In this chapter I will describe a theoretical framework for understanding multiplicity and dissociation which I have been developing for the past twelve years. The framework is divided into two parts; the first outlines a structural model to aid our overall understanding and the second is a set of dynamic working models which can be applied to clinical work.
A conversation with John Bowlby circa 1988
I took the lift at the Tavistock and at the 4th floor turned along the corridor, to be welcomed by my supervisor John Bowlby. On that day I showed him lots of drawings of little children being abused and telling me their stories of unbelievable horrors. My patient was a middle aged woman who could not understand why I could not understand these children. John mused and thought, looking away and thinking as he often did and said "I think this woman is a multiple personality." And I said - a what?. He said there is a lot of work in the USA on Dissociation and proposed that I should talk to these children and listen to the story they were trying to tell me.
All I have to say today is a continuation of that conversation about listening to the children within us. (in Southgate 1996).
What I have learned over the ensuing 12 years is:
1.
The considerable creative potential of many dissociators.
2. That one must distinguish that group from those who have psychotic selves
who are often but not always abusers.
3. That a therapist who has primarily worked with those labelled as neurotic
will need to adapt her or his approach when working with dissociators.
4. That the overall goal in any therapy can be described as helping the person
become what I have called an Associating Multiple Person
Before describing the framework in detail we need to reflect on a more fundamental question about the nature of self.
My
own view, and that of many contemporary philosophers and relational psychoanalysts
in the post-modern tradition is that the Self is always in relationship to an
Other, sometimes described as selfother, and is multiple from the beginning.
Putnam (1989) writes
"We are not born into this world with a single unified personality. Rather
the infant research data indicate that we come organised as a basic set of behavioural
states with the capacity to generate new states and develop and modify complex
sequences of behavioural state....Two of the fundamental developmental tasks
facing a young child are the integration of a more continuous sense of self
across discrete behavioural states and the development of self-modulation of
behavioural sates.
Bromberg
(1996) states that
""Psychological integration does not lead to a single real you or
true self...it is the ability to stand in the spaces between realities without
losing any of them...the capacity to feel oneself while being many" and
"What is required is that the multiple realities being held by different
self states find opportunity for linkage....through narrative.
With a similar argument Pizer (1996:499) in an article entitled "The Distributed Self" discusses the evolving contemporary model of a post-modern Self as "decentred and disunified: in short a normative multiple self.
Val Bucknall (1999) writes that amongst writers it is almost taken for granted that people have many selves and operate on many levels. It is a sine qua non for writing fiction. (Similar views have been expressed by Doris Lessing (1998: ).
In a very complex analysis of the way in which the concept of individual is privileged over the concept of group, Farhad Dalal (1998:94) also argues:
There is a Sufi saying "we are in this world, but not of it. The thesis of this book is the polar opposite of that - it is saying we are completely of this world from our molecules, to our thoughts, to our feelings to our aspirations. To counter the Sufi saying, let me indulge in inventing an elliptic epigram: The I is We.In one of his lectures he has substituted Wego for Ego!. Later he says:
Once again whilst in broad agreement with the proposition that the more complex society becomes the more layers there are, the point I would take issue with is the fantasy that there has ever been a time of singularity. As we saw in the chapter on biology, the division of labour and the multiple roles that imposes on one, is as old as existence itself.
As psychotherapists we need models of the Self and Other that cover a multiple of continua to guide our clinical practice. It is my view that the dissociative response of the multiple self to trauma is fundamentally creative and for survival. In attachment terms summarised as The essence of disorganised attachment is fright without a solution. Hesse and Main (in press) and van Ijzendoorn et al (1999: 225 - 249.)
In the next section I argue that you cannot separate the Self from the group dynamics within the individual and the social context.
On the need for a group dynamics theory when working with dissociation.
The therapist gets involved not only in the dynamics of a pair but of a group when working with dissociators. One has to remember that there is an internal group within the patient modelled on the family or group systems (K.White 1999). Group dynamics are also relevant to our subject because ritual abuse and other abusive family systems take place in groups. The most appropriate group theory is in my view that of Wilfred Bion.
