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Hypnosis has long been successfully used in the treatment of trauma and related disorders. In this paper, I describe a hypnosis-informed approach to PTSD using mindfulness. The Mindfulness-Based Phase-Oriented Traumatic Therapy (MB-POTT) follows the phase-oriented tradition that was originally proposed by Pierre Janet, later expanded by Daniel Brown and Erika Fromm using clinical hypnosis. MB-POTT comprises four distinct, yet recursive, stages: (1) therapeutic alliance building and symptom stabilization, (2) formation of a narrative about the trauma, (3) re-creation of meaning of life after trauma, and (4) future symptom management. In explaining these categories, I delineate the nature of mindfulness, both similarities and dissimilarities to hypnosis, with an emphasis on techniques that resemble hypnotic approaches (e.g., ego state therapy, ego-strengthening). Finally, I provide a case study in which MB-POTT was implemented with a client who suffered from PTSD after a near-fatal industrial accident.

The author describes ego-state therapy. This psychotherapy is used for treating multiple personality disorders. The author mentions the theoretical background of this method, and practical points. Initially, ego-state therapy was developed as a type of hypnotherapy, but it evolved as a safe therapeutic method in combination with trauma processing therapies. The author presents a case study, and discusses the clinical significance of this treatment.

The purpose of this article is to shed light on the psychodynamic complexities of the resistance encountered in treating the wounded self. Conceptualized on the basis of ego state therapy it offers a rationale for the use of precision-targeted abreactive hypnosis to treat these patients. Grounded in evidence-based efficacy research, the authors also briefly explain how to target treatment in wounded-self patients.

This paper compared Ego State Theraphy (EST), Systematic Desensitization (SD), and the combination of both treatments to reduce school refusal among high school students. It employed experimental approach with pretest‑posttest control group design. It used Scale Revised‑Child (SRS‑RC). It took 40 high school students in Surabaya. The data were analyzed one‑path anava. It concludes that first, school refusal declining in the subjects of experimental group which underwent EST, SD, and SDEST are significantly different from control group. Second, the three strategies tested in this research are more effective in reducing the symtomps of school refusal. Third, subjects in experiment group with SDEST strategy have sustained a decline in school refusal score greater than subjects in experiment groups which underwent single strategy

Numerous studies have identified links between psychopathology and a history of traumatic life events and dysfunctional attachment relationships. Hence, given the possible traumatic origins of this pathology, it may be useful to provide a trauma-focused intervention such as the eye movement desensitization and reprocessing (EMDR) therapy. This article illustrates a clinical case by describing the positive results of the EMDR therapy in the recovery of unremitting anorexia nervosa in a 17-year-old inpatient. She had previously been hospitalized on 4 occasions in the previous 4 years and received both psychodynamic and cognitive-behavioral therapy. At pretreatment, the client weighed (28 kg, 62 lb) and had a body mass index of 14. She was designated with a dismissing attachment style on the Adult Attachment Interview. EMDR therapy was provided for 6 months in hospital, in twice weekly 50-minute sessions and consisted of standard procedures primarily focusing on her relational traumas, interspersed with psychoeducational talk therapy sessions, and integrated with ego state therapy. At the end of treatment, the client weighed (55 kg, 121 lb) and had a body mass index of 21.5. She no longer met diagnostic criteria for anorexia nervosa, and her attachment style had changed to an earned free-autonomous state of mind. She reported an increase in self-confidence and in her ability to manage various social challenges. Results were maintained at 12 and 24 months follow-up. The treatment implications of this case study are discussed.

The status of research in ego state therapy is examined against the backdrop of 20th and 21st century developments in the philosophy of science and the emerging recognition of the subjective as a vital element in all science. Attention is paid to the phenomenological method because until recently phenomenological studies have been the basis for the standards of care and training in ego state therapy as well as in many aspects of hypnotically facilitated psychotherapy. The importance of bringing an end to the "science wars" through the integration of the subjective and the objective, of phenomenological studies and evidence-based studies in ego state therapy and hypnosis research, is proposed.

