The Developmental Needs Meeting Strategy:

Eight Case Studies

Shirley Jean Schmidt, MA, LPC, Private Practice and
Arthur Hernandez, PhD, University of Texas at San Antonio

Published in the March 2007 issue of Traumatology,

Volume 13, Issue 1, pages 27-48

Traumatology is an on-line journal published by Sage Publications

2455 Teller Road, Thousand Oaks, CA 91320 http://www.sagepub.com/

Abstract

This study investigates the merits of the Developmental Needs Meeting Strategy (DNMS), a relatively
new ego state therapy. The DNMS is based on the assumption that many presenting problems are
due to wounded ego states stuck in childhood because of unmet developmental needs. DNMS
protocols endeavor to identify and heal the wounded child parts most responsible for a presenting
problem. When internal Resource ego states, which serve as competent caregivers, meet the
wounded ego states’ developmental needs, the wounded ego states become unstuck and heal. Eight
participants were recruited from the private practice caseloads of 3 DNMS therapists. All participants
reported significant improvement in the targeted problems, with gains maintained at follow-up.
These findings suggest that the DNMS has therapeutic potential.

Acknowledgments

The first author (SJS) wishes to thank Ricky Greenwald, PsyD for his significant contribution to the
design of this study and the preparation of this manuscript; and Joan Bacon, MA, licensed psychologist
and Richard Holcomb, MA, MBA MNZPsS, AAPA, Registered Psychologist, for their skillful
contribution to this study as DNMS practitioners.

Address correspondence to:

Shirley Jean Schmidt, MA, LPC,
DNMS Institute, 6421 Mondean St, San Antonio, TX 78240;
e-mail: sjs@dnmsinstitute.com.
DNMS: Eight Case Studies Page 2 of 20

The Developmental Needs Meeting Strategy:

Eight Case Studies

Shirley Jean Schmidt, MA, LPC, Private Practice and

Arthur Hernandez, PhD, University of Texas at San Antonio

The Developmental Needs Meeting Strategy (DNMS; Schmidt, 2005) is a relatively new psychotherapy. Its development
has been informed by a number of well-known therapies and disciplines, including ego state therapy, inner-child
work, Eye Movement Desensitization and Reprocessing (EMDR), neuroscience, attachment theory, and developmental
psychology. The DNMS is grounded in the premise that children grow and develop in stages and that each
developmental stage involves specific needs that must be met by parents or caregivers. It assumes that the degree to
which childhood needs were not adequately met at a given developmental stage is the degree to which the adult
client is “stuck” in that stage (Erikson, 1950; Illsley-Clarke & Dawson, 1998; Maslow, 1968). Being stuck means that
behaviors, beliefs, or emotions connected to unresolved childhood wounds can get triggered today. For example, a
person may feel like an adult one minute – then something upsetting happens and the person suddenly sees the world
through the eyes of a sad, angry, or fearful child. The DNMS aims to remediate the developmental deficits at the root
of such reactions.

Ego State Therapy

The notion that we are composed of ego states, subpersonalities, or parts of self has been around since Freud
(1923/1961) proposed the id, ego, and superego. Many therapy approaches use ego state theory principles, including
Psychosynthesis (Assagioli, 1975), Transactional Analysis (Berne, 1961), the SARI Model (Phillips & Frederick, 1995),
Internal Family Systems Therapy (Schwartz, 1995), Voice Dialogue (Stone & Stone, 1993), Ego State Therapy (Watkins
& Watkins, 1997), and Inner Child Psychotherapy (Bradshaw, 1990; Capacchione, 1988; Napier, 1990). These
models share the premise that different ego states can have different views of reality. Each approach aims to help
individual ego states heal and to increase healthy communication and cooperation between ego states.
The DNMS is also an ego state therapy. It differentiates two classes of wounded ego states: reactive parts and
maladaptive introjects. Reactive parts are wounded child ego states that evolve in reaction to significant childhood
role models who are physically or emotionally wounding. For example, a fearful reactive part may evolve in reaction
to a violent father, or a sad reactive part may evolve in reaction to a rejecting mother. Some reactive parts hold painful
emotions such as fear, sadness, shame, or anger. Some clients cope with these emotions with pain-avoidant behaviors
such as withdrawing, drinking, or overeating. Some clients try to manage hurtful people with strategic behaviors such
as pleasing, complying, or overachieving. Typical reactive part descriptions include angry, ashamed, bossy,
compliant, controlling, drinker, fearful, frozen, helpless, invisible, lonely, numb, overeater, perfectionist, protector,
pleaser, powerless, rebel, sad, self-critical, self-punishing, stoic, traumatized, vigilant, and withdrawn. Clients often
seek therapy to address the problems that stem from the unwanted behaviors, beliefs, and emotions of reactive parts
(see Figure 1).

Figure 1. In childhood, reactive parts form in reaction to wounding caregivers.

DNMS: Eight Case Studies Page 3 of 20

Internal representations of significant role models, such as primary caregivers, are called introjects (Watkins &
Watkins, 1997). These are the parts of self that act like or mimic those role models. This can be adaptive and healthy
when a role model is supportive, loving, and kind, or it can be problematic when a role model is unkind, neglectful,
abusive, or enmeshing (Siegel, 2003). The child parts that mimic role models (e.g., parents) who are physically or
emotionally wounding are called maladaptive introjects.
The DNMS model conceives of introjection a little differently from other ego state models. Children naturally
evolve internal representations of their caregivers. The development of these internal representations is not a decision,
it simply happens. It appears to be biologically driven by mirror neurons (Ramachandran, 2000; Rizzolatti & Gallese,
2002). In DNMS language, the creation of an internal representation in a developing brain starts with a blank slate
neural network.1 This neural network is a collection of mirror neurons before mirroring begins. It is the brain’s
potential to mimic someone. In a young person, this blank slate could be considered a child ego state with a point of
view – to be curious, engaged, and eager to learn from role models and whose true nature is to be in respectful
harmony with self and others (Montessori, 1936). The internal representation of a neglectful, abusive, or enmeshing
caregiver will not integrate well because it does not match the child’s true nature. Instead it will integrate
superficially, like a child reluctantly wearing a (metaphorical) mask that mimics the dysfunctional caregiver’s
behaviors and words. The child part wearing the mask does not like the mask’s behavior or words, and if given a
choice, would not choose that behavior (see Figure 2).

Figure 2. In childhood, maladaptive introjects reluctantly mimic wounding caregivers.

When an adult is under stress, maladaptive introjects can convey to reactive parts the same wounding
messages the caregivers conveyed in childhood. Maladaptive introjects keep the reactive parts stuck in childhood and
the adult client stuck in unwanted behaviors, beliefs, and emotions (see Figure 3).

Figure 3. In adulthood, maladaptive introjects under stress can convey wounding messages to reactive parts.

1
A “blank slate neural network” includes a child’s temperament and genetic predispositions.
DNMS: Eight Case Studies Page 4 of 20

The DNMS protocols help find and liberate the innocent child from under the mask. As the child part gets
unstuck from the past, the mask disappears along with the wounding messages the mask was conveying. Once
unstuck, this child part can finally live authentically, from a natural inclination to be in respectful harmony with self
and others. The cessation of the wounding message is a great relief to the associated reactive parts, who no longer
need to react with the usual unwanted behaviors, beliefs, and emotions. The client can then handle the stress with
adult skills and strengths (see Figure 4).

Figure 4. After the DNMS protocols get maladaptive introject unstuck, the associated reactive parts experience relief.

