THE INNER SELF HELPER AND CONCEPTS OF INNER GUIDANCE: HISTORICAL ANTECE­ DENTS, ITS ROLE WITHIN DISSOCIATION, AND CLINICAL UTILIZATION

Christine M. Comstock

Christine Comstock is a therapist at Horizons Counseling the developmentofthe patient'sability to leadanautonomous, in Parma Heights, Ohio. competent life. The ISH is thought not only to provide addi­ tional information concerning the patient's internal expe:' Forreprintswrite Christine Comstock, HorizonsCounseling, rience and make internal adjustments within the patient, 5851 Pearl Road, Parma Heights, Ohio 44030. but also is seen as able to develop the patient's ability to access a calm portion of his or her consciousness, removed ABSTRACT from the intensityofthe internal emotional storms. This lat­ ter ability is believed to provide stability, clarity, and a sense The Inner SelfHelper (ISH), a specialized psychic structure said to of peace. The patient's frequent use of inner guidance is be uniqueto MultiplePersonalityDisorder(MPD) and/orDissociative understood to begin to develop the patient's accurate self­ Disorder (DD) patients, has its roots deep within traditional psy­ understanding and self-directedness as a way oflife. chiatric and psychological heritage. This article examines some of Others who do notendorse the ISH concept argue that the historical antecedents ofthe use ofa source ofinner guidance the existence of the ISH is unprovable, unnecessary, and within the patient, a source that has been called the unconscious probablyiatrogenic. Interestingly, manyofthese arguments mind, the observing ego, and the higher selfin addition to the ISH. are these same arguments which were originally directed This paper explores the ISHas it has been conceptualized in the past against the existence of MPD as a separate diagnostic cate­ and as it presently is understood. Some clinical applicationsfor the gory. use ofthe ISH structure are also presented. The controversy surrounding inner guidance in the study ofMPD has been more intense in the past than it is at INTRODUCTION the present time. Early proponents ofthe Inner SelfHelper described intensely vivid experiences beyond the realm of Allison (1974) described the InternalSelfHelper (ISH) ordinary therapeutic encounters. They reported incidents as a s<7-parate source ofwisdom, perspective, andunderstanding in which an ISH would comment with great clarity and rel­ within multiple personalitydisorder (MPD) patients, greater evance about another patient seen only briefly in the wait­ than is usually available to the conscious mind. He thought ing room; offer the therapist a cryptic and profound obser­ thatworkingwith the ISHwasreIevantand useful in the treat­ vation concerninga personalissue in the life ofthe therapist; ment of such patients. The concept of inner guidance is or make reference to spiritual matters of great interest to ancient; recent clinicians' describing the ISH as a form of the therapist. Thiswas exciting to some therapists and unset­ innerguidance is consistentwith a long tradition. This paper tling to others. It seemed to result in a rift between those will review the debate which has surrounded the discussions who held firmly to understanding interactions in tradition- of the ISH, describe some of the historical antecedents of al scientific psychiatric terms and those who seemed ready the conceptfrom psychiatryand psychology, discuss the con­ to embrace alternative explanations. Those who maintained cept of inner guidance in the context of dissociation, and a traditional understandingofpatient/therapistinteractions conclude with a discussion of the clinical relevance of the expressed concerns that ISHs were compliant fabrications ISH. This review discusses areas and subjects that often are by the patient in response to the therapist's suggestions or both untraditional and speculative. Its purpose is to orga­ difficulties. Those readyto embracealternative explanations nize and share observationsaboutan importantphenomenon viewed the ISH as a different and more spiritual manifesta­ that is more often the subject of informal discussion than tion ofconsciousness, perhaps even the portion of the per- ~ scientific exploration within the dissociative disorders field. son most closely related to and most closely identified with God. CONTROVERSIES SURROUNDING As the debate continued, thosewho held differentpoints THE ISH CONCEPT ofview tried to further their arguments by raising the issue of narcissism. Therapists' narcissism was advanced as the Within the dissociative disorders field, the ISH became explanation ofboth encountering ISH phenomena and fail­ the focus ofconflicting opinions. Proponents ofthe useful­ ing to do so. The identification ofan ISH as a potentially co­ ness of the concept of the ISH hold that the utilization of equal or even wiser part than the therapist within a special inner guidance can aid both the therapeutic process and patientwilling to talk to a special therapists could be attribut-

