcomes her aversion to joyful sexuality. A man releases the love for his ex-wife which had prevented him from moving on. Another man releases his obsession for internet pornography. A woman works through her personal issues of body and beauty to accept herself as she is. A gay man releases his obsession with adolescent boys which he feared could ruin his relationship and his career. Another man heals his lifetime depression and anxiety while withdrawing from a soup of psychoactive medications. In each of these cases the solutions to overwhelming emotional issues lay in discovering and healing the wounds of small but significant life traumas, especially those of childhood and adolescence.

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Sunday, October 18, 2009

Psychotherapy for Love

Most frequently patients come to individual psychotherapy for love for one of two reasons. The first is when they have been dumped. The pain can be overwhelming, so great that the person cannot function and may even contemplate suicide. The second reason is when the patient is confused about not being “in love” anymore. The person’s sex drive has diminished and he or she may be thinking about divorce or taking a lover—or may have already done so. Treatment for these issues in Parts Psychology involves first the identification of the internal parts, or subpersonalities, who are involved. We all have parts who handle love feelings just as we have parts who specialize in anger or sadness, or work performance. Generally speaking there are sexual parts, romantic parts and attachment parts. While all of these functions can be rolled into ways of being for any one part, my impression is that they tend to be allocated to separate parts. My general impression is that sexual parts are most often mature adults; romantic parts are often teenagers presenting as 13 to 15 years of age; and attachment parts are often child parts. There are also many exceptions to these generalizations.

Helen Fisher is a biological anthropologist who has actually studied the chemistry and brain mechanisms of these different kinds of love. Each of them involves a different set of brain chemicals. Sexual drive, as most of us have come to know, is regulated most strongly by testosterone for both men and women. Romantic love, what Fisher calls the “attraction” component, involves elevated levels of norepinephrine and dopamine and lowered levels of serotonin. Attachment involves vasopressin and oxytocin. Fisher discusses these and other love issues in her book, “Why We Love.” It’s a good read. Fisher doesn’t say so but I wonder whether people with elevated levels of serotonin, such as those taking one of the SSRI antidepressants, might experience a decreased amount of romantic love.

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Sunday, October 11, 2009

The Parts Psychology Book

My book is now 15 chapters in length with approximately 400 pages. It presents a novel model for treating psychological problems by addressing the parts of the whole person that carry the distress. These are the parts we casually speak of when we say things like “A part of me was sad when he left, but another part of me felt a tremendous relief.” Or, “I know I can do this job, but a little part of me asks ‘Are you sure?’” Talking in this way is more than just a manner of speaking. It is the expression of the natural structure of the whole personality. Here is an experiment. Think of the person who irritates you most of all the people in the world: family, friends, colleagues, bosses, politicians, etc. Try to build up that irritation or anger by remembering particular ways this person has bothered you. Then notice where it is in your body or head where you feel the irritation most strongly. Focus your attention on the sensation or emotion you feel there and then speak to it, subvocally or aloud, and ask it to give you a picture of itself. Most people who do this exercise will visualize themselves at some other time in their lives, or as they are now but with a frown or angry expression. A minority of people who do the exercise will visualize the person who causes this irritation. And some will visualize a person they don’t recognize or perhaps an object or a color, especially the color red. For those who picture the irritating person an additional step is needed. But for everybody else the image that comes to mind is one of the “parts” or “subpersonalities” I write about. You can actually have a conversation with this internal image, and eventually you can discover that you, the observing self, are not simply role playing both sides of the conversation. You will discover that the “part” you visualize has a point of view different from yours in a number of ways. You might even be surprised by the response of the part you visualize. You might find that the part, if an angry one, will tell you to go away or otherwise indicate that it is irritated. The blogs I write once a week have to do with healing through work with these invisible parts of the whole personality.

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Sunday, October 4, 2009

Healing Hoarding with Parts Psychology

My client is a 42 year old man with whom I have worked for more than a year. We have cleared away most of the major issues he came to work through. Recently, he asked if we might be able to do something about his inability to throw away some of the things he has accumulated over the years. These things included about 30 motorcycles and motorcycle parts, about 25 bicycles, hundreds of old videotapes and phonograph records, and a large number of unused exercise machines of various types. When he thought about letting go of any of these things he experienced anxiety bordering on panic. In order to help him find the internal part or subpersonality involved in his hoarding, I asked the man to connect to his anxiety and to ask the part who carried the anxiety to show itself.

The part presented itself as the image of a child, perhaps eight years old. I asked the child part to share with us its earliest memories that connected somehow to the anxiety my client felt when he thought about getting rid of any objects from his accumulated hoard. The child part identified three relevant sets of memories. The first was of his mother throwing away food which had spoiled when it sat too long before being eaten. The second was of having to discard relatively new shoes because my client had outgrown them. The third set of memories also involved discarding relatively new shoes, but this time because of tears or other problems that prevented their further usage. If we look at the common elements in these three troubling sets of memories (i.e., troubling to the child part), they all appear to have something to do with unused or wasted product. That also appears to be what troubles my client in the present. For example, he imagines that he could use the parts from some motorcycles to repair other motorcycles; he just never gets around to doing it.

Using the “unburdening” technique from Richard Schwartz’s Internal Family Systems model, we helped the child part to give up all of the negative energy (distress) connected to its memories of childhood loss. Once the childhood memories were no longer troubling to the child part or to my adult client, my client was able to think about getting rid of some of his hoard of objects. He hasn’t yet begun to do so—it’s only been a week since our work—but he can think about it now without anxiety or panic.

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Saturday, September 26, 2009

Problems with Treating Rage--Parts Psychology

Rage may be the most significant challenge to the Parts Psychology approach. The problem is not the lack of connection to a person’s subpersonalities. Those who rage generally have quite vivid images of their internal worlds when they look inside. And the difficulty is not with communication between the observing self and the angry part. Instead, the problem has to do with the relative autonomy of many angry parts who are given to rages. Sometimes, they simply refuse to cooperate in the therapy, taking the position that their ability to rage is essential to protecting the Self or young, vulnerable child parts. Or they may insist that the problem lies with those who provoke their rage. Sometimes a person’s angry self will be quite similar to the alter personalities of multiple personality disorder (now called dissociative identity disorder) in that when anger turns to rage the part takes full executive control of the person during the raging incident and, later, the person will not remember what happened during the rage.

A case of marital therapy illustrates a problem angry part in action. The husband agreed to work in individual therapy on his “temper.” However, once there, he really only wanted to talk about the failings of his wife. When his angry part was differentiated, its first comment was “Get rid of the Bitch!” Speaking for the angry part, the husband said that while he agreed he had a temper it wouldn’t be a problem if his wife didn’t behave the way she did. She was the one who needed to change. In our sessions the husband was content to describe in depth the many ways his wife had wronged him. The angry subpersonality flatly refused to participate in any unburdening of its memory set for fear that it would make the husband weak and vulnerable to his wife’s deceit. The wife, with an anger problem of her own, was similarly unwilling to do much work on freeing herself from her complaints against her husband. The couple eventually decided to seek another therapist. Neither party could dislodge their angry parts enough to work on their own contributions to their marital problems.

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Sunday, September 20, 2009

Illustration of Ego State (Parts, Subpersonalities) Dynamics

I just finished writing a summary of the dynamics involved in treating an extended case which is the subject of one chapter of my book. I present the summary here because it illustrates some of the dynamics of working with normal internal parts.

