Multiple Personalities: Some Psychoanalytic Listening Perspectives
Lawrence E. Hedges*
ABSTRACT: The history of multiple personality is reviewed.
Major research findings are presented and discussed along with the most
important treatment recommendations that have been made by leading
experts in the field. A radically different approach to
understanding and working with multiples is presented, one derived from
contemporary psychoanalysis, object relations, and self
psychology. The Listening Perspective approach is introduced and
the four major watersheds of psychotherapeutic listening discussed and
applied to the problem of multiples. The central thesis is that
"multiple personalities" express the emergence and creative elaboration
in the psychotherapy setting of the earliest affect-ego states, and that
they may be considered unintegrated "ego nuclei."
The History and Themes of Multiple Personality
Throughout recorded time and across all cultures, altered states of
consciousness have claimed a special place in human existence a place
often shrouded in mystery; mysticism and religious zeal. At times
altered states have been exalted to heights of cultural wisdom and
prestige as in prophets, oracles, seers and religious glossolalia.
other times altered states have been associated with evil, witchcraft,
devil worship and madness. In the twentieth century hypnosis, drugs,
and meditation have been among the more common ways of producing and
perhaps of benefiting from the effects of altered states. Such
techniques have largely replaced ritual incantations and other
rhythmical and social forms of ecstasy production and enjoyment known
The recent emergence of a large group of persons said to have
"multiple personalities" is an altered state phenomena
deserving special study. One psychiatric observer (Schafer, 1984)
estimates a rapidly increasing incidence of persons experiencing
multiple personalities, numbering more than 50 per million in Southern
California which makes multiple personalities hardly rare.
As an observer who is neither an enthusiast of mysticism nor a
skilled practitioner of hypnosis, I would like to examine a few aspects
of altered states as they appear repeatedly in the psychotherapeutic
consulting room. I will begin with a historical survey of how altered
states have been considered in the past several decades in American
psychiatric nomenclature. I will review some of the salient themes
appearing in recent research and clinical lore having to do with
multiple personalities. I will then explain the context out of which my
own interest in "multiple personalities" has grown and
summarize my own listening perspective approach which promises a fresh
vantage point from which to consider some altered state phenomena.
Brief Historical Survey and Research Questions
The first Diagnostic and Statistical Manual of the American
Psychiatric Association (DSM-I, 1952) reflected the general view that
"Dissociative Neuroses" are relatively rare, if not somewhat
esoteric forms of psychological disorder. Fugues, amnesias,
sleep-walking, sleep talking, multiple personality; and other altered state phenomena were thought to be among the manifestations
of persons who employed dissociation as a repressive defense.
general notion was that a few persons, well enough developed to merit
the general diagnosis of neurotic, employed dissociative mechanisms in
the service of fending off unwanted or unacceptable ideas and impulses.
Dissociation was formulated as a "vertical" splitting of the
personality; that is, a temporal or contextual separation or walling off
of one or several aspects or constellations of personality from other
aspects. Vertical splitting was thought to contrast with the more
widespread concept of repressive "horizontal" splitting, that
is, a separation of so-called conscious from unconscious personality
manifestations or constellations.
It was thought that The Three Faces of Eve (Thigpen & Cleckley,
1957) and similar rare cases could be understood as basically neurotic
phenomena in a personality prone to repressive vertical splitting.
more or less intact ego structure was assumed to be present in neurosis,
the expectation was that such splits would be restricted in number to
one or possibly another. That is, the assumption of good ego development
in neurosis would be considered contradicted if extensive vertical
splitting occurred so that a character diagnosis more in the direction
of psychosis would be in order if many splits were in evidence. For
example, the later reported and widely publicized case of Sybil
(Schreiber, 1973) could hardly be considered an instance of repressive
The fate of the "dissociative neuroses" of the 1950s
appears to have paralleled in American psychiatric history the fate of
all the neuroses a radically diminished reported incidence over time.
Since the dissociative pictures were already the rarest, they were the
first to go. In DSM II (1968) dissociation was collapsed as a category
into a subspecies of the broader class of "hysterical
neurosis." Whether the number of diagnosed neuroses have diminished
in proportion to the character disorders, narcissistic constellations,
and borderline states because of cultural changes, conceptual advances,
refinements in diagnosis, alterations in therapeutic practices, or
fluctuations in psychiatric fads is still up for debate.
Elsewhere I have detailed the powerful arguments for continuing to
consider certain styles and levels of personality organization as Oedipal-neurotic even if contemporary
understanding of pre-Oedipal development modifies the way neurotic
constellations are considered (Hedges, 1983b). A spatial metaphor for
considering dissociation as repressive activity was involved in
conceptualizing the "span" of the ego. The reasoning was that
certain (potentially traumatic) impulses, ideas, and experiences which
belonged to conscious awareness could not be contained" or
"integrated into" the existing ego span (Cameron, 1963).
because these selected psychological contents or experiences were so
powerful they could not be relegated easily to unconsciousness, they
were thought to become "dissociated" with their manifestations
appearing only in altered states of consciousness.
This way of thinking about dissociated experiences has a certain
clinical appeal. For example, I recently consulted on the psychotherapy
of a bright, lovely, shy, and markedly "feminine" little girl
aged seven-and-one-half whose presenting complaint was nightly
sleepwalking and sleep talking. The child was also requiring special
education procedures for problems in learning. By day, this sweet,
extremely pleasant, delicate little girl charmed everyone. At night she
stalked angrily to her mother's bedside to scream obscenities,
accusations, and dreadful names. It seemed no mystery that such feelings
and words could not be easily integrated into her kind and gentle waking
personality. The approach taken by her play therapist was to verbalize
even the most subtle nuance of negative affect which conceivably could
be a part of the various play situations the child created. The results,
as anticipated, were that the shy; quiet little girl gradually became
more certain of herself and assertive in her general approach to life.
Verbalization of her disagreeable affects first appeared in the mouths
of little boy dolls before fathers, mothers and little girls were able
to express such intense, aggressive feelings, or forbidden thoughts.
Needless to say, her learning problems cleared as she was able to be
more aggressive in her approach to learning materials and in her
challenge to her mother and her (woman) teacher. She was extremely
bright and quite bored with the simple tasks she had been presented to
learn at home and at school. Soon her reading and mathematics soared
above her classmates and her parent, teacher, and peer relationships
became drastically improved.
Similar dissociations are by no means uncommon in clinical practice
and a wide variety of expressive techniques have been employed by
therapists of all persuasions with similar favorable results. The
general formulation would be that expressions of assertiveness and
negative affect had become unacceptable to this little girl, perhaps
because of her associations to the meanings of masculinity or her wish
not to be a "nuisance" like her little brother. These
expressions might be thought of as having become repressed through
dissociation into her nocturnal activities. An expressive, interpretive
technique shed light on her impulses and inhibitions, thereby unraveling
(analyzing) the need to repress her assertiveness with its accompanying
consequences for learning activities and important relationships in
school. This sort of clinical formulation is common enough in practice
and regularly yields sufficient enough clinical gain that there is
seldom cause to question it.
Formulations of neurotic dissociation styled after DSM-I and DSM-II
specified the criterion of amnesia for all or parts of the split off
material, confirming the basic assumption that the dissociation
mechanism was successful as a neurotic defense in preventing (at least
temporally or partially) certain ideas from crystallizing in full
consciousness. A large conceptual shift occurred in DSM-III (American
Psychiatric Association, 1980) which portrayed neuroses in general as a
vanishing species and relegated advanced level repressive activities to
relative unimportance in psychiatry. The shift was partly based on the
diminishing reported statistical incidence of neurosis, but many
observers felt it was also based upon various political biases within
the psychiatric community which have placed increasing emphasis on
neurophysiological formulations in deference to psychological or
DSM-III-styled thinking virtually obliterated the notion of
dissociation as a neurotic level activity with the omission of amnesia
as a necessary diagnostic criterion. "Multiple Personality
Disorder" received its own classification under "Dissociative
Disorders" in DSM-III. Braun and Braun (1979) have provided a brief diagnostic description which incorporates the shift in
... [O]ne human being demonstrating two or more personalities with
identifiable distinctive and consequently ongoing characteristics each
of which has a relatively separate memory of its life history ...
[T]here must also be a demonstration of the transfer of executive
control of the body from one personality to another (switching).
However, the total individual is never out of touch with reality.
host personality (the one who has executive control of the body the
greatest percentage of the time during a time) often experiences
periods of amnesia, time loss or blackouts. Other personalities may or
may not experience this.
Does this shift in diagnostic thinking mean that dissociation cannot
be nor perhaps ever was a form of repressive activity and that multiple
personality involves more primitive splitting processes which are
predominantly preneurotic? And, how are we to consider the radical
increases in reported incidence in recent years? In what ways have the
repeated showings of Sybil and other altered state adventures on network
television and widely publicized court defenses affected the emergence
of altered states in the therapeutic situation? And do multiple
personalities represent (as some observers suggest) an iatrogenic effect
of a therapeutic technique (such as hypnosis) which tends to encourage
or at least permit the therapeutic experiencing of altered states?
DSM-IV (American Psychiatric Association, 1994) continues to remind
us that diagnoses used in psychiatry are not constant and unchanging
scientific findings, but rather are the product of a myriad of forces
operating within the socio-politic-economic purview of psychiatry.
Multiple Personality has now disappeared completely as an official
diagnosis. We now see a series of "Dissociative Disorders"
which are characterized by "a disruption in the usually integrated
functions of consciousness, memory, identity, or perception" (p.
477). Amnesias, fugues, identity, and depersonalization disorders
are all formulated to be the product of dissociation. The essential
feature of Dissociative Identity Disorder is "the presence of two
or more distinct identities or personality states (criteria A) that
recur and takes control of behavior (criteria B). There is an inability
to recall important personal information, the extent of which is too great to be explained by
ordinary forgetfulness (criteria C). The disturbance is not due to the
direct physiological effects of a substance or a general medical
condition (criteria D). In children, the symptoms cannot be attributed
to imaginary playmates or other fantasy play" (p. 484).
Further, "Each personality state may be experienced as if it has
a distinct personality history, self-image, and identity, including a
separate name. Usually there is a primary identity that carries the
individual's given name and is passive, dependent, guilty, and depressed
... Individuals with the disorder experience frequent gaps in
memory for personal history, both remote and recent ... The number of
identities reported ranges from 2 to more than 100. Half of reported
cases include individuals with 10 or fewer identities" (p. 484).
The DSM-IV also indicates that Dissociative Identity Disorder may be
a "culture specific syndrome" in the United States. It is
diagnosed three to nine times more frequently in adult females than in
adult males with females averaging 15 or more personalities and males
averaging approximately 8. The diagnostic manual indicates that the
presence of a true identity disorder must be "distinguished from
'Malingering' in situations in which there may be financial or forensic
gain and from 'Factitious Disorder' in which there may be a pattern of
help-seeking behavior" (p.487). Obviously psychiatric thinking
about the nature of multiple personality continues to evolve, especially
with the escalation of reported incidence in the United States.