Bion (1961) proposed that in any group, organisation, ethnic clan or nation state which fears that its existence is threatened (realistically or otherwise), two emotional and usually unconscious processes arise, one creative and the other destructive.
The creative group is called the work group (w-group) which manages and controls the destructive process and tries to pull in a creative developmental direction.
The destructive one he called a "basic assumption group" in which the group acts or cycles between three assumptions . As we are descended from group animals Bion assumed this to be programmed into the individual by evolution (a view which both Bowlby and Freud would endorse). The three assumptions are:
1.
The Basic Assumption of Fight-Flight (shorthand baFF) where the group acts as
though it must fight or flee
2. The Basic Assumption of Dependency (shorthand baD) where the group acts as
if it must seek a leader to be utterly dependent upon
3. The Basic Assumption of Pairing (shorthand baP) where the group acts as if
it must seek a pair whose sexual activity will produce an idealised family
I
have divided Bion's Basic Assumption Groups into two categories. One is "normal"
found in everyday life and can arise in any organisation or group or pair. In
therapy it is illustrated by the complaints some patients make about the annual
family gatherings where people do not actually murder or rape each other but
experience very painful and difficult dynamics. I have named the more extreme
version a "Primitive Basic Assumption Group".
The Primitive Basic Assumption of Fight-Flight is important in this context
because it effects both large scale, small scale and pair relationships so I
will expand a little about it. Bion rudely but accurately said that the leader
who is unconsciously "chosen" by this group is the most psychiatrically
sick member of the group. Neither leaders nor members can think creatively nor
developmentally - the unconscious goal is to preserve some earlier cultural
or emotional state.
Large scale examples of this are Hitler in Nazi Germany (c.f. Alice Miller 1983), some religious sects (see Greven 1990). In contemporary terms one can see it in Milosovic in Kosovo or any of the ethnic conflicts around the world (sadly all too common in what Eric Hobsbawm (1994) has called "the most murderous Century in human history.") Bion had personal experience of this situation as a young tank commander in the first world war and was one of very few to survived in this role. (Bion 1982)
Having explored the need for therapists of dissociators to understand groups, there are two alternative ways of reading the rest of this chapter.
Some people are mainly visual thinkers and relate well to charts and diagrams. In this case a reader might turn to the composite diagrams in the appendix. On the other hand, if you are more a verbal thinker then it might be easier to read straight through.
Structural Working Models
On working models.
I use the term working model which is taken from the work of John Bowlby (1979:117). In his view working models, derived from his interest in systems theory, can be open or closed. The open working model allows for extension and change. The closed working model does not. It is intended that all the working models here except for one, are "open" and the test of this is whether the reader can apply them creatively to working therapeutically with people.
I will use 4 Archetypes about people as a fundamental basis derived from the notion that "Everybody's multiple, in their own way". These are:
1.
The Associating multiple person i.e. relatively good emotional health.
2. The Repressed multiple person i.e. ordinary neurosis
3. The Dissociating multiple person who blames the Self but has no psychotic
selves
4. The Dissociating multiple person who blames the Other and has psychotic selves.
One of the difficulties in writing about human interaction, both internal and external, is its immense complexity. We need to be able to hold thoughts and ideas at multiple levels
Please have a preliminary look at Figure 1. I hope it is not too complicated but it is the best way I can find of holding a complex set of factors in a succinct way. The reader will need to hold in mind the matrix below dialectically whilst I describe the framework linearly.
Figure 1
Reading
the columns downwards:
The Associating Multiple Person. Archetype 1.
At
the end of a successful therapy, or if you are lucky to have had good-enough
parenting, then you will be healthy in the sense of being able to choose which
self-states are appropriate at particular moments in time. Looking down Column
1:
· You would be securely attached to those close to you and able to let
selected Others be secure with you.
· You would also be able to give and take in the arena of primary erotic
attachment which is modelled on the infant-carer relationship (and includes
men as well as women).
· You would enjoy love and the creative orgasmic cycle
· You could take part in creative play and improvisation.
· You would not avoid conflict and be able to make management decisions.
· You would have a capacity for creative and reflective thinking.
