Joseph Wolpe popularized the idea of desensitization in therapy during the 1950s. He was a forerunner in the development of Cognitive Behavior Therapy. With great care, we can apply the principle of Wolpe’s Systematic Desensitization in the treatment of DID. As in all varieties of exposure therapy, the goal is to diminish the power of the past trauma to impact the victim in the present moment.
Exposing a patient any cues that remind them of their trauma has re-traumatization risks. That is why it is critical to guide the patient to identify, at the beginning, a minimal trigger. The therapist must ensure that the trigger is not so strong as to bring back the full force of the traumatic memory.
In vaccination, a patient receives a dose of the virus in a weakened form. This way it provokes the defensive response of the body without overwhelming it, which is what the virus can do in its unchanged natural potency. Using a weakened form of the virus, the vaccine allows patients to build up and strengthen their own defense system in preparation for a later encounter with the unadulterated form of the virus.
With desensitization therapy, you must tread carefully. Take baby steps to make sure the triggering exposure will not overwhelm the patient’s current capacity to cope with even the minimal cue the patient has identified with you. Exposure to cues that activate the sympathetic nervous system without triggering re-traumatization, with their concordant heightened blood pressure and pulse rates, is the goal in exposure therapy.
Continuing on the same path by then exposing the patient to successively more intense cues, can lead to deep healing. In this mode of therapy, the patient is supported through gradually increasing their ability to successfully overcome stronger and stronger traumatic triggers.
When I let my patient Joan talk about her past abuse (trauma), I used time and space variables to give herself a clear path to ground herself in the safety of where she was right at that moment. In other words, when she, or any alter that emerged, became frightened, I asked her to look out the window and tell me what she saw. I asked her what year it was right now and who she was sitting with in the room. With those perceptions grounded in the present, I reminded her that the trauma took place thousands of miles away as well as many decades ago.
This allowed her current perceptions to be an anchor to hold onto for a sense of being protected and safe. While it was difficult in the beginning, like exercising any weakened muscle after an injury, it became, more and more, a comfortable and comforting exercise for her to reclaim her present moment from the impact of past trauma.
When Joan spoke of her past, it was necessary to permit it only in small doses that were clearly within her capacity to speak about. I let her tell me more or less, whatever she wished, on any given day. When her memories would start to become overwhelming, I would go back to asking her to look outside through the window. Asking her to pay attention to her perceptions and physical sensations in the here and now was a positive anchor for her increasingly solid sense of safety.
Upon her return to safety, I generally suggested that she simply sit where she was and rest. I did not try to re-engage with the traumatic memory, nor did I encourage her to do so. With this approach, we were able to regulate the intensity of the trigger and give time in the safe confines of our session to allow everyone inside to process that re-engagement of traumatic memory without being trapped in the cycle of uncontrollable re-traumatizing flashbacks.
I was actually giving Joan one form of exposure therapy. If exposure therapy moves too fast, a patient may drop out or be reluctant to ever participate in therapy. In Joan’s case, I was able to regulate how fast the therapy was proceeding by how much I let Joan go engage with the past in any single session. It was easy to stop the flow of her abreaction as indicated above.
Once she became acclimated to checking the outside through the window as a way to remain or return to the present, I also would accomplish the same thing by asking her to slow down and attend to her breathing. I would simply ask, “What is the feeling in your lower chest as you exhale?”, “Can you breathe into your belly?”, or “Can you feel the weight of your right arm on the arm rest?” These were all techniques she was able to use outside of our sessions, exercising the mental muscles needed to remaining grounded.
In this way, you can gently move the engagement with past trauma to safety by diluting the emotional intensity through asking a few simple neutral questions that connect to the patient’s sense perceptions. You can do EMDR or any other variant of exposure therapy in this way, so long as you sure the patient’s emotional reactivity level is manageable. What matters is the control you jointly exert in presenting the stimulus step by step during the desensitizing process. I think that is more important than the method used.
Looking at the case histories I presented in Volume 1 of Engaging Multiple Personalities, each of those case histories is different, based on the needs and presentations of the patient. No psycho-therapeutic method is a “one-size fits all”, and therapists must adjust their approach based on the patient. Once again, this critiques and distinguishes genuine therapy from the cookbook recipe style approach of therapists focused on psycho-active pharmaceutical treatments. When therapy accomplishes its goal, the patient can talk about the past trauma safely; meaning that the patient can consider it, not be perturbed, and see it as past history rather than a present threat.
