VARIOUS
PERSPECTIVES ON
PARENTING AND
THEIR IMPLICATIONS
FOR THE TREATMENT
OF DISSOCIATIVE
DISORDERS
Lynn R. Benjamin. 1I.A.. MEd.
Robert Benjamin, M.D.
Lynn R. Benjamin, M.A., M.Ed., is a certified parenting edu-
cator and a therapist in private practice in Dresher,
Pennsylvania.
Robert Benjamin, M.D., is Chairman of Psychiatry at the
Carrier Foundation in Belle Meade, New ,Jersey.
For reprints write Robert Benjamin, M.D., 12 Mayo Place,
Dresher, PA 19025-1228.
ABSTRACT
The parent-child dyad has been an underutilized resource for clin-
icians who treat individuals with dissociative disorders. This arti-
cle examines the functions of the parent from the perspectives of var-
ious fields of knowledge: psychodynamic psychotherapy, attachment
theory, infant development, affect theory, and family systems. It then
elaborates on how dissociative symptoms may interfere with the nor-
mal processes of parenting and child development. Finally, it points
out that there are a number of advantages to dealing with the par-
enting subsystem of the family of dissociative disorder individuals.
Sensitizing clients to their own parenting can serve to benefit the
therapeutic alliance as well as help the client/parent improve the
parent-child relationship. This work has the potential both to aid
in the recovery of the individual dissociative client and to begin to
correct the transgenerational exploitation and mistrust which cause
and perpetuate dissociative pathology.
INTRODUCTION
A number of authors have elaborated on the etiology
of dissociative disorders, especially multiple personality dis-
order (MPD) and allied forms of dissociative disorder not
otherwise specified (DDNOS) (Kluft, 1984a, 1984b; Kluft,
Braun Sachs, 1984; Braun Sachs, 1985; Fink, 1988; Albini
Pease, 1989; Barach, 1991; Liotti, 1992) and reflected on
their transgenerational transmission (Kluft, 1984b; Braun,
1985; Coons, 1985). Some have tried to determine the kind
of parenting that leads to the development of a dissociative
disorder. Muff, Braun, and Sachs (1984) characterized the
parents of children who developMPD as inconsistent, unem-
pathic, and out of touch with the developmental needs of
children. Kluft (1984a, 19846) , in the final factor of his Four-
Factor Theory of Etiology, addressed how the parents con-
tribute to the formation of dissociative pathology in their
child by failing to provide stimulus barriers and restorative
experiences to the traumatized child. Albini and Pease (1989)
also saw parenting functions as vital factors in determining
whether or not a child develops a cohesive self. Barach (1991)
and Liotti (1992) studied the attachment literature in an
effort to understand the development of dissociative pathol-
ogy. Although they diverged in their conclusions, they both
linked the kind of parenting that the child experienced to
the formation of different patterns of insecure attachments.
Finally Kluft (1987), in a seminal investigation of the
parenting of mothers who had MPD, took the first step in
the actual study of dissociative parenting. In that article, he
concluded that 61.3% of the seventy-five women in his sam-
ple were either compromised/impaired or grossly abusive
as parents. He tabulated the types of pathological parent-
ing, many of which included symptoms or behaviors char-
acteristic of patients with MPD.
This paper endeavors to further these pioneering efforts
in the area of parenting. It looks at some of the functions of
the primary caregiver (the person who is principally respon-
sible for the care of the child and who is usually, but not
always, the mother), several theories of parent-child rela-
tionships, how a dissociative parent may impact the devel-
opment of his or her child, and how the parent-child unit
of the family can be utilized as a potent resource in the ther-
apy of the dissociative client.
FUNCTIONS OF PARENTING
Psychodynamic Ideas
The psychodynamic literature represents a vast treasure
house of wisdom and clinical insights. In a brief paper, how-
ever, it is impossible to completely represent the full range
of rich (yet often conflicting) views formulated by psycho-
analytic thinkers over many years. Therefore, we are only
able to address selected ideas.
Freud (1938) himself saw the child mother as the
paramount love-object and the relationship between moth-
er and child as the basis for future relationships. Moreover,
he (Freud, 1914) viewed parenting as a revival of the adult
childhood narcissism. Benedek (1959) further elaborated
on that theme, characterizing parenthood as a continuation
of personality development beyond adolescence. She believed
that at every psychosexual milestone in a child develop-
ment, the parent has an opportunity to rework earlier devel-
opmental experiences and conflicts in a new way: during
pregnancy (Benedek,1970b;_Jessner, Weigert, Foy, 1970),
infancy (Winnicott, 1970) , the separation-individuation peri-
od (Mahler, Pine, Bergman, 1970), the Oedipal period
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DISSOCIATION.1 ol. V IL No, I, De( etlllw1 11(14
BENJAMIN/BENJAMIN
(Anthony, 1970a), latency (Kestenberg, 1970), and adoles-
cence (Anthony, 1970a). Each critical period of develop-
ment in the child has the potential to reactivate related devel-
opmental conflicts in the parent. The parent then has an
opportunity either to resolve the conflict and further devel-
op the personality or to not face the conflict-which might
result in a pathological outcome. Galinsky (1981) later built
upon the idea of stages of parenthood in a study in which
she interviewed 228 parents in a search for common devel-
opmental tasks and themes.
Benedek (1959, 1970a) saw introjection, identification,
and imitation not only as processes that help to shore up
the psychic structures of the baby in the mother-baby dyad,
but as processes that serve the maturation of the caregivers
psychic structures as well. For example, when the infant intro-
jects and identifies with the "good" mother who satisfies his
drive for food, the baby internalizes a mental attitude of
"confidence" in Eriksonian (1963) terms, "basic trust." In a
parallel fashion, the successful mother who satisfies her infant
can introject and identify with the gratifying experience and
feel self-confident about her mothering. If, through her pos-
itive mothering, she achieves a resolution of earlier conflicts
with her own mother, then she manages a new integration
in her own personality. The mother ability to nurture her
child results from the identification with and introjection
of her own mother. These themes were examined by
Ghodorow (1978) in her feminist book which explores how
"mothering is reproduced across generations" (p.3).