· You would take part and assist a group to be creative
Now this all sounds too good to be true and to some degree it is so. More realistically you can tend towards being an Associating Multiple Person but still have parts of yourself that are repressed or dissociated though you would be able to relate to others in terms of secure attachment.
The Repressed Multiple Person. Archetype No. 2
We are speaking here of ordinary neurosis which has been studied by psychoanalysts for a long time. On the surface, such a person may seem singular rather than multiple. But like everyone else, when dreaming the multiple selves of the unconscious are present. The goal of therapy is to move from being a repressed multiple person to an associating multiple person. There is so much literature accumulated on this sort of therapy that it is included here only to complete the picture and to contrast with other self states. A brief summary is:
·
Anxious resistant and/or avoidant attachment relating
· Anxious resistant and/or anxious avoidant sexual relating
· Able to play sometimes, sometimes not and sometimes only able to engage
in trivial pursuits
· Prone to anxious forms of fight/flight
· Sometimes can think creatively and sometimes not.
· Prone to the Basic Assumption group dynamic
It is usual in working with such a person to use transference and counter transference, interpretation, the analysis of dreams etc. as major tools. This works well in working with neurosis because the psyche is split horizontally and working with the unconscious has to be indirect because the unconscious selves are not available directly. But it is important to be aware that such methods are not always effective when working with the dissociating multiple persons described below because the split of the psyche is vertical, so to speak, with each self able to speak directly about the past experiences. In using transference and counter transference there is a danger of treating the reliving of real experience as imaginary or symbolic. There is value in the child's use of the imaginary for survival both then and now which must not be misinterpreted.
A crucial clinical distinction for those who work with dissociators is between Archetypes 3 and 4.
Archetype 3. Dissociating Multiple person who blames Self. No psychotic Selves.
This person will readily come for psychotherapy, though it may take, in my experience, 8 - 10 years work at 2 or 3 times per week or more. Sometimes sessions need to be longer than 50 minutes. The long term prognosis is very good. The key factor is that this person blames themselves rather than the Other. To summarise:
·
Because of early life traumas, has anxious disorganised attachment and has used
the defence of dissociating in order to survive.
· Tends to have the repetition of choosing unhealthy partners and may
act masochistically in a sexual relationship to please the Other. Despite the
history, the person may be a more than good enough parent.
· In play and exploration, tends to please the Other and sometimes unable
to play.
· Can easily get in to forms of flight (rather than fight) - for example
fugue and self-harm.
· Can be very creative but often in the service of the Other.
· Prone towards the Basic Assumption Group but can work co-operatively
with others.
This person rarely comes voluntarily for therapy and is often, but not always, an abuser of some kind. A part of the person's system may have been programmed, through destructive early relationships, to destroy. The prognosis for cure is very poor indeed. Usually, if therapy is undertaken it does not last for very long as the patient runs away or wears out one therapist after another. The person may have paranoid and suicidal selves. The summary is:
·
Prone to take part in punishing attachment and brainwashing.
· The erotic and sexual system may be infused with sado-masochism, rape,
sexualised cruelty and desires for castrating the Other.
· Play tends towards cruel rituals and humiliating games.
· Extreme fight systems can lead to murder, and torture where the desire
is to harm the Other.
· In the primitive Fight-Flight group there is, as Bion originally pointed
out, no developmental thinking at all. He also points out that this is not only
in groups but programmed by evolution into the individual as a group animal
· Tends to join or lead a Primitive Basic Assumption Group acting as
a leader or follower who must fight or flee
Reading across the rows.
If you read across the categories then you can see upon changes across the four archetypes:
The Attachment innate system goes from secure, anxious avoidant, anxious resistant, to anxious disorganised and the primitive punishing attachment where the person has been controlled and brainwashed by carers.
Erotic & sexual innate systems go from primary erotic attachment ; the creative orgasmic cycle and orgasmic rituals (e.g. dancing) to masochistic sexual relating to please the Other and finally sado-masochism, rape, sexualised cruelty and castration.
The innate system for exploration and play moves from the creative, then a mixture of creative and trivial pursuits; to play which is designed to help or please the Other and finally cruel rituals and humiliating games.
