Ego state therapy

1. Introduction

Version followed: John G. and Helen H. Watkins, Ego States: Theory and Therapy (Norton, 1997), used through the German edition (Ego-States: Theorie und Therapie, Carl-Auer, 5th ed. 2025): its full table of contents and the case chapter 14 (pp. 240–245), which the publisher provides as a sample. I added Helen Watkins's silent abreaction (1980, as summarised by Krakauer 2009), John Watkins's affect bridge (1971) and somatic bridge (1990), as cited by Lawrence (1998) and applied by Degun-Mather (2003). The phase-oriented safety layer around the Watkins techniques is my own [synthesis]; the Watkins material used here gives no formal phase model. Sourced from published records: the format of the manualised single-session abreactive ego state therapy (one 5–6 hour co-therapy session, a 5-phase procedure, placebo-controlled trials; Barabasz, Barabasz & Watkins 2012; Christensen 2012; Barabasz et al. 2013), the Watkinses' claim that intensive ego-state work of about 8–12 hours can bring lasting change (via Peichl 2012), the page locations of the ch. 9–11 and 16 procedures, and how ch. 14 used the door of forgiveness and an imagined chair. Contraindications to trauma exposure are sourced from the German ego-state school (Peichl 2018). The Watkinses' own step-by-step text for the chair technique, the door of forgiveness, transitional objects, ch. 11 short therapy and ch. 16 family and couple work, and the phase content of the single-session manual, are not reproduced in any public source and are marked [uncertain].

Ego state therapy is a psychodynamic, hypnoanalytic approach. Paul Federn introduced the concept of ego states. John Watkins, who was analysed by Federn, and Helen Watkins built the therapy and taught it from the 1970s to the 1990s [source: Wikipedia; Paulsen 2015]. The personality is treated as a "family of self": ego states are organised systems of behaviour and experience bound together by a common principle. States lie on a continuum from normal differentiation to dissociation, and their boundaries are more or less permeable. The state that holds "ego energy" is executive, the "I" in the here and now; others are experienced as objects or are out of awareness. States formed around trauma may be walled off. [source: Wikipedia; Paulsen 2015; Lawrence 1998 citing H. Watkins 1991]

How change happens: the therapist contacts the relevant states, usually in hypnosis but also conversationally. They learn each state's origin, function and needs. Then they apply family- and group-therapy methods inside one person: diplomacy, negotiation, release of bound affect (abreaction) and nurturing. The aim is to make boundaries between states more permeable so they communicate and cooperate. The goal is integration, a cooperative "internal diplomacy", not elimination of states. [source: Wikipedia; Abramowitz & Torem 2018 citing Watkins & Watkins 1979; Rabbie 1994]

This is a clinical hypnosis method for licensed health professionals working within their competence. Related parts approaches, in one line: Phillips & Frederick's phase-oriented ego-state hypnotherapy (Healing the Divided Self, 1995), Emmerson's ego state therapy, the ego-state work of the German school (Reddemann, Fritzsche, Peichl), ego-state-informed EMDR (Paulsen) and Internal Family Systems. For parts work outside hypnosis, see Domain III guide 109.

2. Framework

What the Watkinses publish. The book is organised as a toolkit rather than fixed phases [source: Watkins & Watkins 1997, German ed., table of contents]:

Principles (ch. 8): transference, resonance, the mind–body link, the therapist's stance toward ego states, dependency, building trust, and integration versus fusion.
Techniques (ch. 9): contacting ego states, diagnostic exploration, getting an overview of how states interact, an objective observer, resolving inner conflicts, transitional objects, abreaction techniques (the affect bridge, the somatic bridge and the silent abreaction), and ego-state short therapy.
Specialised procedures (ch. 10): problems of child states, managing fear, the dead as targets of feelings, adult states as helpers, voluntary ego states, the "pain" ego state, critical and blaming states, the door of forgiveness, and a non-hypnotic chair technique.
Hypnoanalytic ego-state short therapy (ch. 11): session frequency and an illustrative weekend-intensive therapy.

Formats on record.

Ongoing outpatient hypnoanalytic therapy. In the ch. 14 case this was long-term, with homework between sessions.
Brief and intensive formats (ch. 11, German ed. pp. 179–182: session frequency, and a representative ego-state weekend therapy; ch. 9 also has a section on ego-state short therapy, p. 158). Peichl, citing Watkins & Watkins (1997/2003, p. 15), reports their view that hypnoanalysis can shorten treatment markedly and that intensive ego-state work of roughly eight to twelve hours often brings lasting structural change [source: Peichl 2012, Klett-Cotta sample, pp. 12–13]. How often the Watkinses hold sessions and how they structure the weekend is not publicly described in the sources used here [uncertain].
Manualised single-session abreactive ego state therapy for combat-related PTSD and acute stress disorder (Barabasz, Barabasz & Watkins). Abreactive hypnosis brings out intense expression of an ego state with a supportive therapist, followed by interpretation, ego strengthening and reintegration [source: Barabasz et al. 2012 poster]. Format: one co-therapy session of 5–6 hours, following a manual (Barabasz, Christensen & Watkins 2010), described as a 5-phase process whose abreactive part aims to exhaust bound-up psychological and physiological reactions [source: Christensen 2012 dissertation record; Barabasz, Barabasz & Watkins, Part 2: the procedure, abstract via science.gov]. It was tested against placebo in two trials, with follow-up at 4 weeks and 16–18 weeks (36 patients) and at 1 and 3 months (30 patients; placebo was the Ochberg counting method) [source: Barabasz et al. 2013 and Christensen et al. 2013 abstracts via science.gov]. The content of the five phases is not drawn on here [uncertain on procedure].
Combined treatment. In Degun-Mather's (2003) eating-disorder case, CBT came first. After relapse came two ego-state hypnosis sessions: a safe place and self-hypnosis, then contact with and negotiation with the "addict" state. An affect-bridge session followed about three months later, then couple, sex and cognitive therapy [source: Degun-Mather 2003].

