NORMAL AND
PATHOLOGICAL
DISSOCIATIONS
OF EARLY
CHILDHOOD
Theresa K . Albini, M.S.W.,
A.C.S.W., L.C.S.W.
Terri E . Pease . Ph.D. (cand .)
Theresa K . Albini, M .S.W., A .C .S.W., L .C.S.W. is in private
practice in Chicago, Illinois . Terri E . Pease, Ph .D. (cand .) is
a doctoral candidate in child and family psychopathology at
Cornell University and a professor in the Division of Psychol-
ogy and Counseling at Governors State University, Univer-
sity Park, Illinois.
For reprints write : Theresa K . Albini, M .S.W., L.C .S.W., 300
N . State Street, Suite 3707, Chicago, Illinois 60610.
An earlier version of this paper was presented to the Second
International Conference on Multiple Personality/Disso-
ciative States, Chicago, Illinois, 1985.
This work was completed in part when Ms . Albini was
affiliated with The Institute of Juvenile Research and the
Department of Child Psychiatry, University of Illinois at
Chicago.
ABSTRACT
The authors hypothesize that multiple personality disorder is related
to the processes that lead to the formation in children of a distinct and
cohesive self. Three clinical propositions concerning MPD derived
from this hypothesis are : first, multiple personality disorder should be
seen as a childhood disorder,  second, cohesion of the self is best
understood as a developmental achievement mediated by specific
experiences in the early years of ; third, some dissociative disorders,
including multiple personality disorder, are survivals of an earlier
personality organization in which distinct centers of experience and
initiative existed within a single individual.
NORMAL AND PATHOLOGICAL DISSOCIATIONS
OF EARLY CHILDHOOD
The problem of multiple personality disorder (MPD)
has generated much controversy and enthusiasm in recent
years . This phenomenon of distinct identities possessing
most of the behavioral and psychological characteristics of
"separate persons " in a single body is a fascinating one.
Those affected exhibit discontinuous behavior, emotion,
and identity, features which are often part of the typical
developmental presentation of young children . It is not
known if all children have dissociative-like states . Dissocia-
tive potential has been cited as being biologically deter-
mined (Braun & Sachs 1985, p . 43) . The following is a
developmental focus upon premorbid factors which may
144
correlate with dissociation . Comparisons of normal children
with very young victims of severe abuse lead us to suspect that
the momentary establishment of centers of experience ex-
ternal to the core self during transient hypnotic-like states
may be typical in young children . Such episodes may com-
prise a normal developmental analogue to the dissociative
phenomena characteristic of MPD, such as described by
Kluft (1984a) as Factor I (in the Four Factor Theory of the
etiology of MPD), the capacity to dissociate . The theoretical
underpinnings of the ideas about childhood development
presented in this paper rely heavily on some major tenets of
the psychology of the self as formulated by Heinz Kohut
(1971, 1977, 1984) and expanded upon by his followers.
Although Kohut 's salient concepts of the "cohesive self' and
the "vertical split " (disavowal) have been described by previ-
ous authors who have contributed to the MPD literature
(Berman, 1981 ; Gruenewald, 1977 ; Greaves, 1980), their
theses predated the later expansion of his findings and his
models . By 1977 Kohut's theory of the development of the
self encircled and transcended Freud's instinct theory.
Narcissism, instead of being relegated to a stage of early
development, was described as having its own developmen-
tal line, paralleling the developmental line of object rela-
tions . Thus, pregenital as well as Oedipal pathology could be
understood as disorders of the self (Kohut & Wolf, 1978).
Therefore, a brief overview and definitions of the key terms
utilized in this paper will be presented in order to provide a
frame of reference.
Kohut describes " . . . the growth of the self experience
as a physical and mental unit which has cohesiveness in space
and continuity in time " (1971, p . 118) . Elsewhere he ob-
serves:
. . . the developmental path of the experience of his (i .e .,
the child's) self is separate from that followed by his ex-
perience of the single body parts and single bodily and
mental functions . . . .the child's experience of his body
parts and of their functions and of his various mental
activities has its own line of development ; that this devel-
opment leads toward the increasing neutralization of
these experiences, toward the increasing recognition of
the spatial interrelatedness of various body parts and of
the cooperation of their various functions . (Kohut,
1978, pp . 748-749)
Kohut (1978) states that the stage of the cohesive self " . . .
begins at the point when the (separately developing) self has
DISSOCIATION . Vol. 11, \o :September 1989
+1 I
become strong enough to gain ascendency over the experi-
ential world of the body-mind parts" (pp, 747-48, f .n . 3).