The work with Suzie demonstrates a number of the basic concepts of Parts Psychology. First, it is occasionally necessary to explain the philosophy of parts and Self to one or more of the parts. Sometimes, a part refuses to acknowledge a relationship with the Self and other parts, and this misunderstanding must be addressed before the unburdening work begins. Next, internal parts can have different orientations to the current situations in the client’s life, including employment activities, marital status, and even whether the client’s children are also the part’s children.

Suzie had a few experiences of releasing a burden and finding it had returned, or of having difficulty reaching a SUD ("Subjective Units of Disturbance") level of zero for a particular memory or belief. This is almost always a sign that there is another part somehow blocking the work, intentionally or otherwise. Also, unburdening negative beliefs rather than single memories often involve several sessions or work with more than one part.
Within the conversation about the inner work, it is not uncommon for individuals to switch from referring to an experience using the pronoun his or her for the client in the same breath as the personal pronoun I. That is, sometimes parts present as separate from the Self even as they identify with the Self in the next moment. Changes in parts' inner physical appearance are also common, as we saw both in the work with Suzie and with other individuals in the previous chapters.

Parts therapy requires that we work with both present day sources of stress as well as previous life experiences. Suzie’s unburdening involved unburdening the unhealthy beliefs she had acquired while growing up as well as current life stressors. Working with both historical and current triggers for extreme behaviors permitted us to reduce and finally eliminate most of Suzie’s blocks to healthy functioning. After Suzie had completed her course of therapy she felt that she was able to face current challenges without further therapy or the use of her previous psychoactive medications.

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Sunday, September 13, 2009

The Development of New Internal Parts

In previous blogs I wrote about Kerri, a client who didn’t feel much enthusiasm for being pregnant. The part of her who wanted to move ahead in her career was greatly disappointed, as was the part who wanted to travel and experience new things. In her 12th week of pregnancy Kerri came to the session with a serene look on her face. She had begun to enjoy being pregnant and had begun to look forward to the birth of her child. She was no longer nauseous and uncomfortable. She also looked positively on the three months break she would have before returning to work following the arrival of the child. The way she presented herself was so different from the usual that I asked here who was the new part. She didn’t know. But when she turned her attention inward she found a part who did know. This part said that she was aware of the new part and her name was Duffy. (Duffy is the name of an actor who appeared in a sitcom Kerri liked and who had a baby in the sitcom). When Kerri was able to visualize Duffy she asked if the part knew who she was. She did. She said that she was “the mother,” and Duffy was “the mother’s caretaker.” Duffy’s earliest memory was of the second ultrasound of the baby. So she was a new self-state in the client’s internal world. Like all parts she appeared when the person faced a novel or demanding new circumstance.

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Sunday, September 6, 2009

Jaycee Dugard: Why Didn't She Run

Jaycee Dugard: Why Didn’t She Run?

Parts Psychology has a pretty simple answer to this question. She didn't run because she didn't have a runner among her adult parts. Some popular ideas about the case are correct: she went into survival mode. Parts Psychology gives us an understanding of how this works at the unconscious level. A new part, or subpersonality, developed to help the Self adapt to the shock of her new circumstances. Actually, there would have been a number of new parts who developed. This is a universal process. We all develop new parts when we have to adapt to new and demanding situations. In the Dugard case the new parts would probably have entirely supplanted the child’s previous ways of living her life. The older ways of being an 11 year old girl would not have disappeared; instead, they would have been pushed into the unconscious background until it became safe for them to come forward again. Effectively, that probably took 18 years. I would hypothesize that the adult Jaycee only knows how to relate to her parents as she did when she was eleven years old.

I would guess that Jaycee did not develop multiple personality disorder as the result of her captivity. However, the same process of identifying with the perpetrators that we see in multiple personality disorder was undoubtedly active in Jaycee’s inner world. In my opinion the best therapists for Jaycee Dugard would be those experienced in work with dissociative disorders or with the subpersonalities of normal people.

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Sunday, August 30, 2009

The Experience of Internal Self States

Kerri was pleased to become pregnant after about 5 months of trying. But her inner system was not unanimous with its pleasure. The part who wanted a successful career was quite unhappy. I wrote about her three weeks ago. The career part was not aware of Kerri’s pregnancy until she learned of it during our session. Another part, who Kerri called her “hippie” part, was also unhappy. She said that she knew about the pregnancy from the beginning, and she was very angry with Kerri. She was angry because of the limitations a child would place on Kerri. Travel outside the U.S., for example, would now be much more limited. Since Kerri was a child she had wanted to visit other places around the world, but circumstances had largely prevented her from acting on her opportunities. Her only visit to Europe had been spoiled when Kerri had the flu for the entire week.

Kerri was in the first trimester of her pregnancy. In her session she said that she was quite irritable because she felt “fat, uncomfortable, and nauseous.” During Kerri’s guided conversation with the hippie part, Kerri learned that the self state felt the same irritability as she did; however, the hippie did not experience Kerri’s body discomfort or nausea. This is not unusual. Internal parts often carry only a portion of the person’s body experience. In a different case the client came to the session with the beginning of a migraine headache. We were able to discover that only some of her parts experienced her pain, and one part in particular seemed actually to be the source of the migraine. This part’s pain was greater than that experienced by the external person. In Kerri’s case it will be interesting to find out which of her self states actually experience her body discomfort as she does.

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Sunday, August 23, 2009

Parts Therapy of Child Parts

Parts therapy involves working with the subpersonalities that are a natural and universal part of all human minds. They are present everywhere in our normal language when we say things such as, “A part of me wants to get up and get started on my list of things to do, but another part of me wants to stay in bed a little while longer.” We see it also in such comments as “I hate going over to my in-laws, but I know it will be worse if I don’t.” This last statement is equivalent to saying “A part of me hates going; another part knows I have to.”

Today’s case example relates to work with a very young child part of 36-year-old Tristan. We were trying to help the child part release her sadness which was connected to the time when Tristan was in the care of her grandmother and her mother was away. Tristan visualized the child part giving up her sadness to the wind as Tristan brought the wind to blow over, around, and through the child. But the symbolic intervention wasn’t working; instead, the child just cried and the wind parted around her. In doing this sort of symbolic work, when a part shows significant distress during the intervention, rather than almost painlessly giving up the negative emotion, we would expect that another internal part is interfering. But when Tristan communicated with her child part she found that the child just wanted to cry for a while, because her grandmother had always forbidden her to cry. And so Tristan imagined that she held the young part of herself in her arms as the child cried. After a few minutes the child part successfully returned to the wind intervention and permitted the wind to carry away her sadness.

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Sunday, August 16, 2009

Psychotherapy of Childhood trauma

When Edith was a little girl her foster mother took her and her younger brother to the toy store to buy them Christmas presents. They each got to choose one present. Edith chose a truck with which to play in the sandbox. Her foster mother didn’t think a truck was appropriate for a little girl, and so she bought her a doll in a box with a clear, plastic cover, so that she could see the doll in its box. She bought the truck for Edith’s brother (who had no interest in it). They stayed with the foster mother for several years, but Edith never got to play with the doll (although she got to sneak some time with the truck). The doll was kept on a shelf and her foster mother encouraged Edith to gaze at her doll, but she was never permitted to touch it. It stayed in its box.

About 45 years later, when Edith processed her childhood traumas, the double pain of having to take the doll instead of the truck, and not being permitted to play with the doll, were important and painful childhood memories. In therapy she gave up her pain when she visualized herself as the little girl again, and gave back the doll to her foster mother. Over many sessions of therapy she gave back many dolls to many false gift givers.

