Ever worked with a client and suddenly gotten a strange reaction from them? Was it almost as if you are seeing a totally different person in your client’s chair? If so, there’s a good chance you encountered an ego-state related to early life trauma.
Noticing ‘The Shift’
So you’ve been working with a client for some time and they have been relating to you fairly easily and pleasantly until you bring up a certain topic or issue, then their face suddenly changes or there is a marked change in their voice or demeanor. You wonder to yourself: What did I say that caused this? Have an awareness that your client has gone into what is called an ego-state. This is a key concept of trauma-informed care to recognize that this may be what is happening. There is nothing in particular for you to do at this point except to recognize this ‘shift’. As some clinicians like to say, awareness is the first stage of change.
What Am I Supposed to Do Next?
- You might gently apologize for ‘offending’ the client
- Ask what you said or did to offend or upset them
It is meant to help preserve your tenuous rapport with them at this point. They may be thinking they don’t want to come into your office anymore. They will hopefully tell you about this if they are. The main thing is to somehow honor this ego state, because it is something older than the ‘normal’ personality you have been interacting with up to this point. Sandra Paulsen, PhD likes to refer to these parts of a client’s psyche as ‘King Tut’s Tomb and Other Memories’ in her book Looking Through the Eyes of Trauma and Dissociation. That helps get across the point that this is ‘old stuff’ that the client is bumping into, so much so that it almost seems like a different person that is in the office with you.
Advanced Training is Necessary to Make Much Progress
If you haven’t received specific training in working with ego states, the most you can do is to wait it out. Try to avoid triggering this ego state. It’s like trying to talk a language you don’t know and unless you have some training to work with the client’s ego state, you need to try to keep working with the ‘Apparently Normal Personality’ (ANP) that Andrew Leeds, PhD and Dolores Mosquera, MA have spoken about in trainings they have led. This is so because, as I’ve already mentioned, what you’re bumping into is a part of the person that is so old it overrides that ANP that I just talked about. This part may be like the ‘kingpin’ with respect to all the various ‘parts’ that make up one person’s psyche.
Do I Refer Out?
Maybe. It depends on how well attached the client is to you. If not, they’re likely to terminate prematurely.
If you can do enough as far as stabilizing the client and keeping this/these ego states from ‘running the show’ both in and outside of the office, you may not need to. Is keeping them as your client doing a disservice to them? Hand them over to someone who is experienced in doing trauma therapy or working with what might be a personality disorder, or both.
Scott Kampschaefer, LCSW is a private practice therapist in Austin, Texas. He has an extensive background in working with depression, anxiety, and bipolar disorder at a clinic for older adults with these disorders in Austin. He now works with adults and adolescents of all ages in private practice. Find out more about Scott here: https://www.scottkampschaeferlcsw.com/