The above is especially relevant when we consider the
infant and/or toddler 's subjective experiences of any inap-
propriate or brutal physical intrusions by their caretakers.
Muslin (1981) states:
. . . the self refers to a specific content of mental appar-
atus, a cohesive configuration of the mind which con-
tains the collection of percepts of one's body and
mind . It is most importantly understood as the individ-
ual's experience of a unified assortment of features of
his body and mind at any one time . While there are
several selves, there is only one that is experienced as
basic and resistant to change . Kohut terms it the
`nuclear self .' This self contains the central, self-
assertive goals and purposes of the individual, as well
as his talents and skills (p . 9).
Kohut (1971, 1977} states that barring inherited factors,
the nascent self comes into being with the capacity for
achieving cohesion . He refers to self-object functions as the
"psychological oxygen" needed to realize this capacity, just
as well formed lungs require oxygen to achieve their life
sustaining capacity . The major danger to the vulnerable self
is disintegration (loss of cohesion), signaled by disintegra-
tion anxiety which includes fragmentation, serious enfee-
blement, or uncontrollable rage . Kohut (1977) describes
fragmentation as " . . . the (child's) estrangement from his
body and mind in space, the breakup of the sense of his
continuity in time" (p .105) . Self-object functions are divided
into three basic forms : mirroring, twinship (a specific kind
of mirroring) and idealizing . Mirroring consists of empathic
admiration, approval, echoing the unfolding self, and thus
offering the child in developmentally age-appropriate and
phase-specific ways confirmation of the child's overall worth,
and appreciation of his talents and skills . Twinship consists
of the confirmation of the self s need to experience the
presence of essential alikeness with others . The idealizing
self-object functions are those of calming, soothing, tension
regulation, protection and guidance . Optimal self-objects
are empathically attuned with the subtle and gradually
changing self-object needs of the self moving along its
developmental lines . Since the infant and preoedipal child
does not really experience these functions .as distinct from
his own self, he does not perceive the provider of the
functions as a discrete object but as a so called "self-object ."
There is an infinite diversity of self-object experiences from
all phases of the life cycle . Kohut (1984) proposes we never
outgrow our need for self-objects ; rather the self-object
functions are gradually transformed from archaic to mature
forms through the process of transmuting internalizations.
Kohut and Wolf (1978) state that the nuclear self crystallizes
as a result of this process of intrapsychic structuralization.
Gedo and Goldberg (1973) state:
It should be emphasized that cognitive differentiation
between the self and an object in the external world is
achieved much earlier, usually before the end of the first
year of life ; . . .Long after the achievement of this
cognitive distinction, the child continues to utilize the
object as part of his narcissistic world (p . 61).
Tolpin (1978) observes that " . . . structural deficits occur
when the child's self-objects fail to meet normal endowment
half-way and do not provide the indispensable transitional
precursors of psychic structures which gradually undergo
internalization and effectively maintain the vitality, initia-
tive, and self-esteem of a cohesive self ' (p .172) . Muslin and
Val (1987) describe self/self-objects by saying, "These early
relationships are experienced as fusions or mergers, i .e ..,
immersions (psychologically speaking) into the body and
mind of the caretaking self-object" (p .27).
