EMDR as a Special Form of Ego State Psychotherapy
The ego state shift.
While the ego state bridge allows one to understand the full dimensions of a problematic hidden ego state, this understanding by itself is generally not enough to produce a lasting therapeutic effect. That ego state was largely hidden through dissociation, usually for a purpose, and that purpose almost always is to protect the system from excessive anxiety. Usually the patient has been “stuck” in this problematic ego state because at the time the ego state developed, the patient had no way to alleviate the anxiety associated with that ego state, except through dissociation. The therapeutic task is to facilitate a natural shift from the problematic ego state to some other ego state that can soothe or relieve the anxiety associated with the problematic ego state. That shift, which the patient could not do by himself at the time of the development of that ego state (either because of the biological limitations on information processing during a traumatic experience or because of developmental immaturity), can usually be conducted fairly easily with the facilitative assistance of the therapist.
This process can be facilitated through the use of imagery, simply by inviting the patient to let whatever needs to happen in the image to happen. Usually the patient will know exactly what needs to happen to get relief from the anxiety or other affective tension being experienced in the initial ego state. Sometimes, however, the patient may need encouragement to “let go of historical reality” in order to allow the image to unfold as necessary. Most patients are then able to shift from the problematic ego state to a new ego state and provide relief for themselves.
For example, a patient with PTSD who has associated to the early origins of the trauma can resolve the terror of that traumatized ego state by shifting to an ego state that would provide a sense of empowerment with anger, or to an ego state that provides protection, nurturance, or comfort. Those ego states may not have been in fact historically available, but the patient is free in the here and now to access these ego states, so that he need not remain stuck in the previously helpless one. The advantage of imagery is that it allows the patient to discover his own ego state needs, in contrast to the prescriptive approach that many hypnotherapists are inclined to take. For example, a patient who needs nurturance and soothing will not respond therapeutically to a therapist who exhorts him to make an ego state shift by angrily beating up his abuser.
It is important to note that, as with the amplification of an ego state during the ego state bridge, a shift from a stuck ego state to a more adaptive ego state should be facilitated through whatever ego state component is optimal for that particular patient, whether it be affective, cognitive, somatic, behavioral, or imagistic.