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In dissociative states or experiences, people can feel detached from reality, themselves, others, and their own emotions (Busch et al., 2021). Dissociation can involve a disruption in the integration of behaviors, thoughts, consciousness, feelings, memories, and/or identity. Severe trauma is a common source of dissociative states, as it can cause memory impairments, intolerable emotions, and bodily distress (Lazarov et al., 2017). People often don’t recognize the links between dissociative states and the trauma they experienced, sometimes because these connections were never formed. Alternatively, dissociative states can act as a defense, warding off the connection to distressing memories, fantasies, feelings, and bodily experiences associated with trauma.
Trauma can also cause fragmentation of identity, including aspects of one’s own self (Bromberg, 1998; Nijenhuis et al., 2010), out of one’s awareness. How might we understand what becomes dissociated in these circumstances? As we grow up, we develop models of ourselves and others, which stem particularly from experiences with caregivers (Bowlby, 1973). These models include self-assessments, accompanying emotions, and expected responses from others (Luborsky, 1984), all of which affect our personality, relationships, and potential psychological difficulties (Dutra et al., 2019). When dissociation occurs, individuals in one mode of representation of self and others are unaware of the other mode, disrupting efforts at integration. This dissociation, although not as severe as found in dissociative identity disorder (American Psychiatric Association, 2022), can have a profound impact on one’s thoughts, emotions, behaviors, and relationships (Schimmenti & Caretti, 2016).
An example of dissociated representations of self and others can stem from an intense need to connect with abusive caregivers, who may be controlling, critical, neglectful, or rejecting (Busch, 2024). Individuals experiencing such childhood maltreatment on the one hand feel pressured to yield to caregivers’ expectations to avoid attack or abandonment and on the other hand feel enraged (consciously or unconsciously) at their caregivers. Such feelings can trigger the development of what was described by the analyst Donald Winnicott as a “false self” (Winnicott, 1960), submitting to others’ expectations, alongside a self that rebels against these demands, and individuals remain unaware of shifts from one state to another. These dissociated representations frequently prevent individuals from recognizing the adverse impact of their angry or rebellious behavior.
One example was a patient who used drugs as a form of rebellion, not recognizing the adverse impact on his health; when the drugs wore off, he switched from rebellion to guilt and shame about having used the drugs, along with expectations of punishment. Another pattern was shown by a patient (described in more detail below) who was highly fearful and avoidant of expressing his needs to others, and at other times enraged about feeling deprived or exploited. In each case, they were not aware of these shifts and were not accessing the alternate set of self and other representations.
Jason, a 42-year-old computer programmer who sought treatment for longstanding anxiety, depression, irritability, intrusive painful memories, self-criticism, and unstable relationships that had worsened after a contentious divorce, entered into trauma-focused psychodynamic psychotherapy (Busch et al., 2021). Prior treatments, including a series of medication trials and cognitive behavioral therapy, had produced limited improvement. A central complaint involved repeated cycles with his girlfriend in which he was overly accommodating and fearful of disappointing her, followed by sudden angry outbursts toward her. For example, he felt pressured to meet her expectations by taking her to expensive dinners despite serious financial strain from his divorce because he feared she would abandon or reject him if he failed to please her. Then, on occasion, following even minor criticism from her, he would abruptly shift into a rage, yelling at her, accusing her of exploiting or controlling him. After these episodes, he experienced intense guilt and confusion about why he had reacted so strongly and became submissive again. This pattern occurred with friends, family, and even at work, creating recurrent disruptions in these relationships, exacerbating his anxiety and depression.
The therapist conceptualized these patterns as reflecting dissociated self and other representations and explored whether they derived from traumatic childhood experiences. Indeed, Jason described his father as controlling, demeaning, and physically threatening. As a child, he learned that expressing disagreement or personal wishes could lead to humiliation, intimidation, or violence. Over time, he developed enduring representations of himself as weak, vulnerable, and easily rejected, alongside representations of others as critical, domineering, and dangerous.
These representations produced conflicting relational strategies. In one state, Jason became compliant, inhibited, and excessively focused on preventing abandonment or retaliation. In another, previously disavowed feelings of anger emerged in the form of explosive rage and controlling behavior. The therapist understood these angry reactions as an “identification with the aggressor” in which Jason unconsciously adopted aspects of his father’s intimidating behavior to ward off feelings of helplessness and shame. Jason initially experienced these states as unrelated and had little awareness that his vulnerability and rage were connected.
Treatment focused on helping Jason recognize the split-off representations. Accordingly, the therapist repeatedly highlighted Jason’s oscillation between these contrasting self-states: one marked by fear of asserting needs or expressing frustration because of anticipated retaliation, and the other characterized by angry attacks on others with little regard for the possible consequences. The therapist helped him identify the sequence linking fear of rejection, inhibited assertion, rage, and guilt. He began to work with Jason to become aware of the mounting resentment that preceded the onset of his rage.
The therapist clarified that the relationship with his girlfriend activated earlier traumatic expectations and dissociated relational patterns. Thus, Jason began to recognize that he would be overly accommodating because he feared retaliation and humiliation, as with his father. He could identify that he inadvertently contributed to his mounting resentment and began to recognize that others would not inevitably humiliate or abandon him. He recognized how his rageful state was connected with his father’s bullying behavior and the damage this caused to his relationships. The therapist also worked with Jason to develop more direct and adaptive expressions of frustration and vulnerability, allowing him to communicate his needs without being submissive or attacking. As these split-off representations became more integrated, Jason developed improved emotional regulation, greater assertiveness, more stable relationships, and relief of anxiety and depression.
This case illustrates how traumatic experiences can lead to dissociated self and other representations, causing a variety of symptoms and problematic relational patterns. Trauma-focused psychodynamic psychotherapy (Busch et al., 2021) helps patients recognize, tolerate, and integrate these split-off states so that vulnerability, anger, and assertion can be more integrated, diminishing symptoms and adopting more adaptive relational patterns.