The Treatment Protocols

There are three main DNMS protocols: a Resource Development Protocol, an Ego State Mapping Protocol, and a
Needs Meeting Protocol. These protocols are described in detail elsewhere (Schmidt, 2005). The Resource
Development Protocol provides a set of special DNMS meditations, used systematically to help clients connect to and
strengthen three internal “resource” ego states: a Nurturing Adult Self, a Protective Adult Self, and a Spiritual Core
Self. These Resources, which join together to form a Healing Circle, assume competent caregiver roles.
The Ego State Mapping Protocol is used to identify (a) the messages conveyed by childhood caregivers that
inspired a current problem, (b) the reactive parts that formed in reaction to the caregiver message(s), (c) the
maladaptive introject(s) that mimicked the caregiver message(s), and (d) how stuck each reactive part is, 0 to 10, with
respect to the introject message (see the Results section for a sample map).
The Needs Meeting Protocol has 20 steps. Throughout this structured protocol, the client holds a mental
picture of the Resources in proximity to a maladaptive introject (the source of a current problem). While holding this
mental picture, the therapist facilitates reparative communications between these ego states. The Needs Meeting
Protocol begins when the maladaptive introject is invited into the Healing Circle. Once there, the child under the
mask is prompted to name her unmet needs. The therapist invites the child to notice that the Resources can meet
those needs for her now. The Resources meet many needs, one at a time – simple needs, such as love, attention,
connection, validation, and protection, and more advanced needs, such as guidance, age-appropriate responsibility,
and information about the world. In the next step, the Resources meet needs specifically connected to anger and
sadness to help the child part work through those strong emotions. Next, the child part is invited to notice an
emotional bond with each Resource, individually and as a group, to help the child part feel securely attached. Over
the course of a typical Needs Meeting Protocol, between 15 and 30 needs are met by the Resources. Collectively,
these steps and others provide the needed “corrective emotional experiences” (Alexander & French, 1946). As the
protocol proceeds, clients report that the introject mask becomes incrementally smaller and less important, until it
eventually disappears. At the same time, the child appears calmer and happier – incrementally more like a carefree
child who is securely attached to competent caregivers. By the end of the protocol, a child part is totally unstuck from
the mask and the message that had been delivered by the mask, and likewise totally unstuck from childhood. When
this is complete, clients typically report significant improvement in the original problem. (For a more detailed
description of this protocol, see the Results section, Case #1.)

Alternating Bilateral Stimulation

Alternating bilateral stimulation (ABS) is used throughout the DNMS to strengthen all positive experiences (including
enhancing internal resources and positive beliefs about self). Shapiro (1989) discovered that rapid side-to-side eye
DNMS: Eight Case Studies Page 5 of 20

movements could be used to facilitate trauma desensitization. Eye movements became a cornerstone of the EMDR 8-
Phase Protocol. Shapiro also observed that rapid eye movements could also help strengthen positive beliefs about self.
In clinical practice, both alternating bilateral tactile and auditory stimulation were found to be effective alternatives to
eye movements (Shapiro, 2001). All three modalities are considered forms of ABS.
Greenwald (1993) and Leeds (1998) have explored the use of ABS to strengthen positive personality traits.
Greenwald proposed using ABS to strengthen a client-generated image representing the psychological resource
necessary for successful EMDR processing. Leeds introduced the term Resource Development and Installation (RDI)
to describe his EMDR-related protocol for using ABS to strengthen positive images, memories, and symbols. In two
single case design studies, Leeds’s RDI protocol was found to be an effective intervention for clients with complex
posttraumatic stress disorder in the preparation phase of EMDR (Korn & Leeds, 2002). In the study, ABS was used to
enhance a positive felt sense of internal resources and to strengthen the probability clients would use their resources
to manage future stressors. Schmidt (1999) developed an ABS protocol for integrating ego state therapy and art
therapy. Clients were directed to shift their eyes back and forth between artistic representations of resource ego states
and wounded child ego states to facilitate healing.
The application of ABS in a therapeutic intervention does not make that intervention an “EMDR therapy.”
Therefore, even though DNMS uses ABS, it is not EMDR, and it is not a variation of EMDR. These approaches are
distinctly different. DNMS protocols are focused primarily on repairing developmental deficits, whereas EMDR
protocols are focused primarily on resolving trauma memories. Other than the use of ABS, the DNMS and EMDR
protocol steps share little in common. Clinical observation suggests that DNMS clients may process more deeply or
quickly when ABS is present, but DNMS sessions without ABS have also been successful. ABS does not appear to be
as important to the DNMS protocols as it is to the EMDR and RDI protocols.

What the DNMS Treats

Many clients report present-day problems that clearly link to wounds inflicted in childhood. Unresolved childhood
abuse (verbal, physical, or sexual), neglect (physical or emotional), enmeshment, and unskillful/ inadequate parenting
are all indicators of unmet developmental needs. But not all presenting problems are linked to unmet childhood
needs. Unwanted symptoms can come from organic brain dysfunction (e.g., schizophrenia), acute trauma (e.g.,
stranger rape), chronic physical stress (e.g., chemotherapy), and inherent temperament (e.g., hypersensitivity). These
conditions can be exacerbated when unmet developmental needs are also a source of problems. The DNMS appears
to relieve symptoms only to the degree the symptoms are linked to unmet developmental needs. Whereas many
clients are drawn to the DNMS, some are not. For example, some clients reject the idea of parts of self, some are
dead-set on a particular intervention (e.g., EMDR, hypnosis, CBT) and refuse to discuss DNMS, and some need basic
help (e.g., personal safety interventions) more than DNMS.
DNMS can treat motivated clients regardless of initial diagnosis or ego strength. Clients with a lot of ego
strength and few unmet developmental needs will generally progress more quickly with the DNMS than clients with
little ego strength and many unmet needs. Nevertheless, the same DNMS protocols can be used for a wide range of
cases – from simple to complex. Clinicians have reported finding the DNMS helpful for treating depression, anxiety,
panic disorder, social phobias, substance abuse, complex PTSD, relationship problems, obsessions/compulsions,
sexual abuse, eating disorders, dissociative disorders, borderline personality disorder, sexual addiction, self-injurious
behavior, and complicated grief.

DNMS DID Case Study Report

Schmidt (2004) described the use of the DNMS for the treatment of dissociative identity disorder (DID). The client,
Lisa, had a childhood history of chronic neglect and abuse, including sexual abuse. She began DNMS therapy a few
days after being released from a psychiatric ward, where she had been admitted for a deep depression with significant
suicidal ideation. Symptoms of severe anxiety, depression, and alcohol and cocaine abuse had been present for years
prior to DNMS treatment. None of her prior hospitalizations, drug therapies, or psychotherapies had alleviated her
symptoms. The DNMS treatment initially focused on meeting the developmental needs of ego states stuck in
childhood – both introjects and reactive parts.2 Nine months into DNMS treatment, it became apparent that Lisa
suffered from DID. Then DNMS treatment shifted to meeting the developmental needs of the alters who were creating
the most problems, internally and externally. As each wounded ego state and alter became unstuck, Lisa made
tremendous progress. Seventeen months into her treatment, she reported a near total elimination in frequency and

2
As the DNMS has evolved, it has become clear that getting reactive parts unstuck is not nearly as beneficial as getting introjects unstuck. Now
DNMS protocols are focused exclusively on targeting introjects.
DNMS: Eight Case Studies Page 6 of 20

severity of symptoms of depression and anxiety. Her Trauma Symptom Inventory (TSI; Briere, 1995) scores were in
the non-clinical range. Her scores on the Multidimensional Inventory of Dissociation (MID; Dell, 2003), an instrument
designed for diagnosing dissociative disorders, indicated she no longer met the diagnostic criteria for DID. At the start
of therapy, she was taking drugs for depression, anxiety, sleeplessness, and psychosis, and by 18 months after the start
of DNMS treatment, she was off all medications and functioning well without them. A follow-up examination
revealed that the original gains have been maintained (Schmidt, 2006b).

Hypothesis Tested in This Study

This study investigated the hypothesis that using the DNMS to treat problem behaviors and emotions that originated
in unmet developmental needs would lead to a significant reduction in those behaviors or emotions and in the
associated negative beliefs.

METHODS

Three experienced DNMS therapists, all in private practice, provided the treatments for the 8 participants in this
study. In preparation for this study, the first author held a special research/certification workshop to (a) provide
training on the research protocol and (b) test knowledge of and fidelity to the DNMS protocols. These therapists met
or exceeded the minimum criteria for becoming a certified DNMS therapist (competent practitioner) at the conclusion
of the workshop (Schmidt, 2006c).

