 |
Treating Dissociative, Abused and Ritually Abused, Children, Part II, Copyright, 2004, Ellen P. Lacter, Ph.D.
Play Characterizations and Abuser Personalities
In evaluating the meaning of the play of a DID child, and in planning interventions, the therapist should consider that
characters in dramas may represent figures in either the child's outer world or inner world. Or, a figure may simultaneously
represent both. In DID, most traumatogenic experiences, defensive responses (e.g., identification with the aggressor), emotions,
and object representations become embodied in personality states, which are then manifested in play. Aggressive figures likely
portray abusers as well as personalities who behave as does the abuser. Violent themes can represent prior abuse, angry fantasies,
and inner struggles between personality states. Drawings that depict retaliation against a perpetrator often, on a deeper
level, reflect the childs fear of terrifying attack. Caregiving may represent external relationships or inner caregivers of
traumatized baby personalities. Figures often shift characterizations within dramas, as the child often shifts identity states.
For instance, a figure may initially portray an external abuser, then become the disavowed "bad" aggressive self,
then represent the fearful child-self.
This multi-determined derivation of play characterizations has critical treatment implications. Until the meaning of
the drama is fully elaborated, the most safe response may be to reflect the actions, feelings, and motives of all characters
in the drama.
The therapist should observe the play carefully for representation of abuser personalities. Most DID children have abuser
self states who take on the appearance and demeanor of the child's actual abusers. Traumatized child personalities tend to
perceive them as their actual abusers. Abuser personalities often threaten bodily harm should the host remember the abuse
or should disclosure be threatened. They may internally kick personalities in the head to silence them, sometimes resulting
in migraine headaches. They often "keep other personalities in line" with physical punishment, not realizing that
this injures the one body they share. In some cases, they have been programmed to inflict severe physical injury, placing
the child at risk for suicide.
Some abuser personalities were originally created by the child as a protective measure, to ensure compliance with abusers
so as not to incur their wrath. They act in a frightening manner, as did the abusers, and threaten the child with harm should
any personalities consider violating the wishes of the abusers, as in disclosing the abuse, or refusing to comply with abusers
directives. Their inner tyranny may continue for years after protection has been afforded since many of these personalities
are often "stuck in a time warp", experiencing their abuse as ongoing.
Abuser personalities can also be self-states who were hurt at a very young age and who defend against their fear and
sense of helplessness by identifying with their abusers and assuming their demeanor and behavior. They may believe the lies
and promises of the abusers and buy into their abusers view of people and the world and way of life. They may be at risk of
sexually or physically abusing other children or animals. They often frighten the child. They may take executive control of
the childs body and consciousness and commit abusive acts while other more central personalities are amnesiac, having experienced
only a loss of time.
In organized ritualistic satanic abuse, as well as in some child pornography and pedophilia rings, children are forced
to abuse other children as soon as they are physically capable, as young as 2 years. They are encouraged to direct their pent-up
rage into abuse of more helpless victims. By design, this results in their viewing themselves as willing cult members. Faced
with their capacity for abuse, many DID children, and other severely abused children, often develop keen insight, sometimes
even in the preschool years, that their abusers were also victims. Theirs is a painful struggle to determine if both the abuser
and self are irredeemably evil and deserving of death, or forgivably rageful and abusive, secondary to abuse.
While it is helpful to facilitate expression of anger toward figures representing actual abusers, attacks against figures
representing abuser self-states are likely to make them feel threatened, hated, and condemned. While incarceration of figures
representing actual abusers is an adaptive resolution depicting protection, incarceration of aggressive self-states will result
in their feeling afraid and hurt and will cause greater internal polarization rather than synthesis of personality states.
In protest or desperation, threatened abuser self-states may respond by retaliating against other personalities, resulting
in acts of self-harm, or in acts of violence against external people.