The fight/flight innate system goes from creative conflict and management, to sublimated competitive games and anxious forms of fight/flight. The dissociating multiple person who is self-blaming engages predominantly in forms of flight such as fugue and self harm. Finally, murder and torture where fight predominates to harm the Other is the characteristic, in this analysis, of the dissociating multiple person who blames the Other, Archetype 4.
The Group dynamic innate system goes from the creative work group to the basic assumption group and finally to the primitive basic assumption group.
Incidentally, some schools in psychoanalysis privilege a part of the Fight/Flight system such as innate greed and envy. I think this is a mistaken emphasis since we are born with the 5 innate systems intact.
The last Row is about Thinking (Bion's K i.e. Knowing). Reading across it starts with linking creative thinking to secure attachment, then goes to some creative thinking and continues to some not so creative thought, often in the service of the Other. These latter categories are associated with forms of insecure avoidant and resistant attachment. Finally "no developmental thinking at all" is linked to chaotic attachment.
Clearly there are far more variations in multiplicity than the above would indicate. Some persons may have aspects of all four and everyone has their own unique way of relating. However, it is important to distinguish between archetypes (3) and (4).
Work with archetype 3, the dissociating multiple person who blames the self can be very rewarding indeed and is the kind of person who my own organisation has most experience of working with therapeutically. Some of these persons can become excellent therapists themselves.
Work with archetype 4, the dissociating multiple person who blames the Other is very difficult, and sometimes dangerous. Looking back over 30 years of clinical practice and doing supervision - the score or so persons who fit this category bears out this statement.
Real persons are not archetypes.
In reality few patients are "pure" examples. The archetypes can be seen as stages of therapy, the same person moving through archetypes and with Archetype 1 the best possible outcome of the therapy.
Having discussed structural frameworks I now move on to dynamic working models.
Dynamic Working Models.
The problem and joy of working in ways derived from psychoanalysis is that you never know in advance what the person will say, do or feel from one moment to another! Structural tools help with overall understanding, diagnosis and supervision but do not solve the problem that confronts the clinician i.e. dynamic tools that help you to think from one moment to the next in a session.
Perhaps the first impression that a therapist or other helper should expect in working with a dissociator has been described by a therapist reviewing early meetings with dissociators. She was surprised at "the extreme speed that the emotions can alter - whether of happiness, sadness or whatever. I always wonder how did we get to this place so quickly?" (Michael J (1999)
In
working with neurosis (the repressed multiple person) there are plenty of dynamic
concepts developed over the last 100 years, many of them by Freud himself. The
dynamic unconscious, dream analysis, transference and counter-transference are
just a few of such concepts. However, when working with dissociation you also
need fluid concepts that help in moment to moment interaction.
Moments in movement - the microscopic aspects of the therapy process.
The structural models presented in Fig.1 illustrate the macro, long term processes and are a general guide for practitioners. But in any one session between therapist and patient, what is happening is a series of "moments". Moment 1, for example, could be opening the door; we look at each other (or don't look), smile or remain impassive, speak or not speak and follow whatever routine has been evolved in the therapy. The inexperienced therapist may rely on received wisdom and do the same routine with each patient - for example to look impassive, make no comment in ancient psychoanalytic terms or engage in an immediate bear-hug in ancient humanistic terms. The important factor is be empathic to what is happening in this specific now moment and for both parties, patient and therapist, to be aware of their lived-experience at this moment in time.
The 4 archetypes of multiple persons can also be seen as moments rather than rigid structures, for example,
Secure moments - attachment, erotic relating, love, creative play , creative conflict creative group dynamics and creative thinking.
Insecure Moments - of anxious resistant and avoidant attachment & sexualrelating, play, fight-flight, Basic Assumption in group dynamics, some creative forms of thinking.
Moments of psychosis and destruction punitive attachment, sado-masochistic sexuality, cruel rituals and humiliating games., murder and rape, primitive Basic Assumption group dynamics, and primitive form of not thinking or developing.
Figure 2
The mourning cycle, is a core therapeutic process. It is most simply understood in the case of bereavement yet it applies to any kind of trauma (Southgate 1989). It does not have to be learned but has been "wired in" by evolution. Bowlby called it "nature's cure for trauma". Over a year or so the mourner goes through phases, or sometimes gets stuck in one of them.
