As mentioned in Volumes 1 and 2 of Engaging Multiple Personalities, years into my retirement I accidentally bumped into Ken, the husband of Joan, one of my former patients. Joan’s healing journey remains successful and ongoing more than 15 years following the conclusion of our treatment time together.
With her permission, Ken and I met many times to work on Volume 1, trying to put the pieces together of the healing journeys of Joan and several of my other patients. I wanted to include journeys that were successful as well as those that were not. The intention was to create a book that would provide a context for understanding DID, whether one is a patient, a spouse/family member, or a therapist. I had the perspective of decades as a psychiatrist working with trauma including some specific cases of DID.
Ken had the perspective of a spouse, trying to support someone he loved that had DID. I was particularly interested in Ken’s view as the significant other of a DID patient prior to, during and post therapy. These notes were part of a discussion exploring Ken’s experience participating in Joan’s journey of recovery from severe Complex PTSD symptoms. I believe it will be of benefit to others.
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D (David): Looking back, I was very reluctant to allow you to participate by sitting in on Joan’s therapy sessions. On the other hand, I could not see a way out, not to get you involved, given that Joan insisted on you being present in the first and all subsequent sessions. Having seen alters emerge during those sessions, when an alter appeared at home, I could not ask you to ignore her.
K (Ken): I think I was absent for one session when I had to be out of town. As to ignoring the appearance of alters at home, I could not hit a pause button to wait until the next time she saw you. When an alter appeared, it was often connected to something that needed to be related to immediately; a potentially re-traumatizing flashback.
D: By and large, there are many elements governing the emergence of an alter, some of which are not predictable. Correct me if I am wrong, but it seemed that alters felt safe to come out to you because you responded with genuine support and understanding.
On the other hand, alters also pop out when some circumstantial situation serves as a trigger. For example, when a situation is perceived as dangerous, a protector alter may jump out. I think alters appeared in my office because they felt safe there, and sensed that I was willing to listen to them. Your presence in the second session of therapy, when SW emerged and you didn’t deny or otherwise protest his presence, must have generated enough confidence in your openness of support to test you further at home, to see whether or not you would deny the alters or what they said.
K : Yes, first SW came out in your office and I passed that first test. I think I also passed your test of me, in that per your instructions my role during the sessions was limited to simply being there without saying anything or otherwise reacting, other than to repeat more loudly Joan’s softly spoken comments.
In fact, after we left your office, Joan asked me if there really was a little boy that came out and spoke. I confirmed that he had, and that it was ok. Then, when he came out at home the first time, that was a much bigger and more intense test. The first time, in your office, SW had the possibility of triangulating the two of us, giving him the possibility that at least one of us would listen to him. It was more dangerous for him to emerge at home, just with me. If I had dismissed him, denied his presence, or denigrated him, that would have been a true setback, I think.
When I listened to him, and we connected directly at home, his energy shifted completely. I was moved from being seen as a likely enemy to someone he could speak with almost as a friend. Other alters followed; at first slowly but then rapidly as each alter that emerged was given that same acceptance by both you and by me – whether they came out enraged, sobbing, or otherwise. It seemed that when some alters saw that I didn’t deny or cut off the alters that did emerge to speak to me, they felt that it was worth the risk to see if I was truly safe for them as well. They tested me to see if I would acknowledge them on their own terms, and whether I would be open to hearing their pain, anger and/or fear, without judging them or pushing them away.
D : Tell me more about how and when they usually come out.
K : For the first few months of therapy, some alters that hadn’t come out during that day’s session would emerge about 10 minutes after we left your office. First, there would be quiet when we got into the car. Then, a few minutes later, Joan would start to seem uncomfortable. I would pull over to stop in a park in case my undivided attention was needed by her. We would walk together and I would pretty much just listen. She would complain about a pain behind her right eye, and then out would come a very angry alter. Then, just like during the sessions with you, the alter would soon announce that they were very tired, and then they would disappear. Joan would re-emerge and ask if someone had come out.
Not too much later on during her therapy with you, because evening time was when the abuse had generally taken place, it was not a surprise that alters would come out late at night once they decided it was safe to do so with me. I wasn’t initially prepared for the intensity and duration of those conversations. I think that was a product of the trust that had been created during the sessions with you coupled by the fact that I was an ongoing witness in those sessions.
