Learning to take care of yourself is a complex process for many trauma survivors. I have written about the additional challenges for those with dissociated, separate parts of themselves. This post is a variation on that theme: self-care and child parts of your self.
A word about language. Those with dissociative identity disorder and dissociative disorder NOS often have parts that they experience as younger. They may be referred to by a variety of terms: younger selves, children, littles, child alters. In the context of therapy, I am interested in learning your language while also wanting to communicate about wholeness. I am using “child parts” here in that spirit.
Why is this topic so challenging? Many adults who have experienced early abuse or neglect may feel disconnected from the child they were. Or they may actively blame or hold negative feelings about themselves as a child. The same can hold true for those with dissociative disorders. How do you cope with child parts of you while living your adult life?
Are you aware of child parts within? How do you cope with them? Do you ignore them and leave them to fend for themselves? Do you hope they will get their needs met by people in your life? Do you work with them as part of your overall approach to healing from trauma?
Do you understand your younger parts as attempts to solve life problems and as adaptations to disturbances in your early development and subsequent life or as actual children?
I have seen some people with dissociative disorders go to extremes in their treatment of child parts. Both approaches can be problematic and may represent steps along a path toward acceptance of them as part of the whole of you.
One extreme involves ignoring/punishing reactions. Some child parts hold traumatic memories and the corresponding feelings such as terror, depression, self-loathing, neediness. Some people want to disavow such parts of themselves or may even blame them for their pain. They may ignore, disavow and even abandon their child parts such that they are revicitimized in the present. The problems with this approach are pretty clear.
The other extreme may involve experiencing and treating your child parts more like children. This can lead to organizing life around them more so than to facilitate adult functioning. The problems with this approach may be less apparent. I know some may disagree with my thinking about this; I welcome your views! What matters ultimately is whatever works for your system of course! In discussing the idea of “what works”, I ask you to keep in mind the difference between what is comfortable/familiar versus what facilitates your healing. You get to decide what the goals are for your system! If your goal is working through the past trauma, decreasing separateness and increasing internal cooperation that means understanding how your child parts fit into the picture of the whole of you.
Some child parts are curious, endearing and seem to hold the capacity for joy for the whole system. Some systems may organize around these engaging child parts, having them come forward (often automatically, unconsciously) with people in your life so they can have fun and receive the nurturance you did not. Who wouldn’t want to embrace and cater to these inner kids? Appreciating them may even be your first experience of finding something lovable about yourself. The key here is to get that they are “yourself”!
So what’s wrong with that? Why not encourage and facilitate the caretaking and play and nurturing you as a whole did not receive as a child? Can you see any downside to relating this way with friends? Online? With your partner/spouse? In therapy?
To help us think through how to approach working with child parts, I want to share the following clinical illustrations from the article Therapeutic Hazards of Treating Child Alters as Real Children in Dissociative Identity Disorder:
Case Example #1: Ms. G is dating an older man who is married. She has tried to break it off countless times, but he always wins her over again by playing to her more endearing childish aspects. He takes her out to a fast-food establishment that provides special meals, each including a toy, for children, and he buys her one of these. By catering to her child alters’ bottomless need for nurturing, he manipulates Ms. G into spending time with him and usually succeeds in engaging in sexual activity with her, reenacting her childhood traumas of being seduced with favors and gifts into having sex with older men. When they have such an encounter, Ms. G regresses, falls into a deep depression, and entertains ideas of suicide.
What are your reactions to this example? Is Ms. G doing a good job of taking care of herself/her child parts? Do you think it is important to supervise the activities of your younger parts? Do you feel okay about them engaging directly with people in your life? Friends, your significant other, your outside children? What about online activities? Do you expect/allow people in your life to “parent” them? How has this worked for you?
Certainly not everyone you encounter will be manipulative/abusive as described above, but you as a whole are more vulnerable if child parts are present with no adult part is
“minding the store.” Aside from abuse, what kind of dynamic does it set up with important others in your life, if they routinely interact with you presenting as a child?
Good self-care means that you consider the safety of all of you. As part of a good safety plan you must consider the developmental capacity of child parts even while working towards seeing them as part of the whole adult you. Think about whether you need rules about when, where and with whom circumstances younger parts can be present. Are there adult only activities or times in your life? Driving a car, using the internet, and/or sexual encounters might be adult only activity examples. How have you negotiated this?
Case Example #2: Miss P begins treatment with a new therapist who is known to be experienced in treating DID, and in the first session regresses into a little-girl ego-state and attempts to climb onto her therapist’s lap. When this is not permitted by the therapist, the patient breaks into sobs and says that her other therapist did this and she “needs” to be held in order to heal. The bewildered therapist finds herself facing an enraged adult ego-state who fiercely says, “The kids need to be held, and Dr. So-and-so used to do it. If you aren’t going to hold us, we will find someone else who will.” Miss P storms out of the
What are your thoughts about this vignette? Is Miss P confusing needs with wants? Would the therapist holding the child part of the client on her lap be therapeutic? I think that while it might feel comforting for that child part to be held, it is not fostering the goal of decreasing separateness of increasing adult functioning. In fact, other parts of that client might have a very different reaction to physical contact with the therapist! It might feel retraumatizing or simply embarrassing for those aware of living in an adult body. I think processing and understanding the reasons for the request would be crucial! It could also be a great opportunity for education about the realities of sharing one adult body, safety and personal boundaries.
Some therapy approaches have focused on “reparenting” attempts, providing child parts with experiences they missed out on as a child. In my experience (and according to the International Society for the Study of Trauma and Dissociation) interventions geared towards reparenting alone will not help you heal. They lose focus on you as a whole person, an adult, whose goal is to process your trauma to improve your functioning in the present. This kind of therapy may foster further separateness, get in the way of you mourning what you did not receive as a child, and collude with the wish that someone can love you into health.
Do not get me wrong, your child parts belong in your therapy just like all of you. You absolutely need a therapy relationship that supports and nurtures all of you. You can also experience caring relationships with others who are aware that you have others inside. Many complex trauma survivors need that care and concern modeled before they can begin to apply it to themselves.
In my opinion, the role of the trauma therapist is also to help you look at some hard truths: ultimately your child parts need to be nurtured primarily by you. You can over time learn how to nurture and take care of each other in fact! It is of course important for your therapist to also help you in this process, and to provide support and nurturance to all of you. There are subtle and profound ways that this must be done that also acknowledge you as a whole, competent adult.
Shusta-Hochberg, S.R. (2004). Therapeutic Hazards of Treating Child Alters as Real Children in Dissociative Identity Disorder. Journal of Trauma and Dissociation, 5 (1), 13-21.