Part 5

[5] Stay Open

It is important to also remain open to the possibility of all levels of amnestic barriers among the alters as well as between the alters and the host. This can range from the extreme of complete amnestic barriers, such as when the host cannot accept a diagnosis of DID, to cases where there is full awareness of having many discreet alters inside shouting and arguing all the time.

In this context, some therapists and spouses/SO may feel that DID may be faked. It is true that there are no objective laboratory tests, like blood work or brain scans, to confirm DID mechanistically. But, as a therapist or a spouse/SO, consider why this person might make something like this up.

For example, is there an ulterior motive to claim non-culpability or to use it as an excuse for one’s irresponsible behaviour? In the absence of the individual being in prison or facing prison, I have never encountered any patient with motives that would support making up a fake DID diagnosis.

For a spouse/SO, it can become more complicated as the relationship dynamic is quite different than that between the therapist and the DID individual. While a therapist might think it would be difficult in the beginning to have confidence that DID is the correct diagnosis, the experience of the spouse/SO can often confirm it. A supportive spouse is likely to have seen far more evidence of switching personalities even without having the framework to understand the context of the behavior.

With some of my patients, there were terrified young alters that were so different from the host, and that came out regularly at particular times of the night related to when the abuse had taken place. For those patients, spouses relating their experience at night was what raised the question for me. For the spouse/SO who may be uncertain about the diagnosis, stay open to the different possibilities.

The advice of simply listening with empathy and encouraging grounding in the present moment will likely serve both people well regardless of questions about the diagnosis. It will engender more trust in the relationship regardless of the intensity of the dissociative responses, and that will lead ever more clearly to the path of healing.

[6] Empathy and Compassion Are The Critical Supports

One way for a spouse/SO to deal with the appearance of alters, whether they are frightened, angry, paralyzed or beholden to any other emotion, is to clearly focus your own mind on understanding that the dissociation is a non-conceptual response to handle the horror of remembered trauma. In a flashback, that unconscious choice cannot be changed on your partner’s command or on yours. The immediate response is uncontrollable.

You might think of the dissociative response in a flashback as a dam breaking. In that analogy, water breaks through the dam because its power is far beyond the dam’s ability to hold it back. The consider that the way to release pressure on a dam is to open a flood gate – a safe alternative path for the water to exit in a way that bypasses the dam before or even after it has broken. If a flashback, that safe exit is grounding in the now, in the present moment, without criticizing the intensity of the emotional energy that has been unleashed. Criticism is irrelevant and not helpful, grounding is.

This means that the compassion and empathy of the spouse/SO to invite the partner to experience the safety of the now is not offered as a way to eliminate the fear and panic. Instead, it is offering and holding the emotional space to allow the fear and panic to subside, to come to rest, in the safety of the present moment. This can only happen when the space is protected within the compassion and empathy of the supportive spouse/SO.

Remember, trauma is defined as an overwhelming event that exceeds the normal coping mechanism of the individual. It is a natural reaction to that event. A deeper understanding of this will answer many therapeutic concerns. It will also give comfort and support to any spouse/SO seeking a path to genuine compassion for all the alters they may engage.

[7] Do Not Deny The Alters

For therapist and/or the spouse/SO, seeking to convince the patient that the alters inside are not real is a grievous error and will be experienced as a re-traumatizing attack. It cuts off any possible therapeutic or supportive communication because you are arguing against something the patient is experiencing directly, and has experienced for years and often decades. There is no need to fear that accepting the alters in context will strengthen any pathology of dissociation. Dissociation that arises from intense terror is an inherent adaptive, preservative and survival response to overwhelming trauma. It is what saved the patient at the time, and so should be respected. If you can communicate it genuinely, then it should be thanked.

The pathology that is problematic is the consequence of splitting which results in a disharmonious relationship among the dissociative parts. It is part of the Complex PTSD suffered by all with DID. Therapy should focus on helping the patient to live in the present, which means bringing them to the point where they are be able to identify the present as distinguished from the past.

In that way, the therapy undermines the power of past trauma to hold the patient hostage right now through re-traumatizing flashbacks, often decades after the fact of the original trauma. As that power is limited further and further, the disharmony within the system also tends to be quelled: The different parts are less likely to be triggered when the power and intensity of flashbacks are diminished. The protective function of dissociation is not roused to the same extent when the intensity is softened.

With the therapist and a supportive spouse/SO engaging alters in this way, the individual with DID will come ever closer to relearning and reclaiming that actual experience of “safe”, which was decimated by the trauma.

This foundation to working with DID is applicable whether the individual has ten alters or hundreds.