EMDR as a Special Form of Ego State Psychotherapy

The internal dialogue.

Sometimes the pathological dissociation in a system is not aimed at keeping a single ego state hidden, but rather reflects dissociation between two or more major groups of ego states. For example, when the therapist invites an ego state shift to occur, the patient may appear to be unable to make such a shift, regardless of what technique or ego state component the therapist attempts to utilize. Such a patient is often labeled as “resistant.” This resistance, however, simply reflects the presence of a protector ego state, which feels that it must protect the system by not allowing this ego state shift to occur. In other words, there are one or more ego states that are opposed to a change in the system, even though it means that the patient will not get symptomatic relief. It is now this protector ego state that is more or less covert, and this covert protector needs to be flushed out, explored, and engaged with in order to understand what its concerns and agenda are. Thus, whenever there is a significant therapeutic impasse, the therapist should suspect that there is a covert conflict, led by one or more covert protector ego states.

This therapeutic impasse is perpetuated by the maintenance of a dissociative barrier between the ego state(s) which hold the symptomatic pain, and the ego state(s) which are opposed to a change in the system. This dissociative barrier can be diminished by introducing an internal dialogue among these previously unconnected parts. The goal of the dialogue is to undo the dissociation between these parts and to foster a collaborative, cooperative attitude among them.

There are a great variety of specific techniques for facilitating such an inner dialogue, including imagery, the Gestalt empty chair, writing with the nondominant hand (Capacchione, 1991), psychodrama, voice dialogue (Stone & Windelman, 1989), the parts party (Satir, 1991), and internal family systems (Scwhartz, 1995). Each of these techniques has certain advantages and disadvantages, but whatever the methodology, parts of the system will oppose the process, and these parts will need to be addressed. Regardless of the therapeutic modality used, it is important to appreciate that the process is intended to facilitate reduction of the dissociative barriers among the separate ego states and to enhance a collaborative attitude among the parts. All parts must accept the notion that each part is entitled to have its needs addressed in some way.

This process of connecting the ego states interactively and non-dissociatively develops a biological infrastructure among the ego states so that they are now more likely to flow back and forth spontaneously and freely, thus optimizing the patient’s adaptive functioning in the future.

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