Multiple Self-states Research Articles

Hidden Self-States: Some Reflections on the Patient’s Trauma and the Analyst’s Undreamt Dreams

In the treatment of trauma survivors, analysts often find themselves befuddled and disturbed by their clients’ unpredictable and self-destructive behavior. One or more dissociated self-states, initially hidden behind the patient’s high-functioning presentation, may eventually make themselves known in the treatment. The analyst is then challenged to find ways to forge a healing alliance with a disavowed part of the patient’s personality that has previously existed only in the context of a perpetually abusive internalized object relationship. Not only must the multiple self-states learn to communicate with each other, but the unformulated components of the trauma survivor’s childhood experience must be formulated with the analyst in the interpersonal field. At the same time, the analyst’s dissociated self-states and unformulated experience are interwoven in the therapy, creating their own confusion and blind spots. A case study illustrates how the client’s and analyst’s vulnerabilities intersect in the shared unconscious of their work. Psychoanalytic theories on multiple self-states, dissociation, transference-countertransference configurations and unformulated experience all combine to shed light on the difficulties faced by wounded healers treating traumatized patients. The analyst’s countertransference dream is pivotal in exposing her previously inaccessible reactions to her patient.

“Traits Don't Change, States of Mind Do”: Tracking Olive in Olive Kitteridge by Elizabeth Strout

ABSTRACT Elizabeth Strout’s Olive Kitteridge consists of thirteen interrelated chapters, each one involving to some degree the novel’s eponymous character. Readers are presented to Olive both mediated through other characters’ viewpoints, and with more seemingly direct access into Olive’s mind and motivations. The novel’s chapters move across different time frames and thus present its characters in various stages of change. Strout’s narrative style means that the reader, as Guaccero (““Standing in the Spaces” with Olive Kitteridge by Elizabeth Strout.” Psychoanalytic Perspectives 7, no. 2 (2010): 411–415, 412) suggests, is required to keep track of “the sense of multiple self-states that unite to form her [Olive’s] continuity and coherence over time”. In this paper, we explore the process of tracking Olive by integrating several cognitive stylistic frameworks to examine how multiple representations of Olive and her life are processed in reading the novel. Drawing explicitly on the concept of mind-modelling, we provide, to our knowledge, the first stylistic analysis of character across a short story collection. We further argue that tracking Olive is a process that places particular demands on readers: Strout shifts our attention across numerous iterations of events and characters in a way that invites constant readjustment of our understanding of Olive and the significance of her actions and relationships with others.

Linking Self-States in Eating Disordered Patients: Multiplicity in Multidisciplinary Teams

ABSTRACT Novack (this issue) provides opportunities for clinicians working with patients with eating disorders to think of the various team members, including additional therapists, as representing and helping to bring to the forefront the patient’s various self-states and expands the idea of multiple self-other configurations to a multi-person configuration. However, the complexity of this multi-person field can be fraught, as the clinician is pulled into engagement with these various team members, while simultaneously containing multiple self-states and body-states, and working internally to link an awareness of each of their functions. In this commentary, I address how the expression of dissociated self-states across a multi-person system can serve both defensive and expressive unmet needs for both patient and therapist. Is linkage with others external to the treatment dyad as therapeutically useful as linkage from within the dyadic field? Holding the tension of what is gained and what is lost in expanding the idea of multiple self-other configurations from the analytic dyad to a multi-person field requires careful consideration.

Ability to move between self-states and emotional experiencing and processing as predictors of symptomatic change.

Contemporary relational theories consider clients' ability to move between multiple self-states and clients' ability to experience and process emotions to be two therapeutic processes inherently connected and fundamental to growth and change in psychotherapy. The current research aimed to empirically explore these theoretical assumptions by (1) examining the between- and within-client temporal association between clients' levels of ability to move between multiple self-states and clients' emotional experiencing and processing over the course of therapy, and by (2) testing whether this association would be more prominent for clients presenting good treatment outcomes. Based on treatment outcome measures, two contrasting groups were selected, nine successful and nine unsuccessful. Ninety session transcripts (five per client) were analysed using the Two-Person APES (TPA), an extension of the Assimilation of Problematic Experiences Scale (APES), for the measurement of the ability to move between self-states. Sessions were also analysed using the Experiencing Scale (EXP), for the measurement of emotional experiencing. For all predictors, we disaggregated within- and between-client effects. No association was found between EXP and TPA levels. However, at the between-client level, an interaction effect was found indicating a positive correlation between TPA and EXP only for the good-outcome cases, whereas a negative correlation between these variables was found for the poor-outcome cases. The ability to move between multiple self-states and accessibility to emotional experiencing may be seen as complementary processes enhancing the effectiveness of therapy. However, a high level of one process combined with a low level of the other may be a sign of poor therapeutic outcome. Clients' capacity to negotiate between conflicted self-states and their ability to experience and process emotions are two determinants working in a synergistic way to predict improvement in clients' symptoms. The presence of only one of these psychological processes without the other might be an indication of poor therapeutic outcome. Therapists should aim to increase their clients' progress in both the movement between self-states and emotional experiencing.

