Joan of Arc Meets Mary Poppins: Maternal Re-nurturing Approaches with Male Patients in Ego-State Therapy

Phillips, Maggie

Many patients with posttraumatic fragmentation demonstrate a positive response to the corrective possibilities provided through ego-state therapy. However, full resolution of presenting symptoms may not occur for individuals with significant childhood histories of parental abuse and neglect without opposite sex, as well as same sex, re-nurturing interventions. This presentation emphasizes the use of maternal re-nurturing methods with men who struggle with the effects of significant attachment deficits in early life. Case examples feature male patients with long-term difficulties in their adult relationships with women that had proved refractory to other therapy methods. Following Ego-State Therapy interventions with maternal symbolic figures, however, these problems improved dramatically. Therapeutic implications for cross-gender re-nurturing with patients who report different types of maternal attachment trauma are explored and discussed.

Keywords: Ego-State Therapy, gender differences, maternal re-nurturing

There is a growing branch of hypnotic literature that emphasizes the development of positive feelings about the self which can be fostered through various ego-strengthening approaches. Within the realm of Ego-State Therapy, these approaches are emphasized throughout every stage of treatment (Phillips & Frederick, 1995). Since Ego-State Therapy is focused on the repair of divided-self issues and the development of more integrated functioning across various personality states, ego-strengthening methods play a crucial role in the growth of the personality as a whole as well as of individual ego states.

Although there are a number of ego-strengthening approaches of demonstrated effectiveness that are regularly used in ego-state work (Frederick & McNeal, 1998), the area of corrective re-nurturing and self-reparenting is of particular interest when considering clinical needs that require the treatment of developmental delays and attachment deficits. Since maturation of aspects of the self appear to proceed along several simultaneous dimensions, the therapist must consider multiple issues, including psychosocial and cognitive as well as object-relations, somatosensory, psychosexual, and affective/emotional needs.

From the perspective of Ego-State Theory, parts of the human personality are believed to originate as dynamic responses to early and ongoing needs for adaptation to complex environmental demands, as well as to inner requirements for coping with overwhelming traumatic events and developmental crises. Along with ego states who reflect ages along the entire life span, the resulting internal family also includes introjected parental figures, those who have nurtured the developing individual personality, as well as those who were abusive, damaging, abandoning, or neglectful (Watkins & Watkins, 1997).

Individuals who have been victims of early childhood abuse, neglect, loss, and other types of trauma often evidence wide variation in their need for developmental repair. Some ego states may be exceptionally mature, demonstrating consistent success with interpersonal boundaries, and may initiate and sustain wholly appropriate selfactualizing experiences. Others, however, may be dramatically immature, unable to soothe distress in relation to significant others, woefully inadequate in terms of object relations, and unable to engage in higher-order thought and emotional processes (Phillips & Frederick, 1995). With many developmentally immature ego states, effective intervention is needed in order to meet the maturational goals that will allow them to form cooperative relationships with other self states. There is an inherent danger in fostering dependency on the therapist during corrective maturational experiences due to challenging transference and countertransference reactions that can arise, such as the desire to be "loved into health" by the therapist (Kluft, 1993). Hypnosis may be uniquely suited to access inner resources in ways that will not be regressive or intrusive to the patient.

Hypnotic Re-nurturing and Self-Parenting Approaches

There are many types of hypnotic re-nurturing methods that have been advanced to address these needs. Within the Ericksonian tradition, for example, many professionals have explored applications of Erickson's "February Man" technique (Erickson & Rossi, 1989). As most students of Ericksonian hypnosis know, Erickson worked with a woman who wanted to conceive a child, but was conflicted about becoming a mother because she had experienced a lack of maternal nurturing in her childhood. In a series of hypnotic age-regression sessions, Erickson visited the little girl state that had missed being mothered. Through suggestion, Erickson came every February to visit her as a friend of her father's, providing in trance experiences many nurturing encounters that had been lacking.

