COMPARISON TO RELATED APPROACHES
Vignette 1: Kate
Kate’s ‘‘underdog’’ was playing the damsel in distress, not knowing what to do about a problem that was plaguing her. Her therapist said, ‘‘Sit in that chair and be the ‘Kate Who Knows.’’’ A new being (middle mode) came forth and glibly gave her the answers she was seeking.
The termGestalt therapywas first used as the title of a book written by Perls, Hefferline, and Goodman in 1951. After its founder’s death in 1970, Gestalt therapy lost the limelight of public attention, but it spawned many ideas that found their way into other methods. The excitement of direct contact between therapists and clients, emphasis on experience in the here and now, and the use of active experimentation inspired others to uncover many alternative approaches to therapy.
EGO-STATE THERAPIES
The termego statefirst became popularized by Eric Berne when he baptized the parent, child, and adult ego states in 1961. Later these flowered into nurturing, spoiling, structuring, and critical-parent ego states and cooperative, resistant, spontaneous, and immature-child ego states. John and Helen Watkins developed a different type ofego-state therapyin the early 1970s. Both Berne and the Watkinses came across the concept of ego states in the work of Paul Federn.
Paul Federn
Federn was one of Freud’s earliest and most faithful disciples, but his ideas differed from those of other psychoanalysts. Freud definedegofrom the GermanDas Ich—the I. Ego is the identifying and alienating aspect of the Self—This is meandThat is not me. For Federn, theegowas an energy that united thoughts and feelings into a new entity.
An ego state (first defined in 1952) is a system of behavior and experiences, separated from other such states by a boundary that is more or less permeable. The elements in an ego state would only contain ego energy. The ego (self sense) remains constant, but different states could pass in and out of it when invested with ego energy. When a system was not invested with ego energy, it
continued as a unit but was represented as an object. Although Federn was the first to define an ego state, he never realized the significance of his concept or how to use it in treatment (Watkins &
Watkins, 1997, p. 25).
Eric Berne’s Transactional Analysis
All analysts must undergo treatment, and Eric Berne’s doctor was none other than Paul Federn. Berne recognized the merits of an ego state and made use of it in his popular transactional analysis (TA) to describe systems of feelings and behavior patterns (Berne, 1964). They can organize external stimuli asparent ego states, internal experiences from early life aschild ego states, and current awareness asadult ego states.
A particular ego state can switch in with such power that a person relates to a current experience with the facilities of a child. While Freudian analysts were focused on working through the feelings
In an even more striking example, a different therapist in a different time asked Kate to put her ex- husband in the empty chair and tell him, ‘‘Don’t ignore me.’’ In that chair, she placed not only her ex- husband, but also, the doting mother who once said her problems were boring, the father who talked endlessly about his fascinating legal cases but ignored Kate, and her ‘‘top dog’’ with its lofty expectations.
As directed, her underdog weakly pleaded, ‘‘Don’t ignore me.’’ Her therapist gently pushed, ‘‘Say it again. . . .’’ The phrase was repeated several more times until it came out with such force that the walls of the room reverberated, and all present were awed into silence.
Without switching chairs, the uncertain underdog had been replaced by a formidable voice that tapped into a source of strength deep within Kate’s belly. Now fused to power from within, it became difficult for Kate to play the victim in the future.
Forerunners to Therapies of Parts and Selves
of what Berne referred to as the child ego states, he recognized the importance ofobject energyin parent ego states. Unlike Freud’s superego, which acted as a conscience carrying cultural values, parent ego states were very personal, internalized images of early caretakers. However, Berne did not describe a course of treatment for parent ego states. Therapy focused on keeping the adult ego state from being contaminated by recognizing when child or parent ego states were intruding (Erskine, 1997).
Inner Children and Erskine’s Integrative Transactional Analysis
The idea of personality facets became popularized by the quest for theinner childthat was
encouraged by twelve-step self-help groups and the abuse survivors’ movements. Books abound on nurturing, recovering, liberating, rescuing, freeing, affirming, forgiving, and finding your inner child.
There is aninner child therapythat stresses learning about toxic shame, family dysfunction, and personality development; disclosing abuse and neglect; embracing feelings; identifying inner dialogues; reparenting the inner child; and empowering the inner adult (Potter, 1992). These themes echo many of John Bradshaw’s in his best-selling book,Homecoming: Reclaiming and Championing Your Inner Child(1990).
