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Commentary on "Cherchez la Femme, Cherchez la Femme" Waugaman Commentary on "Cherchez la Femme, Cherchez la Femme: A Paradoxical Response to Trauma" Reality as an Inkblot: Looking at the Trauma Literature

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Commentary on “Cherchez la Femme, Cherchez la Femme”Waugaman
Commentary on “Cherchez la Femme, Cherchez la Femme:
A Paradoxical Response to Trauma”
Reality as an Inkblot:
Looking at the Trauma Literature
Richard M. Waugaman
Penelope Hollander has shared a
highly personal account of her childhood
trauma and its ongoing sequelae. She shows
how she has struggled to come to terms with
this trauma, using a variety of coping strate-
gies. In addition to her “survival relation-
ships” with women, her introspection, and
her exploration of both creative literature and
psychodynamic literature, she may have used
the process of writing this article to further
her healing. If this hunch is correct, her article
illustrates the therapeutic benefit of writing in
recovering from childhood trauma.
Many survivors of trauma have used
their journal-writing1as a valuable adjunct to
their treatment. Abusers often threaten dire
punishment if the child ever tells anyone
about the abuse (see Lister, 1982). These
threats actively interfere with the survivor be-
ing able to remember and talk about her
abuse. Such threats also constitute one possi-
ble impetus for the persisting use of the de-
fense of dissociation. But children tend to
think concretely, so that survivors often find
that writing about their abuse constitutes a
sort of loophole in the abuser’s injunction
against telling.
Most of the patients with dissociative
identity disorder (DID; previously known as
multiple personality disorder) whom I have
treated have spontaneously made extensive
use of writing in their treatment, often bring-
ing in their journals and other written work.
One patient initially denied that she could
have dissociative identity disorder. She had
never told anyone about her repeated sexual
abuse during childhood. But she eventually
showed her therapist a journal she had kept
years earlier. In that journal, she wrote of the
childhood abuse, and her narrative voice and
even her handwriting showed abrupt shifts,
as different “alters” did the writing.
Hollander found Tess Gallagher’s
poem “Instructions to the Double” to be per-
sonally meaningful. Many survivors of child-
hood abuse, as well as their therapists, will
Psychiatry 67(3) Fall 2004 222
1. I prefer the term “journal-writing” to the less felicitous word “journaling,” which illustrates a
current fad for “verbing nouns,” as Professor John Fleming (personal communication, 2003), has aptly
put it.
Richard M. Waugaman, MD is on the Faculty, Washington Psychoanalytic Institute; Clinical Pro-
fessor of Psychiatry, Georgetown University School of Medicine; and Adjunct Professor of Psychiatry,
Uniformed Services University of the Health Sciences, Bethesda, MD.
I am deeply grateful to Mary Jo Peebles-Kleiger, Ph.D. for sharing her illuminating insights into
many of the topics I discuss in this commentary.
Address correspondence to Richard M. Waugaman, MD, 4701 Willard Avenue, #204, Chevy
Chase, MD 20815-4607; E-mail: rwmd@comcast.com
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relate to the following two poems by Emily
Dickinson (1960), who clearly knew much of
emotional pain, “exiled knowlege” (adapting
Hollander’s phrase), relational conflicts,
dissociative defenses, and the healing power
of poetry:
There is a pain—so utter—
It swallows substance up—
Then covers the Abyss with Trance—
So Memory can step
Around—across—upon it—
As one within a Swoon—
Goes safely—where an open eye—
Would drop Him—Bone by Bone.
(poem 599, p. 294)*
* * * * * *
There is a Languor of the Life
More imminent than Pain—
‘Tis Pain’s Successor—When the Soul
Has suffered all it can—
A Drowsiness—diffuses—
A Dimness like a Fog
Envelops Consciousness—
As Mists—obliterate a Crag.
(from poem 396, pp. 188-189)*
Both these poems were probably writ-
ten in 1862, which has been called “the most
crucial . . . year” in Dickinson’s life, when she
“was undergoing an emotional disturbance of
such magnitude that she feared for her rea-
son” (T.H. Johnson in Dickinson, 1986, p.
166). In April of 1862, she wrote her first two
letters to T. W. Higginson, enclosing some of
her poems and asking his literary opinion of
them. She tells him in the second letter, “I had
a terror—since September—I could tell to
none—and so I sing . . . because I am afraid . . .
