EGO STATES THROUGH BIPERSONAL PSYCHODRAMATIC EXPERIENCE: THE EXTERNALIZATION OF INTERNAL ROLES (PARTS)

ABSTRACT

This article aims to present the clinical management for externalization of internal roles or parts, through psychodramatic experience, based on the techniques of Moreno and Rojas-Bermúdez, such as the construction of three-dimensional and two-dimensional images through people, objects, puppets, tissues and the internal psychodrama developed by other authors. The genesis of the parts, in general, is related to dissociation resulting from trauma or the introjection of significant parental figures, especially when the attachment is insecure. Complex traumas related to bullying, sexual abuse, domestic violence of various natures throughout the child’s development will bring to light these internal parts, which need to be well understood because they affect various social roles. Internal roles, parts, partial self, internal division, characters, ego states, wounded children, subpersonalities are denominations of the same phenomenon, which is manifested by the multiplicity of selves. This phenomenon is also observed in the field of neurosis and in normotics.

KEYWORDS
Bipersonal psychodrama; Internal roles; Partial selves; Ego states

RESUMO

Este artigo tem como objetivo apresentar o manejo clínico para externalização dos papéis internos ou partes, através da experiência psicodramática, tendo por base as técnicas de Moreno e de Rojas-Bermúdez, a exemplo da construção de imagens tridimensionais e bidimensionais por meio de pessoas, objetos, bonecos, tecidos e o psicodrama interno desenvolvido por outros autores. A gênese das partes, em geral, está relacionada à dissociação decorrente de traumas ou ao introjeto de figuras parentais significativas, principalmente quando o apego é inseguro. Traumas complexos, relacionados a bullying, abuso sexual, violência doméstica de várias naturezas ao longo do desenvolvimento da criança vai trazer à tona essas partes internas que precisam ser bem compreendidas porque afetam vários papéis sociais. Papéis internos, partes, eu parcial, divisão interna, personagens, estados de ego, criança ferida, subpersonalidades são denominações de um mesmo fenômeno, que se manifesta pela multiplicidade de eus. Esse fenômeno é também constatado no campo da neurose e em normóticos.

PALAVRAS-CHAVE
Psicodrama bipessoal; Papéis internos; Eus parciais; Estados de ego

RESUMEN

Este artículo tiene como objetivo presentar el manejo clínico para la externalización de roles o partes internas, a través de la experiencia psicodramática, basada en las técnicas de Moreno y Rojas-Bermúdez, como la construcción de imágenes tridimensionales y bidimensionales a través de personas, objetos, marionetas, tejidos y el psicodrama interno desarrollado por otros autores. La génesis de las partes, en general, está relacionada con la disociación resultante del trauma o la introyección de figuras parentales significativas, especialmente cuando el apego es inseguro. Los traumas complejos relacionados con el bullying, el abuso sexual, la violencia doméstica de diversa índole a lo largo del desarrollo del niño sacarán a la luz estas partes internas, que deben entenderse bien porque afectan a varios roles sociales. Roles internos, partes, yo parcial, división interna, personajes, los estados del ego, los niños heridos, las subpersonalidades son denominaciones del mismo fenómeno, que se manifiesta por la multiplicidad de Yoes. Este fenómeno también se observa en el campo de la neurosis y en la normótica.

PALABRAS-CLAVE
Psicodrama bipersonal; Roles internos; Yoes parciales; Estados del yo

INTRODUCTION

The idea of parts or states of ego resembles internal roles and characters in psychodramatic psychotherapy. The poem Traduzir-se, by Ferreira Gullar¹, approaches this theme poetically and profoundly. In some situations of internal conflict, we all perceive conflicting inner voices, popularized with the mental image of the devil and the little angel arguing with each other. This internal dynamic is a way of perceiving the working mechanism of the inner parts of our psyche as if they were subpersonalities in action or interaction. Using this same concept, we can think of ourselves as an internal psychic system, in which each role or part has dynamics that affect external social roles. André Monteiro (2020), speaking of the language of the parts that emerge in our thinking, makes an analogy with the Talking Cricket²:

I feel as if a part of me is reluctant, I›m not entirely convinced, I have this little voice inside that tells me... my intuition tells me... I don›t control my emotion, this pain, this voice inside me, these thoughts, sometimes I have a desire.

(p. 15)

Let’s see the poem Traduzir-se by Ferreira Gullar (2017), in Fig. 1::

Figure 1
Poem Traduzir-se by Ferreira Gullar, originally published in 1980.

In this poem, Ferreira Gullar brings all the duality and multiplicity of the human being, portraying the subtleties of all the parts of which we are made. When he says “a part of me, other part”, he is already bringing the human contradiction in the poetic narrative. Another part of the poem that catches my attention is: “A part of me is permanent, other part is suddenly known”. There is a part of us that is remarkably constant until something happens. From there emerges panic, acute stress, brutal anxiety, which sends out a warning signal: something is wrong.