However, in the case of dissociation, each phase of the mourning cycle may be divided between different selves. For example, one self may be in the "then-now" re-experiencing the trauma in the forms of a "flash back". Another is simply numb. Another expresses disbelief in what has happened. Another may idealise the abuser, yet another handles anxiety and guilt, another wailing and rage and so on. Yet with each self the mourning cycle will need to be worked through over time in what I have called the "Attachment space". I have described this (Southgate 1996) as bringing each self on to the attachment space created between the therapist and patient -
"We have to have a space on which our attachments take place, which is why attachment is a spatial theory. As you read this or hear me speak, there is a space on which we both exist whether on the written page or this lecture hall. There is such a space inside and outside both of us, but it is not always very obvious".
This concept has similarities to Mollon's "global workspace" (1996:186)
"The therapists own mind, which is part of the therapeutic setting, provides an enlarged Global Workspace within which various dissociated parts of the patient's mind can communicate. ...The patient can draw upon this enhanced Global Workspace and make it his/her own.
The managing self of the patient may create a working alliance with the therapist where they both act as a parent to the younger selves and advocate for the older ones (cf. Frawley and Davies 1997)
So what essentially happens on the attachment space? It is here that one must consider the dynamics of any creative process. The Creative Orgasmic Cycle (figure 2) was derived by Southgate (1976) from the work of Reich and Bion. The essential argument is that any creative activity whether it be erotic, sexual, intellectual, craft, or science or art goes through a discernible cycle. This is where there is a nurturing phase where ideas or practices are prepared, an energising phase where these are put into operation, an orgasmic peak, and a phase of relaxing and celebrating. In Co-operative and Group Dynamics (Southgate 1981) examples were shown of a co-operative organisation going through such a process. To return to this process in a psychological frame, one of the outcomes of successful mourning in therapy is to help a person to express their creativity. At a micro level Moments of Meeting (see below) could be seen as the work of the Orgasmic Cycle.
The working alliance is important here to help the different selves to partake in the creative cycle. I have noticed for a long time that many dissociators are extremely imaginative in arts and sciences, and may draw, write poetry, dance, sing or play music. In fact the therapy relationship can be very enriching for all participants and helps us to endure the consequences of terrible trauma.
However, in "pure" versions of Archetype 4, the Dissociating Multiple Person who blames Other it is difficult, and sometimes impossible, to go through either the mourning or the creative cycle successfully.
Figure 3
Moments in movement, time and reconstruction.
This dynamic working model tries to deal with the micro movements in time and reconstruction.
Stern et al (1998:) in examining the successful moments leading to creative change in the process of psychoanalysis discovered that these were characterised as "Moments of meeting" where (a) both participants have an experience of enlightenment, (b) a greater sense of attachment to each other and (c)they are in implicit mode of relational knowing. It is something that everyone knows but not even psychoanalysts have given it the importance it deserves although they know about it but have not given it a name. It is the emotional non-verbal communication that underpins discourse. For example, if you taped and typed up the conversations in a pub or restaurant they would largely be banal. But in fact people do not go to "talk" but to relate emotionally. Watching and listening to the "music" behind the words one sees messages of love, hate, fear, seduction etc. Psychotherapy takes place very much in this implicit mode.
Figure 3 is an extension of the ideas in stern et al (1998). It is a stylised map of important moments in time that are part of a relationship. The language uses words like moving along, now, then, new, old, wow!, emerging, core, intersubjective, verbal, dissociating, depression, mania, paranoia and splitting. What they have in common is that they are various States-of-being-with-the-Other.
This
schematic diagram tries to show visually various pathways constructed of moments
in time. The definitions and origins will follow later:
Now-now, then now and Was-then ((Kitsen)
Moments of Meeting, Moving along (Dan Stern)
Schemas of being with. (Dan Stern)
Old-Old, Old New, New-New, (Shane, Shane and Gales)
Wow! moments (E. London)
Moments of emerging, (Stern-Southgate)
Core moments, (Stern-Southgate)
Inter-subjective moments (Stern-Southgate)
Verbal translation moments (Stern-Southgate)
Moments of Madness Moments of Mania
Moments of Paranoia Dissociating Moments.
