A Trauma-Based, Self-State Therapy for Emotional Healing in Counseling and Psychotherapy: Case Studies in Normal Dissociation
Author’s Website
Case Study Contents/Story Lines:
Sexual Issues
Chapter 6, Sexual Swinging and Jealousy
Carson was a 38-year-old corporate vice president who came to therapy to prevent divorce. He was sleeping on the couch, but back in the family home after three months of separation. He had admitted a number of indiscretions to his wife, such as frequenting strip clubs and texting one stripper in particular. These behaviors were the immediate cause of Carson’s forced separation from his wife. She now wanted him to address his larger issues in therapy: his excessive jealousy of her and his compulsion to involve them in sexual swinging. Carson should stop checking on her activities; he should stop trying to track her movements away from the home; and he should stop his daily phone calls to her at work, sometimes as many as 12 to 15 a day. Carson’s wife was no longer willing to engage in wife swapping or sexual threesomes to please him. He should get himself fixed so that he no longer needed these experiences. Giving up his compulsion was difficult for Carson. The threesomes were especially powerful for him, although he avoided touching the other man involved. He just wanted to witness his wife and the other man having sex, or he wanted to have sex with her while the other man watched or touched her.
Chapter 3, Rage with Sexual Aversion
Tina was 30 years old and the mother of one when she first came to therapy. She was an assistant manager in the accounting department of a major casino. Petite and vivacious, Tina explained that she had to control her anger if she was to keep her job. She had recently been passed over for a major promotion, an opening for which she felt she was by far the most qualified candidate. She believed that her supervisor unfairly promoted others based
upon how much they “stroked his ego.” Women who flirted with him were especially likely to do well in their careers. When Tina asked for an explanation for why she had not been promoted, the supervisor scolded her for “not knowing [her] place.” Tina’s rage began when she was a child; much of it was generated by her relationship with her stepfather. Her lack of interest in sex was linked to a very early experience with “playing doctor” as well as to her stepfather’s behaviors. She was still nauseated by her memory of the taste of his saliva when, at age 11, he insisted on greeting her with a kiss on the lips.
Chapter 5, Low Sex Drive
Katie was a 26-year-old medical technician who supported her husband during his last year of college as he prepared for medical school. The difficulties Katie was having with her husband had several sources. The first was her anger over unkept promises. The second was their differences over the physical part of lovemaking: her husband enjoyed raunchy sex while Katie wanted the spiritual connection her church taught her sex should be. There was also Katie’s “duty sex” part, named Wife, who “just lay there like a dead fish,” according to her husband.
Healing Lost Love
Chapter 7, Letting Go of Love
Sam was 44 years old and an engineer with a local casino when he first came to see me. He was struggling with his wife’s bitter divorce of him, even as he begged to work it out. She had already moved in with another man. There was no hope for reconciliation. Even after he had worked to let go of his pain of rejection, his love for her kept him in a state of suicidal depression. The solution was to let go of his love for her. The procedure is the same as that for relieving the pain of rejection. Amazingly, love can be released in a few minutes once the proper stage is set. Following the release of his love for his wife, Sam’s depression lifted immediately. He began dating in the following week.
Eating Disorders
Chapter 8: Binge Eating, Panic, and Rage
Brandy was a 26-year-old special needs teacher who drove 220 miles from southern California every weekend to attend our Saturday appointments in Las Vegas. Healing both her rage and her binge eating required that we revisit her childhood and her relationship with her mother, who was emotionally abusive throughout her life. Brandy vividly recalled her first episode of binge eating as a high school sophomore: “I had always been healthy and took care of myself. I was disgusted by my mother’s overweight body. But one day I bought some fast food and took it home and ate it really fast.” The binge was incredibly soothing and released her temporarily from her life problems, most of which had to do with her mother. “She was so mean at that time. She cursed me and called me names every day. She said that she and my dad were going to get a divorce and it was all my fault. I had tried smoking, drinking, drugs; and promiscuity was a disaster. But food was the best relief.”