My Mother does not care for thought—and
Father, too busy with his Briefs—to notice
what we do—He buys me many Books—but
begs me not to read them—because he fears
they joggle the Mind” (Dickenson, 1986, p.
173). So Dickinson turned to “singing” her
poetry, even though she may have been too
afraid to “tell.”
Returning to Hollander’s writing, it is
striking to follow the shifts in the way she re-
fers to her abuser: “my perpetrator”; “I be-
came my father’s wife” (Hollander’s
emphasis); “the man in question”; “the origi-
nal object (Dad), the root cause of the
trauma.” It is understandable that she may be
ambivalent about how much to reveal to the
reader in “this [her] first narrative.” It would
also be understandable if these shifting ways
of referring to him reflect her difficulty in rec-
onciling her various experiences with her fa-
ther. Many children with one parent who
suffers from a severe emotional or medical ill-
ness become especially dependent on the other
parent, and then especially vulnerable to sex-
ual abuse by that more emotionally available
parent. They may be left with contradictory
feelings toward a parent who is both their
primary caretaker and their abuser.
Hollander writes that “relational viola-
tions” lead to familial roles that “destroy the
natural order of relationships.” She thus
draws attention to a central dynamic in the
psychology of pedophiles. As Kaplan (1991)
observes, “The fundamental wish in a perver-
sion is to obliterate all knowledge of the differ-
ences between the child and adult generations.
The perverse . . . adult will arrange his per-
verse scenario so that he may live forever in
the never-never land where there are no real or
significant differences and no difference be-
tween infantile sexuality and adult sexuality”
(p. 128).
Hollander tells us she felt “genuine
pleasure” from her childhood experience of
being sexually abused. Readers may find this
difficult to accept, just as therapists often find
it difficult to hear such reports from their pa-
tients. We may prefer to see the perpetrator as
Waugaman 223
*Reprinted by permission of the publishers and the Trustees of Amherst College from THE PO-
EMS OF EMILY DICKINSON, Thomas H. Johnson, ed., Cambridge, Mass. The Belknap Press of Har-
vard University Press, Copyright © 1951, 1955, 1979 by the President and Fellows of Harvard College.
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all bad. Although the sexual abuse of children
is in fact morally indefensible, we still need to
be empathic for the full range of a patient’s
feelings about such experiences. In fact, it is
the contradictory mixture of feelings the child
experiences that leads her to resort to dissocia-
tion as a coping strategy. Being repetitively
abused by someone the child loves and trusts
is probably a necessary precondition for the
development of DID. A patient may lose trust
in a therapist who seems to have her own
agenda of demonizing the perpetrator, since
this forms an alliance with only one side of the
patient’s own deeply conflicting feelings
toward him.
One patient remembered the first time
her father had intercourse with her during her
early childhood. She told him he was hurting
her. “He told me, ‘No, I wouldn’t hurt you,
because I love you,’ and then the pain disap-
peared.” This captured one moment when she
had to resort to profound dissociation to cope
with being physically hurt and emotionally
betrayed by a father who did in fact treat her
lovingly most of the time, in contrast with her
severely alcoholic and unavailable mother.
One of her dissociative symptoms was pro-
found psychogenic anesthesia to physical pain
that persisted during her adulthood.
This patient had been cutting herself ev-
ery night while hospitalized at Chestnut
Lodge. She had dissociative identity disorder,
and working directly with her alters in inten-
sive psychotherapy eventually clarified and
resolved her self-cutting. The therapist asked
to speak with the part of her mind that was
cutting her. Referring to the patient in the
third person, this alter then said, “Sarah is so
innocent. I want her to stay that way. I don’t
want her to be contaminated with my anger.
She still thinks there was a reason for the way
people abused her when she was a child. She
doesn’t realize what I realize, that there was
no good reason for people to treat her that
way. So she’s not as bitter as I am.” Sarah then
told her therapist she felt her true self emerged
only when she was doing art therapy. She
brought some of her art work to the next ther-
apy session. She found that allowing her alter
to speak “helped bring together the past and
the present.”