D : The emergence of alters at home after initiating therapy must be a common phenomenon. I wonder why in my reading I have not come across any discussion on this topic.
K : Once they decided they could come out to me, many times it was with overwhelming energy. They came out night after night, usually when I was about to fall asleep. I think they felt that I was more vulnerable due to my exhaustion at the end of a long day, which became exaggerated exhaustion from staying up with them night after night. Once they were out, I had to remain awake and present for them.
Because I had to go to work the next day, it was not such a great thing for my health or efficiency. But the pain they expressed in flashbacks was so intense, there was no choice but to be there for them. As a basic message to other SOs, I think it is really important to remember to eat well, take care of yourself and rest when you can, so that you have the strength to be there for them when they need it.
The impact of ensuring that they feel safe has two consequences: 1) they can begin to process their trauma; and 2) you experience joy unlike any other that you were able to make someone you love feel safe – possibly for the first time in their life. As they process trauma and your experience that joy, your self-discipline and stability must be maintained to ensure that you are not subconsciously seeking to validate yourself informally as a co-therapist. When I recollect that joy, it is more in the nature of seeing a child take its first steps. The joy is simply an expression of your love, nothing more and nothing less because those steps are part of the child’s self-actualization; not a validation of you as parent or witness.
Without having been in the therapy sessions, strictly bound to only listening and staying still, I would not have had the understanding or the tools, from watching you interact with alters, to actually be genuinely helpful when alters emerged, fully expressing their pain or fear or anger, with me at home.
D: Did you feel comfortable talking to the alters? What would you say to a therapist who worries that you, as a spouse, have no training in psychiatry and should not be the one talking to the alters?
K: If you understand that the alters are part of your SO, then it is really just listening to someone you love cry out in pain. Of course you are there for them. Talking to them directly is not so difficult. Listening without judgment, remaining present and warm, and gently reminding them of where they are right now, what the date is now, who they are with right now isn’t so hard if you keep at the forefront of you mind why you are doing this. In other words, loving them and maintaining your self-discipline are not mutually exclusive.
D: Do you think patients would feel more secure if the SO is involved? In effect, it means that the SO ends up being some kind of co-therapist. I actually have more experience in encouraging alters to become internal co-therapists than having an SO take that kind of role. In fact, you are really the only one that I would characterize as a genuine co-therapist.
K: While I can see how an SO could be seen as a co-therapist, I think a better understanding of the role would be the SO as the deepest best friend. The risk of seeing oneself as co-therapist runs the risk of setting up a potentially dangerous power dynamic in the SO as therapist. By taking notes of all the evening conversations, with Joan’s permission, I remained as a witnessing scribe. By applying the grounding recommendations you used in the sessions, it maintained you as the therapist and, again, me as the witness.
I think the idea is not that the SO knows more than the DID individual as to what they should do to heal, but rather how deeply, warmly and stably the SO can listen. Also, I don’t think there is a blanket rule that all SOs should participate in therapy. It really depends on the wishes of the patient and the internal stability of the SO. If the patient gives permission, then the SO could be told at least an outline of the issues that DID individuals face, and that it would likely that those issues would come out at home. That would at least give the SO some guidance on how to conduct themselves if an alter appears.
D: If the SO is a lover or spouse, how can the SO address the take-over by a child alter who jumps out reliving a past experience of sexual abuse? It could be that an alter conflates the spouse with the original abuser. This is a very real possibility. The therapist has an obligation, sooner or later, to address this concern. I don’t see how it can be addressed properly if the SO is not participating in some way in the therapy.
K: I think the SO has to have the intention, self-control, discipline and understanding to use those opportunities as a way to empower the frightened alter. This was the essence of the exercises I did with Joan, insisting that the frightened alter needed to say “no,” to show her that she had that power and that I would absolutely stop on the spot. And further, that following that “no,” there would not be sexual activity for the rest of the morning/day/evening. This was true whether or not other alters came out with sexual intentions or invitations.
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I invite readers to write to me about their opinion and their experience. I do not have enough large sample to form an opinion as to the general experience of involving the significant other (SO) in the therapy sessions.