Tolpin (1978) points out how " . . . Mahler et al .'s (1975)
theory of a decisive, pathogenic 'rapproachment conflict'
. . and Kernberg's (1975) theory of pathological idealizes
tion, . . . grandiosity, and archaic conflicts misunderstand
transference revivals of legitimate developmental needs
toward their legitimate self-objects" (p .180) . She goes on to
say:
This "change of emphasis, " and the shift in point of view
from conflict to structural development have been made
possible by the discovery of the missing piece of the
childhood psychic reality of an expectable environment
and its indispensable psychological functions - a
prestructural self-object "environment" which for all
practical purposes is indistinguishable from the child's
own mental organization and his cohesiveness or lack
thereof . The concept of self-object as the precursor of
psychic structure is the indispensable theoretical bridge
which now links the most important contributions of
psychoanalytic developmental psychology to a theory
which is consistent with the child's need for structure,
his normal and abnormal structural development, and
to a theory of analytic treatment which actually fosters a
needed process of further structural growth . (Tolpin,
1978, p . 181)
We propose that in traumatized young children, prior to
the formation of a nuclear self, whose environments provide
inadequate soothing (where Kluft's [1984a] Factors II,
overwhelming stimuli, and IV, inadequate stimulus barriers,
are present) a few self nuclei vertically split off from (dis-
avowed) the core self may be used and reused, because their
capacity to support self soothing is superior to any other
available to the child and is the child's only alternative to its
traumatic true environment, (Kluft's [1984a] Factor III,
shaping influences) . It may be that it is not solely the capacity
to form these external condensation points that distin-
guishes MPD children from normals, but the persistence of
such external nuclei and the firmness of the vertical-split
barrier that separates them from the center nucleus and
prevents their becoming integrated into the core of the
child's self . Thus, varied aspects of the self co-exist without
integration.
Two cases of probable MPD-like phenomena in very
young children in treatment are presented, and contrasted
145
DISSOCIATION, Vol . 3: September 1989
with similar but non-trauma-based self soothing dissocia-
tions in children of similar ages.
CASE ILLUSTRATION ONE
The child, Pam, was a 4 year old girl whom the therapist
had seen in weekly psychotherapy since the age of 2 years
and 9 months when she was first referred for evaluation of
her developmental status . She told the therapist about a
monster to whom she gave the name of a popular TV figure,
who comes into her room and scares her and bites her . This
child had first been referred for multiple fractures on x-ray
before 6 months of age . There were also several opportuni-
ties for retraumatization of this child . In the course of her
treatment there was working through of much of her fear of
injury, her tendency to be afraid to he alone, and her
difficulties with repeated traumas related to indecision on
the part of systems involved in deciding her ultimate cus-
tody .
There had been one early hint of distinct selves crystal-
lizing in this child . In an earlier session she had emphatically
denied (while cutting up a lump of play dough into several
identical-sized pieces - an important activity) that she was
not Pam but was Karen, giving the name of a baby of her
acquaintance.
In the period between her fourth and fifth birthdays,
much of the clinical material had to do with playing that we
were throwing things out of the window . This seemed to be
the child 's attempt at mastery over her traumatic experi-
ences . In fact, we did throw out toys and run outside to get
them and soothe them and make sure they were all right.
Over time, the play had moved from throwing inanimate
objects like paintbrushes, to throwing baby dolls . She then
engaged the therapist in throwing the baby doll from one to
the other on a staircase, with first Pam and then the therapist
soothing the baby, asking her if she was all right and comfort-
ing her.
In later sessions Pam began to use make-up and paint to
paint her face and that of the therapist . In these sessions she
would become very distressed and would use dark, thick
make-up or watercolor paints to paint her own face and
hands, and the therapist's and those of her foster mother, in
an urgent attempt to communicate something . These ses-
sions were frightening for her and for the therapist . What
had been comfortable, related, engaged treatment sessions
with a child who seemed to be maturing well and to be
functioning well in kindergarten, family and church school,
had turned into tense, anxiety ridden hours with a child who
seemed compulsively to paint her face, to stand with the
therapist in front of a mirror to deny that she was herself, and
seem to beg to have words said that would help to make sense
of what she was experiencing internally.
Other examples suggest that this child was forming
distinct selves that could evolve into MPD phenomena . On
one occasion an adult acquaintance saw the child "change
into another person ." Pam was visiting in the neighbor's
home when the adult asked her to wait in one room while she
put the baby to bed . The woman stated that when she did this
she looked at the child who seemed to have changed . The
146
adult described it as making the hair on the back of her neck
stand on end . The look, she said, was one of rage and hatred.
The adult was stirred up enough to call attention to this
event to Pam's foster mother and to ask to have the therapist
explain what had happened . The therapist saw a similar
event when the little girl turned into a "scary bear"- roaring
and for all the world truly a frightening beast and not the
child the therapist knew, totally unable to respond to the
attention or intrusion of anyone . The therapist spoke to the
child inside the bear, using her name, to recall her to herself.