Working sequence for everyday practice [synthesis, organised from the chapter order above and the two published case reports used here (ch. 14 and Degun-Mather 2003); not a Watkins protocol]. It follows the same logic as the SARI model of Phillips & Frederick (Safety and stabilisation; Accessing the trauma; Resolving and stabilisation; Integration and identity), which the German ego-state school uses as its phase frame [source: Ärzteblatt review of Fritzsche & Hartman 2010]:

Stage	Goals	Typical format	Move on when
A. Assessment and consent	Formulation; dissociation and risk screening; explain ego states; informed consent to hypnosis	1–3 sessions, conversational	Client understands the model, consents, and passes screening (Section 3, Screening)
B. Preparation and ego strengthening	Safe place, self-hypnosis, ideomotor signals, inner resource figures	1–3 sessions with a 20–30 min hypnotic segment	Client can enter and leave trance, use the safe place on their own and give reliable signals
C. Contact and mapping	Contact states with permission; learn each one's age, origin, role and needs; map alliances and conflicts	Several sessions	Executive state and key protective states agree to cooperate
D. Conflict resolution and nurturing	Diplomacy and negotiation; adult states nurture child states; reframe protectors	Several sessions; homework	Inner conflict eases and symptoms shift; protectors consent to deeper work if it is needed
E. Affect release or trauma processing (only if indicated)	Affect bridge or somatic bridge; observer-position work; silent abreaction	Single, titrated segments inside a session, always closed with the safe place	Readiness criteria met (Section 4, Readiness for Stage E)
F. Integration and consolidation	Post-hypnotic suggestions for cooperation; home self-hypnosis; relapse plan	Spaced sessions; follow-up	States report cooperation; gains hold between sessions

3. Guiding principles

Principles named in the Watkins table of contents (ch. 8) are marked TOC; their one-line meanings are my reading [synthesis] unless another source is given.

Therapy as family therapy within one person. Treat states like members of a family or group: give each a voice and work toward diplomacy [source: Wikipedia; Abramowitz & Torem 2018].
Integration, not fusion (TOC). Aim for permeable boundaries and cooperation, not merging or abolishing states [source: Abramowitz & Torem 2018; Lawrence 1998 states the same distinction in his own model].
No state is to be got rid of. Ego state therapy normally avoids eliminating a state. In Degun-Mather's case an "addict" state was let go only because all states agreed, and the author reports the Watkinses endorsed that judgement [source: Degun-Mather 2003]. Ch. 6 discusses removing maladaptive, malevolent or anachronistic states in true multiple personality; its content is not drawn on here [uncertain].
Respect the protector's purpose and challenge its method. Affirm that a defensive state's goal is valid while showing it the harm its method causes. Make small openings, never a frontal attack [source: ch. 14].
Match your stance to the state (TOC: therapist's stance toward ego states). In ch. 14 the therapist avoided soft reassurance with a contemptuous protector, which would have read as weakness, and acted as a firm ally. With frightened child states, warmth and comfort are used [source: ch. 14; Degun-Mather 2003].
Build trust before depth (TOC). Each state must come to trust the therapist; protectors can sabotage work they did not consent to [source: ch. 14].
Watch dependency (TOC). Prefer having the client's adult state nurture child states over the therapist becoming the caregiver [source: TOC; Degun-Mather 2003 shows the adult self comforting the child].
Transference and resonance (TOC). Different states form different transferences. Use your own felt resonance with a state as information. The detail of the Watkinses' account is unconfirmed [uncertain].
Mind–body link (TOC). Somatic symptoms may be the language of a state; this is why the somatic bridge exists [source: TOC; Lawrence 1998].
Hypnosis is optional. States can be contacted conversationally. Once a state is identified, behavioural, cognitive, analytic or humanistic techniques can be applied to it [source: Wikipedia; Abramowitz & Torem 2018].
Confront in imagination, not in reality. Imagined confrontation of an abuser is preferred. Real confrontation can leave the internalised figure intact and cause family or legal problems [source: ch. 14].
The client chooses, and imagery stays open-ended. Let the client pick what a symbol stands for, which anger to release and which tool to use. Explain procedures beforehand [source: Krakauer 2009 on H. Watkins and later adaptations].
Memories are experience, not evidence [synthesis]. Work with what a state reports as its experience. Do not use hypnosis, regression or bridging to establish what historically happened, and do not suggest abuse content.
Safety and stabilisation first [synthesis]. No abreactive or bridging work until Stage E readiness is met.

Screening and contraindications. The Watkins material used here states none formally [uncertain]. What the sources do give: Peichl (German hypno-analytic ego-state school, not the Watkinses) names psychosis, acute suicidality and ongoing contact with the perpetrator as absolute contraindications to trauma exposure, and puts stabilisation first (safe place, inner helpers, a safe-box or container) [source: Peichl 2018, Klett-Cotta sample, pp. 21–22]. Paulsen (2015) notes that ego-state work became important in EMDR because processing highly dissociative clients without it raised the risk of retraumatisation. Krakauer (2009) shows that releasing affect by force can flood a dissociative system. The ch. 14 client self-harmed during deep work. Further screens and contraindications are my own [synthesis] unless marked:

Screen with a dissociation measure and a clinical interview for dissociative disorders, plus suicide and self-harm risk assessment, substance use, current safety (ongoing abuse or contact with a perpetrator), psychotic symptoms and medical causes of somatic symptoms.
Contraindications to hypnotic ego-state work: active psychosis, or a paranoid process that could weave the therapist or "parts" into delusions; acute suicidality; current intoxication; and a clinician without training in hypnosis and dissociation. Psychosis and acute suicidality are absolute contraindications to trauma exposure in Peichl (2018) [source]; the rest is [synthesis].
Contraindications to the abreactive and bridging techniques specifically: ongoing contact with the perpetrator [source: Peichl 2018]; dissociative identity disorder or OSDD outside a specialist phase-oriented treatment; poor affect tolerance or no reliable grounding; current crisis; and pending legal proceedings that turn on the client's memories, because hypnotic work can alter memory confidence and testimony [synthesis]. Seek legal and ethical advice before any hypnosis in such cases.
Medical symptoms (pain, migraine, eating disorders) are treated only as an adjunct within medical care, after medical assessment.

