New Treatments for PTSD

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Symptoms of PTSD

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Situational Awareness and The Development of Non Verbal Skills orThe Fallacy of Conflict Avoidance and Therapy


Those of us who are victims of traumatic childhoods develop awareness skills that act like radar. They help us recognize danger zones and dangerous people. Sometimes we recognize those situations because the people that are dangerous telegraph that through their voice and tone, or through their posture and behavior. Many of us learned those skills as children growing up in dysfunctional homes.


My father was a violent alcoholic and he was married to a woman who planned and provoked situations that would result in outbursts of anger and loss of control on the part of my father. There were times that we children were led into the danger zone through her nuanced and calculated maneuvers. For our own survival we had to learn to recognize the moves in the game that would eventually end in an outburst of violence and anger on the part of my father. We learned over time to see it coming because we developed situational awareness of the atmospherics of our environment.


Dad was so physically and emotionally imposing in his rage that everyone was afraid of him. My step-mother could not stand up physically to his anger or his explosiveness, but she came to feel that she had achieved a victory over him and win their “conflict” if she could cause him to lose his composure and explode or implode in a violent and unreasonable manner in the home. My brother and I were often the collateral damage of such “game” strategy on her part. We were pawns in her chess game with my dad, and as is common with pawns, we were often sacrificed to her strategic agenda.


I learned over time that she did not pay the price for being the strategist and manipulator behind one of these one-act plays, but my brother or I did. Dad would stay out for hours or days drinking and eventually come home hung over and exhausted. While he was out, she did not know where he was or when he would be home. She would worry and cry and pace the floor, her anxiety was real and palpable. The longer he was gone the more she would rage and rant about him and his negative qualities. She would call all over town to try to track him down, but his watering holes would deny that he was there or that they knew of him. They would protect him from “the little woman” (She was about 5’4” and weighed 120lbs soaking wet and he was 6’ 3” and weighed about 350 lbs.) . Eventually, Dad would run out of money or stamina and wend his way home.


The minute she heard his car in the driveway, her entire demeanor would shift. She had two alternate strategies she would use for the next stage of the game. In the first strategy, she would become pathetic and fragile. She would pile up in the bed and cry and moan and present as if she was ill enough to need to go to the hospital. She would instruct us boys to say that we had tried to find him and tried to get the doctor but no one would respond and we were terrified. There were two or three different “dances” they would do as this game unfolded. Eventually she would guilt him enough till he confessed his sorrow and remorse, then she would forgive him and the drama would be over for that day. The second strategy was that she would become a shrew. She was a harpy who nagged and ranted and attacked his masculinity, his sexual prowess, his parenting skills, his ability to earn a living for the family, etc. . She would harp and scold and scream until he lost his composure and hit her. Then she would become the pathetic victim and he would revert to confessing his remorse again.


These behaviors were much like the cocking of a pistol. The atmosphere in the house would become a ticking time bomb. Equilibrium had to be re-established. The most common way for restoration of normalcy to happen was that something bad had to happen that would unexpectedly pull them together as a team. It would need to be something that required them to become united in their method of handling the disaster so their traditional day in and day out roles would be reasserted. She would not be fragile and ill and he would not be hung over, remorseful, apologetic and guilty in order to show her he loved her.


The most typical cathartic explosion in our house was that one of the two boys would be identified as miscreants. Some failing of ours would be presented in all caps and loud voices. It could be anything, a note from the teacher complaining about our performance or our behavior. (In my case it was almost always my mouth had run away from my judgment and gotten me in trouble, in my brother’s case he was almost always failing some assignment or task and receiving a poor grade.) Of course it could be other failures on our parts as well, failure to complete some regular task or chore satisfactorily, such as not washing the dishes well enough to satisfy the inspection, or failing to feed the dogs, the duck, or the rabbit properly, some infraction of a household rule (“What? You forgot to run the vacuum sweeper?”) At any rate, something would happen, some card would be played and my dad would either lose his composure on his own or she would provoke such an outburst by some dialogue she initiated, i.e. “I got an interesting call from school today and I am very disappointed in you……..” unleashed on one of us. My dad would ignore the first couple of exchanges but the pressure of the unfinished fight with her would be nagging him and tension in the house would be palpable. Whether he consciously understood what was happening or not, it always worked out that he would get sucked into the fray and it would end with either me, my brother or both of us getting a beating. That would be the catalyst that broke the tension and allowed a few days of “normalcy” in our home.


As most alcoholic families, we had rituals and games that enabled us to live together with a habitual pattern. There was no intimacy, there were only roles and scripts to follow. One of my first situational awareness moments was when I learned to recognize which play we were performing so that I would know which script to read.


There were rhythms to our days that allowed us to present to the outside world like most of the other families we knew. (of course I did not know then that we lived among similar families in our neighborhood. Almost all of them were working out the same patterns in their families we were in ours. The basis of the patterns we acted out were the scripts that are written for poor uneducated violent families beset by addiction). Over time I learned to read the rhythms and early warning signs. I learned to develop a radar like the DEW line used during the cold war. I had a distant early warning radar that told me it was time for chaos and violence and release of tension. I could feel the tension and measure it as if it were a temperature and I had a thermometer. I could predict the acts of the play and script of the acts. Because of this ability, I knew as soon as I came in the door that it was a bad or unsafe day to be home. I could feel it in the air.


Because of what I knew, I was in a position to delay the outburst by not following the script, but that would increase the level of tension and lead to a greater and more damaging explosion when it finally came. I could send in a sacrificial lamb (my brother) who would do something to set a match to the gasoline and be the most likely recipient of the violence. Sometimes I would volunteer to be the sacrificial lamb for reasons that at the time I did not understand. (I still believed in fairness and taking my turn.) But the same old play would act itself out in the same old way, and after the catharsis there would be peace and what passed for harmony for a while. Eventually, it would start all over again. Due to my situational awareness, I became extremely manipulative and passive aggressive. I used those survival skills extensively for many years. I had to unlearn them in order to have any healthy relationships.


These patterns in my childhood taught me to recognize the patterns of conflict and tension that are evident in the world around me. I developed at a very early age the skill of situational awareness. I am a watcher. I rarely am anywhere unaware. I never get drunk, I am never out of control and I am always alert. For me, and for those of you have traumatic childhoods these are automatic and reflexive skills. If these were the defenses you learned, you are like me. I awake from a sound sleep in an instant at a strange noise or a “sense” that something is wrong. I am instantly and fully ready to deal with whatever it is. I “see” situations when I am out in the community, at a restaurant in a grocery store or a parking lot. I am then able to make a decision; avoid, go straight, get involved, be provocative, whatever I want to do to protect myself or entertain myself in the circumstance.