Chapter 12: Bulimia and Child Abuse
Maria was 46 years old when she decided to try again to heal herself of her bulimia.
She was slim and attractive and looked 10 years younger than her actual age, but
she had maintained her slim body only through regular purging with self induced
vomiting. She had purged on most days of her life over the last 30 years, often as many as four or five times a day. Healing the bulimia meant healing the memories of the chronic child abuse she experienced from age two onward at the hands of her mother and her sisters.
Body Image
Chapter 10, Body and Beauty
Georgia was a divorced, 41-year-old licensed attorney who came to therapy for help in dealing with work stress and anxiety. After she had successfully dealt with those issues she stayed to do more work on her body image. Writing about how she viewed herself at the beginning of therapy she said, “Fair complexion, brown eyes and dark brown hair cut short and worn spiked up on top. From my shoulders to my knees, my body looked like an apple-shaped blob. I saw the same shape whether I looked at myself straight on or in profile.” At the conclusion of our work she viewed herself differently:”Fair complexion, brown eyes and dark brown hair cut short and worn spiked up on top. My body has a curvy, hourglass shape and all the parts are in proportion to each other. When I look at myself in profile, I now see the contours of my body.”
Jealousy
Chapter 2, Extreme Jealousy
Sharon was a 34-year-old married professional who came to therapy with a problem of excessive jealousy. Her greatest problem was her frequent outbursts of anger at her husband. She screamed at him, demanded he account for all time away from her, accused him of infidelity, and found herself enraged over the smallest issues. She got upset when he talked to another woman, even a fellow employee or a member of his staff. She was irritated even if he glanced at a passing woman when they were out together. She had been jealous of this, her second husband, throughout the five years of their marriage. Additionally, her outbursts had increased since the death of her father three years before.
Samantha was 24 and struggling somewhat with the question of parenthood versus career. However, her primary reason for coming to therapy was her concern with her extreme jealousy and anger toward her husband. Her first comments in the therapy room were about her fears of abandonment. She connected those fears to her parents’ sudden divorce when she was a teenager. They came home from a walk one evening, with her mother sobbing, and told Samantha they were divorcing. Her father had decided to resume his old love affair with his high school girlfriend. Now, every couple of weeks, Samantha’s husband did something, such as going golfing in the afternoon without telling her, that triggered her fear that he, too, would suddenly leave her. “I try to be a perfect wife,” she said, “so he won’t leave me. My fear controls me since I became a wife.”
Depression and Anxiety
Chapter 13, Lifetime Depression and Anxiety
Richard was a 38-year-old schoolteacher, and feeling that he could barely function when he first came to therapy. He had panic attacks “out of the blue” that felt like he was having heart attacks. His everyday anxiety left him wide awake at bedtime, unable to sleep for an hour or more after going to bed. He was depressed and cried for no reason, sometimes four or five days in a row. He had been on antidepressant medications for 10 years. At the conclusion of therapy, Richard was off of all his medications, was not crying or having panic attacks, and was leading an enjoyable life with his wife and children.
Porn Addiction
Chapter 11, Gay Porn Addiction
Henry was 37 years old when he came to see me for help with his addiction to pornography. He was successful and prominent in his profession as an emergency room physician. His compulsion to view porn had become a serious issue with his male spouse and threatened their 13-year committed relationship. During a two week period when his partner left him, just prior to his committing to our therapy sessions, he took a leave from his work. For those two weeks, he spent virtually all of his waking moments, 16 hours a day, on porn websites. His addiction was complicated by the fact that without it, he had very little sex drive, and very little sexual interest in his partner. Healing the addiction required both neutralizing the pleasure he gained from viewing porn and neutralizing the negative emotions he still carried from his childhood sexual abuse.
