TRIGGER WARNING
The following is in response to an enquiry which I think may have a general relevance to our readers. As the question involves violence within a DID multiplicity system, please note that this post comes with a trigger warning.
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A reader with DID spoke to her therapist about an alter who was attacking small alters inside, including sexually. The therapist told her to get over it because it didn’t really happen. I believe this is a mistaken approach to therapy that will undermine the possibility of a genuine therapeutic alliance with those alters. In my view, it perpetuates the belief in the system that no one believes them about their trauma. This experience is not particularly different from when one angry alter does physical harm to another alter, like cutting or cigarette burning. The alters experience it in the same way – they are under attack, they cannot defend themselves, and they are not being believed.
In establishing a therapeutic relationship with DID individuals, the therapist has to get over their conventional view, their own ties to the logic of a unitary consciousness. They have to accept how the alter that is communication genuinely feels rather than impose their own logic on to his/her patient. To an outsider, an individual cutting himself is hurting himself. It is visible to the therapists eyes. In the context of a DID system, this is often seen as one alter trying to cause harm and injury to another alter. When the damage is not visible to the therapist, that doesn’t mean it isn’t happening.
I remember the case of Ruth in Chapter 5 of my book. Ruth was hospitalized against her wish to keep her from bleeding to death, because of her continuing attempts to cut herself. She was forcibly kept in a general hospital for 5 continuous months. She was discharged with the case-note indicating that she was still alive. Despite the clear dissociative symptoms, she was not given a dissociative diagnosis.
So, how was she able to survive and heal? Most important, she wanted to heal. She interviewed me as a potential psychiatrist to help her. Treatment was quickly instigated through weekly psycho-therapeutic sessions, and by inviting her alters to air their complaints. For Ruth, it took the form of therapy through journaling and discussing the written material she brought to the therapy sessions. While she never responded to anti-depressant medication, involving years on heavy dosages including in the hospital, her “depression” responded to psychotherapy. Her cutting was quickly reduced as a result and did not pose any more danger to her life. So long as she felt hopeful, I never worried that she would succeed in killing herself.
Therapists have to get over the hurdle of understanding that the experience of a DID individual is based on understanding the context in which alters engage each other and the outside world. The most effective way to do this, in my experience, was to engage the alters as they presented. In considering this seemingly “illogical” proposition of one alter sexually abusing another, it could be seen quite straightforwardly as one alter angry enough to want to cause physical and psychological harm to another alter.
The therapeutic task with the angry alter is then to engage that angry alter to understand what function the rage and conduct is serving, why they feel it is necessary to do this. It is no doubt related to that alter’s own trauma and the seeds of healing will be found in that engagement. The therapeutic task with the abused alter is, as always, to engage that alter to allow them to process their trauma. While there is no “one size fits all” approach in helping alters process their trauma, engaging each alter as they present their feelings, their experience, opens the gate for healing. In my practice, I would often suggest that other alters engage with the angry alter, to listen to that one as well as to intervene as a friend just as I would suggest that other alters engage with the abused alter to listen as well as intervene as a friend.
It is not appropriate for an outsider, therapist or otherwise, to debate what they see as the impossibility of one alter abusing another, when they are sharing the same body. It misses the entire point of the dissociative response.
We, as therapists, have to accept how an alter feels, which is genuine and real, no matter how “illogical” this may appear to an outsider. Without that acceptance, a genuine therapeutic alliance simply will not take root.