165 DISSOCl.\TIOi\. Vol. 1\'. No.3, September 1991 INNER SELF HELPER .

ed to therapist narcissism. On the other hand, the assertion the truth" (1972, p. 50). The inner man may have referred that there could be no ISH in a patient, no part wiser than to a place similar to the concept of the safe place technique the speciallywise, trained, and gifted therapist could also be used in hypnosis (Kluft, 1989), or it might have referred to attributed to therapist narcissism. another aspect ofconsciousness such as the still, small voice Therapist sensitivity/naivete was another issue raised within or to yet another, deeper aspect of the self. in the debate. Were those who accepted the ISH more sen­ As the conceptofthe unconscious became popular but sitive to the spiritual nature of the human being, or were remained obscure and poorly understood, it was credited theynaive (andperhaps highlyhypnotizable, fantasy-prone) with a multitude ofdifferent functions, Carus (Ellenberger, people engaged in a folie a deux (or more) with the patient? 1970), French physician and philosopher, described his per­ Also, for a newly emerging field such as MPD, credj­ ception ofthe source ofthe truth in the inner man in state­ bilityin the face ofthe general scientific communitywas con­ ments alluding to the abilities and gifts of the unconscious sidered crucial. Many considered an interest in the ISH phe­ mind. His words are similar to those later applied to the ISH: nomenon as potentiallydamaging. Therefore, theunscientific generalization issue became anotherissue in the controversy. ... the unconsciousis indefatigable; itdoesnotneed Therapists who were not personally aware of a source of periodic rest, whereas our conscious life needs rest inner guidance could be considered to be guilty of unsci­ and mental restoration ... the unconscious is basi­ entific generalization in that they assumed their patients callysoundand doesnotknowdisease; ... the uncon­ were constructed psychicallyjust as they experienced them­ scious possesses its own inborn wisdom, in it there selves to be. Conversely, therapistswhowere personallyaware is no trial and error. (p. 208) of an inner source ofguidance might be guilty of a similar preconception. In 1886, psychologist Alfred Binet discussed the posi­ Inextricably woven among these controversies was the tive functioning of the unconscious mind and concluded content ofsome ofthe ISHs messages and the reactions they that, "there is a permanentand automatic process ofuncon­ evoked. Some ISHs claimed to have psychic abilities, an scious reasoning at the bottom of man's psychic activity" unproven claim which can neither be confirmed nor dis­ (quoted in Ellenberger, 1970, p. 355). missed peremptorily. As some ISHs reported stories ofrein­ Ross (1989) described Breuer's patient, Anna 0., and carnation, miracles, spiritual encounters, special knowledge the portion of her personality which seemed similar to an about the future, and instructions for their,own care, and ISH. "Anna O. had a third state as well, which today would expressedwith conviction observations aboutother patients be called a hidden observer, internal selfhelper, or center" or the therapist, conservative eyebrows rose. On the other (1989, p. 33). This state was, in Breuer's (1895) words, "A hand, ISHs did surprise many a therapist with the accuracy clear-sighted and calm observer (who) sat, as she put it, in oftheircomments and 0 bservations. Therapistsand patients a corner of her brain and looked on all this mad business" who utilized the concept of the ISH in their work together (p. 101). Ross noted that this state could have been more believed (withoutconfirmation ordisconfirmatoryevidence) useful to Breuer, and therefore to Anna 0., had it been uti­ that they were having fewer crises with less need for patient lized more effectively. "IfBreuer had been able to enlist this hospitalization than would occur in comparable therapies stateas a co-therapist, he mighthave uncoveredearlierchild­ in which there was no use of the ISH. hood traumaandprovideda more effective treatment" (1989, As with many other controver;ies in the field, this one p.33). hasmellowedas proponents ofboth pointsofview havegrown In the late 1880s, PierreJanet treated a patient,Justine, in clinical experience and sophistication. Presently, in my who either created an internal representation ofJanet or view, thereseems to beanemergingconsensus thatnotevery­ had a part that utilized the representation ofJanet to pro­ thing the identified ISH says is literal fact, but that there is vide guidance. Justine saw her internalizedJanet's appear­ a source ofwisdom available within the patient. ance and heardJanet's voice frequently. Ellenberger (1970) wrote: A BRIEF OVERVIEW OF THE SUBJECT OF INNER GUIDANCE In a hallucinatory state she asked him for advice, and he answered with good counsel which, inter­ The Unconscious as Inner Guidance estingly enough, was more than a mere repetition Jaynes (1976) theorized that early man had no con­ ofwhat he had actually said, but proved to be ofa scious mind but rather had a bicameral mind composed of novel and wise nature. (p. 369) an executive portion which was perceived as a god, and a follower partwhich was perceived as a man. These parts, the In 1903, Myers (Ellenberg, 1970) posited three differ­ wise part and the ordinary part, were dissociated from each ent functions of the unconscious mind: the inferior func­ other. tions or the pathologically dissociative functions; the supe­ Descriptions of sources of inner guidance or of ISH­ rior functions or the creative genius functions and the like functions and instructions to utilize inner wisdom are mythopoeticfunction or the unconscious tendency to weave not new phenomena. In 400, St. Augustine wrote, "Seek not fantasies (p. 314) .Jung (1958) mightview whatMyers labeled abroad, turn back into thyself for in the inner man dwells "fantasies" as the unconscious mind's active presentation to

166 DISSOCLUIOX, Vol. IV, :"10. 3, September 1991 the conscious mind ofarchetypal images to represent or to (Bion, 1957; Boyer and Giovacchini, 1967), ... an compensate for the unbearable psychic tension ofdissocia­ aspectofthe patientfunctioningin a "non-psychotic tion present in the collective conscious or in the personal part of the personality." (p. 39) unconscious. Jung (1944/1954) conceptualized the unconscious as It is my understanding that the clinician who utilizes more than simply a repository for repressed drives, impuls­ the concept of the ISH in an MPD or dissociative disorder es, thoughts or wishes. He wrote: (DD) patientis operating upon the same basic setofassump­ tions. The unconscious is an "autonomous psychic enti­ For years, psychoanalysts have maintained that the exis­ ty.... It is and remains beyond the reach ofsubjec­ tence ofa functional observing ego was a desirable and even tive arbitrarycontrol, a realmwhere nature and her essential psychic structurewithin a patient (Sterba, 1934/1990; secretscan be neitherimprovedupon norperverted, Greenson, 1967), something to be actively pursued ordevel­ where we can listen but may not meddle. (1944, p. oped. The dissociation of the ego into observing and expe­ 46) riencing components is seen to be critical to the success of therapy. Jung viewed the unconscious mind as an active source of wisdom, "the unconscious mind of man sees correctly Hence, when we begin an analysis which can be car­ even when conscious reason is blind and impotent" (1952, ried to completion, the fate that inevitably awaits p. 24). He listened to the unconscious through theinnervoice, the ego is that of dissociation. A permanently uni­ "the voice of a fuller life, of a wider, more comprehensive fied ego, such as we meet within cases of excessive consciousness" (1954, p. 184) .Jung believed that this wider, narcissists or in certain psychotic states where ego more comprehensive consciousness is a psychic richness that and id have become fused, is notsusceptible ofanal­ is available though not always claimed. ysis. The therapeutic dissociation ofthe ego is a neces­ More recently, RobertLangs (1988) credited the uncon­ sity. (Sterba, 1934/1990, p. 267) scious mind ofthe patientwith greaterwisdom than the con­ scious mind ofeither the patient or the therapist. He wrote, Sterba (1934/1990) described a process ofsplitting of "... the deep unconscious system does not distort, butalmost the ego so that a portion ofthe patient's ego can eitherform always perceives accurately and soundly" (p. 190). an alliance with or can identify with a portion of the thera­ Despite observations of the type noted above, interest pist's ego, that portion being the analyst's analyzing ego. in the unconscious itself as a potentially active participant The therapeutic alliance is thusformed between the patient's in the therapy process has not been a major focus of inter­ observing ego and the analyst's analyzing ego. est. In an increasingly Freudian era, the unconscious was Racker (1956) also employed this concept of a disso­ seen more as a somewhat unpredictaple storage place for ciated ego and requested his patient "to divide his ego into consciously unacceptable feelings, thoughts or memories. an irrational partthatexperiencesand another rational part that observes the irrational part" (p. 176). This accurately The Obsenting Ego as a Form ofInner Guidance describes manyMPD patients' reported experienceswith their Many clinicians assume there is a healthy part of the own ISHs. Greenson (1967) continuedthe focus on the neces­ patient, a heart-beatofsanitywithin the tumultuouslabyrinths sity to have a dissociated, more neutral observing portion of ofthe mind, thatpersists no matterhowdisturbed the patient the ego: seems to be. Freud (1940) described the situation as he observed it, Patients who cannot set apart a reasonable, observ­ ing ego will not be able to maintain a working rela­ Even in a state so far removed from the reality of tionship.... The patient is asked to split his ego so the external world as one of hallucinatory confu­ that one part ofhis ego can observe what the other sion, one learns from patients after their recovery part is experiencing. (p. 193) that at the time in some corner of their mind (as theyputit) there was a normal person hidden who, Notonlydid Racker (1968) insist that the patientdevel­ like a detached spectator, watched the hubbub of op an observing ego, he also advocated that the therapist illusion go past him. (pp. 201-202) either find or develop an observing ego of his or her own. Only in this way, he noted, can the therapist avoid becom­ Frankl (1963) wrote, "Indeed the innermost core of the ing entrapped in unending countertransference responses. patient's personality is not even touched by a psychosis" (p. "Hence itis ofthe greatestimportance that the analystdevel­ 211). Ogden (1989) wrote: op within himself an ego observer of his countertransfer­ ence reactions...." (p. 138). I conduct all phases of psychoanalysis and psycho­ An observing ego developed within the context of a analytic therapy ... on the basis ofthe principle that therapy relationship has not been labeled as iatrogenic or there is always a facet ofthe personality ... capable discounted as a compliantly-produced observing ego and of utilizing verbally symbolized interpretations therefore of questionable value. The observing ego devel-

