I would like to make clear the importance of concluding any DID therapy session with at least 5 and preferably 10 minutes of simply allowing the patient to process whatever has arisen during the session. By this I mean that the therapist should ensure that the interactive talking part of the session is completed with sufficient time remaining for the patient to process what has transpired. It should be made clear to the patient that gently ending the session’s verbal communication at that point is not to cut off any part’s communication. Rather, it is to permit the entire system to take in and begin to digest what was exposed, addressed and/or clarified during the day’s session.
Why do I feel this is so important? I believe it is important for two different but connected reasons. First, it allows for all the parts to begin to process what has come up through one alter without any outside pressure to resolve anything conceptually. In other words, it is often really important to let the body and mind synchronize after what can often be an intense experience in a place of complete safety.
This dovetails with the second reason. Following a session, there is the critical boundary of transition as a patient moves out from a safe place under the protection of their trusted therapist to that unprotected space outside the office door. Remember, there is always a period of increased vulnerability following working in a session on trauma. It is extremely important for the patient to be able to focus on processing, synchronizing and feeling grounded as a system before going outside the office where hyper-vigilance will often be triggered given the sense of increased vulnerability due to the immediacy of working on difficult material in the session.
Within that short period of quiet in safety, the patient is able to direct their internal resources first to process what arose during the session and then, with that, to be able to redirect their internal resources to re-establish their external boundaries needed for safety outside the therapist’s office environment. How patients utilize that time can differ but simply sharing the therapeutic space together, resting in the safety of the therapeutic alliance, has benefit.
I had one patient whose husband told me that following the early sessions, before I introduced this quiet period as part of the therapeutic process, he always had to pull off the road when driving his spouse home. By doing so, his spouse could walk as different parts expressed themselves – usually quite intensely. By allowing her the space to do this while they walked, he could safely pay attention to all the parts. Paying such close attention was not something he felt he could do while driving in traffic. The walks were usually 10-15 minutes in duration. Upon returning to the car, he was able to safely drive them home as she quietly became more settled.
Once I included 10 minutes at the end of her sessions, there was never a need for him to pull off for a walk on the way home. For that patient, when I encouraged the transition to quiet processing, she would invariably and almost immediately fall asleep. It was quickly clear that this was her way of processing the trauma material. So, as we came to that part of our sessions, I told her that once she fell asleep I would go out of my office, close the door behind me and wait outside with my cup of coffee or tea. I made clear that she was allowed to sleep as long as she needed to, and to come out when she was ready.
She would come out in about 10 minutes to use the washroom, and then, regardless of which part(s) had been speaking in the session, upon returning from the washroom, the host would say goodbye to me. I found it interesting that when the host returned from the washroom to say her goodbyes, there was never anything that would indicate that she had either gone deeply into trauma material or had awakened from a nap. With her stability re-established, she and her husband would then leave the office.