This skill has helped me more than I can relate. As a therapist, it allows me to read the nonverbal and atmospherics that my clients radiate. I use my words to describe what I “see” or “sense” and ask for validation. Often my clients reject my interpretation and deny my accuracy. I always accept that gently and verbally, but I am almost never wrong. I realize that I could be wrong, and when I am I try to learn from each occasion. But usually I am correct and the client is either lying or in denial. Whatever it is, it is part of the pattern of their interactive skills and it is informative for me. I must learn from it and wait for the opportunity to present it in a hearable way for them to consider. The process is never about “being right” or “scoring points,” it is about allowing them to step out of their script in a safe place and a safe way to see if they can open their eyes and learn then perhaps choose a new script to follow. Of course, as a therapist, one must have a different script to offer them and a somewhat safe or “graduated” implementation for progress to be made.


These skills are helpful in my personal life and relationships, in my professional responsibilities and in social gatherings.


If you are a therapist or a therapist in training, and you have acquired these skills from your own childhood experience, you are ahead of the game. If you did not have a childhood such as mine, you will have to learn these skills in a more conscious and deliberate way. All of us are born with the ability to read non verbal messages. The challenge is to learn to attend to them, to move them into conscious awareness rather than subliminal processing. If you needed it to survive, you will have learned to attend to it. If you did not need these skills to survive, you will have just unconsciously automated the input process and let the information “filter up” into your consciousness whenever it did.


Learning conscious awareness can be done. There are sequenced things to ask and notice as you learn to assess a situation and label the parts correctly. This is what we call situational awareness and we work with individuals suffering from socially limiting conditions such as ADD, Asperger’s, Bipolar conditions and so on. We attempt to teach them that they must learn to read the environment and the reactions of others to them. (Even if they believe that the others are “wrong” they must learn to attend to them! Try explaining this to a twelve year old boy with Asperger’s.)


At the bottom of it, you cannot be afraid of conflict. Conflict is inherent in human relationships and most of us avoid it like the plague. You should not seek it out as an act of dominance or aggression, but you should not run from it when it is present. Therapists must develop the ability to be present and aware and unafraid when they are in the presence of intense emotionality. They must be able to function and process usefully under these conditions.


When your clients are angry or upset there is information to be gleaned, even as you help support them, calm them and focus them. Review what has been presented to you, look at the behaviors, ask about the changes in emotional status, make sure you have the words that describe the actions and the awareness of the people involved. When they have gone and the situation has stabilized go somewhere quiet and review. Replay what you experienced and ask yourself to break it down the way a sports analyst does. The ability to recognize, forecast and maneuver through conflict will help you help others. An added benefit is that it will make you safer and happier, because your scripts will be consciously chosen rather than automatically and reflexively delivered.

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Playing the Chaos Game, A Strategy for Co-Dependents and Adult Children of Alcoholics

Adult Children of Alcoholics and Co-Dependents often seek employment in careers or jobs that automatically generate high stress, often involve people in crisis, are high stimulus and require rapid fire problem solving and a high degree of personal responsibility.

When you work in a high stimulus environment, your adrenal glands are constantly firing. Often hyper-vigilance is a requirement of the job. Co-Dependents are raised to be acutely aware of others in their environment. The primary requirement of a Co-Dependent within their family is to learn to read the mood and determine the needs of the parent (often the alcoholic). From infancy, these children learn to read the atmospherics to know when the situation at home is dangerous or problematic. When the radar goes off to alert them, they instantly begin to process options for resolving the needs of the adult, for being able to soothe them and quiet them down just the same way one would a frightened horse or dog. Co-Dependent children learn to speak in a quiet soft voice that pacifies the adult. They learn to notice what the adult likes, items such as; food, drink, snacks, favorite blankets or TV shows, anything that will help the out of control raging adult become quiet and safe for the family to be around. You learn to fix their favorite meals, to anticipate when things are going poorly at work, and make sure that all is well at home. You learn to take on their rage when it is necessary in order to protect the other children or adults.

Some how the co-dependent knows that their job is to take on this responsibility. They know that they are stronger (perhaps because they learn to be dissociative in response to pain so they think it does not bother them as much to be hurt, or beaten.) They believe that the other children or adults in the family do not have the strength to handle the rage or adrenalin of the alcoholic.

An infant is supposed to be born into a household that pays attention to the infant; one that learns to understand or know what his cries mean and to provide hugging and nurturing responses to the needs of the child. When children are born into co-dependent households there is no focus given to the needs of the child. The child is a reflection of the level of satisfaction and “ok-ness” of the adult. The needs of the adult are the primary needs of the child. The child is not taught to ask the questions: How do I feel? What do I want? What makes me happy? These children are in a constant condition of survival mode for themselves or others and externally focused on identifying the needs of those around them. They learn to obtain their sense of ok-ness by pleasing and satisfying others. Safety is the primary goal, and safety is obtained by earning the right to be safe. Love is obtained by earning the right to be loved by satisfying the needs of others, even when those needs are never articulated. You are supposed to know what is needed, to anticipate it and to provide it without being asked. If you learn how to do this, then you can be relatively safe as a child. The problem is when you are an adult, you still approach relationships from this frame.

Grown up Co-Dependents enter relationships with an unwritten and unspoken contract. This contract exists entirely in their heads. Their contract is: I will love you (whomever they have selected) I will learn everything you need and want and provide it for you without being asked. In return I want from you two things: 1) I want you to give me my OK-ness (my attaboy’s) because I am unable to provide them for myself) and 2) I want you to promise never ever to leave me. The unconscious fear of the co-dependent is the fear of abandonment. These children grew up in households where love was never given, it was sold, and it was unpredictably but regularly withdrawn and readministered based on the manipulation by the adults for training or torment purposes. What these children learn is that they have to earn love, affection, acceptance and safety. They must earn it over and over again every single day. It is never secure and never an innate right. The messages these children hear from their parents are:“You are not loveable because you are, you are loveable because of what you do to please me. If you do not please me, then you are toast. Be afraid, be very afraid! Don’t cry, don’t make demands. Don’t talk outside the family, it is no one’s business but ours. If you cannot do these things the way I need you to, then you will be punished and/ or driven away. “

Growing up in this kind of environment and with this unspoken unwritten script causes you to learn to only be alive when you are alert. You are only capable of feeling when you are on maximum attention so that you can quickly shift among competing demands to compartmentalize to meet the needs of as many people as possible. You learn to juggle activities, focal points, behaviors, attitudes, and all with a smile and a warm reassurance that it is really no problem at all, because it is just what you do. You do not need praise, you do not need anything other than the satisfaction of doing a good job and being secure in your job. We seek out jobs in the emergency room, we become policemen, we become special operations soldiers, we teach in inner city schools, we take jobs at the epicenter of information flow and decision -making. This is where we live we make great second bananas. When we are not in these environments, we suffer from anxiety, we dissociate, we self medicate, we take on second or third jobs, we become thrill seekers and we learn not to feel, not to care, not to expect. We are never surprised when relationships or jobs end. We just move on to the next one and try to do a better job. Maybe this time we will get it right, maybe this time we will earn the right to be loved and ultimately to be safe and never be abandoned.

