Attending to Dissociative Symptoms with Parts Work Therapy: Looking at the Inner Child

Parts work therapy recognizes that we all have different states of mind and emotion. Often, we will deem certain emotions, needs, or sensations as acceptable while pushing away and rejecting others. It might even feel as if some feelings are more “real” while others are fake or phony. In truth, all parts of our self are real, important, and necessary. However, it is common to experience conflicts between opposing emotions or needs. For example, there may be times when we both love and hate a parent. Or we might have a part that longs to be close to a loved one while another part feels fearful of intimacy. Sometimes these internal conflicts may be too disruptive for us to hold within our sense of self. In this case, competing needs can become polarized within us, leading to anxiety, indecision, procrastination, or self-sabotaging behaviors.

When an individual has a history of chronic, repeated trauma, there can be a greater divide between these different parts of the self and a greater likelihood of dissociative symptoms. In some cases, they might feel an unrelenting need to be perfect, be plagued by a harsh inner critic, or exhibit self-aggressive tendencies that lead them to feel at war with themselves. They might also feel as though they are cut off from their feelings or as if they are going through the motions of their lives without meaning or a sense of connection. Often, individuals with C-PTSD report alternating between feeling disconnected from their emotions and overidentifying with their pain.

There are three key premises common to parts work therapy. The first premise is that the human mind is capable of conflicting thoughts, feelings, and needs. The second is that our parts are reflections of our family of origin. The third is that all parts are important. Different parts of the self can be considered different ego states. For example, there may be times when we feel younger than our current age, such as when we return to visit our childhood home. This “inner child” connects us to the emotions and sensations related to events or memories from childhood. Additionally, we tend to internalize our relational experiences with parents and primary caregivers.

When we attach to another person, they become a part of us. So much so, that we incorporate their behaviors and attitudes so strongly that they can no longer be separated from our own sense of self. This is not only a loss of boundaries between the self and other, this is experienced as a loss of the self. As a result, a critical parent might become the voice of our own self-critic, or a neglectful parent might lead us to dismiss our own or other’s feelings and needs.

Children will form an attachment to a parent or caregiver even when that person is also the source of pain, fear, confusion, or rejection. In these situations, children might respond by taking care of the parent or by restricting any expressions of their anger or distress toward the parent in the hope that doing so will reduce the likelihood of more neglect or abuse. In many cases, children begin to turn these negative feelings toward themselves, which is often the root of depression, somatic symptoms, and self-harm.

From the framework of parts work, individuals avoid acknowledging or remembering the abuse by cutting off or send into “exile” the parts of the self that hold trauma-related emotions and memories. They cannot integrate these feelings into an overall sense of self. In some cases, clients develop complex internal systems with several “exiled” parts that are stuck as if they are living in the time of the trauma.

The goal of parts work therapy is to help clients realize and integrate the disowned emotions and traumatic memories held by exiled parts of the self. We often need to help clients hear the voice and understand the needs of each part. We can also help them recognize that their needs for protection and nurturance can and will be met through other, healthy relationships, including the therapeutic relationship.

This healing practice from The Complex PTSD Treatment Manual focuses on helping clients to increase awareness of emotions and needs of their inner child through the use of a photograph or visualized image of themselves from childhood.

Click here to download the Build Awareness of a Part through a Photograph or Imagined Picture exercise from The Complex PTSD Treatment Manual.

You can find more information on how to conduct successful therapy with clients who have experienced prolonged exposure to traumatic events in The Complex PTSD Treatment Manual: An Integrative, Mind-Body Approach to Trauma Recovery.

*This is an adapted excerpt from The Complex PTSD Treatment Manual by Arielle Schwartz, PhD. Copyright © 2021, Arielle Schwartz. PESI Publishing.

Learn more about treating complex trauma in Dr. Arielle Schwartz’s other blog posts: Somatic Psychology in the Treatment of Complex PTSD and Connection & Co-Regulation.