Violent dramas should be observed and understood before determining the therapeutic response. Play interventions should
aim to represent the childs psychological dilemmas and resolve them. For example, the childs violent drama may represent generalized
rage toward both abusers and self. The therapist may be able to guide the drama to more clearly identify an abusive adult
character, such as figures who intend harm to a frightened baby, puppy, or little frog. The therapist may also be able to
help the child to choose a pro-social character with protective anger, such as a police office, a guard dog, etc. Abuser self-states
have always wished they could direct their anger against their abusers. These fighters for good can then rescue the defenseless
figures and take them to a safe and nurturing place, where they can subsequently provide them with protection. Their big and
bad demeanor is borne of fear. Once they feel empowered and safe, they can drop this defensive posture.
The complexity of the issue of abuser self-states does not end here. Victims of organized abuse often have personalities
intentionally tortured into creation to serve the abusers. Pain and terror are used to force another split, the formation
of a new personality. This new part is tested for compliance to the abuser group, usually with commands to hurt another child
or kill an animal. If it does not comply, the torture continues until a personality is created who is completely loyal and
servile to the abuser group. It is given a name and function, e.g., reporting to the abusers. Further torture ensures its
silence. These personalities are often programmed to inflict severe physical self-injury, placing the child at risk for suicide,
if the abuse begins to be recalled or disclosed. These personalities comply with the abusers agenda out of terror and in the
(false) hope that they will be harmed less, spared, or given a position of status and power, if they perform as they are told.
Abuser personalities defensively created by the child, and personalities intentionally created by the abuser group to
serve them, both pose danger to the child should the host personality begin to recall the abuse or make abuse disclosures.
The fourth kind of abuser personality is not actually a part of the child. Victims of organized abuse may have figures
in their inner worlds who function in many ways like abuser self-states, but are actually external entities "implanted"
in a child's internal world through prisoner-of-war-camp-style mind control programming. These pseudo-personalities function
like robots, performing limited behaviors for the abusers, such as telephoning the abuser, or entering a particular building,
and have no human volition or feelings, and little real intelligence. These non-human implants are, in cases of sophisticated
abusive mind control, anchored to genuinely human personality states of the child to give them the capacity for planned action.
By design, removal of implants without first disarming and disconnecting them from true personalities can have severe psychological,
and secondary physical, consequences. For example, the child may psychologically re-experience being shocked, suffocated,
frozen, etc. In these complex cases, their removal should be done, or at least overseen, by specialists experienced in safely
disabling complex mind control programming (Stephen Oglevie, 2001).
The fifth type of internal abuser is perceived in the inner world as an evil spirit of an abuser, usually attached to
true personality within spiritually abusive rituals. Whether its derivation is truly spiritual, or simply perceived to be
so, is an interesting spiritual and psychological question, and subject of debate among clinicians treating victims of ritual
abuse. These entities play a more sinister and dangerous role than the robotic implants, since they function with the apparent
motive of ensuring the continued abuse of the child, and can carry out more complex functions, such as reporters to the abuser
group or punishers of the child to ensure compliance with the abusers. They can pose significant danger to the child.
The Importance of Safe Places in the Treatment of Dissociative Children
The symbolic creation of safe places in play, art, and guided imagery, is an important key to reducing the dissociative
child's perception of danger in both the internal and external world. We are informed in our understanding of the nature and
form of such safe places by DID adults, who tend to have complex internal landscapes with safe places, such as houses with
rooms for personalities or sanctuaries with man-made or natural features. Many sequester potentially dangerous personalities
in secure places where they are contained and can do no harm to other personalities or the body.