One evening, she talked with her father
by telephone. That night, she had a nightmare
“about someone pushing me into a tunnel, or
me pushing something into a tunnel, or of me
being the tunnel something was being pushed
into. It hurt, and I wanted it to stop. I said
‘Stop it—it hurts!’” The patient then
switched, and a young sounding alter said,
“People use secret words I don’t understand,
like saying it doesn’t hurt when it does hurt.”
This alter presumably split off from Sarah
when Sarah stopped feeling pain after her fa-
ther had said, “No, I wouldn’t hurt you, be-
cause I love you.” Following this work, Sarah
stopped cutting herself every night, and in-
stead began crying every night, reflecting her
gradual development of increased tolerance
for dysphoric affect, which is always a central
therapeutic goal in working with survivors of
childhood trauma.
Hollander’s title alludes to her anecdote
about the rebuffed suitor who then said,
“Cherchez la femme.” Her interpretation of
his words may illustrate what she calls “a par-
adoxical response.” That is, she heard him as
advising her to look for the woman in herself. I
assume that, more explicitly, he was advising
himself to keep looking for a more pliable
woman (I admit my transference to French
men is less positive than Hollander’s seems to
be). This would be the conventional meaning
of that French adage, as in the story about the
man who was following an attractive woman
down the street, until he noticed she was car-
rying France’s most erudite newspaper. He
then said, “Ah, elle lit Le Monde! Cherchons
une autre.” (“Ah, she reads Le Monde! Let’s
look for another woman.”). Yet Hollander’s
interpretation must reflect her subjective
reality.
All the world is like a Rorschach card,
onto which each of us projects elements of our
own subjectivity. Ambiguity in the object en-
hances the ink-blot nature of our subjective
perceptions. And for Hollander, the French-
man’s advice seems to direct her to a fuller ex-
ploration of her inner world—and the aspects
of herself that she tells us she has dissociated.
224 Commentary on “Cherchez la Femme, Cherchez la Femme”
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Finding something positive in an ambiguous
situation may reflect a reservoir of psycholog-
ical resilience that is an important coping skill.
In addition, I wonder if she implicitly felt in-
structed to find her mother—to find who her
mother actually was, amidst her mother’s un-
predictably recurring bouts of paranoia. This
interpretation may then have contributed to
her inability to give in to her “longing to be
with this man.” “La femme” means both “the
woman” and “the wife” in French. Hollander
writes that she felt like her father’s wife; their
relationship doubtless complicates her wish to
be intimate with other men. In addition, Hol-
lander’s “instructions to the double” may
have included a desire to find in herself some-
one who could be a wife in an actual marriage
(Elisabeth P. Waugaman, Ph.D., personal
communication, November 12, 2003).
Hollander writes that “dissociation
manifests itself . . . as a fierce desire for attach-
ment.” Her comments about the paradoxical
response to trauma have important connec-
tions to attachment theory. The findings of at-
tachment research further clarify clinical
observations about patients who repeat
self-destructive relationships with one person
after another. People find a degree of reassur-
ing familiarity in repeating attachment pat-
terns that characterized their relationships
with their parents and other important people
in their childhood.
Sophisticated research during the past
two decades has in fact revealed crucial con-
nections between parent-infant interactions
and later use of dissociation (see Lyons-Ruth,
2003, for an excellent summary). Specifically,
“disorganized” attachment patterns correlate
highly with subsequent dissociation. One fea-
ture of this attachment pattern is that the par-
ent frightens the infant, even though it is this
same parent to whom the infant turns for
comfort and safety. The enduring nature of at-
tachment patterns is mediated physiologi-
cally. These patterns are recorded in the
infant’s implicit memory system, since they
occur before the explicit memory system is
fully myelinated and functional. Physiologi-
cally, “the attachment system may also be
foundational . . . in setting up relatively endur-
ing patterns of neurotransmitter activity and
levels of hypothalamic-pituitary-adrenal axis
responsivity to stress or threat” (Lyons-Ruth,
2003, p. 887).
Some attachment research (e.g., Ogawa
et al., 1997) has questioned whether, once a
disorganized attachment style has developed
during infancy, any later trauma or abuse is
needed to create dissociative defenses in ado-
lescence and beyond. However, I would un-
derline the distinction between the broad
spectrum of dissociative defenses and
full-blown dissociative identity disorder. Re-
petitive and sadistic sexual abuse by someone
the child trusts correlates highly with subse-
quent dissociative identity disorder, while
emotional abuse and neglect (especially failing
to protect the child from abusers), physical
abuse, traumatic medical and surgical proce-
dures, and witnessing violence may also con-
tribute to its development. I would speculate
that disorganized attachment patterns in the
absence of sexual abuse might correlate with a
range of adult psychopathology, including
dissociative disorder not otherwise specified
(DD-NOS) and some ego state disorders (see
Watkins and Watkins, 1997).