Within the hypnoanalytic tradition, Joan Murray-Jobsis (1990a, 1990b, 1998) has offered a series of creative re-nurturing scripts that can be used to repair deficits in a variety of developmental areas that were created because of damaging or inadequate parenting. First used with psychotic and borderline patients (Scagnelli-Jobsis, 1982), they are now more widely employed with the whole spectrum of ego-state problems. Jobsis weaves various types of nurturing possibilities into age-regression scripts, potentiating experiences such as early bonding and forming a positive sense of identity in the early weeks and months of life, discovering a more secure sense of being held, soothed, and fed, exploring the pleasures of the physical body, and beginning to enjoy separateness (Murray-Jobsis, 1990b). Her method invites the patient to use his/her imaginative capacities to travel back in time as an infant or young child in order to reexperience a more complete life beginning, adding nurturing experiences that may have been missed or inadequate.

Similarly, Murray-Jobsis (1990b) has also devised scripts that teach patients how to experience self-mothering, by imagining themselves both as a young baby and as the parent who will "mother" the child in a different way than has been remembered from personal histories. Others (McMahon, 1986) have reported similar scripts with patients who had been sexually molested as children. McMahon's suggestions were designed to teach self-mothering as a way of becoming reacquainted with the body and with healthy sexuality, and emphasized multiple sensory suggestions to deepen the patient's involvement and responses.

Phillips and Frederick (1995) and Frederick and McNeal ( 1998) have also applied these techniques successfully in work with individuals who suffer from a wide range of posttraumatic and dissociative difficulties. In addition, they have emphasized the use of mature ego states to assist in nurturing younger, less developed self-parts. These authors have also advanced the possibility of encouraging or completing the introjection of positive models of mature functioning in the patient's current life as well as identifying and reclaiming nurturing figures from past times marked by traumatic stress (Frederick & Kim, 1993). These and other self-interactive strategies can assist clients in significantly enhancing their capacities for self-nurturing.

Additional Developmental Concerns

Other developmental concerns may need to be addressed prior to the initiation of re-nurturing or remothering interventions. For example, some patients with borderline or psychotic issues need assistance to facilitate inner boundary formation and utilization (Brown & Fromm, 1986; Baker, 1981). Brown and Fromm (1986) have recommended the use of imagery to create a sense of containment in a safe space and the visualization of various barriers that surround, protect, and contain the body (Brown & Fromm, 1986). McNeal and Frederick (1993,1994) and Frederick and McNeal (1998) have demonstrated how conflict-free areas of the personality can be activated to strengthen individual ego states, induce internal self-soothing, assist with boundary formation and stabilization, and improve affect modulation. Phillips (1997, 2000. 2001) has applied conflict-free imagery, potentiated by EMDR and energy psychology methods, to promote integrative processes as well as the mastery of psychophysiological and posttraumatic symptoms. Elgan Baker (1981) has proposed a series of sequential exercises based on the developmental stages of Margaret Mahler. Within a protocol of structured imagery, the client is encouraged to explore various degrees of closeness and distance from the therapist in order to stabilize boundaries and to potentiate object permanence and constancy.

In addition to her strategies for early remothering, Joan Murray-Jobsis also developed hypnotic scripts to promote affect regulation of the distress of separation. For example, one script titled "Accepting the Imperfect World" is designed to help the patient weather the losses inherent in the individuation process and to give up "the fantasy of that perfect union of perfect care, everything, every need being cared for and met" (Murray-Jobsis, 1990b, p. 327). Although her suggestions refer to the early process of individuation from mother, they also help the adult patient tolerate disappointment and grief related to individuation within here and now attachments.

Yet another focus in this area has been the application of hypnotic suggestion to facilitate the use of transitional experiences. Baker (1994) has proposed that, for more disturbed psychotic patients, the hypnotic experience can serve as a container and that the hypnotherapist can act as a transitional object, helping to promote the growth of more mature defenses and the completion of important developmental tasks. Morton and Frederick (1997) and Phillips (1997b) have applied these concepts in relation to ego states. They have explored how the therapist can provide transitional experiences for less mature ego states, as well as how more developed personality states can serve in this capacity for less developed ones.

