THERAPEUTIC

ALLIANCE WITH
ABUSER ALTERS IN DID:
THE PARADOX OF
ATTACHMENT TO
THE ABUSER

Ruth A. Blizard, Ph.D.

Ruth A. Blizard, Ph.D., is in the private practice of psychol- by dle host's increasing attachment to the therapist and con-
ogy in Vestal, New York. sequent rejection of the abuser alter. The abuser personal-
ity may also perceive the therapist as trying to undermine
For reprints write Ruth A. Blizard, Ph.D., P.O. Box 129, Vestal, its power over the host.
New York 13851-0129. The abuser personality was a part of the self that was
split off or dissociated in order to help the self to survive,
An earlier version of this paper was presented at a workshop both emotionally and physically. Paradoxically, this dissoci-
at the Annual Meeting of the International Society for the ated part of dle self had to do so by turning against the self
Study of Dissociation in San Francisco, in November, 1996. and causing emotional or physical inju'1'. In many cases, the
therapist can begin to engage abuser personalities in a ther-
ABSTRACT apeutic alliance by empadlizing with the dilemmas they have
AlYuser alters present a dilemma in the treatment ofadults with dis- faced. Instead of merely trying to contain or bargain with
sociative identity disorder, because they often undelmine the thera- abuser personalities, the therapist can begin to work col-
py as well as re-alYuse the patient. They aTe paradoxical because they laboratively\\~th them to transform the marmer in which dley
were created to help the child suroive abuse, but continue to do so by perform their functions from harsh and abusive to com-
abusing the self. They were often modeled after an allusive primary passionate and nurturing.
caTetaker to wlwm the child was attached. Object-relations and It is essential for therapists to be aware that not all abus-
attachment theories clarify how creation ofthe alYuserpersonality Selves er personalities can be productively engaged in therapy, and
to prese>-ve the attachment to the alJusing caretaker. By undet"!itanding in fact, some may be exu'emely dangerous. Ross (1989) com-
how abuser alters function to maintain attachment, contain over- ments, "Most persecutors can be brought into the therapy
whelming memories, and protect against alJuse, therapists can bet- ... They have a number of positive qualities ... in which the
ter engage abuser alters in a therapeutic alliance. Empathy, cogni- host may be deficient" (p. 259). But he goes on to caution,
tive rejraming, and gentle paradoxical techniques can help host and "In forensic cases persecutors may be sadistic sex murder-
abuserpersonalities become more mnpathic toward one another, devel- ers ... and beyond rehabilitation" (pp. 259-260). Hall (1989)
op common purpose, and begin integrating. By working thTough the describes an attempt to treat a patient \\~th DID who had a
transference, attachment to the intemalized abusive caretaker is sociopathic alter who did not present in therapy. This alter
replaced by a healthy attachment to the therapist in the therapeutic very cunningly committed a gruesome murder of which the
alliance. host personality apparendy had no awareness. She com-
mented:
One of the most difficul t aspects of treating persons with
dissociative identity disorder (DID) is working with abuser Entrenched antisocial components may resist
alters. These are personalities which abuse the patientexter- integration not only for fear ofsurrendering their
nally, by causing physical or sexual harm to the patient's own individuality, but more because they wish to
body, or internally, by presenting verbal criticism, frighten- retain their power to rule or destroy dle person
ingvisual images or somatic pain. [n addition to abusing the at all costs.... The grandiose nature of such per-
patient, the abuser alter may also actively attempt to sabo- sonalities is so pervasive d,at they may feel strange-
tage the therapy. These personalities may openly express ly immune to death or punishment, almost as a
anger at the therapist's attempts to stop the patient's self- terrorist sees death as no deterren t ... The prog-
abuse, but often also coverdy undermine these efforts. nosis may be questionable for MPD patients with
Therapists often find that their endeavors to help the such characteristics, because they may have an
patientstop self-abuse are thwarted by the tenacitywidl which inability to develop dle trust essential for lasting
patients conceal, protect, or cling to abuser personalities. dlerapeutic change. (1989, p. 87)
In some cases, the abuser personality may feel threatened

