Re:ego state work

To all readers I'll repeat my caution that this forum doesn't have enough information to do individual case consutlation, we just have a partial picture. And clearly, there is a lot at stake for people who post here.

Here are a couple of general thoughts that are triggered by the above posts.

1) work with dissociative clients can be very thorny -- there are transference reenactments and counter-transference issues as well. No therapist has 100% completion of their own issues and triggers -- and some have a lot of personal work to do around attachment and trust, and those issues can be hot spots in work with dissociatives, who specifically and energetically test around those issues, to see if the therapist is safe or malignant. Introjects often specialize is such testing, because they are not BAD but protectors in their way.

2) the power dynamics with highly dissociative clients can be extremely intense, and the client can sometimes evoke their own issues in their therapist even if the issue ISN"T an unresolved issue for that therapist. That's when projective identification is operating, rather than counter transference. In that case, the therapist can find him/herself responding in ways she normally wouldn't, as if in fulfillment of the client's deepest fears. This isn't to blame the client, but to identify another way these dynamics of reenactment and protection can unfold.

3) There are ways and there are ways to terminate work with a client. Although laws and ethical codes vary from state to state and profession to profession, it tends to be a guiding principle that terminations have to be conducted in an appropriate way, usually with closure sessions unless extraordinary behavior has interfered with the therapist feeling physically safe to close with the client in person. Typically, therapists are expected to make sure the client has follow up care, so that the client is not abandoned and at risk.

4) Typically, if a client has moved to a new therapist, the old therapist SHOULD NOT have continued contact with the client -- boundaries need to be clear here. Murky boundaries and continued contact with prior therapists can mess up subsequent therapy.

5) It is among the most difficult challenges to therapists to monitor and observe all of the transference, counter-transference and projective identification reenactments that can occur in work with highly dissociative and/or borderline clients. It can also be among the most rewarding, but it is guaranteed to bring therapists to the limits of their knowledge. This can result in a feeling of being deskilled, which can lead to burnout. For that reason, therapists who find themselves in any of these circumstances often benefit by seeking consultation with someone who can help them sort out if it is transference, countertransference, or projective identification leading them around by the nose.

Again - I don't know if ANY of these comments apply in the above case. Its simply what comes to my mind, having personally learned some of these lessons the hard way and seeing them in therapists with whom I consult.

Replies:

termination, by wondering, 08/10/03 afterthought, by wondering, 08/10/03 Re:afterthought, by Sandra Paulsen Inobe PhD, 08/11/03 Re:afterthought, by wondering, 08/11/03

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