Gender Differences

The area of gender differences has recently been suggested as an important consideration in the design of hypnotic interventions, particularly in the area of women's health care and in empowering women in their management and mastery of somatic symptoms (Hornyak & Green, 2000; Mutter, 1999). Although less has been written about the issue of male needs in the hypnotic process, Hornyak (1999) points out several important gender differences that are germane to the topic of this paper. The first is that interpersonal intimacy is the central organizer of female experience and the key to understanding women's "different voice" (Jack, 1991). She suggests that for women, differentiation of the self occurs by developing their own abilities within the framework of relationships. This is in contrast to the more traditional developmental model of separating from relationship in order to individuate (Hornyak, 1999), which more typically governs the needs of men in our culture.

Hornyak (1999) further reminds us that gender differences in strengths and vulnerabilities arise from the different social contexts and norms that affect male and female development. While females may tend to disconnect within themselves in order to keep important relational connections, men may tend to disconnect more from relationships in order to express and experience their strengths.

Clinical Cases

In this paper, I begin to examine the implications of these differences in the area of ego-state therapy focused on re-nurturing and self-reparenting experiences with male patients. Two clinical examples are presented to illustrate the relevance of gender differences related to these tasks and how they may be utilized in hypnotic contexts. Both cases involve male patients who have experienced significant trauma in early attachment relationships with women and who subsequently develop central difficulties with intimate relationships with women in their adult lives.

Case 1: Alex

Alex, a 41-year-old professional, grew up in a family where his mother was depressed, withdrawn, and largely unavailable during his formative years. His father was intrusive and angry at Alex's dependency needs related to his mother, and abusive in later childhood when Alex's anger about his unmet needs began to explode in selfdestructive and acting-out behavior. Alex had one sibling, an older sister, who served as a surrogate mother figure in his early life, but abruptly rejected him as her own needs for autonomy and stronger peer relationships took precedence. Alex had a difficult time in school and, during high school, was sent to boarding school where he excelled. After his sister left home for college in his junior year, however, he returned to his hometown to live at home during his senior year. all of his adult relationships with women had been disappointing to him. He described women generally as not knowing how to meet his intense needs to be seen, understood, and supported. His intimacy patterns had typically resulted in his female partners becoming depressed regarding their inadequacies in meeting his needs and deciding to end the relationship, or his becoming increasingly angry and disappointed in their ineffectiveness with him, and making the decision to leave.

Alex began therapy at the age of 10. Most of his therapy experiences had been positive ones, yet have not made an impact on these relational patterns. he began work with me with excellent access to his feelings and inner world, yet with relatively little insight about his contribution to his difficulties with women. Narcissistic defenses made the development of this insight quite difficult, yet as he became more settled in the therapy with me, he has been better able to form an objective view of how his unresolved attachment issues have impacted on his inability to sustain healthy intimate relationships.

Early in the therapy, we decided to use an ego-state model, as working with inner self-parts had proved helpful to him in past therapy. What became different in our work, however, was that I began to engage key ego states directly, to form attachments with them, and to work with the intense transferential reactions that ensued. Several key ego states have emerged in the therapy. These include: A raging protector and gatekeeper whose role is to keep me away from early traumatic material that is yet unknown; a little boy ego state named "Allie" who contains most of the early grief and fear related to losses involving his mother and sister; and an angry 15-year-old adolescent, who was enraged at the decision to return home from boarding school, and the resulting emasculation that occurred for him within the intense refocus on Alex's relationship with his mother.

As therapy unfolded, much of our emphasis was placed on repairing the transferential wounding that took place because of disruptions in our schedule due to Alex's financial problems and my travel schedule. He developed tinnitus during this time, which distracted him from an inner focus and further challenged our developing relationship. To strengthen the therapy process, we turned to self-nurturing as a central goal. Alex already had a well-developed regular practice of meditation, which he found generally calming and grounding. To this practice, we decided to add work in imagery to help him begin to engage the angry, frightened, and grieving parts inside. As Alex said, "I need to have a way to soothe my anxiety related to the women in my life. Becoming too dependent on you for that will just kick up all my early issues and leave me even more vulnerable and upset."

At first, Alex decided to incorporate positive images of me in the nurturing capacity he had come to trust in his therapy. He found this imagery to be helpful, though it did not produce results that lasted significantly beyond his morning meditation period. His next step was to add imagery that involved his adult self accepting the angry states inside and comforting the little boy part named "Allie." This met with somewhat the same outcome, initially helpful, but not sustaining him throughout the day.