The purpose of this article is to formulate a theoretical conceptualization for utilizing ego state therapy (EST) as an adjunct with cognitive hypnotherapy (CH) for depression. As the relationship between life events and onset of depression is very complex, it is not clear from current literature how stressors cause depressive symptoms. The notion of "wounded self," derived from the work of Wolfe (2005, 2006), is examined as a potential unifying concept for binding the role of risk factors in the precipitation of depression. By incorporating wounded self, the circular feedback model of depression, on which CH for depression is based, is expanded. This revised version provides conceptual and empirical underpinnings for integrating EST with CH in the management of depression.

A single 5-6 hours manualized abreactive ego state therapy session has recently been subjected to two placebo-controlled investigations meeting evidence-based criteria. Ego state therapy was found to be a highly effective and durable treatment for posttraumatic stress disorder. Apparently, ego state therapy works because it is emotion focused, activates sub-cortical structures, and because the supportive, interpretive therapist reconstructs the patient's personality to be resilient and adaptive. In this article the author reviews the treatment procedures and presents the findings of both studies.

Using manualized abreactive Ego State Therapy (EST), 30 subjects meeting DSM–IV–TR and Clinician-Administered PTSD Scale (CAPS) criteria were exposed to either 5–6 hours of treatment or the Ochberg Counting Method (placebo) in a single session. EST emphasized repeated hypnotically activated abreactive “reliving” of the trauma and ego strengthening by the cotherapists. Posttreatment 1-month and 3-month follow-ups showed EST to be an effective treatment for PTSD. Using the Davidson Trauma Scale, Beck Depression II, and Beck Anxiety Scales, EST subjects showed significant positive effects from pretreatment levels at all posttreatment measurement periods in contrast to the placebo treatment. Most of the EST subjects responded and showed further improvement over time.

Ego-state therapy is regarded an effective therapeutic technique for addressing dissociation. However, studies by psychologists (especially educational psychologists) who utilise ego-state therapy with adolescents presenting with dissociation are not readily available. This article derives from such a study aimed at exploring the experiences of educational psychologists with regard to the process followed in ego-state therapy, as well as its appropriateness for adolescents experiencing dissociation. Data were collected from four participants through incomplete sentences, semi-structured interviews, and symbolic artefacts, using a phenomenological research design. The findings demonstrate the value of utilising ego-state therapy as a therapeutic intervention for adolescents manifesting with dissociation.

This paper has reviewed the author's experience with hypnosis and related therapies from 1934 through World War II, psychological warfare, multiple personality, the origins and feuding of hypnosis societies, the development of hypnotic ego state therapy and the unique contributions of his colleague and wife, Helen Watkins.

The URGES approach is a theory and protocol to treat trauma and addiction simultaneously. It combines hypnotherapy, ego state work, alternate bilateral stimulation, and energy psychology.It was developed to meet the need to address trauma without disturbing mainstream addiction treatment.Based on the premise that trauma and addiction are co-relational, this method uses ego state images including an Addict ego state that hypothetically reflect brain chemistry dynamics and changes.URGES is a combination method that incorporates basic concepts from hypnotherapy, Eye Movement Desensitization and Reprocessing, ego state therapy and several energy psychology techniques.Orchestrated ego state conflicts hypothetically exercise the brain.Ego state patterns are emerging from URGES that indicate a degree of predictability in assessing patient's internal response to treatment.The main focus of this approach is using the addictive urge to locate and process underlying trauma.

