Professional Documents
Culture Documents
Model of Trauma
Jo Stuthridge
A Story of Self: Development of I, Me, and Self The internal structure of the self, then, arises
This section offers a theory or story about the from a matrix of relationships. I use the phrase
emergence ofselfwithin a relational paradigm; "Parent/Child ego state dyad" to stress that a
it revisits ego state theory in light of infant re- whole relationship is internalized, not just an
search and neurobiology. introject: for example, an anxious Child ego state
Is it appropriate to begin writing about incest in response to a critical Parent ego state. Little
with comments about my sons' underwear? (2005) refers to a similar concept as "ego state
How did this happen? Me watching I. William relational units" (p. 136).
James (1892, p. 176) made this distinction be- We might assume that the mind contains mu-
tween a complex reflecting self-a "me"-and ltiple ego state dyads that reflect the child's ex-
the simple experiencing "I." I propose that the perience ofthe caregiving environment. Fonagy
selfin James's sense ofa transient experiencing (2001, p. 165) and Schore (1994, p. 498) refer
"I" is best conceived of in transactional analy- to multiple sets of self-other representations in
sis terms as a multiplicity of discontinuous securely attached children. Relational psycho-
ChildlParent ego state configurations that pro- analysts (Bromberg, 2001, p. 181; Mitchell,
duce shifts in consciousness in response to con- 1988) describe multiple relational configura-
text. A sense of"me" as coherent and continu- tions within the mind. Bromberg (2001, p. 244)
ous over time develops with the Adult ego state suggests it is only with maturity that we attain
capacity to link ego states through story, thus an adaptive illusion of self that overrides the
creating a "narrative self." This concept of self awareness of discontinuity.
encompasses the paradoxical experience of This ordinary phenomenological experience
changing with time or context while knowing I of being many selves is summed up succinctly
am the same person. It also allows for the pos- by Virginia Woolf (1928/1993): "A biography
sibility of an "I" that is not part of me. is considered complete ifit merely accounts for
Citing infant research, several authors (Beebe six or seven selves, whereas a person may well
& Lachman, 1988; Lichtenberg, 1983; Stern, have as many thousand" (p. 224).
1985) suggest that an emergent sense of self Selfas Story: The Adult Ego State. One starts
develops out of repetitive reciprocal interac- to wonder, how do we experience any sense of
tions between infant and caregiver. Beebe and identity, a single "me" in the midst ofthis shift-
Lachman (1988, p. 306) used empirical evi- ing milieu?
dence of the infant's capacity to recognize, re- Berne (1961) referred to the integrative func-
member, and expect these recurring interac- tion of the Adult ego state but acknowledged
tions to suggest that the infant forms symbolic that "the mechanism ofthis integration remains
representations of self and other. This process to be elucidated" (p. 213). I suggest that self-
of internalization involves representations of narrative is the key mechanism for integrating
both infant and caregiver, a dyadic system that disparate Parent and Child ego states into a uni-
cannot be described on the basis of either part- fied sense of self or "me." The capacity to tell
ner alone (Beebe & Lachman, 1988, p. 305; stories about the self involves a reflective pro-
Fonagy, Target, & Gergely, 2000, p. 104). cess.
In transactional analysis terms, we might say Fonagy, Gergely, Jurist, and Target (2002)
that repeated transactions between the child argue that the development of such a reflective
and his or her caregivers are aggregated and capacity is dependent on attunement in early
internalized to form the basis of developing relationships. When the caregiver accurately
Child, Parent, and Adult ego states. As Berne represents experience for the child, this pattern
(1961) put it, the mind contains "relics of the of relatedness is internalized, and the child de-
infant who once actually existed, in a struggle velops an ability to integrate experience into
with the relics of the parents who once actually narrative. The child learns to name his or her
existed" (p. 55). He emphasized that ego states internal states and those ofothers. Fonagy et a1.
are phenomenological entities, not abstract rep- (2000, pp. 108-9) cite empirical evidence to
resentations (p. 4). demonstrate a high correlation between secure
attachment, reflective abilities, and narrative "subsymbolic" refers to affective and somatic
coherence. patterns of organization (Cornell, 2003, p. 45).
