Dissociative Identity Disorder is a specialised field and not all therapists are trained in Dissociative disorders. Often clients are unable to be picky about who they get as a therapist and they can find themselves in a position of actually knowing more about D.I.D. than the therapist does. This can be frustrating for both the client and the therapist as a lot of time and money is wasted on just educating them before any real trauma work can be started. It’s not just educating a therapist about the actual disorder either. Often, therapists just simply don’t quite know how to react to someone with multiple personalities, and this puts added stress and anxiety on both parties. It’s okay to not know. It’s okay to learn together. That said, here are some guidelines for therapists on how to react and interact with someone with D.I.D.
· It’s okay to ask questions. Although plenty of resources are starting to become available as D.I.D. is becoming more researched and widely accepted, often the best resource is the person who has the disorder. Asking them questions about what they are feeling, how they communicate with the Alters and how they would like their therapist to communicate with the Alters is key in establishing good communication between everyone. The client may not always know the answers; after all, that’s partly why they are seeing a therapist, but they will know how they want to be interacted with and they may already have some understanding about their System, so ask questions that would be relevant to the individual.
· Understand the different roles Alters have within a System. Every Alter is formed out of a need the System has at the time. No Alter is redundant or useless. The ultimate reason for the Alters in the first place, ie: the original trauma, may no longer be happening, but the System has worked since that first trauma to keep everyone safe. Get to know the different roles, why they are formed and their strengths and weaknesses. Different roles of Alters is covered here.
· Address the Alters by their name and respect them as individuals. There is nothing worse than someone completely ignoring an Alter and referring to them by the Core/Host’s name. An Alter is a valid individual with their own set of memories, experiences, likes, dislikes, opinions, styles etc. In essence, they are a complete person living in the same body as everyone else in the System. Refusing to speak to them as an individual separate from the Core/Host is not only harmful but it’s disrespectful. Remember, they are just as valid as the Core/Host.
· Don’t be afraid to ask the Alters questions about themselves. As said above, they have their own personalities, memories, experiences etc, and often, their memories will be completely different to the Core or Host’s memories. To get a decent overall picture of the whole life, you will need to engage with all of the Alters and get to know their backstories and reasons for existing.
· Validate everyone equally. This is so important. I cannot stress it enough. The Alters are wanted, and needed and valid. To tell them otherwise is very damaging. Telling them to leave or go away is equally damaging. They have as much right to the body as the Core/Host. They have equal rights to Front as any of the others. Always seek to validate them and remind them that they are doing a good job at keeping the System safe. Explain that you are there to help them with their enormous task, not to try to get rid of them.
· Establish a good relationship with your client. In doing this, your client will start to trust you and so will their Alters. It may take time, so be patient and understanding. Once you have established a good relationship, you may find that you can request to speak to certain Alters who may be near the surface or, with the client’s permission, use positive triggers to bring forth an Alter that you’d like to work with. Remember to always be respectful and don’t force a switch. If an Alter doesn’t want to front, they don’t have to. Alters will become more willing to Front as the trust grows between you all, so work on that trust and be patient.
· Don’t assume the Core/Host is aiming for total Integration and Fusion. Some people with D.I.D. just want Functional Multiplicity, and that’s okay! There is no law that says every person has to be a singlet. Some clients may simply find the thought of not having headmates frightening, and they just want their System to function smoothly and be able to manage their triggers in healthy ways. Work with your client at what they all want. Some clients may well be aiming for total integration and fusion, and if that is a goal shared by all, then that is something you can work on together.
· Understand what Integration and Fusion is. People often get the two mixed up. Integration is where the walls of amnesia break down between Alters (and I include the Core/Host as an Alter because essentially they are). When those amnesic walls come down, the two (or more) Alters will remember each other’s past. This is the first step towards Fusion. Fusion is where two or more Alters merge into one and either become a new Alter or they merge into the Core. Integration can happen without Fusion, but Fusion cannot happen without Integration. Sometimes clients are happy with just having all the Alters Integrated and no amnesia between them. And that’s okay too.
· Do some independent research. As stated earlier, more and more information is becoming available about D.I.D. Utilise that research to learn between sessions. The more you learn, the better therapy will be.
· Learn the disorders that are often co-morbid with D.I.D. Dissociative Identity Disorder is rarely a stand-alone disorder. It usually is co-morbid with several others. These include, but are not limited to, Borderline Personality Disorder, Bi-Polar Disorder, Depression, Anxiety, P.T.S.D., O.C.D., Panic Disorder, Dissociative Seizures, Dissociation, Headaches and Migraines, Chronic Fatigue. Most people with D.I.D. will have several of those alongside their D.I.D. It’s important to address those issues as well. Having D.I.D. is exhausting. Not only does the client have an almost constant dialogue going on in their heads, affording them little to no rest, but they will battle with depression and anxiety, P.T.S.D. and many others. They will be in constant Flight or Fight mode and nearly always be hyper-alert. Be sensitive to the fact that they may well be totally exhausted all of the time.
· Understand how triggers work. Triggers are a big part of D.I.D. They are usually what starts a dissociative period or a switch. They can also cause panic attacks and be overwhelming. It’s important to understand the difference between positive and negative triggers and know when it is safe and allowable to use positive triggers. Never ever use a negative trigger on a client, and only use positive triggers with permission.
· Don’t be afraid of Littles or Persecutors. Dealing with Littles for the first time can be quite shocking and unnerving. You will suddenly find yourself talking to a child in an adult (or teenage) body. It can take some getting used to so be prepared to speak to a child at any time. Persecutors can also be quite daunting as often they can be rude or abrupt. They can also be aggressive and demanding, and in many cases, they actively harm the body. Be prepared for that. Persecutors are misunderstood and are just trying to cope with trauma in the only way they know how. Often Persecutors are the aggressive Protectors of the System, but they have unhealthy coping mechanisms. Littles and Persecutors probably will be the two types of Alters you will work with the most as they are the ones who usually hold the most trauma.
· Learn the Lingo. D.I.D. has its own unique terminology. This will be covered in a different chapter too and it would be a good thing to learn. If you understand what a client means when they say “I feel switchy today” you will cut out a lot of unnecessary questions. The list of terminology is quite long, so having that written out in your notes might be useful to refer to when speaking to the client.
· The client is not broken. Contrary to popular belief, the person with D.I.D. does not have a broken mind that needs fixing. Actually, their mind is working perfectly. D.I.D., although regarded as a disorder, is actually a safety mechanism built into the brain and is activated in some children when they experience ongoing trauma and abuse. It’s a survival mechanism and it works perfectly. The problem is, as the child grows to become an adult, generally the danger of abuse has past, and therefore the need for this mechanism becomes redundant. Note: I am not saying the Alters are redundant. I’m saying the mechanism becomes redundant as the adult is no longer experiencing the abuse. That said, some clients may still be living in abusive situations with a relative or partner, so that does need to be taken into consideration. But for the most part, the adult is living an abuse-free life now, but still has Alters.
· Alters can still form in adulthood. Once the mind has learned to split once, it remembers how to do it any time there is extreme stress or anxiety. This can be upsetting for the individual and even for the entire System. The idea of therapy is to mitigate that stress and help the client with coping strategies so that future splits don’t happen.
There is no hard and fast rule for helping a D.I.D. client. The thing is to be open-minded and willing to learn. If you can do that, you are well on your way to establishing excellent communication with a D.I.D. System and that will pave the way for healing and restoration, however that looks for the client.