Salient Themes from Clinical Research and Lore
devoted its January, 1984 issue to a series of
updated reports from prominent researchers and clinicians in this area.
Donald Schafer in June, 1984 has reported on his impressions from a
long-term multiple personality study group which he heads. Since that
time a mushrooming literature suggests a marked increase in the
frequency of multiple personality diagnosis. Most authors in one way or
another attribute this increased frequency to increased sensitivity on
the part of members of the therapeutic community. The effects of media information on the clinical
population seem to be, "it is okay to be a multiple, there are
others like me." But some observers question even if multiple
personalities exist or if the idea represents some sort of ruse people
use to get off the hook for things they do. Legal implications regarding
personal responsibility for activities sometimes cloud clinical issues.
The vast majority of reported cases are women (9 out of 10 or at
least 4 out of 5). The chief etiological hypothesis is exposure to
overwhelming experiences in early childhood, usually of a violent,
intrusive sexual nature. The supposed early traumas are often reported
as some form of incest perpetrated by an older male, though mothers or
other women are frequently named as co- or passive collaborators. More
recently multiples have claimed memories of satanic ritual abuse or
abductions by space aliens. Frequent homosexual themes are said to
appear in male multiple personalities and are presumed etiologically
related to the maleness of the molester. No other significant
etiological hypotheses tend to be cited in the literature though direct
trauma or abuse often cannot be confirmed and corroborating evidence of
satanic cults and alien abduction is lacking. The possibility continues
to arise that, since the therapist expects to hear of early abuse, the
person produces it certainly a possibility that has been noted often
enough in other kinds of therapeutic research. In the earlier literature
persons with multiple personalities are generally spoken of as being
exceptionally intelligent with IQ's often estimated to exceed 130,
though that factor is not emphasized so much recently. High intelligence
has sometimes been postulated as a key factor which kept the person from
becoming seriously psychotic (Schafer, 1984).
The central dynamic universally cited is that at the moment of severe
stress part of the personality defensively splits off. Altered states
are said to emerge for the "purpose" of avoiding traumatic
(sexual or violent) overstimulation. The effect of the split in terms of
pervasiveness is said to range on a continuum from most of the person's
conscious life to only occasional dissociations under conditions of
severe stress in an otherwise intact personality. Schafer (1984) states,
"a personality comes into existence when the personality already in existence can no longer tolerate the world.
personality may then be brought back in parallel emotional
Researchers are not altogether clear on the nature of subsequent
additional splits whether later traumas which are different in character
tend to produce altered personality states compatible with the type or
source of the new trauma or whether splitting simply becomes adopted as
a style with later splits representing attempts to cope with other
aspects of one's personality. In using the concept "defense" as
a cause for splitting, researchers neglect to differentiate between
"defense" meaning fending off real intrusions, and
"defense" as used in the more traditional sense meaning
fending off unconscious wish/fear contents or psychic conflicts of
various types. The diagnostic and therapeutic approach most often
described is based upon the assumption that there was, in fact,
traumatic abuse and that therapeutic benefit comes through encouraging
repeated abreactions related to the supposed traumas. Since traumatic
etiology and cathartic therapy approaches have repeatedly been found to
be oversimplified in other areas of psychological research, they
certainly must be questioned as the best explanatory hypotheses or
treatment approach in multiple personality as well.
Much to their credit, hypnotherapists appear to have recognized the
highly hypnotizable nature of this clinical population early on. This is
no doubt partly because hypnotists are trained to be sensitive and
responsive to alternating states of consciousness. Perhaps they also
tend by virtue of training to be more comfortable, or at least less
upset, than the average therapist when strange or contradictory mental
states begin emerging in psychotherapy. Perhaps hypnotherapists have
less of a need to observe monistic, consistent personality functioning
than other groups of psychotherapists. Responsible hypnotherapists are
sensitive to the limits of hypnosis as a technique and are judicious in
its application in psychotherapy. Braun (1984) states:
I withhold the use of hypnosis until I have exhausted other means.
One consideration is to avoid difficulties and criticism (including
artifacts). A more substantial reason is that since these patients
have been abused, I do not want to do something abruptly or early on
that might be perceived as another assault. Spending extra time in observation and
building rapport is generally worthwhile (p.35).
There also seems to be a general awareness in the hypnotherapy
community that, especially with the multiple personality population, the
hypnotic trance experience itself can be used as a way of evading social
or unconscious issues. Conversely, Braun (1984) notes that "heterohypnosis
may facilitate rapport via its association with autohypnosis which has
rescued them so many times before from overwhelming circumstances"
(p.36). There is limited recognition in the literature that hypnosis
itself might replicate whatever early trauma the person might have
experienced in the past. That is, the hypnotist may be unwittingly
repeating the intrusion.
The assumption of an abusive etiology in early childhood suggests to
many therapists a definite therapeutic direction remembering and
abreacting to the early trauma(s). In using this approach, therapists
stress the importance of establishing rapport and trust. They also
consider it important to establish various indirect ways of obtaining
data about the alter personalities since the main or host personality
cannot be expected to be consistent and reliable.
Kluft (1984a,b) has elaborated a number of ways of inquiring
indirectly about the alternate personalities. He suggests asking
questions about problems with memory, overwhelming experiences in the
past, or being as a child called a liar or blamed for things the person
couldn't remember doing. Questions can be asked about inner voices,
imaginary companions, and autohypnotic experiences. Since Kluft believes
most multiples had school problems, questions can address this; for
example, did the rest of the class seem to have been taught something
that the person had missed? Has the person ever found something in his
or her possession which cannot be accounted for, such as personal
articles, art work or handwriting? The therapist might inquire about
perplexing incidents in relationships such as people behaving as if the
relationship had been affected by factors they couldn't understand or
explain. Perhaps people they don't know appear to know them on occasion
and even to greet them by another name. Are there experiences of passive
influence, such as thoughts being put into the person's head, or being withheld from consciousness, or sudden
impositions of thoughts, or feelings or acts? Kluft suggests that the
person maintain a journal in which the person writes for 30 minutes a
day whatever thoughts seem to be present. Other personalities may
announce themselves in the journal.
Most earlier authors report an interval of perhaps a year or more as
not unusual before a confirmed diagnosis of multiple personality is
established. Putnam, Post and Guroff (1983) reported a median of 6.8
years from time of initial therapeutic contact to diagnosis. That time
has been shortened drastically in more recent years. Most of these
people apparently do believe that something is wrong but they frequently
cannot say quite what (Schafer, 1984). Once a diagnosis is made and/or
the alter personalities begin to appear in the therapeutic setting,
therapists typically attempt to gather as much information as possible
on the attributes and habits of the alters and eventually to establish
names, ages, life histories and times of emergence of each personality.
Keeping careful notes and even a family tree of the various
personalities has been suggested since the therapist can easily become
confused. This material is then used by different therapists in various
styles of working.
Perhaps they inform the main personality of information provided by
alters or encourage conversations among the various personalities.
the extent that the trauma theory is correct, the importance of
remembering, restoring and abreacting in some way to the traumatic scene
is assumed to be central to the course of therapy. Interestingly, both
patients and therapists often question the actuality of traumatic events
reported or relived through in the therapeutic setting (with or without
In addition to the "main," "host," or
"birth" personality, a variety of "alter"
personalities may be constellated. Sometimes these have names or telling
nicknames and may have even been thought to have participated in an
inner dialogue for years. They may have begun as imaginary companions.
Some alter personalities emerge only slowly as therapy proceeds. They
may take on designations such as "the bitch," "the
rapist, the competent one, momma's little angel," "the
anesthetic personality," "the memory trace personality,"
and so forth. There may be an opposite sex personality and perhaps even one or more homosexual or otherwise
Allison (1974) has suggested a name, "internal self-helper"
(ISH), to designate the core of the personality that desires to be
healthy. Schafer (1984) has commented that "the killer"
personality often possesses considerable strength that the therapist can
ally with. Suicidal and homicidally prone personalities often exhibit no
understanding that all of the other personalities in the same body will
be punished or die if the offending personality murders, suicides, or is
Therapists working with multiple personalities have become accustomed
to entering a subjective world in which sometimes characters
"switch" rapidly, each in turn giving its special messages to
the therapist. A therapist has more than once been used as a
"switchboard" for intercommunication of the various characters
until the time they can comfortably "talk to each other."
Most cases reported in the past have had relatively few
personalities. For example, Taylor and Martin (1944) reported that 48 of
the 76 cases they reviewed had only two personalities while 12 had three
and only one had more than eight. Among modern cases "Sybil"
had 16, "Eve" had 22 and "Billy Milligan" had 24.
Kluft (1979) reported in one study a modal range of 8 to 13
personalities in a series of 70. In a later study (1982) he reported
55.7 percent had between 2 and 10 personalities while 44.2 percent
reported 11 or more. The historical change in the number of
personalities suggests either an emergent phenomenon or increased
A certain tone often found in reports of multiple personalities may
demonstrate how difficult it is even for therapists and researchers to
completely free themselves from the amazing, awesome, other worldly,
unreal, or near mystical qualities frequently associated with altered
states of consciousness. For example, otherwise bright and objective
researchers tend to report with a tone of awe or amazement (as if to
challenge the reader's disbelief) that evoked EEG potentials, Rorschach
protocols, or EKG tracings are markedly different when different
personalities dominate. That cardiac arrhythmia or petit mal seizures
can be prevented by the person's recognizing the physiological or
prodromal signs and "switching" personalities may be presented in the literature as
for the existence of multiple personalities. Perhaps this tone derives
its justification from the numerous attacks which have been made on
practitioners involved in this area of work or some of the challenges
posed in courts of law. The existence and influence of altered states
apparently is still puzzling, troublesome, or even unbelievable to many.
Diagnostically, reports indicate that it is not unusual for multiples
to have been previously diagnosed as hysteric or phobic or to have
received any one of a variety of major (psychotic or character disorder)
psychiatric diagnoses. A wide range of somatic or psychosomatic
disorders frequently accompanies the multiple personality picture.
Psychotropic drugs are considered at times to benefit one personality
but simultaneously they run the risk of putting other personalities out
of commission so that drugs have tended to be used conservatively.
Hospitalization tends to be advisable when a controlled environment for
the expression of rage may be required or other disruptive psychotic
Kluft (1984b) proposes a multidimensional treatment approach in which
he sees the therapist's empathic capacities as often being greatly
taxed. In speaking of hospital treatment he has a series of suggestions
to make to therapists:
||A private room should be provided so that the person will have a
refuge for diminishing crisis situations.
||The personalities should be met "as they are," calling
the person by whatever name he or she desires at the moment and treating
all alters with respect.
||The therapist should not assume the responsibility for promptly
being able to recognize each alter as it emerges nor try to play dumb.
||Likely crises should be discussed with the staff in advance.
should be encouraged to phone the therapist rather than pressing extreme
measures without consultation.