In transactional analysis terms, accurate at- Implicit memory remains outside of aware-
tunement facilitates the Adult capacity for re- ness. These memories are stored in emotions,
flective function and self-narrative. This con- sensations, and behaviors, with no sense of
cept of neopsychic function as a process of in- conscious recollection (LeDoux, 2002). Stories
tegration, reflective function, and narrative is stored in implicit memory systems might be
consistent with recent theoretical developments associated with Berne's (1961, p. 118) concept
in transactional analysis (Allen, 2003; Erskine, of protocol, which comprises the early rela-
2003; Tudor, 2003). Allen (2003) uses the term tional patterns that form the basis of script.
"psychological mindedness" to refer to "peo- Allen (2003) suggests that experience stored in
pIe's ability to think about their psychodynam- implicit memory creates "nonconscious organ-
ics and to put their experiences into narrative izing principles" (p. 131) that underlie later
script context" (p. 132). script decisions. Implicit storytelling is not re-
The mind is experienced, then, as an unruly placed but continues to exist alongside later
crowd ofChild-Parent ego states with their own explicit story forms (Damasio, 2000).
unique modes of relating and affective tones For example, when an infant's earliest inter-
that are given meaning and shape by a narrator actions are experiences of being adored and
-the Adult ego state. held snugly with a full belly, this set of sensa-
The Narrative Self. Accumulated evidence tions forms a subsymbolic narrative. These
from neuroscience supports the idea that the wordless stories form an emotional background
self does not start as an integrated whole but -setting the mood, tone, and broad themes-
rather is nonunitary in origin (LeDoux, 2002). that defmes the world as safe or dangerous.
LeDoux (p. 192) and Damasio (2000, p. 189) Simple symbolic stories about the selfemerge
both argue that narrative provides the essential with the development of explicit memory at 18
glue that binds various neural networks to cre- months (Schore, 1994, p. 483). Explicit memo-
ate a unified sense of self. The brain uses stor- ry involves conscious recall, language, and
ies to create a single "me" out of fragmented symbolic processes. These stories define the
experience. Neurological research suggests that basic plot, the ending, and the goodies and bad-
memory plays a major role in this process (Da- dies. This is the magical and concrete thinking
masio, 2000). of Beme's (1961) Little Professor or AI neo-
In transactional analysis language, script theo- psychic process. Al process tends to overgen-
ry aptly describes the crucial role ofstory in the eralize experience, thus forming injunctions
development of self-identity. A life script is a
story that arises out of interactions between a
child and the world. It can either be life en- Table 1
hancing or self-limiting (Allen & Allen, 1997; The Narrative Self
Cornell, 1988; Loria, 1995). Using a structural Ao Subsymbolic. affective.
ego state model, neurological findings about sensorimotor stories of self. Present
memory can be used to deepen our understand- at birth (Cozolino, 2002, p. 178).
ing of an integrating Adult ego state, the emer- Implicit memory systems.
gence ofscript, and the development ofa narra-
tive self (see Table 1). A, Simple symbolic. verbal stories of
self. Present from 18 months
Our earliest stories are wordless and arise (Schore, 1994, p. 487). Explicit
from nonverbal transactions between infant and episodic memory.
caregiver; they rely on sound, touch, and move-
ment internalized as PriCo ego state dyads. This A2 Complex symbolic stories of self and
experience is integrated into subsymbolic nar- reflective capacity. Present from 4-5
years (Fonagy, 2002, p. 245).
rative by an early Adult ego state (An) that re-
Autobiographical memory.
lies on implicit memory systems. The term
Several studies indicate limbic system abnor- experiences; the abusive father/abused child
malities and reductions in the size of the left and the good respectable father with the good
hippocampus in adult survivors of child sexual child remain side by side. These incompatible
abuse (Teicher, 2002, p. 71). What does this ego state dyads seem to alternate in Annie's
mean? Van der Kolle(2000) argues that disrup- consciousness.
