Self-Care and Child Parts

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
office.

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.

Kathleen Young, Psy.D.

 

Reference:

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.

 

 

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On the Threshold of Adulthood: ISSD at Age 21
Steven N. Gold
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Therapeutic Hazards of Treating Child Alters as Real Children in Dissociative Identity Disorder
Shielagh R. Shusta-Hochberg
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Trauma and Adaptation in Severe Mental Illness: The Role of Self-Reported Abuse and Exposure to Community Violence
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The Interrelatedness of Disconnection: The Relationship Between Dissociative Tendencies and Alexithymia
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22 Responses to Self-Care and Child Parts

  1. Pingback: Tweets that mention Self-Care and Child Parts | Dr. Kathleen Young: Treating Trauma in Chicago -- Topsy.com

  2. Jeanette says:

    Your timing is uncanny. I’m dealing with the first time emergence of my child parts and I’m having a rough time of it. I’ve known they were there, but I’ve been avoiding them. Not totally intentionally, but more out of fear. I don’t remember much at all about being a child, I don’t remember how it felt, what things were like for me. It’s blank. But for some reason, and maybe it’s just because I have worked my way back to this time frame, slowly, I am needing to break ground in this era and also with the holiday season, they seem to be emerging. A lot of crying going on. A lot of random eating habits that are odd. A lot of confusion and fog in my mind. No focus.

    I haven’t a clue how to care for child parts. I can’t even wrap my adult mind around this. I don’t want things to get out of control, but I don’t know how to communicate. Frankly, it makes me feel crazy. I struggle with the idea that I am crazy to have all of this going on inside me. It’s been there all my life, but I am just now coming to terms with it and it’s very hard to find my way through it.

    They don’t come out in any kind of demanding way, not with others around me. I would say more playful, and then very very sad. I live alone, so I think it is easier to stay oblivious to the way they operate.

    I printed a copy of this, I hope you don’t mind. I will need to read it a few more times and see if I can make sense of what I’m dealing with. I do have a therapist, and we have a great working relationship, unfortunately, I don’t always remember what is discussed in therapy. That is the frustrating thing about this disorder and therapy. A lot gets lost in the dissociation. Very frustrating.

    Thank you for another really helpful post on this topic. :)

    • Hi Jeanette-
      I am glad about the timing for you. Definitely print this if it helps! This information is yours to use as needed. :)

      I know the beginning of this process, just becoming aware of child parts, can stir up a lot! I often hear what you write, that it can feel crazy. You are not! And you can navigate this and work with what these parts of yourself in ways that benefit all of you.

      • Jeanette says:

        Thank you Dr. Young.

        I also found your link to the article “Therapeutic Hazards…” interesting, thought provoking, unsettling and comforting all at the same time. I can see where this is going to be a process that will take ‘practice’ to find a good balance. Allowing child parts expression and finding ways to care and nurture them, without falling into self indulgence. Whew! But, I’m not in this alone, I have a therapist who will help in this process. It does help me though, to be able to read about these things and see that there are others out there who have gone down this road, that there are therapies that have been tried and have been successful. Hope is the key for me to continue on with the courage needed to see it through. And all of these tools give me hope. :)

  3. Anon says:

    There is a lot of physical contact in my therapy and everyone here is fine with it. There are certain times that without it, the child would not feel safe enough and nothing could be processed. There are other times when, without this closeness, everyone would flee the body and absolutely nothing could be accomplished with the robo-person who is left. No one should have to confront terror without physical support from another human being just so they can present as being more ‘adult’.

    I have found that cold approaches simply shame and retraumatize. The same with approaches that immediately go for ‘the present moment’ when the stink hits the fan. This can forbid remembering and block processing. When the child hears these words, she knows she is not welcome. Also, there are many here who become VERY angry when they or another are trying to come forward and share how they feel (which might be extreme) only to be told to ‘get grounded in the present’. We know when we are being asked to pretend to feel something different and more ‘acceptable’ to the therapist than what we really feel. And we hear we are supposed to accept our feelings and yet we must act opposite to what we really feel when we are scared and crying and needy (don’t feel that) because we and our feelings are not REALLY acceptable. The therapist just wants to say that because it sounds good.

    And boy do we get upset when we are told to watch ourselves on a movie screen and distance ourselves from our experience! It hurts when a therapist asks us to be depersonalized instead of giving sufficient support. That is gaslighting, really. It’s why I left the last therapist. I’m guessing he might have been a bit horrified if the child had ever latched on to HIS body in the same way that she did to the current guy one night. He certainly would have tried to distance me emotionally in therapy after that and it would have been destructive and painful.

    I’m glad I’m with a different kind of therapist now. I’m glad I am with someone who will hold me when I’m terrified and let me listen to his heartbeat instead of telling that the present moment is all there is.

    • Hi Anon-

      Thanks for sharing. I can tell you have strong feelings and opinions on this. Like I wrote, every one is different and what matters for you is what works for you!