What clients like this never figure out is that the only way they can arrange to never be abandoned is to learn to love themselves, to learn to ask and discover what they feel, what they want, and to say no to others. Doing this is very hard. Therapists must gently and consistently teach them to say no and not justify or explain. They do not need the approval of someone else to say no. But they do not know this. You as a therapist must resist the seduction and temptation to rescue them from their anxiety when they try to say no and get flooded with fear. They will try to manipulate you into signaling what they “should” do and what you “want them to do” so that they can satisfy you and become safe. Your job is not to rescue them from their anxiety. Not to indicate to them what you want them to do and certainly not to tell them what you like. You must develop your ability to be comfortable in the presence of their anxiety. Remember, you are probably Co-Dependent as well. So you may feel unbearable anxiety when your clients are anxious. You must maintain your calm and do not rescue them, encourage them to stretch their tolerance for feeling anything at all, especially anything perceived as negative, such as anger. Do not help them go away somewhere, and do not resolve their anxiety by letting them focus on “doing” for you or someone else rather than “being” for themselves.

Eventually there is hope for the Co-Dependent if they are able to break the reflexive conditioning of being a caretaker as a way to be “safe” and “love-able.” They must learn that they cannot nor should they live to please everyone else. They must get in touch with their inner self and learn to listen to the messages from their bodies. They need to learn the answers to the questions: What do you want? What do you like? How do you feel? As a therapist, you need to get out of the way and stay out of the way. Be a strong reassuring consistent presence that does not reward them for pleasing you and does not punish them for not pleasing you by withdrawing your emotional connection from them no matter how they are behaving. You can teach them appropriate limits, you can say no to them and still care about them, and you can teach them to do these things with you so that they can begin to do them with others.

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: Permissive vs. Authoritarian Parenting


One of the challenges that all parents face is the question of discipline. While almost no one wants to be a martinet, it is generally accepted that without discipline of some sort, children will not thrive. The task for parents is to decide how to motivate, encourage, and require the habituation of particular standards of behavior of their children.

Let’s talk about all three of these words: motivation, encouragement, and requirements. It is true that children have intrinsic motivation to try to please their parents. Very young children will work hard for a smile of support and an encouraging word from their parents. Nevertheless, as they go through the separation and individuation phase, they will begin to assert their own will to try to dominate their environment and master it. The nature of the beast is that the child will employ unconscious strategies to get his/her way. They cry and they throw fits; they seduce, cajole and use their will power in a struggle to satisfy their desires. Sometimes there is joy and positive energy in the child and sometimes there is rage and frustration. In response to these motivators they will work hard to master the situation to reduce their frustration and deplete their rage.

Parents receive a child at birth that has a personality and a level of will power and awareness. In the tabula rasa theory, the child is viewed as a blank slate upon which society and parents write to create the adult that evolves. It is through the application of reinforcements and modeling within an environment of support, frustration and mastery that the child evolves both their sense of capacity and the skills to assert their sense of self.

My father often said that he would rather my brother and I fear him than love him. In his world, it mattered more as a responsible parent that he could command our compliance than create a feeling of safety or security or God forbid, happiness. He was driven by an internal vision of us. He would mold and shape us to fit that vision.  Dad was not an educated man, but he was street smart and wily. I do not know where his vision came from, but it required us to do well in school, develop the courtesies of what were considered to be “high class” behaviors (by him), and that we learn to work hard so that we would always have employment. His mantra was work harder than anyone else and you will always come out on top.  He did not believe in praise or rewards. His methodology was to tell us over and over that we were stupid and hopeless and needed to work harder to be average. Our futures were very limited, in his view. We were destined to be laborers, working for minimum wages and would be lucky to get jobs doing physical work. He insisted that the saving grace in our lives would be to get a union job and work hard. The union would protect us, help us earn a living and obtain a pension for when we were old and retired.  This vision was a reflection of his life. It is exactly what happened to him. He was union blue through and through. I remember being told that I was too dumb to take Calculus and that I was not smart enough to go to college. I would be better off to get a reputation as a skilled and hard worker, then someone would always take care of me because I had worth and marketability.

My parents did not encourage the arts, reading, or any activity that did not offer financial return in the short term. Gambling was OK, hunting and fishing were acceptable because they both could bring food to the table that did not have to be bought. Discipline brought the capacity for skilled repetition of behaviors that were rewarded monetarily. In order to teach that discipline and instill it at a subliminal level, my dad practiced corporal punishment and emotional abuse. I was beaten regularly for almost any failing. As children my brother and I were sent out together to get switches. The switch I got would be used on my brother and the one he got on me. This kind of psychological strategy was one of my father’s favorite ploys. Another tactic he used pretty often was to whip us at the same time, one of us would “volunteer” to go first and the other would have to watch, and count strokes at the same time so that the whippings would be “fair” in the number of lashes. There was no advantage in going last and the psychological pain of the fear of what was coming taught me to go first to get it over with. My brother never figured that out.

There were standard things that always brought a beating. We knew what they were and could anticipate them. For instance if we received a discipline note from school we always got a whipping. We were told that the teachers were right even when they were wrong. My dad believed in authority within the hierarchy. The problem for us was the randomness of other beatings. Any thing could cause one to happen. My dad could be mad at his wife, he could have gotten a traffic ticket, we could be making too much noise playing in our room, we could have forgotten to rake the leaves, etc. Any of these could and did bring about whippings.

Perhaps a word about whipping is in order. In our house it consisted of being beaten until he was tired by a belt, a switch, or by an extension cord that was kept hanging on a hook on the refrigerator for particularly egregious failings. He would hold our left hand in his and swing with his right arm and work up and down our back from our neck to our heels. He did not feel that he had done his job until there were open wounds and welts from top to bottom.

In order to survive, we learned to endure, manipulate, hide, seduce and dissemble. One of the first lessons one learns in an alcoholic family is that one never lets them know what one is afraid of, what one wants or hopes for, or what one cares about. I learned to suppress my own feelings and bury them deeply because whenever they learned that I cared about it became a weapon in the war of control. I had to wear a mask and develop a false persona in order to survive at home. I could actually feel a “switch” throw when I left home as I became another person entirely when I went to school. When I came back home, the switch would throw in reverse and I would go back to being the survivalist representation of whatever they wanted me to be at home in order to avoid being hurt.

As a result of the development of these skills and these masks, I was able to survive and achieve. I internalized a discipline and a determination that I value and appreciate today. I do not like the forces that impelled me to acquire these skills/masks, but I value them deeply today. What saddens me is the possibility that I might have developed them without all the costs that my parents discipline strategy imposed. What if, I wonder, there was praise, affection, and safety in a child’s home? Would the child become soft and lazy? Would the child internalize the character and self- discipline he needed to compete economically in the world? As a parent I need to help my child lose his innocence in graduated levels so that he has a realistic world-view and a plan of action for engaging in society. If I fail to facilitate this, then I fail as a parent.