Research Participants
Although the DNMS can be effective with unstable, low-functioning clients (Schmidt, 2004), they usually need longer
term therapy. Because we planned to collect outcome data within a 12-month period, participants were limited to
those considered “stable and reasonably high-functioning.” Clients who met any of nine exclusionary criteria were not
eligible for the study. Participants who met any one of the exclusionary criteria after enrolling in the study were
dropped from the project (but not from treatment). Clients were excluded from the study if:
1. They were overwhelmed by neutral stimuli or small triggers.
2. They could not self-soothe after being triggered.
3. They needed more than 300 minutes to get one ego state unstuck (cumulative over the course of many sessions).
4. Their emotional instability made working through processing blocks especially time-consuming.
5. They did not attend sessions consistently or regularly.
6. They needed substantial session time for debriefing about current events/crises, leaving little time for DNMS.
7. They routinely scheduled sessions more than 4 weeks apart.
8. They had one or more significant experiences during the data collection period, which made it difficult to
attribute psychological and physiological changes to the DNMS (e.g., radical change in drug therapy, sudden
debilitating illness, acute trauma, etc.).
9. Their presenting problems were unrelated to unmet developmental needs.
Criteria 1 to 4 were used to screen for clients who were not sufficiently “stable and reasonably high-
functioning” to complete the study within 12 months. Criteria 5 to 7 were used to ensure that the participant’s DNMS
experiences were frequent enough, or intensely focused enough, to account for any positive changes reported.
Criterion 8 was used to screen out obvious confounding variables. Criterion 9 was used to ensure that the DNMS was
an appropriate intervention for treating the presenting problem.
Except for exclusion #9, these restrictions are not at all relevant to the application of the DNMS in normal
clinical practice. These limitations were only applied to ensure a sampling of participants who could complete their
work within the 12-month time frame of this study.
Participants were recruited from the private practice caseloads of the three DNMS therapists – the first author
(in Texas), Joan Bacon (in Pennsylvania), and Richard Holcomb (in New Zealand). Clients who were not ruled out by
the exclusionary criteria were invited to participate in the study if they had completed the Resource Development
Protocol and were planning to do DNMS needs-meeting work anyway. Participants were not recruited to engage in
DNMS treatment per se; rather, they were recruited to take part in data-collection activities that would systematically
track their progress with the DNMS treatment they elected to get.
DNMS: Eight Case Studies Page 7 of 20

Human Participants Protection

All methods, protocols, and instruments were reviewed and approved by the Institutional Review Board of the
University of Texas at San Antonio. Clients invited to participate were given an informed-consent form to read and
initial. The consent form explained that if they chose to participate, they would be receiving the same therapy
whether they participated in the study or not and would be able to continue with therapy after participation in the
study concluded.

Study Design
In an initial interview, participants were asked the following four questions:
1. What problem or symptom are you most bothered by?
2. On a 0-10 scale, where 0 is “not at all” and 10 is the “worst possible,” how much does this problem/ symptom
bother you? (Greenwald, 1996)
3. What negative belief(s) are associated with this problem/symptom?
4. On a 0-10 scale, where 0 is “not at all true” and 10 is “totally true,” how true does each negative belief feel?
Then these four questions were asked again for two more problems (or one more if participant could not
name two more). Responses were handwritten on the Initial Assessment Interview Worksheet. These answers were
later typed onto a Treatment Progress Report form, which included a preprinted Likert-type scale for each problem
and negative belief listed. At the start of each subsequent session, participants were given the preprinted Treatment
Progress Report form and asked to circle the number, from 0 to 10, that best described the current significance of each
problem and negative belief listed.
One at a time, each problem named in the initial assessment interview was addressed, in order of
importance, with the DNMS Ego State Mapping and Needs Meeting Protocols. (Standard DNMS protocol calls for
processing a client’s most important issue first.) Once all the targeted problems were resolved, and the significance of
each problem and each associated negative belief was rated 0, the treatment portion of the collection process was
complete. The DNMS treatment data were collected over a 12-month period. Follow-up data were collected 15
months after the project began. Follow-up intervals varied from case to case (from 3 months to 1 year), as each of the
8 participants started and finished at different times over the course of this study. Those who finished treatment closer
to the start date provided longer range follow-up than those who completed treatment later.

RESULTS

Of the 8 cases, the first is described in detail and the remaining 7 are summarized. (All participant names have been
changed to protect their identity.) A brief summary of childhood history relevant to the targeted problems is provided
for each participant. Pre-treatment, post-treatment, and follow-up ratings are shown for each case. For the problem
ratings, 0 refers to “not at all a problem” and 10 refers to “worst possible problem.” For the negative belief ratings, 0
refers to “not at all true” and 10 refers to “totally true.”

Case #1: Annie

Annie was a middle-aged, married (but separated) unemployed female. She reported that by age 7 her mother had put
her in charge of raising her four younger siblings. She had no control over her siblings but would be punished when
one of them upset mother. Annie recalled her parents neglected her needs and told her to meet her own needs. Her
father conveyed that a woman’s job was to make men happy. She had developed her Resources and successfully
completed several needs-meeting sessions before enrolling in this study (see Table 1).
Problem 1, “I panic when I perceive I might be controlled by another person,” was addressed first. The
therapist began with the Ego State Mapping Protocol. He wrote the problem statement on the top of a blank ego state
map page and wrote below it the two associated negative beliefs. Annie recalled coming to believe these statements
in childhood while listening to her dad convey, “You’re powerless to get away. You should be a real woman who
wants to do what men tell you to do or else you’re a failure. You should make me happy. You can only go when I let
you go.” She named the two child parts that formed in reaction to dad’s message: “Frozen” and “Panic.” The therapist
drew this on the ego state map. He also drew an introjected dad and explained how a blank slate neural network
(innocent child part) had taken on dad’s persona as a mask. They discussed how his message had generalized
internally to “You’re powerless to get away. You should be a real woman who wants to do what men tell you to do or
else you’re a failure. You should make others happy. You can only go when others let you go.” The therapist
DNMS: Eight Case Studies Page 8 of 20

explained that the mask creates internal distress by delivering dad’s wounding message to reactive parts now. He
asked how stuck each reactive part was, 0 to 10 where 10 equaled totally stuck. Annie reported each reactive part
was stuck at 10. She was told that the DNMS could help the child part wearing the mask get free from the mask and
the message delivered by the mask, by getting all her needs met by the Resources, and that both reactive parts (frozen
and panic) would feel a little or a lot of relief once the child behind the mask was healed. (Figure 5 shows Annie’s
Problem #1 ego state map.)

Table 1. Annie’s Progress Report ratings of problems and negative beliefs

0-10 Ratings
Pre-treatment Post-treatment 6-Mo Follow-up

Problem #1: I panic when I perceive I might be controlled by another person. 10 0 0

Neg Beliefs: 1. If I allow myself to be controlled, it will be worse than being dead 10 0 0
because I can’t stop it. 10 0 0
2. I’m powerless once I’ve agreed to be in a situation, because I can’t get
out.
Problem #2: Excessive need to control and organize others. 9 0 0
Neg Beliefs: 1. I have to control everything or else something bad will happen and 10 0 0
it will be my fault.
Problem #3: Can’t recognize my own needs. 8 0 0
Neg Belief: 1. I don’t deserve care and attention. 8 0 0

Problem #1: I panic when I perceive I might be controlled by another person.

Negative beliefs: If I allow myself to be controlled, it will be worse than being dead because I can’t stop it.
I’m powerless once I’ve agreed to be in a situation, because I can’t get out.

Dad Dad Mask

You’re powerless to get away. You should be a
real woman who wants to do what men tell you
to do or else you’re a failure. You should make
me happy. You can only go when I let you go.
others others

Frozen Panic
How stuck? 10 10
Figure 5. Annie’s Problem #1 ego state map.

When the map was completed, the therapist began the Needs Meeting Protocol. He said, “I’d like to invite, to
approach the Resources, the part of you that mimics dad and conveys his message: ‘You’re powerless to get away.
You should be a real woman who wants to do what men tell you to do or else you’re a failure. You should make
others happy. You can only go when others let you go.’” When Annie indicated the dad introject was approaching the
Resources, the therapist asked the child under the introject mask about her age and mood. She reported she was 9
years old and scared. He invited the 9-year-old to come into the Healing Circle and to bring the angry dad mask
along. Once there, the child’s sense of connection and safety in the Resources’ care was strengthened with ABS. The
child was informed that the Resources could help her get unstuck by meeting her needs now. She was asked, “What
do you need most right now?” The child said, “To be nurtured.” She was then asked, “Can the Resources nurture you
now?” When she said “yes,” the therapist said, “Good, notice that. Take as long as you need to let it strengthen. Tell
me when it’s strengthened all the way.” ABS was applied to help it strengthen. Once fully strengthened, the child part
was asked, “And what else do you need?” The child identified a second need, “acceptance,” and the experience of
DNMS: Eight Case Studies Page 9 of 20

