Listen in to hear part two of the discussion of ego state work, including the installation of a work place, boundary setting and more!

Article: Integrating EMDR and Ego State Treatment for Clients with Trauma Disorders- Carol Forgash & James Knipe 

Check out Episode 44: Ego State as Preparation and Resource (Part 1)


Choosing and Installing a Workplace for the Ego State System:

  • Ego stated can be accessed in many different places: office, workplace, or conference room. 
  • Many types of workplace or conference rooms are suggested in the literature.
  • In Fraser’s (1991) Dissociative Table Technique, the client sits down at an oval table where they can begin to invite other ego states. 

Orientation to Present Reality:

  • The exercise called Orientation to Present Reality (OPR) (Forgash, 2005; Twombly, 2005) allows the ego states to learn about present time and place. This can enhance feelings of actuality and security and a sense of appropriate caring by the adult.
  • Parts can use some sort of screen in their workplace to view images of the therapy office or the client as their current self. It could depict the adult’s present age, body, gender, career, etc. 
  • They can imagine sitting or standing next to the client to become aware of the size differences.
  • A tour of the adult’s home, job, present life, family and so on is helpful.
  • This OPR work is utilized as needed. OPR typically needs to be repeated many times during the course of treatment. Reason being parts who need orientation/ reorientation may appear at any period of treatment.

Constructive Avoidance:

  • The therapist must teach the client not to expose unhealed parts to possible triggering events. Examples of these include medical procedures, sexual interactions etc. This also includes situations for which they  lack understanding or appropriate skills. This may include public speaking, employment interviews, or arguments with spouses (Forgash, 2004; Kluft, 1993).
  • The client then encourages the parts to stay in the secured area, which could be considered home,  until the adult says, “I’m home” or “It’s over.” This differs from what was experienced in the family of origin because the needs of the child were not considered or met.
  • This requires practice in and out of session in order to create support for the more vulnerable parts. 
  • In order to acquire a sense of mastery, repeating this work using different circumstances is needed. This opens up a chance to end the client’s past avoidances so that they are able to have more fulfilling life engagement. 

Boundaries for Participating in Ego State Work:

  • The therapist initiates parameters of respect, consideration, and overall attention that were not sufficiently provided during childhood. 
  • Recognition and appreciation of the variance in developmental abilities and eagerness among the parts help therapists time their interventions based on the continuation of assessment.
  • Readiness and consent must be granted by the states before beginning any activity.
  • To prioritize areas of treatment, the therapist can determine which ego states are suffering the most. Permission must be given by the other states to work with those that need the most help.
  • Participation by each state isn’t required, but all must agree to not disrupt the client or the other parts.
  • Ego state conferences can be utilized to resolve issues. This may create a greater sense of acceptance of all ego states. Openness of communication may increase understanding of their overall desires and intentions.
  • Old behaviors are viewed as once having a beneficial and adaptive strategy to protect but now are no longer helpful. These states are frightened by change as it may jeopardize their existence.
  • Working with a certain part may include setting small goals for the client. Acknowledging every ego states’ determination to improve the person’s chances for survival is important. Therapist must do so even when their approach may appear to be working in a counterproductive manner..