In clinical practice, I often integrate psychodrama with brain-based therapies or techniques³ and with Alexander Lowen›s Bioenergetics to treat patients in the field of neurosis and/or with complex and straightforward traumatic scenes in their history. The handling of client parts (ego states) is frequent, as theoretically advocated by Salvador (2018), by Richard Schwartz (2004), in the Terapia dos Sistemas Familiares Internos, and by Van der Hart et al. (2006), who developed the Structural Decoupling Theory. This article aims to show forms of clinical management to externalize these parts, through the psychodramatic experience, based on the techniques of Moreno and Rojas-Bermúdez, such as the construction of three-dimensional images, through people, objects, dolls and tissues, and concepts from other authors such as the internal psychodrama.

STRUCTURAL DISSOCIATION, NEUROCEPTION AND INTERNAL SYSTEM

The verses above refer to the concepts of Van der Hart et al. (2006), who associate part with a failure in the integration of the personality, compartmentalized in several fragments, after exposure to a traumatic event. According to Van der Hart et al. (2006, cited by Neves, 2019, p. 1), we have two parts:

an abnormal (ANP), which presents total or partial amnesia concerning the memories of the trauma, oriented to day-to-day tasks, and another emotional part (EP), intensely identified with the traumatic experience, oriented towards the survival of the central personality.

The internal dynamics between these parts cause an intense inner conflict, a source of anguish and suffering. Without citation, I will refer to ANP as PAN and EP as PE throughout the text.

This compartmentalized personality structuring has three levels: the primary structural dissociation, with a basic division into a PAN and a PE, associated with post-traumatic stress disorder (PTSD); secondary structural dissociation, with a PAN but more splits in PE, caused by prolonged trauma, associated with borderline disorder and unspecified dissociative disorder; and, finally, the tertiary structural dissociation, with several divisions in PE, and also several divisions in PAN, associated with a dissociative disturbance of identity

(Van der Hart et al., 2006, cited by Neves, 2019, p. 1).

For Breunlin et al. (2000, p. 80), multiplicity or differentiation is inherent like the mind, and the parts› behavior is affected by the external world or trauma. In this direction, we observe, in clinical practice, clients who travel in the field of neurosis and normotic patients⁴, without a history marked by traumas, but which, even so, manifest parts.

Compared with the poem, the «permanent part» is the PAN and the «part that is suddenly known» is the PE. The PAN is a functional part that acts adequately, as a person skillfully playing his professional role. The counterpoint is PE. It means that, even with a functional part, a probable stimulus from the context (environment area) stops the PAN and activates the PE, which is generally impulsive and devoid of rationality. Activated P E floods the system, knocks down the functional parts, leaving the client extremely anxious, as their psychological self (SMP) dilates⁵ and the person›s social roles cannot be objectified. The state of alarm (neuroception) goes off out of nowhere, turns on without any apparent danger to justify the emergence of these feelings and emotions, often causing anxiety, fear and panic. The person enters a state of danger without motivation from the current context because something from the past has been reactivated.

Neuroception is the process that assesses risk, without the need for awareness. In this automatic process, brain areas that evaluate signs of safety, danger and risk of death intervene. Although we are generally unaware of neuroception triggers, we are usually mindful of physiological change (ie, interoception). Sometimes we have a hunch, a feeling, an intuition that a situation is dangerous. This system also gives rise to physiological states that favor trust, social connection behaviors, and the generation of close relationships. Deficient neuroception can detect non-existent risks or safety signals where there are risks (Porges, 2018, p. 35).

Every traumatic event (simple or complex) in the past or events experienced with great emotional intensity has its memory record in the limbic system, specifically in the hippocampus, whose function is to transform any event experienced into a narrative. But the cortisol level increases in the traumatic experience, when a hormonal dysfunction occurs that impacts the hippocampus and it can no longer appropriately translate the event into narrative, as the most significant record stays in the body. Many situations experienced in the present activate past moments as triggers, making us reexperience those feelings, anxieties and sensations from the past (flashback).

Psychotherapies that focus on the body, mapping and purging the body felt sense-perceptions resulting from these events, seem more adequate and efficient for these cases. Parts, ego states, internal roles, partial self, characters, inner child, subpersonalities are denominations of the same phenomenon manifested by the multiplicity of selves, as an internal psychic system. Throughout the text, I will name this phenomenon of parts from now on.