the Resources accepting her was strengthened all the way. This process was repeated with additional needs met,
including “kindness,” “freedom to be myself,” “someone on my side,” “safety,” “security,” and “love.” The therapist
then asked Annie to report on the appearance and mood of the 9-year-old. Annie reported that the mask was getting
smaller and less important and the 9-year-old was no longer scared.
Next, the 9-year-old was invited to work through anger and grief. The therapist asked, “If you could feel anger
about your dad’s message, completely and fully in your body now, how intense would it be, 0-10?” She answered
“8,” and he asked, “Of your dad’s behaviors, which is most connected to that 8?” She answered, “His disrespect.” The
therapist asked, “Can you count on the Resources to treat you with respect now?” When she said “yes,” the therapist
said, “Good. Notice that. Tell me when it’s strengthened all the way.” ABS was applied to help it strengthen. Once
fully strengthened, the child part was again asked to rate the level of anger. This time it was a 6. Again this rating was
linked to an unmet need – a need that was met by the Resources. These steps were repeated. Each time a need was
met, the anger intensity diminished a little more. After a few minutes of meeting anger-related needs, the anger rating
had diminished to 0 – gently, easily, and without lengthy, painful abreactions. This procedure was repeated for sadness.
Once the emotion processing was complete, Annie was asked to report again on the appearance of the 9-year-old.
The mask was completely gone, and the child appeared very happy. Next, the therapist invited the 9-year-old to
notice and strengthen (with ABS) her emotional bond with each Resource, one at a time, and as a group (Napier,
1990; Paulsen, 2000; Steele, 2001). Once the bonds were strengthened, he asked the 9-yearold if she felt “somewhat
unstuck, mostly unstuck, or totally unstuck.” She replied, “Mostly unstuck.”
She was then asked to disconnect from the Resources for a moment, in order to (mentally) revisit being in her
parents’ care, especially her dad’s care, just like it was in childhood, without Resources there to support her, and to
rate any disturbance that came up, on a 0 to 10 scale (10 = worst possible disturbance). The 9-year-old rated the
disturbance a 10. He then asked which of her parents’ behaviors were most connected to the 10. She said, “I can’t get
away from them, I’m trapped and powerless.” The therapist asked, “Are you trapped and powerless in the care of the
Resources now?” She answered “no.” “Can the Resources grant you age-appropriate power and freedom now?” When
she said “yes,” with ABS on, he said, “Good. Notice that. Tell me when it’s strengthened all the way.” This routine
was repeated. Each time the Resources met another need, the disturbance rating decreased. This step was complete
when the 9-year-old reported that she could revisit her dad’s care, without the Resources present for support, without
any disturbing body sensations arising. This step is important because it ensures that the gains reported are due to
more than a temporary feel-good connection to the Resources. It is similar to Peter Levine’s technique of
“pendulating” between comfort and trauma when processing through disturbing memories (Poole Heller, 2001).
Next, the therapist asked the 9-year-old, “Do you know you’re in an adult body now?” The child was invited
to fully recognize the benefits of being in an adult body, in contrast to the perils of being age 9 (Paulsen, 2000;
Twombly, 2000). That awareness was strengthened with ABS. Again the therapist asked the child part how stuck she
felt now, “mostly unstuck or totally unstuck.” She replied, “Totally unstuck.” Annie reported her body felt clear and
relaxed, and she pictured the child doing cartwheels – a free and happy 9-year-old. The therapist asked the child,
“When you think about what we have done today, what you’ve learned and how you’ve grown, what’s a positive
belief you know to be true about you now?” The 9-year-old replied, “I am strong (even when others try to control me).
I can leave bad situations. I can change my mind (even after I’ve agreed to something). It’s okay to do what I want.”
She reported that each of these beliefs felt totally true. These statements were strengthened with ABS. The therapist
then thanked her for her hard work and invited her to “tuck in” (Paulsen, 2000) with the Resources. Returning to the
Ego State Map, she reported each reactive part was totally unstuck with respect to dad’s message. She re-rated
Problem 1 a 0 (not at all a problem), down from 10 (worst possible problem), and both negative beliefs a 0 (not at all
true), down from 10 (totally true). This work was completed in one 115-minute session.
Problem 2, “Excessive need to control and organize others,” was addressed next. As the therapist constructed
the ego state map, Annie recalled her parents conveying the message “You must control your brothers and sisters so
we don’t have to. You must set a good example for your brothers and sisters. You’re in charge. You have to be good,
or else you’re in trouble.” She named five reactive parts that evolved in reaction to this message: “I’m a failure,”
“Stressed out,” “Logical/Analytical,” “Black & White,” and “Anxious.” When the map was complete, the therapist
invited into the Healing Circle the part of her that mimicked mom and dad conveying the generalized message “You
must control (uncontrollable) others, so others don’t have to. You must set a good example for others. You’re in
charge. You have to be good, or else you’re in trouble.” The therapist guided the 7-year-old wearing the mom/dad
mask through the steps of the Needs Meeting Protocol. By the end of the session, Annie reported the dad/mom mask
was gone and the 7-year-old child part and all five reactive parts were totally unstuck. The Problem 2 rating was down
to 0. The associated negative belief rating was also down to 0. This work was completed in one 100-minute session.
Problem 3, “Can’t recognize my own needs,” was addressed next. As the therapist constructed the ego state
map, Annie recalled her parents delivering the message “You’re a nuisance, and a pain in the ass. Your needs are an
DNMS: Eight Case Studies Page 10 of 20

inconvenience, and a trial for us. You shouldn’t be here – you shouldn’t exist. You don’t have any needs. If you are
here, then don’t want anything.” She named six reactive parts that evolved in reaction to this message:
“Unimportant,” “Hindrance,” “Rejected,” “Bewildered,” “Distressed,” and “Pleaser.” When the map was complete,
the therapist invited into the Healing Circle the part of her that mimicked mom and dad conveying the generalized
message “You’re a nuisance, and a pain in the ass. Your needs are an inconvenience, and a trial for others. You
shouldn’t be here – you shouldn’t exist. You don’t have any needs. If you are here, then don’t want anything.” The
therapist guided the 5-year-old child wearing the mom/dad mask through the steps of the Needs Meeting Protocol. By
the end of the session, Annie reported the dad/mom mask was gone and the 5-year-old child part and all six reactive
parts were totally unstuck. The Problem 3 rating was down to 0. The associated negative belief rating was also down
to 0. This work was completed in one 90-minute session.
Once the research data were collected, Annie chose to continue therapy to work on additional issues.
Follow-up data were collected 6 months after her last DNMS research session – all ratings were still 0 (see Table 1).
Shortly after completing these sessions, she reported to her therapist that she was no longer feeling intimidated by
controlling people. She proceeded to divorce her estranged, controlling husband. She began to set and maintain firm
boundaries with her controlling and verbally abusive mother and overly needy sister. She had a longstanding pattern
of over-focusing on others’ needs while ignoring her own. This was evident by the way she over-controlled and
overprotected her teenage children at a time they needed to become more independent. She was able, for the first
time, to give her children age-appropriate responsibilities and freedoms. This significantly reduced family conflicts. She
found that, when she stopped over-focusing on her children, she could start listening to and responding kindly to her
body. She began to take care of herself by appropriately managing activity/ rest cycles and by setting boundaries when
her needs were being compromised. She commented, “Since starting the DNMS, I noticed it’s much more peaceful in
my head. The part that used to react to any idea with ‘you can’t make me’ or ‘you can’t stop me,’ appears to be gone.
What a relief. Once I address an issue, not only does it no longer bother me, but I can’t remember what it was. I can
remember incidents clearly, but the negative emotional response doesn’t exist anymore. This seems to be permanent.”

Summary of Annie’s DNMS treatment

Problem #1 Problem #2 Problem #3

I panic when I perceive I might be controlled by Excessive need to control and organize others. Can’t recognize my own needs.
another person.
Introject message: Introject message: Introject message:
Dad: You’re powerless to get away. You Dad: You must control your brothers and Dad/Mom: You’re a nuisance, and a pain in
should be a real woman who wants to do sisters so we don’t have to. You must set a the ass. Your needs are an inconvenience, and
what men tell you to do or else you’re a good example for your brothers and a trial for us. You shouldn’t be here - you
failure. You should make me happy. You sisters. You’re in charge. You have to be shouldn’t exist. You don’t have any needs.
can only go when I let you go. good, or else you’re in trouble. If you are here, then don’t want anything.
Number of reactive parts on map: 2 Number of reactive parts on map: 5 Number of reactive parts on map: 6
Child part under mask: Nine-year-old under Child part under mask: Seven-year-old under Child part under mask: Five-year-old under
dad mask. dad mask. dad/mom mask.
Once nine-year-old was totally unstuck: Once seven-year-old was totally unstuck: Once five-year-old was totally unstuck:
– Both reactive parts totally unstuck. – All 5 reactive parts totally unstuck. – All 6 reactive parts totally unstuck.
– Problem #1 rated 0. – Problem #2 rated 0. – Problem #3 rated 0.
– Problem #1 negative beliefs rated 0. – Problem #2 negative beliefs rated 0. – Problem #3 negative beliefs rated 0.
Completion time: One 115-minute session. Completion time: One 100-minute session. Completion time: One 90-minute session.

