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.

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.

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.

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.

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.