Work Stress
Chapter 4, Career Loss, Procrastination and Helping Too Much
Georgia was a divorced, 41-year-old licensed attorney and mother of one, who came to therapy for help with dealing with work stress and anxiety. She had given up, at least temporarily, any plans to continue her career as an attorney. The workload was both exhausting and anxiety producing. A year previously, she was fired for not billing enough hours, in spite of working evenings and weekends. Her problems included procrastination, perfectionism, and spending too much time helping others when she should have been doing her own work. She took a job as a paralegal in order to reduce her work load, but was fired there, too. Now she was looking for a job as a legal secretary. She had a fascinating inner world visualized as Disney characters and other animated entities. Once Georgia fixed her original problems, she chose to work on additional issues. Her story continues in Chapter 8, Body and Beauty, and in Chapter 14, Scaredy Cat and The Monster.
Grief and Depression
Chapter 9, Grief, Depression, and Marital Problems
Sandra was 45 years old and a seasoned executive recruiter when she first came to therapy. She had three teenage children of whom the eldest, her son, would soon graduate high school and move on to college. She was deep in depression and considering divorce. Her husband had brought his alcoholic father to live with them in order to help him following rehab. Unfortunately, his sensitivity to his father’s needs triggered Sandra’s memories of his insensitivity to her needs after her mother died many years previously. She was now reliving her unresolved grief over the loss of her mother—her best friend.
For the general reader or the self help seeker, this book offers 15 chapters telling the stories of 12 patients’ personal transformations through therapy with Parts Psychology. Parts are the invisable part-selves with differing views and attitudes within our larger personality. Parts include the “Inner Child,” the “Critical Self,” and many other ways of being who we are.
For the professional clinician, Parts Psychology offers a complete treatment approach to ego states and subpersonalities. Each of the case studies includes virtually every single intervention in the treatment of each patient.
Excerpt:
Treating Divorce Procrastination Anxiety in Three Sessions
Note: The following short chapter describes three sessions of work from a Parts Psychology perspective. It is an excerpt from the book before I reduced it to a more manageable length. In this case, the work aimed at freeing a man from the frozen place he found himself, unable to take action in getting the divorce upon which both he and his wife agreed. The case is especially interesting because some of the man’s subpersonalities present as animal parts or fantasy parts rather than people parts.
Sean marked the escalation of problems as having coincided with Jennifer’s raving about a new golf pro their club had hired about 18 months previously. She spent an inordinate amount of time with him and signed up their two children for lessons with him also. As time passed, Sean began to suspect an affair. Jennifer spent virtually no free time at home, leaving Sean with all the responsibilities for child and home care. Within the last few weeks his children, out with another family, ran into their mother and the golf pro apparently on a date. Three months previously, he had asked for a divorce from Jennifer. She accepted immediately, and the two of them began their at-home separation. But Sean was still confused about what to do. He didn’t know how to proceed from where he was. Should he see a lawyer? Should he try to do the paperwork himself? How could he protect his remaining assets from his wife’s excessive spending? With every thought about taking a given action, he also had conflicting thoughts that effectively made him take no action. He was trapped in indecision. “I’m angry,” he said of his wife. “I am frustrated to the point I can’t think. I hate her.” We ended the session with Sean’s observation that “At first I agreed to move out, but now I’ve told her she should move out. It’s inappropriate for her to be dating while we’re still married.”
In the previous week, I had given Sean a handout describing some aspects of the personality’s organization into internal parts. I introduced him to his own work with parts in the second session. I asked him first to focus on the anger and hate he felt for his wife and to sit with those feelings for a moment and wait to see if an image formed to represent what he was feeling. Almost immediately, he visualized two internal parts. The first was green and reptilian, “like a dinosaur but smaller.” This was his angry part. At the same time, he noticed a second part, who looked like him but was older and was wearing a robe. The image struck Sean as “priest-like.”