4. Intervention inventory

The procedures below are those named or described in the published sources. Where the Watkins book names a technique in its table of contents but its description is not publicly available, I say so and give only a [synthesis] outline. All example wording is illustrative and my own.

General structure of every hypnotic segment [synthesis, consistent with Degun-Mather 2003 and H. Watkins 1980 as summarised by Krakauer 2009]:

Consent and preparation: agree today's aim and how the client will signal "stop".
Induction: relaxation or eye fixation, or another permissive method; hand levitation is also used [source: ch. 14].
Deepening: counting, or descending stairs or a path.
Safe or special place.
Work: contact, negotiation or bridging.
Ego strengthening and post-hypnotic suggestions.
Return to the safe place, then re-alerting with a count up.
Debrief: what came up, how the client feels now, a check that the client is fully alert and oriented, and a self-hypnosis practice plan.

4.1 Psychoeducation on ego states

Purpose / when: At the start, so the client can describe symptoms as "parts" without fearing they are "crazy".
Steps:
1. Explain that experiences cluster into states with more or less permeable boundaries.
2. Explain that some separation is normal, and that trauma can create walls between states, which leads to inner conflict.
3. Link this to the client's own phrases, such as "part of me wants…". [source: Degun-Mather 2003]
Example language (illustrative): "We all have different sides that come forward in different situations. The one at work isn't quite the one at your mother's table. Sometimes a side gets stuck doing a job it learned long ago. We can get to know those sides and help them work together."
Watch for: Relief and recognition are good signs. If the client is frightened of "having parts", normalise it. If the client describes amnesia, time loss or voices, stop and assess for a dissociative disorder before going further [synthesis].

4.2 Hypnotic preparation: special or safe place and self-hypnosis

Purpose / when: First hypnotic session (Stage B). It gives the client a refuge to open and close every later segment from, and a home practice.
Steps:
1. Induction and deepening.
2. Invite the client to find or create a place where they feel safe and calm. Let them furnish it with all the senses.
3. Anchor it (for example with a word or a hand gesture).
4. Re-alert.
5. Teach self-hypnosis to return there.
6. Optionally, give a recording for home use. [source: Degun-Mather 2003; ch. 14 used a recorded self-esteem exercise together with an imagined safe room]
Example language (illustrative): "Let your mind find a place where you feel completely safe and at ease. It can be real or imagined. Notice what you see there, what you hear, the temperature of the air. This place is yours, and you can return to it whenever you choose."
Watch for: A safe place that turns bare, threatening or invaded. In ch. 14 this was read as interference by a protective state. Do not push on; invite the client to talk with the part that changed it [source: ch. 14]. If no safe place is possible, use external grounding instead [synthesis].

4.3 Ideomotor finger signals

Purpose / when: To get yes / no / "I don't want to answer" responses from states or from the "inner mind" without disturbing trance. Also used for the client's "done" and "stop" signals.
Steps:
1. In trance, suggest that one finger will lift for "yes", another for "no" and a third for "not ready to say".
2. Test with neutral questions.
3. Then ask permission questions, such as whether a part is willing to talk. [source: ch. 14; Degun-Mather 2003]
Example language (illustrative): "Without trying, just let your inner mind choose a finger that will lift by itself to mean yes… and now one for no."
Watch for: Slow, small, automatic-looking movements suggest genuine ideomotor responses. Treat answers as the client's inner perspective, not as factual verification, especially about past events [synthesis].

4.4 Contacting and activating an ego state (hypnotic)

Purpose / when: Stage C. Used when a symptom, urge or inner conflict appears to belong to a specific state (for example an "addict self", a "censor" or a frightened child).
Steps:
1. In trance, ask permission (by finger signal) to speak with the part linked to the symptom.
2. Invite it to come forward.
3. Ask it to answer in words, in the first person.
4. Greet it, thank it, and ask its name or description. [source: Degun-Mather 2003; ch. 14; ch. 9 "contacting ego states"]
Example language (illustrative): "I'd like to speak with the part of you that's connected with the bingeing, if it's willing. When that part is here, it can say 'I'm here.'… Thank you for coming. What would you like me to call you?"
Watch for:
- Shifts in voice, posture, age-appropriate language or affect indicate contact.
- Refusal is information: respect it and ask what it would need in order to talk.
- Spontaneous switching with amnesia suggests a dissociative disorder; slow down and reassess [synthesis].

4.5 Non-hypnotic contact: conversational naming and the chair technique

Purpose / when: For clients who decline hypnosis or are low in hypnotisability, or for early mapping.
Steps:
1. Identify and name facets of the personality in conversation, such as the "frightened child" or the "control freak".
2. Learn each facet's characteristics and function.
3. Then apply any fitting cognitive, behavioural, analytic or humanistic technique to it. [source: Wikipedia; Abramowitz & Torem 2018]
4. The Watkinses describe a non-hypnotic technique using chairs (ch. 10, German ed. p. 173); its steps are unconfirmed [uncertain]. Ch. 14 (p. 241) shows a related imagined use in hypnosis: the client was asked to picture her mother sitting on a chair and to express her anger to her; she froze, able to talk about her feelings but not to act them out in imagery [source: ch. 14]. In a related ego-state school, Emmerson names the empty chair as one of the easiest non-hypnotic ways to reach ego states, and notes the Gestalt two-chair form, in which two states, or a state and an introject, speak to each other; the sample gives no numbered steps [source: Emmerson 2007, pp. 27–30, publisher sample]. As a [synthesis] outline of a non-hypnotic version, not the Watkins text: assign each state a chair, let the client move to that chair to speak as the state, and return to their own chair to respond as the executive adult.
Example language (illustrative): "If that critical side had a chair of its own, where would it sit? Move over there and tell me, as that side, what you're worried would happen if you stopped criticising her."
Watch for: Affect rising when the client speaks from a state shows engagement. Intellectualised talk "about" the part suggests you need more concreteness or hypnotic access. Freezing when asked to address an imagined figure in a chair, as in ch. 14, means the step is too big: go back to talking about the feelings, or use non-verbal channels (4.22) [source: ch. 14 for the freeze; response partly synthesis].