According to Benedek (1959,1970a) , the process of imi-
tation is also a mutual interaction between child and par-
ent. When the baby imitates positive patterns of the care-
giver, the parent can then imitate the baby imitations in
an affirmative spiral of interaction. On the other hand, when
the baby imitates negative patterns, the parent can either
change her own behavior (thereby changing the baby behav-
ior) or not change her behavior. If she does not change her
negative behavior, she maintains a negative interaction, and
she may reject and find unlovable that part of the child that
imitates her.
Imitation is often understood as a forerunner of true
ego identification. Benedek (1959) believed that A. Freud
(1936) "identification with the aggressor" is a person infan-
tile imitation of the aggressor. This defense serves to help
master emotions experienced in traumatic situations. Fraiberg,
Adelson, and Shapiro (1975) elucidated this concept of "iden-
tification with the aggressor" in their classic article "Ghosts
in the Nursery." There, they detailed how parents uncon-
sciously inflict the actions of their childhood betrayers on
their own children.
While Benedek (1959, 1970c) looked at the synchrony
between the growth of parenthood and the child psycho-
sexual development, other psychodynamic theorists con-
centrated more on the specific functions of the parent.
Winnicott (1965) established the concept of the"good enough
mother" who facilitates the growth and continuity of the
healthy ego in the child through protection, satisfaction of
physiological needs, reliability, and empathy. He warned that
failures in the "holding environment" could lead to "ag-
mentation of being [in the baby]. The infant whose pattern
is one of fragmentation of the line of continuity of being
has a developmental task that is, almost from the beginning,
loaded in the direction of psychopathology" (1963, pp. 60-
61).
Elson (1984), using the concepts of Heinz Kohut, dif-
ferentiated between the main "task" of parenthood and the
"process" of parenthood. She believed that the parent task
is to support the formation of healthy narcissism in the devel-
oping child. The parent supplies support through empath-
ically mirroring, merging, confirming, and guiding the
childs forming self. The parent as selfobject to the child
allows the child to transmute the parent responsiveness
into the child own developing psychic organization. At the
same time, the caretaking functions also transform the psy-
chic structure of the parent.
Ornstein (1981) also saw selfobject functions as occur-
ring in a dual way between parents and children: the par-
ents perform selfobject functions for their children while
the children perform selfobject functions for the parent. In
that latter process, the parent consolidates the "parental self."
The process of parenthood, in fact, can be seen as the con-
tinuing transformation of the parent own narcissism
through "maturing parental empathy, wisdom, and accep-
tance of human transience...while moving toward a less cen-
tral position in the lives of their children" (Elson, 1984, p.
312).
Many of the psychodynamic (and self psychological)
authors (Winnicott, 1965; Benedek, 1970a; Paul, 1970;
Kohut, 1971; Ornstein, 1981) saw empathy askey element
in parenting. Paul (1970) clarified the concept of parental
empathy:
Empathy ... presupposes the existence of the object
as a separate individual, entitled to his own feel-
ings, ideas, and emotional history. The empathiz-
es makes no judgements about what the other
feel, but solicits the expression of whatever he
feel and, for brief periods, experiences these feel-
ings as his own. (pp. 340-341).
Kohut (1971) believed that empathic failures in parents result
in self pathology in patients.
While many authors presume mothers are the primary
caregivers to children, Benedek (1959, 1970d) was careful
to look at "fatherliness" as well as "motherliness." She con-
cluded that there were two sources of fatherliness: biologi-
cal bisexuality and the father earlier biological dependency
on the mother. Fathers, like mothers, through interactions
with their children, have the potential to continue consoli-
dating the personality. Finally, Fisch (1984) noted that the
parenting experience itself can be utilized to build a thera-
peutic alliance. A focus on a client relationship with her
child is a non-threatening way to direct the client to exam-
ine libidinal and developmental material.
Attachment Ideas
Bowlby (Bowlby, 1969, 1973, 1980, 1988; Ainsworth,
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DISSOC1 PION. Vol. Vii, No. 4. December 1994
PERSPECTIVES ON PARENTING
Blehar, Waters, Wall, 1978) attachment theory drew from
ideas in a number of fields: psychoanalysis, ethology, psy-
chobiology, cognitive development, and control systems the-
ory. He explained that under normal circumstances a recip-
rocal behavioral system-attachment behavior in the child
and maternal behavior in the parent-operates in order to
preserve proximity to and protection of the infant. Such a
system ensures the survival of the species. Attachment behav-
iors can be activated under certain conditions: absence or
distance from the caregiver, return of or leaving of a care-
giver after an absence, lack of responsiveness or rejection
by the caregiver, distressing events, and internal conditions
such as hunger or illness (Ainsworth et al., 1978).
Ainsworth and others (Ainsworth, 1982, 1985a, 1985b;
Ainsworth et al., 1978; Main Solomon, 1986; Parkes 
Stevenson-Hinde, 1982; Sroufe Fleeson, 1986) carried on
the work of Bowlby in their identification of types of attach-
ment in children: secure, anxiously avoidant, and anxious-
ly resistant. In the context of the evolving parent-child rela-
tionship, over a period of time the child develops certain
expectations of the parent. These expectations, or mental
constructions that form the basis of personality, are called
working or representational models (Bowlby, 1980, 1988).
They include affective as well as cognitive components
(Bretherton, 1985; Zeanah Zeanah, 1989; Alexander, 1992) ,
and they determine the child s expectations about both the
availability of care by significant others and about the child
own worthiness for care (Sroufe, 1988).
Secure babies develop a working model of their moth-
ers as responsive and accessible. Anxious-resistant babies build
up a working model of their mothers as inconsistently acces-
sible. Anxious-avoidant babies develop a working model of
their mothers as rejecting, and they try to shield themselves
through defensive detachment. Main and Solomon (1986;
1990) discovered a fourth classification of attachment: inse-
cure-disorganized/disoriented. One of the most prominent
features of this behavior in the child is a dazed demeanor
accompanied by a "dead stare, a limp mouth, and a still body"
(Main Solomon, 1986, p. 120), characteristics that are
reminiscent of a trance state. The parents of these children
are characterized by unresolved traumas from childhood
(Main Cassidy, 1988; Main Hesse, 1990).
