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Back to Reality

In my article Time Out of Mind (Toronto, Ellen L. K. (2009).  Time Out of Mind: Dissociation in the Virtual World. Psychoanalytic Psychology.  26 (2) 117-133. ), I discuss the idea that the virtual world with its myriad of personae and infinite variety of props, settings, and storylines appears, in fact, tailor-made for someone who, although able to function, does so by means of dissociative defenses. DSMIV-TR defines dissociation as a break in the normally integrated functions of consciousness, memory, identity or perception of the environment, (American Psychiatric Association, 2000).  The Psychodynamic Diagnostic Manual (PDM Task Force, 2006) understands dissociative disorders as a diminution or lack of the ability to synthesize information from their various senses (sight, sound, smell, touch) into an integrated experience of what is happening to them. Complex social experiences and their associated affective states cannot be taken for granted but may be split off or perceived as alien. Wilkinson (2005) addresses the multiplicity of definitions of the phenomenon and suggests that it reflects the complexity of what analysts may experience as they work with patients who dissociate.  Fonagy and Target (1995) also note the complexity of psychological states one may encounter in working with dissociative disorders

Dissociative States.

For the purposes of this discussion, I would like to stress the view of dissociation expressed by Schore (2001), Siegel (2003) and others as a disruption in the development of agency or self, that is, a relational, inter-subjective self that has emerged from the earliest and most fundamental experiences of relating. When that early experience supports the infant in the management of physiologic and affective states, minimizes unsettling ruptures and provides an option for the reparability of inevitable failures, he or she is able to construct a more or less continuous biographical narrative. In the absence of secure human relatedness (Bromberg, 1994) and a stable, though largely nonverbal and unconscious, foundation for internal affect-regulation, the individual splits off intolerable feeling states, giving up an experience of wholeness in order to go on. The ability to act from a cohesive sense of agency is not destroyed but re-packaged in unlinked states as “time out of mind.”

Unable to hold in conscious thought the intolerable and conflicting feelings of love and hate, guilt and reparation, the person functions by splitting off unmet needs or unmanageable affect, defining it as “out there”, a part of the not-me experience. The individual may be able to maintain contact with reality but does so by severely distorting a sense of self, agency and relationships with others. In Kleinian terms (Envy and Gratitude, 1980) he or she occupies the paranoid-schizoid position in which projected parts of the self can be managed by controlling another person or another action figure in a video game. Aggressive impulses are assigned to someone else. The individual becomes the object of projected persecution and feels justified in seeking revenge for injustices. It becomes a narcissistic adjustment in which the normal give-and-take of relationships is minimized or, shall we say, deleted.

Transition to Reality

The therapeutic task requires that patient and therapist co-construct a transitional reality within which faith in the reliability of human relatedness can be restored. It requires interpersonal engagement that combines affective honesty and safety. The goal is to provide a foundation of reparability that allows for successful negotiation of interpersonal transactions that are essential to the rebuilding of trust. We may explore the destructive or addictive behavior but we also seek to disengage it from the underlying self-state which has had to be preserved in the interests of psychic survival. (Davies and Frawley, 1994; Bromberg, 1995) In the absence of reliable caregiving the individual has learned to substitute dissociative defenses such as excessive involvement in the virtual world as a way of regulating helplessness, desire, and the relative unpredictability of human contact. The therapeutic aim is to search for the relational bind embedded in the computer use, formulate it as a conflict in symbolic terms, and explore it within the new relationship developed in the transference. (Director, 2005)



Bromberg, Philip M. (1995). Psychoanalysis, Dissociation and Personality Organization: Reflections on Peter Goldberg’s Essay. Psychoanalytic Dialogues, 5(3), 511-528.

Davies, J.M. and Frawley, M.G. (1994). Treating the Adult Survivor of Childhood Sexual Abuse. New York: Basic Books.

Director, Lisa (2005). Encounters with Omnipotence in the Psychoanalysis of Substance Users. Psychoanalytic Dialogues, 15(4), 567-586.

DSM IV (1994). American Psychiatric Association.

Fonagy, Peter and Mary Target (1995). Dissociation and Trauma. Current Opinion in Psychiatry: Volume 8 (3) pp. 161-166.

Klein, M. (1980) Envy and Gratitude. London: The Hogarth Press.

Shore, A. N. (2001). Minds in the Making: Attachment. The self-organizing brain, and developmentally-oriented psychoanalytic psychotherapy. British Journal of Psychotherapy, 17, 3, 299-328.

Siegel, D. J. (2003) An interpersonal neurobiology of psychotherapy. In eds. M. F. Solomon and D. J. Siegel, Healing Trauma. New York: Norton.




Wilkinson, Margaret (2005). Undoing dissociation: Affective neuroscience:a contemporary Jungian clinical perspective. Journal of Analytic Psychology, 50, 483-501.


Winnicott, D. (1974). The Mirror Role of the Mother and Family in Child Development: Playing and Reality, England: Penguin.
































Back to Reality

Ellen Toronto, Ph.D.

Dr. Ellen Toronto is a licensed clinical psychologist/psychoanalyst in the state of Michigan.

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APA Reference
Toronto, E. (2020). Back to Reality. Psych Central. Retrieved on March 29, 2020, from


Last updated: 23 Jan 2020
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