Some therapists believe that they should not engage with alters, particularly child alters, because that would encourage dissociation. There is no need to fear that you are encouraging dissociation in your clients. DID clients are already experts in dissociation. Dissociation has been and remains their survival defense mechanism. No one can encourage them to dissociate any more than one can encourage a fish to swim.
Therapists: Stay on your toes, so to speak. While you should not try to bring out an alter, never miss the opportunity to respond to alters when they come out to communicate with you. Seize that opportunity and engage them. It is the most important therapeutic opportunity in DID psychotherapy.
There are critical guidelines to keep in mind when dealing with alters. Always remember that the alter is part of the whole of the individual. They exist as part of the whole person. You cannot consider any one alter as a unique individual existing apart from the whole person. Avoid picking favorites, avoid identifying those you don’t like, and avoid even appearing to do those things. Maintain your own stability in engaging with alters. Do this by engaging with impartial attentive kindness whichever alter emerges whether they be nice or mean, happy or sad, young or old, manic or depressed.
Always remember that the whole person is your patient, not the host alone and not any individual alter alone.
In the absence of a clear and present danger to the system, seeking to call out front a child alter, or any alter, is a mistake. When an alter, especially a child alter, feels safe enough to engage you (or angry enough for some), that is when you relate directly with them. The alters will usually withdraw on their own, and someone else may come out. That withdrawal is not a mistake, so don’t try to prolong the interaction. It is far more likely a decision (conscious or otherwise) by that alter or the system to allow for further processing of the material you engaged about.
It is also an expression of them establishing a sense of their own agency – an important aspect of healing. This is quite distinguishable from an alter’s appearance in the midst of a re-traumatizing trigger, which displays a lack of agency in that kind of uncontrollable eruption out.
Having that engagement, even once, is a great opportunity to invite that alter to listen in when therapy is taking place – whether or not they will emerge in that session. It is also a great opportunity for you, as a therapist, to be reminded and appreciate that many alters may indeed be listening when you speak to any one particular alter. So, make sure your words are well considered. But, at least as important, remain stable, warm and kind – whichever alter you may be speaking directly with at the time.
If alters do not withdraw and the session will be ending soon, particularly with young child alters who remain out, therapists need to guide them to quietly process what they need to process and gently lead them into a neutral space before they leave the session. This allows for one more gentle transition, from the office to the reception area.
Make sure you allow for at least 5 to 10 minutes to allow the processing and transitioning to take place. After all, once outside that very brief therapeutic hour in the office environment, the patient returns once again to the conventional world. Providing time for a transition is critical to avoid re-traumatization by allowing time for processing what has come up in the session. Remember, patients cannot simply switch a child alter on or off at a moment’s notice..
Further, in the conventional world, child alters likely need the protection that other parts of the system provide. A gentle transition makes for yet another opportunity for the patient to briefly practice co-consciousness and self-directed agency.
Boundaries
Enthusiastic therapists probably feel the urge to re-parent the inner child in their clients, as we often perceive the desperate need of the inner child for the nurturing that was missing in her childhood. As much as we may wish to do this, experienced therapists follow certain boundary guidelines for the safety of all concerned. These include no socialization outside the office as well as rules against any exchange of gifts or money outside the therapist/client office fee transaction.
In other words, some aspects of a normal relationship between parent and child may be inappropriate in the patient/therapist relationship. For example, a parent will generally respond to phone calls at random hours of the day and night. They will hug their child, often very close, as part of a greeting or goodbye. They share meals, vacations and other family events. But while they are important in the family dynamic, these are not acceptable between client and therapist because they can, despite the best of intentions, undermine the actual therapeutic relationship.
As I said above, in DID therapy, when talking to the inner child presenting as an alter, one must assume the presence and attention of all the other alters. While you may be speaking appropriately to a 4 year old alter in language that might be used by a kindergarten teacher, one must also be cognizant that other alters may be listening to what is being said, and the other alters may have their own different connection with the system’s trauma history. They may, as a result, have needs and reactions quite different from the 4 year old.
In other words, conversational boundaries we might presume, such as that we are speaking during a therapy session to one person in front of us and not a crowd, is not a boundary that our patient may share with us in common. And boundaries, amnestic barriers within a DID system, might not be so immediately apparent to the therapist when alters switch during a session.
Once again, this is an opportunity. The therapist can let the other alters know, indirectly, that other parts inside can be very helpful to the young alters (as well as to each other). It is not that you have to figure out what language to use that would be appropriate for a 4 year old as well as a concurrently listening 44 year old. Instead, you can explain what the 4 year old needs and invite other parts inside to fulfill some of those needs. For those that will not or cannot, you can invite them to listen. In this way you can create an environment where the parts grow to be kinder and more respectful to each other’s needs, wishes and responses to trauma history.