As we discussed together what we might add to this process, I suggested that we consider adding another figure, in addition to the two of us, who could provide different nurturing experiences. I shared with Alex the story of "the February man" (Erickson & Rossi, 1989). Alex was intrigued by this concept, and we agreed that the nurturing figure needed to be female, in order to repair the wounding in his early relationships with mother and sister. As we explored the possibilities for this figure during a hypnosis session, Alex responded, "I don't know why but I'm thinking of Mary Poppins. I used to love that movie when I was little. I think she might be a good person, especially for Allie."

Over several weeks, Alex practiced using Mary Poppins as a transitional nurturing figure. He found this quite helpful. His adult protector ego state told me during a hypnosis session, "I need to hold on to her now, not you. She says she won't leave Allie alone, that she will go with me everywhere in my life and will always be there." As the re-nurturing work with Mary Poppins unfolded, we gained greater access to early traumatic material related to all of his family members and were able to complete reparative work involving the central ego states inside. Other outcomes were that his tinnitus symptoms subsided; his abilities to collaborate with me successfully were strengthened; and the positive effects of his morning imagery sessions extended over a greater span of time. He found himself turning to the image of Mary Poppins in response to stressful situations he encountered during the day and evening.

After several more weeks of intensive imagery work, Alex told me, "You know, I feel more calm inside. I find that I can have her [Mary Poppins] now as well as you. I feel stronger and more connected to the other parts inside and what they need." Positive sequelae in the therapy included further unfolding of his inner process with access to several new ego states related to events that shaped his sexuality during adolescent years. He began to form a more mature, realistic relationship with a woman, weathering various disappointments with her, and forming a more objective view of their strengths and vulnerabilities as a couple. Alex also demonstrated more flexibility in his openness to therapy experiences, asking about additional approaches that might be helpful. We discussed and implemented successfully the use of ECEM (Hollander & Bender, 2000), a synthesis of hypnosis with EMDR, and the use of more interactive, conversational hypnotic inductions. Alex continues now in therapy to further integrate these positive results.

Case II: Michael

Michael is a 42-year-old computer salesman. When he was first referred to me, he was seriously depressed. Medication was not working for him, his wife had just announced she wanted a separation, and he had lost a lawsuit he had filed against a former client who had pirated one of his software programs. Tall and handsome, Michael had the looks of a man for whom life was easy.

Michael had grown up in the Midwest, born into a family of three children. His family lived on a farm and Michael had always enjoyed hunting and fishing and being in the outdoors. His older sister had memories of being sexually molested by their maternal grandmother. Michael wondered if he, too, had been molested, especially since he had always been slow to get erections and almost always experienced delayed orgasm.

Early on in therapy, Michael proved to be a good hypnotic subject and responded well to ego-strengthening that utilized imagery related to his activities in nature. His depression began to lift, he responded to medication, and he began to feel more hopeful about recovery from his impending divorce and about finding a new job situation.

We began to explore the possibility of ego-state work since he had begun to date and his sexual response was even more delayed due to side effects of his medication for depression. Work with a 6-year-old ego state, and an even younger one, revealed imagery and emotional reactions consistent with his sister's memories of sexual abuse. We worked through several difficult events related to his grandmother, and provided corrective experiences for the child energies who appeared to hold this memory material. We brought in older states, particularly a 13-year-old whose energy was connected to the pleasures of first exploring his sexuality and a 19-year-old that had enjoyed exploring sex with various women Michael had met in college. These two ego states appeared to be dissociated from the abuse, and they were able to improve his sexual performance.

As he got to know Carla, who was a candidate to become a serious partner, however, he began to struggle again sexually. Ego-state exploration suggested that the more serious he became about a woman, the more difficulty he had concentrating during sex. The younger ego states began to "space out" and drift back to scenes involving the basement at grandmother's house where they had felt terrified and humiliated. These states were also worried that Carla would be like his ex-wife, and leave if times became difficult in his life again. he tried Viagra, which helped with erections, but did not help him sustain sexual sensations or to reach orgasm. Using older ego states to help increase sexual response, even when potentiated by the use of EMDR, was no longer effective, and Michael quickly became discouraged.