The ward rules should be personally explained by the therapist
instructing all alters to listen. When amnesia or inner wars lead to
infractions, the rules should be reexplained to the offending alter in firm but nonpunitive
||The therapist should consider excusing multiples from verbal group
therapy (at least at first) since confusions often result for the
patient and for other group members. Participation in art, music and
occupational therapy groups should be encouraged.
||The staff should be warned that disagreements often arise in
planning for and working with a multiple personality. The staff should
be prepared to work through their disagreements gradually.
||Issues of greatest priority should be focused on with the multiple
rather than permitting minor mishaps to take center stage. Side issues
frequently preoccupy the multiple patient.
|| The therapist should make clear that no other person should be
expected to relate to the various personalities in the same manner as
Group therapy is often reported to be useful for increasing the time
of therapeutic contact (though not necessarily with the same therapist)
as well as letting the person know that there are others with similar
difficulties. Caul (1984) has developed an interesting ''internal group
therapy'' technique to be used judiciously. Joint patient and therapist
videotape viewings of sessions in which the alter personalities have
appeared can provide a valuable form of feedback to the patient if done
in a collaborative and non-threatening manner.
The age of confirmed diagnosis of multiple personality disorder tends
to be between 18 and 30, with children seldom receiving this diagnosis.
Early reports of treatment were characterized by extensive involvement
with the therapist over a protracted period of time. Now it is generally
believed (after Beahrs, 1982) that the therapeutic relationship can be
maintained on as little as an hour or two a week, perhaps with
additional group time. Countertransference is often viewed as a
potential danger since this population can be extremely demanding of
time and energy if reliable boundaries are not set and maintained.
Schafer (1984) sees five to seven years of several times a week
psychotherapy as not unusual therapeutic contact for functional integration to occur with multiple
In attempting to make a differential diagnosis, most authors agree
that multiple personalities are not overtly psychotic in the traditional
sense of presenting delusions and hallucinations or their affects being
radically out of control. Like schizophrenics, multiple personalities
report "head voices" but the nature and content of these
voices tends to be quite different (Schafer, 1984). Schizophrenic
auditory hallucinations tend to feature voices which are not always
identifiable or are perhaps identified as mother or vaguely as a man or
a woman who is castigating them harshly or telling them to do something.
In contrast, the head voices of multiple personalities are more likely
to have whole conversations with one another, often carrying on complex
discussions and disagreements between the characters who frequently have
names and assume various roles.
Schafer (1984) emphasizes distinguishing the true multiple from the
"pseudo" multiple. The pseudo generally has a life history of
social isolation through puberty, often having one or several imaginary
companions which at that time are thought to become "introjected as
internal characters." In contrast to the true multiple, when the
therapist "calls out" one of the personalities, the pseudo may
close his or her eyes and go through a variety of "getting into
character" rituals or fantasies. The true multiple simply opens his
or her eyes and "switches." At that moment he or she is the
other personality. Schafer speculates that the pseudos are likely to
show little real differences on EEG evoked potential or on psychological
tests when in different characters whereas pronounced differences are
reported in true multiples. Sociopaths in trouble with the law may
indeed attempt to appear multiple but Schafer maintains these can be
easily unmasked through common diagnostic procedures. On the other hand,
most psychiatrists agree that occasionally multiples can and do have
run-ins with the law when in alter personalities and since this is a
psychiatric difficulty they do have a legal right to an opportunity for
Discussion of psychotherapy with multiple personalities centers
around the notion of establishing trust so that traumatic situations
which produced the original splitting can be remembered and abreacted to.
The process is
spoken of as making possible gradual "fusion" or
"amalgamation" of personalities which finally permits a
resolution of the conflict" and ''integration of the
personalities.'' Some quasi-religious techniques are based upon mystical
or ritual exorcisms, but any apparent positive effects of these
techniques are not fully explainable at this time. Schafer (1984) makes
it clear that each personality must be valued and respected if it is to
be fully understood and finally traced to its origins, abreacted, and
Beahrs' (1982) approach in Unity and Multiplicity stresses that
complete unity is not always necessary if all of the personalities
remaining are fully aware of all of the others. His therapeutic aim is
not so much for unity as for a person who doesn't need to split
defensively, for a person who has developed new ways of handling
stressful situations. Schafer (1984) holds that every important trauma
must eventually be worked through. All reports in the literature portray
successful treatment of multiple personalities as a long and arduous
task, requiring continuous therapist availability. Availability is
especially important during the working through phases of the
psychotherapy since various personalities tend to emerge spontaneously,
giving rise to confusions of all sorts.
Wilbur (1984) formulates that:
(T)he ultimate goal is to fuse the alternates with one another and
the original personality ... Fusion begins with the coming together
of alternates who are close to one another and deal with the same or
similar conflicts and affects. ... As the affects are abreacted and
the conflicts resolved, fusion often takes place automatically. Fusion, of course, can be encouraged or facilitated by suggestion, but
in my experience fusions which occur through suggestions will come
apart more readily than those that take place spontaneously. ...
Final resolution is the result of the total integration of all
personalities into the birth personality (pp. 28-31).
Marmer (1980) has published a quite interesting and detailed case
study of a multiple personality treated with fairly standard
psychoanalytic technique. His discussion revolves around Freud's concept
of "split in the ego" and the use of self as a transitional
object. In time his patient came to use her analyst in a transitional
way which made personality integration possible.
One can see from this brief review of the salient themes in the
multiple personality literature that many questions remain unanswered
and many paradoxes remain unresolved. It is my purpose to present a way
of considering multiple personalities which is compatible with but
basically different from the approaches discussed so far. But before
going to the specifics of theory and technique I must outline briefly
the listening perspective approach which I have spelled out in detail in
Listening Perspectives in Psychotherapy (1983b).
The Listening Perspective Approach
The psychotherapeutic enterprise has been considered in a variety of
ways over the past century. Central to any discussion of the nature of
personal psychological dilemmas is the language and conceptual system in
which the issues are framed. Ekstein (1984) has noted that implicit in
each of the languages of psychotherapy and psychoanalysis is always a
working technique. That is, we formulate issues in terms which reveal
the way we work in the clinical setting. Far from being objective or
neutral, theories of psychotherapy and psychoanalysis are laden with
various assumptions, values, and implied technical approaches. For
example, Kohut (1984) has pointed out the hidden moralities in the
Freudian and KIeinian criteria for cure (i.e., adult genital
heterosexuality and post-ambivalent object relations). Kohut further
acknowledges a strong value system implicit in his own
"self-psychology" approach (i.e., mature self to selfobject
Post-Einsteinian science no longer assumes that there are
observer-free, value-free, context-free, theory-free facts, but rather
that we have defined a series of specified approaches for noting and
interacting with the realities of the universe. In translating these
notions to psychoanalysis, I have borrowed from the work of the
philosophers Gilbert Ryle (1949), Ludwig Wittgenstein (1953), Jean Paul
Sartre (1956) and J. Michael Russell (1978a, 1978b, 1980) to demonstrate
how four distinct "Listening Perspectives" have evolved in
psychoanalytic and psychotherapeutic thought over the last 100 years.2
In considering four vantage points for listening to people who
consult a therapist, I have chosen a line of consideration known as "self and object representations"
(following Jacobson, 1954, 1964; SandIer & Rosenblatt, 1962). This
approach considers the expanding psychoanalytic narrative in terms of
how at any given moment in time the person experiences sensations or
"representations" of self (ego, I) as distinguishable or
indistinguishable from various sensations or "representations"
of others. The criterion
for making such inferences is not the verbal content or linguistic form
of the narration (such as using "I," you, or
"they"); but rather, the manner or mode of relatedness actually being lived at the
moment. A very brief statement of each
Listening Perspective should clarify my general approach.
|| The Listening Perspective of the Constant Self and the Constant
Other is a way of listening when the speaker appears to be making a
clear and reliable distinction between his or her needs, motivations and
activities and those of others. Other people are considered and related
to as separate (parallel, contrasting, or conflicting) centers of
initiative. The activities and motivations of other people may be
experienced as gratifying to, harmonious with or frightening and
dangerous to the needs and activities of a reliable unitary, consistent,
and constantly experienced sense of self It is within this listening
context that "normal/neurotic" modes of relating which persist
from the Oedipal period of development have been defined. The specific
ways in which an Oedipal child (aged 4 to 7) experiences loved ones
tends to persist so that various expectations based on those separate
but intimate relationships tend to be transferred to new people in
subsequent life experiences. Until the last two decades all
psychotherapies have been characterized by an implicit assumption of
experienced separateness and constancies between selves and others.
The Listening Perspective of the Selfother is a way of listening when
the speaker's mode of address or activities indicates that the other
person is thought of as separate but in fact is being related to or used
as a part of or augmentation of a fragile or nascent sense of self.
Kohut (1971, 1977) has specified an era prior to the Oedipal (i.e.,
Mahler's "rapprochement," 1968) in which the growing child's sense
of self relies upon various mirroring, twinning, and inspirational
experiences in connection with important others (so-called selfothers or
"selfobjects"). Kohut has shown the ways in which these
grandiose, twinned and idealized aspects of self are transferred to
others and has developed therapeutic techniques for analyzing what he
has called "narcissistic" or "selfobject"
|| The Listening Perspective of the Symbiotic or Merger Object is a
way of listening to a speaker who may appear (linguistically or
cognitively) to be distinguishing between self and other but who, in
fact, fuses, entangles, or confuses the distinction in any of a variety
of ways. Metaphorically, the merger experience is thought to date from
the eras between 4 and 24 months of life that Mahler (1968) has called
"symbiosis" and "separating." A young child is
thought to engage in mutual cueing with important others which
establishes permanent modes of relating to other people. What mothers
call "the terrible twos" marks the (separating) opposition a
child develops to relinquish the established symbiotic bonds. Individuation to the later selfother era is facilitated by parental
acceptance and containment of the separation-individuation activity.
the extent certain entrenched modes of fusing with, entangling with, or
opposing the relatedness demands of early others are retained, the
ongoing personality displays what have been called "borderline
features." For listening purposes the concept of
"scenario" defines the interpersonal relatedness dimension or
interaction which persists from the symbiotic or separating era and
which tends to be replicated in subsequent relationships, especially the
therapeutic one. That young toddlers internalize both active and passive
roles of the scenario means that skills in "interpreting the
counter-transference" (Hedges, 1992) are important.