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Sunday, August 9, 2009

Coconsciousness in Normal and Dissociative Patients

A nearly universal misconception among students of dissociation is that normal people are not split in their consciousness; that is, when a normal person knows something all parts of that person knows it, too. This is supposedly in contrast to the dissociative patient diagnosed with Dissociative Identity Disorder (DID), where different subpersonalities may have information not shared throughout the system of alters. In fact, however, normal people and dissociative people are alike in that it is common for there to be a lack of coconsciousness among a person’s subpersonalities. The misconception continues primarily because clinicians and researchers simply haven’t looked very closely at the inner worlds of normal people.

Case Example. Kerri, a patient who was looking to improve her relationship with her husband, had been trying to get pregnant for many months in spite of her misgivings about the limitations children would put on her lifestyle. We had previously done enough inner work to discover two aspects (parts) of her larger personality who did not want to become pregnant. There was the “hippie’ aspect of Kerri, who wanted to be free and unfettered, and there was the “career woman” aspect of Kerri who wanted free rein to devote all the time she needed to ensure that she would be successful in her career. When Kerri finally announced that she was pregnant, it seemed to be a good idea to work with the parts of her who had been opposed to pregnancy. I wanted to help Kerri make pregnancy and motherhood work smoothly for her. When Kerri went inside and visualized Career Kerri, she found that although Kerri had known for several days of her pregnancy, Career Kerri did not yet know. After Kerri silently communicated to Career Kerri that she was pregnant, the visualized image of Career Kerri responded by raising her hands to the side of her head and shaking them as she moaned, “No, no, no!” There is more to the story, but the point of this example is that a lack of coconsciousness among normal parts is common.

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Sunday, August 2, 2009

DID Fusion/Integration in Psychoanalysis

I just finished reading Richard Baer’s book, “Switching time: A doctor’s harrowing story of treating a woman with 17 personalities” (2009). I am not sure what was so harrowing about the treatment, but the childhood experiences of the patient certainly were harrowing. She had a cancerous tumor on her forehead as a toddler with treatment involving surgery and radiation. Then she was physically and sexually abused for 12 or 13 years, often in the context of satanic ritual abuse. Her subpersonalities began to develop by 18 months of age.

Baer is a psychoanalyst (“psychoanalytically informed psychotherapy”) now heading up Medicare in the states of Illinois, Indiana, Ohio, and Kentucky. It would seem to be a good thing that a member of the medical establishment has written a book on DID treatment. Although he says he read the scientific literature on DID, he remains misinformed about the condition’s prevalence since he states that DID is a rare condition.

He says little about actual treatment until the sixth year of therapy when he begins to use hypnosis to interact directly with Karen’s alter personalities. Then, a little more than a year later he begins to integrate them through hypnotic interventions. He does not make a distinction between integration and fusion. With each of the integrations, Baer guides Karen into hypnotic trance, visits her in her own internal little room and then suggests that the alter to be integrated enter the room. He introduces Julie, the alter to be fused, to Karen with a short biographical sketch and then elicits from Karen her internal perception of the alter’s characteristics. Following this Baer guides Karen and Julie in the fusion process: “Is Julie next to you?” Julie answers through Karen that she is. Baer then guides Julie in sliding over and into Karen.

He continues to describe this fusion process by quoting how Julie says she is feeling as she becomes accustomed to experiencing through Karen. Poignantly, Julie says to Baer, “You won’t talk to me again.” Noting that Julie’s voice is faint, Baer says, “You’ll always be with me as a part of Karen.” A few moments later, Julie says, “It’s like I’m in a spaceship…rushing past stars. I feel like I’m dying—getting weaker. Will you remember me?” Baer assures her that he will and then Julie finishes, “Then I’ll let go. Good-bye.” Baer concludes with, “I say good–bye and watch her fade from Karen’s expression” (p.201).The integration is completed over the next two or three weeks as Karen adjusts to the new memories and feelings. After a few weeks or months Baer guides the next fusion/integration. They complete the fusion/integration work in the tenth year of therapy, but continue to do psychotherapy for another eight years.

The book is an interesting read, but I wonder how well it represents those of my colleagues who do fusion/integration rituals. There appears to have been no trauma processing per se, except for the gentle discussions between Baer and Karen’s subpersonalities, prior to fusion/integration. Thus, the fusion of alters into the evolving Karen—who does not represent any particular alter or self state—brings together the new Karen entity and both the negative and positive experiences of energy-charged alters. Perhaps the apparent absence of direct trauma processing is why therapy continued for another eight years.

Those of you with an acquaintance with Parts Psychology know that I do not work in this way. I see no need for fusion of parts. It seems to me contrary to the natural organization of the mind. We all have parts and we all need them.

Sunday, July 26, 2009

A New Book on DID

I am half-way through a new book (2009) on the treatment of a single case of DID: Switching Time, by Richard Baer. He is a psychiatrist who practices what he calls “psychoanalytically informed psychotherapy.” Psychoanalysis seems to be helpful in the treatment of DID, although it is probably not the most efficient treatment approach. One problem is that it is so slow. The most famous of all DID cases is that of Sybil, whose treatment by psychiatrist Cornelia Wilbur is described by Flora Schreiber in 1976. Treatment lasted in that case 11 years at an average of four sessions a week. If you think of it in terms of the usual once-a-week therapy sessions held by most psychotherapists, Cornelia Wilbur treated Sybil for the equivalent of 44 years. That’s a lot of therapy.

In the case of Richard Baer, he diagnosed his patient in the first year of treatment but didn’t share that diagnosis with his patient. It wasn’t until four years had passed that he actually began to work with any of the 17 subpersonalities, or alters, who made up the whole person. In the sixth year of treatment they have still not done any trauma resolution work, save letting alters know that the primary perpetrator, the patient’s father, died during the fifth year of treatment. Still, there continues to be progress, if slow progress. I will write more when I have finished the book. A final note: this psychiatrist, like so many under-informed psychiatrists, believes DID to be a rare condition. Actually, it is not rare at all. Probably about one percent of the adult population of the United States suffers a major dissociative disorder, including DID. For more information on this see The International Society for the Study of Trauma and Dissociation website, http://www.isst-d.org/.

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Sunday, July 19, 2009

Restructuring Memories in Parts Therapy

One of the techniques we use in Parts Therapy is that of restructuring memories, most commonly by helping a client to visualize rescuing a remembered child part from a painful memory scene and taking the child to a safe place. This sort of intervention has a long history in psychology. In 1889 Pierre Janet described his work with a patient named Marie, in which among other things he cured her of her hysterical blindness in the left eye. The blindness was linked to Marie’s memory of being forced to sleep at the age of 6 with another child who had a terrible case of impetigo on the left side of her face, after which Marie developed impetigo in exactly the same portions of her own face. The long term effect was that Marie developed blindness in her left eye and numbness of the left side of her face. Janet used hypnosis to retrieve the traumatic memory of sleeping with the diseased girl. He convinced the remembered child self that the other girl was not ill and guided the child self in being comfortable with her bedmate, even caressing “without fear the imaginary child.” Most of the work we do in Parts Therapy is much less complex than that of Janet, and hypnosis is not a necessary ingredient.

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Sunday, July 12, 2009

The Diagnosis of Herschel Walker's DID

I raised doubts in my previous blog about the diagnosis of Dissociative Identity Disorder for Herschel Walker, based upon the first three chapters of his book, “Breaking Free” (2008). Having now finished the book I am still in doubt about the legitimacy of this diagnosis. It seems to be based largely on the presence of alters: Walker talks about the Indifferent Dare-devil, the Warrior, the Sentry, the Judge, and others. But everyone has alters. I usually use the terms, ego states, parts, or subpersonalities, but they are the same as alters. In order to avoid arguments with other professionals who do not understand this, I usually go along with reserving the alter term for persons with DID. However, It is circular reasoning to say that the subpersonality of a DID person is an alter, and it is the presence of alters that qualifies someone for the diagnosis of DID. The DSM IV criteria require, in addition to the presence of alters, that there be autonomous switching between alters, and that there be significant amnesia for what happens when an alter switches into control.

