INNER CHILD WORK: WHAT IS REALLY HAPPENING? Donald A. Price, Donald A. Price, Ph.D., is a Marriage and Family Therapist in Salt Lake City, Utah. For reprints write Donald A. Price, Ph.D. , 182 S. 600 E., Suite 203, Salt Lake City, Utah 84102. ABSTRACT The popular concept of " the inner child " and "inner child work " will be evaluated and compared to various theories of personal devel- opment, including object relations, self psychology, Jungian and dis- sociation theories. It will be suggested that much of what is being accessed in such work is compatible with these theories and may be at least ego-state based rather than just a pleasing visualization or metaphor. Terminology clarifications and cautions as well as direc- tions for effective hypnotic approaches will be outlined. INTRODUCTION The concept of the inner child is not new, clinically dat- ing back at least to Jung (Abrams, 1990). Abrams (1990) traces its earliest roots back to Greek mythology, implying an origin in primordial times. Modern day definitions, how- ever, are quite varied. The experiences of individuals attend- ing large group workshops providing "Inner Child Work" range from no effect to over-stimulation and the opening of a Pandora box, sometimes without a therapeutic alliance in place. It may escalate the difficulty of the work for some already in therapy. Because of witnessing these latter experiences in some of my patients, I delved further into the literature. Based on clinical experience and discussion with colleagues, I have found both positive and negative aspects to the concept. In the process, I found myself needing to clarify and attempt to ground the concept in solid theory. This stimulated me to look for parallel constructs across various theories. As I pursued this aim I formulated a number of hypothe- ses as well as raised a number of as yet unanswered questions, and would suggest a few cautions. The Inner Child Movement According to Abrams (1990) , there are six important rea- sons why the image of the inner child has such a compelling message for us today: 1) There has been a popular expan- sion of interest in psychology, particularly in the relevance of human childhood and its developmental importance; 2) A parallel general growth in psychotherapy has occured, along with a growing interest in Jungian depth psychology and in the treatment of narcissistic personality disorders. "Both of these disciplines identify the image of the inner child as the vulnerable soul, the wounded child in need of inte- gration, and the injured self (Abrams, 1990, p. 7); 3) The Adult Children of Alcoholics (AGA) program, a spin-off of the twelve-step programs of Alcoholics Anonymous, makes broad use of the child-within concept. According to Abrams, "[I] t has been estimated that the ACA program is growing at a rate of one new group nationwide every day" (1990, p. 8) ; 4) Child abuse is receiving increasing acknowledgment; 5) Contemporary parents are finding their roles burdensome. Changing attitudes about children and their development, child care outside the home, and women in the workforce all, in Abram view, bring special attention to the child with- in the parent, as well as to the inner life of the child: The quality and success of parenting is deeply enhanced when parents can realize their own neglected child selves and transform them into com- passionate resources for the care of their own chil- dren. The way one treats the inner child strongly determines the way one treats the outer child" (Abrams, 1990, p. 9). 6) Abrams maintains there is a hunger for spirituality and meaning in our era, "a longing for a second coming of a divine inner child whose appearance would announce the beginning of a new millennium of hope" (1990, p. 10). The Concept of the Inner Child There are many definitions in the literature of the inner child. Some are very superficial; others are more fully devel- oped. Whitfield (1987) states: "[W]e each have a `Child Within- the part of us that is ultimately alive, energetic, creative, and fulfilled. This is the Real Self - who we truly are" (p. 9) . Bradshaw (1990) though focusing on the "wound- ed child within," should be credited with integrating a vast amount of self psychology, developmental psychology, object relations, and family systems theory in his popular writings and television series. Napier (1990) also integrates self psy- 68 DISSO( IATION, l ol. IX, No. I, March 1996 PRICE chology, object relations, and dissociation theories in her writ- ing, providing suggested self hypnotic scripts to access and relate to a variety of types of inner children. Some groups and books that promote inner child work provide adequate precautions (Bradshaw, 1990), but most do riot. There are a number of possible theoretical bases one could use for conceptualizing the inner child. Abrams(1990) book of readings looks at the