Other researchers demonstrated that these attachments,
without intervention, will persist throughout a person life
(Ainsworth, 1985b; Ricks, 1985; Collins Read, 1990; Feeney
Noller, 1990) . Main and her colleagues (cited in Ainsworth,
1985b; Main Goldwyn, 1984; Main, Kaplan, Cassidy,
1985; cited in Zeanah Zeanah, 1989; Main Hesse, 1990)
developed an Adult Attachment Inventory in which they clas-
sified four main patterns of adult attachment: autonomous,
enmeshed (or preoccupied), detached (or dismissing) , and
unresolved. The autonomous pattern is the counterpart of
the child secure attachment. Adults with this pattern are
self-reliant, objective, and nondefensive. The enmeshed adults
continue to be enmeshed in earlier relationships. Adultsi n
the detached group remember little of early attachment rela-
tionships, tend to idealize their parents (even though anec-
dotal episodes contradict that picture), and tend to reject
attachment to others. Finally, the unresolved group is the
counterpart of the disorganized/disoriented attachment in
childhood. Although these adults may share some charac-
teristics with any of the other three types, they are distin-
guished from the other groups by their confusion about past
unresolved losses or traumas. The kinds of attachment that
the parents demonstrate influence the subsequent attach-
ment behavior of the child. The autonomous parents tend
to rear secure children, the enmeshed parents tend to rear
insecurely attached (although not strongly avoidant) chil-
dren, the detached parents tend to rear anxious-avoidant
children, and the unresolved parents tend to rear disorga-
nized/disoriented children. Thus, a transgenerational pat-
tern of attachment began to be discerned (Main Goldwyn,
1984; Ricks, 1985; Sroufe Fleeson, 1986; Zeanah Zeanah,
1989; Main Hesse, 1990).
The implications of attachment theoryfor parenting are
many. The responsive parent tends to imbue the child with
a secure attachment and provide a "secure base" (Bowlby,
1988) from which the child can explore and develop. The
inconsistently accessible or rejecting parent tends to rear an
anxiously attached child. Such a parenting stance could lead
to a negative parent-child relationship with a high risk of
child maltreatment (DeLozier, 1982; Main Goldwyn,
1984; Schmidt Eldridge, 1986; Aber llen, 1987; Sroufe,
1988; Barach, 1991).
Barach (1991) saw a detached (avoidant) pattern of attach-
ment as a first step toward the development of a dissociative
disorder. Liotu (1992) differed from Barach in that he con-
ceived the disorganized/disorienting pattern as predispos-
ing the child to dissociation as a defense. Because of the par-
ent alternating frightened and/or frightening stance
toward the child, the child may develop numerous contra-
dictory self-caregiver constructs. For example, when the par-
ent behaves in a frightened way, the child may see the par-
ent as helpless or distressed and himself as threatening or
rescuing. Or, the child may see the parent as neglecting and
himself as unlovable. When the parent is aggressive and fright
ening, the child may see the parent as threatening and him-
self as helpless.
Finally, Rutter (1974), who studied maternal depriva-
tion, noted that the main attachment figure for a child did
not need to be a biological parent, and it did not even need
to be a female. Moreover, a child could develop multiple
attachments.
Daniel Stern Ideas on the Parent Infant Dyad
Fink (1988) was the first to offer a developmental per-
spective to the etiology of MPD based on applications of the
ideas of Daniel Stern (1985). Stern placed the growth of a
persons self within a relationship context from the moment
of birth. He elaborated four senses of self that continue to
grow and exist throughout the lifespan: the emergent self
(birth to two months), the core self (two to six months), the
subjective self (seven to fifteen months), and the verbal self
(fifteen months and later).
According to Stern (1985), the role of the caregiver in
the development of these various senses of self is of great
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DISSOCIATION. Vol. VII, No. 4, December 1991
BENJAMIN/BENJAMIN
importance. The mother brings her own personal history
with its working models into each interaction with the infant.
Early on, the parent interacts socially with the baby in the
service of physiological regulation. At the same time, the
parent attributes intentions to the baby and treats him as an
already developed person (Stern, 1985; Cramer, 1986). Parents
exaggerate their social behaviors with baby talk or overstat-
ed facial expressions aimed at the infant so that the infant
gives maximal attention to the parent. Through fine-tuned
mutual regulation of arousal, infants get experience with
self-regulation of stimulation. Similar to behaviors that
excite the baby in social play, parents also exaggerate sooth-
ing behaviors to calm a distressed baby. The parent, who
regulates the infant self-experience, becomes a self-regu-
lating other for the child. The many interactions with the
parent are represented mentally by the infant as
"Representations of Interactions that have been Generalized
(RIGs)" (Stern, 1985, p. 97). Activation of the RIG becomes
the memory of the interaction, and it is accompanied by an
"evoked companion"-the experience, either in or out of
awareness, of being with a self-regulating other (Stern, 1985,
p. 112).
Additionally, the caregiver shares affective states with
the baby through a process called "affect attunement"
(Stern, 1985, pp. 138-161). Unlike empathy, which is medi-
ated by cognitive processes, affect attunement is a more auto-
matic matching of affect state through intensity, timing, or
shape.
In the detailed description of the parent-infant inter-
personal experience, Stern emphasized the parent role as
a finely-tuned instrument that is sensitive to the behaviors,
affect states, and vocalizations of the baby.
Affect Theory
Like Stern (1985) , many other theoreticians and observers
of child development (Brazelton Yogman, 1986; Demos,
1986; Tronick, Cohn, Shea, 1986; Radke-Yarrow, 1986;
Nathanson, 1993; Kelly, 1993) viewed the caregiver as the
essential and critical regulator of affective states in children.
Affects are innate, physiologically based, and operate as ampli-
fied analogues of a stimulus gradient and intensity (Tomkins,
1962, 1963, 1991, 1992; Demos, 1986; Nathanson, 1992; 1993) .
According to Tomkins, affect influences a person memo-
ry, perception, thought, and drives (cited in Demos, 1986).