I have two sons. I have tried to raise them to be loving respectful men with self -confidence and self discipline. I would say that I have not abused them physically or emotionally (but one should perhaps ask them.)  I have encouraged them to ask questions and choose their paths rather than follow the herd and do all that they are told. I have used discipline (external) including a script that says: “You are making a choice, the choice you are making now is not a good one and comes at a consequence, the consequence will be……., is that the choice you want to make?” I think known consequences with the freedom to choose them are among the most comforting lessons a child can learn. Discipline should not be reactive and should not be delivered in anger. It is designed to shape behavioral choices and to inform and educate. Discipline with consequences should be illustrative not punitive. When a child develops to the point of transitioning to an internalized discipline script then they have good self -esteem, good self -discipline and will power.  Self -esteem is based on capacity. Capacity requires the ability to anticipate and choose among consequences. Sometimes children choose to act out even though they will receive the consequence they do not desire. That is OK, they need to feel the consequences and learn through that process whether or not to continue the behavior. As Dr. Phil often asks, “How is that working for you?”  I want to ask my children, do you like the outcomes of your choices? What other choices might you make? Can you afford the cost of your choices? Every choice has costs and every choice has pay offs. What do you choose?


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The Id, the Ego, and The Super Ego, When the Balance is Broken


In my last two blogs I talked about the Freudian concept of the Id, the Ego, and the Super Ego as personality constructs. The theory is that there are three component parts, each of which has a function and role to play. The ideal situation is when all three are doing a good job. I like to picture it as a three-cylinder engine. When all three cylinders are working properly, the engine just hums along perfectly. However the machine can get out of balance due to many different causes, and, according to the theory, this is when pathology occurs.

As a clinician, you may encounter a situation with a client who has become dominated by a single one of the three cylinders, their engine is running rough and seems as if it may implode. Their lives and relationships are out of balance and they are unhappy. It is also possible that they come to you because some person of authority in their lives makes them come. They may not feel like there is anything wrong but their wife, their boss, their principal etc., may say if you do not work on this then your life will be a bed of pain and loss. These clients are resistant and hard to work with because they are there under duress. Part of the challenge in working with them is to engage the Ego so that it can reality test the situation. If you can get that part of the personality co-opted to work with you, then things will go more smoothly for both you and the client.

When you have a client who is forced to come in because others are demanding that they change, it is important to help them look as objectively as possible at the available data. Why do others feel this way about them? What evidence is there to consider that can be measured in terms of cost/benefit ratio? Is it possible to evaluate the circumstances and predict alternative behaviors and their outcomes? Can the individual then make those changes in a rational, reasoned, measured way in order to reality test the situation and the changes?

While it is important to engage the rational choice making part of the Ego, it is also necessary to spend time listening to the feelings that the person has. Not in a judgmental, dismissive or condescending way, but in a validating way. Their feelings must be uncovered and validated, even if they are then asked to consider changing their behavior because of what the current situation costs. Or, as Dr. Phil used to ask his guests, “How is that working for you?”  The client must realize that even if it hurts or angers them, there is still a need to objectively look at the cost of the situation and estimate and or plan for alternative strategies so that changes can be made. Ultimately, the client has the option of leaving the job or the relationship because he determines that they are toxic for him, though the cost of leaving may be high, the cost of staying and attempting to be disingenuous may be too high to bear.

When you get a client that comes in of their own volition and you spend time with them observing how they present themselves, you may determine that their system is out of balance. The constant flow and interchange between and among the three disparate parts of the system will become obvious and you will begin to make some assumptions about what is out of whack and why. Depending on your theoretical orientation and your beliefs about change in therapy, you will choose a manner of response that will encourage and invite the client to a healthier life choice pattern. As a therapist, you will need to remember two basic tenants: The client has the right to make their own choices. The client has the responsibility to do the work. Our job is to invite them to live a more ego syntonic life than they previously have.

Let’s consider the presentation styles of the three possible kinds of cylinder malfunctions. We will begin with the Id.  The Id is the part of the personality that does not reality test, has no moral values and does not consider consequences. It is all about immediate gratification. The vocabulary of the Id is, “Yes!  Now! I Want (or don’t want) it!” The Id never sleeps or rests and is always monitoring conditions of want and need in the organism. It will immediately suggest solutions to any perceived state of need. It seeks resolution of the imbalance immediately and continually, without regard to appropriateness or cost.  When you have a client that is imbalanced in the direction of the Id, the client will present with major impulse control problems. They will have a history of anger outbursts and acting out, they will have lost jobs and relationships for “no good reason.” They will resist any effort to get them to anticipate cost and consequence, they will say they “felt” that they had to do something and that it was not their fault, others are to blame.  It is common for them to say, “Something just made me do it, I don’t know why and it just happened.” When they lash out in anger at others or lose their tempers it is all about what the other people made them do because the others were unreasonable in not letting them have or do what ever they wanted at the time. It is never about “fair,” “reasonable,” “turn taking,” “social obligations” or “self control.” They do not require themselves to have self -control.

These individuals are very difficult to work with, it is like  they are large children. Their Ego has not developed in its role of reality testing and problem solving. The voice of the Id is so loud that other voices cannot be heard. When you work with them, the sessions will be full of noise and pain and anger. You cannot take that personally and you cannot attack or punish the client for being an overgrown child. You must be persistent, gentle, matter of fact, well bounded and consistent. You are not the punishing parent or the critical parent. If you want to help you have to gently validate, effectively reflect, and invite them to consider another path. Lay the path out but take no ownership of it. Invite them to see it, to consider what might happen if they walked upon it, but be patient and gentle, but with good boundaries. You must not let them be inappropriate with you, damage things in your office, you or others. You must not take on their projection of the angry parent against whom they can rebel. This is a large challenge for therapists. If you work with the imbalanced Id, Good luck!

The second distorted cylinder you may encounter is the Super Ego. These individuals are highly moralized. They are extremely “shouldistic” and limited in their options of behavioral choice because so many things are “wrong” or “wicked” and not possible. They feel that the world is going to hell in a hand-basket and that by their “good living” they can model and demonstrate the true path to righteousness. I find this type of client to be the most difficult. In my experience they often turn my attempts to get them to look more objectively at their behaviors and world -views into efforts to proselytize me to their point of view and get me to see or attempt to justify the error of my ways. In these cases, therapy is often denigrated as the “devil’s work” and I am viewed as the tempter who tries to get them away from what is good and right. It is a challenge to find a way past their armor. One method for approaching this is to continue to ask them to explain to you their faith- based concepts of forgiveness. Invite them to consider that there may be more complex ways of understanding a phenomenon, that there might be a larger plan at work that they cannot see from where they stand. Invite them to focus on their own behaviors and the costs of those versus the rewards, while at the same time encouraging them to be compassionate towards the errors of others. They can still be clean and pure, but do not have to control or challenge others to follow their vision.

Many of them will resist all efforts to challenge their fanaticism. Their belief system will not allow it. This anchor of “truth” is all that holds back the abyss of fear and defeat. If you are working with a client that has the over dominant Super Ego, focus on helping them find out where it hurts and how to survive the hurts with minimum damage. How can their lives be happier or their relationships be more satisfying? Remember, you are there to help them feel better and function better, not to judge them or change them to your own point of view. Return to the safe holding environment and invite them to spend time there with you. If you work for small incremental steps of peace from that breathing room, change has an opportunity to occur.