Case #2: Betty

Betty was a married, middle-aged, female graduate student. She recalled that while growing up, her father was
constantly verbally abusive to all family members. Her parents attended a fundamentalist church that valued boys
over girls. She reported that her 3-year-old brother died in a hospital when she was 5 years old. Her parents did not
tell her about his death until after the funeral, and then only one sentence was spoken. They never talked about it
again. She recalled being treated as though she should have died instead. Her parents discouraged her from excelling
at school. Betty understood that if she succeeded too much, they would exclude her from the family. She enrolled in
the study shortly after beginning DNMS therapy (see Tables 2 and 3).
Once the research data were collected, Betty reported she had met her goals and chose to terminate therapy.
Follow-up data were collected 1 year after her last DNMS session (see Table 2). She reported to her therapist shortly after
the work ended that she had attended a large professional meeting that she had been dreading before the DNMS and
had felt completely comfortable. She reported that before the DNMS, she had felt like a child around a particular
controlling professor at school, who reminded her of her father. After the DNMS, he no longer felt like a threat. She
DNMS: Eight Case Studies Page 11 of 20

reported that she had met with a suicidal client without panicking, and she could now talk about her deceased brother
without panicking. At follow-up, she commented that as a result of the DNMS she had experienced “dramatic changes in
affect, both to the stimuli that previously bothered me and to my general level of tension. I have noticed that I no longer
go around malls with my hands clenched, my breathing is normal in places when there are a lot of new people, I feel
relaxed and also have noticed somatic relief from eczema and irritable bowel syndrome. I have more confidence.”

Table 2. Betty’s Progress Report ratings of problems and negative beliefs

0-10 Ratings
Pre-treatment Post-treatment 12-Mo Follow-up

Problem #1: Feels anxious in professional meetings. 7 0 0

Neg Beliefs: 1. I’m inadequate. 8 0 0
2. I’m not good enough. 9 0 0
Problem #2: Feels like a child when talking to controlling people. 7 0 0
Neg Beliefs: 1. I’m powerless. 9 0 0
2. I can’t give a logical response 7 0 0
Problem #3: Panics when with suicidal client or talking about death of brother. 9 0 0
Neg Belief: 1. I must be in control 8 0 0

Table 3. Summary of Betty’s DNMS treatment

Problem #1 Problem #2 Problem #3

Problem: Feels anxious in professional Problem: Feels like a child when talking to Problem: Panics when with suicidal client or
meetings. controlling people. talking about death of brother.
Introject messages: Introject message: Introject message:
Mom: You can’t please me no matter what Dad: I’m right, you’re wrong. You’re Dad/Mom/Sister: You mustn’t talk about
you do. stupid. You should be seen, not heard. death. It’s morbid - just get on with the job.
Dad: You’re an inconvenience. You’re not Your needs are not important. You should You can’t cope with death. You must be pro-
important. Your ideas are flawed. be a boy (not a girl). You should be an tected from knowing about death. You can’t
adult. attend to death because you can’t cope. You
shouldn’t have to deal with death.
Number of reactive parts on map: 5 Number of reactive parts on map: 6 Number of reactive parts on map: 7
Child parts under masks: 4-year-old under mom Child part under mask: 6-year-old under dad Child part under mask: 12-year-old under
mask, and 4-year-old under dad mask. mask. dad/mom/sister mask.
Once four-year-olds were totally unstuck: Once six-year-old was totally unstuck: Once twelve-year-old was totally unstuck:
– All 5 reactive parts totally unstuck. – All 6 reactive parts totally unstuck. – All 7 reactive parts totally unstuck.
– Problem #1 rated 0. – Problem #2 rated 0. – Problem #3 rated 0.
– Problem #1 negative beliefs rated 0. – Problem #2 negative beliefs rated 0. – Problem #3 negative beliefs rated 0.
Completion time: One 90-minute session. Completion time: One 90-minute session. Completion time: One 90-minute session.

Case #3: Cathy

Cathy was in her 30s – a married mother and housewife. She reported her father had been very abusive toward her,
her mother, and her siblings. Cathy recalled her father and two brothers physically and sexually abused her. Her
father would eat lavish meals while his children went hungry. He was eventually jailed for murder. She recalled being
actively and persistently discouraged from getting an education. Cathy learned to manage the trauma of the sexual
abuse with a pattern of “forgetting.” As an adult, she had great difficultly remembering even everyday things. Cathy
had been in treatment intermittently for 2 years with her therapist prior to enrolling in this study. (See Discussion
section for more about the earlier treatment.) (See Tables 4 and 5.)
After the research data were collected, Cathy continued with therapy intermittently to work on other issues.
Follow-up data were collected 5 months after her last DNMS session (see Table 4). Shortly after the research sessions,
she reported a dramatic improvement in memory and gave several accounts of successfully asserting herself with
intimidating superiors. Months later she reported her memory and assertiveness skills continue to improve, as she
gained confidence from doing these activities repeatedly, without internal conflict. At follow-up, she commented,
“The quality of my life has improved. I really enjoyed the DNMS. This is definitely a good tool to help me to break
through the barriers.”
DNMS: Eight Case Studies Page 12 of 20

Table 4. Cathy’s Progress Report ratings of problems and negative beliefs

0-10 Ratings
Pre-treatment Post-treatment 5-Mo Follow-up

Problem #1: Panics when required to remember things. 10 0 0

Neg Beliefs: 1. I’ll get it wrong. 10 0 2
2. I must not know too much, or else I’ll get rejected. 10 0 2
Problem #2: Feels intimidated by authority figures.. 10 0 1
Neg Beliefs: 1. I’m wrong. 10 0 1
2. I’m guilty. 10 0 4
3. I’m a victim. 10 0 0
4. I’m nothing. 10 0 0
Problem #3: Can’t assert herself without getting upset. 10 0 3
Neg Belief: 1. I’m worthless. 10 0 1
2. I’m not good enough. 10 0 1
3. I’m nobody. 10 0 0

Table 5. Summary of Cathy’s DNMS treatment

Problem #1 Problem #2 Problem #3

Problem: Panics when required to remember Problem: Feels intimidated by authority Problem: Can’t assert herself without getting
things. figures. upset.
Introject message: Introject message: Introject message:
Mom/Dad: What others do is okay, but Dad: It doesn’t matter what you do, feel, Dad: You’re worthless. You’re not good
what you do isn’t. You’re wrong. You think or say, others are going to do what enough. You’re nobody. Whatever you say
don’t know what you’re talking about. they like with you. You will be punished if doesn’t count.
Don’t be smarter than others. You’re a you speak out for yourself. You have no
smart alec. Don’t learn. You’re stupid. control over others. You’re powerless.
Number of reactive parts on map: 8 Number of reactive parts on map: 8 Number of reactive parts on map: 7
Child part under mask: Seven-year-old under Child part under mask: Three-year-old under Child part under mask: Five-year-old under
mom/dad mask. dad mask. dad mask.
Once seven-year-old was totally unstuck: Once three-year-old was totally unstuck: Once five-year-old was totally unstuck:
– Four reactive parts were mostly unstuck – All 8 reactive parts totally unstuck. – All 7 reactive parts totally unstuck.
and four were totally unstuck. – Problem #2 rated 0. – Problem #3 rated 0.
– Problem #1 rated 0. – Problem #2 negative beliefs rated 0. – Problem #3 negative beliefs rated 0.
– Problem #1 negative beliefs rated 0.
Completion time: One 150-minute session. Completion time: One 180-minute session. Completion time: One 120-minute session.