246
DISSOCL\llO:\. \'01. X. :\0. i. December 1997
,
BUZARD

It is important to dctcnnine whether an abuser aller is abuse ma\ consist of flashbacks of childhood abuse (some--
capable of engaging in the therap'. DiscO\cring whether times elaborated in f.mtas\·) complete \<o;th audiloT\'. \isua!.
there is an elllrenched. sociopathic personalil\ ma\' be '-en and t.'lclile components. which the palient percei\'es as exter-
difficuh. because such alters m;n remain carefully hidden nalh perpetrated assaults or rapes.
and ne\'cr ~·eall.hemseh·esto the therapisL The process of
t"\<lluating for the presence of dangerous, <tmisocial allers Containment, Controi, mid Protmitr.e Roles
i" oo'ond the scope orlhis paper. Ifowe\'cr. if abuser ahcrs Abuser personalities ha\e been understood as ha\ing
can be engaged b\' me therapist b\ mirroring the importance four l}rima'1 functions:
oftheir roles. and ...11("\' respond b) Ix.-ginning 10 de\'c1op some
working relationship with me therapist. their capacity fOf I) The) maintain thc dissociative dcfenses used to iso-
IhcrdpclIIic change can then be assessed. late and contain traumatic memories or to protect
In many patients with DID, lhere is an illlense allach- Ihe hosl from rC\ealing secrets that ma)' ha\'e been
lIlent belween an abuser aller and the hosl or other alters. life-threatening (Pul1larn. 1989). For example, I\,an's
W
When paticl1ls arc asked to describe how abuser ahers first WAngry Part produced frcquent intrusive images of
came 10 be.lhc}'oflcn tell stories tbatsuggest that these altcrs genital organs being cut with a razor to \\~.trll wla:n
\\cre created to help presel....e allachmCIHS to abusi\'e care· he approached 100 close to mcmories of abuse.
takers on whom the patient was dependelll during child-
hood. Auachmem and object relations theories can con- 2) Thcv hold feelings such as anger and rage that the
tribute to understanding how main mining auachment to an hostcannottolerate (Pulllam.19S9. Ross.19S9).or
.lbusing C"dretaker"dS necessary for the child's psychic sur- darc not express for fear ofret.'lliation by the abus-
\iyal. When a therapist can understand the role of abuser er (Watkins & Watkins. 1988). When Tamm) felt
alters in mainrainingamu:hmcnt. and hO\'!' that interacts"ith angT\' because her lllothcr blamed her for her
thcir roles in the containment of memories and emotions. father's abuse. an abuser alter would cause Taunm
control of pain. and protection from funherabuse. the ther- to CUi herself. In this wa\ she could act out her rage
apist can understand the paradoxical role of abuser alters withoUi risking her mothcr's retaliation, and she
dnd begin 10 reframe their functions as necessan' and adap- could also cause herself to dissociate her emotion-
ti\·e. This pro\idesa framework from "'hich the thcrapistcan al hurt and anger. As the child dC\'e1ops into an
support abuser personalities' adaptive goals. while helping adull. the abuser altcr llla) also ser.·c locontrol rage
thcm to see thai their harsh methods are not always consis- againsl others 1>\' directing it toward the self.
lent \\ilh Ihose goals.
3) They mal' ;nOkt pain on the hO>l I"'''''nalit)' ., a
ABUSER ALTERS means of taking cOl1u'ol of the pain inflicted by the
abusing caretaker (Watkins & Watkins, I9S8), or as
Abuser personalities have been described as imemal per· a means of idcntifying with the aggressor and dis-
'l:CUIOl' alters (Pulnam, 1989; Ross, 1989) and male\'olcnt ,wowing their own \'ulnerabilit}' to pain and degr.l-
ego stales (Watkins & Watkins. 1988). Ross. Norton. and dation (I-lowell. 1996). Whcn Milton felt O\'cr'
Womey (1989) found that in a sel'ics of 236 cases of DID. whelmed b)' rejection and depression. an abuser
~.t% of J}dticl\lS wcre obserwd to ha\'e intclllal persecutor aher would cause him to cut himself. This enabled
'iliers. Persenllor personalities can often be idcntified as him to focus on the physical pain while dissociating
IIltroje<:lS of an abuscr (Pulllam. 1989; Ross. 1989). from the emotional pain. He also reponed feeling
Abu.ser ahers ha\'e been observed to abuse the host or more powerful because he \<odS able to be in control
other personalities physically. sexualh. \·erbally. through of thc pain and endure it.
;,omatic pain or \isual images. or in severe cases, through
Ildllucinated episodes. The fonn of the abuse may often be 4) ThC) rna)' attempt to protect the host ~. being sus-
a reenacunemofthe manner in which the paticm "dSabused picious of persons who might abuse them (Ross.
asa child. PIn ical abuse often tales the fonn ofhiuing. cut- 1989; Watkins & WatLins. 1988). or by punishing
ting or burning the body. Sexual self-abuse may occur ~ dIe host to comral beha\ior that could expose them
insening objects into bodil) orifices. 01' ma\ il\\'oh-e imag· to further abuse (Goodman & Peters, 1995). Whcn
ming or remcmbering scenes ofabuse while engaging in self- Wilma dared to ackno\<olt.-dge that she herselfmighl
~tilllubHion. Verb.'ll abuse may consist onnlemal \'Dices shout· wanllO come 10 thcrdpY, a 5.'ldistic alter would cause
ingat. criticizing. or berating the patient. Whcn abuserahers her to hit herself repeatedl). causing severe bruis.-
inflict somatic pain. they may be eliciting body memories of es. For Wilma, to W'dnt an)thing for herself"dS to
plwsical or sexual abuse. Abusive \isual images may consist ri.sk Wasking for too much. ~ Her abuser a1tcr was pun-
of \isions of frightening objects sllch as snakcs or bugs, or ishing her to prevent her from risking anticipated
Intrusivc ilnages of gruesome sccnes of abuse. Hallucinated rcjcction and humiliation.