tion to the limbic system-in particular, to the Attachment and Trauma. Child attachment
hippocampus-results in a failure to integrate researchers describe a similar process using dif-
traumatic experience into narrative. The hippo- ferent language and concepts. Numerous stud-
campus is responsible for the contextualization ies (Carlson, Cicchetti, Barnett, & Braunwald,
of experience in time and place. Impairment to 1989; Lyons-Ruth & Jacobvitz, 1999) verify a
hippocampus functioning leads to the persis- high correlation between child abuse and dis-
tence ofdissociated memory fragments, smells, organized attachment patterns. The child strug-
images, and sensations that are not located in gles to integrate contradictory experiences of
time and space. the caregiver as protective and hostile, leading
To return to the example of Annie, she did to contradictory clinging and fight and flight
not come to therapy with a neat story. She pre- behaviors.
sented, instead, with a series of symptoms that Longitudinal studies show that disorganized
made her feel crazy: disgusting smells that would attachment in children predicts dissociative
not wash away; nights lying awake in frozen symptoms in adults (Carlson, 1998). Fosha
terror hearing footsteps in the hallway, and (2003, p. 250) explains this link by suggesting
vivid images ofher father standing by her bed. that painful feelings and events are dissociated
She slept with the light and TV on. The events in order to maintain the attachment to the abu-
of her childhood were not integrated into self- sive caregiver. This Faustian compromise cre-
narrative; instead, the trauma intruded in the ates autobiographical narratives that lack emo-
present in the form of sensory intrusions or tional coherence.
flashbacks. Clinical Evidence and Dissociation. Adult
Damasio's (2000, p. 235) work with brain in- survivors of intrafamilial child abuse present
juries confirms that damage to the hippocam- with symptoms that meet a vast range of DSM
pus will halt the growth of autobiographical IV disorders (American Psychiatric Associa-
memory. Memory research also suggests that tion, 1994). However, clinical evidence from
under extreme stress, explicit memory can fail three key areas of research-sexual abuse
while implicit memory is enhanced (LeDoux, (Briere & Runtze, 1988; Herman, 1992), PTSD
2002, p. 29; van der Kolk & Fisler, 1995). Sie- (McFarlane & Yehuda, 2000; van der Kolk &
gel (2003) and Cozolino (2002) both argue that Fisler, 1995), and dissociative disorders (Put-
trauma impairs neural integration in the devel- nam, 1989}-all confirm a connection between
oping brain, resulting in a failure to integrate childhood abuse and the process of dissocia-
implicit memories of trauma into autobio- tion. The evidence suggests that dissociation is
graphical narrative. a critical mediator between child abuse and a
In transactional analysis terms, these biologi- variety ofpsychiatric symptoms, including sub-
cal changes interfere with the Adult ego state's stance abuse, self-harm, suicide (Kisiel &
capacity for integration through narrative. Feel- Lyons, 2001), somatization, borderline person-
ing states, events, and relational patterns of ality disorder (BPD), and PTSD (Streeck-
trauma can all be recorded in implicit memory. Fischer & van der Kolk, 2000). Dissociation
In other words, whole ego state systems may be can be understood as a disruption in the inte-
dissociated, not just the sensory elements of gration ofmemory, consciousness, and identity
trauma. (American Psychiatric Association, 1994, p.
For example, Annie's proud memories of 477).
walking to church hand in hand with her father Braun (1989) described a continuum of dis-
sit alongside vivid sensory memories of the sociation from normal that includes "highway
sexual abuse. There is no integration of these hypnosis" to PTSD and finally to dissociative
identity disorder (DID). The degree of disso- through the kaleidoscopic lens created by his or
ciation in an adult survivor depends on the her unique ego state patterning. This ego state
availability ofan adequate caregiver, age ofon- matrix determines affect regulation and rela-
set, severity of trauma, and closeness of the tional patterns. Neutral cues are experienced as
relationship to the abuser. With patients with signs of danger, while other people are per-
DID, 95-98% of them have been victims of ceived as untrustworthy or abusive. The inter-
severe child abuse (p. 308). nal world is turned inside out through projec-
The evidence accumulating from empirical tions of excluded Parent and Child ego states.
studies, like a braided river, seems to take dif- The unintegrated experience oftrauma is reen-
ferent pathways to a similar destination. Neu- acted through these repetitive patterns oftrans-
rology, attachment studies, and clinical re- ference, thus reinforcing the traumatic script.
search all point to the same conclusion: Trauma At this point we have an answer to the ques-
interrupts the capacity to form self-narrative, tion posed at the beginning. The monsters were
thus creating a division of experiences or dis- outside but they get inside via the internaliza-
sociation. In transactional analysis terms, we tion of early relationships in Parent/Child ego
might call this exclusion. states. The intrapsychic structure then shapes
the view of self, others, and the world outside
Self without Story: A Transactional so that the adult survivor of abuse continues to
Analysis Model of Trauma see monsters long after they are gone.