When Sean spoke to the reptilian part, he found that the part was indeed angry, and especially angry over the wife’s financial activities. His name was Rex and he considered himself a male. His earliest memory dated to a time just after high school and before the couple was married. While still a girlfriend, Jennifer acquired “credit card debts behind my back.” Rex was angry with Jennifer, whom he did not see as his own wife, for her out-of-control spending, angry at her mother for “allowing her to be like this,” and angry with Sean himself “for permitting the spending to continue.”
Sean described the second part as an “older, wiser me in a robe, a monk’s version of me.” His name was Gregor and his age was “between 60 and 80.” Gregor felt sad toward Rex and wanted him to “forgive [Jennifer] and move forward for a better life.” Rex responded to Gregor by saying that maybe he could become “smaller” and learn to “forgive.” Both parts agreed, however, that Sean needed to take a stand. He had to stop being so passive and to take a stand against the wife’s control. At this point in the conversation another internal part appeared. It was, said Sean, “a stronger version of me.” He wore a suit without a tie, and his age was the same as Sean’s. His name was Mike. Sean agreed that he wanted Mike to take a stand. Mike said that was why he was there.
When asked why he hadn’t previously taken a stand, Sean was unable to provide an explanation, except that “maybe” he was afraid Jennifer would leave him. He acknowledged that there was a “weak” part of himself. When he focused upon this feeling of weakness and followed it to its source, he found “a small version of myself, pink, mouse-like.” The part knew who Sean was and said its name was Mouse. He was 10 years old. His earliest memory was of the loneliness he felt when he began middle school. “I was alone a lot,” Sean said. He remembered struggling a lot without guidance, and “learning how to survive.” His parents had divorced when he was young and his father wasn’t around. His mother worked to support the family, and so he rarely had companionship. He had school acquaintances, but no friends. He was shy and afraid. Sean suggested that maybe those experiences were the reason he had never confronted Jennifer on her behavior. Mouse rated his painful middle school experiences as an 8.5 on the 0-10 SUD (Subjective Units of Disturbance) scale. Sean readily accepted the idea of unburdening his Mouse part, and so did Mouse. Sean used three different metaphors to unburden the complex of negative emotions associated with his years in middle school. He chose a waterfall to dissolve his ache over the lack of parental guidance to help him with his struggles through adolescence. He chose a wind intervention to scatter his remembered loneliness into the distant sky. And he disposed of his fear by discarding it into a bonfire. Following these three visualized interventions, Mouse rated his continuing distress at a SUD level of two. This had to do with the slow and difficult learning process he had experienced as he found his way through the most difficult part of growing up, becoming somewhat of a social person. He agreed to relinquish this last portion of pain but wanted to keep it nearby. “He wants to put it in his pocket,” Sean spoke for Mouse. “He said he needs to feel what it’s like, the learning.”
We were at the end of our session as we finished our work with Mouse, and so we closed with the intention of meeting in the following week. Sean believed we had accomplished a lot. He felt the confidence of Mike, the more powerful version of himself, and he had largely healed the weaker Mouse version of himself. He was ready to organize his life in a way that left him in control rather than feeling he was at the mercy of the whims of his wife.
He had only one remaining concern. He had been scratching his head so much that many places on his scalp had scabbed over. His barber wanted him to see a dermatologist. In the days since Jennifer agreed to his divorce plans, his head scratching had increased dramatically. Sean recalled that he had scratched his head frequently over many years, so much so that it bothered Jennifer, who would say, “Stop that! You look stupid.” I asked Sean to reach up to his head as if he were going to scratch it, but to keep his fingers a few inches away from his scalp. He did so, and reported that he felt a mixture of pain and itch as he held his fingers there. I asked him to speak to this scalp sensation and ask it to give him a picture of itself, but there was no response to his request. Sean then checked with the part, Rex, to see if he might know the source of the sensation. Rex did, and agreed to connect Sean with the part involved. The part was yellow and “spider-like.” It “ran into a corner to get away.” As he connected to this part, Sean reported “a sense of spite, of revenge,” with Jennifer as the focus. The part, he said, had the thought, “I’ll show her!” When Sean spoke directly with the part, it reported its age as five years old, but Sean doubted this because it seemed “much more sophisticated” than that. His name was Seth. He knew who Jennifer was, but he said he was not really acquainted with her. She had not hurt him, personally. Seth’s job was “to make me scratch,” Sean said. “He’s there to show [Jennifer] I can do all I want to do. I can scratch if I want. His job is to irritate me so I prove I can do what I want, when I want.”