4.6 Diagnostic exploration of a state

Purpose / when: Once a state is present. You want to learn its age of origin, the event it formed around, its job, its beliefs and its needs.
Steps: Ask the state:
1. How old it is, or how old the client was when it began.
2. What it does for the client, and what it fears would happen if it stopped.
3. Whether it is content with its role.
4. What it needs. [source: ch. 14, where a protective "censor" dated itself to age three after being blamed for a playmate's fall; Degun-Mather 2003, where the "addict" feared being made homeless]
Example language (illustrative): "How long have you been doing this job for her?… What are you afraid would happen if you stopped?… Are you happy doing it, or tired?"
Watch for: A protective function behind a destructive behaviour, which is the basis for a reframe. Record the reported origin as the state's narrative, not as established history [synthesis].

4.7 Mapping how states interact, and the objective observer

Purpose / when: Stage C. Used to understand alliances, conflicts and who is executive when. Ch. 9 covers getting an overview of the interactions and an "objective observer". Chapters 3 and 7 link ego states to Hilgard's "hidden observer", a part that registers experience the person does not report [source: TOC; Abramowitz & Torem 2018 on Hilgard].
Steps [synthesis; the Watkins procedure text is unconfirmed, uncertain]:
1. In trance, invite a part that "knows about all the parts" or can observe without being caught up to comment.
2. Ask it which parts are involved in the problem and how they affect one another.
3. Draw a map with the client afterwards.
Example language (illustrative): "Is there a part that can see the whole picture calmly, without being pulled in? If so, the yes finger can lift… What do you notice about how the angry part and the scared part get along?"
Watch for: Do not treat the observer's statements as an oracle about historical facts. Use it for perspective and for coordinating the states.

4.8 Resolving inner conflict: diplomacy and negotiation

Purpose / when: Stage D. Used when two or more states pull in opposite directions, or a state maintains a symptom.
Steps:
1. Have each state state its goal.
2. Affirm the positive intent behind each goal.
3. Ask a state to speak directly to the client's adult state, or to another state.
4. Look for a deal: a new role, a reduced role or a condition for change.
5. Get each party's explicit agreement, checking with finger signals.
6. Seal the agreement with a post-hypnotic suggestion.
7. In Degun-Mather's case the "addict" admitted it had been manipulating the client, asked for a dignified "burial", and both sides agreed to let it go. [source: Degun-Mather 2003; ch. 9 "resolving inner conflicts"; Wikipedia "internal diplomacy"]
Example language (illustrative): "You've worked hard to keep her from feeling lonely. Would you be willing to tell her directly what you've been doing, and hear what she'd like now?… Is there a job you'd rather have?"
Watch for: A forced agreement tends to collapse quickly. A genuine one is followed by relief and a drop in symptoms; Degun-Mather's client had no urge to binge within a week. Letting a state go is an exception and needs all states' consent [source: Degun-Mather 2003].

4.9 Working with protective, critical and introjected states

Purpose / when: Used when a harsh, controlling or sabotaging state blocks therapy, for example by spoiling the safe place, shutting down feeling or punishing the client. Ch. 10 covers critical and blaming states. In ch. 14 the "censor" was understood as a child-level introject of the father, carrying rules such as "don't cry, don't feel" [source: TOC; ch. 14].
Steps:
1. Address the state directly and with respect.
2. Acknowledge its protective intent.
3. Name the harm its method causes now.
4. Explore its origin: when it started and what it was protecting against.
5. Position yourself as its ally in the shared goal of protecting the client.
6. Make small breaches, not frontal attacks. Keep in mind the protector's fear that love or feeling is dangerous.
7. After each step, check how the protector reacted before going further. [source: ch. 14]
Example language (illustrative): "I can see you've been guarding her since she was very small, and that you're strong. I'm not here to take your job away. But shutting down every feeling is costing her a great deal now. Could we find a way to protect her that doesn't hurt her?"
Watch for:
- Backlash after a session (self-harm, cancellations, the safe place being sabotaged) means you went too fast. In ch. 14 a protector framed cutting as a way to end therapy; the therapist moved to safer outlets and kept the alliance [source: ch. 14].
- Run a self-harm risk review whenever a protector escalates [synthesis].

4.10 Nurturing child states; adult states as helpers

Purpose / when: Stage D. Used for frightened, lonely or ashamed child states. Ch. 10 covers problems of child states and adult ego states as helpers [source: TOC].
Steps:
1. Invite the client's competent adult state to come into the child's scene or the safe place.
2. Have the adult comfort the child, without words if needed.
3. Ask the child what it needs (for example holding or reassurance).
4. Have the adult tell the child it was not to blame and is not bad.
5. Negotiate a working partnership between them.
6. Optionally, move forward through ages, the adult caring for the child at each.
7. Bring both back to the present and the special place.
8. Give a post-hypnotic suggestion that the adult will comfort the child whenever it is distressed.
9. Homework: imagine caring for the child at a given age between sessions. [source: Degun-Mather 2003; ch. 14]
Example language (illustrative): "Let the grown-up you go over to that little one… What does she need from you right now?… Let her know, in whatever way feels right, that what happened was not her fault."
Watch for: The child state calming and accepting the adult. If the adult feels contempt or disgust for the child, treat that as a critical state to work with first (4.9). Prefer the client's adult over the therapist as the carer, to limit dependency [source: TOC "dependency"; Degun-Mather 2003].