This section proposes a model oftrauma that The real tragedy for most survivors of child-
integrates a relational theory of self with em- hood trauma is the struggle they have in form-
pirical evidence about the impact of trauma on ing satisfactory loving relationships as adults.
development. Traumatic Script.
The Disorganized Self. Trauma impairs the Subsymbolic narrative, A o.. Physiological
Adult ego state's capacity to organize experi- symptoms ofPTSD give voice to three corner-
ence through narrative, which results in a fun- stones of the traumatic script using Ao sensori-
damentally disorganized self, one without an motor language. These symptoms tell a story
effective story to bind disparate Parent-Child without using words,
ego states into a cohesive identity. The disor- 1. "Never forget" is the message expressed
ganized self includes many different "I"s and through intrusive symptoms: flashbacks,
no coherent "me." somatic symptoms, nightmares, and panic
Inside Out. attacks, all relating to implicit memories
1. Outside gets inside. The experience ofchild of trauma,
abuse is internalized structurally as a kaleido- 2. "Never go this way again" is suggested
scope oftoxic Parent/Child ego states stored in by avoidant symptoms: forgetting, emo-
implicit memory systems (PoIC o)' These rela- tional numbing, denial, dissociation, and
tional prototypes represent the child's diverse drug and alcohol abuse.
emotional experience ofabusive and neglectful 3. "Be prepared" is the clarion call of hyper-
Parent introjects alongside abused and aban- vigilantsymptoms:agitation,anxietystates,
doned Child ego states. and exaggerated startle reactions (Dalen-
2. The capacityfor self-narrative is impaired. berg, 2003).
In the absence ofsecure attachment, trauma im- Simple symbolic narrative, A J• AI process
pairs the Adult capacity for complex self- gives rise to simple, overgeneralized, concrete,
narrative (A2) . The abuse survivor relies on or magical stories. A traumatic script is formed
earlier forms of neopsychic functioning (Ao or based on beliefs about the self as bad, mad,
At), thus forming restrictive stories or trauma- unworthy, or unlovable, while other people are
tic script. Incoherent self-narrative gives rise to depicted as malevolent, untrustworthy, or un-
excluded ego states. caring. Bad things are attributed to a bad self.
3. The inner world shapes the view outside. The child without narrative has no buffer against
The adult survivor continues to see the world external events.
For example, Nancy first knew she was bad image with the charming, friendly, quite hu-
at age four when her mother suddenly aban- morous Sharon who turned up to subsequent
doned the family, pinning a note to Nancy's sessions. At other times, she would walk out of
back as she left. Nancy did not feel bad-she sessions in fits of rage, quit her job, overdose,
was bad. When her uncle, a priest, sexually cut herself, and binge eat. These diverse pre-
abused her when she was five then threatened sentations reflected a series of alternating ego
to shoot her father if she told, she knew this had states with no coherent self-narrative.
happened because she was a very bad child. Sharon had been sexually abused by her fath-
When her stepmother locked her in a dark cel- er from her earliest memories until she was 16.
lar, Nancy knew she was as black and bad in- Her father disguised this exploitation with ap-
side as the cellar was outside. Years later, the parent adoration and involvement in her activi-
black returned, perceived as a sticky black sub- ties. Her mother never asked questions. The
stance inside her body. Sometimes the black secret of incest remained safely hidden behind
would ooze out and stick to her hands. She of- the family's quiet middle-class lifestyle. Sharon
ten scrubbed them until they bled. Nancy was either pretended that things were fine or she got
careful not to tell her husband about the black sick. She had no words to explain her distress.
for fear he would see her badness. She told him This childhood reality was reenacted during
nothing of her past. He left one day after 20 her adult life. For long periods Sharon pre-
years of marriage saying she did not trust him. tended, hiding the incest secret from her own
Nancy knew he left because she was bad. awareness. She looked after her children and
Exclusion. Exclusion is defined here as a worked in a supermarket. Alternately, she be-
process of "dis-integration" due to a failure of came sick with depression, self-disgust, suici-
the Adult ego state to integrate experience into dal thoughts, and flashbacks of sexual abuse.
