Many years ago, a fellow psychiatrist courteously wrote and explained why he disagreed with my therapeutic approach of speaking to the alters. He clearly considered this an error that would lead to “consolidating a pathology of dissociation.” He was taking DID as a disease in which the 6 year old alter speaking in a 6 year old voice was seen as the illness rather than a symptom. Effectively, he saw the alter as the pathology that needed to be eliminated. Thus, he viewed engaging in dialogue with the “voice” (the alter) as clearly an unwise practice that would only consolidate the problem rather than eliminate it.
In fact, the correct analytic approach should be to consider that the unprocessed trauma is the pathology, not the alter. The alter needs to be brought back into harmony with the other parts because they are all pieces of the same psychological system.
The treatment of DID is to engage the patient’s experience of having an alter as a separate part. Talking to an alter, acknowledging its presence, is a necessary step to draw that split-off piece of the self back in order to bring the whole system into a functioning unit instead of a group of perpetually conflicted and competing parts (alters).
This means that the therapist must be open to the fact that a 6 year old alter in the body of a 46 year old adult is not a symptom to be eliminated. Rather, it is a separated part of a wholeness to be healed, like a fragment of broken bone. With a broken bone, it is the fracture that is the pathology, not the bone fragment. And just as with a fractured bone, the broken piece that manifests as an alter is not garbage to be excised and thrown away. Treat the brokenness, which is the unprocessed trauma, don’t denigrate it.
A fractured bone can become quite strong and functional once it is healed – although never exactly identical to the bone that has never broken. It doesn’t need to be. In that same way, once a DID system is healed, it can likewise become strong and functional – although never exactly identical to a mind that has never been fractured in that way.
I learned over the course of 40 years of practicing psychiatry never to ignore or try to get rid of an alter. This is true however vicious an alter may initially present. Even the most angry and self-destructive alters can be seen as a repository of highly charged energy, worthy to be engaged and brought into harmony, not eliminated. Often they hold the keys to the knowledge of how the system protected itself under the pressure of the trauma as well as the clarifying the path to healing.
All of the alters hold gems of insight. With a proper therapeutic alliance, they will show the therapist those gems without interrogation, prodding or challenge. Kindness and connection open the doors to healing. It is the task of the therapist to invite the patient through those doors. Just as setting a broken bone in its proper position will allow the fracture to heal, creating the proper invitation to the alters will allow that fracture the is DID to heal.