Therapists can guide DID children to enhance their internal landscapes. Child states in stark rooms can be given a fluffy
blanket or stuffed animal. Internalized protective parents, caregiver personalities, and spiritual figures can bring these
to the children. Protective perimeters can be created to conceal safe places from outside detection. Intra-system communication
devices be installed in each room, such as intercoms or video monitors, either one-way or two-way, depending on the needs
of each personality. Traumatized child personalities stuck re-living their abuse can found. Cathartic release of grief within
a supportive, therapeutic relationship, especially with a protective parent, facilitates this process, but the fear and physical
pain need not be relived. Horrible memories of physical pain and terror can be stored in a notebook, safe, or other object
to prevent their being re-experienced. A drawing of this object can make it more usable. The abused child parts can be rescued
and relocated to an internal healing place, or may be able to grow older and be brought forward in time away from their trauma.
These enhancements and shifts in the internal world have surprisingly enduring, beneficial effects.
Harmful psychological or spiritual messages (claims, curses, covenants, etc.) can be rejected, refused, and renounced,
and thrown in a garbage can made of art supplies. Prayer within the protective familys spiritual framework can declare these
harmful messages null, void, and forever broken. These can then be replaced with true blessings.
Removal of spiritual entities can be a complex task. Clearly, there should be no attempt to spiritually remove a part
of the childs true self. However, victims of ritual abuse often derive great benefit from prayer by skilled clergy and appropriately-trained
therapists to spiritually separate perceived sources of evil, such as spirits of abusers, abusers ancestors, and demonic forces.
Abusers trick some personalities to believe they must permit evil attachments. These parts need to be found, the abusers lies
exposed, and these parts must decide to separate the evil from themselves. Help of clergy and spiritual healers specialized
in working with ritual trauma is often important to discover and resolve complex abuse involving evil attachments.
McMahon and Fagan (1993) suggest the use of fanciful images to help DID children create internal safe places, e.g., a
bird to take personalities to a safe place and an entryway like a tree stump. They suggest placing a protective guide in the
sanctuary, but only after obtaining the child's commitment to protect the sanctuary to prevent any harmful parts of a child's
personality system from providing a "false" guide. They reinforce the image by guiding children to experience its
content and sensory elements. Shirar (1996) suggests children draw the safe place to make it more easily visualized. With
children younger than 4 years, McMahon and Fagan suggest the safe place be initially represented with toys, then imagined
with closed eyes to internalize the image. They suggest children visit the safe place at the start and end of sessions for
continuity. Transitional objects, e.g., a special toy or stone, are used between sessions as symbols of strength. As personalities
tell their stories, express and release their pain, and give up defensive identifications with aggressors, guided imagery
is used to take them to the safe place inside, accompanied in imagination by whomever the child chooses, e.g., protective
caregivers or even deceased relatives or pets.
Unfortunately, for many victims of organized abuse, their internal landscapes and its features, including seemingly-safe
places, were mentally installed in torture-based mind-control and hypnosis for abuser control over the individuals system
of personalities. Such clients are at risk for developing only contaminated new images of safety and healing. In such cases,
the therapist should suggest novel helping images that contrast thematically with those the client already uses or finds alluring.
Nurturing, protective caregivers serve important functions in the play therapy process with dissociative children. Their
symbolic portrayal of protective parents or socially-sanctioned protectors, such as police officers, in role play and figure
play, concretizes the concepts of protection and safety, facilitating internalization of their protection. Furthermore, portrayal
by nurturing caregivers of loving parental figures helps segregated and frustrated attachment strivings re-surface and find
expression.
Direct Interpretation and Intervention in Dissociation of Trauma
The younger the child, the more likely inner personalities are in a process of formation rather than fixed. These fluid
personalities become more separate and consolidated in response to ongoing trauma. And they become more synthesized into a
coherent sense of self in response to a protective, supportive environment, at home and in therapy, that allows a child to
process and "metabolize" (Peterson, 1991, p. 154) traumatogenic experiences. Since many young dissociative children
have ill-defined personalities who are little more than pretend characters, when dissociative barriers are no longer needed
to defend against ongoing abuse, these imaginary characters naturally find expression in child-generated play. In play, the
child can manage them and gradually integrate them into a coherent whole, not unlike the process of synthesis of self in non-dissociative
young children.