Finally, the third distorted cylinder is the over -dominant Ego. These people are like machines, always calculating and manipulating. They play chess with all their relationships and always have multilayered strategies that leave multiple options for movement to them. They seldom get in touch with their feelings and are entirely logic and evidence driven. Pragmatism is their mantra. They constantly evaluate and cut their losses. They leave relationships behind that are full of wounded people, but they do not understand the complaints of those people. “Why can’t everyone just see that it was time to do X. Look at the data, it makes sense.”

The challenge of working with these individuals is getting them to get out of their head and into their bodies. What about the feelings? What about the feelings of others?  One way to get them to look in this particular closet is to ask them to speculate and analyze about the feelings of others and to predict the outcomes of any strategies for change. While they think they are playing a higher form of chess, ask them to imagine the feelings.  Ask them to pretend to feel themselves in the room with you. Point out that it is a safe place to experiment with feelings in an environment where they can walk away and deny. They can explore with no cost.

The problem for these clients is that you cannot unpeel the onion or un-break the egg. Once they begin to get in touch with their feelings their defense mechanisms are in trouble. You will need to be prepared for their anger and their flooding. You will have to help them bridge the gap of going from all machine systems to all feelings. The goal is to re-tune the engine so that all three component parts work at the same time and contribute what they are supposed to contribute so that the individual works in balance and harmony.

Remember as the therapist you have a job to do. Your job is to listen and observe so that you see accurately what is going on with the client. You make take the client  into the safe holding environment and then you invite them repeatedly, gently to consider the possibilities for change. Then, you let them do the work. You help, you facilitate, observe and reflect. You do not judge, condemn, punish, or control. It is a challenging, yet rewarding process.

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Continuing Thoughts on the Observing Ego


Since I posted my last blog, I have had several conversations with people about it. They indicated that I did not make myself clear. They ask, “What is the observing Ego, and how is it different from the Ego?”

In my thinking, the Ego is a heuristic concept that was created by Sigmund Freud. It is something that he explains as a portion of his personality development theories. My understanding of Freud’s concept is that the Ego is the executive functioning portion of the personality; it makes the decisions and responds to the demands of survival and life. The job of the Ego is to evaluate the reality that surrounds it in terms of risks, benefits, costs and consequences. According to the theory, there are two other, equally important parts of the personality. Those parts are the Id and the Super Ego.

The Id is fully developed at birth. It never changes and it never grows or matures. It is always a voice in your head that says “I want it and I want it now”. The function of the Id is to satisfy needs and gratify desires. Anytime you want something, you are thirsty and crave liquid refreshment, the Id will try to force you to find something to drink. It does not care what it is that you drink, from water to battery acid. It just finds liquid and shouts, “Drink this now!” The Id is amoral; having no moral values it seeks only instant gratification. It never rests and it never sleeps. It is always monitoring you and your surroundings for sources of gratification, and like a child, when it spots one, it intrudes and shouts, “I want that now!” According to the theory though, the Id does not have any motive power. It can only demand. It does not move the system to act or  chose.

In many ways the Id is like a child, standing at your side, tugging on your dress and saying over and over again, “Mommy, Mommy, Mommy,” without regard to what you are doing or whether or not it is appropriate, or even if you are getting angry. It just says, “I want that now.” When the Id does not get what it wants, it throws a fit. You have seen the Id in action in a grocery store when the child wants something (candy, toy, shiny object) at the check out lane. When it, the Id, is told no, it screams and yells and cries.

The Id is fully formed at birth and only knows two vocabulary words “yes” and “now,” but has no power to make you move. Some other source of active energy must exist in order to help you manipulate your environment so that you can get the relief that the Id demands. That motive force is provided by the Ego. The theory maintains that the Ego exists at birth, it is functional but not developed. The job of the Ego is to learn to move the body, then act to gratify the demands of the Id. In the first few years, the Ego is a slave to the Id. It uses energy to manipulate you or others to gratify the shouting of the Id.

But, the Ego can learn and grow. The Ego continues to learn and grow as long as it is conscious even to the moment of death. Its role as the executive function of the personality is to learn how to manipulate the environment to acquire the things that the Id needs to gratify its demands. Many of these demands are primitive, unconscious and survival based. For instance you need nourishment and liquid to survive. In the beginning you scream (action of the Ego) for attention when there is a need, such as the need to feed. But the Ego learns to be more complex. It learns to be seductive, proactive, deliberate and to reality test danger and consequence and reward. Those of us with a highly developed and skilled Ego learn how to get more out of life and make our lives more comfortable than many of our peers. It is this area that becomes the Observing Ego. This is the area that can calculate risks, costs, and benefits that can evaluate paths forward and chose among them. The successful Ego will learn to find ways to meet the needs of the Id without surrendering control to the Id.

The third level of personality is the Super Ego. The Super Ego is the moral, conscience of the personality. It is sometimes (in other theories) called the Parental Introject. It consists of the right and wrong messages based on values, such as religious or spiritual, that we are taught by our parents, our churches, and schools. Once it is internalized it does not grow or change either. Just like the Id, it has a limited vocabulary. Its vocabulary is NO, should, or must. It is often the source of the guilt we feel when we do not do what it wants us to do in order to be “moral, righteous and good” according to its internalized map of right action.

The challenge of the Ego is to navigate between the competing and equally loud demands of the Id and the Super Ego. It is kind of like the scene in the movie Animal House where the young boy is trying to make a choice about a course of action, and two miniatures of him are on his shoulder arguing with him. One is an angel who counsels upright good and moral behavior, and one is a devil who counsels pleasure, seeking gratification without regard to costs or consequences. The boy in the middle of the conversation represents the Observing Ego. It has to find a way forward. It must satisfy each of the competing parts at some acceptable level. This is one of the goals of the defense mechanisms, which are all tools for the Ego, even though these tools are unconscious, automatic and hierarchical for the most part.

The more complex and better developed the Observing Ego is, the more capable it is to navigate the troubled waters of the demands of the Id and Super Ego and still function in a real, concrete world where choices have consequences. The Ego is the only one of these three parts that has any power to actually move. Actions are taken at the Ego level, even when they are instigated by, or in response to the demands of either the Id or the Super Ego.

In my previous blog, I was talking of ways that the Ego becomes the Observing Ego. Reality testing is a crucial skill of the Ego. Learning to avoid a victim script and learning to accept responsibility and power for action are critical steps along the way. Some of the questions I have received about the blog were about the part where I talked about people using religion as a victim script, or as a script for obtaining something they wanted or valued without taking any responsibility for choosing or acting. What I said is that sometimes people use the phrases, “It was (or was not) meant to be,” or “If God wills it,” or some variant of that. I want to try to clarify my thinking here for the reader. I do not mean to say that there is no God involved in this process of choice making or that there may not be a path that such a God would prefer for us to take. What I meant is that I strongly believe that the individual “I” has a responsibility for choosing a way forward. Our maker gives us the power to make choices and to use our skills and assets to learn and grow in directions of our choosing.

