What is Structural Dissociation Therapy?

To understand the theory of structural dissociation, we must first get to know the personality. This is an element of one’s character that is often passed off as ‘just the way we are’. Though times are rapidly changing and the efficacy of working in this way in therapy is now being realised.

Based on the American Psychological Association (APA), the personality refers to “the enduring characteristics and behaviours that comprise a person’s unique adjustment to life, including major traits, interests, drives, values, self-concept, abilities, and emotional patterns.” There are various theories concerning the development of the personality and whilst all agree that personality impacts behaviour, not all align in their fundamental understanding of it.

Ego States Therapy (EST) originated with Paul Federn and was further refined by Watkins and Watkins, who argue its foundational role in the theory of structural dissociation. Ego states represent neural pathways that develop and organize around specific ages, actions, or situations, collectively shaping an individual’s personality. This process of combination is characterised by the integration and differentiation of the ego states, which undergo progressive changes from birth and can have varying degrees of flexibility in their boundaries.

We can observe different sizes of ego states and the repression of some of them. Certain ego-states will become “the self” if more energy is invested into them. EST provides a basis for the concept of segmentation of personality based on three pillars: psychoanalysis, hypnosis and Janet’s concept of dissociation. The theory of structural dissociation takes the assumption from EST that no one is born with an integrated personality.  To find out more about ego-states ahead of the check out our on-demand video course on Ego State Training with Robin Shapiro

Childhood trauma disrupts the process of merging ego states. The result has varying levels of severity and essentially causes the formation of a distinct, trauma-containing part, separate to the main personality. In childhood, when the person lacks the integrative capacity to face the traumatic event, is often when structural dissociation occurs. The boundaries of an ego state become rigid and impermeable, unable to merge with others, making it a dissociated part. The most basic structural division is between the ‘emotional part of the personality’ (EP) and the ‘apparently normal

EPs are the parts that contain the traumatic materials: traumatic memories, internalised beliefs and perceptions, learned responses, etc. Devoted to defence, this part remains rooted in the trauma, often reenacting it and is focused on a narrow range of cues that were relevant to the trauma.

Additionally, contrasting a non-traumatised individual with a traumatised one helps understanding the distinctions: in a non-traumatised individual, the apparently normal part (ANP) manages daily life smoothly without intrusion from emotional parts (EPs), whereas in a traumatised individual, the ANP’s normality may be intermittently disrupted by the intrusion of EPs, resulting in observable shifts in behaviour or attitude.

This is observed when one EP and ANP remain separate from the main personality. Simple PTSD, simple dissociative amnesia (memory gaps when recalling personal information of a traumatic or stressful nature) and simple somatoform disorders (physical symptoms with a link to psychological factors) are a few examples of primary structural dissociation.

This involves one ANP and more than one EP, observed in cases such as complex PTSD, complex forms of acute stress disorder and some forms of trauma related personality disorders such as borderline personality disorder (BPD).

This is observed when there is the formation of two or more ANPs in addition to two or more EPs. Dissociative identity disorder (DID), often comorbid with complex PTSD and some personality disorders is characteristic of tertiary structural dissociation.

PTSD can induce memory loss, which is a component of traumatic experiences leading to the erasure of memories. This memory loss, or amnesia, is a characteristic of Dissociative Identity Disorder (DID). It is a crucial factor that clinicians pay attention to significant gaps such as amnesia in the present moment. It’s important to differentiate between spacing out and structural dissociation; individuals who space out might experience hours of unaccounted time because they are mentally absent, and they are not engaging in any activities. This type of amnesia indicates a lack of presence. On the other hand, DID creates amnesia where one part of the self is aware while another part is not. Clinicians should approach suspected cases of DID with caution, allowing the condition to reveal itself gradually rather than rushing into diagnosis. Each step should be taken carefully as patients in such situations can be highly vulnerable.

Don’t miss this exclusive opportunity to train with creators of the theory of Structural Dissociation – Kathy Steele and Onno Van der Hart with Suzette Boon in their upcoming webinar on the 3^rd of June. Become proficient in identifying and treating these symptoms in your clients.