Friday, July 01, 2011

The Developmental Needs Meeting Strategy (DNMS) - An Ego State Psychotherapy for Healing Childhood Wounds

One of the new therapies I have been learning as an intern at the Southern Arizona Center Against Sexual Assault (SACASA) is called The Developmental Needs Meeting Strategy (DNMS) - An Ego State Psychotherapy for Healing Childhood Wounds. This feels like a useful addition to the parts work models that currently exist - I like that it is more embodied (with the bilateral stimulation), although it feels more rigid to me in some ways.

Some of this also sounds a little woo - even the art is very off-putting to me, but they have been putting this model to the test, with two published papers so far, and I think there are more in the works.

Here is a brief introduction from the main page of their website:
The DNMS is an ego state therapy designed to treat a wide range of clients, symptoms, and issues. This includes adults with complex trauma wounds, such as those inflicted by verbal, physical, and sexual abuse; and with attachment wounds, such as those inflicted by parental rejection, neglect, and enmeshment. The DNMS is based on the assumption that the degree to which developmental needs were not adequately met is the degree to which a client is stuck in childhood. It starts by guiding clients to establish three internal Resources: a Nurturing Adult Self, a Protective Adult Self, and a Spiritual Core Self. Together these Resources gently help wounded child ego states get unstuck from the past by meeting their unmet developmental needs, helping them process through painful emotions, and by establishing an emotional bond. Alternating bilateral stimulation (made popular by EMDR therapy) is applied at key points in the process. The DNMS focuses special attention on healing maladaptive introjects (ego states that mimic abusive, neglectful, or dysfunctional caregivers). Since these wounded ego states cause the most trouble for clients, their healing results in a significant benefit. As introjects heal, clients report unwanted behaviors, beliefs, and emotions diminish.
You can watch a pretty in-depth slide show introduction to the basics of the model by clicking this link: The DNMS Slide Show.

There is also a longer introduction to the model (which can be downloaded as a PDF) that offers a good overview. Here is the beginning of that introduction.

The DNMS: What It Is and How It Works

Click here for a seven-page printable PDF version of this document.


The DNMS was developed by Shirley Jean Schmidt, MA, LPC, a psychotherapist in private practice in San Antonio, Texas. It is a therapeutic approach based on what is known about how a child’s brain develops within a healthy family. It was designed to treat present-day problems that originated with unmet childhood needs. The DNMS has been found helpful for treating depression, anxiety, panic disorder, social phobias, substance abuse, complex post-traumatic stress disorder, relationship problems, obsessions/compulsions, sexual abuse, eating disorders, dissociative disorders, borderline personality disorder, sexual addiction, self-injurious behavior and complicated grief. It has also been used to resolve memories of painful physical, emotional, or sexual traumas that were inflicted by a person. A brief explanation of this therapy, its specialized terminology, and the concepts it is built on are presented here.

Getting Stuck in Childhood

Children grow and develop in stages. Each developmental stage involves a set of needs that should be met by parents or caregivers. The degree to which developmental needs were not adequately met is the degree to which a person may be stuck in childhood. Being stuck means that behaviors, beliefs, or emotions connected to unresolved childhood experiences can still be triggered today. For example, a person who feel confident one minute may, after something upsetting happens, suddenly see the world through the eyes of a sad, angry, or fearful child. This may explain why people have behaviors, beliefs, or emotions that they do not like or want, but which they cannot stop.

A person may become stuck in childhood after experiencing:

  • verbal, physical, and/or sexual abuse;
  • physical and/or emotional neglect;
  • unmet developmental needs; and/or
  • unskillful or inadequate parenting.

A child may become stuck even if loving, well-meaning caregivers fail to parent well enough, because:

  • a child’s needs are particularly complex or obscure,
  • a caregiver has unresolved emotional issues,
  • a caregiver is under extreme stress, and/or
  • there are hardships which make it impossible for a caregiver to meet needs he/she would otherwise be able to meet (e.g. financial problems, health problems, natural disasters, war).

Children get confused when their needs are ignored, misunderstood, or trivialized – intentionally or unintentionally. When this happens often enough, a child will get stuck in those experiences. When there is a good match between a child’s needs and a caregiver’s parenting skill, the child will grow up feeling secure. When such a match is not so good, a child may grow up feeling wounded.

Parts of Self

Everyone has parts of self. Perhaps you have experienced ambivalence, where one part of you wants to eat cake while another part wants to diet. You may have noticed that you have different states of mind for different roles – perhaps you have a professional work self, which is different from a playful parent self, which is different from a romantic spouse self.

Some parts of self form when positive experiences happen. These are healthy parts of self that live in the present. Likewise some parts of self form when upsetting experiences happen, such as parental abuse, rejection, or neglect. These wounded parts of self are stuck in the past. Parts of self that are stuck in the past can have competing agendas, which lead to internal conflicts. These conflicts can generate unwanted behaviors, beliefs, and emotions. The DNMS aims to calm such internal conflicts by getting wounded parts of self unstuck.

