Working with Ego States
L. Beall, Ph.D. 2008
The purpose of this paper is to help the reader better understand what ego states are, how they function, under what conditions they can become dysfunctional, and what therapeutic interventions can be used to improve their condition, and correspondingly that of the client.
To me ego states are elements of the mind that carry out the functions of solving life’s problems, overcoming obstacles, absorbing pain and pretty much all the demands of day to day living. They originate out of the needs of the individual, particularly those needs resulting from relationships with dominant persons or challenging situations. In the therapeutic setting, this often means helping the client cope with abuse or neglect. In my clinical experience, it is common for psychological pain to be absorbed by ego states and manifested most commonly in behaviors of anger, self-defeating behaviors, or somatic symptoms.
Our common, day to day experience gives us evidence that could be interpreted as manifestations of ego states. Different “sides” of our personality surface under different situations. For example, you feel and behave differently when talking with a friend who you feel completely safe with, versus another adult who is threatening or authoritarian over you. Do you feel and behave differently when playing a game for fun, versus a game that is fiercely competitive? My wife noticed she could not help “becoming an eight year old” when we visited her parents as a family. Of course, there are many psychological theories to account for these differences in one’s responses, but one that has useful application relates to the functioning of ego states. Ego states may be organized into different dimensions. They may be large and include behaviors and experiences activated in one’s primary relationships, occupation or daily experiences. They may be small and include only behaviors and feelings elicited when participating in specific activities such as sports. They may represent current modes of behavior and experience or represent memories, behavior styles, feelings, etc., that were evident only at an earlier age.
Ego States & Dissociation
Over the years I have worked with various degrees of dissociation which opened the door to my understanding ego states. Dissociation can perhaps best be understood as stretching along a continuum of severity. The reader is recommended to another paper “How to Recognize Dissociation and What to Do About It,” also found on the website. On the left side of the continuum lies the dissociation representing day to day living. To the right of that lies the less severe forms of dissociation such as “traumatized dissociation.” This is when the individual dissociates or checks out from the traumatic experience that exceeds his or her ability to cope. This is the dissociation witnessed with Acute Stress Disorder when the person has been exposed to a traumatic event that elicits a “response of intense fear, helplessness, or horror.” On the other end of the continuum is Dissociative Identity Disorder (DID), previously termed Multiple Personality Disorder, where there is the presence of separate parts or alters of the personality which function independent of one another. There is often amnesia of their activity to the individual.
In working with patients diagnosed with DID, I began to consider the possibility that DID was a more extensive manifestation of a natural process inherent in various degrees in all of us; that we all have “parts” that influence what we say and do. These parts have sway in our personality functioning, more or less, depending on various factors like the presence of adverse experiences in childhood, levels of stress and toxicity in our environments growing up, genetic endowment, and the extent to which we as children were given freedom to give expression to the different sides of our personality. As I have worked with individuals, using this ego state model of personality functioning, I found interventions on an ego state level to have greater potential to bring about needed changes, to release unwanted emotional burdens, and to solve life’s problems, at a more core level of the personality.
When an Ego State Becomes Dysfunctional
As an illustration, I was asked to complete an evaluation for an adolescent female client, we will call Mary, who was killing small animals on the farm of her foster mother. Therapy had not helped, and only seemed to worsen her unwanted behavior. Upon inquiring, it was learned that Mary had no recollection of the killing of these small animals, and in fact seemed sincerely appalled that such a thing could be done to innocent creatures. Diagnostic work revealed she had an “angry ego state” who was indeed killing these small animals. This ego state or “sub-self” of Mary had taken much of the painful abuse she had undergone as a young child. She had unconsciously assigned an ego state to take this pain, evidently in order for her overall personality to not be burdened or impaired with it. Unfortunately, even though this pain was being housed in an element of her personality, the pain didn’t disappear, and was contributing to these aberrant behaviors. It could be called “covertly expressing” the pain, that was carrying out an inner mandate to keep the pain from reaching her consciousness. The fact is the pain this part of Mary took from the abuser was real, did not go away, and had to be controlled and managed in such a way so as to not bring too much interruption to Mary’s life. As often is the case with ego states in pain, the pain can’t remain repressed, and has to be expressed somehow, most often in some kind of “acting out behavior.” Private acting out eventually becomes a problem to the individual and others. If resources are available, treatment becomes recommended. Unfortunately, in the author’s experience, conventional treatment does not reach the ego state level of the personality, and only temporary relief is obtained.