It is because autonomous switching and amnesia are largely absent that I doubt the diagnosis of DID. There are exceptions. Walker describes dislocating his shoulder during a Sugar Bowl football game and insisting that his coaches put it back into its socket on the sidelines. He says he had no pain during the procedure and that he did not remember the process. Additionally, he had a wisdom tooth removed without anesthesia and felt no pain during the surgery. Evidently, a subpersonality switched into control in these special cases and blocked the pain from Walker’s consciousness. But is this amnesia enough to qualify for a diagnosis of DID? I don’t think so. I believe that the ability to block pain for short periods of time is not rare, and although it is dissociative, those who intentionally make use of this ability do not qualify as DID. Walker also describes amnesia for long drives between work and home. This is also a fairly common occurrence in the larger society. It is often referred to as the result of “highway hypnosis.”

So does/did Walker have DID? Maybe; but based upon what he says in his book, I doubt it. I think his symptoms fall short of diagnostic. Clearly, though, he is significantly dissociative. I would say the symptoms warrant a diagnosis of DDNOS (Dissociative Disorder Not Otherwise Specified), a diagnostic category specifically reserved for people whose symptoms fall short of DID. It is actually a close call as to whether Walker has a dissociative disorder at all. Although he is dissociative, the diagnosis of a “disorder” requires that the condition be distressing to the person or to others in relationships with him. In Walker’s book he generally describes the benefits of being dissociative, but he does eventually say that he sometimes feels shame for being that way. That appears to be enough to qualify him for a “disorder.”

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Sunday, July 5, 2009

Normal Multiplicity Versus Dissociative Identity Disorder

I just bought and read the first three chapters of Herschel Walker’s, “Breaking Free: My Life with Dissociative Identity Disorder.” Walker is a Hall of Fame football player whose book, because of his fame, has the potential to normalize having dissociative disorders. So far, however, I am not even sure that his diagnosis is correct. In the “Prologue” he describes the overwhelming rage he felt when a Mercedes salesman failed to deliver his new car where and when he said he would. Walker drove to where the car had actually been delivered, fighting off his murderous impulse to kill the salesman when he arrived at the car’s location. As he drove he heard two opposing voices, one telling him to shoot the man, and the other telling him that would be wrong. He did not lose awareness of who he was and where he was going. This is not Dissociative Identity Disorder (DID). In order to fit the diagnosis of DID, Walker would have had to have amnesia for all of part of the incident, and there would have to have been a dissociated alter personality who took control of his consciousness during the experience.

Hearing voices is not in itself sufficient to qualify as a mental disorder. In fact, up to 20 percent of the population hears voices at one time or another. But the crucial missing evidence may appear later in the book. In his first chapter Walker suggests that what separates DID from other dissociative disorders is the creation of alter personalities. This is a common misconception shared with many professionals. Those of you who have read other of my blogs will know that having subpersonalities is normal. We only begin to call these subpersonalities “alters” when the subpersonality takes executive control and the person has amnesia for the time when the subpersonality was in control. I will follow up on this question when I have read more of the book.

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Sunday, June 28, 2009

Rage, Porn Addiction, Eating Disorders

This week’s blog will be a short one. I thought I would just remind readers of blogs I have previously written. For the topics I list an interested reader can consult previous blogs.

In the field of psychotherapy there are now “cottage industries” that address certain problems widely experienced across the American landscape. These include problems with rage (anger management classes), pornography addictions (12 step programs), and eating disorders (dozens of stand-alone treatment centers). I am sure that these programs help some people some of the time. However, in my opinion these programs rarely provide permanent healing. The problems are generally chronic. The Parts Psychology approach about which I write, however, offers permanent healing. That healing comes about through the healing (neutralizing) of the painful life experiences that created the problems in the first place. The healing concept is so simple: neutralize the negative life experiences that brought about the problems. With Parts Psychology the neutralization of negative life experiences takes place through working with the parts, or ego states, that constitute the normal multiplicity of mind characteristic of being human.

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Sunday, June 21, 2009

Symbolism of Internal Self-States

The most frequent images our internal part-selves give us of themselves are pictures of ourselves at different ages, or with different clothing, or with different expressions on our faces. But sometimes our parts present themselves as people who don’t look like us at all. Sometimes they present themselves as demons, monsters, or animals. These sorts of images make it clear that all internal parts should be considered to be metaphors, and not separate people. They are aspects, or parts, of the Self. Neither they, nor the Self, stand alone.

A recent client, Thomas, came to therapy for help with his impending divorce. He and his wife had agreed to divorce, but Thomas had so far been unable to get himself organized to take care of his part of the process. At the end of just four sessions he was able to find and activate the parts of himself who needed to find an attorney, stand up to his wife’s continuing spending, and make arrangements to move forward. His wife seemed to be unable to take any further action after stating that she wanted a divorce.

The first internal part Thomas differentiated was his angry part, which represented itself as a large reptile with the name, “Rex.” Rex was angry at the wife for her out-of-control spending and her accumulation of credit card debt. A second part presented itself as a monk, and wanted Rex to forgive the wife. Together, they contributed to inaction by Thomas through their stalemate with each other. A third part was a younger, more muscular version of Thomas. This was the part who would take a stand. A fourth part was 10 years old and timid, mouse-like—pink and furry. A fifth part was spider-like and scurried into the corner when addressed. What needed to happen was for the angry part and the monk to step back and allow the younger Thomas to take charge. The mouse had to give up his fear of being alone; and the spider needed to stop being passive-aggressive and let the younger Thomas take direct action. By the end of four sessions Thomas had everything under control, with all internal parts working with him. But there were no animals or people inside his mind; only metaphors for different ways Thomas had of being himself.

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Sunday, June 14, 2009

Risistance to Normal Multiplicity

For those who have worked with their inner world of part-persons, this new way of understanding the self is nonspectacular, even obvious. But for those with an investment in viewing the mind as normally unitary and indivisible, the idea of parts psychology is an extreme threat. Recently, I posted several examples of the normal multiplicity I often talk about on this blog to a listserv of professional clinicians. These professionals include clinical psychologists, psychiatrists, marriage and family therapists, licensed professional counselors, and clinical social workers. Most are the “in-the-trenches” clinicians who supply the needed therapy for troubled individuals throughout the United States and Canada. Some are from as far away as Australia, New Zealand, and Europe. Some of them are recognized as world experts in the field of trauma and dissociation. With a few bright exceptions, the overwhelming response to my posts is one of harsh criticism and rejection. A few resort to name-calling, with suggestions that I am incompetent or ignorant about the field of trauma and dissociation. Often these critics seem to be angry that I would challenge their accepted wisdom.

It is not at all unusual for those with entrenched ideas to resist change. Nor is it unusual for them to label those who present innovative ideas as ignorant, incompetent, or just plain “stupid”—as one world expert recently said of me. In the case of normal multiplicity, however, the problem is worse than usual because it is so easy to test the concepts directly for validity. One can test the ideas among friends and family members if the clinician lacks sufficient skills to make use of the concepts in the therapy room. Here is how to do it. Think of someone who causes you to feel a strong emotional reaction. For most of us that is someone who irritates or angers us. But other emotions such as sadness, anxiety, or joy will also work well for the experiment. Then focus on the emotion you feel—or the body sensation you experience when you think of the targeted person. Then, speaking aloud or just with your thoughts, say to the emotion or sensation something like this: “Give me a picture of you, please; show me an image in my mind of the part of me who feels this way.” I have found that in 60 to 75 percent of cases, this simple request is all it takes to allow you to visualize the part-self who feels the feeling you began with. From this point all you have to do is to hold the image in your mind and treat it as if it were an actual person rather than a subpersonality within your mind. You can ask such questions as, “Do you know who I am?” “Do you know that you are a part of me?” “Do you have a name?” “How old are you?” Or, “How old do you feel?” “What is your job in my life?” With only a little bit of persistence you can have a conversation with a part of yourself. This is normal multiplicity. Virtually everyone can do it (at least 90 percent of us). Yet professional clinicians fear to go there.