The phenomenology and paradigm of a therapeutic method, referred to as ‘hypnotherapy’, are overviewed here. Phenomenological descriptions of the terms ‘waking state’ and ‘trance state’ are offered. Both states together constitute an experience referred to as ‘reality’ and thus the question arises as to whether it is important to induce such a trance state if it already exists in our daily reality. In this opinion piece, the authors suggest that the trance state has been long since buried under a surface of culture and education-driven complaisant behaviour. However, complaisant behaviour fails to be supported by our secret demands and wishes. In contrast, the hypnotic or trance experience delineates the fact that we, as human beings, are far more than a function of alien conceptions and demands provided by our cultural and education system. Second, a description of the paradigm of how hypnosis could act within an individual is offered. Epistemological arguments are provided to designate the hypnotic experience as a process which, in turn, generates authenticity. Copyright © 2007 British Society of Experimental & Clinical Hypnosis. Published by John Wiley & Sons, Ltd.

In this paper, we introduce Intra-Relational AEDP (I-R) as an attachment-based experiential approach to trauma treatment. Integrating Accelerated Experiential Dynamic Psychotherapy (AEDP) (Fosha, 2000a,b, 2002, 2003) with ego-state methodology, intra-relational interventions specifically seeks to help clients by (1) fostering capacities for self-regulation through shared states of affective resonance between therapist, client, and dissociated self-states; (2) facilitating authentic, open internal dialogue between self-states which can alter engrained patterns of intra-psychic conflict and self-punishment; (3) developing abilities for self-reflection and emotional processing by co-mingling previously disowned affect and emotional memories with here and now experience; and (4) attending to positive affects evoked through experiences of transformation, self-compassion, and self-affirmation. Drawing from object relations and attachment theory, intra-relational interventions places particular emphasis on internal attachment relationships formed through interactions between the client's subjective selves (internal subjects) and reflective selves (internal objects). Through visual imagery, internal dialogue, and explicit relational techniques, intra-relational interventions aims to develop this subjective-reflective dyad's capacity for reciprocal attunement, resonance, and responsiveness. Such clinical strategies aim to foster healing and psychological integration between the client and heretofore disavowed aspects of self.

This study investigates the merits of the Developmental Needs Meeting Strategy (DNMS), a relatively new ego state therapy. The DNMS is based on the assumption that many presenting problems are due to wounded ego states stuck in childhood because of unmet developmental needs. DNMS protocols endeavor to identify and heal the wounded child parts most responsible for a presenting problem. When internal Resource ego states, which serve as competent caregivers, meet the wounded ego states' developmental needs, the wounded ego states become unstuck and heal. Eight participants were recruited from the private practice caseloads of 3 DNMS therapists. All participants reported significant improvement in the targeted problems, with gains maintained at follow-up. These findings suggest that the DNMS has therapeutic potential.

The symptoms of medical illness often speak through eloquent, embedded metaphors that express deeper unconscious conflicts and meanings. Therapeutic attunement to the multilayered issues associated with a patient’s illness can be instrumental in the uncovering and working through conflicts that may impede both physical and emotional healing. Among hypnotically facilitated psychotherapeutic approaches that can be helpful, ego state techniques offer rapid access to these illness-associated issues. This article discusses six different ego states that are key players in the illness drama for many patients. Five of these are indwelling components of the patient’s psyche, whereas the sixth player belongs to the therapist’s resonant self. All of them are relevant when the practitioner seeks to facilitate deeper healing in patients with mind/body conditions. A version of this paper was presented at the 55th Annual Scientific Meeting of the Society for Clinical and Experimental Hypnosis, Santa Fe, NM, 2004.

The aim of the current study was to evaluate the effect of a prenatal hypnotherapeutic programme on the postnatal psychological well‐being of first‐time mothers. The developed programme integrated principles from developmental psychology, Ericksonian and ego state therapy, and from positive psychology. Results indicated that the experimental group (n = 23) showed a significant improvement on most measures of psychological well‐being at two weeks postpartum, while the psychological well‐being of the comparison group (n = 23) remained unchanged. At ten weeks postpartum mothers in the experimental group showed significantly less general symptoms of psychopathology and less depression. These results suggest that the hypnotherapeutic programme focussing on the enhancement of strengths contributed to the enhancement of psychological well‐being and alleviation of depression of first‐time mothers.

