In general, therapist and clients have an extraordinary relationship. While therapists make their living by providing therapy services, their relationship with clients must be genuine, congruent and empathic to be effective. It is not the same as having a conventional or ordinary close friendship because the trust and power dynamics are neither conventional nor ordinary.
Naturally, some alters, particularly the young ones, want to cling on to the relationship with their therapist after termination of therapy. This is true whether it is the end of a single session or the end of therapy completely. This is an important issue in the therapeutic relationship. Expressing the confidence and willingness to be there for the next session is something a therapist commonly does to encourage and support the client in ongoing therapy. It is saying that the relationship is not over – just the session. This is quite different from ending the therapeutic relationship. This is something I dealt with in preparing my patients for my retirement a decade ago. I took a year to help prepare them for that transition.
Clients often see their therapist as a particular kind of a close friend: One willing to communicate confidentially about the client’s personal history for the sole purpose of helping them heal from trauma. It is someone with whom clients can talk about issues and histories that are not so safe for to communicate about outside of the therapeutic environment. So, even thought the therapist/client relationship is based on payment for services, it is also like the best part of a friend who gives you their undivided attention. They give that undivided attention for an hour every week or 2 weeks. This is different than an ordinary friendship, no matter how genuine.
In normal personal relationships, you choose your friends based on certain qualities that appeal to you, whether he/she is funny, handsome or smart, etc. There is an expectation of sharing information about one’s life, more or less deeply depending on the depth of the friendship. Change and growth are implicitly expected in any relationship, but in a therapeutic relationship that expectation is solely about the change, growth and healing of the client.
Therapists don’t choose patients in the same way they choose their friends, such as common interests, social circles, and the like. They treat the individuals that come into their office, whether or not they have friends, hobbies or other things in common. Unless there are exceptional circumstances, the therapist takes whoever comes into their office needing his/her service. It is important to understand that your therapist-friend has problems of his or her own, but, unlike a conventional friendship, he does not share them with you. He maintains this boundary in order to ensure that he is there solely for your needs, not his own. Your therapist has to keep his problems to himself in order to properly be there for you.
Deep down, the therapist treating DID is often providing a corrective parenting experience offered in the safety of a therapeutic relationship to support the client processing past trauma. What is a corrective parenting experience? It is being there for someone when they are hurt, reassuring them of their basic goodness and helping them feel better. For example, when a child falls down and scrapes their knee, a proper parental response would be picking up the child, looking at the injury, assessing it and either getting the child medical treatment or reassuring them that the injury will heal without much of a problem. In other words, providing comfort and safety. A traumatizing parental response would be something belittling, mean. It would be using the incident as an excuse to further crush the child’s self-esteem and sense of safety by eliminating the idea that the parent will ever serve as the child’s adult protector in the world.
There is a risk that the the young alters in particular will not understand that the therapist providing a corrective parental experience is not the same as the therapist becoming a replacement parent. This is something the therapist must gently and consistently clarify for the client.
After termination of therapy, there is no legal requirement that there be a complete cessation of contact. However, for ethical and genuinely therapeutic reasons, it is risky and inappropriate for the therapist to engage in a direct relationship of friendship with a former client. The power dynamic inherent in the original relationship will not disappear. Further, and critically important, is the fact that should the client need therapeutic assistance in the future, a direct relationship of friendship will cut off that possibility.
It might be OK if the client wishes to send their former therapist an occasional greeting card. Sometimes that may be done by the client in order to leave open the possibility of returning to therapy with the original therapist. In fact, one of my patients continued for years to send the occasional brief letter to my secretary to maintain some continuity with my office. in my experience, maintaining that boundary is important for the well-being of the (former) client. It is my view that when the client finishes with therapy, it is important that he/she feels the improvement is based on their own efforts, rather than something to be credited to me. It is their successful processing of the past trauma, their survival, that is the point – not my achievement. If they can move on in life without further therapy, it is all for the better.
This is very difficult for some of the alters to understand, particularly when they remain infantile or of very young age. This does highlight another question, whether or not young alters grow and mature in their age during therapy. As is shown in some of my other writings, integration is not necessarily the goal. If the alters integrate, and their age approximates that of the body’s chronological age, that is fine. But, in my opinion, the most important mark of successful DID therapy is that the conflicts among alters are resolved so that they are working together rather than at cross-purposes based on unprocessed trauma.
This answer will not satisfy all, especially those who remain having young alters in their system. There are really no comforting words that are guaranteed to reassure a group of children (in DID – the young alters) when we take away their caregiver (in DID – the therapist) and say everything is OK. It doesn’t work for a child traumatized and separated from their loving parent as a result of worldly circumstances like illness or war, and it doesn’t work for a DID system traumatized in the past and now separating from their therapist.
However, one can give them all confidence in their ability to continue on their healing journey. That is part of the preparation work, prior to termination of therapy, that I tried to do for all of my patients. Perhaps some of the adult alters in the DID system can take over some parenting function transferred from the therapist. Perhaps the alters can become really good friends inside, supporting and mentoring each other. Perhaps the system can become more firmly established in their self-care and grounding exercises. The best reminder for the system is that all the parts are there for a reason so be kind to everyone inside, always be kind.
