A reader posted a question regarding the diagnostic label that might be applied to him. Apparently, his therapist read my Volume 1 of Engaging Multiple Personalities and decided the reader was not “multiple” but has “dissociative parts”. Not surprisingly, the parts see that as a statement invalidating their existence and significance. In short, it was taken as making the parts appear to be less than real – even though, as the reader put it, “we feel pretty darn real”.
This issue may be something of interest for the general DID community and its support networks.
I am not sure why, after reading Volume 1, a therapist would take the position distinguishing dissociative parts from multiples in that way. In Volumes 1 and 2, I do distinguish between parts that have executive functioning capability and those that don’t. But that distinction is useful only to identify which parts developed in ways that encouraged executive capacity and which parts developed for holding discrete pieces of trauma. This distinction has nothing to do with whether one part is more real than any other part – or any less real than any other part. If the individual has dissociative parts that feel they are not being fully acknowledged because they are not seen as “personalities” , but just as ” dissociative parts”, then I don’t see how a true therapeutic alliance can fully form between the patient and therapist. If the parts feel they are separate individual personalities, who am I or any therapist to argue that they are not sufficiently distinct and separate to be given that classification? If you feel deeply about the sense that you are a personality, just like other alters, you should be acknowledged accordingly.
Diagnostic labels are just that – labels. They are just words. They are labels used to organize ideas and facilitate communication of phenomenon or experience. They should be used to promote healing, not conflict.
For example, some readers have complained that I use the words “multiple personalities” in the title of the series. Given the change in the DSM from Multiple Personality Disorder to Dissociative Identity Disorder, why do I continue to do that? It is because many DID individuals, and certainly my patients when I was in practice, prefer the word personalities. They feel the term to be more appropriate to how they, including alters, feel. That was more important to me as a therapist than the views of many people outside the DID experience, including doctors or therapists, who vehemently object to the use of the words multiple and personality together, who insist the there cannot be more than one person in one physical body. One could have a philosophical argument about that but will it help process any trauma? No.
I do not have any problem if my patients or anyone else prefer to use the word personality instead of identity. These are just words, so use any word that you feel applies to you that communicates your experience. Of course, you have to pay attention to your immediate circumstances in choosing the appropriate words for that context. There is no problem explaining that you have 7 personalities or identities while in a therapy session but there is no point in expecting an immigration officer at the border to understand that there are 7 of you as you show your passport at the border.
In therapy, the focus is to process the past trauma that keeps on intruding into the here and now. It is to facilitate internal cooperation, communication, coordination within the system. The idea is to minimize the conflict among the alters because that conflict prevents processing the trauma and prevents you from reclaiming your life.
It is important for the therapist to concentrate on helping the alters to feel respected, validated and taken seriously, as they individually appear, so that a genuine therapeutic alliance can be established. With that, an environment of healing can be created. Everything else is of minor importance. If you have a therapist you can work with, I would not waste time fighting about a diagnostic label. It is better to simply tell them what you need. If it is too difficult for someone to say out loud, then written messages from alters that can be delivered in a therapy session may be helpful.
Diagnostic labels are created by theorists trying to describe observed phenomenon. In my psychiatric practice, the guiding principle was not theory but rather practicality – how to help someone process trauma. Processing trauma is not theory. It is hard work. Its success is based on the efforts of the patient and the application by the therapist of psycho-therapy with kindness, compassion and empathy.