Much of the literature focuses on the pathology that falls to the far right of the Watkins (1997) differentiation-dissociation continuum, such as Dissociative Identity Disorder and Dissociative Disorder NOS. Adding a “far left” to this continuum, as well as a construct of what the “far left” looks like, makes apparent the value of healthy adaptive differentiation for those individuals that fall to the “far left” of the spectrum; those who don't differentiate enough. A discussion of sexual dysfunction at this end of the continuum and cases of Hypoactive Sexual Desire Disorder and Vaginismus demonstrate the clinical effectiveness of an approach combining hypnosis and ego-state therapy to facilitate healthy adaptive differentiation.

This article describes the use of the Developmental Needs Meeting Strategy (DNMS) for the treatment of dissociative identity disorder (DID). The DNMS is an ego state therapy which guides a client's own internal resources to meet developmental needs that were not met in childhood. After 17 months of DNMS treatment, a client with DID reported a near total elimination in frequency and severity of symptoms of depression, anxiety and suicidal thoughts, her Trauma Symptom Inventory scores indicated no trauma-related symptoms, and her Multidimensional Inventory of Dissociation scores indicated she no longer met the diagnostic criteria for DID. She was functioning well without any medication. Further research concerning this treatment strategy is warranted.

Many patients with posttraumatic fragmentation demonstrate a positive response to the corrective possibilities provided through Ego-State Therapy. However, full resolution of presenting symptoms may not occur for individuals with significant childhood histories of parental abuse and neglect without opposite sex, as well as same sex, re-nurturing interventions. This presentation emphasizes the use of maternal re-nurturing methods with men who struggle with the effects of significant attachment deficits in early life. Case examples feature male patients with long-term difficulties in their adult relationships with women that had proved refractory to other therapy methods. Following Ego-State Therapy interventions with maternal symbolic figures, however, these problems improved dramatically. Therapeutic implications for cross-gender re-nurturing with patients who report different types of maternal attachment trauma are explored and discussed.

The challenge in the management of a number of the dissociative disorders–which is not present in any other psychiatric or physical disorder–is the need to manage a person who has a dissociative plurality of self identities. Each self identity or ego state believes in its own separate existence, and that it can relate to the outside world without any need of the other co-existing ego states. The primary treatment of dissociative disorders is psychotherapy (and psychopharmacology when Axis I comorbid disorders cause functional impairment), much like the psychotherapy of other disorders. However, in treating dissociative disorders, it is often necessary for the therapist to interact with the various ego states. To ignore the clients' subjective reality of such ego states often leads to therapeutic failure, a fruitless focus solely on the comorbid conditions, termination of therapy, or a flight to another therapist. Effective therapy most often results from the recognition and acceptance of the subj...

This report describes the treatment of a woman with a diagnosis of binge eating disorder and a history of bingeing and periods of starvation throughout adolescence and adulthood. She had sought a number of different therapies, but not really benefited from any of them. She felt confused about herself and did not have a sense of her identity. She had recognized there were parts of herself that seemed separate from each other. Ego-state therapy with hypnosis helped her to understand the cause of her compulsive bingeing. This was followed by the hypnotic affect bridge which enabled her to access another child part of herself concerned with a fear of starvation and abandonment, and wanting to remain ‘solid’ but not ‘fat’. These phases of therapy produced great improvement in her eating behaviours, which she had not experienced before. By accessing the ego-states, she was able to start an inner communication, and make cognitive and emotional changes. This was reinforced later with cognitive therapy, from which she had not gained much benefit previously. The importance of combining these therapeutic approaches is discussed. Copyright © 2003 British Society of Experimental and Clinical Hypnosis

The development of the power therapies, behavioral medicine, and short term interventions have reported such success even with trauma cases that it is relevant to question the justification for lengthy psychotherapy. Yet some patients with complex mind/body conditions impervious to medical treatment/hypnosis may require extended, multi-modal, integrative therapy. This paper details a single complex case of paruresis as a prototype for illustrating a holographic treatment model for recalcitrant conditions: Component features of the proposed model presented include: 1) the sequential utilization of hypnobehavioral and analytic approaches; 2) uncovering work providing access to the somatic ego state associated with the illness condition; 3) the extended treatment time frame required for deep psycho-physiological change; and 4) the stages of counter-transference expectably evoked by such patients (e.g. urgency, exuberant optimism, frustration, discouragement), and the transformation of such reactions to achieve maximum therapeutic efficacy.