Case #4: Debbie

Debbie was a single, middle-aged, female graduate student. Her father was a successful professional, and her mother
was a stay-at-home mother. Debbie was the eldest of three children. She remembered her mother as cold and
rejecting. They often had power struggles over food. Her only emotional connection was to her father, so she was
desperate to please him. Debbie recalled her father was attentive and approving of her as long as she kept her mother
happy. If her mother became upset, he would leave the house. As an adult, she has believed that having sexual
intimacy with a man would betray her father. Debbie enrolled in the study shortly after beginning DNMS therapy (see
Tables 6 and 7).
Once all the research data were collected, Debbie reported she was satisfied her goals had been met and
chose to terminate therapy. Follow-up data were collected 3 months after her last DNMS session (see Table 6). At
follow-up, she commented to her therapist that she had completed graduate school and was about to begin a new job,
that she was taking good care of her body now, and that she was open to finding a romantic partner. Debbie was the
only research participant on a psychotropic medication (bupropion hydrochloride) at the start of the study. A few
weeks after beginning the DNMS, she stopped taking it, stating she no longer needed it.
DNMS: Eight Case Studies Page 13 of 20

Table 6. Debbie’s Progress Report ratings of problems and negative beliefs

0-10 Ratings
Pre-treatment Post-treatment 3-Mo Follow-up

Problem #1: I avoid romantic relationships with available men. 9 0 0

Neg Beliefs: 1. I would lose myself in a romantic relationship. 9 0 0
2. If I have intercourse I’ll disappear. 10 0 0
3. Unless I sacrifice myself for my partner, I will be left. 10 0 0
Problem #2: I am unable to lose weight. 9 0 0
Neg Beliefs: 1. I need the weight to keep me safe from men. 8 0 0
2. I need food to nurture myself. 9 0 0
3. Overeating is a way to assert my independence. 10 0 0
4. I need to eat now before I run out of money for food. 10 0 0
Problem #3: I have to make career choices now and I get too overwhelmed to think 9 0 0
about them.
Neg Belief: 1. I am afraid I’m not good enough. 8 0 0
2. I must have done something wrong because no one loves me and I 9 0 0
have to do this all by myself.

Table 7. Summary of Debbie’s DNMS treatment

Problem #1 Problem #2 Problem #3

Problem: I avoid romantic relationships with Problem: I am unable to lose weight. Problem: I have to make career choices now
available men. and I get too overwhelmed to think about
them.
Introject messages:
Mom: It is your fault if others leave Problem #2 resolved automatically once the Problem #3 resolved automatically once the
because you will never be enough. problem #1 introjects were totally unstuck. problem #1 introjects were totally unstuck.
Dad: Others will leave because you aren’t
making them happy.
Number of reactive parts on map: 8
Child parts under masks: Four-year-old child
under mom mask, and four-year-old child
under dad mask
Once four-year-olds were totally unstuck:
– All 8 reactive parts were totally unstuck.
– Problems #1, 2, & 3 rated 0.
– Problems #1, 2, & 3 beliefs rated 0.
Completion time: Six 90-minute sessions.

Case #5: Ellen

Ellen was a married, middle-aged female paraprofessional. Her parents were high school students when she was
conceived. They married young and had two more children. Ellen reported that while her father stayed in the
background, her mother was a physically abusive alcoholic and rageaholic. She remembered her mother telling her
that she had “ruined her life.” After her parents divorced, her mother remarried. She recalled her stepfather sexually
molesting her and her siblings. Ellen became a rebellious alcoholic adult. Her three children were taken from her by
the courts and given to her ex-husband. Prior counseling had addressed the addictions. She was in recovery when she
began the DNMS. Ellen enrolled in the study shortly after beginning DNMS therapy (see Tables 8 and 9).
Once the research data were collected, Ellen chose to stay in therapy to work on other issues. Follow-up data
were collected 8 months after her last DNMS research session (see Table 8). After this work, she could finally initiate
projects. She reported to her therapist that she was starting to write a children’s book, enrolling in knitting lessons,
and forming a creativity study group. She reported she had stopped working long hours to prove herself. At follow-up,
she commented, “I can see that troubles are temporary now and get through them knowing they will pass. I am not
worried about what my coworkers or family members think of me anymore. I do not feel like a failure or a phony. I
feel GREAT about myself!”
DNMS: Eight Case Studies Page 14 of 20

Table 8. Ellen’s Progress Report ratings of problems and negative beliefs

0-10 Ratings
Pre-treatment Post-treatment 8-Mo Follow-up

Problem #1: I don’t start new things because I never finish anything. I have a genius 10 0 0
IQ and a GED. I feel stuck. I can’t move forward.
Neg Beliefs: 1. I am a bad person and I don’t deserve anything good. 9 0 0
2. I fail at everything. 9 0 0
Problem #2: I work long, hard hours, so no one knows I'm not qualified (not college 10 0 0
degree) for my job.
Neg Belief: 1. If people really know the truth they would think I’m not good enough. 10 0 0
2. I don’t know what I am doing. 8 0 0
3. I must fight constantly for everything or I’ll drown. 10 0 0
4. I am a phony. 8 0 0

Table 9. Summary of Ellen’s DNMS treatment

Problem #1 Problem #2
Problem: I don’t start new things because I never finish anything. I have a Problem: I work long, hard hours, so no one knows I'm not qualified
genius IQ and a GED. I feel stuck. I can’t move forward. (not college degree) for my job.
Introject message:
Mom: Others lives are ruined because you were born. You are not Problem #2 resolved automatically once the Problem #1 introjects
allowed to have emotions or needs. You are so bad you deserve to were totally unstuck.
be destroyed.
Number of reactive parts on map: 7
Child parts under masks: Four-year-old child under mom mask.
Once four-year-old was totally unstuck:
– All 7 reactive parts were totally unstuck.
– Problems #1 and 2 rated 0.
– Problems #1 and 2 negative beliefs rated 0.
Completion time: Four 50-minute sessions and one 90-minute session.

Case #6: Frank

Frank was a middle-aged, married, educated, self-employed professional male. He recalled that, while his parents for
the most part were caring and kind to their children, they completely failed to meet certain important needs. He
reported his father shamed him whenever he expressed pride or joy for his outstanding sports achievements. That
shame held him back from being a star player. He explained that if he went to his mother with an upset, she would
try to comfort him with an unsatisfactory, “There, there – it will be okay.” Frank felt unable to discuss with his parents
the challenges of growing up. During a visit with his grandparents, he watched his enraged grandmother threaten to
kill his grandfather. This reinforced the stoicism that was modeled and rewarded by his parents. Frank enrolled in the
study shortly after beginning DNMS therapy (see Tables 10 and 11).
Once the research data were collected, Frank reported he had met his immediate goals and chose to
terminate therapy. Follow-up data were collected 5 months after his last DNMS session (see Table 10). At follow-up,
he reported to his therapist that he was able to discuss his angry feelings to resolve whatever issue caused those
feelings. He said he was no longer taking every job he was offered, so consequently he was much less likely to take
on too many jobs. He reported he was open and present much more of the time. In times of work stress, he would
notice an impulse to fall into old patterns but would succeed in choosing more effective behaviors.
DNMS: Eight Case Studies Page 15 of 20

Table 10. Frank’s Progress Report ratings of problems and negative beliefs

0-10 Ratings
Pre-treatment Post-treatment 5-Mo Follow-up

Problem #1: Whenever I feel angry I completely shut down. 8 0 1

Neg Beliefs: 1. If I feel anger, there is something deficit in me, so I have to shut it down. 8 0 0
2. Anger can be lethal, so I have to suppress it. 9 0 0
3. There is no good anger (i.e., it feels as if there is something shameful 7 0 0
about that emotion).
Problem #2: I have trouble setting appropriate boundaries, especially with client workloads 7 0 3
and deadlines. As a result I take on too much work, which stresses me out.
Neg Beliefs: 1. I can’t tolerate the stresses of setting boundaries (e.g., saying "no" to 8 0 0
someone asking for my help or confronting someone who has trespassed 7 0 1
my boundaries in some way).
2. If I set boundaries, people won’t like me and they’ll leave me.
Problem #3: I am a little shutdown emotionally all the time. The more personal or interpersonal 7 0 1
pleasure or pain I feel that is outside my "safe zone," the more I shut down.
Neg Belief: 1. I should not feel a lot of deep personal pleasure (e.g. proud of self for 8 0 0
accomplishments), because if I do I'm being too egocentric (arrogant, self- 8 0 1
centered, selfish, not humble). 9 0 1
2. I should not feel a lot of interpersonal pleasure (e.g. giving and receiving
affection), because if I do and then lose their love I will be devastated.
3. I cannot tolerate deep personal or interpersonal pain.

Table 11. Summary of Frank’s DNMS treatment

Problem #1 Problem #2 Problem #3

Problem: Whenever I feel angry I completely Problem: I have trouble setting appropriate Problem: I’m a little shutdown emotionally all
shut down. boundaries, especially with client work- the time. The more personal or interpersonal
loads and deadlines. As a result I take on pleasure or pain I feel that is outside my
too much work, which stresses me out. "safe zone," the more I shut down.
Introject message: Introject messages:
Grandmother/Mom/Dad: In spite of a cap- Mom/Dad: If you can’t grin and bear it, Problem #3 resolved automatically once the
acity to be extremely loving, you have the you’re not a man. problem #1and 2 introjects were totally
capacity to extinguish life, if you get angry Dad: Shame on you for bragging about unstuck.
enough. You must keep your self-shame yourself.
self talk to keep your anger in check.
Number of reactive parts on map: 8 Number of reactive parts on map: 5
Child part under mask: Seven-year-old child Child parts under masks: Ten-year-old child
under grandmother/mom/dad mask. under mom/dad mask, and eight-year-old
child under dad mask.
Once seven-year-old was totally unstuck: Once 8 & 10-year-olds were totally unstuck:
– All 8 reactive parts were totally unstuck. – All 5 reactive parts were totally unstuck.
– Problem #1 rated 0. – Problem #2 rated 0.
– Problem #1 negative beliefs rated 0. – Problem #2 negative beliefs rated 0.
Completion time: Three 90-minute sessions. Completion time: One 90-minute session.