CASE ILLUSTRATION TWO
A contrast to this case example is one of a child abused
in similarly intense ways at a similarly young age, but for
whom consistent empathic mothering, separation from the
abuser, and early identification and treatment seemed to
have led to a more favorable outcome.
This child is the offspring of a mother who qualifies on
level 3, highly probably evidence of DISS/MPD (dissocia-
tion/multiple personality disorder) according to Braun's
(1985) rating system for diagnostic certainty . His maternal
grandfather and one maternal aunt also qualify for level 3.
Two other aunts qualify for level 4, confirmed evidence of
DISS/MPD . Three of the adults in this child's life entered
treatment with the authors following the termination of the
child's therapy.
This child was brought for treatment by a mother who
was desperately looking for someone who would believe that
there was something seriously wrong with her two year old
son, for whom she sought assessment and treatment . She
reported that he cried unconsolably at diapering, that he
manipulated his own genitals and his nipples, and attempted
to stimulate himself on his mother's body, subsequent to
visits to the home of the presumed abuser . He was terrified
of bathing, had severe prolonged and frequent night terrors
and was an unhappy, poorly functioning little boy.
His mother reported trance-like phenomena at age two
and again later at age four after an interruption in the
treatment . During these events he would awaken terrified,
crying, talking, and not responding to his name or to
attempts to awaken him . He would cry for his mother as
though she were not there, even as she was holding him . He
would not remember any of these events in the morning, or
would attempt to divert her attention from discussing them.
He had further been reported to enter fugue-like states
between ages three and four in which he would attempt to
touch his mother's breasts and say things like, "I has to do it,
I has to do it ."
When the therapist first saw him in treatment at the age
of two he presented as a tense, precocious, verbal, pseudo-
mature boy with tremendous fears of broken toys, fear of
playdough (which he called "soap - I don't like soap") and
concern about mildly phallic toys . Of a Mighty Mouse doll he
asked, "Why does it have a tail, why does it have a black tail?
I hope it won't hurt me ." He was also concerned about
"fooling around" and said that he hoped the elephant's
trunk could help to fix things . He stimulated himself on the
corner of a low table as he talked about the tail and showed
DISSOCIATION, Vol, II, No . 3:September 1989
111ill II Jeff:
in many ways that will not be detailed here the clearest
evidence of sexual abuse of a very young child that the
therapist had seen . After three years of therapy and suppor-
tive advice to his already empathically attuned mother, this
child was able to achieve cohesion . He exhibited a healthy
sense of assertiveness and the process of internalizing ten-
sion regulating functions had begun.
MPD AS A DISORDER ROOTED IN CHILDHOOD
Multiple personality disorder is primarily a disorder of
childhood, although it is one with long-term developmental
implications . Greaves (1980) in his review of the literature
on MPD pointed out that "altered selves usually first manifest
themselves in early childhood, as early as 2-1/2, and typically
by age 6 or 8" (p . 587) . Fagan and McMahon (1984) con-
cluded that " . . . multiplicity is established by 5 years or 8 at
the latest ; yet it is almost never diagnosed before adulthood"
(p . 26) . This suggests that it is useful to look at the adult
manifestations . of MPD as survivals or long term conse-
quences of a process that begins in childhood . This needs to
be understood in the light of such phenomena as they
present in childhood.
Ulman and Brothers (1988) expanded the principles of
self psychology to include an understanding of trauma . They
contend that trauma results from real occurrences that have,
as their unconscious meaning, the shattering and faulty
restoration of "central organizing fantasies" of self in rela-
tion to self-object . It is the shattering and faulty restoration
of such archaic fantasies that are symptomatically mani-
fested by dissociative phenomena . They found that these
fantasies had undergone relatively little developmental trans-
formation, which made the victims vulnerable to repeated
shattering . Thus, the event itself does not hold the key to
understanding the psychological meaning for the child
experiencing it . They give examples of the lengths to which
survivors of incest go to defend and compensate in order to
restore their shattered fantasies . For example, a daughter's
grandiose exhibitionism is fostered by early intrusions of
incest by her father . Her fantasies were shattered by his
brutal violence, which destroyed her illusions of becoming
a famous performer . Efforts at defensive restoration were
her illusions of having a powerful impact on the world while
turning her father into an "evil genius" served as a compen-
satory restoration . Her dual personality was explained as an
unconscious effort, although maladaptive, to restore her
shattered fantasies (p . 111).