Moments of Sanity Moments of depression
These
moments can move to a higher level or to a lower one.
Moments in movement derives from the work of Stern, et al. (1998). The study
group of psychoanalysts and infant developmental theorists were exploring the
complex interaction in therapy and what could be identified as producing therapeutic
change. They were linking it to their observations of the infant carer relationship.
An important part of clinical work is what Stern et al describe as the Implicit
Mode of Relational Being.
Then-now, Was-then and Now-now were coined by Kitsen (1999). Then-now experiences are when a self is experiencing what Bowlby (1988) called " a real event displaced in time". Was-then is simply a memory of something recalled from the past and stored in the preconscious. The Now-now is when both patient and therapist are fully in the present relating in now moments and sometimes Wow! moments (see below). When therapist and patient are familiar with this schema the therapist, for example, in helping a person prepare for the end of a session can say something like, "You are in the then-now but if you come with me into the now-now they (abusers) will not exist".
The concepts of old-old, old-new and new-new were coined by Shane, Shane and Gales (1997) to describe three configurations in the patient-therapist relationship. Old-Old is dealing with repressed material in both participants. Old-new is where one partner, either therapist or patient, is into old material and the other into the new. Moments of Madness, Moments of Sanity (which even the very mad usually have), Moments of Paranoia, Moments of Depression, Moments of Mania, and Moments of Splitting speak for themselves.
In explaining the Wow! moments E.London 1999 writes:
A wow! moment comes at a point in time just after the peak of the Creative-orgasmic cycle. It is a significant Moment of Meeting (Stern 1998) that is very moving and special.
Wow! is perhaps the first word spoken between you after you have mutually shared an intense emotional experience. Together you share this moment of exhilaration and pleasure at its peak. Although a Wow! moment can be experienced alone, there is perhaps always the desire somewhere to share the revelation with a person you are close to. The whole experience including the Wow! moments takes place in the New-New (Shane, Shane and Gales 1997) It is fresh, lived emotionally in the present, built of many Now - Moments-of-being with (Stern 1995) and uses the Implicit Relational Mode as its primary means of communication. The experience may be mainly non verbal, but is not without form or structure which has within it many familiar Schemas-of-being-with (Stern 1995) and also improvised creative play that is full of joy and anticipation. With the familiar and the improvised, a sense of pleasurable anticipation builds throughout the experience until the peak has been reached. As well, there are smaller waves Anticipation-Joy-Surprise rising and falling with their own interweaving rhythms and phrases which help to build the total symphony, gestalt, or experience. It is just after the peak has been reached, when the whole experience has been seen and felt together that you stand back with awe and amazement, wonder, joy and surprise. This is a Wow! moment. Afterwards you relax and begin to digest the total experience still feeling the afterglow of joy and surprise at the same time. c.f.Theodore Reik's Aha! & Surprise (1949).
So what does the therapist do with these lived moments? My metaphor would be like two tailors making a complex tapestry (cf The Tailor of Gloucester, Beatrix Potter 1903). The moments are eventually stitched or woven together until the therapist and patient can jointly see a pattern and verbalise what it is. This can be a Wow! moment, or a moment of inspiration and joint realisation of a truth known at the Real, Imaginary and Symbolic levels. The process of reaching such a point may have taken years or a decade to arrive. It is very exhilarating when it happens. It is not an everyday happening but when it does it justifies celebrating and relaxing.
Figure 4 is a visual summary of the process by Bob Miller (1999)
Figure 4
The Real, The Imaginary and the Symbolic Registers.
Figure 5
Working traditionally with transference and counter-transference often does
not help and sometimes is correctly resisted by the dissociating patient. Most
helpful in my experience are Lacan's terms The Real, The Imaginary and The Symbolic
and though most obscure when you read Lacan (1966) I find that many patients
intuitively can grasp these notions without much definition.