DNMS Resource Parts of Self

In the DNMS, special guided meditations are used to help a client connect to three Resource parts of self: a Spiritual Core Self (or Core Self), a Nurturing Adult Self, and a Protective Adult Self.

The Spiritual Core Self: This Resource is considered the core of one’s being. It is the part of self experienced during meditation, prayer, yoga, peak spiritual experiences, enlightening near-death experiences, and profound connections with nature. Some people believe this is a part of self that existed before the body arrived and will exist after the body dies. The following qualities, commonly experienced during deep prayer or meditation, are characteristic of the Spiritual Core Self.

- Sense of interconnectedness to all beings
- Sense of completeness and wholeness
- Sense of safety and invulnerability
- No ego, no struggles
- Non-judgmental, non-critical
- All things and events are equally special
- No desires or aversions
- Unconditional, effortless happiness
- Unconditional, effortless acceptance
- Unconditional, effortless loving kindness, compassion
- Timeless, cosmic wisdom and understanding
- Timelessness; present moment is precious and full

For those of faith, this Resource would be the part of self that resonates with divine love from a higher power. Connecting to this Resource does not require a belief in God or spirituality. Clients averse to notions of faith are guided to connect to a Core Self.

The Nurturing and Protective Adult Self: Most people have all the skills needed to be a good enough care giver, whether they are aware of it or not. A caregiver skill that was applied just once in the past can be applied again in the future. The DNMS uses two guided meditations to heighten awareness of these skills. One meditation strengthens a Nurturing Adult Self (a part of self that can competently nurture a loved one), the other strengthens a Protective Adult Self (a part of self that can competently protect a loved one). The process is anchored in a personal memory of a meaningful relationship – current or past – a favorite time when all or most of the skills on a list of 24 caregiver skills and traits (e.g. empathy, understanding, patience, compassion, courage)were naturally, effortlessly, and appropriately applied.

The Healing Circle: Once a client has established each Resource, all three are invited to come together as a team, to form a Healing Circle. Later, wounded child parts will be invited inside the Circle where the Resources will provide the emotional repair necessary to help them get totally unstuck.

Reactive Parts of Self

Child parts that form in reaction to wounding caregivers are called reactive parts. Some reactive parts hold raw emotions, like anxiety, terror, anger, sadness, hopelessness, grief, despair, and shame. Some hold details of traumatic experiences. Some reactive parts engage in “coping” behaviors such as overeating, starving, complying, intimidating, overachieving, drinking, withdrawing, etc. All reactive parts have good intentions, no matter how problematic their behavior may be. Clients notice the problems created by reactive parts. These are the problems they want therapy to fix, such as: depression, withdrawing, perfectionism, eating disorders, substance abuse, anxiety, anger, and trauma memories.

Maladaptive Introjects

It is normal for a child to be curious, engaged, and eager to observe and learn from caregivers. Children automatically and unconsciously form mental representations that mirror the caregivers they observe. These mental representations are called introjects. When children mirror caregivers who are supportive, loving, and kind, they thrive. But when children mimic caregivers who are unkind, neglectful, abusive, rejecting, or unable to meet developmental needs, they suffer.

Child parts that mirror wounding caregivers are called maladaptive introjects. These introjects can act out the same abuse, neglect, or dysfunction on other people and/or reactive parts. This is like a child wearing a costume he/she does not like but cannot take off; or playing a role he/she does not like but cannot stop playing. The costume’s message does not match the child’s true nature – to be in respectful harmony with self and others. Maladaptive introjects are very wounded and stuck in the past. Newly discovered mirror neurons appear to explain how this happens. It is not a choice; it is a biological reflex.

In childhood, many unwanted behaviors, beliefs, and emotions get generated by reactive parts in reaction to wounding caregivers. These same behaviors, beliefs, and emotions can be perpetuated by maladaptive introjects – both in childhood while the caregivers are still around, and in adulthood, long after the caregivers are gone.

When stressful experiences happen in adulthood, the maladaptive introjects that formed in childhood can get activated, and deliver a caregiver’s wounding message to reactive parts. This keeps the reactive parts overreacting.

Getting Unstuck

The DNMS focuses a lot of attention on getting maladaptive introjects totally unstuck by guiding the Resources to provide them the emotional repair they need to heal. This repair work involves meeting needs, processing through painful emotions, and establishing an emotional bond. As the Resources provide for these needs, the introjects begin to feel safe, wanted, and loved. As they heal, they stop mirroring the wounding caregiver and begin to express their own good true nature instead. Because their good true nature does not evoke internal conflicts, it does not aggravate reactive parts. As maladaptive introjects heal, they transform into parts of self that are loving and supportive. As they get totally unstuck, the associated reactive parts experience great relief, and their unwanted behaviors, beliefs, and emotions abate.

Clients are then better prepared to respond to adulthood stressors without wounded child parts overreacting. Clients can simply respond to their world from their most adult self.

There's more - go read the rest. For those who are interested, there is also a book, a home study course, and trainings.

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