The tendency to approach MPD as a pathology of
adulthood, and to search for comparisons between inte-
grated adults and MPD adults risks having us miss the more
important comparison between children who do become
MPD in adulthood and those who do not . When we look at
adult MPDs we tend primarily to contrast them with inte-
grated or non-split adults and to seek the explanation for the
disorder in differences between them . When we look at MPD
as a disorder of childhood, the primary contrast is drawn
with children in whom the process of integration has not
been arrested.
Adult MPD patients are not pure examples of the pathol-
ogy underlying this disorder . The clinical picture in adult
cases involves a great deal of secondary elaboration and
alteration over time of the initial pathology (Kluft, 1985).
Thus the study of adult multiples is limited as a pathway to
discovering the fundamental process that goes into making
up this disorder . In observing adult patients we do not see
what MPD looks like in its purest form.
In contrasting our clinical experience in the treatment
of children with that of the retrospective data collected in
the treatment of adult MPD patients we have noted that the
emotional states of children as they are experienced in
childhood are not always perfectly preserved in memory into
adulthood . However, the presence of a child alter in an adult
patient is so striking that it may lead us to believe that we are
hearing from the real child . Thus we tend to overlook some
significant differences between real children and the child-
in-the-multiple . Also, the real child's external world is sur-
rounded by self-objects the child can appropriately depend
upon to provide the psychological functions necessary for
internal structure building . In contrast, the child-in-the-
multiple was created and maintained internally as a restora-
tive measure, to provide a function within the internal
system to cope with both the external and internal worlds.
It is also important to the understanding of MPD that we
learn how young children who will grow up to be MPD adults
differ from those who will not . We need to learn at what point
these groups diverge, and what the factors are that influence
this divergence . Noting how MPD children differ from non-
MPD children should be more fruitful than comparing
adults with MPD to integrated adults.
Kluft's (1984a) Four Factor Theory provides some help
in this process by identifying the retrospectively described
experiences that accompanied the memory of the splitting.
We have found that these same factors, viewed prospectively,
lead to a reorientation in the interpretation to be placed on
these factors and on the treatment implications, especially
the implications for the treatment of children.
COHESION AS A DEVELOPMENTAL ACHIEVEMENT
Kluft's (1984a) Factor I, capacity to dissociate, and our
experience of treating very young children, suggests that
unity of the self through time and space is a developmental
achievement that reflects specific child-adult interactions
subjectively experienced by the child prior to the formation
of the nuclear self . The states of non-association and the
distinct centers of experience that, in adult multiples con-
trast sharply with integrated adults, are familiar and phase
appropriate in young children . Gedo and Goldberg (1973)
alluded to this by saying, "The utilization of the construct
`self' has been hampered . . . by the inherent difficulty of
grasping the subtle idea that the organization of the person-
ality as a whole maybe an important developmental achieve-
ment of early childhood but also by the semantic problems
created by attempts to superimpose this concept on the
tripartite model of the mind . . ." (p . 64) . From our experi-
ence with young children in treatment, as well as preschool
children and toddlers in other settings, it seems clear that
the state of cohesion that we take for granted in normal
147
DISSOCIATION, Vol. II, No . 3 : September 1989
children after the age of six and into adulthood is an
important achievement, arrived at only after specific kinds
of experiences in the first three to five years of life.
It may not be possible to find a place for the self within
the scheme of the ego since ego is a concept at a diff-
erent level of abstraction, referring to a narrower seg-
ment of behavior and cogent with regard to behaviors
that do not begin operation until long after the unifica-
tion of the self . . . . If we apply the clinical discoveries of
Kohut . . . to an expansion of developmental psychology,
we may conclude that the phase of self-cohesion must be
preceded by one in which aspects of the self are not yet
unified . We believe that Freud was alluding to this state
of organization when he postulated a phase of `separate
instinctual activity,' or autoeroticism (1911) . (Gedo &
Goldberg, 1973, pp . 64-65)
Taking this into consideration, Gedo and Goldberg
underscore the utility of Glover's conception of "separate
ego nuclei" (1932, 1943) in the early phase of psychic life.