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Sunday, June 7, 2009

Dissociatively Normal and Abnormal

For this week’s blog I want to return to the example of Richard, about whom I wrote last week. Just scroll down to that blog if you need to. I said that Richard was dissociatively normal. By that I meant that his internal parts, or ego states, did not take executive control, and he did not experience amnesia when he was influenced by these internal parts, such as in incidents of anger when Richard would find himself shouting at his wife in describing the demands and restrictions of work. I also meant that he did not experience the world as through a fog or as if he were watching a movie. Nor did he find himself observing himself as if he were outside himself. In short, when I say he is dissociatively normal I mean that he did not have a dissociative disorder. This is not to say however, that he was normal in all ways. He was depressed. He cried frequently. He was on high doses of two different antidepressant medications, an anti-anxiety medication, and an atypical antipsychotic for use as a “mood stabilizer.”

Although he was dissociatively normal, that does not mean he lacked subpersonalities, or ego states. We all have ego states. It is the nature of ego states that each has a sense of self, a sense of continuity, its own agenda, and a desire to continue its existence. In most cases, when in the treatment room we work with a newly differentiated ego state, that part is aware of who the person is. In Richard’s case the angry part claimed not to know who he was. Usually, our internal self states know who we are, but it is not unusual for a part to be briefly unaware or disoriented when making the initial connection with the Self. In almost all cases with dissociatively normal people, when a part doesn’t recognize the Self, it readily does so either following an explanation of parts or through a simple demonstration. For example, in Richard’s case I coached Richard to ask the angry part to look through Richard’s eyes to see what I was doing with my right hand. I was waving it. Then I asked Richard to close his eyes and ask the part what I was doing with my hand then. In this way the part came to realize that it could only see what I was doing by looking through Richard’s eyes. Thus, it had to be a part of Richard and not separate from Richard. In contrast, in cases of dissociatively abnormal persons suffering from Dissociative Identity Disorder, the ego states (alter personalities) often refuse to recognize that they are parts of the person even after such demonstrations. They are committed to their separateness.

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Sunday, May 31, 2009

Introducing Parts Work in a Session

Here is an example of a fairly typical interaction involving the introduction of parts work with a new, dissociatively normal, client whom I will call Richard. Although the manner of introducing work with the part is typical, the response of the angry part seen here is less typical. Richard was male, 38, and had a history of depression. He was troubled as well by his experience of anger. For example, at the end of the day Richard might be talking with his wife about his frustrations at work and slowly build in anger until he found himself shouting at his wife about the people at work.

At our second session I asked Richard to think about the feeling of being overwhelmed at work that was the foundation for his anger. When he did so, he was able to access some of that anger in our session. I asked him to focus on his feeling of anger and to ask it to give him an image of itself in his mind. Almost immediately Richard visualized a man, red-faced and tall, with brown hair, clean-shaven and wearing grayish clothes. His hair was combed up and sticking out from his head. He did not look like Richard. As I guided Richard in having a conversation with this visualized part, the part indicated that it did not know Richard. When asked to guess who it thought Richard might be, the part said, according to Richard, “You’re an asshole!” At this point I coached Richard to explain that it was a part of Richard. The part refused to accept this as true. We spent some time demonstrating that the part was indeed a part of Richard, but when the part finally accepted the explanation, it still said that it didn’t know Richard’s name. It had a name of its own but couldn’t remember it. Finally, after more discussion, the part indicated that it had a vague recollection of Richard. The hostility of the angry part is not unusual, but most of the time even angry parts know who the Self is. I emphasize that this interaction between Self and part involved a dissociatively normal person.

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Sunday, May 24, 2009

Dissociatively Normal Discussion

Here are some propositions that seem to be widely, but not universally, shared by those doing clinical work with dissociation. I’ve made no effort to be exhaustive. Here are seven propositions.

1 People with separate parts are not normal.
2 People who have named parts are not normal.
3 People whose ego states sometimes take executive control are not normal.
4 A person with amnesia for some of his ego-state-influenced behavior should be considered to have a dissociative disorder.
5 When a person is influenced by an ego state, this means that the ego state has taken executive control from the person.
6 It is not normal for ego states to be unaware of the actions of other ego states.
7 If ego states influence a person in real world actions then that person has a dissociative disorder.

Regarding proposition 1: As those who have done “Parts Therapy” believe, each of these propositions appears to be false. It is, in fact, apparently universal for people to have internal parts, or ego states. It is usually a simple matter for a therapist to help a person begin to differentiate internal parts. For an overview of techniques used to differentiate internal self states (ego states), I suggest Mick Cooper and Helen Cruthers, (1999), “Facilitating the expression of subpersonalities: A review and analysis of techniques. In John Rowan & Mick Cooper, (eds.) The Plural Self: Multiplicity in Everyday Life. London: Sage Publications Ltd.

Regarding proposition 2: Sometimes parts have names before we do the internal work; sometimes the parts choose names at the time we work with them; and sometimes parts do not have names and do not want them. In the last case we usually refer to parts as something like “the 20-year-old,” or “the angry one.”

Regarding proposition 3 & 5: The usual way for parts to influence a person is from behind the scenes. When I am sad, for example, the sadness I experience is the sadness of one of my internal parts. But I am still in charge of myself. I am influenced by the part and I act in a sad way, but I do not experience the sad part as having taken executive control from me. I am not even aware of the part as a part at that moment. I am merely sad. Thus, having a part influence you is not the same as having a part in executive control.

Regarding proposition 3 & 4: Having a part in executive control is not something most of us experience, but it occasionally happens. When it does we are generally not aware of it. An example is the case of the man I wrote about last December. He was tired after a long day of play, beginning with a bar-b-q and beer around noon. Now, sober in the evening, and preparing for going to work the next day, he did not remember slipping a love note from his girlfriend underneath his wife’s keys where they lay on the kitchen counter. The next day his wife was furious and the man had no idea how the note got under his wife’s keys. In session, the man discovered that one of his parts took executive control for less than a minute to do the deed. The part wanted the man divorced from his wife, it took direct action to try to bring that about. This sort of event is unusual, but I believe it probably happens fairly often when people cannot explain or do not remember something they have done, usually, of an ordinary sort. Less ordinary, and probably abnormal, is the extensive executive control taken by some parts when a person rages. Often the person does not remember what she/he did while raging. Or, the person can remember what he/she did, but felt during the experience that he/she was not in control of herself/himself.

Regarding proposition 6: Is it always the case that not sharing memories is abnormal? This is a problem proposition, in part, because it seems to be a core belief among researchers in dissociation that lack of shared memories is a marker for abnormality. It is difficult to point to examples in the relevant literature that actually address the possibility that lack of sharing could sometimes be normal. For now I will only point to my own clinical work in healing persons who have been rejected by their partners. It is common for a “romantic part,” that is, a part with a specialized function of romantic love, to be unaware of the negative characteristics of the rejecting partner. All this part usually wants is for the pain of rejection to stop and for partner to return. The lack of awareness by the romantic part for the partner’s negative characteristics is one of the major difficulties the person has in regrouping and moving on after the rejection. This is different, of course, from a romantic part knowing about the negatives, but not caring.