247
DL'iSOU-mO\. \oLX, \0 t ~ I";
 THERAPEUTIC ALLIANCE WITH ABUSER ALTERS

Attachment FunctiollS mary caretaker becomes a template which the child then
Abuser alters may provide a means for the child to tol- imposes on all relationships. This template shapes the
erate a caretaker who is alternately abusing and nurturant child's perceptions of and reactions to the object as if to fol-
by allowing the child to encapsulate the caretaker's abusive low the primary attachment pattern. He described three dis-
characteristics. By dissociating good and bad aspects of the tinct patterns of attachment: secure, anxious-resistant, and
caretaker, the child can preserve the attachment to the anxious-avoidant. An excellent review of attachment theo-
"good" caregiver. Abuser alters may also serve to maintain ry and its application to clinical practice is provided by
the child's attachment to the caretaker when there was lit- Biringen (1994).
tle or no nurturance and abuse was tl1e primary way the care- A new pattern - disorganized/disoriented attachment
taker engaged with the child. Maintaining a relationship with - has since been described by Main & Solomon (1990). In
the caretaker may have been of equal or greater importance this pattern, the child has no consistent pattern of attach-
to emotional and physical survival than avoiding the abuse, ment. The child may evidence disorientation by simultane-
as the case of Rebecca demonstrates. Rebecca's Satan per- ously displaying contradictory behaviors, such as looking away
sonality reenacted her father's abuse of her by inserting while approaching the parent, or fluctuating between intense
objects into her vagina. He explained, 'That's how I show approach and avoidance toward the caregiver. This pattern
her I want her. Everybody always pushed her away, so she is frequently observed in children who have been abused
felt like she wasn't a person, but when her fatl1er wanted her (Cicchetti & Carlson, 1989; Liotti, 1992). Adults with a dis-
for sex, then she felt like she was somebody." organized/disoriented pattern of attachment tend to have
During some of these episodes when her Satan alter sex- a history of childhood abuse and often exhibit dissociation
ually abused her, Rebecca actually hallucinated an entire sex- (Alexander & Anderson, 1994).
ual assault. She would hear someone breaking into the house In persons with DID, it is often observed that differing
and climbing the stairs, see her attacker, and have tactile patterns of attachment have been incorporated into the var-
sensations of being raped. Satan elaborated on his reasons ious personalities. In particular, abuser alters can be viewed
for producing this hallucinated abuse, "That's what I have as displaying disorganized/disoriented attachment behav-
to do to keep her close to me. I don't want her going out. iors, characteristic of the con tradictory pattern ofattachmen t
Men only want her for one thing and then they hurt her. to the abusing caretaker.
She doesn't need anyone else but me." In addition to intim-
idating her so that she would not seek contact with men and Object RelatiollS Theory
risk further abuse, Satan was also possessively trying to Object relations theorists describe how the child forms
strengthen her attachment to him. internalized representations of the self and the object (e.g.,
As this example illustrates, when an abuser personality Kernberg, 1984, 1985, 1986; Masterson, 1976, 1981). In
is an introject of an abusive primary caretaker of the child, object relations theory, object refers to the object of attach-
there is often an intense attachment between the host and ment, which is the primary caretaker in the case of a child.
abuser personality. Ifmaintaining the relationship with the These are stable, internalized representations of the self, the
caretaker is as important to survival as avoiding the abuse, object, and the affect linking the two. They are derived from
this p~esents a terrible dilemma for the child. Attachment the child's experience of the early relationship with his or
and object relations theories can shed some light on the her primary caregiver. For example, the internalized object-
nature of this dilemma, the defenses used to cope with it, relations representation might involve a self that is confident
the paradoxical role of the abuser personality, and some and competent, an object that is predictable and protective,
therapeutic principles which can be used to help the adult and an affect that is calm and happy. In another case, the
patient resolve the dilemma. self may be represented as weak and uncertain, the object
as unpredictably available and supportive, and the affect link-
A'ITACHMENT THEORY AND OBJECT RElATIONS ing the two as anxious. Or the self may be represented as
capable but unlovable, the object as rejecting, and the affect
In the first half of this century, Fairbairn (1952) broke as empty. These constellations correspond to Bowlby's
with the earlier psychoanalysts by positing that in humans, secure, anxious-avoidant, and anxious-resistant attachment
the primary motivator was not biological drives, such as patterns, respectively.
hunger, sex or aggression, as Freud had theorized, but rather
a relationship or attachment to another human being. This Object RelatiOllS and Attachment to the Abusing Caretaker
principle provided the foundation for attachmen t theory and The schizoid dilemma, described by Fairbairn's student
much of object relations theory. Guntrip (1989), appears to correspond closely with the dis-
oriented/disorganized pattern of attachment. The schizoid
Attachment ThelYf'J dilemma exists because the self is represented as powerless
Bowlby (1969, 1973a & b, 1988) theorized that in early and bad, and the object as dangerous. The affect is aban-
childhood the dominant pattern of attachment to the pri- donment depression (Masterson, 1976) when the object is