Based on the previously mentioned distinction between the
constructs "self" vs . "ego," Gedo and Goldberg modify
Glover's designation to "nuclei of the self ."
When we think developmentally and look to child pa-
tients and their experiences in a developmentally phase
specific way, we see the early MPD phenomena as being not
so much a dissociative but a pre-associative disorder . In saying
pre-associative, we refer to an early period (birth to 6-8 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 complexity 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 nas-
cent selves or separate centers of experience.
It is our view that the phase appropriate existence of
separate nuclei around which self-experiences can con-
dense is more common than not in developing children . We
hypothesize that split-off sectors of self nuclei seen in incipi-
ent cases of MPD are related to a normal developmental
analogue that precedes the establishment of the cohesive
nuclear self.
MPD AS PHASE INAPPROPRIATE SURVIVALS
The third proposition is that incipient MPD and later
periods of initial splitting, as well as some dissociative phe-
nomena in adulthood are not primarily examples of coming
apart (dissociation) but are phase inappropriate survivals of
what were once phase appropriate and distinct centers of ex-
perience and initiative . One hypothesis is that the adults in
the world of the child who is to become a dissociator or
classical MPD adult have not provided the integrating,
consistent experiences over time and space that permit,
148
induce, and maintain cohesion.
Every child requires consistent experiences of soothing
of distress, confirmation of states of being, affirmation of
achievements, pleasure and mastery in close enough prox-
imity over time, space, and person to establish a unified
experience of self . The absence of that cohesion in the pre-
MPD child points not to a primarily cognitive event, but an
internal, nonverbal, experience-near-event . Children do
not come to know that they are a single person because they
have been told this, nor do they know this automatically.
They know it because they subjectively experience it with
consistency over time and space by the psychological func-
tions provided by adequate parenting.
One brief clinical vignette illustrates the adult's acting
in ways that enhance the child's sense of himself as being
always the same person . The occasion was of a transient
regression by a five year old boy, Sam, who had been left in
another therapist's office in an agency by his mother while
she went to spend an hour with her therapist . Sam "fell
apart" in the way of an abandoned 8 or 10 month old infant
- he cried, tried to pursue mother, finally fell on the floor
oblivious to the other therapist's presence or that of other
people . He followed mother as she went up the stairs and sat
on the floor near the locked door of the office where she met
with her therapist . Sam cried and screamed, and was com-
pletely unable to tolerate the separation.
What was striking about his behavior was that although
Sam knew the other therapist, he was not able to attend to
her presence in any way- he was in a trance-like state of rage
and terror . The therapist sat on the floor with him and talked
to him, without much success . The fragmentation state went
on for at least twenty minutes . He began to integrate only
when the therapist was able to catch something he was
saying, to repeat his words, and then to remind him of his
name, of what he wanted (his Mommy) and that he was still
the same boy . What seemed to help him most to calm down
and to become reintegrated was her saying the following
words : " . . . And you're still the same Sam whose Mommy
sings and plays this little piggy goes to market, this little piggy
stays home and she touches your other toe and says this little
piggy had roast beef . . . and the same Sam who misses his
Daddy ." The feeling, in doing this work, was that of gather-
ing together pieces of the child's self from various places,
pointing them out to the child and weaving them together
into a whole child . It seems that successively inducing his
distinct experiences of "self-hood" at moments close to-
gether in time and space helped re-integrate this boy.
Games like This Little Piggy and peek-a-boo are much
enjoyed and developmentally important family play with
infants and in the child therapists ' clinical repertoire . They
set up "slight fragmentation fears" for the child which allow
him/her to test the as yet incompletely coalesced self in the
safety of a loving/caring other, such that mastery of the
fragmentation state can be achieved . This process occurs in
normal child development routinely, although its impor-
tance is often recognized only in cases where the self-object
functions have been inadequate or absent (Kohut, 1971,
1978).