Colin Ross (1989, cited by Howell, 2020) has proposed that the Osiris myth is the best model for explaining the damage caused by trauma and promoting healing from dissociation. Ross tells us that Osiris, the Egyptian god of the Nile, was defeated in battle by his brother, the god of evil, Set, who then cut his body into pieces and scattered them throughout Egypt. Osiris’ sister Isis found the pieces, sewed them back together, and resurrected her brother with her tears of mourning. The story of Osiris divided and fragmented is suitable for traumatized and dissociative clients. As therapists, we facilitate our clients’ ability to piece together the disassociated pieces of their lives, which are scattered in the mind, into pockets of subconscious life.

PARTIAL SELFS, INNER DIVISION, INNER ROLES, CHARACTERS, WOUNDED INNER CHILD & EGO STATES

Moreno (1993, p. 26) reveals that physiological, psychodramatic and social selves are only partial selves; later years’ whole, really integrated self is still far from being born. Operational and contact links have to gradually develop between the conglomerates of social, psychological and physiological roles, so that we can identify and experience, after their unification, what we call the “I” and the “me” (emphasis ours). In my view, the development of healthy and harmonious operational links between social roles is closely related to the harmonization of internal roles or parts that affect social roles. Moreno (1993, p. 26) observed that there are «frequent imbalances in the grouping of roles, within psychosomatic roles or social roles, and between these areas». He claims that these imbalances delay the emergence of a real self or intensify the disturbances of the self. Dias (1987, p. 72; 1994, p. 85; 2006, p. 155), developing intrapsychic research in psychodrama, identifies the coexistence of two or more opposing forces in conflict within the individuals inner world. He calls these forces of internal division, when they present themselves in a more structured way, to the point that the individual reveals different sensations in their manifestation. For him, identifying and managing these internal divisions is a crucial aspect of the individual’s psychotherapy process.

Inner world figure is the person who represents, within the client’s inner world, a set of concepts of moral, religious, philosophical posture and internalized models of behavior. In this way, the father, as a figure of the inner world, is not the father, but the father as a representative of certain internalized concepts, just as Father Chico is not the person of Father Chico, but he as a representative of a series of religious concepts, etc. (Dias, 2006, p. 87).

What Victor Dias⁶ reports is what Sandor Fereczi (1909, quoted by Laplanche, 1991, p. 248) called introjection, as symmetry of the term projection, revealing that «the neurotic seeks the solution, making as much of the outside world as possible enter his ego. , making him the object of unconscious fantasies. This is one of the genesis of ego parts or states. These internal forces fighting each other internally lead to anguish and suffering and hinder development. In the field of neurosis, we often observe internal conflicts between a party that has introjected moral concepts of the family, religion, among others, and new learning and experiences that oppose these existing forces.

Fonseca (2018, p. 256) speaks of «internal partial selves, which arise from the process of successive internalizations of primary relationships. If we imagine that primordial relationships are internalized as positive, negative, and neutral, we conclude that there are also positive, negative, and neutral partial selves.» Fundamentally, it is about the patient’s attachment history. Children who have been neglected in their care (insecure attachment) have these parts well defined with the consolidation of phobias, fear of separation from the mother, abandonment, and rejection. Complex traumas related to bullying, sexual abuse, and domestic violence of various natures, especially the continuous ones (complex trauma), throughout the child’s development, will bring out these internal parts, which need to be well understood by the person they affect various social roles.

Calvente (2002, pp. 26–28), developing the idea of character in psychotherapy, states that the character originates from the patient’s subjectivity and is linked to fantasy, imagination and the environment, occupying an intermediate place between the elementarity of the role and the complexity of identity. He also reveals that the same character can represent different social roles He concludes that the character is more structural than the social role and appears with more autonomy and intentionality. This concept is similar to what we understand as internal role or parts:

The characters of the mind have a more or less elaborate structure, more or less imposed by anguish and by the context that gives them individual-private, but equally creative, validity. ... [The character] belongs to another level of abstraction, that is, to an intermediate instance, of a transactional type, where more or less well-resolved identifications, perceived, accepted or imposed roles are combined. ... It has, as has been said, a structure and a script, and it appears in different roles.

(Calvente, 2002, pp. 29 and 33, emphasis added)

According to Mario Salvador (2018), in people with a history of chronic cumulative trauma whose lives were threatened because they lived and grew up under abuse, neglect or chronic maltreatment conditions, these survival systems and daily interaction may not be integrated into a response. organized, coordinated and sequenced survival. Being fragmented, these systems give rise to the personality that alternately experiences different ego senses. Neurologically, each ego state or parts are a neural network that carries a set of personality characteristics registered in the subcortical region of the brain, at a traumatic or very stressful moment in the person’s history, thus forming a kind of subpersonality that is trapped as if it were an archeological memory, a memory of the past, which is activated by stimuli from the present.