I think it is the job of the Observing Ego to learn to assess and make choices among the various temptations and desires that we experience. Its primary job is for us to survive and prosper. We make choices every day in service of that. We learn to discipline the Id and limit its scope of action, or we suffer the consequences of not learning how to do that. We learn to “hear” the moral values of our super Ego and respond to them in ways that do not put us at risk of being rejected by our families and our culture. We learn to find our path forward. Just as I believe there are many people in our world that we can find and fall in love with and make good lives with (not just one mate destined and chosen by God for each of us in a Universe of billions of people.) I believe that we can choose alternate paths of life. There are lessons to be learned, things to accomplish, and roles to play. It is our job, the job of the Observing Ego, to help us make those choices, and walk those paths, to continue to learn as we move on to the next lesson and the next stage.

I envision God to be like the loving parent who watches over us and supports and nurtures us, even when we make poor or less effective choices. I have children and I do not control their choices. I teach them, taught them and let them go. They have to construct their lives and follow their paths. I will love them and support them whatever they chose and wherever they go. I cannot keep them from breaking the law, from smoking, drinking and fornicating. I cannot make them become doctors, lawyers or criminals. They must walk their road.  My job is to protect them when they are young, to teach them what I know about how I have lived my life, model for them a way to do things, but ultimately, to surround them with my love and support, but accept their independence and their power to chose.

I do not know about forgiveness and salvation. I know about Love and Grace. I have experienced both in my life and hope to be able to model that reality for my children’s Observing Ego and for those that I love in this world. In the meantime, I will be using my Observing Ego to manipulate my own world so that I can live with integrity, dignity and as much comfort as I can obtain.

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The Ego “I” and the Way It Works


I have always been fascinated by theories of personality development. In thinking about my clients, I have wondered many times, “Why would they do that?” I spent my childhood trying to understand the people around me, how to survive safely by studying and anticipating the moves of others in my life.

The theory that makes the most sense to me is an offshoot of Freudian psychology. It has to do with the development of something called the Observing Ego or the Ego “I.” In the theory, the function of the Ego is to evaluate and choose. When decisions need to be made by the individual, the Ego needs to calculate the cost/benefit ratio and choose the best option for success and survivability. As it grows and learns to do this more effectively, the individual steers his/her life in the direction of growth and expansion. This is the rational, executive decision making part of your personality. Part of this complicated, but interesting matrix, involves the motivation of the individual, their world-view (cultural frame) and capacity to analyze. It is a game we all play.

When I was a child, I lived in a violent, alcoholic family. I learned early in life that in order to be safe and to even survive I needed to become hyper-vigilant, to be constantly aware of those in my surroundings and of their level of anger, their sobriety and their expectations. I had to navigate those waters on a daily basis.  I remember when I was about twelve, laying on the couch in the living room reading a book while my father and four or five of his friends sat in the yard outside drinking and showing each other their guns. One of them accidentally fired his pistol and the shot went through the wall of the house, then through the wall behind me, and broke a 4’x4’ mirror hanging over the couch on which I lay. I was standing with the book in my hand, trying to brush all the broken glass off my head and clothes and figure out what had happened when my Dad and his friends opened the door to see what damage had been wrought. My dad took a long look at me and said quietly, “Clean up this mess,” then they all went outside to continue their drinking.

No one asked if I was okay, no one held me and calmed my fear or anxiety. It was a non-event. Clean it up and move on.  On other occasions, I would be asleep in my bed and wake to a feeling of warm wetness surrounding me. My father would be standing over me urinating in my bed, thinking he was in the bathroom. I would yell out, he would blink a few times and say, “Clean up this mess,” and stagger off to bed. Those are only a few of the examples that explain why I became hyper-vigilant, slept very little (I probably averaged about four hours or so a night for most of my adult life) and was constantly assessing my surrounding environment.  I had to develop nuanced radar and antennae, which would warn me in times of risk or danger. I learned as a child in an alcoholic family that one should never ever let anyone know what they wanted or liked or needed.  This information would be used as leverage to control or manipulate you into someone else’s agenda. As a result, I often did not know what I wanted or felt. (There may be those who still think that of me.)

I learned early that my script to follow was to be a laborer without an education, to work a job with a shirt that had my name on it. However, through the encouragement of teachers, I learned that although life’s circumstances may write a script for you, you don’t have to follow it. You can change it through the operation of the Ego I. You can look for a better way and acquire the materials to try to write a different script and move yourself into a different drama.  It became my goal to do well in school and to get an education that would help me move away from the southern, drink ridden, uneducated world that Pat Conroy writes about so well.

Through the years, I have learned to moderate this script as my observing ego has developed. It has processed the input, analyzed the data and made choices. Some of those choices have been good, some bad, but all have been in service of the learning curve. I am now sixty-six years old and sleep the night through. I am not hyper-vigilant (although, still constantly aware and observing.) I am not afraid and I have spent a life-time trying to learn and understand more and more about how personalities form and people grow, as well as how they can make choices that help them overcome or change the life scripts that were originally written for them. I have spent my career as a therapist trying to help individuals who were fighting these kinds of battles.

In the course of my journey I have learned many things.  I have learned about repetition compulsion and flight into sickness as ways we sabotage our success. Both of these defenses are counterproductive and hurtful. We have to learn not to do them. They tend to be driven by the Ego’s unconscious efforts to moderate anxiety and have us back away from the fearfulness of the unknown. It tries to keep us on the same known, albeit, dysfunctional path that is so comforting to us, even when it we know that we will be hurt by following this path. Our Observing Ego needs to consciously learn that we are responding reflexively from a primitive defense and we need to work to override it. That is the beauty of the Observing Ego. It can do that. That is its job. As data comes in and we reality test the patterns of our lives, we have an opportunity to see the patterns that exist. We can assess the costs and the benefits of our choices, even when it is hard for us to recognize that we are making choices.

For many of us, the reflexive position is to be the victim of circumstances. Some of us culturally are conditioned to attribute that to religion or God. We hear people say when they want something to happen or not happen, “If it is meant to be, it will be.”  “If it is God’s will, then it will be.” “God has a plan and it is not mine to understand, but to accept.”  These scripts are cultural ways for us to avoid the concept of personal responsibility, or as I prefer to say “response-ability” (the ability to respond.) We can accept the power to choose and make a choice. We may not get what we want, but I do not believe it is the planned conceptualization of a higher being that I don’t get a new car, or heal from my cancer or win the lottery. I have a responsibility to steer and guide my life towards the things I want and to avoid the cliff that is clearly there for me. I cannot just be the passive lemming whose fate is determined by an “other,” even when that “Other” is a benevolent, loving God. I am here to play, to fight, and to move myself along the trail. I do not control my destiny, but I have a role in determining it and of structuring my life as much as I can, even though I live in a random world.  My belief is that God has given me the tools and strengths so that I can make the correct choice and be response-able when it is time to pay the piper or accept the rewards. I do not deny the existence of God, I challenge the belief that whatever happens to me for better or worse is predetermined according to some agenda of a supreme being.