167 DISSOCLmo~. Yol. IY. ~o. 3. September 1991 INNER SELF HELPER

oped during therapy is not thought to be any the less valu­ more subtle, and wiser than the patient (Hammond, 1984), able or important than an observing ego produced in any an attitude some therapists have adopted towards the ISH. other manner. The use ofideomotorsignals to access informationfrom a knowledgeable, although unspecified portion of con­ Hypnosis and Inner Guidance sciousness, hasbeenadvocated bymanytherapists (e.g., Braun, The therapeutic utility ofhypnosis in the treatment of 1984,1986; Kluft, 1982, 1985a; Putnam, 1989; Sachs, unpub­ MPD/DD is well known (e.g., Beahrs, 1982; Bliss, 1986; Caul, lishedworkshoppresentations). Hilgard (1977) didnotaccept 1978; Kluft, 1989; Putnam, 1989; Ross, 1989). MPD patients the proposition that one could communicate directly with move in and outoftrance with relative ease and readilyman­ the unconsciousmind. Hestatedthataltl10ugh people believed ifest classic trance phenomena when systematically tested they were in communication with the unconscious mind (Bliss, 1986) .Mostofthe dissociative experiencesMPD patients through finger-signalling, in his opinion this was absolute­ undergo spontaneously are experiences that can be repli­ ly not so. cated hypnotically, includingthe accessingofa specific source ofinner guidance. INNER GUIDANCE IN THE CONTEXT OF MPD Two streams ofthought in contemporary hypnosis are relevantto the ISH phenomenon. Hilgard (1977) performed Allison (1974) was the first to describe the ISH phe­ extensive experiments in which he demonstrated the exis­ nomenon in MPD patients and to represent the ISH as an tence ofwhat he called the hidden observer. He interpret­ alter embodying wisdom and inner guidance. Allison had ed its meaning and implications cautiously and conserva­ been influenced in his workbyAssagioli (1965), the founder tively. Hilgard located the hidden observer within the of the Psychosynthesis movement (Allison, personal com­ conscious rather than the unconscious mind, and attribut­ munication, 1990). Psychosynthesis views the human being ed to it a cognitive orientation. The hidden observer, he as composed of many subpersonalities, ego states, or parts. thought, ought not to be compared to a psychic structure Each influences the behavior, cognitions, and/or affective with a will ofits own: response of the whole. Assagioli's conceptualizations sug­ gested a therapeutic style well suited to the treatment of It should be noted that the "hidden observer" is a MPD/DD and well suited toAllison's own beliefsystem.Among metaphor for something occurring at an intellec­ the subpersonalities, Assagioli hypothesized the existence tual leveL ... It does not mean that there is a sec­ of, "a permanent center, of a true self situated beyond or ondary personality with a life ofits own-a kind of above the [conscious self or ego]" (p. 35). He viewed this, homunculuslurkingin the shadowsofthe conscious which is termed the Higher Self, as "the very core of the person. (p. 188) human psyche." He was an enthusiast who advocated "the discovery orthe creation"oftheHigherSelf. Assagioli'sHigher However, the statementsmade byHilgard's (1977) sub­ Selfis obviously similar to Allison's ISH. jectsseem to indicate theyexperienced theirhidden observers Because a multiple dissociates affective and emotion­ as separate, active aspects of themselves: al states such as rage, sexuality, intense fear, and hopeless­ ness, and traumatic experiences into separate and distinct 1. The hidden observer is watching, mature, logical, has personalities it is not unreasonable to suspect that this adap­ more information.... [p.209] tive pattern extends to dissociating wisdom and insight into a separate alter. The ISH's attributes include its ability to 2. The hidden observer was an extra, all-knowing part of function as an organizing force as well as to provide wisdom me.... [p.209] and insight.

3. The hidden observer is analytical, unemotional, busi­ The ISH as Central Organizing Farce nesslike. [ p. 209] The existence of some unifying or central organizing force within an MPD patient may be inferred from his or her 4. He's like a guardian angel.. .. [po 209] overall behavior, even though he or she subjectively may experiencehimselforherselfasbeingwithoutinternalcoop­ 5. He seems more mature than the rest ofme. More log­ erative abilities. The patientmakes and keeps appointments ical, and amused by the me thatcouldn'thear. [po 212] overseveral differentalters; finds herway to the office, school, or work, and then home again despite personality switch­ Among clinicians, Milton Erickson (1979,1981) was a ing; remembers how to use the telephone and the bathroom, proponent ofthe wisdom ofthe unconscious mind. He per­ understands door knobs and shoe laces, and remembers the ceived the unconscious as a positive but not a perfect location ofthe elevator or stairs. Multiples have functioned resource, and as an innersource ofwisdom. He would direct for years with internal separateness butwith sufficient cohe­ people to access their own internal resources when possi­ sive functioning to enable them to hold jobs, to marry, to ble. If he found that their resources were insufficient, he have children, and to have friends. This demonstrates some would work to increase them. In much ofhis work, Erickson sort ofinternal communication, a fact which has one oftwo seemed to view the unconscious as ifit were more creative, meanings: either the MPD patient is misrepresenting her

