Chapter 5 in Engaging Multiple Personalities Volume 1 documents Ruth, who eventually told me that she had over 400 personalities. I treated the fact of such a large number of alters in a low-keyed way. In my approach, it didn’t matter if she had 4 alters or 400. The important point is that the therapy was not dependent on the number of alters – it was dependent on some key general guidelines regarding alters.
Alters usually demand to be treated as separate individuals. That is how they experience their own being. In therapy, integration was not the goal. The ultimate goal is to help all the alters to function as one cohesive unit, like a football team with a common aim of winning the game. I tried to teach them to aim for cooperation, communication, and coordination. The approach was for me to help them to respect each other and encourage them to help each other. This needed to be done without my denying their desire to assert their own individuality.
Initially, there are conflicts that are often expressed quite strongly by alters that are not interested in working with or befriending any other alters. There are usually those that are quite angry with other alters and wish to be violent toward them. This approach requires the therapist to proceed with sensitivity and tact. Without hurting their feelings or telling them to drop their individuality, I would point out to them the need to acknowledge that they should work for the common good because they are all sharing only the one body. This is one of the main tasks in DID therapy, to help alters come to terms with the idea that they have to work together, to sacrifice a small measure of their individual demands so as to be able to work together for the bigger and more powerfully functioning unit.
Eventually, after alters have processed their traumatic memory, the need to be separate individuals often diminishes. As a therapist, it is paramount to control one’s curiosity and undue inquisitiveness as to the individual alters’ personality and characteristics. I never said anything other than the truth that all the alters played a part in saving the system from destruction under the direct assault of the trauma and its after-effects. Therefore, all the parts needed to respect all the other parts.
One must conscientiously refrain from trying to treat each and every alter separately as if you have 400 separate patients. My contact with each of Ruth’s alters was limited to whatever and whoever arose in the here and now of therapy. If one alter was suicidal, I would encourage that alter to come out to address that one’s specific issues, without demanding that she come out. It is delicate balance of neither denying their individuality nor encouraging their separateness. As the trauma is processed, the individuality becomes more and more of a non-issue.
On the other hand, therapy for a suicidal alter must be straight to the point. One can explain to the suicidal alter that she is angry and fighting against herself, whereas the real anger should be directed towards the abuser. It was the pain inside that led her into wanting to hurt herself. I then pointed out different things she could do to sooth and ease that pain. Critically important was to point out that she could use the anger itself as a powerful force for healing and recovery.
Empathy from the therapist goes a very long way. One can seek to motivate other helpful alters to rally to the task of facilitating the healing. Other alters may be assigned the task as co-therapists, or at least to hold the hand of the sad or suicidal alter(s) to let them know they are not alone.
While therapy has to be flexible and dynamic, it needs to be goal-oriented and task-focused. I conscientiously avoided socializing with interesting, colourful and engaging alters. Therapy is not a chit-chatting social event with alters over a cup of tea.
In this way, even with several hundreds of alters, I managed to complete therapy in 2 and half years with Ruth. It is worthwhile to note that in a follow up instigated by Ruth, she reported that she had not needed support from the mental health system since therapy over 20 years ago at this point. This is a far cry from her history prior to psychotherapy that involved 20+ hospitalizations (one of which lasted 5 months), multiple psychiatric emergency visits and ongoing and unsuccessful pharmaceutical attempts at treating her depression.
This is not to say therapy can always be completed in such a short time. There are tremendous individual variations. Nevertheless, this is a confirmation that DID therapy does not have to drag on for years and years.