Affect itself is most visible on the face (Demos, 1986;
Nathanson, 1992, 1993; Tomkins, 1962, 1963, 1991, 1992),
and caregivers send messages to children via their facial expres-
sions (Bugental, Cortez, Blue, 1992; Camras et al., 1990;
Clyman, Emdc, Kempe, Harmon, 1986; Kopp, 1989) which
may give children information to process, activate behavior
in the children, or serve to spread the caregiver affect to
children (affect contagion) (Maccoby Martin, 1983; Miller,
Eisenberg, Fabes, Shell, Gular, 1989; Bugental et al., 1992) .
Similar to Stern (1985) , Nathanson (1993) believed that
the affective system mediates relatedness. Parents, through
their ministrations to children, teach self-soothing and affect
regulation. When a parent repeatedly relieves a child dis-
tress, the child eventually learns "that
need, its identification, and its later relief (Nathanson, 1993, p.
551) ." Such interactions facilitate the child s learning to trust
the information that his emotions give him. When there is
a breakdown in the reciprocal regulatory system either through
neglect or abuse of the child by the caregiver, affective dis-
turbances may occur. The unsoothed and/or hurt child may
develop low self-esteem or depressive states, demonstrate
pathological defenses (such as avoidance, hypervigilance,
denial, projection, splitting), and engage in self-destructive
or aggressive behaviors (Green, 1981). Moreover, the bio-
logical damage to the affective regulating systems may be
lasting in children whose central nervous systems are still in
the process of developing (Van der Kolk, Perry, Herman,
1991).
A major task of parenting is the socialization of chil-
dren. Especially as children begin to socialize with peers and
other adults, parents begin to think about how to help chil-
dren achieve emotional control (Kopp, 1989). One of the
goals of socialization becomes the regulation of affective arousal
in appropriate ways (Maccoby Martin, 1983).
Dix (1991), in a landmark article on the affective orga-
nization of parenting, posited that emotions are the heart
of both effective and ineffective parenting. When the par-
ent affective system is sensitive and in tune with the child,
competent child-rearing is promoted. However, when a par-
ent emotions are too strong, too weak, or out of tune with
the child-rearing task at hand, parenting is undermined.
Sensitivity to children needs and parental warmth predict
favorable developmental outcomes for children (Dix, 1991;
Maccoby Martin, 1983). Conflicts between parents and
excessive negative emotion may contribute to distress in chil-
dren and negative developmental outcomes (Dix, 1991; Radke-
Yarrow, 1986). The stressors that may affect parents (e.g.,
marriage or employment) and the support systems that par-
ents have to relieve stress influence parents affective states.
These factors bear on the quality of their parenting (Dix,
1991; Radke-Yarrow, 1986; Emery Tuer, 1993). Chronic,
severe, negative emotion in parents characterizes family dys-
function (Dix, 1991).
Dix postulated several reasons why negative emotion might
dominate the affective state of the parents: 1) unrealistic
expectations that the parents may have of their children; 2)
faulty attributions that parents may make to the behaviors
or misbehaviors of children; 3) parental focusing on self-
needs rather than on the child needs; 4) parental over-
intrusiveness with a baby that may lead to gaze avoidance or
protest in the child; 5) a sense of inefficacy in parenting.
It is evident that just providing information to children
about how to regulate their affective responses is insuffi-
cient. Both the expression and regulation of the parents
own affect and the intensity of that expression teach chil-
dren more about affect regulation than verbal instruction
possibly can (Maccoby Martin, 1983; Miller et al., 1989).
Parenting and Family Factors
The role of parents is to promote the developmental
growth and emotional well-being of their children (Guttman,
1989). Healthy families have a clear hierarchy of power in
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DISSOCIATION, Vol, VII. No.
PERSPECTIVES ON PARENTING
which the parents are the leaders (Minuchin, 1974; Minuchin
Fishman, 1981). The parents respect the contributions of
the children (Boszormenyi-Nagy Spark, 1973 1984;
Boszormenyi-Nagy Ulrich, 1981; Boszormenyi-Nagy 
Krasner, 1984 1986; Boszormenyi-Nagy, Grunebaum, 
Ulrich, 1991) and empower them in appropriate ways as
they grow (Nichols, 1988). Generational boundaries mean
that parents carry different responsibilities, roles, maturity
levels, and attitudes than children (Glick, Clarkin, Kessler,
1987). The tasks of parenthood change as children pass
through different developmental stages (Galinsky, 1987).
The family operates as a system such that problems in
any part of the system affect the other parts. If either par-
ent does not have a well-integrated sense of self, there is
potential to triangulate a child into the marital relationship
to fulfill certain needs in the parent or the marital dyad
(Bowen, 1978; Slipp, 1988; Roberto, 1992). A parent can
emotionally triangulate a child through the processes of split-
ting, projection, or projective identification (Boszormenyi-
Nagy Ulrich, 1981; Boszormenyi-Nagy, Grunebaum, 
Ulrich, 1991; Zinner Shapiro, 1989; Roberto, 1992). Any
of these processes may lead to overengagement with or rejec-
tion of a child, and they interfere with a child growth.
When the hierarchy of leadership breaks down, parents
may require that a child perform familial tasks that are not
matched to his social, emotional, physical, or cognitive devel-
opment. Such a process is called parentification, and it also
interfereswith normal growth and development. Boszormenyi-
Nagy and colleagues (Boszormenyi-Nagy Spark, 1973 
1984; Boszormenyi-Nagy Ulrich, 1981; Boszormenyi-Nagy
Krasner, 1986; Cotroneo, 1986; Boszormenyi-Nagy,
Grunebaum, Ulrich, 1991) took the idea of parentifica-
tion of children and placed it in the ethical context of rela-
tional justice between parents and children. Parents who
have been robbed of adequate parenting themselves may
parenting their own children in an effort to rebalance the
unfairness of their own childhood deprivation. Such an attempt
to use the parent-child relationship as a substitutive context
to balance out an unfair legacy is a destructive exploitation
because it robs the child of a trustworthy relationship.
In a similar way, parents who have been exploited in
childhood often seek to rebalance the old debts to them
through substitutive retribution against their own children.
