DISSOCIATIVE IDENTITY DISORDER IN THERAPY
Ten years is a long time in therapy. The therapist can learn a lot in a decade.
In 2000 I met my first client with dissociative identity disorder (DID). I was completely unprepared for the onslaught of love and horror. We worked with her internal chaos with mutual bewilderment and devotion. I kept meeting someone different: another age, another gender, another language. More and more parts. Why? What could have happened to her? What was I supposed to do? This wasn’t madness, or make-
I felt very on my own. Books, research, training were ‘on their way, coming’ as they say in Africa. Yet survivors of childhood trauma and neglect were beginning to dare to hint at their suffering. Psychotherapists began to believe. Society is taking longer.
It began to dawn on me that the folk with dissociative identity disorder I was meeting led hidden lives. They were competent, skilled, and talented. They drove cars, raised children, had careers, and led ‘apparently normal’ lives. Their dissociation was carefully hidden, explained away.
UNDERSTANDING DISSOCIATIVE IDENTITY DISORDER AS A THERAPIST
I clawed at anything I could to try and understand. I went to a lecture by Ellert Nijenhuis, which was way above my head at the time, so I bought his slides and his ground-
I began to understand: the worse the trauma, the greater the number of parts. With dissociative identity disorder, the ANPs could be numerous—one to go to work, one to drive the car, one to go to church, one to deal with a social life, one to run the family. And I began to understand too that they may or may not know about each other, and that they may or may not know about the trauma and abuse.
The EPs were harder to understand, until I trained in Sensorimotor Psychotherapy. Slowly I began to understand about trauma—that it overwhelms the body and the brain, that its effects are universal, impacting each of us in similar ways. It is a normal, biological response, but the consequences are most severe when experienced repeatedly at an early age, especially with neglect or inadequate parenting. I began to understand my clients better. I began to understand dissociative identity disorder better.
It’s all about survival.
HOW TRAUMA SHAPES THE BRAIN
And I began to understand, too, that the brain is shaped by trauma, that it adapts to it and is molded by it. We have evolved from being hunter-
Each team of parts, with their own particular strategy, has a different agenda, and very possibly different opinions within the same team. Team Fight wants to slog it out physically or verbally. Team Flight wants to get out of there, and fast. Team Freeze is caught, suspended, in that moment of trauma, and wants to remain invisible and unmoving. Team Flop will do whatever you ask of them. Team Friend may hold the casting vote as the one who needs attachment and has to keep the therapist close. The simplicity of the order and organisation in the apparent chaos labelled ‘dissociation’ was revolutionary for me.
FIGHT, FLIGHT, FREEZE, FLOP, FRIEND
I began to seek to understand the parts I was meeting with this paradigm. What might Team Fight look like? No nonsense. Confrontational. Aggressive. Teenage. Male. Saboteur. Vengeful. Swearing. Threats. ‘Don’t mess with me.’ They get things done, make things happen. Even if at first they were antagonistic towards me, they were pivotal to healing and must be respected. I also began to see how unbelievably brave they were: fight takes a lot of courage.
Team Flight has a different strategy. They want out. Escape. Run. Their behaviours are obsessive. They are addicted to drink, drugs, sex. Their nose is in a book, their head in a computer game, running away mentally. To cope with the sense of entrapment, they dream of suicide and amass a pile of pills. Team Flight began to make sense to me as I recalled my own experience as a young girl home from boarding school. Being chased by a gang of girls from the village, I have never run so fast, panted so hard or leapt fences so well. But being able to flee meant that I had no lingering ill-
Team Freeze is the brakes. At top speed and still accelerating, an emergency stop. Stunned. Stuck. Paralysed. The main consequences lie in the meaning the child makes of this moment of trauma when they are helpless and overpowered: ‘I can’t do it’, ‘I don’t know what to do’, ‘I’m on my own.’ In that paradox of impossibility, Team Freeze drops like a trapped animal, apparently dead. And the icy fingers of powerlessness reach through into our adult lives still: ‘I don’t know how to do it’ has disabled me all my life, until I recognised it as the blended freeze part within me that was stuck in frozen trauma from when I was six and first went to boarding school, separated from home and family.
Team Flop is all-
But submission can be misunderstood. The child must please and obey in order to survive—the fear and dread, even the pain, is otherwise all-
Team Friend is all about attachment, connection and belonging. They work to ensure they are not abandoned. They cry, ‘I want my Mummy.’ They do anything for approval, for the love that is a child’s birthright. If it doesn’t come, they assume there is something wrong with them. They try and try and try to be better, to be good. Connection and belonging is their lifeline, and they are adrift without it. The most devastating words are ‘It was my mother.’ Such pain, such betrayal of trust, while all the time the family insists on loyalty above all else. It is an unwise therapist who criticises the parents: then all attachment-
All these different strategies, in different teams, within one person: the competition between Team Fight and Team Friend alone is at the level of an internal civil war. I began to understand how important it is to recognise each part and understand what it did to survive. I began to realise that I needed to mediate between the parts, and work with utmost diplomacy. But I make mistakes often, and misattune. Usually it happens just when I feel that we are getting somewhere. I began to search for more answers, and they came in the form of therapies such as Richard Schwartz’s Internal Family Systems. He stresses the importance of the work of ‘protector’ parts. These act as the buffer between the functioning parts (ANPs) and the traumatised parts (EPs). Schwartz teaches that if we work with the traumatised, exiled parts too soon, without permission from the protector parts, then the latter will cause havoc and close the therapy down in an effort to stay safe. He calls these protector parts ‘firefighters’: they are fighting the fires caused by going too far, too fast. They cut, they take overdoses, they get lost—anything to flag up an emergency or crisis and to slow things down, to stop the ANPs and EPs from knowing about each other. The protector parts, as guardians and managers, have spent their entire lives channelling all of their energy into ensuring that these parts know nothing of each other. Their job is to ensure that the functioning parts stay functioning.
I have had significant conversations with protector parts. I have explained that the role they have taken has been important and that what they have done for the person as a whole has served a vital purpose. For instance, one protector part made sure that the parts who coped with having sex kept on making themselves available so that the person as a whole would not be tortured or punished for not complying. I explained that this was a valuable role but that it had become unhelpful as things had changed now and life had moved on.
I explained that those parts no longer needed to make themselves available for sex, that the abusers had gone, and sex with strangers was no longer appropriate. I asked the protector part to try to keep the parts who coped with sex to stay inside. He promised to consider it.
It took much longer for me to understand introjected perpetrator parts. A client explained it to me. You’re five years old, you’re humiliated and beaten. You can’t stop the abuse, so a part comes to side with the perpetrator, to be like him/her, to behave the same. It affords a sense of power in the powerlessness. The five-
PARTS AS A WHOLE
Parts make up the whole, but so often they operate independently, each coming from their own perspective, their own survival strategy. I get that but my capacity baulks at having to recognise that adults will deliberately train a child for their use. They use spinning, torture, hypnosis, they withhold affection, and they mingle it all with sweets and treats. Programmed parts robotically answer the phone, open the door, go out on a certain day, switch at a certain touch, or at particular numbers or words. With programmed parts there’s much more for me to understand. But I continue to be humbled by the courage and tenacity of these parts, all of them with their own way of surviving, each of them managing the best way they know how. That might be by managing daily life as the ANPs, by being a protector to keep the ANPs functioning, or by holding the most unimaginable horrors of the EPs by strategies of friend, fight, flight, freeze or flop. Dissociative Identity Disorder truly is a creative survival mechanism.