The Listening Perspective of the Part-Self and Part-Other is a way
of listening to a person whose basic modes of living and relating are of
a "personality in organization." My work on "The
Organizing Personality" (Hedges, 1983a, 1983b, 1994b, and in press and
Hedges & Hulgus, 1991) assumes that infants organize basic
sensorimotor and cognitive-affective systems in accordance with the way
they experience various types of consistency or inconsistency in
relationships with early others. Exposure to and assimilation of a
consistent patterning of care giving leads toward a highly stylized,
idiosyncratic symbiotic mutual cueing process with others. However, if
for any reason (genetic, physiological, or environmental), the infant
cannot experience and learn a consistent address for reliably available
others, various incomplete or faulty organizational patterns are
established which create a wide variety of limitations in cognitive
controls and/or affective regulation. The early limitations of
personality functioning may produce later psychotic indicators or simply
give rise to a loosely or idiosyncratically organized individual.
The "organizing personality" is thought to be in continuous
search for connections with people but is generally not able reliably or consistently to sustain
once they have been established. The patterns or styles of relatedness of the personality caught in
continuous organizing activities are in some sense so unchanneled,
unformed, or unreliable that even connections which may become
established have no secure permanence.
The work of Franz Kafka illustrates the unending, confusing, and
generally unrewarding or frustrating search which organizing
personalities conduct in pursuit of organized modes of establishing and
maintaining reliable connections with the environment. Jerzy Kosinski's
hero in Being There (1970) provides another such example of a character
in search of identity and personhood who is only able to obtain limited,
confusing, changing or ungratifying relationships. I have developed the
concept of "mimical self" to capture the qualities of highly
sophisticated mimicry or imitation of others which characterizes
personalities suspended in various forms of perpetual organizing
activity. A "mimical self" would be a formation which precedes
developmentally Winnicott's "false self" (1952) which arises
out of conforming to environmental demands in deference to more authentic demands of the infant's
The Listening Perspective Approach with Multiple Personalities
As mentioned earlier, the vast majority of persons in the group now
being defined as "multiple personality" are not readily
classifiable as "neurotic" (i.e., suitable for The Listening
Perspective of Self and Other Constancy). This is because of the
multitude of ego splits and the general failure of repression. The
multiples now emerging in clinical practice seldom address the therapist
"narcissistically" either, so The Listening Perspective of the
Selfobject is also largely inapplicable.
In merger or "borderline" states (The Listening Perspective
of the Symbiotic or Merger Object), as puzzling as many of the symbiotic
and separating scenarios can be to the clinician, the expected feature
stemming from early mutual cueing experiences is a reliable mode for
experiencing and engaging others. It may require the therapist several
years to find ways of emotionally interacting with (joining, replicating
and ultimately standing against) the highly idiosyncratic but stylized
relatedness modes. Understood in this way, "bad self"
experiences might be split off from "good self" experiences and
experiences of "bad" others might be split off from
experiences of "good" others (Kernberg, 1975, 1976). But a
host of identifiable alter selves with various affective potentials
would not be expected in the good-bad split. That is, borderline
features are essentially definable as vestigial or retained modes of
interaction based on extensive early symbiotic and separating mutual
cueing experiences featuring more or less consistent but alternating
affects. As strange as many varieties of parent-child bonding may appear
to an outside observer, in time the modes can be shown to be entrenched,
reliable, and once understood, to make a certain special kind of sense
within a given parent-child rearing context.
Ultimately in the therapeutic (analytic) study of borderline level
personality features, the clinician begins to discern a "method in
the madness." Certain relational demands and expectations which
early on seemed puzzling, self-destructive, chaotic, fragmented,
abusive, and so forth, slowly begin to form a pattern which is comprehensible in light of the developing creative narrative and
narrational transference interaction reflecting the parental
personalities and early life experiences. Analysis of the
"replicated transference, in contrast to "analysis of the
transference neurosis, or the selfother transferences" (at higher
developmental levels), gives rise to a series of individuating boundary
issues between the personality needs, activities, or "personal
space" of the person and the therapist's activities, understandings
and "personal space."
These interactional modes and conceptual tools used with
"borderlines" are likely to be minimally helpful in responding
to the variety of (presymbiotic) organizational aspects presented by
multiple personalities. The "split off selves" portrayed by
the multiple are born in isolation and disaffection rather than in
Although multiples are not treatable in the same fashion as
borderlines, almost all of these "lower level" personality
features are indistinguishable from one another upon initial clinical
presentation. Typically, the personality styles presented to the
clinician represent the person's favorable and unfavorable capacities for
adjusting to important demands of the world. Winnicott (1952) has
described the "false self" capacities which a person mobilizes
to conform to early parental and later environmental demands. As an
avenue for interacting the false self maneuvers arise in response to
symbiotic or borderline developmental demands.
My central thesis is that "multiple personalities"
represent the emergence and creative elaboration in the
psychotherapeutic or psychoanalytic setting of a variety of earliest
affect-ego states, and that they may be considered unintegrated
nuclei" (Glover, 1932) or early centers of organizing experiencing.
"False self," "mimical self" or social self"
adaptations may take many forms so that the person's life adjustment may
be highly effective. The person may be basically well coordinated,
intelligent, pleasant, capable, and quite likable. The overall style and
effectiveness of the social self may or may not have permitted awareness
of different types of ego, self, or altered states which emerge at
various times for various purposes.
If we grant that in some sense all people have multiple selves or
various frames of mind, moods, or affect-ego states, it is not difficult to understand how under some
circumstances the usual, expected, or hoped for integrating effect in
personality formation might not be completely achieved. Kohut's (1979)
notion is that a unitary cohesive self develops because from the first
day the mother addresses her child as if the child had a self. The many
affect-ego states of the first months of life are thought to come under
the conditioning influence of what Mahler (1968) has called the
symbiosis (4 to 24 months). Gradually in later individuation (Mahler's
"rapprochement"), emerging individual self states may become
admired, confirmed, and inspired under the influence of selfothers, thus
bringing all of the early affect-ego states into what Kohut calls the
cohesive self. The constant self and constant others of the Oedipal
period inherit this development. But the experience of multiple selves
harks back to the earliest organizing affect-ego centers or ego nuclei
before they have been brought into reliable unification through
On the basis of recent clinical experience with narcissistic,
borderline and organizing states, we can now surmise that several
difficulties might arise in the self consolidation process. These
possibilities stand as clinical hypotheses regarding how we might view
the experience of multiple selves in different individuals:
Integration of various self states may be limited due to faulty,
inadequate, or insufficient age-appropriate consolidating experiences.
Symbiotic bonding experience has been partial or incomplete so that affect-ego states are included.
Self consolidation may be warped or deformed through systematic
conditioning experiences. The demands of bonding or later selfother experiences may continue to
exclude or warp affect-ego states as they develop.
||The process of evolving a cohesive self may at any developmental
era be disrupted by overstimulating experiences which interrupt or destroy the effectiveness or cohesion
of tentative ego or self experiences causing a functional regression to previous unintegrated levels
of affect-ego states.
||Problems in the self consolidation sequence may frequently undergo
later repetitions or replications fostered by persons in the child's environment and/or invited by the
child (usually inadvertently) as a part of a chaotic or ineffective
search for connections with people. These later encounters are often so
intense that they produce regression and fragmentation to earlier
Current literature on multiple personalities places etiological
emphasis on actual traumatic disruptions (number 3 above) which were
perpetrated by intrusive and/or abusive older persons in the child's
environment. But similar effects can be achieved in at least these three
other ways. Access to multiple early affect-ego states can be retained
if later opportunities are insufficient to coalesce early merged
symbiotic selves and a subsequent personal cohesive self. Certain types
of symbiotic molding can promote a socialized or false self which fails
to integrate many early affect-ego nuclei. When the social self is
traumatized or has an opportunity to relax (as in psychotherapy), the
more basic states or personality constellations may become accessible.
The replication possibility (number 4 above) is difficult to explain
succinctly. In wandering, searching, organizing states or certain
established symbiotic ways of connecting with others, a person may reach
out to persons in the environment in ways that invite, induce, or seduce
others to invade, abuse, or molest them. This is not to say, as we might
in an individual with more advanced symbiotic, narcissistic or neurotic
structures, that the person "sets himself up" for abuse or
that a clear motivating repetition compulsion is engaged. Rather,
lacking certain nuances of self-consolidation or social skill which
ordinarily develop through satisfactory relations with people, the
personality in organization moves about the world almost as a ready or
available target ("sitting duck") for those whose need is to
intrude or abuse. We have seen this kind of phenomena with brain
defective and retarded children who are frequently abused and molested
because they seek human contact and yet don't know how to prevent being
taken advantage of.
In a given instance some "repetition compulsion" or
motivated phenomenon might or might not be detectable. But I suspect
that most of the time these people as children, and often in many
circumstances of adolescence and adulthood, simply miss (receptively and/or expressively) subtle social cues and fail to understand fully
the implications of how abusive others approach them. And in their
approach to others they may fail to understand what they are (inadvertently)
making themselves available for. This point is important since many
clinicians think of the repetition compulsion as a way of "holding
the person responsible" for social consequences of their
activities. Or conversely, in "not blaming" the person who has
received abuse, clinicians may miss an opportunity to understand what
personality needs and features may have contributed to the person's
"availability" as a target for various forms of abuse.
I wish to stress the importance of considering multiple etiological
possibilities because a therapist committed to the position that a
person with multiple personalities was invariably molested may become
enmeshed in a serious and naive listening error. For the therapist to
believe that each personality was necessarily created by another
traumatic intrusion or that all early traumas must invariably be tracked
down and catharted may also lead to grave listening errors. The content,
memories, and affects produced in organizing states cannot be trusted in
the same way that we tend to trust similar events and activities
emanating from more integrated states. We have now studied enough about
"screen memories" (Freud, 1914), "telescoped
memories" (Kohut, 1971), and the workings of "projective
identification" (Klein, 1952) to know that anyone can produce
memories and affects (with or without hypnosis) which are not veridical
but which contain significant emotional or phenomenological truths.
therapist would do well to keep to the task of encouraging the subtle
growth of the therapeutic relationship and its analysis and to suspend
judgment (permanently) on such matters.3
My impression is that for every molest or abuse scene that can be
narrated in psychotherapy or psychoanalysis, many more emotional
experiences of a like genre have occurred which will not and probably
cannot be narrated but are contained in moods, self management styles,
and longings for transformation (Bollas, 1984, 1982, 1978). These
statements bring us face to face with some of the many problems of
therapeutic technique. I oppose considering the appearance of any
memory, affect or affect-ego state per se as "evidence" of
Therapeutic narrations stem from an ageless human tradition of myth
making, storytelling, and cultural legends (Schafer, 1976; Spence,
1982). As such, the narrative truth of psychotherapy must be considered
profoundly allegorical. Truth contained in narrations and allegories
need not be confused with historical truths nor need its truth value in
any way be discounted. But a naive listener believing the simple story
at face value is in a poor position to consider the broader picture or
to know how to call for an effective creative elaboration of various key
elements of the narration. A naive therapeutic approach is bound to slow
things down. An exclusive insistence on ascertaining and catharting to
the effects of events remembered or perceived to be real runs the risk
of failing to broaden the catharsis to include all similar events and
then to move the concerns on to the plane of transference and
countertransference. That is, the therapeutic value of straightforward
historical truth pales by comparison to the rich possibilities of
narrative truths which reach into all recesses of the mind and leave no
emotional effect untouched.