This process is called "destructive entitlement" (Boszormenyi-
Nagy Spark, 1973 1984; Boszormenyi-Nagy Ulrich,
1981; Boszormenyi-Nagy Krasner, 1986; Cotroneo, 1986;
Boszormenyi-Nagy, Grunebaum, Ulrich, 1991). The com-
monly heard phrase "my life was unfair, so why should my
childs be any better?" captures the essence of this mecha-
nism. Treating the child as the parent debtor continues
the cycle of familial injustice and further erodes trust reser-
voirs in the family.
Additionally, children are loyal to their parents because
of their attachment bond (Boszormenyi-Nagy Spark, 1973
1984; Boszormenyi-Nagy Ulrich, 1981; Boszormenyi-
Nagy Krasner, 1986; Boszormenyi-Nagy, Grunebaum, 
Ulrich, 1991). Parents compromise the emotional health of
their child when they thrust the child into a split loyalty; that
is, a position in which the child is forced to choose between
embattled and hostile parents (Boszormenyi-Nagy Spark,
1973 1984; Boszormenyi-Nagy Ulrich, 1981; Boszormenyi-
Nagy Krasner, 1986; Boszormenyi-Nagy, Grunebaum, 
Ulrich, 1991). A split-loyalty trap is an automatic parentifi-
cation because it puts an unfair and confusing burden on
the developing child.
PARENTING AND DISSOCIATIVE PARENTS
The parenting of individuals who have psychiatric ill-
nesses has been a topic of intense interest to many investi-
gators (Gunderson Englund, 1981; Beardslee, Bemporad,
Keller,8c Klerman, 1983; Cytryn et al., 1984; Davenport, Zahn-
Waxier, Adland, Mayfield, 1984; Zahn-Waxler, McKnew,
Cummings, Davenport, Radke-Yarrow, 1984; Solnit 
Leckman, 1984; Feldman Gunman, 1984; Rutter 
Quinton, 1984; Tronick Gianino, 1986; Garrison Earls,
1986; Lyons-Ruth, Zoll, Connell, Grunebaum, 1986; Cohn,
Matias, Tronick, Connell, Lyons-Ruth, 1986; Beardslee 
Podorefsky, 1988; DiNicola, 1989; Gordon, Burge, Hammen,
Adrian, Jaenicke, Hiroto, 1989; Guttman, 1989; Copans,
1989; Paris Frank, 1989; Beardslee, Hoke, Wheelock, Clarke
Rothberg, van de Velde, Swatling, 1992; Goldman,
Dngelo, DeMaso, 1993; Bezirganian, Cohen, Brook,
1993) . Fewer authors (Levenson Berry, 1983; Kluft, Braun,
Sachs, 1984; Sachs, 1986; Kluft, 1985, 1986, 1987; Putnam,
1989; Williams, 1991; Benjamin Benjamin, 1992, 1994a,
1994b) have looked at the obstacles to parenting in clients
that have a dissociative disorder. Based on the foregoing dis-
cussion of the functions of parenting from numerous per-
spectives, we can summarize some of the essential ingredi-
ents for parenting that promote the growth of children. We
can then examine how some of these functions get derailed
in the context of the dissociative family.
Growth Enhancing Parenting
Based on information from psychodynamic psy-
chotherapy, attachment theory, child development, affect
theory, and family systems, we can assemble a picture of the
characteristics that might describe a healthy parent:
1) A person who meets the child physiological,
psychological, cognitive, and social needs;
2) A person who protects the child from the effects
of both ordinary and extraordinary stresses and
traumas;
3) A person who is loving and empathically attuned
to the child;
4) A person who is not emotionally or physically
intrusive toward the child;
5) A person who provides a "secure base" from
which the child feels safe to venture forth,
explore, and grow cognitively, socially, and emo-
tionally;
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DISSOCIATION, Vol. VII, No. 4. December 1994
BENJAMIN/BENJAMIN
6) A person who encourages the growth of the
child separate ego;
7) A person who tolerates a range of affects, knows
how to modulate affect, and keeps negative affect
to a minimum;
8) A person who is willing to grow and learn in
the role of parent which includes examining
the ways in which the person herself was par-
ented;
9) A person who is willing to look at unrealistic
expectations and attributions that are project-
ed onto the child;
10) A person who is willing to work with a parent-
ing partner in a cooperative way toward the
best interest of the child;
11) A person who respects and encourages the con-
tributions of the child without burdening the
child with expectations that are inappropriate;
12) A person who socializes the child by teaching
the norms of society;
13) A person who works to minimize stress and max-
imize support for herself so as to be strong and
healthy enough to be available to the child.
DISSOCIATIVE PARENTING
In his article on the parental fitness of mothers with
MPD, Kluft (1987) included mothers whose symptoms inter-
fered with their parenting in the "compromised or impaired"
category. The abusive mothers either failed to protect their
children or physically or sexually violated their children. Of
the abusive mothers, 75% were also psychologically abusive,
and of the compromised/impaired group, 50% were psy-
chologically abusive. Types of pathological parenting includ-
ed: psychological abuse, involving children in behaviors that
reflected their psychopathology (e.g. parentification); impair-
ment due to amnesia; abdication of parenting by alters; phys-
ical attack by a parent alters; intrusive overinvolvement;
affective absence; absence due to prolonged hospitalization;
and sexual seduction.
Dissociative disorders represent extreme disruptions of
behavior, affect, sensation, and knowledge in individuals who
have been severely and chronically traumatized in childhood
(Braun, 1988a, 1988b). Elsewhere, we have noted that dis-
sociation occurs within the context of the family when par-
ents have either directly exploited their children or have
been unresponsive and neglectful when their children were
faced with overwhelming traumas (Benjamin Benjamin,
1992). In our own clinical experience with dissociative
clients, we have noted that various symptoms seem to get in
the way of parenting (Benjamin Benjamin, 1992, 1994a).
We will briefly comment on each of these symptom patterns.
Switching and Accompanying Behaviors
Switching from one state of consciousness to another is
a psychobiological phenomenon that accompanies MPD. The
switching is often accompanied by facial, postural, motor
behavioral, speech, affective, cognitive, maturity level, and
psychophysiological sensitivity changes (Putnam, 1988, 1989;
Coons, 1988). It interferes with parenting in that it is dis-
orienting and does not permit the parent to stay fully respon-
sive to the child."Rapid switching" leaves a parent extreme-
ly affectively labile with a series of inappropriate emotions.
