[3] Treat the trauma, not the drama.

While the presentation of DID may appear to be melodramatic or overly complicated to the therapist, common sense dictates. There is no need to treat every alter as a full fledged individual who needs individual psychotherapy. Generally speaking, they don’t. The key is to just address the alter specific presenting problems in any session. Alters are extremely responsive to, and appreciate such individual attention. And despite their initial hesitation, they are usually highly changeable.

In my experience, alters were willing to take turns to have their problems addressed according to their severity. They can all listen in and learn from each other’s sessions. This allows the healing process to spread throughout the system a little bit at a time without the need for continuos individual treatment. Remember, a therapeutic alliance gives them hope for help in dealing with burdens they have been shouldering all alone for many years. Burdens that have never been acknowledged by anyone outside, and in fact were often terrorized into keeping those burdens tied up inside.

Eventually, alters develop empathy – some sooner than others. With gentle encouragement by the therapist, they will often try to start helping each other within the system. I was often astonished with the efficiency of the inner guide(s) or inner therapist(s), that develop to hasten the therapeutic process. I have attempted to encourage one alter helping another, or to even just be sympathetic to others in pain. Therapists have an important role in teaching alters empathy towards their fellow alters.

[4] Promote co-consciousness and communication.

When talking to individual alters, the therapist must understand that it is like speaking in a classroom to one student but in the presence of the entire class. Such awareness will optimize therapeutic effect, good will, and planting multiple seeds of hopefulness into the system.

[5] Be prepared knowing that there will be both trusting and mistrustful alters remaining quietly in the background watching the on-going therapy.

In extreme cases, hostile dictatorial alters may try to sabotage therapy. They take this position genuinely in the name of protecting the system from being hurt again. Given their history of trauma involving those with power over the patient, this is both reasonable and important to acknowledge.

Occasionally, such an alter may drop a note to the therapist warning them that she/he is watching, protecting the others from being fooled. Don’t be insulted or be defensive and try to convince that alter that there is no need for their vigilance. Therapists should know that this is completely in keeping with that alter’s protective function. I would always thank those alters and encourage them to continue watching me. This is a correct and polite response. While they didn’t need the encouragement to keep watching, such responses generate more trust and good will.

[6] Empowerment is essential for successful therapy.

Following such a “client-centered” approach gives the patient a sense of autonomy and empowerment. There is no better way to help a DID patient than empowering the patient during therapy. Always keep that in mind. Essentially, the trauma the patient has been dealing with all his/her life has been one of dis-empowerment, of being the victim. Abuse is ultimately a process of domination, of one person overpowering the other. If, in therapy, the therapist finds ways to enable the patient to reclaim their power as an individual, there is tremendous benefit in healing. And critically, that empowerment will begin to allow the patient to undermine the strength of flashbacks that otherwise re-traumatize the patient.