As a therapist and as a person, I believe in the importance of reality testing, of obtaining honest and relevant data upon which to base assumptions and choices. I want to face the truth, as it can be known, even if that is painful and frightening. I do not want to be a passive recipient of fate, or a person who simply endures life. I want to put my chips in the pot and play the hand. I am not a victim of fate. I embrace life and want to live it every day to the end. I don’t want to bury my head in the sand. I want my Observing Ego to be conscious and aware, even as I am dying, to try to know and understand the process. There is a line in the movie the “Shawshank Redemption” where one of the prisoners, Red, says:  “You got to get busy living, or you got to get busy dying.”

I think that is the job of the Observing Ego, the Ego I. Life is not always happy and wonderful, and we are not always victorious as we struggle to make optimal decisions regarding the patterns of our lives. But, it is a great ride and it is not over yet!

Life is difficult, pain is inevitable, but misery is choice.

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Dependency vs. Intimacy: Counselor Client Relationship issues in Counseling

Many of my clients come to me because they are frustrated in their relationships. They are often injured, angry, sad, and confused. “Why does this keep happening to me?” they ask. Why am I treated this way? They quickly and easily shift from tears of hurt and frustration to angry outbursts, sometimes at me saying, “You are not helping me at all! Why am I paying you for this? You are just a ‘paid’ friend.”  I have to remind them that ours is a professional relationship, not a friendship. They are paying me for my experience, training and my objectivity. I care about them, support them and listen to them, but we don’t socialize and we are not friends.

Saying this to my clients is like throwing cold water on them. It shocks them because I am not playing the “nice” social game. I do not follow the conventions of social intercourse by denying  reality, instead I insist that they also face the reality of our relationship. I can care about them, can be attracted to them and wish that we could be friends. I can fantasize that when our professional relationship is over, we could be social friends. But I must remember that this type of fantasy is dishonest and unprofessional.

I find that many of my clients are attractive and energizing people to whom I am drawn by my own desire to like and be liked. I have to remember my training and my mantra: They are not here to be your friend. They are here because they are in pain and you are a professional who helps them heal from the pain.  My clients and I have much in common. Everyone has issues, including me. Often, because of where I live and my education and socioeconomic level, my clients and I are very similar. It is this similarity that can create an attraction. It leads to assumptions of sameness that can lead me astray because I may stop objectively attending and listening, and start to assume based on my own biases and limitations. I must guard against that. If I do not, then I am not being professional or helpful. If this happens and I lose my focus and my ability to attend, I begin to use the client to meet my own needs.

I have needs to feel helpful, likeable, powerful and “knowing.” I am flattered by being told how smart and attractive I am, how helpful I am, how much impact I have had in their lives. These things feed my ego and make me feel good. These things are not why the client comes to me. None of them help me, or my client. At their core, I know that they are dishonest projections of myself, or my client, that allow both of us to ignore the reasons they are there.

Clients come to therapy because they are in pain, or because they were told they have to by some one with leverage over them. My job is to create a safe holding environment where they can be supported while they learn to stand in the midst of the pain and hurt and figure out the honest truth about their pain. They need to take ownership of their own power to change and decide the steps towards change they will make and recognize some of what those steps will cost in terms of effort, additional pain and anxiety. They must eventually choose to change or they will continue to repeat the dysfunctional patterns in their relationships. Without change, they will constantly cycle back around the same issues in their lives, their friendships and love relations.

I have an important role to play in this script. I can recognize and allow a certain amount of dependency early in the therapeutic process because I know that counseling relationships involve a one-directional intimacy. The intimacy of the counseling relationship cannot be there to meet my needs for friendship, love, affection or ego satisfaction. My satisfaction has to be in the professional channel of being good at what I do, able to care and support the client as they uncover, explore and discover who they are. I need to feed their grandiose narcissism in the beginning so that the unfinished work of their childhood development can happen. This is all part of the objective in establishing the therapeutic relationship and doing the dance of therapy. Once that level of safety and appreciation happens, I can begin the process of gently but directly reflecting reality to my client. I reflect what they say and how they present. I reflect the inconsistencies in their statements and beliefs. I challenge with reality testing the assumptions they make about themselves and others in their lives. I encourage them to explore options hypothetically and with imagination. We rehearse those imaginary conversations and actions in the safe holding environment before they attempt them in the real world.

I teach my clients that change comes in waves most of the time. They will go out to the periphery of their lives and attempt self assertive or new behaviors at times and in circumstances that are not so costly.  My clients will learn to assert themselves, to say things such as; “I don’t like that. It is my turn. You butted in front of me in line.” These challenges are practiced when it is least expensive and least hurtful to them. They will not go home and tell their mothers, wives or husbands immediately and directly. They are not yet ready to say to the significant people in their lives, “You smell bad. I hate it when you crunch the ice or talk with your mouth full. You never listen to me, etc….”

If they do attempt to do it at home and at the center of their universe before they learn how and why, they will repeat the process of setting themselves up for failure, victimization and repeated injury. They must learn to practice new scripts in less expensive ways and in safe environments. Gradually, they can begin to bring their new strength into their real and intimate relationships.   As this process unfolds, I begin to dampen my responses to their dependency needs. I encourage them to recognize that they do not “need” me as some kind of rabbit’s foot or magical presence that makes them safe. What they “need” is their own strength and integrity. When they learn how to listen to their sense of integrity, they are free to choose and to become response-“able” instead of responsible.

I think words matter and have tremendous impact on the way we interpret the script in our heads. I believe that people who have lived repetitive cycles of dependent relationships have internalized a script that implies guilt and responsibility for meeting the needs of others and making others happy. They learn that the only way they can be safe is in making someone else happy. They learn to do what pleases others, they never learn to ask: What do I want? What pleases me? They never imagine the power of what I call healthy selfishness. When one becomes strong enough and honest enough to be able to ask and answer that essential question, “What do I want?” then one can get rid of the victim script and the dependency -based relationships. One can recognize that intimate relationships are responsive to integrity and healthy selfishness, with a mutuality of sacrifice and accommodation. Healthy relationships involve willing choice making to please others with no resentment of the price of that choice, but with an awareness that the choice is freely made, not made as the result of some emotional blackmail or guilt trip. This helps make them stronger and more attractive to others, and it makes them able to stand with integrity in their own eyes. That makes them desirable to others as well as desirable to themselves.

It is important to recognize the value that the therapist plays in this dance of therapy. The therapist must operate with grounded honesty and a healthy perspective of who they are and what role and responsibility they perform in a therapeutic contract. I subscribe to the idea of one directional emotional intimacy with my clients. I am there to meet their needs, not to have them meet mine. It is my job to have my own healthy relationships and to have my own friends, not get my emotional needs met by the affection or ego stroking that is often available from dependent clients.  If you are going to be a professional counselor, you will also need to walk this line and to recognize the ingredients that make emotional distortions that diminish the choice making of your clients and encapsulate you into non-professional boundary violations because of your own codependent need to be loved, to be helpful and to please.

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Dissociative Process and Trauma Survivors

Over the last several weeks, I have had an email exchange with a young lady from Great Britain.