narrative. Parent/Child ego state dyads become Sharon had frequent hospital admissions over
excluded from Adult awareness and each other, 20 years, diagnosed with bulimia, BPD, and
alternating in mutually exclusive patterns. PTSD. As she became aware of this process,
Excluded Parent/Child ego states may in- she began to describe herself as a Jekyll and
clude painful feelings related to trauma, unmet Hyde: "I have to be either one thing or the other."
relational needs, and conflicted experience of During our work together over 6 years, these
a caregiver as loving and abusive. Exclusion distinct ego state systems achieved some level
results in a discontinuity ofself-experience but of integration. Sharon managed to attend both
also preserves more adaptive ego states that al- work and therapy and learned to live in the
Iowa child to cope. present, creating a narrative of self that in-
Erskine (1993) suggests that trauma leads to cluded her past.
"ego fragmentation and dissociation" (p. 38);
however, the process he describes is very dif- Stories without Words: When Actions
ferent from what I am suggesting here. He as- Speaker Louder . . .
sumes that the selfbegins as a whole entity and The unfolding ofthe script is the substance
fragmentation occurs with lack of contact. I am of the psychoanalytic process. The trans-
proposing that self begins as a multiplicity of ference consists not merely of a set of in-
ego states and integration through self-narrative terrelated reactions, a transference neuro-
is a developmental achievement. sis, but ofa dynamically progressive trans-
Sharon's story illustrates this model. During ference drama, usually containing all the
her first few sessions, Sharon would sit, wring- elements and subdivisions of a Greek tra-
ing her hands, with her head lowered and her gedy. (Berne, 1961, p. 174)
body shaking. Long silences, tears, and stam- The abuse survivor arrives in therapy with a
mering attempts at speech dominated the hour. chaotic display of symptoms-the outer mani-
Her whole presence powerfully evoked the festations of a disorganized state of mind. Intra-
sense of a small, frightened child squirming psychic relationships between ego states are ex-
with shame. It was difficult to reconcile this ternalized through shifting constellations of
Uninvolved
Fairy Parent
Godmother
Abuser
Internal
dialogue
Figure 2
The Disorganized Self: Three Transference Patterns
3. The empty child in relation to the unin- dyad. The concept of transference used here
volved parent, a Victim-Bystander (Clark- draws on Erskine's (1991) defmition-"exter-
son, 1987) theme nalized expressions of internal ego conflicts"
With intrafamilial abuse, there is almost always (p. 66)-and assumes that both Child and Par-
an uninvolved parent who failed to protect the ent ego states can be projected. The transferen-
child. Neglect plus abuse forms a particularly tial relationship is viewed as a mutual construc-
toxic matrix of Parent/Child dyads. tion (Hargaden & Sills, 2002, p. 63).
While the themes and characters are familiar, In the following sections, case vignettes illus-
each ego state system is a manifestation of ac- trate a relational approach to therapy with adult
tual relationships that have been internalized. survivors of child abuse.
The emphasis is on phenomenology: finding 1. The good child and the fairy godmother.
names and addresses for ego states involved in This transference pattern (see Figure 3) is a
transferential transactions. Cinderella story and often marks the beginning
A Parent/Child ego state dyad may be experi- of therapy. Stories of a child being raped or
enced as an intrapsychic impasse, as an active beaten easily tug on the heartstrings, thus in-
Parent or Child ego state, or interpersonally voking the Rescuer ever present in many thera-
when one aspect of the dyad is projected. Cli- pists with the desire to alleviate suffering by
ent and therapist can find themselves experi- magic. From the client's perspective, feeling
encing both aspects ofan internalized ego state believed and understood for the first time can
Figure 3
The Good Child/Fairy Godmother (after Moiso, 1985, p. 197)
provide a powerful elixir that conjures up pain. She used glimpses of me with my family
unheard-of promises and the fantasized fairy in public as proof of her perception.
godmother. This dynamic can be formulated as Over time, an entitled Child ego state emerged.
an expression of Co longings for unrnet needs IfSharon truly was as innocent as I maintained,
(Hargaden & Sills, 2002) or an attempt to find then surely she deserved a few phone calls?