168 DISSOCIATlO~.Vol. IV. No.3. September 1991 sense of herself as separate, or there is some central orga­ ability to distance themselves from their feelings than do nizing force (unrecognized by the multiple) communicat­ other alters. ing across alters. Beahrs (1986) credited the ISH as the central organiz­ Incidence ingforce, "... these internal self-helpers or hidden observers The question ofwhether the ISH is a universally occur­ may in some ways concretize that yet unknown organizing ring phenomenon or is a phenomenon restricted to patho­ force that gives a normal person his sense of unity in the logicallydissociatingindividualshas probablybeenpondered face of the multiple co-conscious ego states we all possess" byall therapistswho have seriouslyconsidered the ISH. Allison (p. 107). (1974,1980), Beahrs (1986), Fraser & Curtis (1984) and I Fraser & Curtis (1984) and I (1984) developed com­ (Comstock, 1984) accept tlle premise that an ISH "is pre­ parable conceptualunderstandings ofsomestructureorforce sent in a normal person as well as in a multiple, although in within the multiple that was stronger, wiser, and connected a multiple personality, the ISH appears as a separate indi­ to all parts of the person. Fraser and Curtis (1984) termed vidual" (Allison, 1980, p. 131). Beahrs (1986) thought they it the Central Subpersonality, and I termed it the Center. were universal: "1 suspect are similar and present in every­ For purposes ofconsistency, Allison's term, ISH, will be used body at all times" (p. 110). Putnam (1989) concluded that, to refer to the source, embodiment, or personification of "ISHs appear to occur in at least 50-80% ofMPD cases where inner guidance. Nonetheless, it is useful to note that Fraser, they have been sought. One can often find this type offunc­ Curtis, and I originally believed that what we had found in tion in non-MPD patients as well as within one's own self' our MPD patients was in some ways similar to Allison's ISH, (p.ll0). but in other ways seemed so different that it warranted the Adams (1987) administered a survey to therapists on use of a different terminology. Perhaps most importantly, membership list of the International Society for the Study the concepts of the central subpersonality and the center of Multiple Personality and Dissociation, concerning their were less mystical and spiritual in orientation than is stated experiences with and their beliefs about the ISH. Outofthe in Allison's original discussion of the ISH. forty participating therapists, 90% (36) had direct contact The ISH is neither the ideal form of the person, nor with at least one ISH in MPD clients. More than half of her how she or he would have turned out had there been no respondents replied that they believed every MPD has an trauma, nor the real self as contrasted with other alters as ISH. splits ofa false self. Allison (1980) described the ISH as "a dis­ The question ofwhether patients have one or several sociated part of the personality, not a spirit with a past life." ISHs also has been considered. Allison (1980) found many Fraser (1987) characterized it as "the core of the person's different ISHs in his multiples. He described an upward spi­ consciousness... buffered by a characteristic interpersonal raling group ofISHs with ever-higher ones available ifneed­ ego style or styles which we call personality" (p. 2). Putnam ed, some of which are beyond the body. He reserved the (1989) wrote ofthe ISH as, "an observing ego function that term ISH for those within the body. Fraser and I recognize can comment accur'ately on the ongoing process, ansi. pro­ one ISH and the possibility of many other helping alters. vide advice and suggestions as to how to aid the patient in Certainly, the first identified apparent ISH within a multi­ achieving some insight and control over his pathology" (p. ple often is later revealed to have been a helping personal­ 204). Beahrs (1986) described the ISH as "a healthy per­ ity. It is not always clinically necessary to make a distinction sonification ofthe creative unconscious which we all share" between the ISH and a helping personality because infor­ (p.l06). mation from the ISH can be communicated through help­ ing. Affective Attributes ofthe ISH As clinicians' experience with ISHs has broadened, it Allison (1988) reported that the ISHs he met had a has become increasingly clear that there is no single way in rather bland affective style. He remarked: 'The ISH lacks which inner guidance is accessed or applied and no single emotions; itanswers questionsand communicatesin the man­ way in which an ISH works. Some generalizations can be nerofa computerrepeating programmed information. The made concerning the potential activities ofthe ISH and pos­ ISH seems to be pure intellect" (p. 132). Putnam (1989) sible methods ofcommunication with the ISH, buteach per­ agreed, 'Typically, they are physically passive and relatively son is unique and develops a unique relationship among his emotionless personalities who provide information and or her own parts. insightsinto the innerworkings ofthe system." Fraser (1990) commented, "I describe it as the Spock of Star Trek. They Communication with the ISH are logical and try to maintain a neutral position as observ­ Communication between an ISH and a therapist may ing ego. However, some do have a sense ofhumor and I have take place verbally or non-verbally. A therapist can become seen them laugh." I found that although ISHs often present aware offeelings that originate within the patient, visual or themselves as emotionally flat, they have the capacity for, auditory representations of a patient's experience, or intu­ and later often demonstrate, the full range of human feel­ itions or knowings which the patient then later describes. ings. They are oriented more toward task accomplishment Therapistshave described experienceswith MPD/DD patients andotheralters than toward themselves, and theyseemeither during which they suddenly know something, understand to have a better ability to tolerate their feelings or a better something, or see something they could not reasonably be

169 DISSOCIATIOl\'. Vol. IV, No.3, September 1991 - INNER SELF HELPER

expected to know, to understand, or to feel. higher than those of other types ofindividual alters. Projective identification (Klein, 1946) is one possible Some types ofstatements made by MPD patients com­ explanation. It is a primitive defense in which the patient plicate the issue. Incidents from before or shortly following splits offa feeling, an idea, and/or a portion ofthe patient's birth, from previous lifetimes, and/or involving encounters self or experience and then passes it over, gives it to or puts it with spiritual entities have all been reported. These memo­ in the therapist. The therapist then accepts and responds to ries, whether simply recalled or abreacted, seem no more the material the patient has passed to the therapist. Thereafter, or less authentic to the patient than do memories or abre­ the therapist either acts out his or her part ofthe projective actions of any of more commonplace material. Simply put, identification or, preferably, works it internally himself or we do not know how to differentiate between a real memo­ herselfand then passes it back (in its reworked form) to the ry or an actual abreacted exogenous trauma, and a confab­ patient. This form ofcommunication takes place forcefully ulated recollection or abreaction ofa pseudomemory expe­ and instantaneously, can happen on the telephone or at rienced within the therapeutic relationship for a different other timeswhen the people are notin direct contact. Freud purpose. Strachey (1934) suggested that abreactions could (1915) commented on such communication: be expressions of "an artificial neurosis in exchange for his original one" (p. 335), a discharge of affect and/or libidi­ It is a very remarkable thing that the Vnc. of one nal gratification. human being can react upon that ofanother, with­ out passing through the C's. This deserves closer The Spiritual Dimensian ofthe ISH investigation... but, descriptively speaking, the fact Every major religion has referred to inner guidance in is incontestable. (p. 194) its teachings with its own referent identifying names (e.g., the Spirit ofChrist, the Atrnan, God within, etc.). Most peo­ Ogden (1990) viewed projective identification as "pre­ ple do believe in the existence of God (Kroll & Sheehan, dominately a communication between the unconscious of 1989) and, therefore, therapists can assume that most peo­ one person and that of another" (p. 79). Neither patient ple have a spiritual interest. With the notable exception of nor therapist can articulate the precise way in which the Bowman (1989), little has been published concerning the communication occurs. Projective identification, parallelpro­ spiritual experiences of dissociative patients. The relative cessing, patient projection, therapist introjection, therapist discomfort of therapists in addressing spiritual issues may projection, and patientintrojection imply the actual passage have complicated, delayed, or prevented the acceptance of ofpatient internal experience to the therapist on an uncon­ the concept ofthe ISH because early descriptions ofthe ISH scious level with whatever is transmittedfrom patientto ther­ so frequently included a spiritual dimension. In the early apist neither transmitted nor received on a conscious level. descriptions ofISHs, the aspects ofinnerwisdom and ofspir­ Some therapists attempt to understand unconscious to ituality seemed to have been dissociated into the same struc­ unconscious communication as ISH-to-ISH communication. ture, the identified ISH. Allison (1980) saw a strong con­ Suchexplanations,while admittedlynotdemonstrable, offer nection between the ISH and God: "I see it (the ISH) as that the possibility ofworking toward voluntary and intentional part ofthe mind through which God is revealed to the indi­ control over such communication, rather than abandoning vidual" (p. 109). He continued, "They [ISHs] feel only love it to the realm ofthe inaccessible, and responding to rather and express both awareness ofand beliefin God. They serve than directing this process. Admittedly, such thoughts are as a conduit for God's healing power and love" (p. 131). completely speculative. Fraser (1989) found both believers and non-believers in the ISHs he met: ''The center ego state has an ability to look Informatian Sharing at things philosophically as well as religiously, but I have Because the ISH is thought to have access to the mem­ known atheist ISH ego states ... religious beliefs are depen­ ories of the person as a whole as well as to the memories of dent on the background of the patient" (personal commu­ each alter individually, and because each alter knows a rel­ nication, 1989). Ross (1989) voiced a conservative view of atively small part of the real history of the patient, one of the spiritual aspects and/or abilities of the ISH. "It is my the most frequently requested clinical applications ofwork experience that centers and inner selfhelpers can be excel­ with the ISH involves its sharing information (Allison, 1980; lent co-therapists, but they do not have transcendental abil­ Comstock, 1985, 1987, 1988, 1989; Fraser, 1985, 1986, 1987; ities" (p. 35). Putnam, 1989; Ross, 1989). I have observed some ISHs similar to Allison's ISHs and Memory is not infallible (Loftus, 1991). Hypnosis does someISHs who notonlydo notbelieve in Godbutare angered not add to the reliability of retrieved memories, but does by the thought of the possible existence of a god who per­ increase the subject's confidence, rightlyorwrongly, in their mitted them to suffer as they did. In many patients, the ISH accuracy (Orne, 1959; Petinatti, 1988). Therefore, the reli­ does seem to be that part ofthe person most apt to deal with abilityofrecoveredand abreacted memoriesremainsanopen spirituality in a relatively undistorted manner (ifany part in question. Itis notknownfor certainwhetherincidentsreport­ that patient is apt to do so). ed by the ISH are more or less reliable than incident reports Allison (1980) did most of his writing during his first of any other person, but clinical experience indicates that years ofwork with MPD, and he may no longer subscribe to the reliability of the ISH reports is likely to be a great deal some ofwhat he believed in those early years. He wrote:

170 DISSOCIATIOI\'. Vol. IV, :-,roo 3. September 1991 The challenge offormulating a methodology and The ISH cannot cure the patient, cannotcontrol an indi­ the necessity of discarding it when it is no longer vidual alter's cognitive processing, or alter entrenched char­ applicable is an integral part of such pioneering acter pathology. However, the ISH's skills and talents can work. I have already found it necessary to revise help the healing process, and the therapist can help the ISH some ofmy early theories and I'm sure this process learn to help the patient, just as non-dissociative patients will continue as longas mywork continues. (p. 202) utilize their observing egos. Dissociation as a defense is only one portion ofthe dif­ Allison (1980) acceptedhispatients' statementsoftheir ficulty the MPD patient presents. MPD originates in child­ experiences quite literally, ~ many originally tended to do. hood, usually as a result ofexogenous trauma (Braun, 1986; He had come to believe patients' reports ofspirit possession Coons, 1986; Greaves, 1980; Kluft, 1984; 1985b; Putnam, as genuine, although he also considered the possibility that 1989; Ross, 1989). Italso haselementsofPost-traumaticStress there was something about the psychic make-up of MPDs Disorder, components of character pathology, and severe that made this particular explanation of their experience developmental gaps and disturbances. The ISH can be most more plausible to them. helpful in addressing and facilitating the remediation ofthe dissociation and the PTSD aspects ofthe disorder. The char­ Repeatedly, I encounteredaspectsorentities oftheir acterological aspects ofthe pathology must be treated in the personalities that were not true alter personalities. usual therapeutic manner over the usual length oftime with It is, ofcourse, possible that multiple personalities expectations ofencountering even more than the usual dif­ are particularly susceptible to such delusions. But ficulties. Although the ISH can make treatmenteasier, itcan­ in many of these cases, it was difficult to dismiss not make it easy. theseunusual andbizarre occurrencesas mere delu­ Thefollowing observationsare drawnfrom clinical expe­ sion. In the absence ofany "logical" explanation, I rience. The ISH is capable of making decisions, initiating have come to believe in the possibility ofspirit pos­ actions, and implementing plans. Potential ISH actions session. (p. 183) include observing ego functions such as analyzing and eval­ uating, the provision of pertinent information to the ther­ Post-integration Experiences wiOl Ole ISH apist or to the patient, the offering ofsuggestions to solve a Because the ISH is conceptualized as a dissociated ego problem or to understand an alter, the orientation of an state, final integration changes both the expression of the alter, the prevention and/or management of a crisis, the ISH and the therapist's experience with the ISH. Allison selection and implementation ofa variety ofinternal adjust­ described the integration process in psychological as well as ments to alter perception or experience, the management spiritual terms. He viewed psychological fusion as the step ofabreactions, the education and management ofthe alters, in which the personalities are gradually merged until only and the blending of alters. Although the ISH cannot pre­ a single personality and the ISH are left. Spiritual fusion, vent denial, suppression, re-repression, or splitting (except then, was the fusion between the remaining personality and for a brieftime), the ISH can hold a picture, a phrase, a feel­ the ISH, a process which could take1place quietly and almost ing, or a lesson in mind to make it more difficult for the imperceptiblyorcould take place dramaticallyamidstvisions alter to deny, suppress, or re-repress the experience. In addi­ and forceful spiritual experiences. tion, the ISH can hold affirmations orother positive thoughts Followingintegration, bothAllison andFraserhave com­ ormemoriesin mind to provide some positive feelings and/or municated directly with the ISH. Fraser wrote, "Even after thoughts. The ISH can remove or block out certain thoughts fusion, I have been able to contact the center ego state with for a time to allow developmentofan alternativeway ofthink­ hypnosis or guided imagery... I believe it remains separate ing. in its role as the observing ego" (personal communication, The ISH can alter memories if requested, but substi­ 1989). tuting therapist-ereated illusion for patient-created illusion I have not had contact directly with an ISH following is not a reasonable therapy goal. The ISH is most apt to be integration. I see the abandonment ofdissociative defenses involved and interested in the internal experience of the as a gradual process, with separateness possibly recurring patient rather than in external life events. This can be dis­ during stressful life episodes. Therefore, I would not be sur­ concerting to a therapistwho mightexpectan ISH to restrain prised to contact an ISH during a particularly stressful time an alter from prostitution or some other activity the ISH has after integration, nor would I expect the ISH to remain sep­ long ignored. Familiar activity is not perceived as an imme­ arate once the stressful time had passed. Those who are con­ diate threat by the ISH. servative in their understanding of the ISH would question whether an integration that left an ISH separate is a true The Use ofOle ISH as Organizing Force integration, and would regard the re-emergence of an ISH The therapist's ongoing work with the ISH can begin as a simple relapse. to develop an organizing force within these chaotic patients to which the alters relate and around which they can coa­ lesce. Therapists who remind the patient ofthe presence of CliNICAL UTILIZATION OF THE ISH the ISH by asking qm;stions concerning the ISH's percep­ tionofa still mysteriousfeeling orperplexingsituation encour-