      I do feel the need to clarify a few things from my perspective, for those who may be early in the therapy process and trying to sort all this out.

      Therapists who do not engage in holding or physical comforting are not necessarily cold and uncaring. Those are not the only two options. There are many clients who do not have good access to their entire system early in therapy and thus do not know what touch may mean to all. For this reason and others some therapists have boundaries about physical contact.

      While you object to grounding and containment tools, other clients find them extremely useful. It is possible to feel your feelings in a manner and at a level that is not completely overwhelming. For some, the extreme level of feeling that goes with trauma memories feels retraumatizing.

  4. Again, here, I think you summarize things well. The path to self-care of child parts is a tricky one. Like you said, one can easily find one’s self in extremes. The key is balance. And this is something that comes with practice (and good therapy) and learning about internal boundaries while still validating and caring and accepting. Thank you Dr. Kathleen!

    • Finding balance is key in so much of the work of healing, isn’t it?

      Boundaries- internal and external- sounds like a good topic for further discussion.

      Thanks for reading and making me think. :)

      • It’s funny, when I read your posts I don’t have much to say… because you say it so well. I usually find myself nodding my head saying “Yup, she gets it.” Not only is it refreshing, but it validates what I’m doing in my healing. So, a big thank you to you!!

  5. castorgirl says:

    I find the examples you used very interesting, and a bit of an “ouch” topic.

    I once saw a therapist who would purposefully set-up playtimes with the younger ones in the system, and one part in particular. There were also small gifts given to the young ones – stickers and other such things. While this felt good for the young one on the receiving end of the gift, it created great confusion for the rest of the system. This became obvious one day when a sticker had been given, and there was a sudden switch to another state… the young one who had been given the sticker, was the one who received the present for being a “good girl” during the abuse. Suddenly the feelings of the past collided with the present.

    Some therapists could have used this in a positive way, but this therapist wasn’t that skilled, and so she was seen as an abuser by part of the system. All sorts of boundaries became (further) blurred.

    Thankfully, I’m now seeing a therapist who validates the different parts of the system; not through touch or presents, but by bringing them back to their emotions in a gentle way. This is helping the entire system realise the young ones as a valid part, with emotions and experiences; but also as part of the system as a whole, making up the adult we present as today.

    Take care,
    CG

    • Hi CG-

      Thanks for reading and sharing your experience. What a really good example of how crucial it is to understand the meaning of something seemingly simple (giving a small gift) to all inside. While it is not always possible to predict what may bring the past colliding into the present (great way you describe that!), a therapist working with DID and trauma sure better be prepared to work with what comes up and to repair any ruptures to the therapy relationship.

      I am so glad for you that you are having such a different therapy experience now!

  6. Freemartin says:

    This is really an “ouch” topic for me too. I have quite recently found a child part, and that wasn´t exactly the warmest encounter. I realized it had always been there, but it could only be seen indirectly. As soon as it somehow tried to emerge, the hostile “I don´t need anyone” part smashed it. The child part triggered overwhelming shame, self-punishig thoughts and behavior. It has been extremely challenging for me to even try to tolerate it.
    I think this is why I react in a very hostile way to my therapist´s subtle attempts to somehow aknowledge my child part. Even some acts of “everyday kindness” trigger extreme hostility and aggression. I guess the hostile protective part gets alarmed when the child part gets emotional.
    For me, boundaries are very important. And it´s crucial that the therapist acts in a consistent, predictable way. I would probably go ballistic and quite possibly become physically violent it my therapist tried to contact my child part in some direct, caring way. Too much commotion between these ill-fitting parts.

    Thanks for this important ouch topic.

    Freemartin

    • Hi Freemartin-

      It is a painful topic for many! Early on in therapy and sometimes throughout!

      I think a consistent, predictable therapist is really important in trauma work! I think it is great that you are in touch with wanting/needing that! I hope you and your therapist keep communicating about all that this means to you and working on understanding what all parts of you are carrying at the pace that is safe and right for you!

  7. Lothlorien says:

    Absolutely FANTASTIC!!!!!!! This is one of the best posts I have read on DID! Loved it!

  8. Pingback: 2011 Intentions | Dr. Kathleen Young: Treating Trauma in Chicago

  9. littlevine says:

    Thank you for your interesting article. I am having a very hard time understanding my dissociation and my “little part.” I just can’t believe I have DID. I do recognize all the other dissociative symptoms though. And even though I understand the symbolic concept of a “inner child” and can intellectually grasp the idea that I am supposed to nurture myself, when I feel little there is no nurturing self to lean on and when I am adult I think this is all ridiculous. I guess I lean toward not wanting the little part to be around at all because it is so embarrassing and scary. It seems like it wants to come out for therapist and my therapist wants to communicate with it, but then I am just so scared and I can’t talk and even find it hard to remember all of the session. I just don’t see how this could be helpful. I am sorry this probably doesn’t make sense.