a symbiotic fusion through projection of the During suicidal crises, pleas for extra sessions
fantasized Parent figure (P 1+) (Haykin, 1980; and phone calls escalated; somehow I was not
Moiso, 1985). I believe there is no reason to doing enough.
differentiate this fantasized introject from other Working through a fairy godmother trans-
introjects (P2 ) ; both are real subjective experi- ference usually involves giving up hopes ofres-
ences formed from a mix offantasy and reality. cue, acknowledging that the abuse did happen,
For example, Sharon had a constant fantasy and mourning for a lost childhood. Instead of
as a child that her kindly neighbor, an older waiting for the therapist to wave a magic wand,
woman, would one day take her home. In thera- the client leams to tolerate the pain of never
py, an idealizing transference emerged very having felt cared for.
quickly in which I was viewed as the best 2. The abused child and the abuser. Fair-
therapist she had ever seen, an all-loving, per- bairn (1952/1992) first noted in his work with
fect mother who could magically remove her abused children that the abusive parent is
frequently internalized and split off or disso- integrity, like sexual abuse. She began cutting
ciated from consciousness. This sadistic Parent herself; memories and sensations of sexual
ego state is evident in harsh internal dialogue abuse flooded her awareness. She phoned me at
and persistent self-blame. It often seems intent home feeling desperate. I calmed her somewhat
on a campaign oframpant self-sabotage, mani- and then suggested we talk further in the ses-
fested in self-destructive behavior like Sharon's sion. Angry at my response, she immediately
starving, purging, cutting, and overdoses. phoned my colleague and then her insurance
This abused child/abuser ego state dyad ap- case manager, complaining about my lack of
peared in therapy with Sharon during long stuck availability. The case manager phoned me, ac-
periods when she would tell variations on the cusing me ofignoring Sharon's distress-guilty
same story over and over (e.g., "People are cruel again. I received this call a day after my mother-
to me"). She felt distressed and helpless (abused in-law died. I entertained a brieffantasy about
Child), while everyone around her, including calling Sharon to cancel the next session be-
me, was seen as being hurtful (projected abuser). cause of the funeral. A retaliatory fantasy-
Occasionally there would be a rapid switch "See how guilty you feel now." At this point I
in ego states. During a period of crisis, Sharon realized the extent of the guilt Sharon had felt
began asking me to hold her hand during ses- as a child and the way it was being tossed be-
sions or to sit next to her on the couch. I gently tween us in the transference and countertrans-
refused the physical contact, suggesting we talk ference. This time it was only a week before
about her need for touch instead. Shortly after- she recognized the pattern.
ward, I received a call from her psychiatrist; Sharon began to accept the depth of her an-
Sharon had complained that she felt abused by ger and to understand her guilt. With this Adult
me. awareness, previously excluded feelings were
Sharon had recreated her family of origin in integrated into an expanded autobiographical
this drama. The psychiatrist requested meetings narrative.
and explanations, while I felt trapped and guilty. Using game theory and blanket labels of
Sharon seemed to enjoy exercising some power "Kick Me" or "Now I've Got You, You Son of
over me. My supervisor made an insightful a Bitch" to explain these events would miss the
comment: "She's fucked you." This summed up subtle detail of the relational dynamics being
the nature of the intrusion I felt-projective repeated in the transference.The sudden switches
identification with an abused Child ego state. in Sharon's ego states resulted from disjointed
Over several months, Sharon and I managed to self-narrative and unintegrated ego states, both
unravel the tangle. She understood that her feel- characteristic ofBPD.
ings ofguilt in coming to see me were much like In my work with Sharon, I found myself navi-
the feelings she had about her relationship with gating an uneasy path between actual recapitu-
her father. She felt guilty about being in ther- lations of past trauma and creating a stage on
apy for several years and kept the relationship which these silent dramas, which have been ex-
secret from her family. When she disclosed cluded from awareness, can be enacted, sym-
abusive memories, she felt abused by me as she bolized, and integrated into conscious narra-
was by him (projection of the abusive Parent). tive. My supervisor reminded me ofthe impor-
She acknowledged the complaint was an ex- tance of keeping the doors to the "theater" shut
pression of anger and eventually recognized (boundaries) while the "play" is in progress to
her own behavior as being like her father's (ac- prevent fantasy from spilling out into the real
tive Parent), an alien, excluded part of herself. world.