4.11 Inner resource and guide figures

Purpose / when: To add wisdom, comfort or perspective, for instance when the adult state is not yet strong enough.
Steps:
1. In trance, invite the client to meet a wise or comforting figure (in ch. 14, a wise figure on a mountain, and a figure from the client's own faith).
2. Let the client consult it on the current problem. [source: ch. 14]
Example language (illustrative): "Perhaps somewhere in this landscape there's someone wise and kind who knows you well. Let them appear in whatever form they choose, and ask them what you need to know today."
Watch for: Use only figures the client chooses; do not impose religious content. If the figure turns threatening, end the segment via the safe place [synthesis].

4.12 Transitional objects

Purpose / when: Named in ch. 9 (German ed. p. 151, between resolving inner conflicts and the abreaction techniques) [source: TOC]; the Watkins description is unconfirmed [uncertain]. Krakauer (2009) describes a related practice: a smooth pebble kept as a "souvenir" of anger work, and a means of self-soothing.
Steps [synthesis]:
1. Agree a small real or imagined object that links a child state to the therapist or to the adult state between sessions.
2. Suggest it carries comfort.
3. Review how it was used.
Example language (illustrative): "This stone can stay with the little one until we meet again, as a reminder that she isn't alone now."
Watch for: Growing reliance on the therapist; if so, shift the object's meaning towards the client's adult self.

Readiness for Stage E (bridging, abreaction, trauma work)

The Watkins material used here gives no readiness checklist [uncertain]. Published frames from outside the Watkins texts: the SARI phase sequence (safety and stabilisation before accessing trauma) used by the German ego-state school [source: Ärzteblatt review of Fritzsche & Hartman 2010]; Peichl's absolute contraindications (Section 3) [source: Peichl 2018]; and, for abreaction in dissociative disorders, Steele's five stages: preparation that establishes safety and protection, identification of dissociated aspects, resolution, assimilation, and application, which returns control and continuity to the client [source: Steele 1989 abstract, ScholarsBank record]. The checklist below is [synthesis]:

Stable living situation and no ongoing abuse.
No acute suicidality, and no self-harm in recent weeks without a safety plan.
Dissociative disorder excluded, or the client is in specialist phase-oriented care.
Reliable safe place, grounding and stop signal.
Protective states have consented, by finger signal, to the work.
The client can tolerate moderate affect in session and recover within the session.
Adequate supports between sessions.
Informed consent that includes the memory caveat: hypnotically enhanced recollections can feel vivid yet be inaccurate.

Dosing [synthesis]:

One target per segment.
About 20 minutes or less of processing within a 60–90 minute session.
Leave at least 15 minutes for closure.
Use the observer position or a screen first; move to full immersion only if the client manages the observer position.

Note that the single-session manualised version (Barabasz et al.) deliberately uses intense abreaction, inside one 5–6 hour co-therapy session with two therapists [source: Christensen 2012; Barabasz et al. 2013 abstracts]. That is a different dosing model from the titrated segments above. The content of its five phases is not publicly available [uncertain]; do not attempt it without the manual (Barabasz, Christensen & Watkins 2010) and specialist training.

Closure every time [synthesis, consistent with Degun-Mather 2003]:

Ego strengthening.
Return to the safe place.
Contain unfinished material (for example in an imagined container).
Re-alert and orient to the here and now.
Debrief, and agree a between-session plan.

4.13 Affect bridge (J. G. Watkins, 1971)

Purpose / when: Stage E. Used when a current feeling (panic, shame, rage) seems out of proportion and may be linked to earlier experience held by a state. It amplifies the present affect and "rides" it back in time to an earlier scene where the same feeling occurred [source: Lawrence 1998 citing Watkins 1971; Degun-Mather 2003].
Steps:
1. In trance, recall a recent situation with the target feeling.
2. Intensify the feeling while letting the situation's details fade.
3. Suggest the feeling forms a bridge back through time to an earlier time the client felt the same.
4. Let an image or scene emerge; do not suggest content.
5. Bring the adult or helper state in to comfort the child state there (4.10).
6. Return along the bridge to the present.
7. Go to the special place, then re-alert. [source: Degun-Mather 2003]
Example language (illustrative): "Let that panic grow a little stronger, while the restaurant fades away… Just the feeling now. Let it carry you back, as if along a bridge, to another time when you felt exactly this… Whatever comes is fine, even if it's only a sense or a colour."
Watch for:
- What emerges is an emotional link, not proof of an event. Do not ask leading questions ("is someone hurting you?") and do not confirm or deny events [synthesis].
- If affect overwhelms the client (SUDS near maximum, loss of contact, rising dissociation), stop the bridge, move them to observer position or the safe place, and ground them (Section 5).
- It is working when the present-day trigger loses intensity in the following week.

4.14 Somatic bridge (J. G. Watkins, 1990)

Purpose / when: As for the affect bridge, but the starting point is a body sensation, for example in pain or other somatic symptoms after medical assessment [source: Lawrence 1998].
Steps: Focus on and amplify the sensation in trance. Suggest it leads back to an earlier time the body felt this way. Then follow the affect-bridge steps 4–7 [source: Lawrence 1998; step detail is synthesis].
Example language (illustrative): "Notice that tightness in your stomach… let it become a little clearer… and let it lead you back to whenever your body first learned to feel like this."
Watch for: The same memory caveats apply. Somatic flooding or pain flare-ups mean you should stop and ground. Medical symptoms stay under medical care.