Hollander has clearly found Freud’s
work helpful in coping with the aftermath of
her trauma. For example, she cites Freud’s for-
mulations about Dora, with whom Hollander
tells us she identified. Other readers might
find aspects of Freud’s work with Dora trou-
bling, especially his contention that she should
have enjoyed Herr K’s sexual advances when
she was 14 (see Langs, 1976). Erikson (1962),
among others, questioned this contention.
Glen (1986) argues that Freud was unaware
of his own erotic countertransference to Dora.
(Jennings, 1986, reviewed the literature on the
Dora case through 1984.)
Hollander’s brief review of the psycho-
analytic literature on trauma did not include
Sándor Ferenczi. But Ferenczi’s (1933) formu-
lations about the sexual abuse of children
challenge Freud in crucial respects. For exam-
ple, Ferenczi emphasizes that what the child
wants is a “tender” intimacy with their par-
ent, not actual sexual intercourse. Adults may
project their own sexual wishes onto the child.
Waugaman 225
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And it is characteristic of pedophiles that they
brainwash their child victims into believing
that they wanted and brought about the sex-
ual interaction. So Freud’s theory of the
Oedipus complex, to the extent that it seems
to attribute adult sexual wishes to the child,
shares troubling similarities with pedophiles
who convince themselves that their child vic-
tims want the sexual contact with them. At-
tributing to Dora repressed sexual urges
toward Herr K enlarged Freud’s blind spot for
Dora’s own subjective experience of feeling
traumatized by the seeming collusion of her
father and Freud to get her to submit to Herr
K. Rachman (1997) has called Freud’s effort
to suppress Ferenczi’s 1933 paper and the
subsequent controversy “one of the darkest
moments in the history of psychoanalysis” (p.
459).
Since Ferenczi’s landmark paper de-
serves to be widely known, I will quote him at
length.
A typical way in which incestuous seductions
may occur is this: an adult and a child love
each other, the child nursing the playful fan-
tasy of taking the role of mother to the adult.
This play may assume erotic forms but re-
mains, nevertheless, on the level of tender-
ness. It is not so, however, with pathological
adults, especially if they have been disturbed
in their balance and self-control by some
misfortune or by the use of intoxicating
drugs. They mistake the play of children for
the desires of a sexually mature person or
even allow themselves . . . to be carried away.
The real rape of girls who have hardly grown
out of the age of infants . . . are more frequent
occurrences than has hitherto been assumed.
It is difficult to imagine the behavior and the
emotions of children after such violence . . .
[They are] paralysed by enormous anxiety.
These children feel physically and morally
helpless, their personalities are not suffi-
ciently consolidated in order to be able to
protest, even if only in thought, for the over-
powering force and authority of the adult
makes them dumb and can rob them of their
senses. The same anxiety, however, if it
reaches a certain maximum, compels them to
subordinate themselves like automata to the
will of the aggressor, to divine each one of his
desires and to gratify these; completely obliv-
ious of themselves they identify themselves
with the aggressor [Ferenczi’s emphasis].
Through the identification, or let us say,
introjection of the aggressor . . . the attack as
a rigid external reality ceases to exist and in
the traumatic trance the child succeeds in
maintaining the previous situation of
tenderness. (pp. 161-162)
Hollander writes of what she eventually
came to understand as her dissociative re-
sponse to her relationship with her father.
Ferenczi also made brilliant observations
about the dissociative sequelae of childhood
sexual abuse, including the person’s lack of
awareness of the full extent of their dissocia-
tion: “If the [traumatic] shocks increase in
number during the development of the child,
the number and the various kinds of splits in
the personality increase too, and soon it be-
comes extremely difficult to maintain contact
without confusion with all the fragments,
each of which behaves as a separate personal-
ity yet does not know of even the existence of
the others” (p. 165).