Regarding proposition 7: Within the framework of Parts Psychology all persons are viewed as being influenced by semi-discrete internal self states (ego states). Consequently, if this framework is correct, internal influence cannot be pathological.

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Saturday, May 16, 2009

Dissociative Forgetting in a Normal Person

Adam is a 38 year old man who just broke up with his girlfriend of 10 years. Just two weeks ago the girlfriend moved directly from Adam’s home into that of her new boyfriend. Adam politely stayed away while she loaded up her share (actually, almost all) of their household furnishings. Adam is a businessman who has suffered significantly during the current economic recession. This week he reported discovering that he had $22,000 in a bank account of which contents he had been unaware. He thought there had been only $220 in the account. Each month over the last six months he had been uncharacteristically discarding the bank statements for this account without looking at them.

As a result of this week’s discovery Adam can now take significant action to protect his personal and business standing. Adam wondered how he could have overlooked the money. Over the previous three months he had been doing twice-a-week therapy with me within a “Parts Psychology” (ego state) framework. We had been working to heal him of the problems that he and his girlfriend had identified as causing their relationship to be troubled. Evidently he had made the changes too late. Over the course of our work Adam had become aware of half a dozen parts (ego states) with an interest in his relationship with his girlfriend. One of them, “Brian,” had previously been identified as significantly involved in Adam’s sexuality. Now, however, Adam found that Brian’s role was greater than that. Brian did not trust the girlfriend. He thought she would take any of Adam’s assets to which she could gain access. He took action to protect Adam. During our second session of the week Adam communicated with the Brian part. Brian admitted to blocking the actual bank balance from Adam’s awareness; he also acknowledged influencing Adam to throw away the bank statements without examining them. With the departure of the girlfriend, Brian now permitted Adam to “discover” the actual amount in the bank account. Now that he has renewed awareness of the money, Adam remembers where he acquired the $22,000 (from a single business client).

Brian is a dissociatively normal person. His score on the DES is 6.1, below the average score of 10. The sort of forgetting he experienced is dissociative forgetting because it involves the activity of a structurally distinct part of Adam’s inner world of subpersonalities. The sort of internal influence shown here by a normal ego state seems to me to be the same sort of influence we see in the structural dissociation of alters in DID and DDNOS.

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Sunday, May 10, 2009

The Haunted Self

I have just about finished reading van der Hart, Nijenhuis, & Steele (2006), The Haunted Self, again. I am glad I am rereading it. I missed so much the first time. This is an amazing book! The scholarship, the connection to existing literature, and the comprehensive clinical description is outstanding. The authors' linkage of their theory with a theory of evolutionary principles of "actions systems" and "action tendencies" is brilliant. In the future I may pose some critical questions regarding structural dissociation-especially as it relates to normal multiplicity. For now, though, I just want to register my admiration for this book. I recommend it for all students of trauma and dissociation.

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Sunday, May 3, 2009

Birth of a Part (Ego State)

I had been working with Sally off and on over several years, mostly when she had new problems with managing her business, when she announced that she was aware of a new part (ego state or subpersonality). She was already aware of her inner world because of the work we had previously done. I call this work “Parts Psychology,” but the general approach will be better known to a general audience as “Ego State” therapy (Watkins and Watkins), or as “Internal Family Systems” therapy (Richard C. Schwartz). This post addresses the matter of the “birth” of the part. There are a number of different theories about how internal self states come to be, and I hope to stimulate commentary regarding this process. Sally named the part “Sweetheart.” The following quoted paragraph is from my edited notes a few days after my first interview with Sweetheart in 2006. Sally spoke internally to the part and returned the answers to my questions. Sweetheart's presenting age is about 12.

“Sweetheart’s first memory upon becoming aware was pervasive fear, together with coldness, darkness, and a sense of being alone. Over time she became aware of other voices and she knew she wasn’t alone. Her fear became better known to her as a fear of losing something. While she was aware of others [i.e., parts] she was afraid to make herself known. But by listening to the others talk she began to understand what she was afraid of losing. Like the others she was afraid of losing her husband. Even as she noted her earliest memory of fear, she acknowledged another ‘first memory.’ It gave her a way of explaining herself to herself. Sweetheart says she was ‘born’ at the specific moment in 2004 when she learned of [Sally’s] husband’s diagnosis of cancer. For a long time after that she remained quiet and alone, and then two years later, she revealed herself to [Sally] and to the other parts. Actually, it was the other parts who told [Sally] of Sweetheart’s existence.”

The points I want to make are that: (1) New internal self states (parts) can appear at any time in a person’s life. Sally was 41 when Sweetheart appeared. (2) Dissociatively normal people have parts too. Sally’s score on the DES was less that 5, compared to the norm of 10. (3) Parts like Sweetheart are different from DID alter personalities largely because they do not take executive control of the person. Sweetheart influences Sally through increasing her anxiety regarding her husband’s health and other potential problems. Sally says that she knows Sweetheart is blending with her when she feels a coldness in her chest and lowered blood pressure (which she has, on occasion, checked). She feels this coldness especially when she and her husband are getting the latest test reports from their oncologist.

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Sunday, April 26, 2009

Sex and Romance in Parts Psychology

From a Parts Psychology perspective sexual and romantic interests are distributed within internal self states (subpersonalities) just as are attitudes and emotions such as anger, sadness, fear, aggressiveness, passivity, etc. The following is a case example illustrating a fairly typical organization of these states.

Sylvia is 40 and in a successful second marriage. In her first marriage romantic love and sexuality were combined in Tanya, the dominant subpersonality who was so powerfully blended with the Self that other parts of Sylvia also believed Sylvia and Tanya were the same. However, when things became difficult in the first marriage and the husband began to show signs that he would leave, other parts of the Self began to assert themselves. Ursula became the internal manager. Her additional characteristic was that she simply liked sex, even with the husband, although she didn’t like him and wouldn’t have chosen him if she had been in a position to choose. Velma was the teenage part who read romance novels. Her sense of romantic love, consistent with that found in the romance novels she read, had never been tempered with actual experiences of sex. She didn’t like the husband. Wanda was the system’s worker part, the part who drove Sylvia to be successful in her career. She handled all the difficult and unpleasant tasks. It was Wanda who stepped in and handled “duty sex” with the husband when Sylvia was uninterested—i.e., when Tanya or Ursula were unblended with her for whatever reason.

This example illustrates the most common types of sexual and romantic parts. There was Velma, the untouched romantic part; Ursula, the sexual part who doesn’t have to love to enjoy sex; Tanya, who both loved and enjoyed sex with the husband; and Wanda, who handled things when sex was a chore. Sylvia’s story is long and complex, and there isn’t space to tell it here. But when I last talked with Sylvia, sex and love were different with her second husband. All of these parts and others loved the second husband. Wanda gave up duty sex and, like the other parts, only had sex if she wanted to do so. The teenage romantic part, Velma, found a focus for her storybook yearnings and managed to be aware only of the positive characteristics in the second husband. Two other parts, child parts, related to the second husband with child love, and didn’t really understand sex. They were not present when the adults had sex.

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Sunday, April 12, 2009

The Problem with Sybil

The following is a passage from the book, “Sybil,” by Flora Schreiber, describing the treatment of Sybil’s multiple personality disorder by her psychiatrist, Cornelia Wilbur.