4.15 Observer-position regression behind a glass wall

Purpose / when: A titrated alternative to full re-experiencing. In ch. 14, in hypnosis, client and therapist sat together behind a glass wall and watched an image of the client grow younger until a child state appeared in a distressing scene. The client was free to look away, and then to act in imagination (rescuing the child) [source: ch. 14; also used by Watkins in an incest-survivor case, Krakauer 2009].
Steps:
1. Set up the protected viewing position, with the therapist beside the client.
2. Let the image change at the client's pace.
3. Ask the client to describe what they see.
4. Offer the choice to look away, pause, act in the scene, or bring the child to safety.
5. Bring the rescued child state to the safe place.
6. Close.
Example language (illustrative): "We're sitting together on this side of a thick glass wall. Nothing on the other side can reach us. You can watch, look away, or freeze the picture at any time."
Watch for:
- Turning away is a valid signal; honour it.
- Stepping into the scene (full immersion) is more intense; in ch. 14 the client could not confront her parents there.
- Do not add content to the scene [synthesis].

4.16 Confrontation and abreaction in fantasy

Purpose / when: To give a child or victim state the protection, voice or action it lacked, entirely in imagination. This is preferred to real-life confrontation [source: ch. 14].
Steps:
1. From observer position or the safe place, invite the client to say or do whatever they need to the person who harmed them, or to have a protector remove that person.
2. Bring the adult or therapist presence in to protect the child, and to question adults who failed to protect.
3. Rescue the child.
4. Interpret afterwards: the client was not to blame, the anger was a natural response to helplessness, and the client has resources now. [source: ch. 14; Krakauer 2009 on H. Watkins's interpretation]
Example language (illustrative): "Here, in this space, you can say anything at all to him. He can't hurt you, and nobody outside will hear."
Watch for: Clients may want to act on this in real life. Explore the risks of real confrontation, as ch. 14 notes them: the internalised figure stays intact, and family and legal fallout can follow. Use the same overwhelm rules as 4.13.

4.17 Silent abreaction (H. H. Watkins, 1980)

Purpose / when: An active procedure to break an emotional impasse caused by suppressed anger, for clients with adequate hypnotic ability. Physical release happens in imagination, silently in the room [source: Krakauer 2009 summarising H. Watkins 1980].
Steps (paraphrased structure):
1. Explain the procedure beforehand.
2. Induction and deepening.
3. Guide the client along a woodland path to a large, dirty boulder with a sturdy stick beside it.
4. The client decides what the rock stands for: a person, an experience, or accumulated frustrations.
5. The client strikes the rock harder and harder in imagination, free to shout inside, since nothing is heard in the room, until tired. They lift a finger when done.
6. Lead them up to a sunny meadow to lie and rest; the therapist sits nearby.
7. Ask for something positive the client can say about themselves.
8. Suggest a warm, tingling glow starting in the toes and spreading through the body, attributed to the client's own strengths. The client signals as it spreads. The therapist adds only genuine confidence in the client.
9. Re-alert; the glow persists.
10. Interpret and reassure.
11. Optionally, practise at home in self-hypnosis.
Later adaptations [source: Krakauer 2009]:
- Let the client choose which anger to release and which tool to use, and drop the requirement to reach exhaustion (Williamson 2002).
- Let the client find a rock the size of their anger in their own inner landscape (Krakauer, with dissociative clients).
- Sand a fragment into a smooth pebble for self-soothing.
- Allow gradual release. One client's "rock" appeared as a dam; inner wisdom advised letting the feelings out slowly.
Example language (illustrative): "In a moment you'll see a large rock beside the path, and something sturdy to strike it with. You decide what the rock stands for today. When you've had enough, just lift a finger."
Watch for:
- Exhaustion followed by calm, and a positive self-statement, show it is working.
- Flooding, terror or collapse instead of release means you should stop and ground. Do not insist on smashing "all" the anger.
- With dissociative clients, use the gradual adaptations only within specialist care.
- Do not use it with clients at risk of acting anger out. Assess violence risk first [synthesis].

4.18 The door of forgiveness

Purpose / when: A Watkins imagery procedure (ch. 10, German ed. p. 171, described there as "my technique") that invites movement toward forgiveness or letting go. Its full description is unconfirmed [uncertain]. Ch. 14 (p. 245) shows it in use: the client refused to go through any of the doors, because the feelings were too painful, which indicates the procedure offers more than one door. The therapist then switched to an inner wise figure on a mountaintop and to a figure from the client's former faith, who told her that being hurt by others does not make a person bad [source: TOC; ch. 14].
Steps [synthesis; do not attribute the details to the Watkinses]:
1. Use it only after anger and hurt have been worked through.
2. In trance, present doors the client may choose to go through, or not, when ready. What each door stands for in the Watkins procedure is unconfirmed [uncertain]; do not assign meanings for the client.
3. Never press for forgiveness of a perpetrator.
Example language (illustrative): "There are some doors here. You don't have to open any of them, today or ever. They're simply there for whenever you might want them."
Watch for: Refusal is meaningful and acceptable, as ch. 14 shows. After a refusal, move to a resource such as a wise figure (4.11) rather than repeating the offer [source: ch. 14]. Pushing forgiveness can re-shame the client [synthesis].

4.19 Other specialised procedures named in ch. 10

The book also covers:

managing fear;
the dead as targets of feelings, which in my reading means expressing unfinished feelings to a deceased person in imagination;
"voluntary" ego states;
the "pain" ego state, which in my reading means contacting a state that holds pain, for pain work alongside medical care.

The Watkins descriptions of these procedures are not publicly available beyond the chapter headings [uncertain]. Do not reconstruct them as Watkins protocols. Where useful, adapt contact (4.4), negotiation (4.8) and nurturing (4.10) to these targets and label that as your own work [synthesis].

