I have set forth below some simple rules I would recommend to therapists encountering alters in a session. They are also recommendations I have made to significant others who were seeking ways to be supportive of their DID partner when an alter appears at home. I did have patients whose significant others did not appear to be so committed to supporting a patient’s healing. I did not deem it appropriate in those cases to discuss anything about such patient’s DID or what to do at home. If such an SO asked me what to do when their partner began crying like a little girl in the middle of the night, the most I might say was “I think you understand that your partner had bad things happen to them when they were young and crying at night is probably her remembering those things. Try to be kind.”
The aim in therapy is not to get rid of the alters, but to establish contact with alters that may appear so as to create a space in which the complex PTSD symptoms can be eased. In this way, the goal is to engage that alter to be able to live harmoniously with the other dissociated parts.
[1] Stay calm when a DID switches so that an alter comes out. It can be very unnerving, especially when it is the first time you are facing an alter. Remember that all alters are parts of the person who is important to you. Understand that there are often barriers between alters holding different extremely difficult memories. Those barriers create the appearance of a personality split off from the person you know and love. The barriers came into being to protect that person when they were a child with no other defense to abuse. Don’t denigrate or deny the barriers, don’t try to break them down. Stay calm and accept this alter as a part of the person you love. By staying calm and offering appropriate support – usually and most importantly by listening – you are already being helpful for the healing of your significant other. It is through healing that the barriers will begin to somewhat dissolve, not through outside pressure.
[2] Never try to provoke the switching of the alters, but remain mentally prepared for a switch – particularly if there is a specific timing cycle for alters to appear, such as late at night.
[3] Treat the alter with gentle kindness. Talk to them in age appropriate manner. If it is a 5 year old, talk to her like you’re talking to a 5 year old. Consider how you provide solace to a child who has been deeply hurt: You listen to them and talk to them, gently and with kindness. It would be disastrous if such an alter is told to behave like her chronological age and adult station in life. If you do that, you will have lost a golden opportunity to establish rapport with that alter, a rapport which is a gateway to help a DID patient heal.
We have to avoid the simplistic view that treats alters as a pathology to ignore, dismiss or eliminate. Like healing a fractured bone, an alter should be gently held in place so it can grow back together with the other part of the fracture.
[4] Do not argue with an alter. As noted above, speak in a way that the alter will understand. For a child alter, always be aware of why the child talks the way he/she talks. It is the same for a teen-age or very old alter. Arguing with an alter will get you nowhere. Instead, it will re-confirm to that alter that you are not listening, not accepting that alter’s experience, and are laying on a blanket of suppression. Such confirmations of non-acceptance will further trigger memories of and responses to past abuse.
[5] The more you understand why the alter behaves in the particular manner, the more you can help him/her to heal. Healing means getting him/her back to the whole, like a football player going back to play the game with his team, instead of running off with the ball as part of his individual agenda. The successful football player works toward the common team goal of winning, instead of playing alone with no regard for his teammates as if they don’t exist. I always use this metaphor to illustrate how we should treat alters in DID patient. In that moment of encounter, you are making the essential steps to help the alter to heal and move towards living harmoniously within the system.
[6] Remember to comfort the alter. It is more effective to use the right tone in your voice rather than clever words – even if you believe those words to be accurate. Use physical methods, such as kinesthetically comforting a frightened child. For example, letting a fearful child lean against your body or, with permission, letting them feel the gentle pressure of your embrace. This can be more effective than a thousand words. A therapist is under professional constraints against using the sense of touch to comfort a client. Obviously, a significant other is in a better and appropriate position to comfort the person kinesthetically.
While sexual contact in appropriate contexts may be comforting, sexual contact may well be the specific contact that you should avoid. This may be true even if such contact is invited by an alter. The reason for concern is because the early childhood trauma that gives rise to DID is commonly associated with sexual abuse. It is dangerous to use that kind of physical contact for comfort because the ramifications of sexual contact to the various alters in the system is extremely difficult to control if you are engaging in it as a means to comfort your significant other. You need to consider what you would do if another, very frightened alter emerges during the sexual activity, one who may come out in a full blown terrible flashback related to early sexual abuse. I have asked the co-author of this piece, the spouse of a former patient, to go into further details of this aspect of comforting the frightened alter later in this post.
[7] Get support for yourself. Once DID therapy begins, you should expect to meet alters, or be able to identify alters more often with which you have previously interacted. You need to stay mentally stable and healthy. Speak to the therapist. Just as I recommended to my DID patients, the SO should similarly do a lot of grounding exercises. Have a friend you trust be on call to support you from time to time.
You do not need to learn any specific therapeutic technique because you are not the therapist. But it may be helpful to understand that alters, forged in the crucible of early childhood trauma, are by their nature generally unable to be considerate of your time or limitations in a way that you will find “reasonable.” The result is that the emotional demands that you will experience during the healing process of your DID partner requires you to take care of yourself in order to support your partner.
For example, an alter in need may keep you awake for hours at night without any consideration to your next day’s work obligations. Like a child in pain, your need to sleep is not a priority for that alter. Be prepared for that. But the reward, when you see that your care and support is helping the healing of your loved one, will be great .