It is difficult to teach affective control to a child when the
parent demonstrates the opposite.
Additionally, given children s very early attunement to
the facial expressions of parents, the facial expressions that
accompany switching may be confusing. As children adapt
to the "normalcy" of switching behaviors, they may also imi-
tate them. If the remaining factors of Kluft (1984) Four-
FactorTheoryof causation are in effect, imitation may become
a "shaping influence" in the potential development of MPD
in the child.
Hearing Voices
Clients with MPD often complain of hearing many simul-
taneous voices in their heads, resulting in a great deal of
internal confusion. Internal confusion works against attune-
ment to the needs of the child.
Alter Personalities
Alter personalities originally occur as defensive respons-
es to traumatic situations (Kluft, 1984a, 1984h; Putnam, 1989) .
Names, attitudes, and degrees of interawareness among alters
may vary (Putnam, 1989). The amnesia among alters pre-
vents consistent responsiveness to a child. Differing attitudes
suggest that different alters may view themselves as having
different relationships with the child. Some alters may deny
being the child parent. Others may play with the child in
a childlike way. Some may dislike the child, while still oth-
ers may wish to hurt or actually may hurt the child. Putnam
(1989) noted that the children of MPD parents are very attuned
to the alter states of the parents and can adapt to the switch-
es. Levenson and Berry (1983) described a case in which the
children of an MPD mother took advantage of her dissocia-
tion and encouraged switching to meet their own needs. We
have worked with a client family in which the non-MPD child
imitated in great detail the mother switching into alter-
nate personalities. Since her mother had insisted on the eval-
uation, the daughter complied by acting like her mother.
She believed that one was supposed to have many" people "
inside if one visited a therapist.
Kluft (1987) noted that alters sometimes parentify chil-
dren by asking the children to perform tasks that are beyond
their age-appropriate capabilities. At other times, alters encour-
age children to comply with altersneeds to the detriment
of the children own needs. Occasionally alters pay no atten-
tion to parental responsibilities and just leave home, giving
their children too much autonomy and too little guidance.
251
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PERSPECTIVES ON PARENTING
On the other hand, alters are sometimes overly intrusive in
their child s activities. Some just go through the motions of
parenting without any affective involvement, and others need
hospitalization. We would add, based on our own observa-
tion, that the parental role is effectively abdicated when the
hospitalizations are frequent and lengthy, or when the par-
ent is absorbed in her own therapy to the exclusion of all
else.
Cognitive Distortions
A number of authors have written about the cognitive
distortions that occur as a result of repeated abuse (Fine,
1990; Fish-Murray, Koby, van der Kolk, 1987; Briere, 1992) .
Such distorted thinking is not conducive to encouraging
cognitive development in children. It models inflexibility
and inability to reason, and it can lead to faulty expectations
and attributions toward children.
Forgetting
Amnesia, a sudden inability to recall personal informa-
tion, or more than normal forgetting, accompanies MPD and
can get in the way of the most basic caregiving functions
(American Psychiatric Association, 1994; Steinberg, 1993).
Additionally, an inability to remember one childhood his-
tory puts the parent at a distinct disadvantage for resolving
past conflicts. Parents who do not have recall of hurtful events
and their affective responses to them are at risk to repeat
the past through the defensive process of "identification with
the aggressor." In that way, they victimize their own chil-
dren.
Detachment from Self and Others
Often a dissociative parent may experience deperson-
alization or derealization. In the former situation, the per-
son may feel disconnected to the body. In the latter, the per-
son may feel disconnected to the surroundings or the people
around her. In either case, the person may feel out of con-
trol and detached from self and/or others. When this situ-
ation occurs in the presence of children, the parent can for-
get personal information about a child or not recognize a
child. Avery young child may easily become frightened, upset,
or distraught if such a scenario occurs. The child may feel
responsible to care for the parent. We speculate that if this
situation is repeated frequently in a child earliest years, it
may contribute to an insecure attachment.
Self-Hurting
Individuals with MPD frequently engage in behaviors that
hurt the body (Putnam, 1989; van der Kolk, Perry, Herman,
1991; Briere, 1992). Parents may work actively to hide their
self-mutilating inclinations and may succeed in doing so while
a child is very young. But as children cognitive abilities
increase, their awarenesses usually do too. Children may be
surprised, confused, upset, angry, or blame themselves when
a parent hurts herself. If the child notices self-injurious behav-
ior, the child may feel obligated to care for the parent.
Alternatively, the child may dismiss it as another sign of a
parent "weirdness," detach from it, and ignore it. "Not notic-
ing" is a safe way not to deal with it, although children, through
identification and imitation, may unconsciously adopt self-
hurting as a coping mechanism of their own.
Suicidality (van der Kolk, Perry, Herman, 1991;
Putnam, 1989) is another common way of hurting the self
in individuals who haveMPD. In addition to feeling upset,
angry, and confused by a parent suicidal gestures, the child
may also devalue his own self-worth. The child may reason
that if the parent is willing to attempt to kill herself in spite
of the fact that she has children, then the parent must not
care very much for the children. While the suicidal mother
with MPD may believe that the child is better off without her
as a mother, the child may feel neglected, abandoned, or
rejected.
Often suicidality leads to hospitalization and separation
from the family. Depending on the age of the child, pro-
longed or repeated separations can leave lasting effects and
interfere with secure attachment.
Other Factors
1) Child Abuse. Kluft (1987) found that 16% of his sample
of mothers had been grossly abusive to their children.
Van der Kolk (1989) observed that adult males who have
been recipients of early abuse and deprivation tend to
be hyperaggressive, while adult females tend not to pro-
tect themselves or their young from danger. Chronic
physiologic hyperarousal prevents the adultwho has been
traumatizedi n childhood from making rational assess-
ments of situations. Rather than thinking to differenti-
ate between present and past stimuli, the individual
responds in an instinctive fashion as though the ancient
trauma were being repeated. Stressful situations may
discharge stimuli that remind the trauma survivor of the
old traumas. Certainly, parenthood can be particularly
stressful at times. The many pressures and strains inher-
ent in rearing children can easily trigger old patterns of
behavior in parents. These patterns may include hurt-
ing the self, hurting the child, or losing affect control.
