Fraser's “Dissociative Table Technique” Revisited, Revised: A Strategy for Working with Ego States in Dissociative Disorders and Ego-State Therapy

Abstract

The challenge in the management of a number of the dissociative disorders–which is not present in any other psychiatric or physical disorder–is the need to manage a person who has a dissociative plurality of self identities. Each self identity or ego state believes in its own separate existence, and that it can relate to the outside world without any need of the other co-existing ego states. The primary treatment of dissociative disorders is psychotherapy (and psychopharmacology when Axis I comorbid disorders cause functional impairment), much like the psychotherapy of other disorders. However, in treating dissociative disorders, it is often necessary for the therapist to interact with the various ego states. To ignore the clients' subjective reality of such ego states often leads to therapeutic failure, a fruitless focus solely on the comorbid conditions, termination of therapy, or a flight to another therapist. Effective therapy most often results from the recognition and acceptance of the subjective reality of the client's separate ego states and the ability of the therapist to lead the client towards a dissolution of the amnestic barriers and disharmony of these ego states. For many clients, however, the switching of ego states is chaotic and uncontrolled. The Dissociative Table Technique offers a technique to allow clients to recognize internal ego states, and to structure and control switching and internal communication. It is an adjunctive strategy to the psychotherapy and has proven successful in establishing internal cooperation and integration of the various ego states. Drawing on principles from hypnosis, gestalt therapy and clinical experience, the strategies of the Dissociative Table Technique allow the therapist to teach the dissociated person to facilitate interaction of ego states, and to integrate and eventually join or fuse the dissociated ego states into a consistent sense of self brought about by the cooperation and coawareness of all ego states who learn to function as a unit. This is an expanded and updated version of the original publication of this technique (Fraser, 1991).