Therapeutic Hazards of Treating Child Alters as Real Children

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Dr. Shusta-Hochberg’s article below supports the existence of child personalities and Dissociative Ddentity disorder, yet she does not think that exploring child alters is a productive method of treating patients.


Therapeutic Hazards of Treating Child Alters as Real Children in Dissociative Identity Disorder
Shielagh R. Shusta-Hochberg, PhD

ABSTRACT. “Dissociative identity disorder (DID), with its typical etiology of extreme, repetitive childhood trauma, usually includes manifestations of childlike ego-states, among others. For many patients, these
ego-states, originating with the initial traumatic insults to the psyche in childhood, have been called forth again and again as new situations evoke the earlier trauma. When clinicians, family and friends react to them with warmth, nurturing, and empathy, this may exacerbate the illusion that such ego-states are indeed actual children. This can result in a patient becoming increasingly resistant to working through the issues and experiences by which these ego-states have become fixed, with the risk of therapy reaching an impasse. Attitudes, interventions, and approaches to move past such impasses are addressed.”

Shielagh R. Shusta-Hochberg is a clinical psychologist in private practice in New York City, NY.

This paper was originally presented as “Fixed Illusions: Treating the Reification of Child Alters in Dissociative Identity Disorder,” at the 18th Annual Conference of the International Society for the Study of Dissociation, November 2002, Baltimore, MD. Journal of Trauma & Dissociation, Vol. 5(1) 2004.

Retrieved 3/30/11. Available as a PDF.

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  1. K

     /  12/24/2011

    When I speak here, I am summarizing a community who posted their thoughts on this exact article elsewhere.

    One point of view was that children alters were not “child-like,” they were children. They had been frozen in time when they retreated inside, and they were quite literally the patient at that age. They’re not needy or dramatic, they’re just little kids; curious and playful. They require love and nurturing, just like any other little kid. It helps to keep an eye on them, and they might occasionally be sad or scared.

    Many thought that the child alters would eventually grow up and integrate, but they required love and care in the meantime. They had been traumatized, so they, like the rest of the psyche needed to heal.

    Most systems took offense at the implication that all child alters are needy and manipulative. For some systems, the age of the alter didn’t matter. All of their alters came out to help with whatever task they were created for, and the children were no exception. The child alters were helpful and skilled at what they did.

    Someone pointed out the article’s incorrect notion that child alters are “stylized packets of adult psyche.” This is incorrect because DID is formed during childhood. The adult has no say on what the alter is like or how it acts. Child alters are, contrary to the article, small packets of childness retained within the sea of adult psyche. They are formed when a child dissociates parts of themself away. These dissociated parts form the child alters… exactly opposite to what the article claimed!

    One final issue was that it’s necessary for someone with DID to love all of themself as a whole. If they are told to ignore their child parts, this is extremely hurtful to the healing process.

    One thing that people did agree with was that therapy cannot focus exclusively on the child parts. However, ignoring them is never the answer. In fact, caring for child alters commonly encourages other alters to come out of hiding, as it proves to them that the host is safe.


    • K, Some of the claims you make seem contradictory.

      On the one hand, you say that child alters are children, not child-like. Then you go on to say that they are “small packets of childness retained within the sea of adult psyche.”

      I have experienced what you say about child alters encouraging others to come out. Therefore, the host person never has the opportunity to grow up. I’ve not read about child alters growing up and going through the process of aging. They stay the same over time. After a child alter is out for say, 3 years, what is it’s purpose? Does therapy continue to listen to him/her? At what point does patient and therapist say: OK, enough dolls, crayons, and juvenile movies it’s time to grow up and get a job?

      The more child alters that appear, the more the adult patient disintegrates and the structure of the adult fades away as more and more personalities appear. At least that is both my experience and consistent with what I read from multiples who publish. thx.


  1. The scientific status of childhood dissociative identity disorder by G.A. Boysen « Multiple Personalities Don't Exist

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