There is a large body of literature that indicates that
child maltreatment is transgenerational, but there is some
controversy over how many abused individuals repeat
the abuse with their own children (Main Goldwyn,
1984; Zeanah Zeanah, 1989; Zaidi, Knutson, Mehm,
1989; Kaufman Ziegler, 1987; Leifer Smith, 1990;
Hunter Kilstrom, 1979; McCord, 1982; Oliver, 1993).
Chronic physical and/or sexual abuse of children is trau-
matic and impedes normal development (van der Kolk,
1989; Putnam, 1991; Cole Putnam, 1992; Putnam 
Trickett, 1993). Moreover, there is evidence that chil-
dren of traumatized mothers with MPD are themselves
at risk for developing MPD or other psychiatric disor-
ders (Braun, 1985; Coons, 1985).
2) Marital Issues. The marital relationship has an impact
on the well-being of children in a family. When there is
hostility and negativity in the marital relationship, it bears
upon the affective environment in the family. In dis-
252
DISSOCIATION, Vol. VII, No. I. December 1994
BENJAMIN/BENJAMIN
tressed relationships, the high negative affect undermines
parental effectiveness and children development (Dix,
1991) . Optimal outcomes for children in families in which
one parent is manic-depressive occur when the other
parent is not psychiatrically impaired (Davenport et al.,
1984) or when the marital relationship is not distressed
(DiNicola, 1989). Feldman Guttman (1984) empha-
sized that in families in which one parent has a border-
line personality, it is essential to mobilize the protective
functions of the other parent.
A number of authors have studied the marriages of
clients who suffer with a dissociative disorder (Sachs,
1986; Sachs, Frischholz, Wood, 1988; Putnam, 1989;
Panos, Panos, Allred, 1990; Williams, 1991; Benjamin
Benjamin, 1992, 1994d, 19940. Putnam (1989) sug-
gested that MPD clients often marry mates with consid-
erable psychopathology. We are in agreement with this
assessment. As previously reported, we (Benjamin 
Benjamin, 1994d) have formulated a typology of mates
who seem drawn to MPD partners, and we have elabo-
rated on the homeostatic patterns that characterize each.
It is our belief that strengthening the marriage improves
the outcome for therapy of the individual client. In cases
where children are involved, a stronger, more harmo-
nious marriage also enhances the child-rearing. Even
when conflict between the partners predominates, we
feel it is necessary that the partners cooperate in their
co-parenting. A few authors (Silberman Wheelan,1980;
Cohen eissman, 1984; Silberman, 1988) emphasized
the parenting alliance in their approaches to parenting.
3) Social Support. A variety of authors have linked social sup-
port to better outcomes in child-rearing (Herrenkohl,
1978; Bronfenbrenner, 1979; Hunter Kilstrotn, 1979;
Cabinet, 1983; Adamakos et al., 1986; Seagull, 1987;
Giarretto, 1989; Corse, Schmid, Trickett, 1990; Willett,
Ayoub, Robinson, 1991; Cochran, 1993). Often, par-
ents with MPD feel very isolated and alone. In addition
to family support, Sachs (1986) has recommended that
clients with MPD find support through parenting pro-
grams, incest groups, assertiveness training groups, the
clergy, peer networks, alcohol and substance abuse groups,
leisure activity groups, tutorial groups, and 24-hour hot-
lines.
We believe that providing support for MPD moth-
ers and their partners through groups in which the par-
ticipants share similar situations can increase the poten-
tial for healthy child-rearing (Benjamin Benjamin,
1992, I994a, 1994b, 1994c, 1994d, in press). Other sup-
ports may include community and religious organiza-
tions, co-worker support through employment, and sup-
ports that provide direct care to children such as daycare
and nursery programs.
CLINICAL IMPLICATIONS
Based on our review of the literature on parenting from
the perspectives of psychodynamics, attachment, child devel-
opment, and family systems, we believe that an emphasis on
parenting is a key element of the treatment of dissociative
disorders. While traditionally individual psychodynamic psy-
chotherapy facilitated by hypnosis is considered to be the
treatment of choice, child and marital interventions are gain-
ing wider acceptance. We believe that interventions in the
parenting subsystem have been underutilized. They have
the potential to increase optimal development for children,
to facilitate the individual treatment of the MPD client, to
strengthen the therapeutic alliance, and to stem the inter-
generational transmission of child abuse.
Benefitsfrom the Psychodynamic Perspective
Clients who were repeatedly traumatized while growing
up often have difficulty trusting the therapist and the ther-
apeutic process. Attending to a client relationship with her
children is less threatening than dealing with transference
phenomena or making interpretations. The therapist s
empathy for both the client and her children demonstrates
early on that the therapeutic context is a safe one. As a trust-
worthy therapeutic relationship builds, the client indirect-
ly works on developmental issues that are stirred up as she
examines her own parenting.
When a therapist pays attention to a client-parent par-
enting and helps the client feel more positive about moth-
ering, the client is then free to introject and identify with
the gratifying experience. Through this process, she may
feel more self-confident about her own ability to mother.
Psychodynamic thinkers alsoviewparenthood as an oppor-
tunity to rework childhood experiences and relationships
with one parents. Remembering the past (and especially
the affect involved in past events) is helpful in the develop-
ment of parental empathy. As empathy takes on a central
role in the parent relationship with her child, the parent
is free to undertake the transformation of her own narcis-
sistic tendencies into a new spiral of developing maturity.
She can then begin to apply the same empathic processes
in dealing with her own internal parts. In describing the
therapist-client interaction, Kluft has wisely remarked in meet-
ings of the Philadelphia Study Group (November 8, 1993
and other occasions) that "MPD is that mental disorder that
dissolves in empathy." In a parallel process, the client can
use this model to deal more empathically with a child as well
as with the alters in the intrapsychic system.
Moreover, a resolution of childhood conflicts may facil-
itate the dissolution of boundaries among alters and thus
aid ultimately in the path toward integration. It also has the
potential to continue personality development through the
formation of a healthier "parental self." This new image of
herself as a competent parent may result in enhanced self-
esteem for the client and thus further the process of heal-
ing and integration.