inner child from a number of different perspectives. One of the first people he includes is Jung, who discovered his own inner child, and found a place in his theory to describe that phenomenon. Jung (1959) said "the child motif is a picture of certainforgotten things in our childhood" (p.161). Certain phases in an individual s life can become autonomous, can personify themselves to the extent that they result in a vision of oneself -- for instance, one sees oneself as a child. Visionary experiences of this kind, whether they occur in dreams or in the waking state, are, as we know, conditional on a dis- sociation having previously taken place between past and present .. The child motif represents not only something that existed in the distant past but also something that existsnow, that is to say, it. is not just a vestige but a system functioning in the present whose pur- pose is to compensate or correct, in a meaningful manner, the inevitable one-sidedness and extrava- gances of the conscious mind. It is in the nature of the conscious mind to concentrate on relatively few contents and to raise them to the highest pitch of clarity.A necessary result and precondition is the exclusion of other potential contents of con- sciousness. The exclusion is bound to bring about a certain one-sidedness of the conscious contents. (Jung, 1959, p. 162) Hall (1986), in looking at the compatibility of dissocia- tion and Jungian theory, observed that the following con- cepts have a bearing on the nature of the inner child from a Jungian point of view: An archetype in itself is simply a tendency for the psyche to structure experience in a certain man- ner; in this regard, the term archetype has some relationship to imprinting, leaving a lasting impres- sion.. . Complexes are groups of related images held together by a common emotional tone and based upon an archetypal core. . .(Hall, 1986, p. 112). While all complexes have an innate tendency toward personification and rudimentary con- sciousness, those that are associated with the ego- complex partake of what is ordinary consciousness. (Hall, 1986, p. 113) Thus Jung described dissociated aspects of the past that tend toward personification. He discovered that he himself had an inner child, and spent some period of time on his own in play therapy, every day after lunch and againin the evenings, building a complete village as a way to access the 11-year-old part of himself who played with blocks. Mills and Crowley (1990) observe that lung contact with his own inner child played a crucial part in releasing the extraordi- nary creative energies that culminated in his theory of the archetypes and the collective unconscious" (p. 222). More recently Heinz Kohut (1971, 1977) self psychol- ogy has focused on the self and fragments of the self, these fragments in relation to significant others, and the devel- opmental task of pulling these self fragments together in a cohesive fashion. Object relations theorists (e.g., Masterson, 1981) talk about both good self and bad self representations. They note the normality of such phenomena in early child- hood development because the child is unable to contain the strong opposite feelings (ambivalence) about self and parents (thus developing corresponding split self and object representations). In later writings (Masterson 1985, 1988) shifted his focus from the object to the self as he develops his ideas about the real self and the false self. David Scharff (1991) describes self and object repre- sentations as structures with the qualities of ego states. Missildine (1963), and Berne (1977) in his work on Trans- actional Analysis, have both argued for work with a child part of the self, describing these parts as some form of ego state. This writer first exposure to the concept of an inner child was while doing a doctoral dissertation, which consisted of the creation of a paper and pencil instrument to measure the relative intensity of the ego states as defined by Transactional Analysis (Price, 1976a, 1976h). The outcome revealed substantial reliability from a variety of measures (including patterns in factor analysis), but little or no valid- ity based on rater perceptions. He concluded that consistent patterns of behavior, feelings, and attitudes are being mea- sured in the study of ego states, but it is difficult to define precisely or consistently what they are. Watkins and Watkins, building on the concepts of Federn (as did Scharff [1991]), define an ego state as "a body of behaviors and experiences which are bound together by some common principle and separated from other such states by a boundary which is more or less permeable" (1979, p. 5). In his bookStates of Mind, Horowitz says such states of mind can be "described as a recurrent pattern of experience and of behavior that is both verbal and nonverbal"(1987, p. 27). Albini and Pease (1989) make a sound argument for the existence of parallels between Kohut ideas of self frag- mentation (due to parental failures in childhood), and the failure to reach the developmental task ofassociation (of the normally existing "states of consciousness" [Putnam, 1989] ). 