At this point Sean and Seth had a silent dialog, some of which Sean later summarized. Seth said that it was not he who was resentful of the wife; instead, it was Sean who was resentful. “I work for you,” said Seth. When asked if there might be other ways for Seth to help Sean do what he wanted without using the lever of resentment, the part agreed to change. His form metamorphosed into the image of “a dashing young man, an adventurer. He likes fun things. He’s courageous.” In his new form, Seth presented as age 26. “He will help me go out and do the things I want to do. Nobody telling me no or stop.”
Sean seemed to have successfully altered the way Seth would help him. Instead of scratching his head as a means of symbolically asserting his independence from Jennifer, Sean would now seek out opportunities to express the urges he had suppressed during the years of his marriage. Seth’s function would be to encourage him to take positive actions of adventure rather than the passive-aggressive actions of resentfully scratching his head in opposition to his wife.
There remained, however, some final work to do on resentment. Since Sean and Jennifer had agreed to an amicable divorce, and Sean wanted to maintain good relations with her for the good of their children, feeling resentful of her would not be helpful in the future. But what part held the resentment? Seth indicated that it wasn’t he who was resentful; he merely acted on the resentment on Sean’s behalf. It wasn’t Sean’s core self because the self does not carry such negative energy. We chose to look for the resentful part with the help of Seth. The technique is useful when the patient cannot easily differentiate the blending part. Sean asked Seth to notice the resentment he perceived in Sean and to speak to it, asking it to step away from Sean. When Seth did so, Sean said he could then see Mouse standing up in fear, but he wasn’t alone. Rex also showed himself, acknowledged that he too was resentful, and wanted to show Jennifer that he could do what he wanted. Sean went on to say that Seth seemed to have been “spawned” out of Rex. However, with the changes Sean had made in his life, and especially with his new take-charge attitude, Rex no longer saw a purpose in irritating Sean with head scratching, Spontaneously, Rex offered up his resentment for unburdening. Sean described Rex as walking over to the fire and burning up his resentment, allowing the wind to blow away the ashes, and then washing his hands in water.
Now, said Sean, Rex was “ready when I need him, when it’s appropriate to be angry. It’s like a car parked in the garage. Ready when I need him.” Sean went on to describe the physical changes that seemed to have taken place in Rex’s appearance. “He had hands now and not claws. He’s more like an alligator than a dinosaur. He’s more civilized now. He has a mouthful of teeth, but his mouth is closed, waiting.”
As we prepared to end the session, Sean said that Mouse was looking nervously around at the assembled group of Rex, Seth, Gregor, and Mike. “He’s afraid he won’t be needed,” Sean said. Sean and I then discussed the positive value in feeling fear in certain situations; in particular, when there is just enough fear to cause a person to take protective action. Sean assured Mouse that he would always be needed, and this resulted in certain physical changes in Mouse: “He’s perking up. He was kinda slimy before, now he’s more furry, a lab mouse type. He’s one hundred percent clean now.” Sean then described how he visualized his inner parts: “They are all lined up and ready to go.” That is, they were ready to work with him as he rebuilt his life.
This was our last of three sessions. Sean felt that he had no outstanding issues. He was in control of his domestic life and no longer resentful of Jennifer. He had plans to either buy out his wife’s share of the house, or to allow her to buy him out and he would purchase another nearby so that the children would not have to change schools. He felt no desire to scratch his head.