In my experience, which I acknowledge is limited, effective DID therapy must involve the alters. Consider that that alters are far more likely to show themselves when the patient is at home with their spouse/SO, than when the patient is with their therapist at most usually once per week. The opportunities for the therapist to provide warmth and empathy to those alters is thereby limited. For my DID patients, the most common time their alters emerged was at night in bed or when he/she was having a difficult day. The spouse/SO is around the patient 24/7 and therefore has far more opportunities to engage with alters.

Without guidance, how does a spouse/SO know how best to respond to an alter suddenly appearing? Even a therapist without experience will find it challenging to respond appropriately in the absence of their own mental preparation. I would like to state categorically that therapists must be prepared for such events. Further, I suggest that therapists take it upon themselves to seek permission of their patient to warn and prepare the spouse/SO of the appropriate behaviour necessary when engaging an alter. I have not been able to find such information in the psychiatric literature and would be grateful if any readers can forward any such reference they have. I would also point out that therapists who deny that DID exists at all will likely be unable to ever respond appropriately, and will likely be unable give appropriate guidance to a spouse/SO.

So, how should the SO of an individual with DID respond to an alter that has decided to, or been triggered to, come out? Anyone who does not understand the correct context is likely to consider the behaviour of an alter as “inappropriate.” This happens because the observer does not see the alter on its own terms, as another identity within the system of that whole person. The alter’s age, manner, speech, emotional expression may completely different from their usual experience of that person. The automatic conclusion for the observing person is that the person in front of them is a “fake,” inexplicably behaving inappropriately, “being childish” etc.

If the situation is handled with insight, empathy and kindness, great healing progress can be made. If it is not handled correctly, think of the many opportunities missed in helping this person to heal. One cannot say that engaging the alter is the sole responsibility for the therapist, that the SO should ignore the alter(s). Why do I say that? It is because the alters will come out with the SO far more often than with the therapist. With a supportive and educated spouse/SO, far more rapid and substantial progress can be made.

It is my view that to help a DID individual to heal, it is essential to do work through Engaging the Multiple Personalities, as the title of my book series suggests.