While inner child advocates and other therapies were focusing on child ego states by encouraging dramatic expressions of sadness and anger, Richard Erskine began stressing the importance of
eliciting emotional statements from parent ego states. His ideas evolved from Eric Berne’s TA to integrative transactional analysis. Therapists direct clients to get into the skin, feelings, and experience of the parent ego state, talk to this state directly to understand its struggles, and gently confront it on what it needs to understand or do on behalf of the child ego state. Compared to the Stones’ voice dialogue process, Schwartz’s IFS therapy, or this book, which talks to a variety of directing or distracting subpersonalities and emotional entities all in one session, integrative TA favors working with dominant subpersonalities. However, all these approaches to the subdivided mind would agree that it is best to addressinternalized parents, that block the path to emotional entities or true Selves, first.
Watkins and Watkins Work with a Family of Self
John and Helen Watkins were accomplished hypnotherapists. They developedego state therapyin the early 1970s and began working with different personality parts in people who were considered normal (not multiple personalities). The Watkinses’ definition of an ego state remains true to Federn’s original description, except that either object or ego energy could be contained in a unit. Otherwise, they agree with Federn that ego states are organized patterns of behavior and experience enclosed by variable boundaries. These patterns may include beliefs and behaviors triggered by particular situations, fairly fixed traits that compromise coping strategies, or memories and feelings from an earlier age. There is acore egothat is fairly constant in the way it presents itself to the individual and to the world. Its boundaries are not rigid, and it can expand or contract. When it expands to include various ego states, these are experienced as self (ego) energy or foreign (object) energy (Watkins & Watkins, 1997, pp. 25–36). For instance, a man might say, ‘‘I just cannot be myself around my boss,’’ not realizing that he has been restrained by an (foreign) ego state telling him that he better not say anything stupid.
The Watkinses typically used hypnosis to do ego state therapy that involved the use of a variety of techniques to resolve conflicts between parts that constitute a ‘‘family of self’’ (Watkins & Watkins, 1997, p. 96). The goal is integration or cooperation between parts and a mutual meeting of needs, not fusion where ego states disappear.1Some states are defined by a time dimension (an old man, teen, or infant) or by their function, trait, or role (nurturer, critic, executive, daredevil, curiosity, and so on).
Communication between statesis facilitated by therapists asking a part what it needs or what it wants the person to do. Every ego state involved in a problem might be invited to a conference table,
1Integration is defined in dialogue therapy as the process of the Self engaging and making contact with personality parts.
Forerunners to Therapies of Parts and Selves
told to find a place to sit, and asked to discuss an issue. An adult part may decide to carry a young one’s pain. At times, facets are encouraged to talk to each other, but therapists often work with destructive ego states.
A therapist usesresonanceto take on an ego state’s feelings and sensations oralter egosfor a part to speak on behalf of a subpersonality. This is beyond empathy, which merely reflects feelings.
The Watkinses emphasized that ego states only surface while a person is under hypnosis. In contrast, the Stones, Schwartz, and this author have no difficulty accessing various subpersonalities without formal inductions.
John Watkins was renowned for his pioneering work with dissociation and multiple personalities.
The comprehensive theory of plurality of parts innormalpersonalities that he and Helen developed owes a debt to their clients who struggled with what is now calledDissociative Identity Disorder (DID). These clients havealter personalitiesthat originally dissociate (detach) during trauma by forming separate identities, developing solid boundaries, and becoming infused with (Federn’s) foreign object energy. They do not require hypnosis to emerge and will take charge when thehost personalitydoes not want to deal with a life event. The person is left with a sense of lost time and amnesia for what occurred while the alter wasout. These fragmented identities think of themselves as separate from their host, yet live inside of him or her. They are frozen in time and have a clear image of their age, and the reason they came to be. They view their host and other alters as objects, may fight for control of the body, and keep their presence concealed through the use of amnesia.
Ego states do not have identities—just patterns of thoughts, emotions, and behavior. Vignettes in Chapter 3 show a clear distinction between anego state versus an alter. Alice’s ‘‘Mr. Nasty’’
(Vignette 2) told her she enjoyed her abuse. This critical ego state took root from her mother’s misguided thinking. Donna (Vignette 3) had an alter that screeched that if her father had not started molesting her when she was a baby, it would never have come to exist to help her weak, miserable, juvenile self through countless hours of pain.
Although Watkins and Watkins did not identify different types of ego states (parent, child, directors, distractors, and so on) or distinguish them from a core Self, they did discover a ‘‘hidden observer ego state’’ that they believed is less emotional and has greater wisdom than other inner parts. Conducting experiments involving hypnotic suppression of pain, they gave subjects
suggestions not to feel hurt when their hands were immersed in iced water. Typically, people would deny any sensation. Then the Watkinses would ask, ‘‘If there is any part that feels the pain, lift your finger and signal that you are ready to come out and talk.’’ A voice would speak, admitting to feeling the ache of coldness. Other hypnotists had observed this phenomena and called the underlying cognitive structurethat felt the pain a ‘‘hidden observer’’ (Watkins & Watkins, 1997, pp. 87–95).