Hollander begins to tackle the complex
question of the relationship between repres-
sion and dissociation. Elucidating their rela-
tionship is a formidable task, since they reflect
two historically “dissociated” intellectual leg-
acies. But I believe Hollander is misleading
when she calls repression “a psychic response
to trauma” and she calls dissociation “a
deeply emotional response” that is “adap-
tive” (Hollander’s emphasis). Both repression
and dissociation are mechanisms of defense
that can be either adaptive or maladaptive, de-
pending on a variety of factors. For example, a
young child who is being sexually abused by a
parent on whom she depends may cope as well
as she can by dissociating these experiences. In
adulthood, however, continued use of dissoci-
ation as a central coping mechanism is
maladaptive, now that the person’s life cir-
cumstances and psychological development
offer more adaptive alternatives. I believe that
Pierre Janet was more on target than was
226 Commentary on “Cherchez la Femme, Cherchez la Femme”
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Freud in highlighting dissociation rather than
repression as a central response to trauma.
Fairbairn chose “The Relationship of
Dissociation and Repression” for his M.D.
thesis in 1929. Fairbairn noted that both
Freud and Janet studied hysteria with
Charcot, but their intellectual paths then di-
verged—Freud viewed repression as central to
hysteria, whereas Janet believed that dissocia-
tion plays this role. Freud did not fully explain
how his theory related to Janet’s. Fairbairn
also observed what we might call a sort of dis-
sociation between the followers of Freud and
Janet, respectively. As a result, “little attempt
has been made . . . to consider what relation-
ship, if any, exists between . . . dissociation
and repression” (Fairbairn, 1994, p. 17).
Berman (1981) provides an excellent
survey of Freud’s evolving position on the
ideas of Janet and on the clinical phenomena
of dissociation and multiple personality. For
example, he reminds us that in his 1923 paper,
“The Ego and the Id,” Freud speculates that
“perhaps the secret of the cases of what is de-
scribed as ‘multiple personality’ is that the dif-
ferent identifications seize hold of
consciousness in turn” (cited in Berman, p.
286) [S.E. 19: p. 31]. Berman notes that in
Freud’s thinking on these topics, “The polemi-
cal rigidity caused by the disputes with Janet,
Prince and Breuer gives way to a new
conceptual complexity” (p. 286).
Dissociation is naturally central to
dissociative identity disorder. In contrast to
material that is repressed, dissociated material
temporarily becomes conscious when the alter
or ego state that contains it is in itself con-
scious. Further, dissociation may become a
central defense as a result of severe trauma. In-
ternal sexual or aggressive impulses can be
subject to repression. The memory of an exter-
nal event may be repressed rather than disso-
ciated. The defense of “vertical splitting”
seems to describe dissociation, while “hori-
zontal splitting” refers to repression. David
Spiegel calls repression “a more generic form
of excluding material from consciousness.”
He notes that repressed content may often be
transformed, while dissociation does not store
contents as “deeply” as repressed material
(personal communication, January 21, 1994).
Brenner (2001) describes a case where
“faulty repression apparently triggered disso-
ciation” (p. 31). There is still a gray area be-
tween dissociation and repression—for
example, if one accepts the Watkins’ (1997)
contention that ego states are ubiquitous.
Hollander raises an important question
about women’s greater vulnerability to inter-
personal trauma, given that they are inher-
ently more relational than men. Women score
one standard deviation higher than men in
“cooperativeness” on the Temperament and
Character Inventory (Cloninger et al., 1994).
This parameter is a measure of interpersonal
relatedness, and includes tolerance, empathy,
helpfulness, forgiveness, and charitable prin-
ciples. Women also score almost one standard
deviation higher than men in “reward de-
pendence,” which reflects a need for social ap-
proval. These findings have implications for a
woman’s vulnerability to trauma, and capac-
ity to make use of interpersonal resources to
cope with trauma (C. Robert Cloninger,
M.D., Ph.D., personal communication, No-
vember 13, 2003). So Hollander’s observa-
tion that women are more relational than men
does point to women’s greater vulnerability to
trauma, but also to women’s potentially
greater capacity to turn to other people
(including therapists) for help in recovering
from the aftermath of trauma.