For example, when talking to a young self (within the person) I might note that in the Real Register (in the musical sense of registers in an orchestra) I am aware at this moment of the Real events displaced in time as they are unfolding in front of me. (c.f. Bowlby (1988).The young person is using the imaginary to recreate now (i.e. a "then-now) the feelings and dissociations. In the Symbolic Register the young person uses language to tell me in words what is happening or I may have to ask another Self to explain to me if the person concerned has not reached the verbal stage. The Real, Imaginary and Symbolic allows a much wider lens on an interaction than those terms useful in the treatment of neurosis.
In working with dissociating multiple persons the therapist often needs to relate to pre-verbal children or babies. The natural way to relate is non verbally in the implicit mode. An infant or child may want to be held physically or sit on your knee. The therapist can get an internal adult or mothering self to hold the baby. Sometimes the dissociator may use teddy bears and the like. Sometimes only real holding of some kind will do, at other times imaginary and symbolic holding is sufficient. The patient can cradle a toy, or the therapist might be given a toy to hold.
Nevertheless, real holding by the therapist should, in my experience, be undertaken only with great caution. Quite often the kind of symbolic or imaginary holding that therapists use is sufficient. The 3rd Archetype, the Dissociated Multiple Person who has no psychotic selves may be held if there is no managing self or others who can tell you what the infant or child is feeling. It is dangerous to hold psychotic selves and it should be avoided at all costs. Phil Mollon (1996) recounts how he was being bullied to hold a woman who threatened in his presence to fatally inject if he did not do so. He decided that he would rather have a live patient than a dead one and reluctantly agreed.
Another aspect of the infant carer relationship is to recognise and understand that for both partners there is what I have called Primary Erotic Attachment where the Attachment and Sexual systems are undifferentiated. It is also the underlying Working Model for successful adult sexual relating. This was pointed out as long ago as 1939 by Alice Balint in ( Michael Balint 1952: )
When working with a dissociated person one may re - experience in the Real, Imaginary and Symbolic Registers this relationship between infant & carer (whatever the gender of those concerned). It is especially important where the original relationship between the patient and his or her mother was either chaotic or altogether absent.
Finally a contribution to our understanding from neuroscience.
Finally we have to think in a non-linear multiple-causation manner because that is how the psyche, the soma and the natural world is organised. Our brains work as multi-modular interacting systems -{Moore (1998)} our bodies operate as an impossibly complicated multi-determined entity and the natural world is a mass of interacting non-linear systems. We have to simplify this mass of information in order to think at all. The clinician needs multiple and flexible working models that can guide us both consciously, pre-consciously and unconsciously as we try to operate in our "impossible profession" (Malcolm 1982).
Technical Notes.
Technical
Note No.1.
The most well known kind of dissociation I would describe as "explosive"
i.e. the person experiences selves as exploding out into the sky, so to speak.
In referral interviews questions like fugue states (lost and not knowing where
or who you are), loss of time, changing style of clothes, seeing the self from
the outside and having more than one self are answered in the affirmative. However
I have discovered another general form which I call "implosive". Such
a person will answer no to all but the last question "have you more than
one self". One man said he had hundreds. The person seems to have self-other
states that have gone deep inside rather than outside and uses imagery like
deep caverns where selves reside. It is often the outcome of torture where the
child cannot get "out there" and so goes "deep down". There
are times when both the explosive and implosive mode is used. The clinical practice
remains the same for both explosive and implosive structures.
Technical Note No.2.
A state of the art discussion of the relationship between psychoanalytic schools and Attachment clinical approaches can be found in Fonagy (1999), and discussion of current developments and future problems in attachment research can be found in Main (1999)
Balint
Alice (1939) in Primary Love and `Psycho-analytic technique Michael Balint,
(1952) Maresfield Library, London.
Bion W.R. (1961) Experiences in Groups. London, Tavistock/Routlege
Bion W.R. (1982) The Long week-end Karnac Books.
Bowlby John (1979) The Making and Breaking of Affectional Bonds. Tavistock.
Bowlby John (1988). Personal Communication.
Bromberg P. (1996) Standing in the Spaces; The multiplicity of self and the
psychoanalytic relationship. Contemporary Psychoanalysis Vol. 32 no.4 pp 509
- 535
Bucknall Val.(1999) Personal communication.
Dalal Farhad (1998) Taking the Group Seriously, Jessica Kingsley, London.
