In traditional psychotherapy, the communication between therapist and client is privileged and confidential. There is no place for including a third person as part of the therapeutic process. I believe that this should be reconsidered, on a case by case basis, in the context of psychotherapy with a DID client.
My suggestion is based on considering, with the benefit of hindsight in my retirement, the therapeutic journeys of my limited number of DID patients. I had some experience with supportive spouses/significant others as well as some experience with spouses/significant others that were quite the opposite. This post includes the rationale for my proposal, some suggested considerations/warnings, and some potential guidelines.
Comments are most welcome as this is intended to open a discussion about something that is generally not considered in therapy. Indeed, I am expecting negative push-back from therapists as well as appropriate concerns. Please remember that there are risks, some clear and some not so clear, associated with even trying this approach. These risks must be taken into account for and with each patient individually when considering this approach but before deciding to try it. It must always be subject to permission of the patient to test the waters, both at the beginning and throughout any ongoing therapy.
While there are certainly spouses unsuitable or incapable of assuming a helpful role in therapy, there are some really caring, insightful, and potentially extremely helpful, spouses and significant others who can and wish to contribute to the healing of the DID patients.
The fact is that it is much more likely that alters will come out when the patient is at home with their spouse/SO than when he/she is with the therapist. A therapist generally sees a patient at most once per week. There are clearly many more opportunities for benefiting the patient available to a supportive spouse/SO given their 24/7 interactions with their DID partner. The grave risk is that an unscrupulous spouse/SO could use information of such diagnosis, and what they might learn in a therapy session, in a more effectively abusive way. One cannot discount that risk. So, inclusion must be dependent on the patient, the individual capacities of the spouse/SO, and the therapist as well as the potentials tools a therapist might be able to incorporate for them to use at home.
Why is this such an important consideration? It is because the most common places and times that an alter might come out is at home, perhaps at night in bed, or when he/she is driving in a car with the spouse/SO. That was the case with my DID patients.
So long as supportive spouses and significant others are kept in the dark about 1) the actual diagnosis their DID spouse/significant other has been given; and 2) the impact of their DID spouse/significant other’s early childhood trauma, there is a problem. Supportive spouses cannot fully engage as a support or as an advocate because they lack the necessary information and the permission from their partner with DID to do so.
This is potentially changing the options for DID therapy from the ground up. Hence, my use of the term “groundswell.” Through social media, those with DID and their spouses/SOs have begun to establish communication networks, the predicate for groundswells.
The purpose of this multi-part post is to begin the conversation. Please share your thoughts about extending therapeutic guidance to include considering how spouses and significant others can learn, engage and therefore protect as well as advocate for their DID partner.
We know that early childhood trauma based DID, a complex PTSD unrelated to wartime service trauma, has been generally ignored since the beginning of psychiatry. I think a primary reason is that there simply were no advocates for those with DID forcing the issue. The fact is that early childhood trauma is usually connected with sexual and physical abuse by family members and close friends of the family – all people that the family unit usually doesn’t want to confront. It is my hope that advocacy for those with DID by their spouses and significant others will become ever stronger.