Depending on the situation, a very suffering and injured part floods the internal psychic system, bringing a lot of discomfort and a wide range of symptoms, such as panic, anxiety, depression. Salvador (2018, p. 127) calls these parts the EXCLUDED ONES. Richard Schwartz (195) calls them EXILES and Stone (1989) REPUDIATED SELF. These parts, sometimes, may have in their genesis a relationship with the history of the ancestors, which are transmitted in a transgenerational way.

In the field of neurosis, we observe that the parts emerge in their entirety as an internal system and that they interact chaotically with each other, significantly affecting the person’s psychic health. In general, when there are excluded parts, we also find other parts that protect it, called by Salvador (2018, p. 131) PROTECTORS. They are often defense mechanisms that fight internally and intensely to avoid anguish, pain and psychic suffering. At their extreme, they follow the path of anesthesia through alcohol, drugs and self-extermination. According to H. Stone and S. Stone (2014, p. 47), if natural instinctive energies are repudiated over time, they begin to operate unconsciously and end up losing their natural qualities, becoming malevolent. These cases are termed by the authors demonic energy or demonic self.

In clinical practice, I have already witnessed client narratives about cruelty to others, in their social behavior, which brought me back to this phenomenon of manifestation of the demonic self.

André Monteiro (2020, p. 10) summarizes and relates the origins of the parts to:

• Differentiation: the child develops behavioral repertoire concerning environments, family members, expectations of the reference group;

• Introjection of significant others and formation of interactional models, with the development of social roles, skills and interactional styles: repetitions in the future;

• Reaction to trauma and/or abandonment/neglect, as we saw above, in which the child is frozen in trauma-time;

  All of the above.

Cukier (1998, p. 24) reveals that, behind the difficulties of his adult clients, there is a «child with his projects of revenge and rescue of lost dignity, and that, precisely through the perseverance of the children’s project, ended up creating the current adult difficulties «. According to the author, a children’s drama often takes place in adults with reversed roles, where the adult client is the one who abuses and humiliates others. In the game of parent-child roles, we very often witness a contamination of the role of parents, when they do not protect the child or treat them symmetrically, as if they were adults. This is a form of child abuse, a type of subordination of power.

Milene Féo (2007, p. 4), speaking of the role of psychodramatist psychotherapist, says that:

We are all governed by ambiguities, we seek to strengthen our client’s ability to face their multiple selves, abodes of desires and feelings, sometimes conflicting with each other, being able to withstand their ambivalence and the impossibility of fulfilling antagonistic desires.

H. Stone and S. Stone (2014) corroborate the ideas of the multiplicity of the self, despite noting that there are oppositions to this theory that fragments the personality. For them, the personality is already fragmented and we have to seek awareness of this fragmentation to make good choices in our lives.

QUALITATIVE SOCIOMETRY AND THE ÍNDICE DE ATIVAÇÃO DAS PARTES (ACTIVATION INDEX OF THE PARTS)

Fonseca (2018, p. 258) proposes the idea of sociometry of partial selves to better understand the relational dynamics of internal roles, which may or may not be harmonic, reflecting on the global self. This proposal is in line with the idea of healing these internal systems by Schwartz and Mario Salvador (2018) model, a theoretical model that I use to support my psychodramatic interventions. In the healing process, the objective is to harmonize these parts, because, in general, the excluded parts have a lot of power and the system needs a lot of strength from the protective parts to hold them (intense psychic wear).

I am currently developing a quantification to measure the strength dimension of the parts, after the client identifies and knows their functionality and emotionality (Figs. 2 and 3). I intend, with this, to lead the client to take better ownership of the phenomenon that he experiences. It is about Índice de Ativação das Partes-IAP (Activation Index of the Parts) After going through the therapeutic process of identifying all its internal parts, the client performs a self-assessment of the parameters, frequency of activation and intensity of activation of the part, using the subjective scale (SUDS), from zero (non-activation) to 10 (activation very frequently and with great intensity). In addition, it describes the soliloquy of the negative beliefs that emerge from each part, quantifying the validity scale of the negative positive belief (VOC⁷)from 0 (no validity/strength) to 7 (maximum validity/strength today), and identifies the triggering stimulus, in the here and now, of the activation of these parts. This information helps in interventions in search of harmonization.

Let us see, in Table 1, an example of a 23-year-old client, depressive, who since the age of 16 has witnessed his mother bedridden at his grandparents’ house, living vegetatively in a chronic coma, after a stroke. He lives with his father, younger brother and stepmother. Their self-assessment defined the names of the parties and the parameters for calculating the IAP. The analysis of the IAP in the graphs of Figs. 2 and 3 reveals that parts 2 and 5 (Table 1) are the most frequently activated with a high rate. Also note that these parts are polarized. Part 2 is the depressed/unable (“Nothing is going to work, I do everything wrong, I want to die”) and the 5 is the rational (“Calm down, let’s think it straight”) (Table 1).

Figure 2
Comparison between the activation rates of the seven identified parts of the customer.