This young lady knows that she is dissociative. She thinks she may have developed this coping strategy as a result of the trauma of multiple deaths of those close to her in a very short time span, including one of her parents. It is entirely possible, but it is not the typical route to a dissociative pattern of survival. What has impressed me most about her is the amount of information she has acquired on her own without professional help or training. She has also taught me some about the National Health System in England as she described her efforts to obtain therapy and  its response to her.



I thought that I would review some of the fundamentals of dissociative process and write about some of my thoughts on treating individuals who suffer from it.  Everyone dissociates sometimes. If you have ever driven home from work and could not remember the actual drive, if you thought you were driving to the grocery store, but pulled up and parked in your ex boyfriends driveway without realizing you were going there, you have been dissociating. If you have become preoccupied with nothing, but suddenly realized a considerable amount of time had passed and you don’t know how that happened, then you have been dissociating.  Dissociation is essentially an unconscious process for “losing” time and awareness. We do it when we are distracted. However, there are others who do it because being in contact and aware is so painful and so frightening that they cannot afford to be connected to their feelings, their memories or their present situation.



The dissociative continuum runs from the defense mechanism of repression, which is the selective editing of the memory or awareness to Dissociative Identity Disorder. An example of repression on the less severe end would be: I don’t like to go to the dentist, I am frightened of what will happen there, so I “forget” my dental appointment until thirty minutes after it is scheduled. That way my unconscious protects me from what I fear and resist. This is the skill we all use at one level of expertise or another.  Dissociation progresses from this type of selective editing of awareness or memory, to a more orchestrated and comprehensive blockage of segments of consciousness, history or life. We may lose an entire year of our life. I have had many clients who tell me they cannot remember the year their mom died at all. None of it, not school, not work, not flash memories of parties or birthdays, or happy events, it is gone. But they remember before that year and they remember after that year in perfect sequence. This is an example of dissociation called amnesia.



Terms such as amnesia and fugue are reflective of the dissociative process. Amnesia may be caused by brain trauma from a blow to the head, or an accident of some kind that injures the brain so that the neural pathways for the memory are blocked. But without injury, amnesia is a dissociative way of protecting someone from something so onerous that they cannot afford to remember it because the fear and pain, or even self -loathing, will be too awful to endure.  The most extreme example of this is what we used to call Multiple Personality Disorder, but now is called Dissociative Identity Disorder. The movie Sybil (1976 Lorimar Productions) is a good example of this. In DID there is a vertical compartmentalization of memory. There will be remembered timelines for multiple slices of reality. Each slice will have a name, an identity, a personality and a history. This history may be limited to a few years, but it will be vertical in the sense that there is a connected awareness for this individual for the entire time slot of their existence.  That is different from the horizontal slice of memory loss we discussed earlier with the example of the death of the parent or the accident (that did not cause brain damage, but which the individual cannot remember.)



I found that when I worked with dissociative individuals, I gradually began to notice that they would shift or “go away somewhere.” They would disconnect from the conversation and from me. They would lose time in our sessions and they could not remember what we were talking about. This tended to occur whenever I would approach talking with them about something that was at the core of their dissociative skill. If we began to talk about a feeling they were afraid of (i.e., if they had been harshly abused about not crying and felt as if they might cry, they would just go away somewhere and not be present for those feelings.)  If we began talking about an event such as the death of a parent, the pain was so strong for them they would just lose the thread of the conversation and the pain associated with it would go away, as well. Dissociation is a protective behavior. It is a complex and valued skill, and we can use it to discover what is going on. I always make the point to my clients that they should be proud of themselves for discovering a defense mechanism that allowed them to survive their traumas so that they could to get to a place where they could seek help from a therapist. I help them learn that my office is a safe place, they can stand in the presence of the pain or fear and find the memory that is hidden and be safe with it. I also gently begin to ask them to be aware of when they go away. I help identify their “tells” that identify for me that they are “going away.” As they learn to do this, they can begin to identify the triggers and we can begin to explore the feelings that are so horrific.



I constantly reassure them that they would not be able to feel or remember unless they were strong enough to handle whatever the “knowing” was. I reassure them that I approve of them and value the strength and courage they have used to protect themselves and survive no matter what the trauma was. This is especially important when dealing with horrific sexual abuse. The shame factor is so powerful and has usually been manipulated so skillfully by the perpetrator that the survivor is self-hating and shamed because they believe, or were told, that this was entirely their fault. That a six or seven year old girl can be so strongly sexual and seductive that she can override the resistance of poor old Grandpa and make him be her sexual slave is often what she was told. It was never Grandpa’s fault; it was the girl’s fault. She was bad seed in some way and she had doomed him and made him the victim. Girls who go through this internalize the propaganda from the perpetrator and come to be self-loathing. I honor their survival no matter what behaviors they had to perform in order to survive. This is a very true statement. I do honor the ability of the victim to survive and to continue to work on survival until they can find their way to my office and learn to heal. With help, they can learn how to challenge the script, to stand tall and proud of their ability to survive and to learn to call a fact a fact. What is real is real; six year old girls are not that powerfully seductive. It was grandpa all along!  When the client can realize that, they can begin to cleanse themselves of the shame and self-hatred and they can begin to re-script their definition of self. They begin to learn that the adult them or the “now” them can love and honor their predecessor, the abused and victimized them. Together these disparate parts of their identity can work to meld into a strong and functioning self that is not constrained by the limits of abuse survival. They will not need to dissociate from feelings that are too powerful to behold, because they have beheld them and survived. They stop losing time and contact, and they begin to learn how to regulate their emotional process in the present moment with confidence and strength.



There are warnings that should be given about working with dissociative process if you do not have the perspective, training and skills to handle the intensity of the emotions or memories. You must remember that as a therapist, it is your job to help the survivor heal. It is not your job to track down and punish the perpetrator. Some survivors want to challenge the perpetrator and tell them the feelings they have remembered and ask for an apology or an explanation. Be extremely slow to support that step. Before they go there they must rehearse the process repeatedly. They must imagine doing it and saying it and all the possible ways that the others in their life will respond when they challenge Grandpa for the dirty old man he is. Many of their critical supporters will abandon them and shame them and side with Grandpa. They must be prepared in therapy for that possibility and learn what they will need to know in order to survive it. Many such individuals, when confronted attack. They deny and they scold and shame the client. The client needs to be strong and practiced, and they need to have a realistic appreciation of what they may get from the perpetrator and how they will incorporate whatever they get into their new definition of self with strength and peace. However, that is a topic for another day. Dissociation is an incredibly powerful defense mechanism and an extremely deft skill for the client to have. It takes an equal amount of skill, strength, and balance for the therapist. Do not go wandering randomly into the dissociative process experience. Get training first.  As a therapist you must not be afraid of emotional intensity. You have to be able to be a grounded presence in the midst of the emotional firestorm. Additionally, when you get angry as you hear their story of abuse, you must tell the client that you are angry (they will have sensed this already, it is a trust and truthfulness issue) but that you are not angry with them you are angry with the perpetrator. This will have to be repeated many times before they can safely believe it. And finally, you have to tell them that you do not need them to be angry with the perpetrator. For some of them it is something they are never able to do. The challenge is to heal them, not rage at the perpetrator, or punish the perpetrator, or justify anything.

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