4.20 Letting go of, or re-roling, a maladaptive state

Purpose / when: Rarely. Used when a state's only function is a harmful one and it wants to stop. Ch. 6 covers removing maladaptive, malevolent or anachronistic states in true multiple personality (content unconfirmed, uncertain). For non-dissociative clients, Degun-Mather (2003) gives a consent-based example.
Steps:
1. Have the state describe its role and its feelings about it.
2. Reassure it that it will not be thrown out "homeless".
3. Agree its wish, for example a respectful "burial" or a new job.
4. Confirm the client's agreement.
5. The client signals when the ritual is complete.
6. Return to the special place and debrief. [source: Degun-Mather 2003]
Example language (illustrative): "You've told us you're tired of this job. What would a respectful ending, or a new role, look like for you?"
Watch for: Prefer re-roling over removal, since the default in ego state therapy is not to eliminate states. Never use this with dissociative identity disorder outside specialist care. Watch for the symptom returning in another form [synthesis].

4.21 Post-hypnotic suggestions and ego strengthening for integration

Purpose / when: At the close of each segment, and in Stage F. Used to anchor agreements and cooperation between states.
Steps:
1. State each agreement as a suggestion, for example that the adult will notice and comfort the child when it is distressed and the two will work together.
2. Add ego-strengthening statements based on the client's real achievements. [source: Degun-Mather 2003; H. Watkins 1980 via Krakauer 2009, where the therapist adds only confidence that is genuinely felt]
Example language (illustrative): "Whenever the little one feels frightened, the grown-up part of you will notice and know just how to help, more and more easily as the days go by."
Watch for: Suggestions that run against a state's wishes will be resisted. Check consent by finger signal first.

4.22 Between-session work: self-hypnosis, cognitive tasks and expressive outlets

Purpose / when: Throughout; also when verbal or imaginal expression freezes.
Steps:
- Daily self-hypnosis to the safe place, or a recording [source: Degun-Mather 2003; ch. 14].
- Simple cognitive tasks, such as rewording "I should" as "I'd like to" to loosen irrational guilt [source: ch. 14].
- Visualising care for a child state [source: ch. 14].
- Non-verbal expression (body exercises, free drawing, scribbling, finger painting) and safe physical release; in ch. 14 the client chopped up an old couch [source: ch. 14].
- Home practice of the silent abreaction in self-hypnosis, only once it has been done safely in session [source: Krakauer 2009].
Example language (illustrative): "This week, once a day, take five minutes to go to your safe place, and just check in on the little one."
Watch for: Practice that triggers distress at home. If so, cut it back to the safe place only.

4.23 Brief, intensive and manualised formats

Purpose / when: Ch. 11 (German ed. pp. 179–182) describes hypnoanalytic ego-state short therapy, how often sessions are held, and a representative weekend therapy [source: TOC; content unconfirmed, uncertain]. The Watkinses held that intensive ego-state work of about eight to twelve hours often brings lasting structural change [source: Peichl 2012, citing Watkins & Watkins 1997/2003, p. 15]. Barabasz, Barabasz and Watkins developed a single-session manualised abreactive ego state therapy for combat-related PTSD, PTSD and acute stress disorder: one co-therapy session of 5–6 hours in five phases, in which abreactive hypnosis evokes intense ego-state expression with a supportive therapist, aims to exhaust bound-up reactions, and is followed by interpretation, ego strengthening and reintegration. Two placebo-controlled trials followed patients up to 3 months and 16–18 weeks [source: Barabasz et al. 2012 poster; Christensen 2012; Barabasz et al. 2013 and Christensen et al. 2013 abstracts via science.gov].
Steps: Not reproduced: the content of the five phases is not publicly available [uncertain]. Use only with the published manual (Barabasz, Christensen & Watkins 2010; procedure summarised in Barabasz, Barabasz & Watkins, Part 2) and specialist hypnosis training. The readiness criteria, closure and the overwhelm response in Sections 4 and 5 apply in full [synthesis].
Watch for: Intense formats demand the strictest screening (Section 3) and planned aftercare [synthesis].

4.24 Ego states in families and couples

Purpose / when: Ch. 16 (German ed. pp. 274–277) covers interpersonal perspectives, ego-state family therapy, partners' ego states, and ego states and the law [source: TOC; content unconfirmed, uncertain]. Emmerson's ego state therapy also lists couples counselling as an application (pp. 128–135) [source: Emmerson 2007, publisher sample, table of contents only]. No published step-by-step procedure for this work is available in the sources used here; use the general contacting, mapping and negotiation steps (4.4–4.8) only within your own couple or family training [synthesis].
Steps [synthesis]:
1. Help partners notice which of their states engage with each other in recurring fights, such as a "hurt child" meeting a "critic".
2. Coach each partner to bring their adult state forward.
Watch for: Disclosure of violence, which takes priority over the parts framing.

5. Handling problems

Protector resistance (states block access, spoil imagery, shut down feeling).

Source-based [source: ch. 14]:

Treat the block as a state with a reason.
Contact it, affirm its intent and trace its origin.
Ally with its goal.
Make small openings rather than a frontal attack.
Check how it reacted after each step.
Choose your tone to fit it; firmness can work better than soothing with a contemptuous protector.

[synthesis]:

Ask the protector what it would need to see before allowing the next step.
Agree a "test" step it controls.

A state will not come forward, or nothing happens in trance.

Switch to conversational naming or the chair method (4.5) [source: Wikipedia; Emmerson 2007, pp. 27–30].
Use expressive channels such as drawing, body exercises or finger painting when words freeze [source: ch. 14].
Accept "not ready" finger signals [synthesis].
Low hypnotisability is not a failure; the methods can be done without trance [source: Abramowitz & Torem 2018].

Overwhelm or abreaction getting out of control during bridging or confrontation [synthesis]:

Stop the content and speak in a calm, slower voice.
Move the client to observer position ("step behind the glass") or the safe place.
Ground them: feet on the floor, name objects in the room, temperature, the date. Have them open their eyes if needed.
Re-alert fully and check orientation.
Contain what is unfinished in an imagined container, with agreement to return to it only when ready.
Lower the dose next time (shorter segments, observer position only).
Do not end the session until the client is regulated and oriented.
Agree an aftercare plan and check in by phone if needed.