Over the past nearly twenty-five years I have encountered hundreds of similar cases in which childhood pain is absorbed by ego states which often manifests in various forms of aberrant behavior, such as aggression or promiscuity. Several early contributors had discovered that the human personality is not singular (although it is usually experienced as such), but is separated into various segments, or unique entities that serve different purposes. Janet (1907) applied the term dissociation to describe systems of ideas that were split off, thus “not in association” with other ideas within the personality. Janet also implied that these personality patterns existed subconsciously, not available to conscious observation.
Mary’s angry ego state was not rigid but could be expanded or contracted to include more or less psychological material. During active periods her angry ego state expanded and she appeared to others as invested with strong emotion, such as anger. This would usually be the case when Mary talked with her boyfriend, Jackson. She would be angered by his provoking, triggering accusations. During rest, sleep, or depression this ego state contracted its boundaries and withdrew its energies, leaving larger portions of Mary’s emotions and behaviors unenergized and dormant. This state would often be what characterized Mary’s day to day living when unprovoked by Jackson’s or others’ triggering interactions.
When the boundaries of an ego state are relatively permeable and not rigid, we think of it as a normally adaptive entity. When the boundaries become rigid and impermeable, such as the case with Mary’s angry ego state, we term it as dissociated. Mary referred to “walls in her mind” that separated highly painful and traumatized experiences. Her angry ego state was compartmentalized with its pain and anger from numerous traumatic incidents of abuse and loss, and only emerged from its dissociated place when triggered by provocations. It is not difficult to understand how an ego state formed and developed under the extreme duress of a sexually abusing and violent step-father when Mary was a child, could be activated by a boyfriend whose behaviors resembled those of the abusive step-father. This dynamic of the angry ego state being in seclusion until it emerged after being triggered has been validated and clearly demonstrated to me by Mary’s foster mother, who observed this pattern in Mary’s behaviors.
Ego states often were first created when the individual was young. Accordingly, they think concretely like a child. A child ego state was formed to adapt to the conditions of an earlier time, not today, and often its attempts to function in the present result in maladaptation or ineffective behaviors.. As one learns about the time and circumstances when an ego state first appeared, one’s approach can be adapted to talking with an ego state younger than the full-grown adult client before you. This adaption can be done without conflict or confusion under deep relaxation. In our case, it was discovered that Mary had not one but four ego states who had absorbed a tremendous amount of pain and functioned as a composite entity in response to extreme stress. When given the opportunity in therapy, they responded as children eager to be relieved of this pain and in a corresponding way their anger and rage. It was easy to see that their combined angry energies created a formidable amount of anger that could easily explain the killing of innocent, young animals. In my opinion, with the removal of pain and anger from Mary’s ego states, concern for her acting out in anger and hurting others was essentially removed. This was confirmed by the observations of the foster mother in the months that followed ego state therapy with Mary.
The Development of Ego States
Original ego states came into being to help the primary personality or your client adapt and be safe. These ego states remained because they were successful in these functions. They further developed to enhance the individual’s ability to cope with a specific problem or situation. Thus, one ego state may have taken over the responsibility of dealing with parents, another on the playground, another when dealing with aggressive peers, etc.
Ego states are motivated to protect and continue their existence. It is easier to modify the motivations of ego states and change their behavior in a constructive direction than it is to attempt their total elimination. (Admittedly, there are times when one is tempted to remove them, even though in the long run it is usually more beneficial for the entire personality system to work through the problems of the oppositional personality state).
It is not uncommon for ego states to have contradictory goals and to develop conflicts with each other. When they are highly energized and have rigid, impermeable boundaries, dissociative identities or multiple personalities may result. However, many such conflicts appear between ego states only covertly, and are frequently manifested by anxiety, depression, medical problems, or any number of emotional and behavioral problems. There is a rich and useful literature on the treatment of multiple personalities, and the reader will discover principles of treatment for ego states as well, in reading them. At the end of this paper is a brief biography of books I have found useful.
Ego states apparently develop by one or more of the following three processes: normal differentiation, introjection of significant others, and reactions to trauma.
Normal differentiation - the child learns to discriminate between things (e.g., foods that taste good and those that do not, persons that cooperate and those that threaten). Patterns of behavior are developed which are appropriate for dealing with life.
Introjection of significant others - the child absorbs strong negative or positive energies of a significant parent and establishes patterns of behaviors which are consistent with those energy clusters. The term “object-cathected” or “introject” means the ego state, or more than one, represents the predominant energy of this significant other. In my experience, pathological introjects most probably develop when the significant other is extremely critical and abusive in any way. The more intense, severe, and chronic the criticism and abuse, the more likely it is the introject becomes autonomous and separate from the personality system. In the more extreme cases of DID, a “Persecutor Alter” can form. An abused child may abuse her own children, if she has identified with her bad parent. That was our fear with Mary, that her angry ego state which had killed animals would be capable of injuring her child. There is reassurance in the fact that the angry ego states, which had apparently absorbed the introjections of the abusive step-father, had been relieved of their pain and anger, and were no longer potentially dangerous.