171 DISSOCIATION. Vol. IV. No.3, September 1991 INNER SELF HELPER

ages the patient to appreciate that a portion of their minds ing an alter distracted by a somewhat mindless activity such is engaged in a rational, thoughtful analysis, no matter what as showering or driving allows the ISH an opportunity to slip their subjective perception is at that moment. thoughts ofideas into the patient.Journal writing is anoth­ The ISH can act as a transitional object or an anchor, er activity that affords the ISH a vehicle with which to com­ as a portion of internal reality to which the alters can cling municate with all or with a part ofthe patient. The ISH may when their newly emerging and quickly changing senses of insert information or supportive statements into an ongo­ selffluctuate. The ISH's positive attitude towards each alter ingjournal. and towards thewhole can begin to create an accepting inter­ At times, it may not be clear whether or not a message nal atmosphere that will be ultimately productive for the is coming from the real ISH or source of inner guidance. If patient. It may seem strange to a therapist who values intro­ the messages are practical and clear, it probably does not spection that MPD patients do not easily internalize the pi:tt­ matter if they are coming from the true center or another tern of turning inward for answers or direction. This is not helper. Ifthe messages do not evidence a positive and help­ an easily learned process for the MPD patient. ful attitude, distortion or misrepresentation is occurring. Communication with the ISH can occur verbally, but Communication with the ISH canoccurnon-verbally through intuition,a hunch, afeltsense Obviously, one of the first tasks to be negotiated in ofknowing, projection, projective identification, parallelpro­ learning to work with an ISH is learning to communicate cessing, or any other form of patient unconscious to thera­ with it. During treatment, the therapist will want informa­ pist unconscious communication. From the perspective of tion and/oropinionsfrom the ISH. However, itis more impor­ those who find the ISH concept useful, the clinician who tant for the patient to communicate with the ISH. The ther­ assumes thatunconscious orISH communication is random, apistcan setthe stage for communicationwith a briefgeneral arbitrary, anduncontrollable loses an opportunity to explore statement describing the ISH or a part of the person with ordevelop this avenue ofcommunication. The therapistwho access to information which is not readily available to all proposes that this process can be initiated or influenced by alters. He or she can refer to that part as the unconscious a portion of the patient utilizes an opportunity to encour­ mind, a sort of inner guidance or observing ego, or a part age communicative efforts by the patient and an opportu­ that can communicate with all of the alters and may com­ nity to make an unconscious process conscious. Making the municate directly with the therapist or may communicate processexplicitcanoften provideenoughheightenedaware­ through other alters. The therapist ought also to include ness and attention so that the ISH can exercise more inten­ the possibility that the ISH may not communicate at that tionality in the transmission or the withholding of commu­ time. Often, the system recognizes the ISH immediatelyfrom nication. the description and may refer to that part with a name, as a color, a sense, ~r even a shape. Caul (1978) advocated the Response ofthe Patient energetic pursuit of the ISH: The response of the patient to the presentation ofthe concept of the ISH reveals a great deal about the patient's The Inner Self Helper (ISH) should be identified internal emotional world and also provides some pertinent as quickly as possible. The therapist must not be clues concerning the possible form the resistances to its use afraid to horse tradewith the ISH, who will always be will take. Patients' responses to the concept vary from com­ protective ofthe personalities and will see to it that fortable, immediaterecognition andacceptance to fear, anger, therapy is provided and that the personalities will and refusal to consider such a possibility. Overly compliant get the best deal possible. (Caul, p. 2) patients may produce a representation of the ISH from a helping alter. Indicating that the ISH may not reveal him­ In early treatment (when there is little co-conscious­ selfor herself directly to the patient or to the therapist may ness among alters), the therapist's direct communication help to minimize this possibility. Patientswho arefrightened with the ISH may be more important than when the task of by the ISH concept may experience the suggestion as a crit­ askingquestions and listeningfor answersgraduallyhasbeen icism of the way in which they are presently managing, as a turned over to the patient. Initial communication between demand to function beyond their abilities, as a hint there is patient and ISH need not include a dramatic presentation something weird or foreign inside them, or as an indica­ of the ISH. It may be dramatic, but more likely, the patient tion/promise that the therapist can read their minds and will first experience the presence of the ISH as a hunch, a will know them better than they need know themselves. physicalfeeling, an ordinaryvoice, a sudden thought, a phrase Patients whovehemently resist theideaoflisteninginside ofa song, poem, or prayer, a picture, a memory ofa scene, give clues to theways theywill express theirresistances through­ or a pervasive feeling of peace or comfort. out therapy. They may be externalizing their present inabil­ In the early stages of communication between patient ity to resolve their struggle between two opposing desires: and ISH, the alteration in focus of attention from external on the one hand, to be taken care ofand, on the other hand, to internalmayresultin the unintentionalswitchingofalters. to learn to take care ofthemselves. Many patientsenter treat­ It may take practice before an alter can both remain pre­ ment with the hope (often unconscious) that they can final­ sent and listen inside. Communication by the ISH to other ly find someone who will take care of them. Intensely desir­ alters may take place in seemingly casual times. It is as ifhav- ing to be cared for by the therapist, they energetically resist

