EMDR and ego-state therapy

Which one of the many people who I am, the many inner voices inside of me, will dominate?

Who, or how, will I be? Which part of me decides?

– Douglas Hofstadter

HAVING PARTS DOESN’T MAKE YOU CRAZY

Somewhere along the way, we were told that having a personality with different parts is equal to being crazy. In DSM 5, Multiple personality disorder was changed to dissociative identity disorder. The diagnosis makes some of us scared of different parts, sub-personalities, or ego-states.

Please remember: having different parts (or ego-states) doesn’t make you (or your client) crazy.

We all have different ego-states. You don’t have to have a mental disorder to have different parts. Just think about how you feel and act when you are with your clients in the therapist role, and how your feelings and behaviors change during thanksgiving dinner when uncle Ray doesn’t stop telling you about how things were different in the 1950s. There is no way you behave exactly the same, and If you do – you probably need some supervision…

When everything goes well, your ego states work in collaboration, in harmony. Although your emotions and behaviors change in different situations – you still feel like the same person. But this is not the case for everyone.

CHILDHOOD TRAUMA AND DISSOCIATION

Trauma, especially childhood trauma, leads to dissociation – a defense mechanism that helps the traumatized individual survive. The result of dissociation is a lack of cohesion between different ego-states. Instead of working in collaboration, the parts start acting against each other.

Ego states have specific ages, roles, and personalities. They can protect, support or attack each other.

Since each ego state has a specific age, it operates and reacts in ways that are appropriate to that age. If a 35-year-old woman had been sexually abused between the ages of 5 and 7, she may react, usually as a response to certain triggers, as a 5, 6 or a 7-year-old.

Many clients who experienced complex childhood trauma can feel when different parts take over. They can tell you in detail about their ego states. When behaviors, thoughts, and feelings are not appropriate for the present moment – ego state therapy can be helpful. And when EMDR processing is stuck, ego-state therapy can get the processing going.

WHY DO WE HAVE DIFFERENT PARTS?

You only have one brain, so why do you have more than one ego-state?

In his book, Social Brain, Michael Gazzaniga describes the human mind as a structure that contains several independently functioning parts. These parts have different and specific roles. Gazzaniga asserts that our emotional and cognitive lives are shaped by the relationships among these parts.

EGO STATES HAVE A NEUROLOGICAL BASIS

To some clients (and therapists), ego states can sound like a vague concept. If your client needs proof that she has different parts, you can tell her that brain scans of people with DID are associated with different patterns of neural activity (see the study in the resources below).

But your client doesn’t have to have DID to have ego-states.

Ego states are groups of neural networks where thoughts, feelings, and body sensations were wired together. These networks have been wired together after forming strong connections in the brain – a result of repeated neural activity from a very young age.

HOW TO TALK WITH CLIENTS ABOUT EGO-STATES

When a client shares an old feeling, I often ask:

how old is this feeling?

This is a good way to start a conversation about ego states. It can give your client some insight into her own parts.

I tell my clients that we all have parts and that people who had experienced complex trauma sometimes have parts that don’t get along with each other. For clients who want to know more, I explain that ego states are memories and thoughts (and sometimes physical sensations) that are stuck in the same neural networks in the brain. Trauma changes the structure of neural networks. Severe or repeated trauma changes the neuronal structure of the brain so much, that ego states can become dissociated states.

EGO-STATES AND DISSOCIATION

When a child is exposed to trauma, especially ongoing trauma and abuse, she learns to dissociate. It’s a defense mechanism that helps her survive the horrific reality of continuous abuse. As the child continues to dissociate, fragmented parts, or ego states, become hardwired into her neural networks. In extreme cases, the ego states become distinct personality parts.

Robin Shapiro explains the process in her book Ego State Interventions: Strategies for Working with Parts:

With consistent abuse, neglect, or lack of positive mirroring, kids can develop an interior voice that criticizes them for any behavior that may bring negative consequences from a caregiver. Sometimes these voices are meaner than the actual parent.

Easy Ego State Interventions: Strategies for Working With Parts – Robin Shapiro

EMDR AND EGO STATE THERAPY

When EMDR processing gets stuck, it is often due to ego-states that interfere with our work.

Oftentimes ego states take the role of an abusive parent or caretaker. The parts can intentionally interfere with our EMDR work, as they feel threatened by the possibility that the client will improve as a result of the processing.

When done in combination with EMDR, you can use ego state therapy in the preparation phase or when reprocessing EMDR targets.

USING EGO STATES AS A POSITIVE RESOURCE IN EMDR THERAPY

You can use ego states as positive resources. In the preparation phase, before you start working with child states, help your client strengthen her adult ego state. Do some grounding work and help your client connect with her strengths. It is important to establish a present moment feeling of safety.

Remember: If your client is not stable – your ego state work can lead to flooding.

Make sure your client can contain. The good old container can help and should always be considered as an intervention. Make sure you don’t put any ego-states in the container.

When approaching younger parts – go slow. Work is small doses. Make sure you go back to the adult in the room, especially if you are dealing with polarized parts. Pay even more attention (and seek supervision), if you treat a client with dissociation.

By understanding her parts and their behaviors, your client will be able to them let go of their extreme roles. The idea is not to fight or eliminate any part but understand their behaviors and motivations, so they can work in harmony with each other (and let you continue with reprocessing EMDR targets).

EMDR and Ego-State Therapy complement each other. Both help clients understand, on a deeper level, that their reactions, thoughts, and feelings are old patterns. Clients learn to recognize these old patterns and develop a better ability to bring their adult self to the present.

In other words, both EMDR and ego state therapy result in helping the client feel that the past is in the past.

Note: If you don’t have any experience working with complex trauma or clients with dissociation – seek consultation. Find a consultant who is experienced working with ego states, parts or dissociation.


Resources

Resources contain some affiliate links. To learn more, please read the affiliate disclaimer.

Dissociative Part-Dependent Resting-State Activity in Dissociative Identity Disorder: A Controlled fMRI Perfusion Study
Yolanda R. Schlumpf, 1 , * Antje A. T. S. Reinders, 2 , 3 Ellert R. S. Nijenhuis, 4 Roger Luechinger, 5 Matthias J. P. van Osch, 6 and Lutz Jäncke 1 , 7
Linda Chao, Editor

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