Listen in to hear Melissa, Bridger and Caleb discuss the article, “Dissociative Table Technique: A Strategy for Working with Ego States, Dissociative Disorders and Ego State Therapy” by George Fraser M.D.

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Article Title:

“The Dissociative Table Technique: A Strategy for Working with Ego States, Dissociative Disorders and Ego State Therapy” by George Fraser M.D.

What is the main neurobiological update?

  • This article is exclusively is practice and intervention, and light on theory. This was written in 1991 when DID was still referred to as Multiple Personality Disorder.
  • The field of neuroscience research called “state dependent memory” 
  • Bessel van der Kolk- article on how the brain fragments in response to trauma. “Post Traumatic Stress Disorder and the Nature of Trauma”
  • Some memories are only retrievable when that specific state is reactivated. 
  • Memories that are only accessible when we reactivate that specific state have difficulty being accessed unless in that particular activated state.
  • Parts in non-stress state are unable to remember.
  • Dissociate and disassociate are very different.
  • Adaptive information processing 
    • Our adaptive memory networks are associated and we are aware and accepting of them. They are part of our autobiographical self.
    • With maladaptive memories that are not integrated into our autobiographical self, they tend to cause problems. 
    • Attunement makes a difference here.
  • This framework gives us the ability to personify the disassociated parts. We are not aware that a part is holding a memory out of our conscious awareness. 

 

Some may that this work is going to give them Dissociative Identity Disorder.

  • Why? Lack of understanding of what DID really is. 
  • You can intentionally create an aspect of self but you cannot intentionally create an alter personality in which you are unaware of. 
  • When someone presents with DID, they have created the most adaptive strategy to survive from their copious amounts/gruesome trauma. 

The Memory Protection Technique- p. 211

  • “It seems that the little child from the scene is very frightened and lonely. Why don’t you get up from the table, walk right into that scene and hug and nurture that child. Tell her that she’s not bad and soon, she’ll be safe with you. One could go on and say as the therapist, ‘perhaps there’s something you wish to go on and say to the adult who is hurting that child…”
  • This is introducing a consolidating experience.
  • An adaptive part of our autobiographical self, such as our motherly self,  intervenes in the scene. “What would the mother part of you do in this scene of your 4 year old self?”
  • Any conversation we are having with someone has the potential to activate their affect of circuitry deep in their brain stem. This is necessary for trauma resolution. 
  • You can’t release what’s in the affect of circuitry without activation. If not, you will only be working with the story.  
  • Cognitive therapy is ineffective at treating dissociative disorders. 

 

Within the Dissociative Identity Disorder research and Ego State research, what does the word “alter” mean?

  • Fragmented parts are referred to as alters. 
  • Based on words that are comfortable to the client and to you as a therapist. 
  • Feels like the word “alters” is connected to MPD. It’s based on a pathological connotation and on a disease model. 
  • Violent alters- incredibly rare.  
  • Why was ‘alters’ used?
    • Possibly the only the worst cases were diagnosed where violent parts were more prevalent. 
    • Most people who present with DID, they themselves fear aspects of their personality and don’t trust them. Possible violent and inconsolable angry parts came from being assured that their responses as children were unnecessary and uncontrollable. 
  • You wouldn’t have that part unless it was needed. 
  • Our understanding of parts of self being an adaptive response to trauma. 
    • Using the word ‘alter’ evokes the sense of “that isn’t me” 
    • But “aspect of self” or “state of self” is more accepting and allows us to be more comfortable with the idea of that part of us being an aspect of our personality.
    • Listing out the strengths of each part and what functions that they serve.  
    • The internal thought that not all parts of me are acceptable. 

 

Guided imagery is an effective method for opening dissociative channels and clearing dissociative barriers. 

  • Channels: lines of communication or direct connection/ neurological pathways 
  • If we are wanting to establish connection and clear the barriers, then Fraser says we must ask them to describe their internal representation. Through the creation of the scene of gathering parts, we are establishing a verbal bridge between the intervisualization and the therapist. 
  • This was achieved by guided meditation to enable the client to imagine a scene (round table) where all the parts are invited. 
  • This involves the creativity of the therapist. “Who’s here that won’t come in? Who is afraid to come in at all?”

How to lower anxiety for therapists who are new to introducing Ego State to clients:

  • The anchoring of safety- letting the client know that you want to know every part of them. 
  • Experience Ego State Therapy personally 
  • When you have a client who is not diagnosed with DID, this may become a little trickier introducing this type of work to them (even though everyone experiences dissociation).
  • From the very beginning, start talking about the relationship with themselves, and parts of you. Slowly sprinkle in this type of language from the start. 
  • Digging deeper at the answer “I don’t know” 
  • Some may not be able to connect to Ego State because of their dismissive style and their left-brain dominant presentation. 

Internal Family Systems (IFS)

  • Formulize and structuralize modality of ego state to the point that it becomes very rigid.
  • May be helpful to have a common language in group therapy
  • You can personalize this to make it more suitable for the client individual sessions.
  • One reason we don’t use IFS is that the self-discovery component of Ego State is very therapeutic. Their nervous system is showing them their unique parts, not them trying to imagine this. 

 

The Relaxation Technique 

  • Having the client imagine a calm, serene place 
  • This gives the therapist the ability to evaluate the system’s ability to engage in guided imagery with a perceptual base. 
  • Then they will switch the environment from a calm safe place to board room/conference table, where the parts are invited to join. 

Spotlight Technique

  • This helps identify which parts have been running the show and what parts haven’t.
  • Maybe give a microphone or spotlight to provide the imagery that one part is speaking at a time. 
  • “Notice how this part activates your body.”

The Middleman Technique 

  • The bridge between exile part and the therapist 
  • In DID, make sure you don’t skip over the parts that never go into the spotlight (shadow parts). These parts are just as important, if not more, than the spotlight parts.
  • Shadow parts and exile parts shouldn’t be directly worked with until strong rapport is built between you and the client. 
  • To bring the part back, there has to be safety established. 
  • Always allow for a change within the system by asking for an update from the client at the beginning of each session.

Screen Technique

  • How to do memory work within this technique 
  • This is a way to directly start working with all the memories from each part. 
  • This also allows the parts to have a sense of control and to remain regulated (giving them the remote control).

Centered-Ego State

  • There is a part of the self that is aware of the entire ego state system. This part can be an ally and is referred to an inner-self helper (ISH). This part can also be a co-therapist. 
  • This is such a valuable part but might be hesitant in letting you fully access all the parts. 
  • We understand neurobiologically what this part is about. It’s the part of the brain that holds the whole story and keeps track of our autobiographical self. – “The Feeling of What Happens” Antonio Damasio 
  • This is the birthplace of personality- every personality part has arised from this part.
  • ISH will present very differently than the other parts.
  • This core autobiographical part umbrellas our emotional parts (EP) and our apparently normal part (ANP).
  • The therapist is a visitor, not the master. Much humility is required, but with a lack of fear.

When working with a very adaptive system with Dissociative Identity Disorder, is the goal of therapy integration: the elimination or part of selves?

  • This didn’t work very well in therapy because the system didn’t have much interest in this. 
  • Fusion should be the goal of integration. 
  • The reason for separation is so important because it wouldn’t have happened unless it was necessary for the system. 
  • Fusion helps the parts communicate while honoring each other. 
  • “You can now all think together.”
  • The parts of self never have to be alone again because a healthy relationship between the parts is now established. 

Takeaways:

  • It has connections to our core case conceptualization model and how we perceive an individual’s internal structure. 
  • The crystal jade example from Melissa- the integration of the fusion experience

If you haven’t already, check our out previous episode.

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