248
DISSOCIATION, Vo), X, ~o, 4, December 1997
 , BU~
i

.lb..ent, and tcrror when the object is present. This cOllslel- dissociation as a form of detachment frol1llhe abllsh'e care-
1,llion is frequemly seen in persons who have been abused taker. While detachment from Ihe abuse may be necessary
b\ their primary carel.aker. Although Fairb<iirn did describe for the child·s sun'ival, dissociation can also be uscd to pre-
the environmem oCthe infant who cxperienccslhe schizoid sen'c the attachment to the caretaker.
dilemma as dangerous. there was little explicit discllssion of Thechildcannot resolve thedilemmaofacaretakerwho
lhe direct role of childhood trauma in the de\c1opmem of is both necessan for. and threatening to, suni,<tl. The child
pwchopalholog" in the object relations literature until ma) dissociate the intemalized representations of the care-
W w
lt.'cenl n"ars (Gunderson & Sabo. 1993. Blizard & Bluhm. taker into -good and -bad or nurturing and abush'e
1994; Davies & Fraw!<=). 1994; Gunderson &Chu. 1993). Two images (Bli7..ard & Bluhm. 199-1: ~Iarmer, 1991), It is Ihe the-
or Fairbairn's hitherto unpublished articles discuss aHach· sis Oflhis anicle rhat when abuse is se\erc and chronic. the
ment to the bad object (D. ScharlT & Binles, 1994). child may create dbsociated :.elf represcnwlions which ha\'e
E\'cn when the object is rejecting or abusive. the child their own paltems of auachment to the abushe and nur·
dings to a\'oid feeling the abandonment depression tuting objcct reprcsentations. This enables the child 10 sep-
\Iaslerson. 1976). Se\eral animal and human studies show arate abusive from non-abushe attachmcnt relationships \'tim
tll.ll attachment to a caregi,·er is necessaI')' for hcalm>' social the caretaker. This helps to pre\·ent me self structure from
dt·,c!opmcnt. and. in faCt. me infam dings more strongh' being Q\elwhelmcd bo.. the n(>¥,in characteristicsoftJle abuse.
when the caregiver is abusive (\'an der Kolk, 1987). 1ltis ding. To pl'cscn·e this separation. these self representations may
ing' has been described as ~traurnatic bonding~ b)' Dutton become highl), dissociated from one anotJlCr. With time,
,llld Painter (1981). Infants exposed to ullpredictable erup- some ma)' become cl:iborated into sepm<tte idcluity Slates
lions from caretakers and prolonged experiences of heir)" or alter personalities.
!t-;,sness were able to obliterate pain from con.sciousness and The child ma~ also attempt to gain psvchic control of
p.tnicipate in ~sadomasoc:histicw pia> \'tim the caretaker the abusi,·c relationship~' identif'.ing with thc aggressor. A
Fraiberg. 1982: Galenson 1986). Based on more recent work sclfrcpresentation that identifics",im an introject ofme abu-
on trauma and dissociation. \'t'e could understand !.his no\'t' sive caretaker m3) dC\·c1op into an abuser personality. By
••, the child dissociating p."lin in order to eng-dge in atL."lch- forming an abuscr personalitv tJIat idclltifil.'S wim me aggres-
1Ilt""1lI beh:t,ior \\ith the caretaker (Braun & Sachs, 1985; sor, the child gains a sense of control and power. and main-
I-rischhol:t., 1985; Putnam, 1985. 1991; Wilbur, 1985). tains the atL."lchmCIll by identitying with the abuscr. B)' dis-
I'raurnatie bonding in children can result in an enduring sociating or disembod)ing the \ulnerable selfrepresentation
p,lItem of attachment to abusive partners in adults (Young (Ho\'t·cll. 1996: Young. 1992). the child m3V find the pain
~Gerson 1991). more tolerable because he or she feels in control ofiL The
Ifme child is driven to maintain a strong altachmenlto paradoxical nature ofdissociation simultaneoush'allO\\ the
the prim:u"\' caregiver. and experiences an illlensc aban- child to maintain the attachment to !.he abuser introject and
donment depression when the auachment is 10Si. then the to feel powcrful b) discmbod)ing the \ulncrable selfrepre-
child faces a special SCI of problems \'t'hen thc primary care- sentation. And, unlike abusing caretaken. abuser alters can~
g'iH'r is also an abuser, The child ma)' ha,·e to go LO grC;1l nOt abandon the child, because thcy arc maintained inter-
lengths to create defcllscs that \\ill allow the preservation of nally.
Ihe attachment to the abusi,·e object (Blililrd & Bluhm. Ironically. while main mining attachment ma>' be one of
199-1). Onh' some of these defenses can be explained as a the plim3n·function ofabuseralters.meir3ttachment needs
lIlcans of avoiding the trauma. An understanding of the ma,· be SO o,·erwhelming that theY a\"()id an\' external rela-
.utachment to the abusing caretaker offers an explanation tionships for fear of becoming dependent and \"lllnerable
of the tenacitv \'tith which the abusc sunivor dings 10 the to abusc. If!.heir sense ofself-sufficieno is threatened. tJIey
irllrojeet of the abuser or 10 the reenacmlelll of abusc by may attack the hosl 10 reaffinn their cOl1u·ol and disa\'ow
Iht' caretaker. an)' feeling of\"llincrability.

AITACI-L\l£.l'\ff, OBJECT RELATIONS. AND /lost PersQnalities

FORMATION OF ABUSER ALTERS In conlJ'aSt to abuser personalities who remember how
ml."}' \'t·ere abused and have a strong narcissistic ill\· unent
Because the dilcmma of maintaining an attach men I to in their role. host personalities are often empty and deplet-
a raretaker ",ho is SC\·ere!" abusive lIla> sccm impossible 10 ed, remember little or nothing of tJIe abuse. and ding to
re\Ohe, some abused children Illil)' resort to me defense of the abusi\·e caretaker. about whom they rna)' maintain a
di~'>OCiation (Br<lun & Sachs, 1985; Frischholz, 1985: PUUlam, '<tgue, distorted, or idealized image. In order to maintain
19R5, 1991: Wilbur, 1985). Frc)"d (1996) prcsents a cogni- their fragile self image and ability to function in the outside
li,t' theon' of traumatic amncsia based on berraval by a care- world. host personalities oftcn need to avoid a\'t<treness of
1.II..er on whom mc child depends. B.."Udch (1991) discusses both the abuse and the alters that ""ere d~'eloped lO deal