Surely here someone will say, "but it is often so important for
some of these people to be believed since many times they have tried to
tell their stories and have been discounted." I say, "believe
them for sure; but don't for one minute assume that the narration and
its accompanying affect anywhere near tells the entire story
too literal or too concrete means one only gets exposed to the tip of
the iceberg. Psychoanalytic empathy means keeping many possibilities of
meanings simultaneously before us." By analogy, as therapists we
must be able to take a conversion paralysis seriously, but an eventual
therapeutic effect depends upon our also taking the person seriously in
many other ways as well. In couples work we hear two versions of reality
but seldom feel a need to side with one or the other as more true.
what can be our therapeutic approach to the multiple personality?
Psychotherapy and Psychoanalysis with Multiple Personalities
Ekstein (1984) maintains that the psychotherapeutic and
psychoanalytical languages we use always contain hidden technique.
I will begin by briefly surveying
the treatment dimensions implicit in the Listening Perspective
"approach" before specifying further treatment ideas related to
multiple personalities. The four Listening Perspectives follow a
developmental format for reasons of logic, consistency, and coherence.
That is, one's listening interests might be specified in many different
ways. The implicit value system of the Listening Perspective approach is
not developmental, but rather one which places a premium on noticing the
nature of each uniquely interacting analytic couple. It does not have a
value system which holds "separation-individuation" as an ideal
or which promotes "mature development," "self
cohesion," "self and object constancy" or "unity in
personality" as necessarily positive achievements. While these may
all be worthwhile goals, they are misleading in analysis and sidestep
what is most important in our work developing the capacity to listen in
the most comprehensive and flexible ways possible to the person who has
come to tell a story.
We can and often do define the development of human possibilities
with an "unfolding" or "growth" metaphor which has a
strong attraction because we know that living things grow and that
complex functions expand in surprising ways. To conceptualize
psychoanalysis as a process to promote unfolding or growth is therefore
tempting. One unfortunate consequence of succumbing to the temptation of
the growth metaphor is that we then view the therapist as some sort of a
parent, teacher, guru, or gardener. Again, not a bad set of models to
put before ourselves, but surely by this point in time we are able to do
The Listening Perspective approach is organized around the chief task
which faces the therapist or analyst listening, not with our ears only,
but with our entire being to what people have to tell us, to show us, to
do to us, and have us do to them. Arranging one's Listening Perspectives
along a developmental axis emphasizes the wide range of human activity
to be communicated and considered in psychoanalysis and the various ways
in which communication can be achieved. It further suggests that
activities and engagements of most humans span the entire developmental
continuum. Some of our most delightful moments are clearly
"infantile" and some of our greatest sufferings spring from the most "mature" parts of
ourselves. Further, conceptualizing psychoanalysis exclusively along
either Oedipal-neurotic, self-psychological, or self and object
representation lines necessarily limits which of the many features of an
analytic hour we are likely to consider and narrows considerably what we
believe our analytic function to be.4
I find that even the most efficaciously conceived theories and
therapeutic guidelines are in some sense utterly useless when I sit
trying to contemplate and to appreciate the person before me. "Who
is this person? What does he or she want or expect from me and from our
time together? What on earth will we come to do with one another?
will I manage to stay abreast of what is being shown to me?" These
are the questions with which I face each clinical hour hopefully, as
much as possible in the way Bion (1962) has suggested, "without
memory or desire, without undue preoccupation with the past or the
A rich armamentarium of theories and techniques may indeed reduce my
fear of the unknown, but I can't imagine how they will help me
they sharpen up my listening habits and open my mind to a wider range of
listening possibilities each hour. The Listening Perspective approach
thus promotes a value of individualized listening but specifies four
broad categories of types of human activities and interpersonal
engagements which we may expect to experience or hear about during
analytic hours. In not considering these categories as
"developmental levels" but rather as four distinctly different
but simultaneously useful perspectives, vantage points, or positions
from which to hear what is told to me, I realize that I am always
adrift, never certain, and always appealing to the person before me for
help in understanding how it is or was for him or her. I will now
summarize a few of the implications which the Listening Perspective
approach provides for the psychoanalytic hour:
1. The Constancy Perspective (For Neurotic Personality Organization)
In states of self and object constancy, verbalizations and gestures
can be assumed to be symbolically integrated and expressive of often disparate or
conflicting feelings or thoughts. Because the constancy mode is
predominantly an individuated way of reacting and interacting, both
members in the analytic couple can generally rely on some degree of
mutual restraint and rapport within a contractual atmosphere containing
a certain degree of emotional distance or separateness (i.e., "the
therapeutic frame"). All that Freud taught about wishes, conflicts,
dreams, symbols, impulses, defenses, compromise formations, and so forth
can be assumed to be operating as "neurotic" transference
configurations. What one experiences as "inner life" is
basically, or will through analytic narrations ultimately be, connected
to or accessible through verbalization and verbal-symbolic
interpretations. In constancy states a person seeks out and perpetuates
complex cognitive-affective states and interactions. These complexes can
be expected to appear in therapy as "neurotic transferences"
and eventually to be largely resolved through a creative narrational
process involving verbal-symbolic interpretation, insight, and working
2. The Selfother Perspective (For Narcissistic Personality
Selfobject states are communicated partly by verbalization but
usually are most evident in the orienting or approach of the person to
the analyst. Although the analyst is known to be separate, emotional
affirmations, confirmations, and inspirations are actively sought from
the "selfother" analyst. Kohut (1971) has formulated these
trends as having the purpose of completing or coalescing the sense of
self. Transference repetitions usually take the form of disappointments
with the functioning of the analyst (so-called selfother failures) which
result in various forms of stressed, tense, and/or disturbed behavior.
If the therapist can acknowledge the failure and correct his/her
understanding with empathic words or gestures, the self gradually
develops the capacity to maintain constancy and cohesiveness without
such frequent, intense, or archaic selfobject supports.
3. The Merger Perspective (For Borderline Personality Organization)
Merged or borderline states take on as many forms as there are
parent-child dyads in the world. When the original mode or patterning of
relatedness can be achieved in the therapeutic relationship, a sense of
wholeness ensues, even if that pattern may seem grim, depriving, or
somehow abusive to an outside observer. Preverbal idiosyncratic patterns
are always difficult to grasp. Verbalizations by the client only rarely
provide the therapist access to the "scenarios" which the person must
actively replicate in the emotional interchange of therapy. Countertransference responsiveness is often the "royal road"
to understanding borderline scenarios (Hedges, 1983b, 1992). Countertransference responses serve as informers providing rough
approximations of the (passive or active) merged states being sought
after and lived out. Interpreting the Countertransference (Hedges, 1992)
involves the therapist being able to speak the countertransference
experience in such a way as to show a recognition of the infant side of
the mother-child interaction. Only after emotional
"togetherness" is in some way achieved is the therapist's
knowledge of the scenario or scenarios sufficient to be able to engage
in activities which promote separating and individuating modes. The
false or socialized self constellation which may seem cooperative with
the treatment must ultimately be confronted as not operating in the
person's best expressive interests.
4. The Organizing Perspective (For Use with Various Psychotic States
and the Personality in Organization)
Every infant's perceptual-motor and cognitive-affective systems
organize around various available features in the immediate care giving
environment. The wide range of affective responses in the early months
of life is subtle and may appear limited because the infant has so few
ways of communicating. The unobservant or untrained adult may only
perceive pleasure-pain potentialities since these match the best
available communication modes.
In therapy, quests for connection to the person of the therapist or
for experiences with various part-aspects of the therapist or the early part-other milieu are bound to
take many forms which may seem as puzzling to the therapist as the
seemingly odd things which infants seem to request from their parents.
Affective states vacillate widely and rapidly. The phenomenology of
experience is unpredictable and psychic content often seems controlled
by forces other than human volition. Delight in and study of various
sensorimotor and cognitive-affective experiences with available others
predominates. Many infants learn to flee from traumatic or
overstimulating human contact in various ways (i.e. fight, flight,
and/or freeze) or to organize their cognitive-affective systems in
idiosyncratic ways which may change rapidly and vary widely (Tustin,
1981). Such fluctuations may make it difficult for a therapist who is
functioning in a more stable organized state to empathize. Transference
expresses the internalized modes of disconnecting used by the earliest
(m)other. Rupturing of interpersonal contact and continuity is the
hallmark of personality functioning at the organizing level. This is
vividly manifest in the multiple "switching."
In a therapeutic milieu which permits the emergence of organizing
states, largely freed of the burden of false self conformity but not the
effects of mimicry, the "personalities" of the multiples have
maximal opportunity for creative elaboration and expression. The search
for contact and the many (transferential) ruptures become the focus for
study in this Listening Perspective.
Recommended Therapeutic Approaches to Multiple Personalities
Each experienced psychotherapist or psychoanalyst has developed an
individual working style and has explicitly or implicitly adopted a set
of theoretical constructs which provides a consistent backdrop and
justification for that style. What the analyst claims to be doing is
invariably embodied in an impersonal theoretical framework and is not
nearly so important as the personal availability and consistent
listening attitude which is established and maintained during the
analytic hour. Actual working techniques are primarily a matter of
personality and choice and the analytic work goes forward so long as
persons in analysis sense that they are being heard and responded to according
to their needs.
What has traditionally distinguished psychoanalysis from the other
therapies has been close systematic attention to the developing
"transference neurosis;" that is, the emergence in the
analytic relationship of features which characterized the child's
Oedipal relationships. As psychoanalytic inquiry has broadened its scope
to include pre-neurotic personality constellations, the distinguishing
feature of an emerging "transference neurosis" per se is not
expected in analytic work with pre-Oedipal states.
However, the history of the study of Oedipal "transference
neurosis" provides a relevant context for contrasting the expected
clinical effects now being spoken of as "selfobject
transferences," "borderline replications," and
"organizing connections." Each of these four sets of
relational phenomena can characterize certain developmental
configurations and become available to analytical attention through each
of the four Listening Perspectives. Each set of experiences may be
thought of as built upon or growing out of the successes and failures of
previous "layering(s)" of experience. Thus, when considering
the listening context for "higher" organizational aspects,
features from each of the "lower" constellations may well make
an appearance at various points in the analysis.