Ego state therapy has often been cited as an effective treatment to help repair fragmentation related to posttraumatic stress and dissociative disorders. This article explores how specialized work with ego states can help to clarify and strengthen internal and external boundaries, create greater boundary flexibility, and contribute to containment and self-regulation. Applications of direct and indirect hypnosis to repair boundary issues through ego state therapy are emphasized, and clinical case examples are used to illustrate results.

Center core phenomena have been utilized in the practice of ego state therapy and other forms of hypnotically facilitated psychotherapy for nearly 40 years. Despite the frequency with which they are employed, many confusions, contradictions, and questions remain concerning them. In this article relevant center core phenomena literature is reviewed and an essential differentiation between two different kinds of center core phenomena is clarified. Psychodynamic explanations are offered for the therapeutic benefits of archetypal center core experiences such as inner strength and inner wisdom. The information provided offers clinicians a sturdier platform from which to decide whether to incorporate center core experiences into clinical practice. The persistent question of whether center core phenomena are ego states is revisited and addressed.

Hypnosis is a therapeutic modality strongly compatible with positive psychology. During hypnosis there is an increased focus of awareness as well as receptiveness for suggestions related to changes in subjective experience, perceptions, thoughts, emotions and behaviour. These suggestions could be phrased to enhance psychological well-being in the context of positive psychology interventions. Two specific approaches to hypnosis, the Ericksonian approach and ego state therapy can be aligned with the assumptions of positive psychology. Although literature on hypnosis interventions to enhance well-being is starting to emerge from clinicians in Europe, Israel, Australia, South Africa and the USA, research confirming its effect is limited. Existing findings suggest that hypnosis could enhance facets of psychological well-being in both clinical and non-clinical populations. This chapter outlines how hypnosis could enhance psychological well-being and reviews existing practices and research findings related to hypnosis and psychological well-being.

This paper explores applications of the ego-state model developed by Jack and Helen Watkins (Watkins, H., 1993; Watkins; J., 1976; Watkins, J. & Watkins. H., 1991, 1997) within the context of psychotherapy with couples. A multi-dimensional approach allows access to ego states within each partner of the couple, and to those in the interactional space between them, which are critical to improving the dynamics of the relationship. Clinical case examples demonstrate how ego-state therapy can offer unique opportunities for the couple to develop empathy for positive functions of destructive ego states, understanding of developmental issues which contribute to interactional difficulties, and ways of discovering effective alternative responses and behaviors which can strengthen the internal family of selves as well as the external relationship.

Ego state therapy is based on the assumption that personality is composed of parts. When people switch from 1 state to another, they take their ego identification with them, while their levels of affect, intellect, confidence, and skill change. A vaded ego state has become overwhelmed by fear or rejection such that when it becomes executive, it interferes with normal function and emotional stability. The angst these states carry are the root cause of psychological addictions, OCD, panic disorder, PTSD, a sense of unworthiness of love, extreme competitiveness, and much more. The invisible bridge is an induction technique that uses the somatic experience of the vaded state to provide a focus for hypnotic induction and a bridge to the original sensitizing event that vaded the previously normal state. This article contextualizes the vaded state within abnormal psychology and describes the invisible bridge induction.

