Ego States therapy is a form of Parts Work that can be used in conjunct to almost any therapeutic orientation. It can be used for clients with a variety of presentations such as; burnout, stress, anxiety, depression as well as clients who have complex trauma, post traumatic stress disorder (PTSD), and dissociative disorders (including Borderline Personality Disorder (BPD) and Dissociative Identity Disorder (DID) (Shapiro, 2016). Ego States therapy emphasizes strengthening and remaining present in the clients most functional adult part, while accessing and reparenting the traumatized younger parts (Grand, 2013).
What are Ego-States?
"Ego states are bundles of neural connections that hold consistent patterns of information, affect, attention, behavior, and sometimes identity, which correspond to specific developmental ages or situations." (Shapiro, 2016). In short, as we develop, monumental situations and events can develop neural connections that wire together in a specific default pattern. This wiring contributes to the behavioral, affective, attentional, and identity that relates to that situation. Humans are wired for many different things innately, including walking, eating, sleeping, showing aggression, connecting with others, among many other examples. (Shapiro, 2016). Research even shows that infants can develop different neural networks of connection and expectation based on different caregivers (Shapiro, 2016). This is what contributes to the development in attachment style that we often see starting at birth and in infancy. As we move through life and we experience repetitive situations, both positive and negative, we thicken and strengthen the neural connections associated with those situations (Shapiro, 2016). This is how adverse childhood events end up significantly impacting adults in later life. Children that are exposed to repetitive situations and experiences of neglect and/or abuse, wire neural connections that prime them for flight, fight, freeze or fawn responses. They also become specialized in managing feelings of abandonment and fear (Van Der Kolk, 2008). In the opposite, if children come from nurturing, loving environments, their brains wire connections that specialize in exploration, play and cooperation (Van Der Kolk, 2008). In other words "neurons that fire together, wire together," and these connections become our default settings throughout our lifespan, unless otherwise addressed (Van Der Kolk, 2008).
The Normalcy of Parts
Humans have parts regardless of negative or traumatic events that have happened to us. It is a normal way of identifying and defining ourselves and does not mean that we have an issue to address. Parts do not exclusively occur in relation to mental health issues nor dissociative disorders. If you were to think about many of the decisions that we have wavered on, much of the time, how we describe it is: "a part of me wants ice cream, but another part of me doesn't enjoy that as much as cake." Or, "a part of me wants to go to Mexico for holidays, but another part wants to see my family." Parts allow us to feel or experience two or more things at one time, both equally desirable but sometimes in conflict with each other. When the conflict is too great to be resolved naturally, a part takes control when it is not congruent with the situation or not helpful to us or when the parts are dissociated from each other- as is the case with trauma or mental health issues, ego-states therapy can help reintegrate and assign a most functional adult part to "drive the car".
How and Why does Ego States Therapy Work?
Most of my clients are shocked, astounded actually, at the results that they get from integrating Ego states with our EMDR work. It is especially effective for clients who experience dissociative disorders. As a symptom of a dissociative disorder, they already feel fractured into dissociative states or parts. Ego states therapy works by:
creating awareness of functional and non-functional (or pathological) states that are present and the switching that occurs during moments that are triggering to the person
emphasizing and strengthening a mature, most adult part, that remains in control during situations, emotional moments or when dealing with others
healing from past trauma by creating a dual attention between the parts that are stuck in the past traumatic event and the here and now adult part
allowing traumatized parts to come forward to the here and now and experience that it is different and safe
reconnecting with resources within the person
depending on the pathology of the client, bringing the most adult part forward to "drive the car" the majority of the time
remove parts that have lingering negative effects on the client (i.e. parts that are highly critical, self-sabotaging, self-abusive)
increasing the presence and control of nurturing, protective, compassionate adult parts
Inner Child Work Vs. Ego-States
In its root, Ego-States therapy is very much akin to inner child work, however it expands into the world of neuroscience and trauma. It also has focus on more than one part, including adult parts that are not considered the client's most resourced adult part. Adult parts can also hold traumatic events, if those events occurred at that age. Both inner child work and ego-states therapy tend to be highly emotional processes for most clients as they are accessing some of the most vulnerable memories and deep rooted emotional experiences. It is a very powerful experience to speak to a younger part in a way that that part deserved or needed, in retrospect. Because of the powerful impact Ego-States or inner child work can have for clients, it may be tempting to do a meditation or dabble in some of the exercises found on the internet. However, as always, I do recommend that, for your emotional and psychological safety, you work with Ego-States therapy trained clinician. Accessing neural networks can have long standing effects and a trained clinician will know how to do this safely as well as to deactivate and contain for the end of a session. The majority of the exercises need to be guided intuitively to be the most impactful to your specific situation and what that part may need from you. Although meditations and scripts can be helpful and in ways cathartic, they are generic and usually do not have the follow through to heal and integrate an ego-state.
References:
Grand, D. (2013). Brainspotting: The revolutionary new therapy for rapid and effective change. Boulder, CO: Sounds True. 2013
Shapiro, R (2015). Easy Ego-States Interventions. WW Norton. 2015.
Van Der Kolk, B., (2008). The Body Keeps Score. 2008