Davies, J.M. & Frawley, M.G. (1994). Treating the Adult Survivors of Childhood
Sexual Abuse. New York: Harper Collins.
Fonagy P, Steele M, B G, Steele H, & Higgitt, AC (1991)The capacity for
understanding mental states: The reflective self in parent and child and its
significance for security of attachment. Infant Mental Health Journal. 13, 200-
216
Fonagy (1999) Psychoanalytic Theory from the Viewpoint of Attachment Theory
and Research in Handbook of Attachent, Theory Research & Clinical Applications.
Ed Cassidy & Shaver, Guilford Press. NY
Greven P (1990) Spare the Child, the Religious Roots of Punishments and the
psychological impact of physical abuse. Knopf NY
Herman J (1992) From Trauma to Recovery Basic Books NY
Hesse E. & Main M. (in press) Frightened behaviour in traumatised but not
maltreating parents: Previously unexamined risk factor for offspring. Psychoanalytic
Inquiry
Hobsbawm Eric, (1994) Age of Extremes 1914 - 1991 Michael Joseph London
Kitsen J. (1999) Time and Multiplicity, Paper at International Society for the
Study of Dissociation Conference. Manchester 1998
Lacan J. Ecrits. A Selection. (1966) Routledge 1977
Lessing D. (1998) Under my skin.
London E. (1999) Wow! Moments. Unpublished M.S.
Lyons-Ruth et al (1998) Interventions that effect change in Psychotherapy: a
model based on infant research Infant Mental Health Journal vol. 19 no.3 1998
Main M. (1999) in Handbook of Attachment, Epilogue. Attachment Theory: Eighteen
points with suggestions for future studies. Ed Cassidy & Shaver, Guilford
Press. NY
Malcolm J.:(1982) Psychoanalysis The Impossible Profession. Pan Books. London
Michael Jess.(1999) Personal communication.
Miller Alice (1983) For your own good: The roots of violence in child-rearing.Virago
Press.London.
Miller Bob (1999) Unblished MS.
Mollon, P. (1996). Multiple Selves, Multiple Voices . Chichester: Wiley
Moore, S.M. (1998) in Memory in Dispute ed V Sinason How can we remember but
be unable to recall? The complex functions of multi-modular memory. Karnac Books
(1998).
Pizer S. A. (1996) The Distributed Self; Introduction to Symposium on "The
Multiplicity of Self and Analytic Technique" Contemporary Psychoanalysis
Vol 32 no.4 pp 499 - 507
Potter Beatrix (1903) The Tailor of Gloucester, Fred Wyayne & Co. Ltd.
Putnam F. W. (1989) Diagnosis and Treatment of Multiple Personality Disorder.
New York: Guildford Press
Reich W. The Function of the Orgasm,(1973) Farrar, Strauss and Giroux, New York.
Reik T, (1949) Listening with the Third Ear, Farrar Strauss & Giroux
Shane M., Shane E and Gales M. (1997) Intimate Attachments, Guilford Press,
New York
Southgate, J.P. Randall R.(1976), The Barefoot Psychoanalyst, Barefoot Books
London.
Southgate J.P. Randall R.(1981) Co-operative and Community Group Dynamics, Barefoot
Books London.
Southgate J.P. (1989) The hidden child within 277-233 ch. in Child Abuse &
Neglect, Ed Stainton Rogers. Open University Press
Southgate, J. P. (1996). An Attachment Approach to Dissociation. and Multiplicity
A presentation at the Third John Bowlby Memorial Lecture. Centre for Attachment-based
Psychoanalytic Psychotherapy. London.
Stern D (1995)The Motherhood Constellation. Basic Books, New York.
Stern D (1998) The Process of Therapeutic Change Involving Implicit Knowledge
Infant Mental Health Journal vol. 19 no.3 1998
van Ijzendoorn M. J., Schuengel C. & Bakermans-Kranenburg (1999) Disorganized
attachment in early childhood: Meta-analysis of precursors, concomitants, and
sequelae Development and Psychopathology vol 11 pp 225-249 1999
White Kate, (1999) Personal communication.
Winnicott D. (1974). Playing & Reality. Penguin. London.