Treating Dissociative, Abused and Ritually Abused, Children, Part II
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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