69 DISSOCIATION, Vol. IX, No. I. Mardi 1996 INNER CHILD WORK When we think developmentally and look to child patients and their experiences in a developmentally phase-specific way, we see the early MPD phenom- ena as being not so much a dissociative but a pre- associative disorder. In saying we refer to an early period (birth to six to eight years) before the formation of a firmly cohesive nuclear self is established. The child needs to come to distinguish her/his existence and achievements from those of the primary caretakers, as well as to integrate and recognize experiences with various people, which have different emotional tone. Due to the com- plexity of these developmental tasks, the young child often fails to see these early experiences as part of the same reality. When, for example, we see how easily children are able to pretend, in play, to alternate between different emotional states, we are looking at separate nascent selves or separate cen- ters of experience It is our view that the phase appropriate exis- tence of separate nuclei around which self-experi- ences can condense is more common than not in developing children. We hypothesize that split off sectors of self nuclei seen in incipient cases of MPD are related to a normal developmental analogue that precedes the establishment of the cohesive nuclear self. (Albini Pease, 1989, p. 148) Putnam (1990) has further elaborated a "states of con- sciousness model." He suggests that although different the- ories use different terminologies when describing aspects of the self, the ego state or states of consciousness concept derived from infant research (Wolff, 1987; Emde et al., 1976) and dissociation theory has perhaps the best capability of becoming a clarifying and unifying concept. The research of Nancy Hornstein (1989) suggests there are five patterns of dynamic family interaction associated with the development of dissociative disorders. There is abundant opportunity, from whatever theory one starts, for an indi- vidual to be left with a split-off or dissociated or unassociat- ed part of self, or for a part of the self not to have had suffi- cient soothing or nurturing to associate or become cohesive. It is this writer opinion that dissociation theory can pro- vide a unifying theory, not only to the inner child movement, but to personality theory as a whole. But in order to do that, several terminological definitions need to be clarified. Of particular importance is the relation betweendissociation and splitting, seeking clarity in the distinction betweenprocessand content. Other authors have discussed or attempted to clari- fy or resolve these issues, including Gruenewald (1977), Grotstein (1981), Mathis (1988), Young (1988), Counts (1990), and Ferguson (1990), none completely satisfactori- 70 ly, though Ferguson comes closest to what is suggested here. First, this writer proposes to define as the men- tal process of distancing or separating from a trauma, unmanageable feeling, an unwanted or unacceptable part of self representation or object representation, an unac- ceptable impulse/behavior, or from conflicting or polarized experiences; (e.g., in a double bind [Spiegel, 1986]). Second, it is suggested that the noun be reserved to describe a mental unit or structure resulting from the rigid- ification or more permanent fixation(a fait accompli) of what was distanced or dissociated (as described above), or from an introjection or incorporation of an external object (Lister, 1982; Rose, 1986) . Ferguson (1990) also draws a con- ceptual distinction between dissociation and splitting, leav- ing splitting to describe "the permanent subdivision of the self into cohesive personality fragments" (p. 436). He states further that "the degree of anxiety necessary for splitting results in permanent alterations in the functioning of the mental apparatus that are not easily reversible. This implies alterations in the functioning of the underlying neurologi- cal substrate" (p. 439). A split can contain any content (Sands, 1994) and, depending on the theory, is called an ego state, self fragment, or part-self or part-object representation. In object relations theory all alters in a patient with MPD can be classified as a personifications of a self or of an object representation. A split is most often the result of repeated dissociations, but can happen in some persons/occasions instantly, once the person is skilled at dissociating and creating parts. A split is probably a combination of the defenses of dissociation and disavowal or denial. The more walled off (amnestic) the split is, the more