Figure 3
Atom of the internal parts from the IAP.

Figure 4
Construction of an Image with fabrics: “how the client feels when she does not receive a response from her boyfriend on her cell phone”.

Figure 5
Parts qualified by the client’s observing self as weak, strong, and confused.

Table 1
Differentiated internal parts of client-protagonist with respective indexes of activation of the parts.

Parts	Soliloquy of Negative Beliefs of the Parts	I	f	VOC	IAP	ID
1. Deprecating-aggressive	“You’re going to f*ck it up again, huh?”	7	5.0	4.0	16	18
2. Depressive-incapable	“Nothing is going to work, I do everything wrong, I wanna die.”	7	6.0	6.0	19	16
3. Procrastinator	“I’ll do it in a little while, I’ll take care of that later”	6	4.5	5.0	15.5	17
4. Optimistic	“Everything will work out... ahh... great, let’s do do it”	6	5.0	4.5	15.5	15
5. Rational	“Calm down, let’s think it straight”	6	7.0	5.0	18	16
6. Seeking approval/insecure	“I don’t want to, but if I say no, what will they think of me?”	6	5.0	5.0	16	12
7. Adult	“you are a good professional”	6	4.0	5.0	15	23

• I: Emotional intensity and body felt sense of the manifested part; f:Frequency of activation of the part, in a given period; VOC: Validity/strength of negative belief; IAP: Parts activation index (IAP = f + I + VOC); AG: Customer’s age when he noticed this part was first activated.

We can roughly say that by harmonizing these two parts, the client is on the path to healing, as one resolves the other. The solution is visible to the client and one of the therapeutic paths is to summon the self (adult-rational) to command the internal system. We are investigating other therapeutic paths. For that, we must answer the question that is the object of ongoing research: When a part is activated, does it attract other parts, is it repulsed or indifferent to them? This is internal sociometry. My hypothesis is that we can better target the treatment with these responses since the chains of associative memories are connected, and the intervention in one part favors neural plasticity that promotes the development of new synaptic connections and new neural networks, strengthening healthy behaviors more appropriately and creatively.

MANAGEMENT TOWARDS “HEALING”: PSYCHODRAMA, COMPASSION, DIFFERENTIATION, SELF AND CREATIVE SPONTANEOUS HARMONIZATION

An internal system is made up of parts and we need to harmonize them to make a healing leap. The first step for this to happen is to differentiate these parts and know that they exist and interact with each other. Self-knowledge is knowing the multiplicity of our parts, when (age) and how (events) they sedimented in the depths of the psyche, becoming organizers of symptoms, syndromes and behaviors in the here and now. It is also to develop the self which, neurologically, for many authors, has the participation of the orbital prefrontal neocortex, located just above the eyebrow. This is the region that allows us to see ourselves (self-observation). It is possible to differentiate and know the internal dynamics of the subjective interaction between the parts from its development. In psychodrama the self⁸ is in spontaneity and its structure is a configuration of internal, particular or collective roles that operates in a centripetal process of retrojection with learning and subjectivation, and the other is the return of the self in a centrifugal movement of externalization and expansion. In this centripetal movement I understand that the differentiation of the parts occurs and in the centrifuge the consolidation of the spontaneous and creative self occurs. The more differentiation and balance of the parts we will have, the more energy and presence of the self, which would be the center of the person acting with compassion and self-leadership in this model. For Schwartz (2004, p. 60), the self’s qualities exist from birth. This idea reminds me of neuropsychologist Jaak Panksepp (1998) and his discovery of genetically predetermined primary affections for natural defense action and life without volitional participation.

When a client tells me they didn’t feel like coming to the session, I ask: What part of you didn’t want to come? What part of you convinced you to come? Inquiring the person leading him to contact his internal parts is a verbal intervention that generates a movement of self-observation and mapping of the internal parts. Richard Schwartz (2004, p. 115) reveals that there are many methods for dealing with parts, such as projection techniques, sandboxes and psychodrama, even though he works with the forms of internal family systems therapies, which are essentially verbal. Psychodrama explores the externalization of these parts, setting up scenes with their characters. The dramatization between them helps the client understand and understand their internal dynamics and, mainly, know how these parts influence the game of their social roles. It is essential to connect the protagonist conflict of these parties, which is not cognitive, but experiential, with the influence of the social role in the various contexts (family, relational, professional and social). We have to connect this voice that doesn’t leave the client’s head and guide him to when, how and where this voice started to appear. Knowing how old he was at the time, feeling and purging the emotions and sensations he aroused in his body until he reached differentiation. Psychodrama facilitates externalizing and harmonizing parts of our clients. Some clients have no difficulty expressing themselves verbally. They contact the essence of their bodily sense-perceptions and are mindfully reprocessing them. Others find it challenging to remain only verbal, so we must intervene with psychodrama and work with various resources: construction of images with fabrics, with dolls, with blocks, with modeling clay, drawings, clay, etc., (Khouri, 2008, 2020).