“Through hypnotic age progression, Dr. Wilbur had metamorphosed what had been fixations in the past into viable parts of the present The hope was that this would become the bedrock on which to erect the superstructure of integration, a way to open the pathways to the original Sybil—and to restore her” (1973, p. 410).

There are several problems revealed in this passage. They are (1) hypnotic age progression; (2) the notion of parts being fixated in the past; (3) the idea of integration; and (4) the idea of an “original” Sybil. The problems are interrelated. Wilbur used age progression to advance all younger parts to the same 37 years of age as Sybil. My criticism has to do with the fact that with normal multiplicity as found in virtually all persons who are not pathologically dissociative, there are internal parts who present with a variety of ages, even occasionally as older than the outside person. If it is normal to have subpersonalities of various ages then why would the therapist want to make all inside parts the same? The second problem is related to the first. Wilbur made the assumption that just because a part presented as younger, it was “fixated” in the past. It is clearly possible that parts can be so fixated, and thus unaware of what is happening in a person’s present time. A close reading of “Sybil,” however, makes it clear that parts were generally aware of present events, even though they presented as younger than Sybil. This is consistent with the multiple internal parts of dissociatively normal people.

The third problem, the idea of integration, is taken by most people to mean that all the internal parts of a dissociatively disordered person should be fused into an entity such that no evidence of internal division into parts can be discerned. Yet, we know from the study of dissociatively normal persons that such internal division into internal parts is normal. This suggests to me that fusion creates a condition that does not occur in the normal population. No doubt fused unity is an improvement over multiple personality disorder, but it does not appear to me to be the achievement of true normality.

The fourth problem, the idea of an original Sybil, is now fairly well recognized to be a misconception. Most students of dissociation would now say that Sybil never had the experience of unity because of the horrible abuse she suffered. She was dissociatively abnormal from a very early age. She never had the chance to achieve an “original” state in the sense that her psychiatrist meant it.

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Sunday, April 5, 2009

Trauma Processing through Unburdening

Unburdening” is a technique developed by Richard C. Schwartz for the release of the burdens carried by his psychotherapy patients as the result of painful life experiences. (See “Internal Family Systems Therapy,” 1995). I have taken Schwartz's concept and intervention and made it a linchpin in the trauma processing approach I take to psychotherapy. This technique should not be confused with hypnotherapeutic techniques that similarly aim to alleviate psychic pain through visualization. Schwartz’s technique must be understood in the context of his theory of normal multiplicity of the mind. In this theory every person is viewed as having a personality consisting of a Self and a number of parts, or subpersonalities. It is the parts and not the Self that carry trauma burdens. Consequently, unburdening is aimed at the specific part which carries a trauma burden or which carries a toxic belief, such as “I’m a failure.” Using an unburdening intervention on the whole person can have a temporary positive effect, but a lasting unburdening is achieved only through work on the relevant subpersonality.

Here is a simple example of how unburdening can work. Tom had a speaking phobia in the present as the result of an embarrassing incident in the second grade. The second grader was called upon to read aloud in front of his class. Unfortunately, during the recess before class he had had an accident in the restroom, resulting in the wetting of the front of his pants. When he stood to read aloud in class some of his classmates laughed and made fun of him for peeing his pants. The incident was so intensely embarrassing that a new subpersonality developed to carry the burden of embarrassment. After this incident Tom found that he could not speak in front of groups without experiencing tremendous anxiety. He developed a public speaking phobia. Eliminating the phobia required healing the child part who carried the embarrassment. His therapist helped him find the child part who experienced the original trauma, and then guided Tom (speaking as the Self) in unburdening the child part. He used a wind metaphor. Coached by his therapist, Tom visualized a powerful wind blowing over the child part and carrying away the original burden of embarrassment. This simple intervention healed about 75% of Tom’s speaking phobia.

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Sunday, March 29, 2009

Suicidal Impulse in a Nondissociative Person

The following case example illustrates the powerful influence that ego states (parts, subpersonalities) in a normally nondissociative person can have on current functioning. I present it here in hopes of drawing interest to ego state, or parts, dynamics even among those who do not qualify for a dissociative diagnosis. My client, call her Alice, overdosed on sleeping pills after leaving my office following a session which included the presence of her husband. The couple had been separated for six months and were completing the financial arrangements for a noncontested divorce. Alice had asked her husband to come to our regularly scheduled session to help her deal with the sadness and anger she felt following her discovery of pictures of her husband with a new female friend. Alice insisted that she wasn’t upset that her husband was moving on. It was she, after all, who had insisted upon the divorce, and she had had numerous dates of her own. She insisted that she was only upset because her husband had let their children know about his new friend. In spite of her protestations, however, the language she used and the vehemence of her complaints made it clear that she was indeed upset about her husband seeing another woman. Although we made an appointment for the following day, Alice overdosed that evening and was hospitalized for four days. When she returned to therapy the next week we were able, over the course of two sessions, to track down the subpersonalities involved in her devastation and consequent overdose.

There were three internal parts involved: two protectors and a wounded child part who presented as age five. The child part was the source of Alice’s devastation. The child part was not coconscious with the Self, but had some awareness of events in Alice’s life. This 5-year-old part identified Alice’s husband as her “father” and the husband’s female friend as her “sister.” For the child part the current events of impending divorce by the couple, the husband (her “father”) turning his attention to the female friend (her “sister”), and the evident replacement of Alice by the female friend (“sister”) in Alice’s husband’s (“father’s”) life was nearly an exact replay of Alice’s childhood experience of being replaced by her younger sister in her parents’ affections by the age of five. Healing involved gaining access to the five-year-old part, convincing her that the husband was not the father and the female friend was not the sister, and then unburdening the child part of her original losses. This was fairly easily accomplished “parts psychology” (See Watkins and Watkins 1997 and Schwartz 1995) approach.

The major point I want to make is that the inner worlds of normally nondissociative persons can be just as dynamic, and have just as serious consequences, as the inner worlds of the pathologically dissociated clients who fit diagnoses of DID or DDNOS. Alice scored a slightly elevated DES score of about 15 in comparison with the norm of 10. However, I am working with another client with virtually the same pattern of subpersonality influence (but without an overdose) who scored only 5.3 on the DES. Those who work within an ego state framework and those who work with Schwartz’s IFS model will not be surprised by these descriptions. Unfortunately, the larger community of workers in the dissociative disorders field apparently still dismisses the idea that normal people have dynamic subpersonality systems, too. Consequently, “parts psychology” fails to be taken into account in the major theories of pathological dissociation.

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Sunday, March 22, 2009

Anger Management with Parts, or Subpersonalities

It has been awhile since I provided an overview of “Parts Psychology” on this blog, and so some readers may sometimes wonder what I’m talking about when I describe the Self in conversation with a part. Most blogs I write here are of two sorts. In the first I write about actual therapy examples, either with “normal” persons or with those who could be diagnosed with Dissociative Identity Disorder. There is not a whole lot of difference in how these systems work, except that DID persons tend to be more extreme in their presentations and their reactions. In the second set of blogs I write more theoretical pieces that may be boring or of little interest to the more casual reader. Those posts are really for me, and they help me clear my mind of conflicts I have with other clinicians and researchers who have ideas about dissociation and how the mind is organized. Today, I’ll talk about just one case, after I provide a brief overview.