likely it is combined with the defenses of dis- avowal ("That is not me") and/or denial ("This did not hap- pen." ) A split may or may not be surrounded by an amnesia barrier. A split-off part or personality may experience itself as conscious, but the content may not be experienced as con- scious by the host. Thus, the "states of consciousness" theo- ry of Putnam (1989) again seems to clarify and unify. The word "splitting " is problematic. It is a verb form describing a process that is linked by many object relations theorists to definite content (i.e., contradictory, black-white, good-bad). As Ross (1989) points out, commenting on and disagreeing with Young (1988) and Kernberg (1975) dis- tinction between splitting and dissociation, "[C]ontradicto- ry states area subset of incompatible states" (1989, p. 151.) In keeping with the position that a split can contain any content, not just good or bad (Ross, 1989; Sands, 1994), the term "splitting" might best be abandoned in favor of a more broad usage of the terms "projective identification " and "countertransference." Thus, regardless of the content of the split off part of self or object representation, the dynamics can be described as the patient transference acting out or reenactment through projective identification, which acti- vates or induces a countertransference response in external DISSOCIATION. vol. I. March 19116 PRICE objects, causing them to enact the role/behavior of the split off part. A fragment (Braun, 1986) is a less developed mental unit or self part.Fragmentation, a term often used in self-psychol- ogy to describe decompensation in an adult, probably describes the state of dissociated regressionin which there is lack of cohesion (association) and often rapid switching between less developed parts or personality fragments. In the dissociation literature, when developed alters are involved, this is referred to as the revolving door switch pat- tern (Putnam, 1989). Switching is the term in dissociation theory used to refer to the change of state, or moving from one part or alter to another. Some writers use the word splitting when referring to switching, creating a further confusion. WHAT IS THE INNER CHILD? With these definitional clarifications, it seems reasonable to suggest that what in the popular literature and workshop circuit is now referred to as the inner child, is most eco- nomically explained as a non-associated or dissociated and often disowned or disavowed part of the self or self repre- sentation; it has some degree of ego-state formation, and is state dependent. It is a mental unit or structure of varying degrees of complexity or development, depending on the individual person, and often has the power to exert passive influence (Kluft, 1987) on the conscious state. If this is true then several corollaries follow: 1. The inner child is not just a visual image or metaphor, but a powerful and influential part of the self. 2. The inner child may not be accessible through conscious exercises, but may need varying depths of hypnosis to be accessed. 3. The large group workshop format may, because of the power of the group and the vulnerability of some indi- viduals, release much more than that format is set up to handle. A person with more developed ego states, may in fact, dissociate more than anticipated, leaving such a participant, if he/she does not have an individual ther- apist, without adequate support or followup. Any ther- apist doing "Inner Child Work" should be prepared to treat fully developed multiple personality disorder (MPD). 4. Though there may be some commonalities in types of inner children (just as there are among alter personal- ities between MPD patients) , the same even-handed atti- tude of approaching each part, alter, inner child as unique or idiosyncratic needs to be maintained. The inner child may be wounded, creative, an angry pro- tector, etc. 5. If the inner child is an ego state, then more time than a quick empathic/integration exercise may he needed to heal and integrate this part. 6. There is, in this conceptualization, no false or real self, but different selves, or identities- each incomplete. The real self comes about through accepting and integrat- ing all the parts, and working through the various patha- logical issues.Whether the strong part or weak part is on the outside or inside can vary from person to person. 