A single manualized abreactive hypnosis session (5-6 hours) based on Ego State Theory (EST) was recently subjected to two placebo-controlled investigations meeting evidence-based criteria. Thirty-six patients in study #1 and 30 patients in study #2 who met PTSD criteria were exposed to either 5-6 hours of a manualized treatment or a placebo in a single session. Abreactive hypnosis emphasized hypnotically activated “reliving” of the trauma experience to physical and psychological exhaustion. In study #1 hypnosis and control group’s reduced PTSD checklist (PCL) scores immediately post treatment (placebo PCL score mean reduction 17. 34 and EST treatment PCL mean reduction 53.11). However, only the hypnosis patients maintained significant treatment effects at followups. Study #2 used the Davidson Trauma Scale (DTS), Beck Depression II (BDI – II), and Beck Anxiety Scales (BAI). Only the hypnosis group showed significant positive effects from pretreatment to all post treatment measurement periods. Abreactive EST was shown to be a highly effective and durable treatment for PTSD. Apparently, EST works because it is emotion focused, activates sub-cortical structures, and because the supportive, interpretive therapist reconstructs the patient’s personality to be resilient and adaptive.

Outcome resulting from the integration of hypnosis with management for reflex sympathetic dystrophy (RSD) is reported in forty-one patients considered to be refractory to treatment. Eighty-five percent demonstrated a high hypnotic capacity. Fifteen percent had a low hypnotic capacity. None demonstrated average hypnotic capacity. Patients with high hypnotic capacity were able to alter labile features and other physical manifestations of the disease. With continued use of hypnosis as part of an integrated treatment program, 60% of the sample gained long-term remission. Remission is defined here as absence of pain, or presence of mild intermittent pain that patients were able to relieve using self-hypnosis. Patients in remission were able to return to work. Results show patients grouped at either end of the scale ofhypno-tizability. Since people at these two extremes characteristically suffer from widely differing psychological problems, this outcome report supports the absence of psychological prec...

Trauma activates primitive defenses which often involve somatic processes. In this paper, the author explores the use of somatic approaches to ego-state therapy, developed by John and Helen Watkins (1979), which has been shown in the literature to be an effective method of treating the internal fragmentation and dissociated response patterns related to early childhood trauma. Through the use of hypnotic techniques such as the somatic bridge, ideosensory signalling, and sensory awareness training, ego-state therapy can be directed to those parts of the self which are more connected to somatic expressions of traumatic experiences. Several clinical case examples are presented to illustrate the potential of this approach in the treatment of trauma. Specific benefits for patients who complain of psychosomatic symptoms are discussed, as well as for those with compromised body image and perception, and its usefulness as a hypnoanalytic tool for uncovering memories that may be more somatically based.

There is reason to believe that multiple personality disorder (MPD) is as frequent in Europe as it is in North America and that the core symptoms are the same. Dissociation is a defence mobilized against the pain and helplessness caused by traumatic experiences. Trauma experienced by dissociative disorder patients is more severe and has started at earlier ages than among patients with other psychiatric disorders. Dissociative symptoms are often covert and have to be inquired for in a systematic fashion; otherwise they may go undetected. Several instruments have been developed to help clinicians diagnose dissociative disorders. The most widely spread ones are the Dissociative Experiences Scale (DES) and the Structured Clinical Interview for DSM-III-R Dissociative Disorders (SCID-D). This article describes a case of multiple personality disorder. The patient had multiple sclerosis and a multitude of symptoms of somatization, posttraumatic stress, and dissociation. She was treated with hypnosis and ego-state...

Using abreactive Ego State Therapy (EST), 36 patients meeting DSM-IV-TR and PTSD checklist (PCL) criteria were exposed to either 5-6 hours of manualized treatment or placebo in a single session. EST emphasizes repeated hypnotically activated abreactive "reliving" of the trauma experience combined with therapists' ego strength. Both the placebo and EST treatment groups showed significant reductions in PTSD checklist scores immediately posttreatment (placebo: mean 17.34 points; EST: mean 53.11 points) but only the EST patients maintained significant treatment effect at 4-week and 16- to 18-week follow-ups. Abreactive EST appears to be an effective and durable treatment for PTSD inclusive of combat stress injury and acute stress disorder.