Parts, or subpersonalities, are those parts of the personality that we are referring to when we say things like, “A part of me wants to avoid sweets and lose weight, but another part of me says we wait until tomorrow to begin the diet.” Or, “A part of me loves him so much, but another part of me has had it, and wants to leave him.” These parts are not just ways of speaking. They are real constellations inside the mind and can be viewed internally as real people or even, sometimes, as animals or objects. What surprises most people is that when the Self, guided by the therapist, speaks inwardly to one of these parts, the responses of the part cannot be predicted. Mick Cooper and Helen Cruthers provide a definition which some readers might find useful. Parts, subpersonalities, or subselves, “can be generally defined as semi-permanent and semi-autonomous person-like constellations of behavioral, phenomenological, motivational, cognitive, physiological and affective characteristics.” (In: John Rowan & Mick Cooper, The Plural Self [1999]).

An example from a recent session comes from a 35-year-old man who came to therapy for help with coping with his wife. He found himself so angry with her that he was considering divorce. They argued constantly. They blamed each other for the major difficulties they were having. Each of them believed that if only their partner would stop acting so stubborn and just act rationally there would be few problems. In one session the man came in especially angry because his wife had hit him with a coffee cup in a jealous rage. I asked him to think about the anger he was feeling at that moment and to notice where in his body he felt the anger most. He felt it most strongly in his upper body, especially his upper chest. I asked him then to focus on that sensation in his chest and stay with it for a moment, and then to speak to it with his thoughts and ask it (the anger sensation) to give him an internal image of itself. What came to his mind was an image of himself, refaced and angry, and with horns protruding from his head.

The part did not have a name for itself, and accepted that we could him “The Angry One.” My client thought it was “stupid” to have a conversation with the image but he agreed to do so anyway. The part’s most powerful memories, next to the present blowups with his current wife, were similar fights with his first wife. The last such memory was the one which led immediately to divorce. The fight became so intense that his wife called the police. She wanted him to go to jail for domestic battery, and so she began beating herself up so that she would look severely beaten when the police arrived. He was not arrested because the wife eventually admitted that her wounds were self inflicted. This and other extreme moments with the first wife were being triggered whenever he fought with his current wife. By the end of the session we had neutralized the painful memories of fights with the first wife so that the man could relate to his current wife only in terms of their own relationship. The work was accomplished through work with The Angry One. The process of neutralizing previous emotional baggage (memories) is called “unburdening,” and I have described it in other blogs. I will do so again in a later blog. It is just about impossible to neutralize such emotionally laden material through work on “anger management” with the external self alone.

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Sunday, March 15, 2009

Parts Psychology in Overcoming Resistance to Work with Pornography

In earlier blogs I described the process of overcoming an addiction to pornography, especially internet porno. The basic process involves desensitizing the client to the powerful memories of porno use. The most important of these memories are the earliest. This work requires, in addition to the desensitization of the porno memories, that the painful experiences from which porno use is an escape, are also desensitized. In the case example below the porno desensitization was blocked by the presence of early childhood memories that an adult might say were trivial.

I had been working with a 36 year old man who found himself unable to give up porno use in spite of his working through a 12-step program aimed at eliminating the compulsion, as well as his regular attendance at a support group for men with the same problem. We had already achieved significant reduction in his porno use through work with two adult parts (subpersonalities) who were devoted to porn use. But then the man had a serious relapse while experiencing an increased work load at his job. He also discovered that his ex-wife was soon to remarry. Before our session he had “acted out” on the last three consecutive days until the early morning hours. When we checked with the parts we had previously desensitized, we found they denied responsibility for the porno use. However, we were able to “bridge” from one of these parts to the part who acknowledged his porn use during the previous three days.

We located this third porn addict in the form of a 12-year-old version of the man. Previously, we had believed that this part was limited in its role to driving the man’s frequent involvement with video games. Now, however, we discovered the part’s memory set included seven experiences with pornography between the ages of 12 and the man’s early twenties. (Note that the apparent age of a subpersonality does not predict the age of the memories held in its memory set). When my client asked if the 12-year-old part would agree to desensitize the sexual energy in those memories, his answer was a flat, “No!” Further questioning elicited the remarks, “I need them. Got to have a little fun sometimes.” He agreed that his video games were fun, but protested that they were not always enough.

With this sort of resistance to desensitizing porn memories we should expect the presence of other experiences from which porno use is an escape. Before I could suggest that we look for those experiences, however, my client said, “I’m picking up insecurity with females, and porno is a way of relating to them.” We followed this lead and asked the 12-year-old part about memories connected to that insecurity with females. The boy part had just three relevant memories: two from the fourth grade and one from the fifth grade. All three memories involved rejection. We could hypothesize that the man’s discovery that his ex-wife was remarrying triggered the memory of her rejection of him, as well as these memories from childhood. Thus, the recent porno use could be viewed as a protective response, avoiding the pain of rejection.

The first memory dated to the fourth grade when, as a boy, my client asked a girl he liked to be his girlfriend, and she refused. The second memory also dated to the fourth grade, but to a slightly later time, when he had had a girlfriend for two weeks. But when he called her at her home “she got embarrassed” and told him not to call her anymore, apparently, because her family teased her. The next day she broke up with him. In the fifth grade he also had a girlfriend. They were walking on the school grounds when he told her he loved her. Evidently, the expression of love frightened her and she broke up with him before the day was over. In just a few minutes we desensitized the 12-year-old part to the pain of these rejections. (See other blogs for an explanation of desensitization through “unburdening”). Once that was done we asked the boy part if he would consent now to desensitize his porno memories. His immediate response was, “Yeah, sure.”

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Sunday, March 8, 2009

How Child Parts Can Affect Adult Functioning

A divorced man living alone came to me for help with his procrastination in work projects. He also had a problem with cleaning up after himself. Dirty laundry was on the floor; clean laundry wasn’t put away; his desk was messy, and important materials were buried under other materials that should have been filed long ago. When asked about his procrastination, the man said he felt an “I don’t want to” attitude, a “childish” attitude. Using techniques that are standard to “Parts Psychology,” the man was able to find the child part who drove his problem with procrastination.

The man visualized the child part as of “kindergarten age,” and as presenting a cartoon image of himself as a child. The part had “stubby legs, a round face, and spiky black hair.” The child part knew the adult self. “You’re the grown-up, the worker, the guy who tries to get me to do stuff.”

In general, when working with parts we want to collect the problem memories that are the foundation for the problem. In this case, however, the connection to memories was indirect, through a set of dislikes. First the child part said, “I hate to put away blocks. Because it means play time is over.” Then it was food: “I hate to eat stuff I don’t like.” And then another problem of childhood: “I don’t like to share.” Finally, it was “I hate doing homework.” In order to treat the problems we used the technique of “unburdening” in the same way we use it directly with memories. We asked the child part to focus upon his dislikes, each in turn, and then the adult self visualized the wind blowing away each of the child part’s dislikes as if they were particles of dust or sand.

Following the unburdening of the child’s problem with blocks, the adult said that the cartoon part recognized that “in putting away blocks you are actually getting to play with them. You put them in particular places in a particular ways. Clothes are the same. It can be a kind of game to put them in certain places—and it leaves more room on the floor to play. You can even have friends over.” With food and sharing, the adult emphasized to the child part, before unburdening, that he was grown up now and could decide for himself what to eat and when to share. Before unburdening the part of his aversion to homework—an important problem regarding the adult’s work projects—the adult self pointed out that there was now a “worker part” to take care of the homework, and that the child part could be playing while the worker worked. When the man asked the child part if he had other concerns he found that the part also “didn’t like to brush his teeth, wash his face, go to bed on time, or get up on time.” After unburdening these dislikes the child part recognized, “it will be nice to just run around being clean and well rested.” The adult self also agreed that the child didn’t have to be present when he took care of the grooming and sleep issues.

The adult client is now able to turn to his work projects without procrastination. He also cleans his apartment in anticipation of the possibility that his new dating life may lead to female visitors to his apartment.

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