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As part of VBC's efforts to revisit seminal papers from the original Dissociation journal archives, we will next present Ruth Blizard's original text regarding working with "abuser alters" which of course has many newly minted labels we have all heard and used since that paper was published. This paper, however, was the first to identify this ubiquitous phenomenon in DID patients and how to understand and approach them theoretically and therapeutically. Although much has been written since with regard to such alter states, the attachment dynamics they represent has not, with few exceptions. I believe it is important to see Ruth's original ideas in order to understand how they were first conceptualized. In fact, Ruth has published subsequent articles on this subject which she has asked me to cite here for your reference. I am including her original abstract for the paper we will discuss.
Blizard, R. (1997). Therapeutic alliance with abuser alters in DID: the paradox of attachment to the abuser. Dissociation: Volume 10, No. 4, pp.246-254.
Abuser alters present a dilemma in the treatment of adults with dissociative identity disorder, because they often undermine the therapy as well as re-abuse the patient. They are paradoxical because they were created to help the child survive abuse, but continue to do so by abusing the self. They were often modeled after an abusive primary caretaker to whom the child was attached. Object-relations and attachment theories clarify how creation of the abuser personality serves to preserve the attachment to the abusing caretaker. By understanding how abuser alters function to maintain attachment, contain overwhelming memories, and protect against abuse, therapists can better engage abuser alters in a therapeutic alliance. Empathy, cognitive reframing, and gentle paradoxical techniques can help host and abuser personalities become more empathic toward one another, develop common purpose, and begin integrating. By working through the transference, attachment to the internalized abusive caretaker is replaced by a healthy attachment to the therapist in the therapeutic alliance.
Blizard, R. A. (2001). Masochistic and sadistic ego states: Dissociative solutions to the dilemma of attachment to an abusive caretaker. Journal of Trauma and Dissociation, 2(4), 37-58.
Blizard, R. A. (2003). Disorganized attachment, development of dissociated self states, and a relational approach to treatment. Journal of Trauma and Dissociation, 4(3), 27-50.
About the Author
Ruth A. Blizard, PhD, is a psychologist practicing in the Binghamton, NY, area with over 35 years of experience in treating persons with severe trauma, dissociation, and personality disorders. BA in psychology from University of Colorado, Boulder. PhD from Alliant University, Fresno. She has presented internationally and published articles integrating psychoanalytic concepts and attachment theory in the treatment of trauma, dissociation borderline personality, and psychosis. She has taught the official ISSTD course, “Diagnosis and Treatment of Dissociative Disorders.” She is on the editorial board of the Journal of Trauma and Dissociation, has served as editor of the ISSTD News and Division 56 of the APA, Trauma Psychology News. She enjoys folk music, hiking, bicycling, kayaking, and most of all, being a grandmother.
All the best,
Rick Hohfeler and Joan Haliburn
ISSTD Virtual Book Club Moderators
The virtual book club is conducted online through a discussion platform which will allow participants in all parts of the world to participate at times that are convenient for them. Discussion will be led by our moderators Rick Hohfeler and Joan Haliburn along with the article's author Ruth Blizard
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