Once the adult self manages to differentiate these usually childish parts, the management begins to harmonize these parts that are records of memories that do not erase. Neuroplasticity favors the expansion of healthy associative networks. The best way to do this is to accept and compassionately embrace your parts because often those parts, traumatic or otherwise, had no choice at the time but to act the way they did. In resignification, it will be necessary to leave the past in the past to not contaminate the present. A very rational and reflective client became aware of a childhood part of him in which his father and mother were dubious in affection. They provided their livelihood with little affection, but the father was a companion. One day, when he was 8 years old, he was happy because he was in his father’s company, who was watching his participation in a football game. At the end of the game, he happily goes to talk to his father and gets a scolding. The father scolds him, saying that he played poorly, twisting his ear because he missed a ball. This mature and successful man was visibly shaken. As the service was being telepresented, I asked if he had objects representing that 8-year-old boy near him. He chose an escape mask, which are those masks used to escape a fire. I asked why that choice and he told me: «Because of the size». I wondered if that mask had a purpose: «It hides you, but it also gives you oxygen and helps you escape a tragic event». Inquiries only have force if they generate movement. «Can you relate this mask to this child, who leaves the football game and suffers a setback from his father?». He understood at that moment that part of him wanted to run away.I continued: «What do you, an adult, 39 years old, looking at this part, perceive, feel or would you like to do?». He said, «I wanted to caress that part.» «I have compassion for this child.» This client is on the path to healing, he has compassion for his wounded child. «Tell your child what you, as an adult, can do for them». Kindness and respect are perceived by prosody in the manifestation of speech with intonation and rhythm that convey tranquility, acceptance and understanding.

Returning to Gullar’s poem, the message about the art of living, which is “ to translate one part into the other part -which is a matter of life and death - will be art!» It is not proper for the stage of everyday life to be dominated by our parts. If that happens, we risk being driven exclusively by emotions. The orchestra metaphor that Mario Salvador (2018) uses is enlightening. The adult, the self is the conductor and the parts are the components of the orchestra that can go out of tune and lose time. The conductor has to be attentive to the melody’s rhythm and the tone of the musical notes so that the great orchestra plays in tune. I always bring this Mario metaphor to my clients, with the intention that they learn the importance of summoning their adult and developing this adult behavior for acceptance and compassion for their most wounded parts.

In a technique that I call internal role gathering (similar to the one used in brainspotting and EMDR for handling parts), we hold, at a hypothetical table, a meeting with the various parts of the client to understand the internal relational dynamics of these parts. When I warm up and manage for externalization and differentiation of parts in the scene, most clients achieve very effective results, making contact with their body felt sense, with mindfulness and reprocessing. We can intervene with the techniques of building three-dimensional images, with fabrics, with dolls, puppets, puppets, pillows (Rojas-Bermúdez, 2012), toys in general and with Legos-like blocks (Khouri, 2008, 2020) and, mainly, the dramatization of scenes between the parties aiming at the subjectivation of intrapsychic relationships between the parties or between interpersonal relationships between the parties manifested through social roles and their complement in various contexts (influence of the internal role on the social role). In addition to these techniques, we can use internal psychodrama similar to the therapist-directed insight and direct access technique (Schwartz, 2004, p. 115), going further with soliloquies, inversion, concretization, and other techniques. If the protagonist’s part is due to traumatic memories, we can use the internal psychodrama model for trauma treatment (Khouri, 2018). Everything takes place in the mind area, and we bring it to the body and the environment. When we investigate the environment, we evaluate contexts and trigger stimuli of parts. When using psychodrama techniques, there will inevitably be activation in the body and this calls us to intervene, if necessary, with the techniques of bioenergetics or bodily experience, EMDR and brainspotting.

In management, it is imperative to be aware of the client’s tolerance window, as hyper-responsive people quickly leave the tolerance window of emotions and bodily sensations through dissociation or intense aberrant catharsis that is difficult to contain. Unresponsive clients demand a thorough and attentive warm-up because they can cool down during the process. For those, I recommend body warming. If the client can easily differentiate his parts with the internal psychodrama — in which the therapist directs him to dialogue and interact with his other internal parts — we continue with the classic techniques, such as inversion, double and mirror. It is also possible to track bodily felt perceptions in the somatic experience model, when the client’s physical sensations and emotions emerge. Suppose there is a difficulty for the client to put the leadership of his self in the interaction with his internal parts. In that case, we recommend direct access, using the appropriate techniques to the client’s carrying out, such as a psychodramatic interview, natural dialogue, and double mirror (Fonseca, 2000). The technique of direct access to the system of internal roles (Schwartz, 2004), presupposes the direct dialogue of the therapist with the inner part of the client or internal role. Our clinical experience in these cases encompasses psychodramatic techniques.