We discussed what could be added to our work. I remarked that it seemed that what was needed to repair what had happened with his grandmother was an older maternal figure, who could help him learn to trust the experience of sharing his body with a woman he could come to love as part of an intimate partnership. We explored possibilities in his past to no avail. I next suggested that he consider movies and books that had inspired him. Michael looked surprised. "What's coming to mind is a movie I saw with my kids a few weeks ago. It seems like a ridiculous idea, but I'm thinking of Joan of Arc." Although Joan of Arc did seem an unlikely choice, we decided to explore what she might have to offer. Her strength and role as a protector of children impressed Michael and we decided to give her a try.

Using a combination of hypnosis and EMDR, an approach called ECEM (Eye Closure Eye Movement), developed by Hollander and Bender (2000), we went through the process of installing the Joan of Arc figure as a re-nurturing resource. During this experience, Michael reported that Joan had told the young parts inside that she would always be there to protect them from any women that might be dangerous for them or who would try to hurt or betray their trust as their grandmother had done. Joan also told Michael that she wanted him to learn to be a strong man and that it was important for him to share his strength and virility, especially with a woman he could come to love, as an important part of their partnership.

Following this intervention, Michael began to involve Carla more in helping him get aroused. He discovered that when both of them were equally involved in stimulating him, he could sustain his concentration and have normal, satisfying orgasms. Although his new-found abilities were tested when he and Carla mutually decided to end their relationship, he was able to work through similar barriers with Susan, his current relationship, much more easily and in a shorter period of time. He continues in therapy to examine and resolve the barriers related to his early sexual abuse by his grandmother and to expand his capacity for physical and emotional intimacy.

Discussion

These two cases suggest several clinical implications for the re-nurturing of male patients in ego-state therapy. First, it is noteworthy that both Alex and Michael had significant early attachment disturbance in relation to primary maternal figures. Alex's bonding with his mother was impaired by her chronic, depressed withdrawal from him and complicated further by his older sister's rejection of him and his father's rage at his unmet dependency needs. For Michael, his grandmother was his primary caretaker during his preschool years while his mother worked full-time. Although we are uncertain as to the exact nature of his sexual and emotional abuse by her, we have partial corroboration from his older sister, who holds clear memories of her abuse and of his presence in the situation. Persistent imagery suggests that he may have been tied up by grandmother as punishment for failure to respond sexually to her. He has recalled thoughts like, "I will never let her have control over my penis." This decision set the stage for sexual collapse during adult life when his wife betrayed him at a time when he faced financial and professional ruin.

In both situations, standard re-nurturing protocols were attempted, using more mature male ego states to strengthen and reparent the young states who were badly traumatized. In both cases, these attempts met with mixed success. Only the addition of imaginary female nurturing figures that were wholly accepted by the personality led to significant behavioral change and to successful ongoing experiences in self-reparenting.

These results may be explained by Hornyak's conceptualization of gender differences. If it is true that men need to separate from relationship in order to individuate and to experience their full potency, as she and others have suggested, then we may better understand the pivotal role played by Mary Poppins and Joan of Arc. As imaginary figures, they may have provided distance from the early betraying and damaging female attachment figures, as well as from current intimacy with women, which was so overwhelming and destabilizing for both of them. These figures appear to have provided transitional corrective experiences that were wholly acceptable and strengthening to the personality system. These powerful transitional experiences seemed also to foster greater intimacy with positive nurturing females in the present, including the therapist, and to permit the maturation of self-nurturing capacities within the personality systems of both men.

Although this approach requires considerably more investigation, it is a promising new possibility in the area of creative re-nurturing. Cross-gender re-nurturing may be particularly important for male patients, especially where their primary early attachments to women have been the source of profound wounding and betrayal, leaving them vulnerable to later attachment difficulties with women in their adult lives.

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Maggie Phillips

Oakland, California

Paper presented in the Gender Symposium at the annual meeting of the American Society of Clinical Hypnosis, Alexandria, VA, March 2003. Request reprints from:

Maggie Phillips, PhD

2768 Darnby Drive

Oakland, CA 94611

email: mphillips@lmi.net

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