In cases of more fixed dissociative processes, the therapist must actively encourage expression and synthesis of dissociated
affect, trauma, and personality states. Emergence of characters representing the full array of aspects of self is facilitated
by the therapist empathizing with all play figures, labeling their feelings, and by introducing to dramas figures that represent
self-states which the child defensively omits, such as frightened, helpless, and dependent figures, or angry and aggressive
figures. When children can tolerate affect and traumatogenic experiences within the play metaphor, direct abuse-focused treatment
can ensue.
A good starting point for direct discussion of dissociative responses is inquiry into how the child mentally coped during
abuse episodes. Shengold, in "Child Abuse and Deprivation: Soul Murder" (1979), explained that children use "autohypnosis"
to "shut off" and compartmentalize all emotion during episodes of abuse. Children report blocking out abuse experiences
by doing multiplication tables, focusing on a spot on the wall, leaving their bodies, flying away, changing to another television
channel in their mind, imagining being elsewhere (the beach, amusement parks), or having another personality take over, one
who "goes away" when the episode of abuse is over, etc.
Shengold (1979) explained that use of autohypnosis tends to become chronic in response to chronic abuse. Both children
and their caregivers should be helped to understand that dissociative defenses were adaptive during abuse, but are no longer
helpful. They cause discontinuity of experience, fragmentation of sense of self, intrusive posttraumatic symptoms (as dissociated
feelings and self-states "push" for expression into consciousness), anxiety, and dysregulation of behavior, including
possible self-harm or reenactment of abuse.
Gradual interpretation of autohypnosis and other dissociative defenses helps clients recapture and express emotions "shut
off" during the abuse. This process of recapturing inner experience is essential to synthesize affect and thought, and
to restore a sense of self and personal history. Shengold (1979) explains:
...the patient must know what he has suffered, at whose hands, and how it has affected him. The means he uses to not
know, to deny, must be made fully conscious; the patient must give up his defenses of massive isolation and compartmentalization;
often, one must analyze the use of autohypnosis to accomplish this. (p. 555)... Only when knowing involves a free range of
feeling is brainwashing undone... Avoiding denial and tolerating rage [are] achieved together (p. 544).
Structured, abuse-focused play facilitates the process of re-association of abuse-related memories and feelings. Children
can be asked to stage the scenes of their abuse, then choose dolls to "be" themselves, their abusers, and others
who were involved. Tolerance of affect is facilitated by focusing initially on the doll representing the child, rather than
directly on the child. The therapist can speak directly to the doll, allowing the child to answer for it, asking about the
doll's inner experience while being abused, including inquiry into the use of defensive dissociation. In time, the child will
be able to discuss these feelings without masquerading behind a doll.
This process is guided by the principals of gradual exposure and Briere's "intensity control" (1996). When
the "therapeutic window" is exceeded, Briere explains that the individual's internal protective mechanisms are overwhelmed,
resulting in what he terms "anti-abreaction". This retraumatizes, floods the individual with anxiety, and consolidates,
rather than allays, defensive processes. The dissociative child's creative capacity can be used to regulate this process.
For example, a metaphor of an internal volume dial can be used to "turn down" anxiety and fear (Silberg, 1996c).
Or containers, such as a box or bag, can be used to "store" anxiety-producing memories and feelings during reassociation
and between sessions (Shirar, 1996).
While anti-abreaction retraumatizes, properly-timed abreaction has significant therapeutic value. When the child (or
adult) feels "held" in the therapeutic relationship, "grounded" in present-day reality, and has internalized
that he or she is finally safe from the abuse, a cathartic release of sadness, grief, and anger, rather than a sense of re-living
and re-traumatization, can occur in the telling of abuse. Ideally, a protective and nurturing caregiver will be present to
soothe the child during this process. If there is no appropriate support person, the therapist often fulfills this function,
including hugging the crying child. Until this intense affect is released, it tends to "push" for expression, often
resulting in episodes of violence, oppositionality, tantrums, and regressive "melt-downs". Once this intense affect
is released, these subside (see The Magic Castle for a mothers biography of her adoptive son who experienced intense behavioral
dysregulation prior to his recovery of ritual abuse memories.)