Conversely, when considering a listening context for
"lower" level organizational aspects, one does not necessarily
expect that aspect to be meaningfully integrated with or connected to
other (similar or parallel) aspects or to be fully integrated with
"higher order" organizational achievements. According to this
use of the developmental metaphor, we would expect at more
differentiated levels to hear strivings for a more integrated, cohesive,
monistic and separate sense of "I" while at less
differentiated levels various disparate, unintegrated, confusional,
partial or pluralistic "I's" will be more apparent.
During the last decade hypnotherapists and developmental
psychoanalysts have been more prepared than ever to hear and experience
these unintegrated and often contradictory aspects of early self
development. This preparedness has allowed the configurations found in
multiple personality pictures to emerge with greater frequency and clarity.
This, however, does not
imply iatrogenesis in the usual sense that the treatment causes the
illness. Rather, since Freud first opened his ears to hear the hidden
features of hysteria, the history of our field has been one of learning
how to create an empathic listening atmosphere which permits elusive
aspects of personality to be interpersonally experienced, expressed and
Basic organizational aspects of personality are not readily
accessible for therapeutic study via the usual verbal-symbolic,
introspective techniques which characterize the analysis of neurotic and
narcissistic configurations. Nor are they available to interactive
techniques or systematic countertransference studies commonly used in
understanding the symbiotic and post-symbiotic relatedness seen in
borderline personality organization. The investigative mode for
listening to aspects of personality arrested at the organizing level
necessarily becomes that of "interception" (Hedges, 1983b).
Organizing Personalities must be met (intercepted, contacted) during
moments of sensorimotor extension in order for the organizational impetus
to be understood and for the impact of the inconstant contrasting configurations
of the (part) other to be experienced and registered in
the emerging personality formation along with various experiences of
The crucial implication of this is that therapeutic connection with
early organizational aspects of personality usually will not be possible
through extensive analysis of symbolic or body-symbolic representations
(the so-called symptom constellation), since these manifestations are
secondary or reactionary to faulty early object relations. That is,
psychotic phenomena represent abortive attempts at self stabilization or
self nurturing and soothing which only seldom include representations
favorable for realistic relatedness to others. Grave therapeutic
limitations have been repeatedly demonstrated through exclusive reliance
on: (1) Extensive analysis of the symbolic content of the psychotic
life, (2) therapeutic immersion in the subjective psychotic world, (3)
systematic utilization of countertransference reactions to (the
fragmenting/withdrawing aspects of) psychosis.
The infant, child or adult whose personality is arrested at or
regressed to early organizing attempts is usually seen as living in a world of his own.
soothing, pacifying other must patiently wait until the infant or person
is momentarily oriented for contact with the other. The child Celeste
reported by Ekstein (1979) played quietly every day in her therapist's
room until at last representations began to emerge in the form of small
Kleenex figures which begin to relate silently to one another until the
magic day when one special Kleenex figure approached and came to rest on
the therapist's shoe! Had the therapist intruded on her play before she
was ready to acknowledge his presence he would no doubt have been
repeating the intrusive trauma of her infancy. The therapist's work
consists of creating an atmosphere in which sensorimotor extensions can
be met or intercepted when they occur.
In Bollas' (1978) language, the task of the mother/other is to be
available to assist in the transformation of various self states as they
occur ... Stimulating experiences produced by internal states as well
as experiences produced by impinging external stimuli are intercepted
with affective containment and pacification, thus "teaching"
(almost by classical conditioning) the possibility of altered or
transformed states. Adequate interceptive pacification experience leads
toward mutual cueing which characterized the "protective
shield" (Khan, 1963) of the symbiotic envelope or canopy. Subsequently overwhelming states are only experienced during the absence
of the symbiotic partnering experience (Hedges, 1983a).
In taking this general approach to the early organizational aspects
of personality formation I have specified several critical listening
1. Reflexive Mental States
Freud (1900, Chapter VII) first described elemental mental processes
as "reflexive." While many writers speak of early mental
states as unintegrated, segmented, disintegrated, or fragmented, such
terms reveal an observer bias or describe confused or pluralistic
states, but fail to describe fundamental organizing processes. Images in
earliest mental states, according to Freud, can be thought of as passing
reflexively forward and backward along a reflex arc, whereas a later
buildup of memory traces causes the arc to become unidirectional. Freud's conceptual model prepares
clinicians to listen for often confusing and fragmented reflexive
sensorimotor and cognitive-affective experiences passing into and out of
awareness with hallucinatory vividness. Observation of reflexive mental
processes is frequently obscured by regressive phenomena such as those
seen in "psychotic" symptoms and in multiple personalities the
rapid ''switching'' from personality to personality.
2. Nonhuman Imagery
Victor Tausk's (1919) classic paper on "The Influencing
Machine" was the first of a long series of psychoanalytic
formulations which have highlighted the dominance of nonhuman imagery in
early personality organization. Searles' (1960) focus on The Nonhuman
Environment has clarified the kinds of relatedness which tend to
characterize organizing processes. His careful delineation of
mechanical, impersonal, and supernatural forces which govern the
nonhuman world prepares the analytic listener to observe and interpret
the attempts to organize sensorimotor and cognitive-affective
experience. Searles' attention to the mystical, mythical, totemistic and
animalistic sheds light on a wide range of possible interpretations of
sensorimotor and cognitive-affective phenomena which are involved in any
given person's effort to organize and relate to perceived dimensions of
the world. The mechanical or nonhuman features of organizing experiences
are frequently found in multiple personalities, in a particular
"robot" personality or can be seen to operate in the way that
the personalities interact with one another or in which certain
personalities interact with the world. Content involving demons and
devil worship, as well as mystical, otherworldly or past life
experiences and vivid "memories" of uncontrollable
beatifications and atrocities, as well as alien abductions all feature
the nonhuman aspects which can be expected to constitute as
"real" in organizing states.
3. The Centrality of Bodily Sensations
The early organizational strivings which form the core of what is to
become known as the self begin with cognitive-affective sensations and sensorimotor operations.
Mahler (1968) and Tustin (1981), in their studies of disturbed children, have
regularly observed preoccupations with and exaggerations of various
sensory experiences. Sensations or hypersensitivities often represent
more than simply symptoms, but rather must be listened to in the context
of developing potentialities for personality integration and
functioning. A preoccupation with body parts and sensations is clearly
the essence of the organizing process. Various forms of focus on the
body range from somatic symptoms to sharply distinguished perceptual
experiences in different "personality" states of multiples.
with psychosomatic indicators, many features encountered in multiple
personalities are usefully considered as somatic sensations or states
which have not found psychic representations which can be integrated
within the ongoing fabric of personality.
4. The Transformation of Primary Sensation and States
As a therapist first assumes a place in the life of the organizing
personality, it will likely be in a transforming role. Bollas' (1978)
discussion of "the transformational object" contributes
fundamentally to an understanding of the listening context of
psychotherapy. Earliest experiences of parenting involve the
transformation of bodily functions and mental states. Bollas points out
that Freud (forgivably) failed to note the fact that the analytic
situation itself constitutes an "acting out" of the early
transformational experience. A person arrested in an organizing state is
presumed to have suffered deficits and/or traumas in the early
transformational processes. While the person may sometimes be quite
ready to have the deficits (usually various dependency needs) responded
to by the therapist, the traumatized areas pose more of a problem.
parental omissions and commissions missed their mark in some way,
resulting in various affective and cognitive constructions which are not
integrated within the entire personality structure.
An awareness that the transformational processes themselves may
enhance or thwart the therapeutic connection with organizing
personalities suggests a new kind of listening concern. The therapist
must be content to set aside verbal and even interactional approaches in deference to the more crucial role of promoting
micro-transformations of various early developing self states through
contact or interceptive pacification until the mutual cueing of the
analytic couple can become an important factor. Bollas (1982), following
Winnicott, has subsequently developed his ideas to include a therapeutic
regression to dependency; which includes attention to primary
cognitive-affective and sensorimotor experiences in the presence of and
with the aid of the analyst.
5. The Establishment of Mutual cueing
Sensitive noninterfering work with all varieties of organizing
personalities may be expected to lead toward mutual cueing processes
between basic personality dimensions of the therapist and elemental
aspects of the organizing personality. In the multiple personality, as
the therapist responds to each different self and attempts to understand
the various selves and, in turn, their relations to one another and to
various experiences of others, a reliable communication system (largely
nonverbal or paraverbal at first) will begin to evolve. Searles (1979)
has depicted psychoanalysis with this level of personality organization
as consisting of the formation of a "therapeutic symbiosis"
symbiosis de novo followed by successive phases of individuation.
members of the analytic couple have the eventual task of individuating
from the symbiotic union in such a way as to be able to honor the
other's separateness and individuality. Searles' notion of the
therapeutic symbiosis can prepare the analytic listener for the gradual
emergence of a mutual cueing process based upon the establishment of
ways of handling needs which each has in the relationship. Only after
the holding (Modell, 1976) and containing (Bion, 1962, 1963) functions
are smoothly in operation as a symbiotic relatedness pattern can the
individuation process be expected to go forward in multiple personality
work. The functional integration of various aspects of self slowly
proceeds as the therapist is consistent in addressing the person as a
single unitary self. I have suggested that various
"personalities" be addressed in the spirit of always
recognizing each as a part of the whole person. None of us are ever so
integrated as to be totally without multiple self states.
6. Fusion and Confusion of Identities
Elemental organizing processes usually do not include reliable
differentiation of self or various selves and/or others. Klein's (1952,
1975) discussion of infantile greed and envy may help to specify expected
"positions" which the organizing person may assume vis a vis the
therapist. More importantly, her concept of "projective
identification" points toward an expected blurring or
indistinctness of early self-other relatedness which is bound to be a
part of the listening situation with organizing personalities or with
organizing states in persons primarily integrated at other levels.
the essence of creativity is the projection into the parameters of the
world a vision or belief which is then taken back into the self as
reality, relatedness on the basis of projective identification is likely
to have significant interpersonal effects which can eventually become
the focus of careful clinical scrutiny. Frances Tustin's work with
autistic states (1981) formulates ways in which young children may wall
off, encapsulate, or confuse their identities with mother. She has
developed fascinating treatment techniques for making contact with
people in such states.
7. The Movement Toward Transitional Activities
Various objects and activities may become part and parcel of the
processes of sensorimotor and cognitive-affective experiences and
transformations in organizing states. Relationships with inanimate (hard
and soft) objects and part-aspects of the therapist and others may be
understood as a beginning concrete means of manipulating or controlling
various sensorimotor and/or cognitive-affective experiences. Winnicott
(1953) has written of the first "not-me" possession as a
transitional object that simultaneously symbolizes mother in her absence
while it remains under the child's manipulation and control. Winnicott
broadens "transitional" to include many other phenomena which
have in common the quality of representing something uncontrollable in a
controlled guise. The worker with multiple personalities will quickly
understand many representations, transactions, and personality features
serve this transitional function. Transitional use of a talisman,
photos, tape recordings, gifts, and other less tangible phenomena can be expected
to mark the transitional phase in therapy with organizing states.
