With respect to mapping one’s DID system, if you find it beneficial, then by all means do so. In my psychiatric practice I neither encouraged nor discouraged my patients to map their systems.
With my patients, it was always important to return to the fundamental point of treatment of DID, which is to allow the system to process trauma. In my experience, this happens through engaging presenting alters in a genuine, empathic and trustworthy manner. Having a schematic of their systems was not necessary to do that.
Again, based only on the experience I had with my DID patients, mapping systems was not necessary to an efficient or focused therapeutic alliance. The problem is not particulary the mapping but rather that therapists who encourage mapping systems may infer, or sometimes outright claim, that you have to understand each and every part of the system before you can heal. Certainly, for systems with massive multiplicity, this runs the risk of turning therapy into a never-ending marathon.
Mapping also suggests that therapists need to have some detailed knowledge of the individual alters, almost like requiring a census of “who is who” including how they are grouped or related. Mistaking meticulousness for clarity, a therapist can be lured or distracted into trying to provide individual psychotherapy of each and every alter rather than simply engaging with alters as they present. In the case of Ruth, described in Chapter 5 in Volume 1 of Engaging Multiple Personalities, some alters’ problems were taken care of as a by-product of other alters who engaged with me as well as by other alters who acted as co-therapists or “preachers” rather than by me as the psychiatrist.
Alters functioning as both co-therapists and preachers made perfect sense in Ruth’s context as she had decided the way to solve her problem was to convert the “evil” non-believer alters into believers (of Christianity.) As her therapist, my task was to maintain my neutrality so as to enable the therapeutic alliance to be extended to all alters, whether they were presenting as non-believers or otherwise. This individual choice by Ruth was a very positive decision in her healing journey. And, as always, I was careful to not interfere in the system as to religious or other matters unless specifically invited to do so.
Ruth had about 100 known alters when she saw me, and continued to present many, many more over time. It was instructive to see how they often had quite separate handwriting styles that remained consistent throughout and then long after therapy had ended. Years later she told me she had hundreds of alters. I was never sure if the number had grown or that she had became more comfortable in recognizing their presence. If her healing was dependent on mapping an ever-expanding system, she never would have healed to the point of going beyond the need for ongoing therapy. The fact is that after a relatively short time in therapy, for all practical purposes, her self-harming activity ceased. She was able to live independently, care for her children once again, and make a fulfilling life for herself which continues to this day, some 20 years later.
Mapping is sometimes also used to encourage the idea that integration is the appropriate goal in DID therapy. It is as if a DID system is really like humpty-dumpty and mapping would allow the therapist and patient to find all the piece so as to glue them all back together. Readers of my books and this blog already know that I don’t believe that integration is or should be the goal of therapy. Why? Because under stress, the integrated personality will again split both out of habit and the need to protect itself from danger. In my opinion, it is far better and safer to focus on healing, on eliminating the intrusion of the past into the present while training to remain vigilant rather than hyper-vigilant. If integration takes place in whole or in part, that is fine. If not, that is fine too.
The goal is to heal from the trauma. To claim that healing from the trauma requires mapping (or integration) is a false leap of logic. The point is to eliminate the power of the past to re-traumatize you in the present. That is not based on mapping or integration. It is based on engaging alters so as to allow them to process the trauma in which they are trapped, that they are repeatedly playing out, and that they likely continue to dissociate around.
My further concern is that focusing on mapping and/or integration runs the risk of driving some alters into resisting a genuine therapeutic alliance. This can undermine another goal of helping the alters function as a team with cooperation and finely tuned coordination. It is incredibly beneficial to shift from alters as a group of mutually antagonistic individual parts to parts working harmoniously together. So long as they are not in conflict, they can have a peaceful co-existence. Otherwise, time loss, competing for time out, or even self-harm, will continue to cause tremendous stress.
Here are some simple therapeutic guidelines:
1. Symptoms can usually be traced to alters getting triggered by repeated intrusion of past trauma into the present. These are flash-backs which turn the patient’s life upside down again and again – just like the original repeated early childhood traumas. So, the first goal is to stabilize the situation, to do a kind of trouble-shooting based on what alters are presenting to the therapist. It is PTSD treatment for the early childhood trauma. Essentially, it is figuring out what to do therapeuticly on a kitchen sink everyday level.
2. Once activated, alters assert their right to be, to exist, to communicate. They can take over and cause havoc in the ordinary life of the DID individual. For example, chunks of time loss can occur which are very disconcerting and often very frightening for the host. At the same time, the alters who take over during those periods of time-loss for the host hold critical keys to healing. The immediate goal in treatment is directed towards quickly negotiating some kind of cooperation among the alters. It is focusing on turning the chaotic conflicted group into a disciplined team-like group with the common goal of healing. That is the ideal. While it is far more easily said than done, that is the target.
3. Engage whatever alters present and work with them. Remember that all of the alters are around when you speak with one, and make sure you formally invite them to participate by listening, by watching and by speaking when they so wish. Many alters can heal as they touch in or simply follow a more principal alter’s therapeutic journey. They do not always need to be called out or to be otherwise addressed directly. In fact, many just feel safer watching and listening. A corollary to this is that being mapped can be frightening to them. It might be seen as telling them they need to stop hiding when they are still not feeling safe enough to be identified. And frightening an alter can make them potentially uncertain about the therapist’s motives. That uncertainty can be a recipe for therapeutic disater.
In my experience, the most important therapeutic tool is deep respectful listening. With that as the ground, inviting all alters to listen in, mapped or not, addressing their concerns and understanding them in their context becomes possible. Other tools I used were stillness on the part of the therapist, working with the practice of one safe breath at a time to connect them to the safety of each present moment, self-soothing techniques, grounding techniques and the 5% rule. Medication, if used as an adjunct to psychotherapy rather than the principal therapeutic intervention, can have clear benefits to support the patient.
