Genesis of a dissociative child: how ‘I’ can become ‘us’ and back again*

ABSTRACT

This paper traces the aetiology of a dissociative identity disorder in a 15-year-old young woman who attended weekly psychoanalytic psychotherapy at a UK Child and Adolescent Mental Health Service (CAMHS) clinic following the discovery of the potentially dangerous ‘second life’ of an alternative personality of which she was largely unaware. The internal impacts of parental dysfunction, sexual trauma and geographical dislocation are examined through the lenses of attachment theory and neuroscience to illustrate how her dissociative disorder was forged in the crucible of a series of unfortunate circumstances and events. Established theories are interwoven into the account, including Putnam’s non-linear shifts between infantile behavioural states, Liotti’s delineation of the tension between opposing inborn motivational systems and Stern’s highlighting of unformulated experience. The material is also viewed from the psychoanalytic perspectives of Fairbairn’s concept of the moral defence, Rosenfeld’s description of the pathological organisation and Michael Sinason’s technique of addressing the destructive internal cohabitee. Details of the internal dynamics between self states and the particular resolution found by this young person are described together with a brief exploration of additional therapeutic approaches with dissociative children: invitational inclusionism, reframing, narrative psychoeducation.

KEYWORDS:

• Dissociative identity disorder
• psychoanalytic psychotherapy
• sexual abuse
• developmental trauma
• disorganised attachment
• dissociation

Acknowledgments

I would like to thank Valerie Sinason for her incisive supervision of my work with Kayleigh and her consistent enthusiasm for the research, Miranda Passey for her helpful reading of the firsts draft and Sophie Boswell for her insightful edit. My greatest thanks to Kayleigh, Priti and Jesssica for their permission to share our work together in the hope of helping others.

Disclosure statement

No potential conflict of interest was reported by the author.

Notes

1. Certainly British psychoanalytic theory as taught on our NHS child psychotherapy trainings.

2. For a discussion of seeking consent from alters in these cases see Russell (2015, pp. 57–8). Names and identifying details have been changed to protect confidentiality.

3. ‘I have been a stranger in a strange land.’ Exodus 2:22.

4. Many dissociative children answer this question about the beginning of a first alter with, often initially a benign companion, with a puzzled “I think they were always there” – it appears that genesis may sometimes predate memory.

5. See Silberg (1998, p.66), for a similar description of development of DID within her 12-year-old patient Lizzie.

6. The discussion of where defence ends and ‘madness’ begins is an important one for which there is insufficient space in this paper. Certainly the mutual amnesia of Kayleigh and Priti from this point on is an important, definitive marker.

7. Some adult survivors with DID manage their dissociative condition by consciously allowing all or several alters to engage with different aspects of their life, a more or less stable adaptation of ‘living as a group’. See Alderman and Marshall (1998) for further illustration.

8. It is of course not immaterial to a court, but that’s another paper!

Additional information

Notes on contributors

Jo Russell

Jo Russell is a consultant child psychotherapist and Professional Lead for Child Psychotherapy at Sussex Partnership NHS Foundation Trust. She is senior editor of the Journal of Child Psychotherapy where she has been keen to broaden the content to include new types of copy from a more diverse range of authors. Her doctoral thesis, Dissociative Identities in Childhood, uniquely investigates therapeutic activity in work with children who dissociate and proposes that allied techniques may enhance a psychoanalytic approach. Jo has experience with EMDR and DBT approaches and continues to explore through her clinical work, teaching and training how these interventions may accompany psychoanalytic work with children who have suffered complex developmental trauma.