Psychoanalysts have been slow to ac-
cept advances in the understanding and treat-
ment of dissociative disorders. Among the
reasons for their resistance is a concern that
we not oversimplify the etiology of
psychopathology, placing exclusive emphasis
on external trauma. It is in fact an error to ig-
nore the role of intrapsychic factors. How-
ever, it is equally an error to ignore or
minimize the role of trauma. The ubiquity of
false dichotomies in our thinking is a constant
source of distortion. We may try to disavow
our own proclivity to use false dichotomies by
projecting this error onto borderline patients
with the concept of splitting, but we all fall
victim to it. Rangell (1995) has attempted to
Waugaman 227
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counteract the false dichotomy between
intrapsychic conflict and external trauma:
When Freud . . . moved from seduction to
fantasy, from the concrete to the psychologi-
cal as an explanatory concept, a split was al-
lowed to develop on the basis of a [falsely
dichotomizing] fallacy, which, to this day,
seems never to have been corrected . . . The
fact is that Freud discovered two streams of
aetiology sequentially; the fused outcome
can only be explained by both together. (p.
15)
Psychoanalysts who minimize the im-
pact of external trauma need to reread Freud’s
fascinating comment in “Analysis Terminable
and Interminable” on the prognosis of pa-
tients who suffer from post-traumatic condi-
tions. Freud was asking if full resolution of a
neurosis is ever possible. Freud (1937) then
states, “Every analyst will have treated a few
cases which have had this gratifying outcome .
. . Nor are we without some insight into the
determinants of these successes. The patient’s
ego had not been noticeably altered and the
etiology of his disturbance had been essen-
tially traumatic . . . the stronger the trauma,
the more certainly will its injurious effects be-
come manifest even when the instinctual situ-
ation is normal. There is no doubt that an
etiology of the traumatic sort offers by far the
more favorable field for analysis. Only when a
case is predominantly traumatic will analysis
succeed in doing what it is so superlatively
able to do” (pp. 219-220).
In contrast with Freud’s optimism
about the analyzability of traumatic neuroses,
Hollander writes that, “This dissociative as-
pect of my experience with trauma has been
the most difficult to treat.” Her comments
about “this intruder, this uninvited guest . . .
this intrusive third party” seem to convey
Hollander’s ambivalence about the role of this
presence in her life. She feels this “third party”
both leads her to seek better relationships,
while simultaneously thwarting their develop-
ment, and has disrupted her “sense of conti-
nuity in relationship.” Subjective
discontinuities are indeed a central feature of
dissociative disorders. Herman (1992), whose
book Hollander cites, quotes Lister’s (1982)
pertinent comments on the traumatic trans-
ference: “The terror is as though the patient
and therapist convene in the presence of yet
another person. The third image is the victim-
izer, who . . . demanded silence and whose
command is now being broken” (Herman,
1992, p. 137; my emphasis).
Naturally, there are many details of
Hollander’s life experiences and treatment
that she keeps private. So I am using her ac-
count to make some general points about the
treatment of posttraumatic and dissociative
pathology. In my experience, these disorders
are in fact highly treatable, assuming the ther-
apist is knowledgeable and experienced with
this group of patients. Our ability to treat
them has been enormously enhanced by our
field’s increased understanding of the causes,
the psychodynamics, and the optimal treat-
ment of these disorders during the past thirty
years. There is a vast and rapidly growing lit-
erature in this area (for example, Pearlman
and Saakvitne, 1995; Peebles-Kleiger, 2002,
pp. 148-165; Putnam, 1989). Posttraumatic
dissociative disorders, most notably DID, are
highly treatable. For example, I have found
that most patients with DID need an intensive
treatment that brings their alters directly into
the treatment. Patients are usually so accus-
tomed to keeping their traumatic experiences
and dissociative self states secret that thera-
pists need to build an alliance with all parts of
the patient’s mind. Psychoanalysts need to
modify their usual stance of waiting for
material to arise in the patient’s spontaneous
associations.
Another patient who was admitted to
Chestnut Lodge had benefitted greatly from
her previous two years of five times weekly
treatment with a psychoanalyst. Before seeing
him, she had had multiple hospitalizations
and suicide attempts. However, the analyst
had never directly asked about her chronic
and profound dissociative symptoms, and she
had never brought them up with him. When
she came to the Lodge, we did inquire about
this group of symptoms, and she immediately
gave a history of repeated amnestic experi-
228 Commentary on “Cherchez la Femme, Cherchez la Femme”
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