The non-integrated state of having distinct nuclei of
DISSOCIATION, Vol. [I . N . 3; September 1989
ALBI
 
' * it
association is the typical state of the young child
nurturing missing when Kluft's (1984a) Factor IV (inade-
quate stimulus barriers) is present, that is the presence of a
consistently empathically attuned adult providing self-ob-
ject calming and protective functions, is the kind of parent-
ing that all children require. Thus we ask not only why does
the child dissociate, but what leads to the inhibition of the
process of cohesion and the persistence and firmness of the
split. This is an important difference.
In Klufts (1984a) formulation, Factor III refers to shap-
ing influences. These act to determine the form, character-
istics and firmness of the isolated self fragments that persist
and may even predominate in the patients we are discussing
here . These shaping influences are important since they
may determine how effectively a particular self fragment
may substitute for the missing self-object functions (Factor
IV). Kohut's (1971, 1977, 1984) "twinship" and "alterego"
self-object concepts may be useful in understanding and
distinguishing the role of "imaginary companion" phenom-
ena in the developing self's manifestations of both pre-
association and dissociation.
Details of a particular event that may have been momen-
tarily soothing protecting, or mirroring, and that may have
momentarily dispelled the effects of a trauma, can be pre-
served as characteristic of a self fragment. The momentarily
protective influences are probably occasional or fleeting.
Thus while effective to help the child retreat from the
trauma (dissociate from bodily and psychic pain), they do
not serve to enhance cohesion because they do not recur in
times, places or with persons who are associated with other
aspects of the child's life . Instead, their very effectiveness
helps to reinforce the barrier between dissociated states and
to ensure the persistence as the nuclei of independent self
fragments. Thus a TV character who is associated with
specific emotions or stereotyped ways ways of solving prob-
lems may become the nucleus of a set of experiences that are
markedly different from the helplessness of a traumatic
sexual intrusion by an adult. When they work really well or
when they contrast sharply with the severity of prior trauma,
these isolated soothing events are reinforced and the barri-
ers that isolate them from the traumatic experiences are
firmed up . In the case of Pam (discussed above), a salient
feature of the therapist was recreated and existed in isolation
from Pam's most common experience of herself.
These issues lead us to conclude that in addition to
physiological components, MPD in early childhood results
from a primary failure of cohesion prior to the establishment
of the nuclear self. We may speculate that different degrees
of dissociative disorders may be distinguished in terms of the
degree to which cohesion had been attempted or achieved
or experienced in rudimentary form in the young person
before the overwhelming trauma.
TREATMENT IMPLICATIONS
While our focus here is not primarily on treatment
issues, there is one important caution that should be made.
The looser cohesion of young children is an important asset
in childhood and not a sign of pathology
and vulnerability to fragmentation that characterizes young
children form an important avenue through which the child
is able to turn to adults for self-object functions which will lay
down profound supplies of self esteem, self-soothing, ambi-
tion, values, internal warmth, empathy, vigor and organiza-
tion which are the stuff of deeper and healthier adulthood
functioning. When we take an adult-oriented approach to
conducting child therapy, we are at risk for setting overly
modest treatment goals.
It is apparently possible to effect rapid and relatively
lasting fusions in pre-associated children. If, as we suggest,
these non-associative states are normal and transient in the
presence of soothing adults (self-objects) then massive inter-
vention specifically designed to reintegrate a split may be
misplaced. It seems very possible that the young child who
seems to have split will be able to make use of the availability
of the self-object functions provided by the therapist to effect
phase appropriate integration of the split off sectors of the
self without the intrusions occasioned by hypnosis or more
massive strategies
to allow the natural, more gradual establishment of cohe-
sion to unfold rather than to bypass the normally looser self-
cohesion of the preschool and young latency child in favor
of a prematurely cohesive but emptier child.
CONCLUDING OBSERVATIONS
The hypotheses underlying this paper's explorations
and reasoning represent a particular paradigm for the under-
standing of mental functioning, growth, and development.
We appreciate that many alternative paradigms for the
explanation of the phenomena we have discussed have been
offered, and have been described astutely and eloquently. It
has been our goal here to bring the perspectives of modern
self-psychology to bear on the understanding of dissociative
processes and dissociative psychopathologies, with the hopes
that the application of this paradigm can further enrich the
study of dissociation and the dissociative disorders a73
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