8. Disruptions in the Personality Functioning of the Therapist
Empathic contact with elemental organizing processes inevitably
entails disruptions in the personality functions of a parent or
therapist. Giovacchini's (1975, 1979a,b) penetrating focus on the
disruptive effects which "primitive mental states" regularly
have on the personal and professional integrity of the therapist points
toward very special listening problems. Giovacchini speaks of "the
impact of the delusion" to refer to both the positive and negative
effects which the person's experiences of reality have on the comfort
and identity of the therapist. His discussions of the problems involved
in maintaining) losing, and regaining the analytic stance prepare the
clinical listener for disruptions in his or her personality functioning when working with organizing and multiple personality states.
Giovacchini indicates that often interventions and maneuvers must be
undertaken by the therapist so that the therapist can continue
functioning as a therapist. Anticipating disruptions in the therapist's
personality functioning and being prepared to undertake tactics or
maneuvers designed to maintain the therapeutic stance or to shore up the
personality functioning of the therapist constitutes an important
contribution to clinical listening with organizing and multiple
There are several kinds of countertransference to organizing states
which can be expected by listeners working the organizing experience.
|| Denial of human potential. The most common form of
countertransference has seen organizing personalities as witches,
evildoers, hopelessly psychotic, and in other ways not quite human.
this attitude is a denial of human potential and a denial of the
possibility of being able to stimulate desire in such a way as to
reawaken it and to analyze blocks to human relating. We hear: "I
can't reach you, you are too sick. You are untreatable so we will lock
you up or give you drugs to sedate or pacify you."
|| Fear of primitive energy. When an analytic listener invites the
organizing experience into a transference relationship, he or she is
asking that the full impact of primitive aggressive and sexual energies
of the analytic speaker be directed squarely at the person of the
listener. Listeners fear the power of this experience because it can be
quite disorienting and, if not carefully assessed and monitored,
potentially dangerous. But fear of basic human affectivity is irrational
and we now have at our disposal many rational ways of inviting and
managing the organizing level affects and energies. The key technical
consideration is not whether the person on the basis of a priori criteria
is "treatable," but whether the listener has sufficient
holding and supportive resource available on a practical basis to make
the pursuit of treatment practical and safe for all concerned.
|| Encountering our own organizing experiences. When we as listeners
invest ourselves emotionally in reaching out again and again to an
analytic speaker only to be repeatedly abandoned or refused, it
stimulates our own most primitive experiences of reaching out to our own
mothers during our organizing developmental period, hoping for a
response and feeling traumatized when the desired response was not
forthcoming. Our own "psychotic mother" transference can
reappear projected onto the analytic speaker as we attempt to provide
systematic and sustained connection for people living organizing states.
How each of us as individual practitioners develop staying power is the
crucial question. Our own therapy is essential as is consultation with
colleagues during trying phases of this work. Attempting to work the
organizing experience without adequate resource and backup support is
like a single mother trying to manage a difficult or sick baby while
holding down a job to support herself, caring for several other
children, and trying to live some life of her own. We need support to do
this very taxing kind of work.
|| Empathy leading to breaks in contact. After the preliminary phases
are well under way that is, after two have established basic working
rhythms that are comfortable and safe, and after the listener has been able to
discern and bring up for discussion the specific ways in which the
speaker searches for contact and then cuts off contact we notice the
speaker begins excitedly to see in outside contacts as well as in the
analytic hour how the breaking of contact is being regularly
accomplished. Speakers in analysis are often excited by the therapeutic
process at this point because for the first time in their lives
something is finally making sense about themselves. They begin a valiant
struggle to maintain contact nearly everywhere they go, especially with
the listener. Then, we notice a tendency on the part of the analytic
listener to begin withdrawing into inattentiveness, preoccupation, or
even drowsiness. This type of countertransference activity, which
generally occurs only well into the treatment process, represents the
listener's empathy for the terror which contact provides for the
speaker. That is, the speaker for the first time feels he or she is hot
on the trail of something that promises human satisfaction
contact. But in the person's enthusiasm to achieve as much contact as
possible as fast as possible, it is the listener who senses the
internalized danger and in some way is deliberately (consciously or
unconsciously) slowing things down a bit. This countertransference
reaction can be spoken to the speaker so that two may gain a fuller
appreciation of the joys and dangers of human contact.
Once again the developmental metaphor may help us to conceptualize
the transforming and/or integrating functions which the psychotherapist
or psychoanalyst serves for the multiple personality. The basic task of
the neonate appears to be that of organizing and integrating a wide
variety of sensorimotor and cognitive-affective experiences in relation
to (m)other. The child who is empathically met (contacted, intercepted)
in moments of sensorimotor or cognitive-affective extension is able to
use people in the environment as the organizing, synthesizing principles
and to move toward the development of the symbiosis with the (m)other.
child whose extensions are not met in timely fashion or whose peaceful
states are intruded upon carelessly will remain to some degree perpetually
caught in a searching, organizing, unintegrated state. Development of
good intelligence and good social skills may constitute what I have
called a "mimical self" or a later constellation of a
"false self" or "social self" which is more or less
successful in imitating or adapting to the demands of the world, but the
person remains in certain important respects outside the pale of human
relatedness. A personality arrested at or regressed to organizing states
may or may not show signs of attempts at secondary restitution
(psychosis) either through exaggerated affects or nonconventional
thinking. Recent observations have suggested that there are many more
persons functioning at the organizing level than has been previously
recognized. One variety of these heretofore invisible organizing
features is recently appearing on the clinical scene as the multiple
Varieties of Transference and Resistance
There are four major categories of transference and resistance
memories. In neurotic personality organization, the subjective sense of
a five-year-old child's instinctual driveness is remembered in
transference along with intense fears (resistance) of experiencing
sexual and aggressive impulses toward anyone so intimate as the analyst
because such intensity was forbidden in the family, triangular
In narcissistic personality organization a three-year-old's intense
needs for admiration, confirmation, and inspiration in relation to his
or her selfothers is central to transference memories. Natural
narcissistic needs are enshrouded in shame (resistance) regarding one's
desire to be at the center of the universe.
In borderline personality organization transference remembering is
rooted in the replication of a set of interpersonal emotional scenarios.
Resistance memories mitigate against living out the positively and
negatively charged emotional interactions (scenarios) in the analytic
relationship so that they can not achieve representation and will not be
In personalities living out the earliest organizing processes, what
is structured in transference memory is the continuous rupturing or
breaking of each and every attempt to form organizing channels to the other.
Resistance takes the form of terror and physical pain whenever
sustained contact with a significant other threatens.
Expressions of the Search for and the Rupture (Primary Repression) of Channels or Links to the
The earliest transference and resistance memories are those from the
"organizing" period of relatedness development (Hedges, 1983).
In utero and in the earliest months of life, the fetus and neonate have
the task of organizing channels to the maternal body and mind for
nurturance, evacuation, soothing, comfort, and stimulation. Infant
research (Tronick & Cohn, 1988) suggests that only about 30% of the
time are the efforts made by an infant and mother successful in
establishing that "rhythm of safety" (Tustin, 1986) required
for two to feel satisfactorily connected.
The many ways in which an infant fails in securing the needed contact
from its (m)other become internalized as transference to the failing
mother. Because the biological being of the baby knows (just as every
mammal knows) that if it cannot find the maternal body it will die, any
serious impingement on the infant's sense of continuity of life, of
"going on being" (Winnicott, 1965) will be experienced as
traumatic. An internalized terror response marks that failed possible
channel of connection with a sign that forever reads, "never reach
this way again." Such traumatic organizing level transference
memories are not only presymbolic, but preverbal and somatic. Resistance
to ever again reexperiencing such a traumatic, life threatening
breakdown of linking possibilities is expressed in somatic terror and
pain which mark "where mother once was."
Green (1986) speaks of "the dead mother" internalization as
the earliest psychic structure (memory) laid down by the early sensual,
pleasurable links to mother which are bound sooner or later to be
subject to being experienced as maternal failure. (Note that the real
mother may be working hard to stay attuned to the organizing needs of
the infant, but for any of a variety of reasons the pleasurable
connection cannot be maintained.) We are left forever searching for this
internalized mother of pleasure who "died," trying in every way to revive her through searching the world for
love and stimulation according to the pleasure mode we once experienced
with her in a primordial and primeval Eden the paradise we knew before
we tasted of the fruit of the tree of knowledge of good and evil
(splitting). Of course the search fails because the paradise of life as
pleasure is not to be found in the outside world but inside our own
bodies. But the human search for the dead mother of primordial pleasure,
along with her failures and our incessant futile efforts to bring her
back to life by finding her outside of ourselves, outside of our bodies,
expresses the earliest transference and resistance memories we bring to
the analytic relationship.
Winnicott (1965) points out that early impingements on the infant's
sense of continuity with life forces the infant to react to
environmental failure before the infant is fully prepared to begin
reacting and thinking. The result of premature impingement is the
formation of a primary persecutory mode of thought which forms the
foundation from which all subsequent thought processes of that person
arise. That is, traumatic impingement on the infantile (omnipotent)
sense of "going on being," insures that the first memory which
is destined to color all later memories is "the world persecutes me
by intruding into my mental space and overstimulating (traumatizing) me.
I will forever be on guard for things coming at me which threaten to
destroy my sense of being in control of what happens to me (my
As a lasting imprint this earliest memory is psychotic because the
world at large offers many kinds of impingement. And searching the
environment tirelessly for the kind of primary intrusion that once
forced the infant to respond in a certain way not only creates perennial
paranoid hazards where there may be (in reality) none, but causes the
person to miss other realistic dangers that are not being scanned for
because of this prior preoccupation of the sensorium.
The Freezing of Environmental Failure
Donald Winnicott, a British pediatrician trained as a psychoanalyst,
is renowned for his understanding of early psychic development. It is
his view that there is a possible maturational or unfolding process for
each child in which environmental provision is a necessary facilitator.
environment with limited provision or unempathic intrusiveness may leave
the child with a painful sense of personal failure:
One has to include in one's theory of the development of a human
being the idea that it is normal and healthy for the individual to be
able to defend the self against specific environmental failure by a
freezing of the failure situation. Along with this goes an unconscious
assumption (which can become a conscious hope) that opportunity will
occur at a later date for a renewed experience in which the failure
situation will be able to be unfrozen and reexperienced with the
individual in a regressed state, in an environment which is making
adequate adaptation (1954, p.281).