The enactment was repeated again some 3. The empty child and the uninvolved par-
months later. On this occasion, Sharon had just ent. In therapy, Nancy was silent for long peri-
been diagnosed with arthritis, a disease from ods, staring out the window. When I asked a
which her father also suffered. She felt as question she seemed not to hear or asked me to
though he was in her body again and experi- repeat it. Her mind seemed utterly discon-
enced the arthritis as a violation ofher physical nected, like a computer that freezes. She was
on medication and had had many courses of Creating New Stories: Cure
electroconvulsive therapy (ECT). Long before I believe the goal of therapy is to strengthen
this treatment she had perfected the art of dis- the Adult ego state's capacity to create coher-
sociation during countless incidents of sexual ent self-narrative. Within a relational therapy,
abuse as a child by numerous offenders, includ- intrapsychic dynamics are externalized through
ing brothers, cousins, and uncles. At these transferential enactments. As client and thera-
times, Nancy would leave her body and view pist resolve these impasses in the relationship,
the abusive scene from a third-person perspec- excluded Parent-Child ego state dyads can be
tive. For long periods I felt as though I had integrated into an expanded self-narrative. At-
completely lost contact with her. She came and tunement in the therapeutic relationship is used
went from sessions with little change, appar- to develop the Adult capacity for reflective
ently unreachable. During sessions I often function and self-narrative.
glanced at the clock, feeling irrelevant. Adult attachment research shows that coher-
In one session, Nancy and I had the follow- ent narrative in a parent is the most robust in-
ing exchange: dicator of secure attachment in infants (Hesse,
Nancy stared blankly. 1999). These findings suggest that integration
Jo: Where are you now? within the mind fosters interpersonal connec-
Nancy: I'm back in the cellar. (She goes on tions. In transactional analysis terms, this means
to describe the wee square of linoleum she that coherent self-narrative can prevent the in-
sits on, the cold and dark.) tergenerational transmission of script.
Jo: What are you thinking about? To return to the story of Annie, one day she
Nancy: That someone might find me ... arrived at the session with a broad smile and
Jo: Your mum? without her baby granddaughter. We both knew
Nancy: No. She didn't want me .... She's this meant she had left the baby with her hus-
dead (said in a deadpan voice). band Bill, trusting him for the first time-ever.
It slowly dawned on me during this session As she said, "It just feels so different. It's only
that I was experiencing myself as Nancy's "dead now talking to you that I realize how different
mother." She had no investment of hope in me I am. It's such a warm good feeling to see Bill
at all. Nancy's mother had left when Nancy was holding the baby." We both share "the warm
four, leaving her vulnerable to years of sexual good feeling" in a moment of eye contact-so
and physical abuse. These feelings ofdeadness different from the furtive glances and shame
or emptiness can be harder to cope with than that has permeated our sessions in the past.
the drama of the abuser-victim dyad. Gabbard Coherent narrative integrates disparate ego
(1992) suggested that the tenacity with which states into a continuous sense ofself. The client
the incest survivor clings to the paternal trans- is free to roam in previously excluded parts of
ference may be an attempt to avoid this deaden- the mind. The stream of consciousness be-
ing void. comes deeper and wider rather than being forced
This transferential dyad often appears as a down the narrow channels carved by the trau-
perception that the therapist is uncaring or un- matic script. The client develops a broader,
available-projection ofthe uninvolved Parent. more flexible story of self that makes sense of
A switch can occur ifthe therapist is inspired to the past and creates a new future. A client
"go the extra mile" to prove caring, thus pro- summed this up for me during a final session.
voking the entitled Child. Attempts to love the When I asked her what had changed, Jamie
client more than the uncaring mother did might said, "It's like having a walk-in wardrobe in
also lead to a sexual transgression of boundar- your mind."
ies wherein the therapist becomes the abuser,
thus repeating the incest. A significant percen- Conclusion
tage of clients involved in sexual relationships This article proposes that self-narrative is a
with therapists have been incest victims as key function of the integrating Adult ego state.
children (Gabbard, 1992). Trauma and neglect in early relationships impair
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