249
D1SS0CL\llO\,\oLX.\o t~btrl~
 THERAPEUTIC ALLIANCE WITH ABUSER ALTERS

\\~th it. It is difficult for host personalities to participate in of her self representation that provided what her mod1er
therapy in a helpful way, because they have so little access wanted, Rebecca created an alter, Butch, who was able to
to either the history of abuse or the defenses developed to split off the sexual, comforting aspect of this relationship
sumve it. Some host personalities may be quite willing to from the physically abusive aspects. [n doing this, she could
turn over therapy to other personalities, while other hosts preserve a sense of her self as good and main tain a sooth-
may stalemate treatment by refusing to let alters talk. In con- ing attachment. Butch then reenacted this form of contact
trast, abuser alters often have more insight into their devel- by picking up lesbian women in bars and providing sexual
opment, their relationship with the abusing caretaker, and stimulation for them witllOut allowing them to touch her.
the dynamics of d1e relationships among the personalities The Harpy was an abuser alter Rebecca created by dis-
in the system. sociating d1e physically abusive aspects of her representation
of her mother. Much as with Satan, this allowed Rebecca to
Case Study preserve her selfby identifying with her mod1er's power and
The case of Rebecca illustrates how she developed two gaining mastery over pain. Because Butch could not main-
abuser alters from split object representations of her par- tain any kind of relationship with the women she picked up,
ents. It demonstrates the ways in which d1ese representations she would feel alone and abandoned. Then she would switch
allowed her to maintain her attachments to d1e "good" and to d1e Harpy alter, dissociate from her body, which she would
"bad" aspects of her parents, as well as to presen'e her sense perceive a belonging to a child self, Becky, and physically
ofselfas both good and powerful. The attachments with both abuse herself. In d1is way, as the Harpy, she could disown
parents were reenacted internally, with abuser alters, as well her weak, submissive self and regain a feeling of control and
as externally, in adult relationships. power.
Both of Rebecca's parents were severely physically and This case illusu'ates how the creation of abuser alters
sexually abusive. While her mother was extremely rejecting, enabled this patient to preserve some attachment to each
her fad1er was very possessive of her. His primary mode of ofd1e abusing parents by dissociating the abusive elements
interaction with her was violent sexual abuse, but he alter- of the relationships from the benign or at least more toler-
nated this wid1 idealization. able aspects. It also enabled her to incorporate a sense of
The host personality, Rebecca, could speak of her moth- power and control and dissociate her feelings ofvulnerability.
er as rejecting and humiliating and her father as attentive, Understanding these principles pro\~des invaluable tools for
but she remembered no physical or sexual abuse. Her inter- engaging abuser personalities in therapy.
nal representations of her parents were vague and one-
dimensional. Although she was able to function effectively ENGAGING ABUSER ALTERS IN THE
in her job as a teacher, she was unable even to engage in THERAPEUTIC ALLIANCE
casual social conversation with her colleagues.
Rebecca split her representation of her father into two The paradoxical role of abuser personalities must be
alters - Marvin and Satan. She had separate self represen- understood to engage them successfully in a therapeutic
tations - Litde Becky and Becca - to relate to each of these. alliance. Abuser alters were originally created to protect the
Litde Becky remained a child, and happily remembered her patient's physical and psychological sumval. They continue
father, Marvin, taking her fishing or to work with him. [n to do so, in their own way, even ifit means undermining d1e
this way, she could pre erve a good self and object, and an therapy, doing physical or emotional harm to the patient,
idealized attachment. Her alter, Satan, was an introject of or endangering her life. In order to bring abuser alters into
her father's violent aspect, through whom she could iden- the therapy in a positive way, the d1erapist must ally \vith the
tify with her father as the aggressor. In describing his own alters' protective and attachment roles, and help them to
creation, Satan explained that his purpose was to protect transform their beha\~ors from abusive to compassionate.
Becca by caring about her more than anyone, so that she The process of transformation can be accomplished by:
would not need anyone else, and dms could nOt be hurt by
them. By abusing her sexually, Satan both incorporated the 1. Reinforcing the abuser alter's strength and self-suf-
power of Rebecca's fatl1er and maintained d1e attachment ficiency;
by reenacting the dominant form of relatedness between
them. 2. Recognizing the attachment of the abuser alter to
Rebecca's mother never held or comforted her. But the host;
when her mother wanted to be comforted, she required
Rebecca to stimulate her sexually. During these sexual con- 3. Reframing the abuser alter's actions as protective
tacts, Rebecca's mother eventually would express her rage or nurturant;
through physical abuse. By dissociating the part of the rela-
tionship that soothed her mother, and dissociating d1e part 4. Containing self-abusive acting out;

250
D1SS0CIATlO;>;.1"01. X. ;>;0.4, December 1997
 5. L'se of paradoxical statementS to creale dissonance more affinned in the prolecti\'c aspects of their roles. they
between protecth'e goals and abush'e means: are able to tolerate more cogniti\·c dissonance about the
harsh methods the}' are using. The therapisl can Ihen sut>
6. I'acing the therap\' to maintain stabilit\,; pol' Ihe alters' efrons 10 contain o\'erwhelming memories.
control rage, or ameliorate the fearofabandonmenL \\l\ile
i. Working through the lJ'3.nsference. helping them lodo these Ihings in a lessabusi\~. 1Il0re com-
passionate manner, abuscr ahers become more engaged in
&i,l/orci"g AbUSft'" Altn'S' Stre1lgih a"d Sdf.sufJiciency the therapeutic process and begin to see the therapist as an
Engagement \\ith abuser alters can begin b)' reflecting all".
their narcissistic pride in their strength and self-sufficiency.
\uemptS to \\'eaken abuser alters may provoke them to auack umtai"illg Self..Abusive Actillg Out
lht: host to demonstrate their cOlllrol. Initially. it is beSt to Although empathy \\ith the abuscr alter's prolecti\'c
avoid empathic Slatements that focus on the abuser alter's funCtions is essclllial, acting Olll of self-abuse musl be con-
need for comfort. help or support. Feelings of attachment tained if Iherapy is 10 progress. This is neXlto impossible if
I(Mard the therapistllla)' seem frightening lO abuscr allers. no relationship has becn cSl..ablished with the abuscr per-
111('~ ma)' ~tir up feelings ofemotional deprivation and \ul- sonality. Conu';.lCting with Ihe abuscr alter can be helpful
nerabilirr 10 abuse or abandonment and ma)' threaten the I\'hcn Ihe diem is in danger, but it is only a lemporal)' mea-
,lhuscr alter's sense of self-sufficiency. sure. II is far more powerful to work wilh abuser person<lli-
ties by understanding their purposes and helping Ihem to
Recog"izing th~ Attachment of th~ Abusn- Alter to th~ Host perfonn their functions more efreeth·el". \\ilhout actingoUl
'\S the therap\ progresses. abuscr alters may begin to the abuse. Ifabuseralters feel supported ralher than threal-
h·t'l safer as their strength and self-sufficienc\' ha\'e been rein- ened by the therapist, the) \\'ill begin 10 ha\'ea stake in main-
Inrced. C"lrefulh' ackno\\'ledging abuscr alters' attachment taining the therapeutic relalionship. Gaining the therapist's
tn the host can increase their l>Cnse of safel\ and a\'ailabili- apprO\'31 or being offered time 10 talk in the therapy session
" 10 Ihe therapeutic process. It mav be helpful to poinl out can become powerful rC\\'ards for cOTllaining the acting OUl.
Ihat an abuser alter cares more about the host than the abu- As some of the abuser allers' n«ds for attachment can
\i\e caretaker. and would nC\'er want to hann the host the be transferred onto the therdpeutic relationship, their need
\\,u thai C"dretaker did. Even if their aggressh'e rreaunenl of to reenact Ihe abusi"c attachment to the caretaker can be
Ihe hosl appears 10 be a direct reenactment of the abuse, r(:duced. TIle therapist can help Ihem 10 perfonn their defen-
abuser alters often t,lke great pride in being able 10 control si\'e functions more effectivel" and adapti\"e1y, reinforce their
the <,t:lf-abu'it' so thaI il is less painful or injurious. Reframing pride in themselves, scpal'ale their self-image from thaI of
their beh;uior in this \\'a}' calls allention to Iheir prolective the abusive care..~ker. and contain and redireci their rd.ge-
and nuTlurant attitudes, and appeals to their narcissistic Cui aCling OUI. This reduces their suspicion that the therd-
pi ide. This can moti\'ate them 10 become more careful, and pisl is another polen tial abuscr and facilitales a therapeutic
1'\ ,'nluall)' more caring. If the therapist can identify the abu- alliance.
~ive actions of abuser personalilies as performing a protee-
ti\!..· or all<lchmenl function, and refr-llne these according- Use of Paradoxical Statemellts
h. lhen il mav be possible 10 begin to dl';.l\\'abuser alters into The nalure of abuser personalities lends itself well to
,I therapeutic alliance. In COntrdSl, criticizing or illlerfering the use of paradox as a Iherapeutic technique. The role of
\\-ilh the relationship of the host 10 the abuser alter mar' the abuser personality isa paradoxical one because Ihe abus-
induce separalion an..xier}' or abandonmen I depression. er alter and hosl are \iewed as separale persons, and the abus-
\\hich both host and alter\\ill slrenuoush resist. er aller tries to protect the hosl b\' causing hann. TIle poilll
D<'"'\'c1oping an empathic relationship \\ith abuser per- of \iew of the host should nOI be presellled to the abuser
""ollalities has tWO benefits. Firsl_ abuscr alters feel safer in personalil} directly, Thai would threalen theabuseraller b...
\I>t'dking\\ilh the I.herapisl because recognilion oftheirpos- breaking down the dissociation or appearing to criticize Ihe
ili\(' role in su"i\'al reduces the threal to theirexislence and attempts al protection. CareCulh COnSlnlCled. gentle para-
all.adllnem. Second. abuser personalitiesC"an begin to inler- doxical slatementS can validate Ihe abuser alter's point of
nalize the Iherapisl's empath} and usc il in relating 10 the 'iew, suggest a more effecti\'e, less abusi\e, means ofaccom-
h()\t more sensiliveh. pHshing tlle same goal. and show how this \\ill bener pro-
tecl the hOSI or maintain attachment,
&framing th~ Abuser Alter "s Adimu as Protective Paradoxical statementS 10 abuser personalities should
Refrdming abuser alters' actions as proteclive or nur- reframe the function of the abusive beha\ior, describe the
hmUlI allo\\'S them 10 shift the focus from acting out to under- relationship of the abuser alter 10 the host, and suggest how
Sl.ll1ding the purposc of thesc actions. As abuser alters feel to resolve the paradox of lJ)ing to protect b}' harming;