Yes-Saying, No-Saying, and the Places In-Between: Seduction and the Psychoanalytic Exploration of Sexual Consent

ABSTRACTOur capacity to give or withhold consent is intrinsically related to our felt sense of agency, and yet complexity theory and the social-constructivist ideas that inform new developments in relational psychoanalysis trouble and unsettle reified definitions of consent. This article explores the phenomenological experience of yes-saying and no-saying in psychoanalytic treatment. What does it mean, for example, to be a choosing subject who isn’t fully conscious, autonomous, and agentic? How are our definitions of consent altered if we make room for thinking about individuals as composed of multiple self-states or dissociatively organized? Furthermore, if all analyses begin with a sense of “hope and dread,” in Mitchell’s terms, and are marked by (as Butler wrote) “ambivalence and an abiding sense of anxiety,” then all analyses begin in a place between yes and no. This has implications for how analysts think about the patient’s explicit and unspoken “no’s” and suggests that perhaps implicit in our concept of empathic attunement is the idea of psychoanalytic seduction. “If you can think yourself appropriately into the inner life of another person,” as Kohut somewhat daringly proposed, “then you can use this knowledge for your own [therapeutic] purposes.” Borrowing from sexual scenarios and clinical vignettes to illuminate some undertheorized areas in psychoanalytic theory and practice, this article posits that there are significant corollaries between sexual seduction and what happens in any given analysis.

Dramatic Dialogue: Dreaming & Drama in Contemporary Clinical Practice

Dramatic Dialog refers to a conceptualization of therapeutic action derived from the legacy of Sándor Ferenczi that articulates how internal object relations and multiple self-states are unconsciously dramatized and brought to experiential life on the analytic stage. The terms dramatic and dramatology imply live dialog in the here-and-now. The metaphors of playing, dramatizing, dancing, and dreaming with the patient are all ways of describing how the analyst joins with the patient in a system of mutual regulation. We define generative enactment as the affirmative and creative dimension of repetition, played out in the intersubjective system and influencing it from the inside out. This article presents an intersubjective and relational perspective on dramatic dialog as a model of therapeutic action and therapeutic traction with case material presented for illustration and discussion. The article samples a wide range of clinical theorists, across schools of thought, geographical regions, and extending over many decades, who view therapeutic action as constituted by dramatic dialog and generative enactment.

“Where All the Ladders Start”: A Clinical Account of Object Relations Legacies, Self-States and Analytic Process

This paper evolved from an earlier panel presentation on conceptual tributaries to relational thinking at the 2015 International Association for Relational Psychoanalysis and Psychotherapy Conference in Toronto. Representing the place of Object Relations theory in the DNA from which Relational Psychoanalysis emerged, I emphasized—and provide here an abbreviated review of—the contributions of Fairbairn, Klein, and Winnicott. Then, as now, believing in the communicative power of clinical examples, I offer an extended clinical narrative in which the medium is the message and clinical phenomena such as multiple self-states, enactments, negotiation, play, and the residue of internal object relations (in both patient and analyst) are brought to life. Also, as the Toronto Plenary overview paper by Jody Davies has developed into its current substantial elaboration of distinctly relational issues (multiple self-states, co-creation, and the interplay of process and insight) and serves as the capstone paper for this published version of our panel, I respond to Jody’s conceptual contributions and her perspective on Relational thinking.

Many Selves in One Body: Discussion of “The Entropic Body”

The discussion of Wooldridge’s paper (this issue) offers two theoretical ideas to conceptualize the psychodynamics and treatment of individuals with severe eating disorders. Multiple self-states posited by Philip Bromberg and others allows for an understanding of the often contradictory nature of eating disorder symptomatology. Pathological organizations and primitive anxieties, elaborated by Paul Williams, suggests that the deep psychotic layer of the personality must be reckoned with in order to help the patient. Wooldridge’s patient Sara is discussed from these two perspectives, and technical considerations are offered.