172 D1SS0CLUIO:\. Vol. IY. ~o, 3, September 1991 anyinstructionsorsuggestionswhichwouldnecessitate their ings behind crises does reduce the intensity of feelings for takingactive responsibilityfor theirown progress. Theyseem the patient by discharging the affect rather than containing to believe that ifthey can get someone to love them enough it. Crises also provide a metaphorical way of communicat­ or care enough, the pain from having received inadequate ing with the therapist concerning the patient's deep feel­ love as children would not be as great (Krystal, 1988). ings orintentions. However, obviously, once the feelings are One aspect of the difficulties of MPD patients is their acted out, they are no longer available for exploring, resolv­ striking inability to either tolerate or mODulate their feel­ ing, or understanding. The ISH can clarifY the underlying ings. Often a strong feeling (or even the merest beginning dynamics of approaching crises so that they can be talked ofa feeling) is a trigger to switch personalities, to lose it and about rather than acted out. Once the cause of or the pur­ fall into a flashback, to drink, to take drugs, to self-mutilate, posefor the crisis is known, the immediate therapeutic issues to contemplate suicide, or to hurt someone. Patients trau­ are usually quite clear. matized as children were so overwhelmed with intolerable Personalities in crisis often are personalities disorient­ feelings that theyresponded eitherbynumbing all theirfeel­ ed in time and/or place. They maybe having hallucinations, ings, by becoming helplessly overwhelmed by them, or by experiencing painful somatic sensations, acting out or re­ alternatingbetween these two responses. Childrenwho have experiencingportions oftheir pasts, and/orliving in a flash­ never learned self-soothing or self-nurturing skills perceive back world (Loewenstein, in press). A personality threat­ all control over their internal states as externally provided ening violence to self or others acts as if he or she assumes (Krystal, 1988) . Manyremaindependent onexternalsources that the hostile, abusive, and dangerous past not only needs such as chemicals, food, sex, or self-mutilating behavior to to be but also can be dealt with in the present time. The ISH alter their internal states. The use ofmusic, relaxation tapes, can help to explain the situation to both patient and thera­ and/or small transitional objects can provide an external pist and assist in re-orienting the personality to the present permission to alter their internal state. The clinical use of time, a time in which violent behavior is neither necessary the ISH as an interim separate-and-therefore-not-perceived­ nor helpful. Although the personality may not be willing or as-internal source of permission can begin to develop the able to recognize the past as past, the ISH at least cqn pre­ natural self-regulating functions so long prohibited. sent a representation oftoday's reality to the patient so that the patient will have two pictures in mind rather than one. The Orientation ofNew Personalities The therapist can make suggestions to the ISH concerning The ISH can help to short-eutrepetitive tasks thatmight phraseswhich could be repeatedinternally orrelevantscenes be time-consuming and/or co-opted in the service of resis­ which could be presented to begin to re-orient the person­ tance, such as the orientation of new personalities. Some ality. Conflicting realities are an improvement over a non­ dissociative patients present a seemingly never-ending sup­ existent reality. ply ofpersonalitieswho experience themselves as never hav­ Active therapist intervention can be more helpful at ing met or been aware bf the therapist. When a new per­ the beginning of treatment when the patient is beginning sonality emerges during sessions, the ISH can be asked to to learn the process of healing and integrating. As therapy orient the personality to the office, to the therapist, and to progresses, the therapist may make fewer and fewer direct the purpose of therapy. This may be communicated very suggestions. rapidly and accepted far more readily than it might be from an external source, such as the therapist. Once this orien­ Internal Adjustments: Hypnotic Interventions tation process has been implemented a few times, the ISH Therapistsworkingwith the ISH offer manyofthe same can begin to orient an emergent alter or one that has been suggestions, comments, and interpretations as do hyp­ unaware of the therapy before she or he gets to the office. notherapists who do not use the ISH construct. A major dif­ With unnecessarilyrepetitive interactionsavoided, alterscan ference in approaches lies in the attributing ofaccomplish­ move more directly toward involvement in the therapeutic ments to a part ofthe patient rather than to hypnosis or the process. Here again, the use of the ISH to orient the alter therapist. There are many excellent compilations of hyp­ encourages the patient to develop and then to rely on her notic interventions useful in the treatment of MPD (Bliss, own internal resources rather than to rely primarily on the 1986; Braun, 1980, 1984, 1986; KIuft, 1982, 1983, 1985a, 1985c, therapist. A patient's inability or unwillingness to do this 1989; Putnam, 1989; Ross, 1989). KIuft's (1989) article is a demonstrates either the internal strength of the patient's valuable compendium of suggestions to alter the affective prohibition against self-care, or the depth of the patient's experience ofthe patient. The readeris encouraged to study determination to create a childlike dependence and make the hypnosis literature in order to understand the rationale of the therapist a substitute parent (Barach, 1987). behind the different types of hypnotic interventions possi­ ble. Most hypnotic interventions, designed to work quickly Crisis Management and/or Prevention to resolve a specific problem, work best for short periods of ISHs maybemetmorefrequently during times ofcrises. time. Although they may not solve problems, that they can Crises (in the patient's eyes) include events, actions, impuls­ postpone acting out until the problem can be solved is most es, memories, upcomingabreactions, orfeelings experienced helpful. as overwhelming. Crises (in the therapist's eyes) include poten­ General hypnotic techniques can be easily altered to tially dangerous actions by the patient. Acting out the feel- fit MPD patients. Common sense additions include the pro-

173 DISSOW.TIO:\. Vol. IY. 1\'0. 3. September 1991 energies of those parts. Any blending images that appeal to Allison, R.B., & Schwarz, T. (1980). Minds in manypieces. New York: the relevant alters can be used to facilitate this process. This Rawson, Wade. can be helpful in a variety ofsituations including crisis man­ agement, learning experiences, calming, or re-orienting an Assagioli, Roberto. (1965). Psychosynthesis: A manualofprinciples and alter, or offering additional energy to a depleted part in a techniques. New York: Viking Press. process similar to Fine's tactical integration (KIuft, 1988). Augustine, St. (1972). City ofGod. (Trans. H. Gardiner). New York: Obviously, each of the involved parts must be willing to par­ Pocket Books. ticipate in the blending, although it can be done when one partis tooyoung ortoo disqriented to participatein an active Barach, P. (1987, November). Transferencere-enactmentsofchildabuse fashion. Personalities who have blended and then separat­ in the treatment ofmultiple personality disorder. Paper presented at the ed again will have a different cognitive and emotional expe­ FourthIntemational Conference onMultiple Personality/Dissociative rience following the blending experience. Itis as iftheyhave States, Chicago, Illinois, been irrevocably influenced by another portion of them­ selves, and now share more ofa common consciousness and Barkin, R, Braun, B.G., & KJuft, RP. (1986). The dilemma ofdrug common experience. therapy for multiple personality disorder. In B.G. Braun (Ed.), Treatment ofmultiple personality disorder. Washington, DC: American Psychiatric Press. Post-integration Following final integration, the experience ofrelating Beahrs,]. (1982). Unity and multiplicity: Multilevel consciousness ofself to the ISH will change, for both the patient and the thera­ in hypnosis, psychiatric disorder, and mental health. New York: pist. The patient's experience ofhis or her selfhas changed. Brunner/Mazel. Communication with the ISH will still occur, but it will not beexperiencedas communication between two separate parts. Beahrs,]. (1986). Limits ofscientific psychiatry: The role ofuncertainty It takes place more in the form of felt senses, answers, or in mental health. New York: Brunner/Mazel. hunches. An integrated patient may be able to speak from an ISH ego state in trance (Watkins, 1982), but this state Bliss, E.L. (1986). Multiple personality, allied disorders and hypnosis. New York: Oxford University Press. does not remain obviously separate outside of the trance experience. An integrated multiple seems to experience an Binet, A. (1986). The psychology ofreasoning. Paris: Alcan. ISH in much the same way'that other people experienced their own inner guidance. Mter integration, the therapist Bowman, E.S. (1989). Understanding and responding to religious may leave the question of consultation with the ISH to the material in the therapy ofmultiple personality disorder. DISSOCI­ discretion of the individual to manage the communication ATION, 11,232-239. within himselfor herself in his or her own way. Braun, B.G. (1980). Hypnosis for multiple personalities. InH, Wain ( CONCLUSION (Ed.), Clinical hypnosis in medicine. Chicago: Year Book Medical. Braun, B.G. (1984). Uses of hypnosis with multiple personalities. As is true of any psychological assumption, the exi~­ Psychiatric Annals, 14,34-40. tence ofthe ISH can neither be proved nor disproved defini­ tively. However, there is sufficient and reasonable historical Braun, B.G. (1986). Issues in the psychotherapy of multiple per­ and clinical evidence to suggest that such a structure can sonality disorder. In B.G. Braun (Ed.), Treatment ofmultiple person­ exist and can be demonstrated to be ofbenefit. In the past, alitydisO'rder (pp. 3-28). Washington, DC: American Psychiatric Press. the concept of dissociation of the ego into the observing and experiencing ego has been observed to be therapeuti­ Breuer,]., & Freud, S. (1955). Studies on hysteria. In]. Strachey cally beneficial to the patient. The extension ofthe concept (Ed. andTrans.), Thestandardedition ofthe completepsychologicalwarks ofinner guidance into the form ofthe ISH for MPD patients ofSigmund Freud (Vol. 2). London: Hogarth Press. (Original work seems logical and corresponds to the reported experience published in 1893-1895). of MPD patients. In the opinions ofmany experienced clin­ Caul, D. (1978, May). Treatment philosophies in the management ofmul­ icians, the phenomenon ofa source ofinner guidance as a tiplepersonality. Paperpresented at the annual meetingoftheAmerican separate presentation of a psychic structure can be a clini­ Psychiatric Association, Atlanta, Georgia. cally helpful conceptualization in the treatment ofMPD/DD patients.• Comstock, C. (1985, November). Internal selfhelpers or centers. Paper presented at the Second International Conference on Multiple Personality/Dissociative States, Chicago, Illinois.