251
D1ssoamo\. \01. X. \". 4. ~ I";
 THERAPEUTIC ALLIANCE WITH ABUSER ALTERS

1. Begin with a positive, narcissistically validating state- might signal a switch to abusiveness. On the other hand, if
ment about the function of the abusive behavior, the abuser sought comfort from the child while sexually abus-
reframed as protective, nurturant or maintaining ing him or her, then the therapist's attempts at comforting
attachment. For example, "I know how poweIful you the patient may be seen as an entree to abuse.
are at controlling pain," As the u'ansference is worked through, the abuser per-
sonality gradually recognizes that attachment to the thera-
2, State the relationship of the abuser alter to the host, pist does not necessarily entail being abused, as did the rela-
such as, "You want to stay in control of Milton so no tionship with the abusive caretaker. As tile therapist supports
one else can hurt him," tile patient's efforts at self-sufficiency, the abuser alter learns
to accept help \vithout becoming over-dependent. This
3. Gently suggest how to resolve the paradox. For exam- increasing sense of safety allows the abuser alter to become
ple, "You've told me how much you hate the hos- more engaged in a therapeutic alliance. As this alliance devel-
pital being in control of him when you cut him. I ops, and the patient begins to internalize the therapist, the
wonder if next time you need to control the pain, attachment to tile abusive object becomes less important,
you could paint a picture or write a story about cut- and tile abuser personality becomes less abusive and more
ting?" empatllic. As the transference is worked through, tlle patient
sees the therapist more as a real person and less as a pro-
An example ofa paradoxical statement involving main- jection of the abusive caretaker. As the patient gradually inter-
taining attachment and protection, rather than control of nalizes the real therapist as an object representation, there
pain, might be, "I know that you care more about Rebecca is less need to maintain the dissociative illusion of a rela-
than anyone else and don't want anyone to hurt her (func- tionship between host and abuser alter as separate persons.
tion) , so that is why you want to keep her close to you (rela- As the memories of abuse are worked tllrough, and more
tionship). So when she gets too close to someone who might adaptive, compassionate defenses are developed, dissocia-
hurt her, you wouldn't want to frighten her so much that tion decreases and host and abuser alters can increase tlleir
she runs away from you. I wonder if, when you show her the understanding of each other. Their perceptions, emotions
picture of tile snake, you could tell her that you are warn- and adaptive coping mechanisms can become more unified,
ing her away from danger so that she ,,~ll know you are try- all of which lessens dissociation and paves the way for even-
ing to protect her and stay close to you? (resolution of the tual integration.
paradox)."
CONCLUSION
Pacillg the Therapy
The patient's resistance in therapy may be an effort to Abuser al tel's appear to be merely sadistic persecutor per-
preserve the selfstructure by maintaining dissociation ofover- sonalities, with no purpose other than to hurt the patient
whelming traumatic memories (Bromberg, 1995). Pacing tile and sabotage the therapy. Paradoxically, in childhood they
therapy is essential to preventing crises that may threaten performed a number of protective and nurturantfunctions
the patient's functioning or survival (Fine, 1991). The sys- which enabled the patient to survive the dilemma of depen-
tem will only be able to tolerate minimal amoun ts of cog- dence on a severely abusive primary caretaker. In adulthood,
nitive dissonance and gentle nudges toward breaking down abuser alters both protect tile fragile selfstructure from being
dissociation. Paradoxical statements should be affirming and overwhelmed by traumatic memories, and provide an inter-
should contain concrete suggestions as to how to resolve the nalized object of attachment that can ameliorate extreme
paradox. If statements are too frustrating or do too much social isolation. If the therapist can understand tile purpose
to break down dissociation, the patient may become over- of the abuser alter's behavior, reframe it empathically in
whelmed by memories of abuse and engage in self-abusive terms of its positive defensive functions, and help the alter
or suicidal behavior to increase the dissociation and reestab- learn to perform these functions more effectively, adaptively
lish the patllOlogical equilibrium (Fine, 1990). and compassionately, the alter can begin to see tile tllera-
pist as an ally. With its memory of the patient's history of
Workillg Through the TrallSferellce childhood abuse, its insight into the defenses developed to
Work with abuser alters can also be valuable in eluci- survive the trauma, and its courage to take on difficult tasks,
dating the nature of the transference to the therapist, which the abuser alter can join in the therapeutic alliance and
can be multifaceted and confusing in patients with DID become a genuine protector of the patient. •
(Loewenstein, 1993). If the abusing caretaker was at times
engaging and positive toward tile child and at other times
violently abusive, the patient may respond positively to the
therapist's interest in his or her activities, but may be hyper-
vigilant for any change or inconsistency in the therapist that