Confronted with severe trauma - or rejection or abuse, the child may dissociate. This is an extension of Introjection of Significant Others. Because the sources of psychological pain are so diverse and extreme for the child in an abusive and toxic environment, ego states can contain psychological pain not differentiated as an introject. For example:
- The lonesome child can create an imaginary ego state playmate with whom (s)he can interact
- An ego state can develop to cope with interpersonal problems the ego state doesn’t judge the primary person capable of handling,
- Ego states can form to handle different classes of emotional pain. Later conflict may cause the effected ego state to reinvest with energy and reemerge in some form in later years. This is often when the client seeks therapy.
The Differentiation-Dissociation Continuum
Few psychological processes exist on an either-or basis. Anxiety, depression, immaturity, etc., all lie on a continuum with lesser or greater degrees of intensity. So it is with ego states and dissociation. Multiple personality only represents the extreme and maladaptive end of the continuum that starts with normal differentiation.
Multiple or Dissociative
A conflict between states may be manifested by headaches, anxiety, and maladaptive behaviors, such as found in the psycho-physiological conditions. In my opinion, Mary’s ego state functioning and dissociation can be found towards the end of pathological dissociation, but not far enough to reach multiple personalities or Dissociative Identity Disorder.
With the above continuum in mind, treatment approaches have the aim of moving the client more in the direction of the “adaptive differentiation” of ego states. The following steps and process has been found useful:
1. A therapeutic alliance is formed and strengthened with the client and ego states by an acceptance of his or her report of traumatic experiences.
2. Psycho-education about trauma and ego state functioning.
3. Exploration of reasons why letting go of the pain from these traumatic experiences may not be desirable from a therapeutic perspective (See handout “Why We Don’t Let Go of Pain.”) For example, there may be a fear of losing identity or power, of forgiving the perpetrator or minimizing the pain.
3. Use the Rapid Pain Release Intervention developed at The Trauma Awareness & Treatment Center.
4. Assess level of cooperation existing between the ego states. Pain is often what keeps ego states apart, and when this psychological pain is removed, there is a natural movement of ego states toward one another. Greater unity and cooperation is achievable.
5. If disharmony continues between ego states, develop more cooperation between them. This can be done by listening to their issues, recognizing how working together would help them reach their personal goals, and giving them opportunity to cooperate with homework assignments. These assignments could include being assertive and truthful with a certain difficult individual, or completing a challenging task that has been procrastinated. It is also important for the client, herself, to undergo ego strengthening by meeting challenges, overcoming obstacles, reaching goals, etc.
It may be recognized by the reader that effective treatment of ego states is just good therapy with the parts of the personality. By not challenging the ego state’s unique identity, but by increasing the communication of ego states with each other we encourage an adaptive togetherness and unity. The formerly dissociated ego state becomes an ego state which cooperates with the other ego states in the personality system, maintaining the individual’s inner and outer worlds. It is not uncommon for many of the original ego states, when their need for separateness no longer exists, disappear spontaneously, their energy and capacity fusing into remaining ones. The remaining differentiated entities are now simply functional ego states – and the individual manifests only one personality to the outside world.
It is hoped the discussion thus far de-mystifies ego state therapy, and helps the reader see that s(he) already possesses many of the individual, family, and group therapeutic skills, necessary for the resolution of conflicts within the individual’s ego state “family.” The only chief difference may be the therapeutic skills are used while the client is in a deeply relaxed state.
The Defensive Barrier and Ego States
As a review and in conclusion, it is recommended that the practitioner who wishes to do ego state therapy recognize the defensive barrier between the conscious and unconscious. This is a protective barrier that keeps painful and difficult to face material in the unconscious from percolating up to the conscious, where it could interfere with day to day functioning. It is also a barrier which keeps us from accessing inner resources which can help us deal with day to day functioning. We do neet to penetrate beyond the conscious level where only “reasonable or rational” thinking is allowed, to reach the symbolic communication and energy of the subconscious. All that is needed to access the sub-conscious is relaxation that is deep enough to lower or penetrate this barrier. If I use a progressive relaxation approach such as provided in the Eight Session Model, that is sufficient to access the sub-conscious. Formal hypnosis training is not necessary. When asked, “Was I hypnotized?” I reply “I don’t know and it doesn’t matter. All that matters is that we are able to do the work we need to do with the sub-conscious.” My clients are always fully aware of everything that happens in the session, unless they are highly dissociative. When they are sufficiently dissociative to have alters the client may not remember the work done by an alter or part.
Diagnostic and Statistical Manual of Mental Disorders IV-TR, p. 471