EMDR as a Special Form of Ego State Psychotherapy
Psychopathology from an Ego State Perspective
One could view all psychopathology as the failure to maintain optimal dissociative barriers among the ego states, that is, to maintain optimal permeability and fluidity – in short, a failure of the psychological system to do an adequate job of time-sharing. Since all of the ego states have a certain energy or need for self-expression, if that energy or need is suppressed by the system, then that ego state that is suppressed will ultimately break through the suppression in the form of some sort of symptomatology. The symptomatic or problematic ego state is called the “hidden” ego state – hidden in the sense that it is unacknowledged or “disowned” by the predominant ego states. However, its presence is made known through the symptomatology. The ego state may be disowned because of an unbearable affect, such as anxiety or terror, or because of some “undesirable” behavior. However, the symptomatology generally does not give an indication of the full nature of the ego state driving it, ultimately requiring that the rest of the ego state associated with the symptoms become fully amplified and developed for therapeutic relief to occur. So, for example, in PTSD, intrusive feelings or thoughts present themselves, often without the patient’s awareness of where they come from. Similarly, phobias, compulsions, and impulsive behavior are reflections of one aspect of an otherwise hidden or disowned ego state.
Sometimes psychopathology derives not from the suppression of a hidden ego state by a predominant ruling group of ego states, but rather from a conflict between two or more major groups of ego states. In this case, an overt or guerrilla war exists between these warring camps. Each camp believes that it is right and that if it only fights harder, it can win. Unfortunately, this process tends to polarize the warring camps and never leads to a real resolution. Either the power simply shifts from one camp to another, without real resolution between them, or one camp may seem to predominate for long periods of time, while the other camp fights a guerrilla war from behind the scenes. For example, an overweight patient may identify with an ego state or a group of ego states that want to lose weight, but there may be one or more ego states with an investment in either eating or being overweight, and these other ego states persist in maintaining the weight problem, in spite of repeated brief periods of successful dieting.
However the balance of power among the various ego states plays out, it is the system’s maladaptive use of dissociative processes that allows the conflict and the pathology to persist. First, there is either the dissociation by the predominant ego states of the hidden ego state, or the dissociation by each camp of ego states of the other camp of ego states. Second, there is the dissociation of the fact that this previous dissociative strategy isn’t working in either maintaining stability or in achieving the specific goals of the various ego states. Hence, dissociation may be conceptualized as the primary mechanism for maintaining psychopathology, not just of “dissociative disorders,” but virtually all psychiatric disorders. For example, defense mechanisms – repression, isolation of affect, splitting – are technically variations of dissociative phenomenology. It is extremely important to attend to the nature of the dissociative barriers in understanding and addressing all psychopathology.