METHOD

This article deals with a report of practical experience in a clinical room environment and face-to-face teleservice, from the observation of interventions articulating with the state of the art of theories on the subject. The clients’ production and elaboration records were made in notes, images or recordings, based on the psychotherapist’s observations and direct feedback from clients during the interventions. Some management examples will be described below.

Externalization of parts intervening with tissue imaging technique (in person)

A 40-year-old graduated woman, today balanced and productive, but during her psychotherapy (four years) she was severely depressed, presenting several symptoms (anxiety, panic), including psychosomatic ones (tremor, dizziness, sweating, tachycardia), in addition to ideation. By her own decision, she decided to be hospitalized for 30 days for treatment in a psychiatric clinic after an outbreak with a self-destructive movement. This session took place 18 months after these events, when the central theme was her relationship with men, usually charged with passion, control, jealousy on her part and mutual abuse. Today she is separated, she has an 18-year-old son from her first and only marriage and a boyfriend with a strained relationship. Psychotherapy was temporarily suspended in January 2021.

The example is from a narrative of hers revealing how she becomes distressed and divided during periods of tension with her boyfriend. I made an intervention using the technique of building images with fabrics and pillows, asking her to put on the platform the internal parts/roles in conflict in the relationship with her current partner. The intention was to see if a standard internal dynamic was comparable to the other relationships. She built three very different parts and only realized that in that session.

In Fig. 4, the first image externalized with fabrics corresponds to how she feels, when her boyfriend doesn’t respond after sending a cell phone message. This is a trigger for the manifestation of a depressed and broken part. Then comes another diabolical part, taken by fantasies of betrayal. «Is he with someone else?» Immediately, a somatic response emerges with a bodily felt sense of tightness in the chest and pangs in the stomach. After getting information about her boyfriend’s fate (takes back control), she pulls herself together and feels solid and balanced. Throughout the session, after the subjective image of the relations between the parts was objectified on the stage, we handled with soliloquies of each image, expression in the body of the complementary image and tracking of the corporal sensorial perceptions, provoking a movement of deep reflection of the dynamics between the parts.

Externalization of parts with dramatization, technique of building images with non-articulated dolls, articulated dolls, Lego-like blocks and other objects

Customer K, 38 years old, had her childhood development marked by her mother’s dubious relationship, between a mixture of affections, care, neglect and intense, violent mistreatment, with systematic physical and verbal aggression («You are like a bag from C store, beautiful on the outside and empty on the inside»). Her parents separated when she was four years old. Her father was an alcoholic, despite building a respected career in his profession. Her mother has remarried and is manipulated by her stepfather, often against her. The initial hypothesis is a case of complex trauma, with clear manifestation of internal roles and somatizations affecting social roles (professional, mother and wife). She has been in psychotherapy since July 2019 and started with a demand to re-signify the maternal relationship. She is now a health professional and has no contact with her mother. In one of the first dramatized scenes, she set up on a stage with three internal roles: the weak, the strong and the confused, and the observing Self (adult), which observes itself and should manage each part (Fig. 5). In this scene, she soliloquized the parts and, in the place of the observing Self, she could not see that that little girl, in that context at the time, could not do anything, she had no way of defending herself, as she did not have the resources she has today, with 38 years old. She felt angry that she was like that and didn’t know how to have compassion for that part, which was herself. The little girl had to be useful to her mother and stepfather, so as not to be mistreated and to receive some affection. At another time, in a face-to-face session, she built the image below, after saying: “Build an image of the parts (internal papers) that are most activated today using these dolls and objects”. She represented herself with structured and articulated dolls, created a scenario with objects related to each doll, to illustrate how she perceived her internal process in each activated part (Khouri, 2020).

So let’s see Fig. 6: a) girl aged 5 to 11 years, a period of deep need from the mother, in which she begged for affection that she only received when he was alone with her, without the presence of her stepfather. In the image, she represents herself and her mother with white blocks, connected by an almost imperceptible cord; b) up to 24 years old, the aged, finished, devastated, falling into a bottomless pit (internal process); c) up to 36 years old, productive superwoman, a tractor, healthy, but she cannot give everything she can, nor remain stable for a long time, because she feels her energy is sapped. She chose the doll with the most colorful outfit. The client’s perception is that this most functional part holds 20% of the energy of the internal system and the others take the remaining 80%. Given this, her productive history is marked by ruptures and stops, with the activation of other parts, mainly the girl, which makes her walk towards the depressive pole; d) 36 years old, the woman tired of carrying the two previous parts, which do not stop screaming in her ear. Recently, in a teleservice session, she started telling me: «I feel like I’m tying myself up». I asked him to construct an image of her tying herself.I used the technique I call the operative double, in which the therapist presents the dolls and/or objects and the client tells them how to build the image. See below in Fig. 7 constructed with two dolls intertwined, showing how one immobilizes the other. She then identified an inner part that feels tied down. She answers «who ties you?» to the question «I do it myself».