Ralph Allison, another psychiatrist who treated Multiple Personality Disorder, found entities, which he calls ‘‘self-helpers,’’ that differed from disturbed alters. The self-helpers had no identifiable time and reason for existence and no defensive function, but had such accurate perception that they were able to advise therapists of their mistakes, mend broken pieces of personality, and understand the mysteries of a person’s life (Allison & Schwarz, 1999).
OBJECT RELATIONS THEORIES
The psychotherapy pot had been stirred by Perls. Federn wrought rumblings even in the heart of psychoanalysis. Several others began to look more closely at the inner images of the Self and others (objects) that the very young develop and how these images affect interpersonal relationships. They used their own nomenclature for divisions of the Self:
True Self: A Self that feels creative, spontaneous, and real; that emerges withgood enoughparent- ing; that is opposed to a ‘‘false Self,’’ which is typically perfectionistic, self-centered, controlling, avoidant, or the like, and that is formed by complying and rejecting parts of oneself (Winnicott, 1965).
Forerunners to Therapies of Parts and Selves
Grandiose Self: A Self that becomes unhealthy when the ego is overwhelmed by demands for external success due to early unmet needs for nurturing or valuing (Kohut, 1971).
Internal object: An object that is loving/rejecting, rewarding/punitive, or protective/attacking and that represents a primary caretaker and his or her way of relating to the child.
Internal Self: A Self or a mental image that is good/bad, superior/inferior, or obedient/nothing (Manfield, 1992). Because young children cannot tolerate having contradictory feelings about themselves or caretakers, they develop split images that relate to an inner ‘‘cold mommy,’’ which protects the ‘‘caring mommy’’ from juvenile wrath. Attitudes can flip in an instant, just as moods can change from euphoric to despairing, depending on which side of the Self is being represented.
Object-relations therapists(1950s–1970s) discovered that some patients could not tolerate interpretations of their inner life; and instead, were constantly focused on objects (people) in the world. They examined personality parts originating from early development, prior to Freud’s ‘‘genital stage’’ when feelings of guilt emerge. Characteristics of blaming, avoiding, and clinging to the very people whom they needed for safety, self-worth, and life force produced outer turmoil, but reduced intolerable anxiety. Such patients may not have difficulties with inner adversaries, but instead, they burden loved ones and coworkers with helplessness, aloofness, arrogance, or impossible
expectations. These theories are helpful to therapies of the subdivided mind that identify distracting parts that help people avoid emotions.
COGNITIVE THERAPIES AND SCHEMAS
Aaron Beck and Albert Ellis are considered the founders ofcognitive therapy(1960s). It took 20 years for this approach to become interested in the subdivided mind. Initially, cognitive therapy held that maladaptive behaviors and disturbed moods are the result of irrational thinking patterns calledautomatic thoughts. Instead of reacting to the reality of a situation, an individual is triggered by his or her own distorted viewpoint.
Gradually, cognitive therapists began talking about internal dialogues that are generated by
‘‘cognitive structures’’ or ‘‘systems of concepts and judgments.’’ There was more talk about
subsystems of thoughts. Then Aaron Beck himself made a distinction between automatic thoughts on one level and ‘‘schemas’’ on another. Schemas are subsystems within the personality that result from previous experience and are used to classify, interpret, evaluate, and give meaning to an event. A follower of Albert Ellis further stated that specific beliefs may be generated fromunderlyingschemas (Rowan, 1990, pp. 108–109).
Another cognitive theorist in the 1980s proposed the idea of a ‘‘subself’’ or a cognitive unit that receives input from current events, one’s self-concept, and emotional states, and sends output to other subselves for organization and action. These multiple subselves are connected to a deeper ‘‘unitary self.’’
The termself-schemawas employed to define packets of information about the self that guide the processing of information. It contains data from repeated experiences categorized according to themes (I’m helpless, I’m worthless, I’m inferior) that seek matching facts. The more often a self- schema is used to process information, the more dominant it will become (Rowan, 1990, pp. 155–
160).
Schemas can also serve as the foundation for future images of one’s self called ‘‘possible selves.’’
They are more than a goal or an intention and contain a blueprint for future action. Most people have multiple possible selves representing a range of desires, dreams, and feared phantoms to avoid (Markus & Nurius, 1987). Clearly, cognitive therapists were coming to terms with the multifaceted personality that could not be captured by simply referring to irrational, automatic thoughts.
Forerunners to Therapies of Parts and Selves