A Common Triad of Ego-States in Abused Children
Although dissociative children tend not to have multiple, well-defined, separate, dissociated personalities (Peterson,
1996), I have encountered a number of abused children with three specific types of partially dissociated personality ego-states.
The first personality is the most functional ego state, the one generally in executive control, and the one that is generally
presented to others. It is age-appropriate, but socially avoidant or superficial, and has little affective charge. The second
embodies frustrated attachment strivings and is very dependent and regressed when alone with loving caregivers. The third
is heavily identified with the child's abuser. It has intense rage and affective memories of trauma, becomes explosive with
little provocation, and may reenact abuse against others. Perceived as largely ego-alien, it is often symbolized by a predatory
animal, an evil entity, a "bad" self, or a voice that issues commands of violence. A child struggling with his aggression
aptly describes the influence of his abuse-derived aggressive ego-state: "When I try not to do what the 'Good Memory'
tells me to do, the 'Bad Memory' has strong magic, and then it pulls on the 'Good Memory', and both of them tell me to do
bad things" (Trad, Raine, Chazan, & Greenblatt, 1992, p. 648).
The dependent and abuser ego-states "hold the keys" to early trauma, losses, and related affect. The job of
the therapist is to work through the characterological and defensive resistance of the "front" personality to re-associate
traumatogenic material.
Compassionate interpretation of the process by which fear fuels identifications with abusers, and normalization of this
as a response to abuse, help the front personality feel safe to acknowledge the existence of abuser self-states and help abuser
self-states come out of hiding. Nonjudgmental guidance in anger modulation help abuser self-states manage aggressive and abusive
impulses. Explanations that this defensive posture is no longer necessary can help them to relinquish this defensive posture
and to re-direct destructive anger constructively or to let it go. They will eventually be willing to assume a benign prosocial
function, e.g., a "guard" against external threats or protector of the younger, dependent, personality.
Inclusion of loving caregivers in therapy sessions facilitates the expression of the dependent ego-states and associated
fears of loss. The therapist should commend the child for reaching out for love and for expressing needs unmet in early abusive
and neglectful environments. When the child attempts to deny dependency needs and to detach from primary caregivers, caregivers
should be encouraged to initially provide the "glue" for the relationship, despite the child's overt rejecting behavior.
In therapy, parent and child can be taught to "play baby" with rocking, blankets, and even bottles. They should
be assigned "homework" to continue this play at home, perhaps at the start of the day to meet attachment needs before
separating to go to school, and upon reunion after school. Or the parent and child can decide another plan to maintain their
bond, such as a morning or bed-time routines, watching television cuddled up together, one-on-one outings, or play sessions.
Intense feelings of jealousy rooted in fear of rejection and loss are likely to arise in traumatized dissociative children
when caregivers show love to other family members, particularly younger children or babies. This often precipitates acts of
violence against younger siblings. These childrens feelings of fear and anger should be interpreted and normalized in view
of their abuse and losses. They must be helped to learn to express attachment needs directly, both verbally (asking for help
and attention) and in proximity-seeking (crying, hugging). They must be helped to verbalize their fears of loss and rejection,
and to express their sense of rage and unfairness about their abuse, neglect, and/or abandonment. When they feel safe to adaptively
express their needs and fears, and receive comforting and support, they will be less likely act out in rage when threatened.
Children who become anxious discussing abuser self-states may be willing to represent them initially in art and play.