    • It makes so much sense, littlevine.

      Confusion, fear, embarrassment, wanting to ignore the whole thing…these are all natural feelings and reaction in the early stages of this therapy work. And frankly those feelings can crop up at any time! Just keep talking about it all with your therapist. Especially let her/him know you have trouble remembering the session so you can work together on ways you can stay present.

      Best wishes to you in this process!

  10. pacific says:

    I am currently working through some really tough stuff with little kids (as I call them). My therapist is around the same age as my mother, and female. I’ve been seeing her for a very chaotic (despite her gentleness) 2 years. The amount of fear felt of someone who has never hurt us makes me feel quite crazy. The desire, simultaneously, to be close to her constantly causes a huge amount of shame. I find it harder to speak of the positive feelings than the fearful ones.

    I constantly fear overstepping some line (and drowning in shame or the proof of being evil after all). My therapist is phoning me over the Christmas break. It feels so good to know that safety is there, but I still fear I am doing something wrong (I would never have asked, she offered). It feels so good, could I refuse it? Should I refuse it? Is this a lesson in trust I should be learning (I am not evil if I accept help) or am I allowing child parts and their needs to overpower my judgement?

    My therapist started, about 6 months ago, sitting next to me at some point during each session. Sometimes while we sit on the floor and I play with sand, or just on the couch next to me. She puts her hand out so I can hold it. It was so hard to start doing that, and yet I pushed through the fear for fear of worse – her giving up on me and not offering it anymore. The little kids need it so badly, and yet it is such a terrifyign thing. Are we doing something wrong? The first number of times I became so overpowered by sleepiness when the safety was realised for the few seconds of touching her hand that I really battled to stay awake. Sometimes I still experience that. And it is such a beautiful thing. When in that state (thankfully they have never been completely alone with her) I have had to learn to try to speak a bit since they cannot. I can barely see, just colours and outlines. And yet I know things like they think her hand is the most beautiful thing on the planet. How can I know that when I can’t really see it when they are there? I hope that one day we will both be able to see at the same time. I could pull out of it if I wanted to, but that wonderful experience of sleepy trust would be broken. They would be gone. I am afraid my therapist would almost seem like the enemy as others, humiliated by what is happening and the neediness allowing it, would take over.

    It is all very confusing, but so good to see someone with knowledge write about it. I so desperately want to find a balance where I am not doing anything wrong, and yet am managing to trust and not holding back from healing. I actually love one thing about my therapist going on holiday (despiet that being a total nightmare) – I get to see another therapist who works with her. I consider this luxury to be sort of therapy for my therapy. I get to ask someone outside of the relationship if these things are ok for me to need. It helps my shame, and helps me feel safer.

    I’m sorry, I’ve just realised I have rambled on. Thank you for your article.

  11. joanncollins says:

    We really liked your article, it was just posted on a fb site we like. I am talking in the plural as on sites like this it is ok. We have a very large system. We are working through our traumatic past so to have the best now and future. We have reached co-consciousness with a system that is the largest and most swiftly free flowing our expert in child abuse, trauma, PTSD and DID has ever treated. Just giving you basic info. Since you asked for input we thought it would help if we gave ours.
    Hewo, I am one of the smawl chiwld parwts. I am spokes pwerson for my gwoup of smawl pawrts. The bigwer parts type the way we tawlk. It has been very wonderfuwl to have ouwr bigwer parts letting us tawk and pway and get betwer. But onwly when it is safe. Not ouwt in “normawl” pwaces. We use stufwed amintals to do pway therwipy. And us older part are always here to learn and help our little ones. It has been amazing for us. Finally after over 50 years we are getting the proof, validation, medical treatment and mental health treatment we have been looking for so long. Have had one heck of a life and still just amazed and going through the grieving process of understanding we were unconditionally hated, believed to be evil from moment of conception and believed to have ruined everyone’s life by being born. Abused in unfathomable ways from birth because of it by everyone we loved so much.
    Balance is absolutely key. Team work and cooperation. Everyone working on individual, group, team, department, division and total team healing. Allowing our small parts, not all are “human”, to come out freely when we are by ourselves or in therapy allowed us to get to the true core, the darkest beginnings and beliefs that lead to everything else. We hewlp a watt! We are impowrtant. It is finawy ok to be us. And as they heal, what greater gift is there than to know, experience, feel the joy of a small child? We older child parts think it is great and about time, too. Love science and learning! It is so Cooool! It rocks! And so together, working in our natural, free flowing way we all are healing. Have a long way to go but never thought we would ever get to this point, not for a very long time.
    Thank you for your article and asking for input.

    • Thanks for reading and commenting!

      I appreciate you making the point that it is really important to evaluate when (or if) it is safe for child parts to be out in the world. I so agree that balance and team work and learning to value all parts of you are crucial to healing!

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