[2] Interacting with Difficult Alters
There may be alters that express the intense desire to kill another alter – perhaps including the host. Understand that such emotion and rationale are driven by deep trauma and likely walled off by amnestic barriers. For example, if “Juliet” wants to kill “Julian”, no matter what the therapist says, Juliet still experiences Julian as a separate person. This is the nature of dissociation. In some DIDs, Juliet may think she can kill Julian without harming herself. This logical gap is one that the therapist is unlikely to be able to correct with reasoning. But this is often accompanied or followed by a suicidal alter that believes everyone will be better off, both inside and outside, if she commits suicide and the entire system dies.
The therapist has to have the strength, warmth and flexibility to accommodate a phenomenon in their work that is not subject to intervention by logic. The therapist must not apply their own logic as superseding the DID individual’s subjective reality. I think this is one of the reasons that some clinicians find it hard to accept dissociation as a pathological concept, because they see it as based on a false logic. Remember that the DID individual is experiencing ongoing trauma and re-traumatization, regardless of logic.
More difficult than the experience of the therapist is the experience of the spouse/SO that likely confronts such situations at home alone with their DID partner. If they have no guidance/suggestions from the therapist regarding how to respond, the terror will go from the DID individual to their partner and back again. Leaving a supportive spouse/SO without guidance is a tremendous disservice to a supportive spouse and to the patient.
At the same time, part of the consideration is whether or not the spouse/SO is supportive. If they are not, then giving such an unsupportive spouse/SO information on the diagnosis of DID may endanger the patient. It is truly something that can only be considered on a case-by-case analysis with the patient being the ultimate decision-maker. Guidance from the therapist must include consideration of the risks if the spouse/SO is potentially not supportive.
[3] Dealing With Multiple Alters
Another problem associated with therapists who accept DID as a potential diagnosis is that they often become obsessed in trying to find out more about each and every alter. It is a waste of time and energy as well as being counterproductive to therapy. It is sufficient to listen deeply to what the alter you are engaging is expressing. Very often an alter is simply created to hold a traumatic experience or an emotion, nothing more. Such alters generally do not have the executive capacity to emerge and interact beyond the emotional context they are expressing. Talk to and listen deeply to each and every alter without prying or trying to call them out. For the therapist, focus on making a trusting therapeutic alliance with the alter. That is the key. With that, you don’t need to explore more than what the alter wants to tell you.
For the spouse/significant other, the guidance is to avoid obsessing about individual alters. Engaging them is critical but don’t obsess about them. Obsessing about alters and demanding their stories to “understand” them is a sure way to re-traumatize those alters and the entire system. It also communicates to the DID individual that you might care for one alter far more than another, that you want a relationship with one rather than with the system in toto.
Do not focus on your desire to know all of the alters. The only thing that needs to be understood is that the alters all arose as a result of dissociation in the midst of hideous trauma. If one or more of the alters wants to talk about such things, no problem. But therapists, spouses and significant others need to listen when alters want to talk without pushing for details. The key point is to help them experientially establish that the right here and right now is safe.
