[8] Who Are You With

For the therapist, the question is, “Who is my patient?” Is it alter Joan, alter Eddie, or host Margaret, or all the alters? The answer is not complicated. Margaret is the registered client for therapy. But, in treating your client, you have to directly engage alters who decide to express themselves directly, in writing, or through other alters explaining what is happening. It actually doesn’t matter who you are talking to, all of the alters, the entire system, is listening. The system is where the therapy is applied.

For the spouse/SO, it is, again, more complicated. The question for them is, “Who is my partner?” That is a very different question that impacts daily life, intimacy, companionship and every other aspect of such a close relationship. Because the spouse/SO will often be present when an alters emerges, the question itself can be very confusing as can the various answers.

Based on my limited experience, I do not believe that the spouse/SO should view their relationships with individual alters as distinct from their relationships with other alters. While one may have an easier, more friendly relationship with one or another particular alter, one must always remember that all the alters are listening in – even if they don’t tell you so.

I have seen in social media many posts about a spouse or SO going on “private dates” with one alter to the exclusion of the rest in the system’s participation in that date. If it generates conflict among alters, as it seems to based on the posts and comments I have seen, then it is the opposite of helping your partner heal. If this is a pattern that has already been established, I would suggest inviting all the alters to join, if and only if they wish, by welcoming them to watch and listen. The idea would be to share the positive aspects of the experience with the goal of enhancing the sharing of communication rather than conflict.

[9] Speak To Alters Within Their Context

How to speak with an alter is an essential component both in therapy and in the spouse/SO relationship. For therapists, talk to each alter in the same way you speak to any non-DID patient in your practice – with respect, empathy and kindness. The adjustment in speaking to DID alters is to speak appropriately to that alter. This means that if the alter is a 4 year old, then your sentence structure and word choices should be age appropriate.

If an adult breaks down like a child sobbing in front of you, telling her to snap out of her apparent “childish” behaviour is clearly wrong whether you are a therapist or a spouse/SO. Shouting and demanding that the person behave appropriate to her age may be the worst response if the patient/partner is a 45 year old adult whose 4 year old alter has emerged in a flashback.

Discipline yourself and talk naturally as if talking to a real life 4 year old child, even if the patient is dressed in a business suit coming from their executive office. Doctors are not taught in medical schools to talk to a 50 year old using Kindergarten language. For therapeutic benefit, one has to adapt – even if you think it makes you appear undignified. Remember how you speak/spoke to your own 4 year child, niece, or nephew when your manner of speaking did not put your dignity at issue!

For the spouse/SO, if you are able to refrain from trying to protect your desired emotional marital/SO dynamic, it can become quite easy to engage with alters. It may even allow for a refreshing breeze of humor once trust is established with the alter you are engaging. So long as you remember that your relationship is strengthened every time you can lead your partner from a re-traumatizing flashback to the safety of the present moment with you, things will progress positively. It will likely never return to what it was prior to the emergence of DID symptomology to the level that required therapeutic intervention.

It is perhaps easier for a supportive spouse than for a therapist to take this approach as “professional dignity” is not something couples generally are concerned with at home. This approach is also a way to enhance your own affection for all parts of the system just at it enhances their affection for you. The more your understand and undermine your own antagonistic reaction to difficult alters, the easier it is for them to dial down their hyper-vigilance to ordinary vigilance. This means a less stressful, less mercurial, emotional life for all concerned.

A therapist with an appropriate index of suspicion who pays attention to the phenomenon of dissociation is able to see the DID pathology which arises from trauma and expresses itself as dissociation. This is critical as it suspends the therapist’s rush toward seizing upon symptoms of anxiety, depression, and panic that can lead to an erroneous superficial diagnosis, whether it be panic disorder, depression, bipolar, borderline personality disorder or schizophrenia. Remember, these are the common labels behind which DID is often missed.

For the spouse/SO, if you have a suspicion or confirmation that there has been abuse in your partner’s past, your own vigilance will likely allow you to take a step back before asserting that your partner simply needs to calm down, or simply needs to take an antidepressant. If you have seen flashbacks in action, or experienced what may be an alter emerging – particularly at the same time each day or night, or in repeated similar circumstances – convey that to the therapist. In other words, you can assist the therapist in coming to a proper diagnosis, DID or otherwise, by communicating what you have experienced as simply and non-judgmentally as possible.

For both the therapist and a spouse/SO, let the alters decide when they want to talk. This is true whether it is in a therapy session or at home after dinner. For example, a suicidal alter, or one threatening to break out into violence, should receive priority attention when they express themselves.

They do not need to be called out or pressured to emerge, but they certainly need to feel that they have the space to come out and express their pain within a compassionate kind environment. It is both counterproductive and dangerous to insist on talking to the host when this kind of alter announces their presence whether it is in a therapeutic session or at home.

Talking to some alters requires tremendous patience and perseverance. Therapy is not simply social chatting, it can be exhaustive, hard work. For a spouse/SO, whether you characterize it as therapy or not, warm patience and perseverance definitely affects the speed and outcome of healing. Personally, I would characterize those qualities in a spouse/SO as love and affection.

Unlike a therapist, the spouse/SO cannot ignore an alter at the end of the office session. You cannot say you are too tired to be present and awake when an alter is caught in a late night flashback because it may be an emergency or the best/only time to offer genuine support in healing. Since you are the anchor for your partner, you have to try to do the right thing on the spot.

As a decent human being, you would rescue a child that you see falling into a pool of water. It wouldn’t matter that you were tired or interested in reading the rest of your book on the beach. This is not about whether you are qualified as a therapist or not. The circumstances are such that you cannot assert your love and affection while seeking to disappear or claim ignorance.

This is why a spouse/SO needs to be prepared and know the simple yet tremendously difficult task of how to talk to and listen to an alter. Keep it simple. To the best of your ability, always be kind. This is what you would hope to experience from someone you think cares about you if you were in distress.