These depictions can appear evil and powerful and children may perceive them as both frightening and enticing. The therapist
must not react with fear nor reject these figures as evil. Instead, the child must be helped to understand the origins of
their rage, redirect this rage toward their abusers, and gradually facilitate expression of trauma-related fear, helplessness,
and grief. When abuser-states act out destructively, more direct interpretation and intervention are generally required to
help children re-associate their trauma and regulate their behavior, as in the following case.
Case Example: Jody A. and the Monster in her Heart
Jody A. was abandoned by her mother at one year of age and placed with a distant relative where she was molested for
two years by an adult male in the home.
At the age of 3 years, Jody was placed in her first foster-home. Shortly after being placed, and long before she first
disclosed her sexual abuse, she reenacted this abuse with some younger children. When confronted, she initially denied it,
but then said, "I just did it cause I felt like it". Jody's foster-mother deprived her of an outing. Jody responded
with, "I wish you were dead", and paced her room all night. The next day, Jody seemed in a trance and said, "You
know what a voice told me to do last night? It told me to kick you". This was the first statement of many about a voice
or monster telling her to hurt, kill, or cut up the foster-mother and her baby daughter, or to burn down the house.
When treatment began, Jody was 6 years old and in her fifth foster-placement. She was defiant with her foster-mother,
externalized blame for all problem behavior, and was mean to her foster-siblings. When questioned about the "monster",
she said it was not real and that other children had given her that idea. In time, she said the monster lived in her heart
and periodically spoke to her or "did" things. She generally minimized its effect.
In her sixth placement, Jody's problem behaviors became more dire. She placed a large knife in the crib of her infant
foster-brother. And she punched other children when jealous of attention given them by her foster-mother. When confronted
with these behaviors, she accused her foster-mother of lying and abusing her. If adults in authority doubted her, she became
verbally belligerent or attempted to flee. If restrained, she fought tooth and nail to escape.
Jody was initially successful in gaining substantial adult sympathy for her protests of innocence and accusations of
abuse by her foster-mother. Only after losing this placement and a month of residential treatment in which her aggressive
behavior resurfaced, did all adults in authority understand her potential for violence and deceit.
True exploration of the origins of her violence began when I had to physically restrain Jody to prevent her from bolting
out of the therapy office. She disclosed that the monster in her heart "makes me do bad things". When told, "Many
abused children want to kill people sometimes", she easily and flatly acknowledged having wanted to kill her molester,
her second foster-mother, her younger foster-sister, and infant foster-brother. Then, she became suddenly startled by what
she had just revealed, and said she did not want to kill her foster-brother; she just wanted to make him stop crying. I focused
on the events preceding her giving the baby a knife, which Jody again denied. Ignoring her protests, I said, "I know
you hate yourself for what you did. I am going to help you understand why you did it and to do other things when you are angry
or sad".
Jody slowly began to explore the feelings preceding her acts of violence. She began to express anger at her mother and
molester in play, art, and direct dialogue. She recalled that her molester frightened her with a knife and began to understand
the origins of her impulses involving knives and cutting. She was eventually able to tell me that when her infant foster-brother
cried, and when her foster-mother went to him, she felt painfully jealous and wished she was the baby. She grieved that, "It's
not fair" that her mother used drugs and gave her away and that she was horribly molested.
Jody was given a small sketch pad for drawing her angry feelings as an alternative to violent acting out. She brought
this pad to sessions filled with scribbled-over pictures of her molester and her mother. In time, she told me that the monster
in her heart was her molester and she did not want to be like him anymore.
Finally, one day, Jody arrived at therapy, looked me straight in the eye, and announced; "I don't want to hurt anyone
anymore cause then they'll have anger in them like me, I don't want to be like him [her molester], I don't want to go to jail,
I don't want to be like someone like my mother who does drugs". She meant it.
Since then, Jody has been in one placement for almost three years. She has had only one incident of aggression when she
hit her foster-mother in defiance. She no longer dissociates her anger into other personality states nor does she blame a
"monster" in her heart for her actions.
Treating Dissociative, Abused and Ritually Abused, Children, Part III
  |
