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.

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.

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.

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.

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.