7. The term "inner child," though popular in some quar- ters and disliked in others, seems to be a term that is acceptable to many patients; it is much less threatening and technical than "alter personality" or "self fragment" or "self representation" or "ego state." Since therapists need to translate professional jargon into useful concepts anyway, this term might just as well be used, at least with certain patients, since people are responding to it. RECOMMENDED PROCEDURES IN INDIVIDUAL TREATMENT For therapists choosing to use the inner child concept, the following steps may be useful: 1. Educate the patient cognitively about the inner child concept. Explain how it is formed and left behind, link- ing this to the problem being treated. For example, one might say, "[F] or people like yourself who have grown up in a difficult family situation where you were abused or ignored, it is not uncommon that a part, an inner child, is left behind without even realizing it. These inner children can have a powerful influence on your feelings about your self and your behavior . .") I also often explain that we are all born with different states of con- sciousness and that association is a developmental task that can be hindered in difficult family circumstances. 2. Provide the patient with training in entering formal trance and achieving deepening. 3. Teach finger (ideomotor) signals. 4. When the patient is ready to explore, give the sugges- tion to go as deep as necessary to determine "if an inner child or part of the mind was left behind." Elsewhere (Price, 1990), the author has described more elaborate imagery. 5. When this depth of trance has been reached, the ther- apist may ask the patient to visualize a chalk board and ask the chalk ("which writes answers for the unconscious mind") whether there has been left behind an inner child. If the answer is "no," ask the chalk about the source 71 D]SSUC]ATH1\. Col, I\. N. I. (larch Ifi91i INNER CHILD WORK of the troublesome behavior/feeling in question and fol- low the procedures outlined by Watkins and Watkins (1979) or Edelstien (1990) for symptom analysis. If the answer is "yes," give suggestions for the adult self to look around inside (e.g. " imagine walking down a hall way in your mind, checking doors, of you might even find your- self looking out of doors") for the inner child. If found, ask the adult to describe its appearance, age, emotion- al state, etc. These instructions should be very open ended. The adult should be instructed to introduce him/herself to the inner child: "Indicate that you are a grown up part of her, and that you did not realize you left her behind. You have come back to take care of her, to meet her needs and hear her story," If the inner child is not found, a note can be left on the chalk board addressed to the child that the adult cares and will return later to search again. 6. The scripts in Napier (1990) are excellent guides for coaching the adult on how to nurture and respond to the different types of children that might be found. It is common that the inner child will be sullen and reject- ing of the adult (because it feels abandoned by the adult) . Angry (protective) parts may be negotiated with along the guidelines of Watkins and Watkins (1988). and Napier (1990). 7. One can ask the inner child if other inner children are around. Sometimes they appear spontaneously or the chalk board conveys this information. Sometimes as ther- apy progresses, the patient senses the presence of anoth- er child part. 8. The goal of treatment is to help the adult accept, under- stand the function of, nurture and protect, and other- wise meet the needs of the inner children. If this is done over time in treatment, they tend to grow up and mature, and/or eventually (visually) fade away (to be framed as integrating or "corning home " ). Sometimes a formal hypnotic visualization of unification may be appropriate. CONCLUSION AND DISCUSSION This paper argues that the inner child represents some degree of ego-state formation and should be treated with the seriousness that this concept demands. The positive thing about the popularization of the inner child concept is that it is a term that can be used to convey well grounded theo- ry with terminology that is less frightening and more accept- able to many patients (e.g., someone with narcissistic traits) than the words "self-representation," "ego state," or "alter." Furthermore, the popularization of the concepts by the Bradshaw television series (both "On the Family" and 72 "Homecoming") , and Napier (1990) book are useful adjuncts to therapy and/or prompt people to become aware of their issues and seek help that they otherwise might not pursue. Questions remain regarding the theory: Does everyone have an inner child as the movement suggests? Possibly every- one does in the same way that Watkins and Watkins (1979) suggest that all of us have ego states, or in the same sense that Searles (1986) states that "borderline phenomena will be encountered in any deep-reaching course of psycho- analysis or intensive psychoanalytic therapy, for these phe- nomena are part of the general human condition" (p. xii). If an inner child cannot. be visualized does this mean that there is none present, or that the person can not visualize well, or, as in the case of some MPD patients, the visualiza- tion is blocked