Dissociation and Enactment

Unlike Kohut, who believed in a unitary self and thought health was an increased cohesiveness in one’s sense of self, Bromberg says that we all exist in a multiplicity of self states, each with its own memory, experience, and unconscious. “Health is not integration. Health is the ability to stand in the spaces between realities without losing any of them.” (p.186), that is, it is simultaneous awareness of these many discrete selves.  The sense of a unitary self, writes Bromberg, is an adaptive illusion. Dissociation of certain self states, with their untenable affects (such as shame) occurs in all of us, often in response to the traumas of misattunement, misrecognition, or attacks on our reality. Bromberg recommends that analysts learn to see the validity of a patient’s psychic reality alongside their own, careful not to claim ownership of arbiter of reality. In this capacity to see both realities, space is made to construct consensual meaning. Their relationship is continually renegotiated.

Sometimes the only way to access dissociated experience is through enactments which can painfully draw the analyst into the early object relations of the patient. Sometimes these enactments additionally allow the patient to see his impact on the analyst. Enactments are

…an example of what Levi (1971) called “a powerful though perverted attempt at a self cure” (p.184). It involves a need to be known in the only way possible – intersubjectively—that is different from the old and fixed patterning of self-other interactions, a version of the situation that led to the original need for dissociation. (p.172)

For a patient in analysis to look into his own nature with perceptiveness, and to utilize creatively what is being enacted, there must exist a simultaneous opportunity for the patient to look into the analyst’s nature with an equivalent sense of freedom and security. (p.176)

In the clinical situation, those patients with the most dissociation, often called personality disorders, cannot resonate with interpretations which address conflict because, until contradictory self states are in simultaneous awareness, the contradiction/conflict cannot be 'seen' by the patient. Because psychic reality varies by self state, an issue already explored in one self state may come up again later in another self state. As one candidate noted to herself as her patient spoke, "Didn't we already go over this!" In this 'Groundhog Day' phenomenon, and the going over and over the same ground, is what I like to call 'the joy of Sisyphus,' and the candidate asks, "So where's the joy?"

From STANDING IN THE SPACES: Essays on Clinical Process, Trauma, and Dissociation (1998). Psychology Press. New York, London; Chap. 12, Shadow and Substance.