Krakauer's (2009) cases show that release can flood a dissociative system and that gradual release may be wiser [source: Krakauer 2009].

Dissociation in session (spacing out, unexpected switching, loss of time, a state that does not "go back") [synthesis]:

Ask to speak again with the adult or executive state by name.
Use grounding and re-alerting.
Afterwards, ask whether time was lost.
If dissociative identity disorder or OSDD is suspected, stop abreactive work and return to stabilisation.
Assess, and refer to or consult with a dissociation specialist. Paulsen (2015) notes the retraumatisation risk of processing dissociative clients without parts work.

Self-harm or suicidality emerging in the work [source: ch. 14 for the pattern; response is synthesis]:

Pause depth work.
Run a standard suicide and self-harm risk assessment and a collaborative safety plan, including lethal-means counselling (storage and removal).
Contact the state driving the behaviour about its function, and negotiate safer outlets; ch. 14 used finger signals to find substitutes.
Increase session frequency or involve crisis services as risk requires.

Non-adherence to self-hypnosis or homework [synthesis]:

Ask which part objects to the practice and why.
Shrink the task (two minutes in the safe place).
Offer a recording [source: ch. 14 used one].
If home practice destabilises the client, restrict it to in-session work.

Rupture with the therapist [synthesis]:

Different states may hold different transferences (Watkins TOC: transference, resonance).
Name the rupture and ask which part of the client feels let down or threatened.
Acknowledge your contribution.
Repair with the executive adult and with the affected state.
Check your own resonance: a state may be stirring a counter-reaction in you.

Dependency ("only you can comfort the little one") [source: TOC "dependency"; Degun-Mather 2003]:

Hand the caring role to the client's adult state.
Use transitional objects linked to the client's own resources.
Space sessions out in Stage F.

The client wants to confront a perpetrator in real life, or to report memories that surfaced in hypnosis.

Ch. 14 favours confrontation in fantasy, because real confrontation can leave the internalised figure intact and cause family and legal problems [source: ch. 14].
[synthesis]:
- Explore the decision outside trance.
- Explain that material from hypnosis or bridging may be inaccurate and that hypnosis can affect later testimony.
- Do not validate or dispute specific events.
- Support the client's own decision with legal advice where relevant.
- Follow mandatory reporting duties for any current risk to children or vulnerable adults.

Pressure to "find the memory". Some historical hypnoanalytic practice, including a moment in the ch. 14 case, asked the "unconscious" in trance for a causal memory. Do not do this.

[synthesis]:

Bridging is for affect and meaning, not for retrieving events.
Do not suggest content.
Record reports as the client's experience.
Recovered-memory goals are a reason to refocus on present functioning and stabilisation.

Somatic symptoms (pain, migraine, eating problems) [synthesis]:

Confirm medical assessment first.
Use the somatic bridge and pain-state work only as an adjunct; never replace medical treatment.
Coordinate with the medical team.

Stuck: agreements keep collapsing.

A state may have been left out of the negotiation. Map again (4.7) and ask whether any part disagrees [synthesis].
Check whether the work is moving faster than the protectors allow [source: ch. 14].
Consider whether another approach should come first; Degun-Mather started with CBT and integrated it afterwards [source: Degun-Mather 2003].

Sources

Web sources

Further web sources:

Books and papers cited

Watkins, J. G., & Watkins, H. H. (1997). Ego States: Theory and Therapy. Norton. (German edition: Ego-States: Theorie und Therapie, Carl-Auer, 5th ed. 2025.)
Watkins, J. G. (1971). The affect bridge: a hypnoanalytic technique. International Journal of Clinical and Experimental Hypnosis. (Cited via Lawrence 1998 and Degun-Mather 2003.)
Watkins, J. G. (1990). Somatic bridge, as cited by Lawrence (1998).
Watkins, H. H. (1980). The silent abreaction. International Journal of Clinical and Experimental Hypnosis, 28(2), 101–113. (Via Krakauer 2009.)
Watkins, J. G., & Watkins, H. H. (1979). Ego-state therapy, as cited by Abramowitz & Torem (2018).
Barabasz, A., Barabasz, M., Christensen, C., French, B., & Watkins, J. G. (2013). Efficacy of single-session abreactive ego state therapy for combat stress injury, PTSD and ASD. International Journal of Clinical and Experimental Hypnosis.
Phillips, M., & Frederick, C. (1995). Healing the Divided Self. Norton.

Added in the October 2026 re-check:

Barabasz, A., Barabasz, M., & Watkins, J. G. (2012). Single-session manualized ego state therapy (EST) for combat stress injury, PTSD and ASD, Part 1: the theory; Part 2: the procedure. (Journal articles; abstracts only, via science.gov.)
Barabasz, A., Christensen, C., & Watkins, J. G. (2010). Manual for abreactive ego state therapy, as cited by Christensen (2012).
Christensen, C., Barabasz, A., & Barabasz, M. (2013). Efficacy of abreactive ego state therapy for PTSD: trauma resolution, depression and anxiety. (Abstract only, via science.gov.)
Barabasz, A. (2013). Evidence-based abreactive ego state therapy for PTSD (review). (Abstract only, via science.gov.)
Peichl, J. (2012). Hypno-analytische Teilearbeit: Ego-State-Therapie mit inneren Selbstanteilen. Klett-Cotta.
Peichl, J. (2018). Integration in der Traumatherapie: Vom Opfer zum Überlebenden. Klett-Cotta.
Fritzsche, K., & Hartman, W. (2010). Einführung in die Ego-State-Therapie. Carl-Auer. (Via review.)
Steele, K. H. (1989). A model for abreaction with MPD and other dissociative disorders. Dissociation, 2(3), 151–159. (Abstract only.) Emmerson, G. (2007). Ego State Therapy. Crown House. (Publisher sample.)

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