Case #7: Gail

Gail was a married, middle-aged, female doctorate-level professional. She reported growing up in a chaotic family. She
recalled her father was an alcoholic who spent little time with the family and that when he was home he was often
intoxicated and frightening. Her mother was a full-time professional who worked a night shift. The five children were
often left at home unattended. She recalled her mother attempting to manage her children with threats of abandonment
and fits of rage. Gail learned to keep quiet, have no needs, feel no body sensations, and avoid conflict at all cost. She
recalled watching her mother enmesh with other siblings and hoping that one day she would get some of mother’s
attention too. When Gail was in junior high, her mother told her father to stop drinking or leave. He chose to leave.
She never saw him again. Gail enrolled in the study shortly after beginning DNMS therapy (see Tables 12 and 13).
Once the research data were collected, Gail chose to continue therapy to work on other issues. Follow-up
data were collected 1 year after her last DNMS research session (see Table 12). She reported an end to her usual
pattern of reacting to a controlling supervisor from a needy child ego state. After this work, she began reacting to him
DNMS: Eight Case Studies Page 16 of 20

as an adult, which included setting boundaries. She stopped making sacrifices for him, just to win his approval. She
reported she had stopped using food to manage her emotions. Furthermore, she joined a gym and hired a trainer. At
follow-up, she commented, “As a result of working with DNMS, today I live with a stronger sense of reality. I no
longer feel like a child trying to figure out the adult world. As a result of this therapy, I am more often in my authentic
adult self more of the time.”

Table 12. Gail’s Progress Report ratings of problems and negative beliefs

0-10 Ratings
Pre-treatment Post-treatment 12-Mo Follow-up

Problem #1: Feeling too needy. 10 0 0

Neg Beliefs: 1. It’s not okay for me to have needs or ask for things 8 0 0
2. I can’t depend on others – I must meet my own needs. 10 0 0
3. If I ask for things I’ll be rejected. 9 0 0
Problem #2: Eating to numb out negative feelings. 10 0 0
Neg Beliefs: 1. I have no control. 10 0 0
2. I am not safe. 9 0 0
Problem #3: Fear of setting boundaries in personal relationships (friends, family, spouse). 10 0 0
Neg Belief: 1. If I set a boundary I will anger others and they will reject me. 10 0 0
2. I don’t have a right to set boundaries. 9 0 0
3. If I set a boundary I’ll lose options. 10 0 0

Table 13. Summary of Gail’s DNMS treatment

Problem #1 Problem #2 Problem #3

Problem: Feeling too needy. Problem: Eating to numb out Problem: Fear of setting boundaries in personal relationships (friends,
negative feelings. family, spouse).
Introject message: Introject message: Introject messages: Introject message:
Mom: You won’t get your Mom: You should be grateful for Dad: I’ll stay if you accept my Mom: Better be who others
needs met, so don’t ask. the sacrifices others make, other- abusive behavior. need you to be. If others reject
wise they won’t care for you, Mom: I won’t love you if you you, you won’t matter and no
and they’ll give up and leave. have your own life. one will care about you.
Reactive parts on map: 6 Reactive parts on map: 7 Reactive parts on map: 10 Reactive parts on map: 8
Child part under mask: Eight-year- Child part under mask: Six-year- Child parts under masks: Twelve- Child part under mask: Two-to-
old child under mom mask. old child under mom mask. year-old under dad mask, and twelve-year-old child under
ten-year-old under mom mask. mom mask.
Once eight-year-old was totally Once six-year-old was totally Once ten and twelve-year-olds Once two-to-twelve-year-old was
unstuck: unstuck: were totally unstuck: totally unstuck:
– All 6 reactive parts were – All 7 reactive parts were – All but 2 reactive parts were – All 8 reactive parts were
totally unstuck. totally unstuck. totally unstuck. totally unstuck.
– Problem #1 rated 0. – Problem #2 rated 0. – Problem #3 rated 4. – Problem #3 rated 0.
– Problem #1 beliefs rated 0. – Problem #2 beliefs rated 0. – Problem #3 beliefs rated 5. – Problem #3 beliefs rated 0.
Completion time: One 90-minute Completion time: One 90-minute Completion time: Three 90-minute Completion time: Two 90-minute
session. session. sessions. sessions.

Case #8: Holly

Holly was a single, middle-aged professional female with a graduate degree. She described her father as a critical,
rigid, and rageful man who believed he was always right and who expected his four children to take care of their
mother. Holly reported her mother was frequently overwhelmed and turned to her for guidance. She and her siblings
were often left in the care of an aunt and uncle. Although the uncle seductively molested her during most of her grade
school years, it was not possible for her to discuss this with her parents. As she got older, she was rewarded for
maintaining her role as the “good child” in the family, while her siblings rebelled. She enrolled in the study shortly
after beginning DNMS therapy (see Tables 14 and 15).
Once the research data were collected, Holly chose to continue therapy to work on other issues. Follow-up
data were collected 4 months after her last DNMS research session (see Table 14). Before DNMS therapy, Holly had a
long history of avoiding unpleasant confrontations. After the work, she reported to her therapist that she was no
longer tolerating the bad work habits of a subordinate. She began actively confronting the situation and took definitive
DNMS: Eight Case Studies Page 17 of 20

steps to solve the personnel problem. At follow-up, she commented, “My quality of life has improved as a result of
DNMS. What held me captive and made me depressed, my low self-esteem and my fear are totally gone. My issues
with feeling unworthy to express my feelings are also gone. I feel and know that I am strong, that I am good, that I am
worth being taken care of and worth being able to speak up for myself.”

Table 14. Holly’s Progress Report ratings of problems and negative beliefs

0-10 Ratings
Pre-treatment Post-treatment 4-Mo Follow-up

Problem #1: I put everyone else’s needs before my own. 9 0 0

Neg Beliefs: 1. I’m selfish if I voice my needs. 10 0 0
2. I’m a failure if I don’t meet others’ needs. 9 0 0
3. I’m bad if others are upset or angry with me. 10 0 0
Problem #2: I act cheerful and competent at all times, regardless of how I really feel. 9 0 0
Neg Beliefs: 1. It’s not ok to ask for help. 10 0 0
2. I won’t be loved if I express anger. 10 0 0

Table 15. Summary of Holly’s DNMS treatment

Problem #1 Problem #2
I put everyone else’s needs before my own. I act cheerful and competent at all times, regardless of how I really feel.
Note: Over the course of the processing it became clear that Problem #2 was a subset of Problem #1. It took addressing both problems, in a total
of six Ego State Maps, for both to fully resolve.
Mapping & Needs Meeting #1 Mapping & Needs Meeting #2 Mapping & Needs Meeting #3
Introject messages: Introject messages: Introject messages:
Mom: You are a failure unless you put Mom: Everything is fine. Dad: You’ll never be perfect enough to get
other’s needs first. You are selfish to have Dad: Family is first! Be cheerful and others’ love.
needs/feelings of your own. pleasant at all times. How we look is more Mom: Your job is to figure out what makes
Dad: You are bad if others are upset. It’s important than how you feel or what you others happy. It’s all about everyone else.
your job to figure out what to do. need.
Number of reactive parts on map: 6 Number of reactive parts on map: 6 Number of reactive parts on map: 5
Child parts under masks: Six-year-old child Child parts under masks: Seven-year-old child Child parts under masks: Six-year-old child
under mom mask, and six-year-old child under mom mask, and seven-year-old under mom mask, and six-year-old child
under dad mask. child under dad mask. under dad mask.
Once six-year-olds were totally unstuck: Once seven-year-olds were totally unstuck: Once six-year-olds were totally unstuck:
– All 6 reactive parts were totally unstuck. – All 6 reactive parts were totally unstuck. – All 5 reactive parts were totally unstuck.
– Problems #1 & 2 rated 4-5. – Problems #1 & 2 rated 6. – Problems #1 & 2 rated 1-2.
– Problems #1 & 2 beliefs rated 1-2. – Problems #1 & 2 beliefs rated 2-6. – Problems #1 & 2 beliefs rated 1-2.
Completion time: Four 50-minute sessions and Completion time: One 50-minute and one 90- Completion time: Three 50-minute sessions.
one 90-minute session. minute session.

