The concept of ego state: From historical background to future perspectives

Abstract Introduction Ego state theory (EST) and therapy was developed by Watkins and Watkins, based on Federn who first proposed the concept of ego state. The Watkins state that EST is based on three pillars: psychoanalysis, hypnosis and Janet’s concept of dissociation. EST has been a major theory and therapy for the treatment of complex traumatization, in particular dissociative disorders, and is also a therapy helpful for other types of difficulties and pathologies. Objective This paper aims at clarifying the theoretical background of EST, as well as recent inputs from EST therapists, and how new concepts on trauma and dissociation challenged and influenced modern EST. Method and results After a thorough analysis of the literature, we provide with a detailed presentation of the main concepts of EST, their strengths and coherence, as well as the lack of coherence of some of these concepts. The development of EST stretches over several decades and attests to the richness of this integrative therapy and to the challenging development of the understanding of trauma and its sequalae. Conclusion Even if the theoretical foundation of EST is imperfect, EST has developed an integrative model of psychotherapy for traumatized individuals that is still valuable today. EST should be acknowledged for its great influence on modern psychotraumatology and on the treatment of dissociative identity disorder.