Hidden Self-States: Some Reflections on the Patient’s Trauma and the Analyst’s Undreamt Dreams

In the treatment of trauma survivors, analysts often find themselves befuddled and disturbed by their clients’ unpredictable and self-destructive behavior. One or more dissociated self-states, initially hidden behind the patient’s high-functioning presentation, may eventually make themselves known in the treatment. The analyst is then challenged to find ways to forge a healing alliance with a disavowed part of the patient’s personality that has previously existed only in the context of a perpetually abusive internalized object relationship. Not only must the multiple self-states learn to communicate with each other, but the unformulated components of the trauma survivor’s childhood experience must be formulated with the analyst in the interpersonal field. At the same time, the analyst’s dissociated self-states and unformulated experience are interwoven in the therapy, creating their own confusion and blind spots. A case study illustrates how the client’s and analyst’s vulnerabilities intersect in the shared unconscious of their work. Psychoanalytic theories on multiple self-states, dissociation, transference-countertransference configurations and unformulated experience all combine to shed light on the difficulties faced by wounded healers treating traumatized patients. The analyst’s countertransference dream is pivotal in exposing her previously inaccessible reactions to her patient.