252
D1SS0ClATlO:\, "01. X. :\0, 4. December 199i
REFERENCfS FrC}'d, JJ. (1996). Iktr.wal trauma: The logic of forgetting child·
hood abuse. Cambridge. MA: I larvaI'd Cl1iversir. Press.
\Ie'i:ander. I>.C.. &: Andel""lOn, CoL (1994). An atl:tchmellt approach
10 p~'chotherap\ wilh the inCeit sur\i\or. PSJrhoihnaPJ, 31(4).665 FrischholJ", [J. (1985). The relationship among dissociation. h\-p-
--Iii."'. nosis. and child abuse in the dC\c1opmcnt of multiple personalih
disorder. In R.I', l\.Iuft (Ed,), CillldllootlOlll«ftlntlHJ/JlfuUipitptrwrwuty
B.l.rdch. P.~I.U (1991). ~llIlliple pcr~nalit\ dborder;u; an all:tch~ (pp. 99-126). Washington. DC .\merican PS\chiauic Press.
lIlt"nt diwrder. D/SM)UITIO.\. 4(1), 117-123.
CaJemoll, E. (1986. October). TM /J1tcUrwn of M65QChis_: f'rolo.
Biringen. Z. (1991). ,\U<lchmelll thWf\ and research: Application MaJ«his __ In M.M. Neril (chair), ~Iasochism in ~Ien and Women.
If) clinical practice. .-\-n/anjfJtJmol ojOrthopsyrhialry. 64(3).404- Snnposium conducted at Mills College. Oakland. CA.
4:?l).
Goodman. 1_. &- Peters,J. (1995). PeI"'OeCUlOf\ ahersand ego Slates:
BliLard. IL\.. &: Bluhm. A,~1. (199~) AtGlchment to the abuser. Protectors, friend\ and allie!o. DI5S0CHTIO.\: 8(2). 91-99.
11Ilegr.uing o~l-rdations and trauma tht'Ories in treatmenl or
dbuse sUf\i\"()~ 1'syr/u)lhnQ/'J. 1/(3).383-390. Gunderson.J.G.. &Chu,J.A. (1993), Treaunelll irnplicationsofpast
trdllma ill borderline personalil\ disorder. Hanoani Rn.""" oj
Bo\'>lm·.J. (1969) . .-\ttol"h_t nndlosJ, 1"0/. I. ,-\ttarh",,'. ;";ew York: Pry/hlatry. 1.75-81.
~ic BooLs.
Gunderson,j.C.. k Sabo.A.N. (1993). Thc phenomenological and
Bowlb\.J. (19733). ,-\ttarh..ml andlosJ. \ 'oL 2. YpamllOn. xC\'>, York: conceptual intcrfdce bet\Ooecn borderline personalit\ disorder and
I\a~ic Books. l"TSn. .-\.-mlan joornal oj P'sTrhlalry, 1'0. 19-27.

(\()\'>lm.J. (1973b). Stpamtlon: .\n:nm and angrr.:\C\'> \ork: Basic Cuntrip. H. (1989). Srhl:.Ofd PMta~a, abyct-nlatlOlU and IN sdf.
Boob. Madison, CT: Intenlational I:ninorsities Press.

Bo\\lb\.J. (1988). o."dopmenul j>S'-chiatf\ cOlliesorage. AlUTiran Hall. I>. (1989). Multiple personalil\ disorder and homicide:
JurnolojPJ,'dlialry, 1'''(1).1.10. Professional and legal issues. IJJSSOCJ.'" TlO.\'. 2, 110-115.