Figure 6
Construction of images using dolls, objects and blocks of the slogan: “which parts (internal roles) are most activated today”

Figure 7
Construction of images using articulated dolls of the client’s speech: “I feel like I’m tying myself up” - teleservice session

That tying part is a defense, because she’s learned to play a victim role for social gain: “Oh, she’s out of clothes. Gosh, I’m going to give her some clothes”, says an uncle. She concluded that this image is a maternal introject with a defense she built (being a victim) to receive affection and other things. She also reflects that, if she didn’t have this part that activates her, she would today be a completely free person to build her life without internal constraints. Freeing herself from the bonds that limit her becomes one of her goals in psychotherapy. In a recent session she surprises me by showing me a drawing of her internal papers entitled “Their Reunion” and declares: “My past no longer takes up my time these days”. See Fig. 8 below.

Figure 8
Drawing of the seven parts of a client by herself.

Differentiation of parts intervening with internal psychodrama

Deise, 41, always had low self-esteem after her father or partner spoke, who never acknowledged what she does for them. That week, both the father’s and the partner’s lines activated this internal part or role. I invited her to see what was happening in another way. After the verbal warm-up, we started the specific warm-up with relaxation, rhythmic breathing, and mindfulness when telling the trigger scene. In the dramatization phase, I intervened with the internal psychodrama, asking her to visualize the Deise part with low self-esteem walking to an imaginary room that is tidy and comfortable⁹. She imagined and connected with the living room of the house where she lived at age 16 when her mother died. I asked her to leave the room and look at this part through a window and, from there, tell me what she thinks and feels when she sees this part. She asked me if she could peek through the door and I said yes. This subtle intervention encourages the differentiation between the low self-esteem part and her (adult) self. She revealed that she saw this part in a corner, crouched, dressed in white and felt nothing for it. As there was no aversive feeling, I understood that she was looking more compassionately through her self. I then proposed that she enter the room with her adult part, to interact and support the crouching young woman, saying how much she understood the reasons for her being so down. I also asked the self to explore what was good about that part and that they walk together, to find a way to incorporate its qualities into their daily lives.

CONCLUSION

The externalization and differentiation of the internal roles (parts) through the psychodramatic experience facilitates the awareness of the internal dynamics of the parts and the strengthening of the self, bringing tension relief, relaxation, resolution and change. In general, clients with tough defenses that are difficult to soften take longer to reprocess the distressing experience of the past and self-promote internal harmonization.

• 1
  Ferreira Gullar,poet, was born in São Luís, on September 10, 1930, with the name of José Ribamar Ferreira.
• 2
  Children’s character from the story of Pinocchi.
• 3
  Brain-based integrative therapies are contemporary psychotherapeutic approaches such as EMDR therapy (Eye Movement Desensitization and Reprocessing), Brainspotting, Somatic Experience (SE) and Trauma Integration and Reprocessing Psychotherapy (ALICÉS method).
• 4
  Denomination is given by Moreno to those people who move between the normal and the neurotic;
• 5
  The SMP (Si Mesmo Psicológico), conforme a Teoria do Núcleo do Eu (Self Core Theory) in Rojas-Bermúdez, has a neural correspondence with the neurovegetative system (NVS). If extremely dilated, it overcomes all social roles, disconnecting the individual from the social network (state of alarm) in this way the relationships established through the SMP are produced in a tense field. For more details see si mesmo psicológico (SMP) na Teoria Emergentista do Núcleo do EU (Emergent Theory of the Core of the Self) (Rojas-Bermúdez, 1997, p. 447).
• 6
  We recommend seeing the references for a deeper understanding of Victor Dias’ concept.
• 7
  Subjective disturbance units (SUDs) and validity scales of positive or negative cognition (VOC) are used to treat EMDR. At the same time, VOC assesses negative and positive belief strengths of traumatized clients using a 7-point Likert scale.
• 8
  For a more in-depth look at the idea of Self in Moreno (1984), see The Theater of Spontaneity.

ACKNOWLEDGMENT

Not applicable.

• DATA AVAILABILITY STATEMENT

  All data sets were generated or analyzed in the ongoing study.

• FUNDING

  Not applicable.

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Edited by

Section Editor: Luzia Lima-Rodrigues

Publication Dates

• Publication in this collection
  28 Feb 2022
• Date of issue
  2022

History

• Received
  29 Aug 2021
• Accepted
  09 Dec 2021