Winnicott's use of the metaphor "unfreezing of the failure
situation" makes clear that he has a specific psychoanalytic
situation in mind which fosters emotional regression to the dependent
infantile state in an environment in which hopefully more understanding
and empathic adaptation to the infantile need can be made the second
time around. Note that what he speaks of as frozen until it can later be
reprocessed in some relationship, is a specific environmental
failure. There is no mention of forgetting and recall but rather that a
situation is set aside (frozen) until a relationship comes along which
permits a reliving of infantile dependency in which there is believed to
be the possibility that the failure can be made good. The purpose of
Winnicott's formulation is to define a kind of memory which the
psychoanalytic relationship calls forth so that an earlier failure of
the environment can be worked on in the current relationship.
Winnicott's formulation does point toward how traumatically
experienced environmental failures may be set aside until an analyst or
therapist comes along with whom the person can relive the failure.
popular notion of "recovery" being the recall of early
memories, having them validated by others, and then confronting those
"responsible" for the long ago failure misunderstands the
psychotherapeutic process of reviving in the present the environmental
failure situation so that it can be worked through in transference and
resistance with the person of the analyst as therapist, not acted out in
the person's contemporary world. It would seem that therapists collude
with the acting out so as to avoid the difficult and sometimes dangerous
transference working through process.
Winnicott's formulation clearly points toward a treatment situation
in which the split off internalized object relation has an opportunity
to become manifest in the analytic relationship as transference and
resistance to transference. Psychoanalytic technique as practiced by
analysts and psychoanalytically informed therapists is designed to bring
early childhood experience into the here and now relationship so that
transference and resistance memories have an opportunity to emerge.
recovered memories, like screen memories, are never to be taken at face
value because the very way in which they are secured for analytic study
necessarily imbues them with extensive primary process thinking
(condensation, displacement, and symbolization).
The Fear of Breakdown
Donald Winnicott was the first pediatrician to become a
psychoanalyst. His understandings of the early mother child interaction
have made a significant contribution to British psychoanalysis and his
powerful influence is now rapidly spreading worldwide. As a result of
Dr. Margaret Little's (1990) publication of her own analysis with
Winnicott, Psychotic Anxieties and Containment, we now realize that
Winnicott was the first psychoanalyst to learn how to systematically
foster a "regression to dependence" in which the most
primitive of human psychotic anxieties could be subjected to analysis
even in people who are otherwise well developed.
In "Fear of Breakdown" Winnicott shows that when people in
analysis speak of a fear of a psychotic break, a fear of dying, or a
fear of emptiness, they are projecting into future time what has
already happened in the infantile past. One can only truly fear what one
has experienced. Terrifying and often disabling fears of breakdown,
death, and emptiness are then distinct ways of remembering terrifying
processes that actually happened in a person's infancy. This nugget of
an idea and all that has followed in its wake has changed the face of
psychoanalytic thinking. What is dreaded and seen as a potentially
calamitous future event is the necessity of experiencing in the memory
of the psychoanalytic transference the horrible, regressive, death
threatening dependent breakdown of functioning that one, in fact,
experienced in some form in infancy. The fear of breakdown manifests
itself in many forms as resistance to transferentially reexperiencing in
the transference and resistance (remembering) the terror, helplessness,
rage, and loss of control once known in infancy. Therapists and clients
both dread disorganizing breakdowns and there are many ways in
resistance and counterresistance that two can collude to forestall the
curative experience of remembering by reliving the breakdown experience
with the therapist. One way of colluding would be to focus on external
perpetrators or long ago traumas to prevent having to live through
breakdown recreations together.
When the environmental provision fails to support the infant's need
to be in control of his or her world, a massive breakdown of psychic
functioning occurs. The break is one of loss of whatever ego functions
the child has attained at the time. Rudimentary or developing ego
functions are not fully independent of the interpersonal situation in
which they are being learned. So when the environment fails at critical
moments, the child experiences a loss of his or her own mind, a loss of
any attained sense of control, and a loss of whatever rudimentary sense
of self as agency may have been operating. From the point of view of the
infant, the loss of psychic control over his or her environment is
equivalent to the loss of the necessary life support systems so that
fear of death (as an instinctual given) is experienced as imminent.
environment is empty, the environment that is not experienced as
separate from the infant's rudimentary consciousness. When the necessary
environmental supports for ego skills and consciousness are lacking, the
infant psyche collapses.
At the level of the infant's primary organizing attempts there is
a functional equivalence between failure of environmental provision, a
sense of emptiness, loss of control, loss of omnipotence, total painful
psychic breakdown, and the terrifying prospect of death. Memories of
primordial breakdowns are embedded in somatic symptoms and terror.
level of memory is guarded with intense physical pain attributable to
the process of primary repression. No one wants to go through the excruciating gross bodily pain and terror necessarily
entailed in physically remembering the process of early psychic
In more normal infantile frustration the disillusionment is managed
by the environment through small and tolerable doses so that the
terrifying fear of death and an empty world (and therefore empty self)
may be averted and the breakdown of omnipotence will be gently helped
along, rather than traumatically forced and abusively intruded into the
child's body and mind. Now it is possible to make sense of the strange
and compelling nature of recovered memories. Environmental failure in
infancy has led to a breakdown of early psychic processes with
accompanying terror and threat of death. The breakdown experience is
blocked by primary repression that says "never go there
again." The breakdown fear lives on as the somatic underpinning of
all subsequent emotional relatedness life but cannot be recalled
because: (a) no memory of the experience per se is recorded, only a
nameless dread of dependence which can be violated, (b) the breakdown
experience itself is guarded with intense pain, somatic terror, and
physical symptoms of all types, (c) the trauma occurred before it was
possible to record pictures, words, or stories so it cannot be recalled
in ordinary ways.
The mythic themes of recovered memories allow for a creative
narration to be built in psychotherapy which conveys the emotional
essence of the infant's traumatic experience. The demand to be believed
represents in some way the violation of boundaries which can be
registered and interpreted in the counter-transference. The working
through of the repeated ruptures of interpersonal contacts by
flashbacks, sudden physical symptoms, bizarre thoughts, panic attacks,
personality switches, and boundary violations can be accomplished
through securing the organizing transference and resistance for
Summary and Conclusions
The remarkable recent increase in the reported incidence of
"Multiple Personality Disorders" has stimulated many questions
regarding how to understand these altered state phenomena and what approaches might provide optimal therapeutic or analytic
responsiveness. Four developmentally derived Listening Perspectives are
summarized which are thought to be ways of listening and responding to
four major levels or styles of personality organization. The expected
listening features for neurotic, narcissistic, borderline, and
organizing states are defined. In principle, an individual's personality
might be dominantly organized in one or another style or mode, but the
multiple selves phenomena are thought to be derived from early
cognitive-affective organizing states or affect-ego nuclei. By
implication, listening to multiple self states in terms of constancy,
selfobjects, or scenarios is likely to detract from the therapeutic
Four complementary etiological hypotheses are considered: (1) limited
early integration, (2) warped or deformed self-consolidation, (3)
overstimulating disruptions, and (4) replicated intrusions. Simultaneous
consideration of all four possibilities is a safeguard against biased or
naive clinical listening. Considering the profoundly allegorical and
narrational context of psychotherapy and psychoanalysis can prevent
faulty listening which stems from an exclusive concretizing emphasis on
abreaction of traumatic memories and affects.7
Optimal listening and responsiveness according to the Listening
Perspective approach places an emphasis on the relatedness dimension.
That is, the mode of self and other relatedness being experienced and
lived at any given moment will determine the therapist's choice of
response. Meeting, intercepting, or contacting various
affective-cognitive states in moments of sensorimotor extension is taken
as the optimal mode of therapeutic responsiveness for working with
features of personality "in organization." Eight expected
dimensions have been defined to enrich the listening context in work
with the organizing features found in multiple personalities.
The key to transformational analytic work with multiple personality
formation is the analysis of the organizing or psychotic transference.
Organizing transference is a structure which spontaneously appears just
as the person orienting for human contact begins to feel the threat of
the engagement. "Something happens" (often silently, invisible
to the therapist) so that the developing interpersonal contact is ruptured
or not sustained. Therapeutic technique is aimed at finding ways of
interpreting the transference which motivates contact rupture. The
interpretation is a variant of, "Your past experience tells you it
is not safe to stay connected to me, but that simply isn't true. You can
connect to me, take things from me, give things to me, and permit us
both to enjoy the relationship."
The current emphasis in research and lore on an invariably traumatic
or seductive etiology, and the importance of fostering a revival of
memories with emotional abreactions have been challenged. Broadening the
therapeutic or analytic approach through the elaboration and utilization
of Listening Perspectives is justified on epistemological, scientific,
and clinical grounds. Multiple personality cannot be effectively treated
without a thorough understanding of how to work with the organizing
transference and resistance. Viewing the emergence of various affect-ego
states as a creative way of expressively elaborating oneself in a
psychotherapeutic setting goes a long way toward removing the magical,
mystical, or pathological emphases which have proven confounding in past
work with multiple personality formations.
||A more recent psychoanalytically informed institutional treatment
approach has been put forth by Ganaway (1991). [Back]
||In a later writing I have reviewed the scientific paradigms used by
quantum physicists and chaos theorists which further point toward the
importance of a "listening perspective" approach in
psychotherapy and psychoanalysis (Hedges, 1992). [Back]
||I have considered in detail the problems involved in "Taking
Recovered Memories Seriously" (Hedges, 1994). [Back]
||I have considered these issues extensively under the heading, The
Paradigm Shift in Psychoanalysis (Hedges, 1992). [Back]
||Since this paper was first written, I have written in great detail
about the nature of and treatment of the Organizing Experience (1994a,
1994b, 1994c). [Back]
||I have written two books which detail the problems with these kinds
of transference and resistance memories and how to treat organizing
issues whether they are pervasive in the whole personality or whether
they form only pockets in the personality (as with most people). The
books are Working the Organizing Experience, (1994b), and In Search of
the Lost Mother of Infancy, (1994c). A four-hour videocassette
presentation by Dr. Hulgus and myself, also titled "Working the
Organizing Experience" is available now through my office. [Back]
||Recently, concern has moved to the danger of taking "recovered
memories" too literally or concretely. See Hedges (1993)
"Taking Recovered Memories Seriously."
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|* Lawrence E.
Hedges is a psychologist and psychoanalyst at 1439 East Chapman
Avenue, Orange, CA 92666. He is the founding director of
the Newport Psychoanalytic Institute, the director of the
Listening Perspectives Study Center, holds a faculty appointment
at the University of California at Irvine,
and is a training and supervising psychoanalyst at the
Institute. This article originally appeared in Remembering,
Reporting, and Working Through Childhood Trauma ()
(pp.85-138). Jason Aronson:
Northvale, NJ. [Back]