Bldllll. B.G.. &- S..tchs. R,C, (1985). The d~dopmenl of multiple Howell, E. (1996). Di\SOCiation in masochism and psychopathic
p<:f<;Qnalih disorder. Predisposing. precipilating. and perpetuating sadism. CqnvmptJmry P~Jrhonllo/Jsu, 32(3). 427-4~3.
finors. In R.P, KJurt (Ed.). Cilildhood mlwtdntlJ oJlllulliplr (XOOn-
./t"(pp. 37-64). WashinglOn. DC: American 1'S\'chiatric Press. Kemberg. O.F. (1984). Obyr1-rrlallons tlvory and run;ral p!iJrhoanal-
pIS. Nortlwale, NJ:Jason Aron.;on.
Bromberg. P.M. (1995). Re~istance, Objecl-us;lge, and human rda!'
("dness. Cant""pomry PS)'rhooflnlysis, 31(2), 173-191. Kernbcrg, a.F. (1985). Inlernal world and external realit\': Obj...'Ct
relations IhcOl' applied. Northvale, :'\'J:Jason Aronson.
Cicrheui. D.. & C.1rlson, V. (1989). HOlldbooll oJrhlld mnflrnllml'11l:
Umlml and IhMrtll(ol/~~tflN$.Ne\\ York: Cambridgc Ulli\'crsil\' Kclllbcrg. a.F. (1986), Srorrr /J"WflalllJ disordnl: Pryeholhna/Jrolll
1'1'1'\1>. siraltgin. N...,w Ha\'cll, CT: Yale University Press.

D,i\in.j.. & Frawlc), M.C. (199'1). TrtfJlmglJltodllll sllrvivoroJrhiltl· Liotli, G, (1992). DborWlIlil.ed/disoriemed auachment in the eti-
!UHX/ y:nwl (jlmu: A jJ!>Jrho(llwlJlje f1r»ptrtilJt'. New York: Basic Books. olog} of the dissociati\c disordef!i./JISS(X!ATfOS. 5(4).196-20·1.

Dutton. D.C., & P;linter, S. (1981). Tr.lllmatic bonding: The dc\-cI- 1\lain. M.. & Solomon.j. (1990). Procedures for identif)ing infants
opment of emotional auachmenLS in battered women and other as disol'g:ltlit.oo/disolientoo during the Ainsworth Slr.I.ngc Siu1.1.tion.
relationships of illlenniucnl abuse. \'ietimology: All Inl",laliollol
Jr>lInlaf. 6, 139-1~~. ill I'"
In M. Greenberg. D. Ciccheui. k N. Cummings (Eds.). Altalhmmt
pn!chool JfflrJ: ·l'luory'. mt'arlh mut ifllm.,."lioll (pp. 121-160),
Chicago: University of Chicago l)re\S.
Fairhairn. W.R.D. (1952), All objt'rl nlalions /hlory OJtM ~llO/tlJ.
:'\e\oo York: B.-.sic Ikloks. Marmer. S.$. (1991). Multiple personality disorder. A ps)'choana-
lytic pe~pective, l'ryrhlQ/I1c OImcs oJSarth Amn1ra, 14(3), 6i7-693.
Fmc e.G. (1990) The cObrnith'e 'lCqueiae of incest. In R.I'. l\.Iuft
(Ed .. lnrt5l-nlat«l SJndrollln oj adldl p!iJrhopathoiot!:J (pp. 161·182). Maslerson.J.F. (1976). I'lJrhoihnuPJ ojlM boninlm~ adult: A
Wd,hington. OC: American I',,-chiauic Press. drotlq/nnmtal approarh.. ;";C\'> 'torI..: Bmnner' Mazel

Finl: e.G. (1991), Tre-aunem SGlbllization and crisis prC\-ention: l\lasterson.J.F. (1981). 1Mllams.wt"lJndboninli~dUardnJ:,-\n in~
Parinl; !.he theraln of the multiple pcrsonalir. disorder patient. gmlnJ dnodOf!lftnIlOI o/JIJ'ffXUh, :"..."", 'tork: Brunner Mazel.
PI\(h,alrir a;",o ojXorth A.-m/a, 14(3), 661-676.
Putnam. r.w. (1985), D~iation as a respon~ to extreme lrdlt-
Fraiberg. S. (1982). Pathological defenses in infano-. Psycho(malylit mao In RP. Kluft (Ed.). auldhood aflt~udmlJ oj _uUllk pnsorwut]
Qt, n-t"". '1. 612-635. (pp.6&-9 ). Washington. DC American PS\1:hiatric Press.

253
IHSSOCU1l0\. \tl X. \t.. t ~ I"'
 THERAPEUTIC ALLIANCE WITH ABUSER ALTERS

Putnam, F.W. (1989). Diagnosis and treatment of multiple pmonality

disorder. New York: Guilford.

Putnam, F.W. (1991). Dissociative disorders in children and ado-

lescen ts: A developmen tal perspective. Psychiatric Clinics of North
America, 14(3), 519-532.

Ross, C. A. (1989). Multiple personality disorder: Diagnosis, clini-

cal features and treatment. New York: Wiley.

Ross, c.A., Norton, G.R., & Wozney, K. (1989). Multiple personal-

ity disorder: An analysis of 236 cases. Canadian fournal ofPsychiatry,
34, 413-418.

Scharff, D. E., & Birtles, E. F. (1994). From instinct to self Collected

works ofWRD. Fairbairn, Vol. 1. New York: Jason Aronson.

van der Kolk, B.A. (1987). The separation cry and the trauma
response: Developmental issues in the psychobiology ofattachment
and separation. In B.A. van der Kolk, (Ed.), Psychological trauma (pp.
31-62). Washington DC: American Psychiatric Press.

Watkins,J.G., & Watkins, H.H. (1989) The management of malev-

olent ego states in multiple personality disorder. DISSOCIATiON, 1(1),
67-72.

Wilbur, C.W. (1985) The effect of child abuse on the psyche. In

R.P. Kluft (Ed.), Childhood antecedents ofmultiple personalit)' disorde>;
(pp. 21-36). Washington, DC: American Psychiatric Press.

Young, G.H., & Gerson, S. (1991). New psychoanalytic perspectives

on masochism and spouse abuse. Psychotherapy, 28(1), 30-38.

Young, L. (1992). Sexual abuse and the problem of embodiment.

Child Abuse and Neglect, I 6( 1), 89-100.

254
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _l - ~