Multiple Cultures, Multiple Selves, and Analytic Influence: A Response to Goldin’s “The Storied Self”

Using a dynamic systems contextual model, I expand Daniel Goldin’s ideas about narrative and the “storied self.” I identify two issues that are key to the development of a coherent life story: first, the identification and integration of the multiple psychic self-states and external cultures with which and in which people live, and second, the meeting and melding of important minds in the person’s environment.

A Response to Weisel-Barth and Bodnar

I consider first the value of reinstating narrative at the center of the psychoanalytic process. I go on to examine how the analytic field encompasses multiple self-states and multiple cultures in a drive toward unity.I want to begin by expressing my appreciation of the thoughtful commentaries by Joye Weisel-Barth and Susan Bodnar, which offer not so much a criticism of the ideas expressed in this paper as an expansion and gentle questioning of them. I want to thank Weisel-Barth in particular for pointing out that my article was an attempt to pick up a vanishing strain in psychoanalysis. Freud (1913) enjoined his patients to say whatever came to mind, and in turn he would try to listen with even hovering attention in order to sift out the unconscious derivations without prejudice. When intense feelings for the analyst got in the way of what was meant to be a scientific and neutral process, Freud trained his “instrument” on the relationship, and analyzing transference became integral to the method. But the purpose of the enterprise was always to cure through reconstruction, to enable patients to remember rather than to relive. From its inception, the process of psychoanalysis involved piecing together a hitherto unarticulated account of the patient’s experiences—in short, a narrative. We may no longer believe that we can precisely replicate the past in words, we may no longer trust the objectivity and authority of the analyst, and certainly the drive-conflict genre has lost much of its persuasive power, but when we forget that we are helping people tell their stories, we lose a shared sense of purpose. Few of us come to therapy to have a relationship, although we usually end up in one.

Compassion-Focused EMDR

Compassion-focused therapy was developed to enhance physiological systems related to well-being, safeness, and connectedness in people where shame and self-criticism inhibited progress in therapy (Gilbert, 2000; Gilbert & Irons, 2005). This system links attachment experiences with emotion regulation capacities, with integrative capacities of the mind and also with the interplay between different motivational systems, which are played out in multiple self-states (Cortina & Liotti, 2010; Cozolino, 2010; Gilbert, 2009; Liotti & Gilbert, 2011). Hence, a compassionate focus could potentially prove valuable in eye movement desensitization and reprocessing (EMDR), particularly where shame or attachment trauma is involved or for those traumas that have impacted on the structure of the self, for example, dissociation. A structured compassion-focused EMDR (CF-EMDR) seems likely to be particularly useful for therapists wishing to pay positive attention to strengths and well-being. The primary task of the CF-EMDR therapist would therefore be to facilitate a warm and wise relationship to the problems that brought the person to EMDR. This article outlines the potential benefit of a compassionate focus in the processing phases of EMDR to address self-critical blocks, giving clinical examples in tables to illustrate the process and language.

Held in mind, out of awareness. Perspectives on the continuum of dissociated experience, culminating in dissociative identity disorder in children

With reference to research from the fields of neurophysiology and psychoanalytic theory, this paper gives an overview of the present understanding of how trauma is processed and the possible aetiology of multiple self-states. Clinical examples of a variety of self-states are given and thought about in terms of neuroception. Finally, some thoughts on clinical implications of treatment are offered.

The Enduring Hope of Shared Creative Exploration: Some Thoughts on the Work of Philip Bromberg

This article discusses several of Philip Bromberg's ideas that have resonated most powerfully for me: the therapist's feelings around his possible role as an agent of the patient's pain; the process of shifting among multiple self-states while remaining the same, applying for both participants; the situating of the self in a relational context, developmentally and in therapy; the core and pervasive impact of the chronic “trauma of nonrecognition,” and the patient's need to be needed as who he is, as a source of pleasure to another person. Building on Philip's characterization of “the analyst's ‘stumbling along and hanging in,”’ the article introduces an expansion of my concept of the referential process to the relational context, as a process of joint creative exploration, including activation of experience, sharing of reveries, and joint reflection; and places this process in the context of current scientific work on embodied cognition and embodied communication.