Mapping & Needs Meeting #4 Mapping & Needs Meeting #5 Mapping & Needs Meeting #6
Introject messages: Introject messages: Introject messages:
Uncle: Others will only love you if you do Mom: If you give others upsetting Mom: You’d better not make others angry
what they say. information, they’ll think you’re crazy and or they will hate you and totally reject
Mom/Dad: I have no idea how to do will be mad at you. you. Keep others happy.
anything, you need to figure it out. You’re Dad: Don’t be so stupid. You’re Mom: Go away don’t bother others with
on your own. overreacting if you have emotions. your problems.
Number of reactive parts on map: 4 Number of reactive parts on map: 6 Number of reactive parts on map: 5
Child parts under masks: Five-year-old child Child parts under masks: Eight-year-old child Child parts under masks: Eight-year-old child
under uncle mask, and five-year-old child under mom mask, and eight-year-old child under mom mask, and eight-year-old child
under mom/dad mask. under dad mask. under dad mask.
Once five-year-olds were totally unstuck: Once eight-year-olds were totally unstuck: Once eight-year-olds were totally unstuck:
– All 4 reactive parts were totally unstuck. – All 6 reactive parts were totally unstuck. – All 5 reactive parts were totally unstuck.
– Problems #1 & 2 rated 1. – Problems #1 & 2 rated 1. – Problems #1 & 2 rated 0.
– Problems #1 & 2 beliefs rated 1-3. – Problems #1 & 2 beliefs rated 1-2. – Problems #1 & 2 beliefs rated 0.
Completion time: Five 50-minute sessions and Completion time: Two 90-minute sessions. Completion time: Two 50-minute and two 90-
one 90-minute session. minute sessions.
DNMS: Eight Case Studies Page 18 of 20

DISCUSSION

This study investigated the hypothesis that using the DNMS to treat problem behaviors and emotions that originated
in unmet developmental needs would lead to a significant reduction in those behaviors or emotions and in the
associated negative beliefs. These findings provide preliminary support for this hypothesis. Each participant’s targeted
problem behaviors and emotions were clearly linked (by the participant) to unmet developmental needs. Pre-
treatment “Problem” ratings ranged from 7 to 10 (10=worst possible problem), whereas post-treatment ratings were
all 0 (not at all a problem). Pre-treatment “negative belief” ratings ranged from 7 to 10 (10=totally true), whereas
post-treatment ratings were all 0 (not at all true). At follow-up, 6 of the 8 participants re-rated all problems and all
negative beliefs a 0. Although Cathy and Frank provided slightly elevated ratings at 5-month follow-up, they also
reported substantial improvements following DNMS treatment. This was especially evident when Cathy disclosed to
her therapist that her memory and assertiveness skills had improved dramatically right after treatment, with continued
improvement over time. Likewise, at follow-up, Frank gave specific examples of how he was managing emotions,
stress, and boundaries with much greater skill.
As these 8 cases demonstrated, it can take one or many sessions to resolve a single problem with DNMS
protocols. The protocols are very structured – one step follows the next step, in a logical sequence. All the steps must
be completed to get an introject totally unstuck. As a general rule, the processing steps will be completed in less time
when (a) a protocol can be completed in one session (sometimes a long session), (b) most of the session time is used
for the DNMS, (c) a client naturally processes quickly, and/or (d) there are few processing blocks to clear, and those
that do arise clear easily. Likewise, it may take many sessions to complete the steps when (a) sessions are only 50
minutes long, (b) a small portion of session time is used for the DNMS, (c) a client naturally processes slowly, and/or
(d) there are many processing blocks that are not easily resolved. Three of the 8 participants, Debbie, Ellen, and
Holly, fell into the latter category.
This study demonstrates that DNMS has the flexibility to handle both simple and complex cases. Annie,
Betty, and Cathy illustrated that sometimes just a single DNMS session is needed to resolve a single problem. Gail
and Holly illustrated that sometimes a single problem is associated with multiple maladaptive introjects and that to
resolve the problem, all the introjects must be named and treated. Debbie, Ellen, and Frank illustrated that sometimes
DNMS work addressing one problem will generalize to resolve other problems too.
It is unlikely that the changes observed between pre- and post-treatment were merely the result of a good
therapeutic alliance. For example, Cathy had a very good working relationship with her therapist long before
beginning DNMS therapy. Early on they recognized a link between the physical and sexual abuse from her father and
her difficulty remembering things and asserting herself. When they tried to desensitize the terrifying abuse memories
with an intense trauma-focused treatment, she became paralyzed with fear (from reactive parts), making it impossible
to deal with the trauma that way. So they resorted to talk therapy and behavioral interventions, such as memorization
practice and assertiveness training, neither of which resulted in much improvement. Once they began DNMS therapy,
the Healing Circle of Resources provided the safe “container” the reactive parts needed to even consider addressing
the abuse trauma. The mapping helped the fearful reactive parts understand that the intimidating abusive dad introject
was not really “dad” but was instead a “dad mask” unwillingly worn by a child part with a fundamentally good
nature. With that understanding, and with a safe/loving connection to the Resources, processing could proceed to a
successful outcome. The therapist described the difference between the previous work and the DNMS as “the
difference between using a chain saw and a scalpel. The precision of the DNMS made all the difference.” In Cathy’s
case, it took much more than a good therapeutic alliance to resolve her issues.
It is unlikely that the changes observed between pre- and post-treatment were due to the personality or
clinical skill of the DNMS developer. The first author provided the treatment for just two of the eight cases presented.
The other two therapists, who contributed three cases each, applied the DNMS in their own offices, in their usual
way, with minimal input from the developer.

Limitations
There are some limitations to this study. (a) Because this was a preliminary study, intended only to investigate the
efficacy of the DNMS, the study design did not include a control group or alternate treatment group. (b) Several
participants exercised their option to continue with therapy (to address additional issues) between the post-treatment
and follow-up assessment. This could make it difficult to discern to what extent the gains maintained at follow-up were
due to the additional therapy. Nonetheless, all participants, including those who had not received additional therapy,
reported gains maintained at follow-up. (c) This study was intended for “stable and reasonably high functioning” clients
only. Therefore, unstable clients, who encountered complex processing blocks during their initial experiences with
DNMS: Eight Case Studies Page 19 of 20

the DNMS, were excluded from the study. In theory, this selection criterion could have resulted in a bias toward
highly responsive participants. Although DNMS has been reported to be effective with complex, challenging clients
(e.g., Schmidt, 2004), such a conclusion cannot be drawn from this study.

SUMMARY

Ego state therapies have been around since the 1960s (Assagioli, 1975; Berne, 1961; Schwartz, 1995; Watkins &
Watkins, 1997). Inner-child psychotherapies (Bradshaw, 1990; Capacchione, 1988; Napier, 1990) have been around
since the 1980s. Although the DNMS shares much in common with these approaches, the DNMS differs in important
ways by (a) systematically developing multiple internal resources (competent internalized caregivers) to facilitate the
healing; (b) differentiating child parts who reacted to wounding childhood messages (reactive parts) from those who
now deliver wounding childhood messages (maladaptive introjects); (c) focusing exclusively on healing maladaptive
introjects; (d) systematically and thoroughly focusing on remediating unmet developmental needs with a variety of
protocol steps, which collectively results in a corrective emotional experience; and (e) providing a stepwise protocol
that ensures maladaptive introjects will get completely and totally unstuck. The DNMS approach stands apart because
it postulates that by strategically healing a single maladaptive introject, substantial improvements can occur, because
that one change can benefit many wounded child parts throughout the self-system.
Future DNMS research studies might include (a) a wait group, (b) an alternate treatment group, (c) unstable
participants, and/or (d) a focus on a particular diagnosis (e.g., eating disorder, panic disorder, borderline personality
disorder). The daily challenges of applying the DNMS in clinical practice have led to ongoing refinements to the
protocols. With each change, the needs-meeting work appears to become more effective and efficient. Several
significant refinements, which were not part of this study, were recently incorporated into the model (Schmidt,
2006a). One major change involves systematically addressing unmet attachment needs in order of importance.
Another change involves finding and processing all the maladaptive introjects associated with a problem/issue, at the
same time. Research on these new DNMS protocols will begin soon. In conclusion, the results of this study suggest
that the DNMS is a promising new intervention, effective in resolving the unwanted behaviors, beliefs, and emotions
that originated in unmet developmental needs.

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