in a defensive way? There is no easy answer to this question. Finally, a caution remains for group work. Since the inner child phenomenon is so idiosyncratic, and the potential is so great for activating more than the format or individual can handle, it is this writer s position that doing inner child work in a large group format is very risky. REFERENCES Abrams, J. (Ed.) (1990).Reclaiming the inner child. Los Angeles: Jeremy P. Tardier, Inc. Allbini, T., Pease, T. (1989). Normal pathological dissocia- tion of early childhood.DIS.SOCiATION, 2,144-150. Berne, E. (1977) . New York: Grove Press. Bradshaw, J. (1990). New York: Bantam. Braun, B.G. (1986). Issues in the psychotherapy sonality disorder. In B.G. Braun (Ed.),Treatment of multiple person- ality disorder(pp. 1-28). Washington, DC: American Psychiatric Press. Counts, R.M. (1990). The conceptof dissociation.journal of The American Academy of Psychoanalysis, 18, 460-479. Edelstien, MC.(1990). Symptom analysis.New York: W.W. Norton. Etude, R.N., Gaensbauer, TJ., Harmon, R.J. (1976). Emotional expression in infancy: A biobehavioral study.Psychological Issues, 10, Monograph 37. New York: International Universities Press. Ferguson, M. (1990) . Mirroring processes, hypnotic processes, and multiple personality. 417-450. Grotstei n, J.S. (1981) . New York: Jason Aronson. Gruenewald, D. (1977). Multiple personality and splitting phe- nomena: A reconceptualization.journal of Nervous and Mental Disease, 164, 385-393. DISSOCIATION, Vol.IX, No. 1, Mardi 1916 PRICE Hall, J.A. (1986). Toward a Jungian theory of hypnosis. American Journal of Clinical Hypnosis, 29, 109-115. Hornstein, N. (1989, November) .Five patternsof dynamic family inter- action associated with the development of dissociative disorders.Paper pre- sented at the Sixth International Conference on Multiple Personality/ Dissociative States, Chicago, IL. Horowitz, M.J. (1987). States of mind.2nd. Ed. New York: Plenum. Jung, C.G. (1959). The archetypes and the collective unconscious. In H. Read, M. Forham, G. Adler (Eds.), R.F.C. Hall (Trans.), Collected worksof C. G.Jung (vol. 9). New York: H. Wolf, New York, Pantheon Books, Bollinger Series XX. Kernberg, 0j. (1975). Borderline conditions and pathological narcis- sism.New York: Jason Aronson. Kohut, H. (1971). The analysis of the self. University Press. Kohut, H. (1977) .The restoration of the self. University Press. Kluft, R.P. (1987) . First rank symptoms as a diagnostic clue to mul- tiple personality disorder. American Journal of Psychiatry, 144,293- 298. Lister, E.D. (1982). Forced silence: A neglected dimension of trau- ma. American journal of Psychiatry, 139, Masterson, J.F. (1981). The narcissistic and borderline disorders. York: Bruner/Mazel. Masterson, J.F. (1985).The real self.New York: Bruner/Mazel. Masterson, J.F. (1988) .The search for the real self.New York: Bruner/ Mazel. Mathis, B j. (1981). Dissociation and splitting: Two different con- tinuums.Psychotherapy In Private Practice, 6, Mills, J.C., Crowley, R j. (1986). Therapeutic metaphors for children and the child within. New York: Bruner/Mazel. Missildine, H. (1963/1982). Your inner child of the past. New York: Pocket Books. Napier, N. (1990). Recreating your self. Price, D.A. (1976a). Construction of scales measuring ego states in transactional analysis. Unpublished doctoral dissertation, Florida State University, Tallahassee. Price, D.A. (1976b). A paper and pencil instrument to measure ego states.Transactional Analysis Journal, 5,242-245. Price, D.A. (1990). Corporate headquarters of the mind. In Hammond, D.C. (Ed.) ,Handbook of hypnotic suggestions and metaphors (pp. 343-346). New York: W.W. Norton. Putnam, P. (1989). Diagnosis and treatment of multiple personality dis- order. New York: Guilford Press. Putnam, F. (1990). Disturbances of the self in victims of childhood sexual abuse. In R.P. Kluft (Ed.),Incest related syndromesof adult psy- chopathology Press. Rose, D.S. (1986) . "Worse than death: Psychodymanics of rape vic- tims and the need for psychotherapy."AmericanJournal ofP.eychiatry, 143, 817-824. Ross, C.A. (1989). Multiple personality disorder: Diagnosis, clinical fea- tures and treatment.New York: John Wiley. Sands, S.H. (1994). What is dissociated? 7, 145-152. Scharff, D. (1991). Workshop on object relations family therapy, Salt Lake City, Utah. Searles, H.F. (1986) . borderline patients.New York: Jason Aronson. Watkins, J.C., Watkins, H. (1979). Ego states and hidden observers.Journal of Altered States of Consciousness, 5, Watkins, J.G., Watkins, H. (1988). The management of malevo- lent ego states.DISSOCIATION, 1,67-72. Wolff, P. (1987) . The development of behavioral states and the expression of emotions in early infancy. Young, W.C. (1988). Psychodynamics and dissociation: All that switches is not split.DISSOCIATION, 1(1), 33-38. 73 DISSOCIATION, Vol. IX. No. 1, March 1996