The latest Journal of Clinical Psychology (sadly no free access) has the whole journal devoted to exploring ideas around the internal multiplicity of the self. Basically this is the idea that the self has or consits of multiple parts, aspects, object or persons rather than that the self is some type of unitary concept. Dimaggio and Stiles offer a very lucid and easy to udnerstand overview of this concept in the opening paper.
Internal multiplicity is present, if not always acknowledged, in most systems of psychotherapy. It is expressed in such cognitive-behavioral concepts as automatic or intrusive thoughts and self-talk or self-statements. Self-criticism and self-blaming, for example, are forms of self-to-self relationships in which a harsh part of the self criticizes or blames another part that is submissive or inferior. Multiplicity is also assumed in such psychodynamic concepts as internal objects and states of mind and in the humanistic focus on contradictory aspects of self and unrealized potentials. Multiple internal voices are central to dialogical accounts of the self , as therapists try to distinguish from what positions patients speak and to understand what parts of the self are suppressed and prevented from expressing themselves. Multiple I positions are deliberately used in the service of therapy, in the facilitation of reflective thinking, in the analysis of reciprocal role procedures in cognitive analytic therapy, in empty chair work and two-chair work in experiential therapies, in archetypal psychology, and in narrative psychotherapy.
The value in this journal issue is not just a discussion of a theoretical concept but a range of papers directly outlining the use of this sort of model in actual therapy with specific clients. Papers are presented from range of therapies using individual case studies to illustrate the value of the multiplicity concept.
For me this multiplicity of selves has always been inherent in my therapy particularly with borderline clients. One of my favourite sayings to my interns who are working with these clients is that working with borderline clients is like doing family therapy inside somebody’s head. To work effectively with a family you must get everybody in the room and this is usually the first task in working with borderline clients, getting all aspects of the self acknowledged and making it safe enough for each of them to express their point of view and problems.
Clinicians who recognize the self’s multiple aspects may be more empathic with their patients’ internal struggles and acute ambivalence. They may exhibit more attunement or responsiveness, thus being more effective as patients present different facets in different sessions or within one session.
To me this is critically important in the delivery of empathy. Neutrality becomes more of a balancing act in ensuring that each aspects of the self is given some attention and understanding rather than a stricter technical neutrality usually demanded in a psychodynamic approach. While it is usually not possible to offer a single empathic statement that acknowledges all aspects of the self it is useful to think at least in terms of responding to which ever dyadic aspects of the self are in the forefront at the time. In virtually all therapies including CBT there are at least two self aspects present.
As respect and empathy are offered to each voice individually, conflicting internal voices can hear and begin to understand each other, a crucial step toward developing internal meaning bridges. On hearing conflicting expressions, a therapist can reflect rather than try to encompass multiple voices in an omnibus reflection. Reflections that address only one voice may facilitate elaboration by the voice that was reflected, or, alternatively, they may stimulate an opposing response from a voice that was not reflected. Either client response may be productive. Trying to encompass multiple voices with one reflection, on the other hand, is likely to lead to confusion, as it is unclear which voice should respond. Accurate empathy can thus be understood as facilitating conversation and hence mutual understanding among the client’s internal voices as well as between client and therapist.
This leads in my view to an overarching reflective view of the self that is more and more able to tolerate and resolve the differences between different aspects of the self. This development of reflective space of self has been a theme propounded by number of therapies working with borderline clients. A recent Journal of Clinical Psychology devoted to the treatment of borderline clients notes this development of reflective space as a commonality amongst many of the therapies.
Problems seem to arise not because the self has many parts but because communication between the parts is poor. One problem is confusion, as individuals are seemingly driven by contradictory and intense feelings, each leading a different way. Patients may feel disoriented when they encounter ways in which their inner worlds are incoherent. “Who am I,” a patient might ask, “a person who is affectionate and devoted to others or an irate egoist incapable of really loving?” Similarly, when there is no dialogue of the various parts of the self, behavior may seem incoherent. Individuals may swing between anger aimed at getting their way, guilt feelings at the idea of harming others, and the idea of not deserving anything. As the positions shift, their actions also change, with the result that none of them is pursued long enough to be effective. A patient who has dependent personality disorder, for instance, may swing between searching for idealized intimacy and refusing the other during a moment in which she feels patronized by the dominant attitude of her partner or of her boss.