Benefits from the Attachment Perspective
Mothers with MPD are handicapped in their ability to
promote secure attachments in their children. Their symp-
toms have the effect of keeping them emotionally or physi-
cally unavailable and/or of frightening or confusing their
253
DISSOCIATION. Vol. VII. No.4, December 1994
PERSPECTIVES ON PARENTING
children. Certainly, parenting interventions, if they help par-
ents understand attachment patterns and educate them to
promote secure attachments in their own children, have the
potential to stem the intergenerational transmission of an
insecure attachment, if not a dissociative disorder. Liotti (1992)
suggested that dissociative disorders could be prevented by
providing "specifically tailored counseling services...to par-
ents who are suffering from serious losses or other unre-
solved traumas while taking care of their infant children"
(p. 202).
Additionally, Barach (1991) discussed how the dissociative
client reenacts early attachment patterns within the thera-
peutic relationship. It makes sense, therefore, that the ther-
apist-client relationship is a powerful resource for impart-
ing the sense of a "secure base" to a client. The therapeutic
context can provide an isomorphic bridge from therapy to
the parent-child interaction.
Finally, in view of Rutter (1974) position that the main
attachment figure need not be the mother alone, ways should
be found to promote other sources of attachment. These
attachment figures might include the non-dissociative part-
ner if he or she is sufficiently healthy, or other substitute
parental figures from within or outside of the family.
Benefits from an Infant Developmental Perspective
Dissociative disorders impede a parent ability to sen-
sitively tune in to the fine variations of a baby behaviors
and affects. While a miserable baby can distress any parent,
a dissociative parent is at a distinct disadvantage because the
parent own ability to self-regulate is so tenuous.
Therapists can invite client-parents to bring infants to
therapy so that they can observe the parent infant interac-
tion. Because client-parents often do not have "Representations
of Interactions that have been Generalized" (Stern, 1985)
of loving transactions between their own parents and them-
selves, they may benefit by watching the therapist interact
with the baby. The therapist can also encourage the par-
enting partner to become " a self-regulating other" for the
baby.
Benefits from an Affect Theory Perspective
Parents with MPD often either may have too little affect,
too much affect, or affect that is mismatched with that of
their child. Reducing negative affect is a first priority.
Therapists can help parents examine unrealistic expecta-
tions and attributions that they have of their children. In
the process, the client can get in touch with the unrealistic
expectations and attributions that had been directed at her
when she was growing up. That understanding can help the
client-parent focus less on self-needs and more on the needs
of the child. In the case of an overintrusive or overprotec-
tive parent, the therapist can help the parent to understand
the origin of the over-intrusiveness/over-protectiveness, the
effects on the parent, and the potential effects on the par-
ent-child relationship. If the therapist helps the client-par-
ent feel more competent in parenting, the parent may expe-
rience pleasure in parenting, thereby increasing her positive
affect.
254
When the therapist works with both the marital and
parental subsystems to increase mutual supportand to help
each parent find ways outside of therapy to garner support,
positive affect may increase. Practical steps to better man-
age stress may also help to decrease negative affect.
The therapists own modulation of affect with the client
is, in fact, one of the most powerful interventions to influ-
ence the affect of the dissociative client. Affective matching
is key to the client-parent learning. With the client and her
children together in the session, the therapist can model
affect tolerance, modulation, and matching in ways that can
be instructive to the client.
Benefits from a Family Systems Perspective
Obviously, an MPD parent does not have a well integrated
sense of self, and frequently, the partner also has an impaired
sense of self (Putnam, 1989; Benjamin Benjamin, 1994d).
The potential to triangulate a child into the marital rela-
tionship is great. Additionally, hostile parents can thrust a
child into the predicament of having a split loyalty.
Consequently, interventions in the marital dyad are impor-
tant to tighten up generational boundaries and to resolve
marital conflicts. Helping the parents to operate as a par-
enting team is crucial. The importance of the participation
of the other partner cannot be overstated.
MPD parents often parentify or exploit their children
because of destructive entitlement. Sensitizing them to the
pernicious effects of their own childhood parentification
and victimization can help them to appreciate that they have
to take responsibility to not parentify or victimize their own
children. If a parent is accountable to her children and she
removes the burden of unfair treatment, she herself earns
constructive entitlement or ethical credit (Boszormenyi-Nagy
Ulrich, 1981; Boszormenyi-Nagy Krasner, 1986;
Boszormenyi-Nagy, Grunebaum, Ulrich, 1991; Benjamin
Benjamin, 1992) . Such a stance empowers the parent because
she is effecting positive change for future generations.
Contextual therapists (Boszormenyi-Nagy Ulrich,
1981; Boszormenyi-Nagy Krasner, 1986; Boszormenyi-Nagy,
Grunebaum, Ulrich, 1991) also emphasize that it is impor-
tant for parents to encourage and validate children for con-
tributing to the family in age-appropriate ways. Blocking chil-
dren from giving can be just as destructive to children sense
of self-worth as forcing them to overgive through parentifi-
cation. This kind of sensitivity to the ethical needs of chil-
dren serves to build trust in the parent-child relationship.
From a therapeutic perspective, working in the parental
subsystem gives the therapist additional leverage toward
change. Boszormenyi-Nagy and colleagues (1981; 1991)
stressed that this leverage is in the ethical realm. Parents are
often motivated to makes changes in their lives because they
feel accountable to their children. Including the children
infamilysessions, encouraging acknowledgement of the chil-
dren s contributions to the family, and helping the parents
explore how their relationship affects the children begin to
deparentify the offspring.
DISSOCttTION, Vol. 11, No. 4. December 1994
BENJAMIN/BENJAMIN
CONCLUSION
In this article, we have attempted to understand par-
enting by reviewing several important theoretical perspec-
tives. We have then utilized these various perspectives to
sharpen our appreciation of how dissociative symptoms inter-
fere with parenting. Finally, we have considered the clinical
implications for the treatment of dissociative disorders
raised by these theoretical points of view. However, we rec-
ognize that our conclusions are derived from theory and are
untested by objective research. Empirical studies are neces-
sary to test the relevance and validity of these concepts. 
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