REFERENCES Comstock, C. (1987). Internal self helpers or centers. Integration. Newsletter of the Canadian Chapter of the International Society for the Adams, A. (1989). Internal self helpers of persons with multiple Study ofMultiple Personality and Dissociation. Winnipeg, Manitoba, personality disorder. DISSOCIATION, II, 138-143. Canada: 3 (1), not paginated.

Allison, RB. (1974). A new treatment approach for multiple per­ Comstock, C. (1988). The use ofthe center ego state in the treatment of sonalities. AmericanJoumal ofClinical Hypnosis, 17, 15-32. multiple personality disorder and dissociation. Paper presented at the

175 DISSOCL\TIOl\'. \'01.1\', :-.10. 3, September 1991 INNER SELF HELPER

vision of internal safe places for individual alters and com­ to understand. The working alter may not even notice that mon areas designed to encourage closenessorvisitingamong information has been shared. alters. The dual foci on separateness and togetherness The ISH can be employed to increase or decrease sen­ addressed through the creative use ofinternal space makes sations so that the personalitycan continue moving through explicit the process which is occurring implicitly. Common the memory. Although the ISH can make other changes in sense exclusions for MPD patients might include beds, base­ the experience, interventions are more useful once the per­ ments, smaU spaces, and the avoidance of images such as sonality has completed the abreaction and is free to attend candlesorropeswhich mightbe threateningfor some alters. to the whole picture. The therapist can use the observations of the ISH to Another effective ISH-facilitated alteration comesfrom help determinewhathypnoticinterventions mighthelp. The the MPD patient's experience ofobserving an incidentfrom ISH is usuaUy not aware of the wide range of possible solu­ several perceived-as-different points ofview. During or after tions known to the therapist. Together, the ISH and the ther­ an abreaction, the ISH can superimpose a more realistic view apist may decide upon an appropriate course ofaction that of the situation on the personality's perception of the situ­ the ISH can implement. Mostofthe stepssuccessfuUy accom­ ation so the personality can observe the incident from two plished by the ISH involve self-suggestions that utilize exten­ different points ofview. This is particularly helpful for those sions or alterations ofnaturaUy occurring phenomena in an personalities who aUege they were rituaUy abused, involved intentional manner. The use of time distortion interven­ with drugs, and/or subjected to the intentional creation of tions for a system of alters that already exists in a time-dis­ delusion or magic to confuse or dominate a child person­ torted world is easily implemented. When it might be ben­ ality. eficial for an alter to age-regress or age-progress, the ISH can Mter an abreaction, the personality thatabreacted can help. Altering the perception ofaffect in a person who has check insidewith the ISH to make certain that everything that experienced both overwhelming affect and total numbness needed to be seen has been seen, everything that needed to is similarly familiar and replicable in the source of a thera­ be felt has been felt, and that everything that needed to be peutic intervention. learned has been learned so that the personality does not In theEricksonianapproach (Erickson, 1965/1983, 1979, need to abreact the incident further. Often I, the ISH, or 1981), it is assumed that somatic symptoms have a purpose. the abreacting personality wiU restate the lesson so that we For example, pain may remind one to slow down, to remem­ can be certain we have not missed anything significant. bersomething, to learn orrelearn something, to thinkabout something, to attend to some partorissue inside. Headaches Dreams may be signs of conflict between alters, between remem­ Often the ISH can create or influence dreams to offer bering or forgetting, between accepting or denying some­ a lesson in another, perhaps more palatable form, or to pro­ thing, between remembering and re-enacting, and between vide comforting experiences the patient neither is having containing and acting out. The ISH can help to translate the nor has had. The ISH can provide one dream for one per­ physical sensations into messages, meanings, orinstructions sonality, many different dreams for many different person­ for a part or the whole. The ISH can alter the perception of alities, or one dream for more than one personality to share. physical sensations in aU the familiar ways; but even more The ISH can stimulate the remembering and/or the for­ importantly, the ISH can explain why the symptom is pre­ gettingofsuch dreams. Freud's (1914) conceptofthe dream sent and what needs to be done about it. censor sounds remarkably similar to descriptions by MPD patients ofexperiences in which a portion ofa dream seems Abreactions to come close to the surface ofconsciousness, feels about to The use ofthe ISH is particularlyimportantin the abre­ emerge into consciousness only to disappear again, almost active process. Some therapists insist on knowing the con­ as ifsomething or someone had snatched itback down, away tent ofupcoming abreactions before theypermit the patient from consciousness. At times, an ISH reports intentionaUy to begin the abreactive work. Such therapists can learn the doing this so that one or many personalities can have had contenteitherdirectlyfrom the ISH orfrom anyalter through the experience ofthe dream without the conscious recaU of whom the ISH speaks. Therapists may also utilize the ISH the dream. This prevents the personalities from conscious­ more extensively during the abreaction process to provide ly resisting or denying the experience of the dream. information, clarity, and modulation. During abreactions, the ISH can alter the personality's perception of the expe­ Blending or Integrating Alters rience so that the personalitywiU not become overwhelmed The MPD patient with no control over his or her sepa­ by the affect and re-repress the content ofthe abreaction in rateness and dissociation faces life with, at best, limited and what becomes a re-traumatization rather than a learning often unavailable resources. Longbefore integration is near, experience. it maybe useful for alters to pool theirresources. A modelwhich Duringabreactions, the ISH can communicatewith the permits the temporary blending or integrating ofaspects of therapist. Information can be given directly or non-directly separatedpersonalitieshas beendescribed (Fine &Comstock, in relativelynon-threatening, non-intrusive, andnon-disruptive 1989). The clinician who works with the ISH perceives the ways through yes or no head movements, speaking through ISH to have the ability to effect a temporary merger of sep­ the alter, or having the alter speak enough for the therapist arate parts, blending the emotions, the contents, and the

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