New York City, NY

Integrating Parts with Trauma & Dissociation

Rev. Sheri Heller, LCSW
Photo by Jack Sharp on Unsplash

Often folks who reach out to me for complex trauma treatment describe feeling unreal and disembodied. Sometimes they refer to themselves as imposters, frauds or performers, alienated from a cohesive sense of authentic identity. In a suspended reality, they exist on the fringe, observing a dreamscape of their life.

As a survivor who has gone through my own recovery process for complex trauma and a trauma therapist of over thirty years in NYC, I can attest that the aforementioned distressing dissociative states of derealization and depersonalization are protective and adaptive psychobiological responses to unbearable traumatic abuse.

By distancing from conscious overwhelming traumatic threats, unhealed fragments of the self associated with the traumatic events are compartmentalized and stored in isolation. This massive repression of annihilating danger is a stress response which results in disturbances in awareness, personal identity, perception, and recollection of memory.

Essentially, when one is repeatedly traumatized in early childhood, the development of a cohesive and coherent personality structure is hindered. Fragmentation of the personality occurs because the capacity to integrate what is happening to the self is insufficient. As a result, the survival mechanism of dissociation kicks in to protect the central organizing ego from breaking from reality and disintegrating into psychosis.

Hence, fragmented dissociated parts of the personality carry the traumatic experience and memory, while other dissociated parts function in daily life. Consequentially, profound symptoms of depersonalization and dissociation linked to c-PTSD manifest. (Herman JL. Trauma and Recovery)

Treatment of the disintegration and fragmentation of the self due to developmental disasters and chronic abuse requires unification. Retrieval of suppressed memory and affect assists with cultivating self cohesion (H. Kohut). This involves integrating the fragmented parts that were disowned in the service of survival.

As American psychologist and psychoanalyst Philip Bromberg conveyed about self-organization, “health is the ability to stand in the spaces between realities without losing any of them — the capacity to feel like oneself while being many.”

An effective process towards achieving this end is known as parts work.

Although parts work is applicable for the full spectrum of dissociative disorders, it’s relevant to distinguish dissociative self-states from alter personalities found in dissociative identity disorder (DID). It is important to keep in mind that DID is an extreme disruption of self states that is conceptualized as tertiary structural dissociation. This means that extreme prolonged trauma was endured prior to the inception of adequate psychic defenses. As a result of severe structural dissociation, the sub-personalities or self-states associated with DID are more autonomous and in control than parts encountered in folks identified with other dissociative disorders. Hence, amnesic fugue states may occur if a DID alter assumes executive control. Accordingly, the facilitating of communication and cooperation of alters in an individual presenting with DID warrants judicious pacing and leading.

Wherever the trauma survivor lands on the dissociative spectrum, parts work involves engaging with self-states, which are “highly individualized modules of being, each configured by its own organization of cognitions, beliefs, dominant affect and mood, access to memory, skills, behaviors, values, actions, and regulatory physiology.” (P. Bromberg, The Shadow of the Tsunami: And the Growth of the Relational Mind)

Identifying and working with emotional parts so as to allow for trauma reprocessing relies on a repertoire of creative methods.
Although there are myriad approaches, principally the therapist acts as a mediator who establishes a rapport with the identified part(s) for the purpose of synthesizing the wisdom and resources of disparate facets of the self so as to harmoniously resolve conflict.

A parts-based psychodynamic approach is known as ego-state therapy. When treating complex trauma and dissociative disorders, the therapist interacts with the client’s various splintered ego states. By identifying and collaborating with these states, client and therapist come to appreciate their ego state's respective core needs, roles and drives. This provides an emotionally organized understanding of the client’s internal and external realities that can lead to consciously resolving painful internal discord. Repetition of this technique assists with ensuring stability and integration.

Developed by Fritz Perls, a humanistic form of treatment known as Gestalt Therapy incorporates parts work in what is termed the empty chair technique. With roots in psychodrama, this technique involves active role play amongst inner selves experiencing conflict. The parts fueling the conflict are given manifest form through embodied characterization and dialogue. As dialogue unfolds, with the therapist facilitating the flow of dialogue with questions and insights, the abstract becomes concrete. The aim of this technique is a harmonious working through of internal strife so that new creative adjustments can occur.

Another well-known strategy derived from ego-state therapy and internal family systems therapy is Fraser’s Dissociative Table Technique. The intention of this technique is to integrate emotional parts (EP’s)that are stuck in a regressed state of unassimilated trauma. The adult self or ‘host’ is invited in to engage with the dissociated traumatized EP. From a neurological perspective, this technique engages the amygdala where emotionally charged trauma is stored and undifferentiated in time, with the logical, wise witness consciousness of the neocortex. From a calm regulated place, the client is led to imagine the distressed and healthy parts (ANP; Apparently Normal Part), gathered at a table. All representations at the table are integral to achieving co-consciousness, establishing stabilizing resources, and self-compassion so that eventually stuck traumatic material can be reprocessed.

Other sundry creative means to engage with and integrate fragmented self parts include Ericksonian hypnosis, doll work, art therapy, psychodrama, archetype work, and storytelling. The methods and techniques are endless. Indeed, moving from adaptation to integration and thriving for the complex trauma survivor beset by dissociative disorders requires a willingness to partake in variable trauma-informed care designed to exhume buried parts seeking healing and assimilation.

Operating from the premise that we are a sum of all our parts encourages the survivor to do what is necessary to engage with the fragments of self previously condemned and exiled. The survivor intent on integration heeds the words of founder of analytical psychology Carl Jung who wrote,

“In every adult lurks a child, an eternal child; something that is always becoming, is never completed and calls for unceasing care, attention and education. That is the part of the human personality which wants to develop and become whole.”

Partaking in agonizing therapeutic work so that compassion and acceptance may replace internalized abuse and self-hatred, is a courageous and prolonged undertaking. Yet it is through this quest and the welcoming and honoring of repudiated parts of the self that the promise of consolidation can be fulfilled. This is where wholeness is realized, and where the survivor of inconceivable brutality can finally safely come home to oneself.

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As a survivor (and thriver) of complex trauma and a seasoned therapist specializing in treating complex trauma, narcissistic abuse syndrome and addictions, I am intent on creating content that affords informative insight, hope and healing from psychological disorders. I aim for my creative content to assist readers with tapping into the resiliency of the human condition while recognizing the countless challenges of being human.

New York City, NY

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