Dissociative disorders (DD) prevail as sequelae to overwhelming experiences in childhood. These readily formed post-traumatic responses and trance states develop in high hypnotizable subjects whose dysregulations become organized into ego states. A cognitive behavioral hypnotherapeutic treatment model will effectively contain, explore, metabolize, and resolve these life-endangering conditions. This article will detail the cognitive hypnotic world of DD patients, the relational spaces of the ego states, and the triphasic treatment mode to successfully resolve the dissociative pathology. Structured and phase appropriate hypnotic interventions will be described.

Ego state therapy (EST) evolved from a psychodynamic understanding of personality as a product of an individual's ego states to a conceptualization of how ego-energized and object-energized elements are bound together to cope with a traumatic event. Neurobiological studies now substantiate Watkins's war neuroses conceptualizations. Because of their severity, trauma memories are encoded in the subcortical-subconscious brain regions that are accessed by the single-session manualized EST procedure but not by the popular cognitive-behavioral management therapies. The imprint of the trauma is not accessible or resolvable by such top-down verbal understanding or reframing; EST is a bottom-up therapy. Abreactive hypnosis facilitates ego state expression at physiologically and psychologically intense levels sufficient to activate subcortical processes to release affect in the presence of the therapist, who adds ego strength to the patient. This is followed by interpretation and reintegration. The result is a reconstructed personality that is adaptive and resilient.

Sexual abuse appears to constitute a major risk factor for a variety of problems in adult life. The effects of abuse on adult living are not uniform therefore intervention strategies should be individualized to address unique symptom constellations. The purpose of this paper is to introduce an integrated Ericksonian and Ego state therapy approach, based on a strengths perspective for the treatment of survivors of childhood sexual abuse. The theoretical foundation for this model is described, followed by a case study. The case study demonstrates how application of this model enabled the client to resolve the experience of sexual abuse, as well as to enhance her sense of general psychological well-being.

In this paper I describe a special form of ego-state therapy that integrates writing letters to one's self as an internal therapeutic communication among various ego states previously not fully aware of each other or engaged in destructive power struggles. Expressing one's thoughts, feelings, and urges in writing transforms primary process activities of the self into secondary processes that are more mature and adaptive to healthy functioning in day-to-day living. This method also reinforces the idea of patient empowerment in the form of self-healing and utilizing internal resources in the process of recovery.

Ego-state therapy has been cited in the literature as a promising tool for the treatment of patients who suffer from the effects of past trauma experiences. In this paper, I review various methods to activate ego states and to uncover traumatic experiences and their related internal conflicts in sexually abused patients with posttraumatic symptoms. I also discuss ego-state-therapy techniques that promote the integration and resolution of trauma. Three clinical case examples illustrate the use of ego-state therapy with posttraumatic patients. I suggest ways in which ego-state-therapy methods can be useful with some of the symptomatology specific to this population. The effectiveness of ego-state therapy is also explored in dealing with certain features of posttraumatic conditions that can complicate treatment, including dissociation and fragmentation, cognitive and perceptual distortion, and rigidification of personality and behavior.

The term narcissism is often pejorative and associated with the diagnosis of narcissistic personality disorder. However, some degree of narcissism can be viewed as essential when considering the ingredients of a healthy personality. The ego state literature contains references to the maturation of ego states, the creation of helpful ego states, transformation of the function of ego states, and the strengthening of healthy ego states as components of the development of a “harmonious family of self.” For an individual to develop healthy narcissism and eventually self-esteem, it's assumed that these ego state interventions are involved and produce changes in internal psychic structure. This article explores theories and therapy regarding the development of healthy narcissism, self-esteem, and a well-functioning sense of entitlement. Case material is summarized to illustrate how ego state therapy can be an important part of this process.