Psicoterapia cognitivo analítica y trastornos de la personalidad: revisión [Cognitive analitic psychotherapy and personality disorders: review

The Cognitive Analytic Therapy is a kind of integrative, brief, focus and action psychotherapy, developed by A. Ryle in England in the 80´s and 90´s. At present, is a treatment reference model in that country and is frequently used to treat personality disorders, especially borderline disorder. These patients have a number of metacognitive dysfunctions which difficult the processes of awareness of the different mental states and their components. Through the model of Multiple self-States, the goal is to help the patient to

Traumatic Loss and Developmental Interruption in Adolescence: An Integrative Approach

Loss of a sibling in mid-adolescence profoundly interrupts the progressive movement along a developmental path. The impact of a sibling's suicide for a first-generation Asian-American adolescent will be examined with respect to identity formation, and how cultural values and beliefs influenced clinical process. The author contends that an integrative treatment model was necessary for the work of mourning and for facilitating progression from one stage of adolescence to the next. This framework blended a psychoanalytic/developmental approach with a neuropsychological/somatic understanding of the synergistic relationship between mind and body. The clinical process utilized co-construction of experience (Stolorow & Atwood, 1992) and a multiple self-states model of the mind (Bromberg, 1998).

Reimagining Yentl While Revisiting Feminism in the Light of Relational Approaches to Gender and Sex

This article is an imaginative endeavor based upon the short story “Yentl the Yeshiva Boy” written by Isaac Bashevis Singer (1982). In taking creative license and entering Yentl's world, a new voice and narrative emerges for her and the major characters in the story. Using psychoanalytic relational theories on multiple self-states and postmodern gender and sexuality perspectives, this article undertakes fleshing out the characters and the motives of Bashevis Singer in writing the story. From each character's point of view we learn more of Yentl's subjectivity, her multiply oriented desires from multiple self-states, and expand Singer's story from its original linear course. In Singer's work, Yentl is a two dimensional girl possessing the “soul of a man,” which would mean in the 19th-century Poland Jewish shtetl world that she longs to study Torah/Talmud in a yeshiva. From this paradoxical premise the story eventually ends with Yentl surrendering all claim to the male world of study and then vanishing from the story altogether. This article plays off of this original premise—a male soul within the body of a female—but, instead of seeing this as a binary kind of conflict that must be resolved, that one must be masculine or feminine, girl or boy, heterosexual or homosexual, now will allow for the multiplicity of selves, wishes, and desires of Yentl, a postmodern woman living in a premodernity world. “Truth itself is often concealed in such a way that the harder you look for it, the harder it is to find.” (Singer, 1982, p. 169)

The Relational Tradition

This essay charts the origins, influences, and evolution of the relational tradition in contemporary psychoanalysis. Considering the theoretical and philosophical influences from nineteenth-century Americans like William James and C. S Pierce, and noting the seminal modern work of Steven Mitchell and Jay Greenberg in opening a critique of one-person focused drive theory, the essay follows developments over a quarter century. Hallmarks of the relational approach-social construction, two-person psychologies, multiple self-states, social regulation and construction of identities like gender and sexual orientation, and an evolving theory of clinical practice-are reviewed. New developments in clinical theory, in the study of identity categories, in the work on embodiment and enactment, and in developmental models are also reviewed.

Bob Dylan's Multiple Self-States: A Wild Analysis

(2010). Bob Dylan's Multiple Self-States: A Wild Analysis. Psychoanalytic Perspectives: Vol. 7, Arts on the Couch, pp. 340-367.

Where's the Gap and What's the Difference?

The relational turn in psychoanalysis brought into the foreground the interactive engagement between analyst and patient as a cocreated bidirectional process. It has developed a theory of dissociation and focused our attention on the ways in which multiple self-parts or self-states within each person interact. The author's perspective also emphasizes the importance of rupture and repair in the building of a new attachment relationship, as first theorized in the mother-infant relation. Depicting enactments as part of a necessary process of encountering otherwise inaccessible self-states and the relations they presume, this perspective allows for more “messiness” and what Stern has called an attitude of “courting surprise.” It includes the proposition that such enactment can produce change through new experiences of lawfulness and recognition of feelings and intentions in an attachment relationship.

Ageing and Transageing: Transgenerational Hauntings of the Self

In this article, I examine the dissonant experience of ageing in the context of two different but related models of the psyche: a vertical model to which repression is central and a horizontal model that emphasizes dissociation. I compare the structure of Freud's melancholic self, as Abraham and Torok (1994) have revised it, with the postmodern, poststructuralist, and post-Freudian self, which is characterized by dissociation and emphasized by relational psychoanalytic theorists. I argue that dissociation is the more capacious model for the consideration of the experience of ageing because it can serve an incorporative or an introjective function. In its defensive, incorporative role, it maintains ghostly specters of youth as consuming objects of loss and desire. In its creative introjective role, dissociation initiates a dynamic and creative process in which multiple self-states of past and present are available for recognition and enactment. In this latter form of the dissociative state, the melancholic longings of ageing are transformed into a productive process, which I call transageing. In the final section of the article, I compare the complexities and contradictions of transageing with those of other projects of category crossing, specifically to those that pertain to sex and gender.