February 10, 2010
Lots of trauma survivors with dissociative identity disorder are just starting their healing process. Other dissociative survivors are not new to their healing process, but they might realize that they haven’t yet covered all the basics.
DID therapy can feel huge, daunting, difficult, and overwhelming. There is so much to do and so many areas of work. For a broader overview of the many areas of DID healing, please refer to the article, “50 Treatment Issues for Dissociative Identity Disorder”.
For individuals building the foundation for their work with your dissociative system, here are some of the first things to do.
DID 101 involves:
1. Get to know your system. Build the courage to find and meet your insiders. Remember, they were formed and created to help you – even if it doesn’t feel like it, you are (or can be) on the same team. Who are your inside parts? What jobs do they have? What kinds of things are they able to do? It’s really ok for you to build positive relationships and actual friendships with your insiders. If this feels scary for you, explore those feelings. What makes it hard for you to get to know your insiders? What fears or resentments do you have? Understanding your resistance to these ideas is important.
2. Become more comfortable with your diagnosis. If you don’t understand what dissociative identity disorder (DID /MPD) is, be sure to speak more with your therapist or psychiatrist about what it means to be dissociative. There are lots of books, websites, blogs, articles, conferences, etc that can help to educate you about the basics about DID. Understanding DID will help take out some of the mystery and confusion for you.
3. Build a support system and capable treatment team. It is very helpful if you can surround yourself with a few other people that understand trauma dynamics, preferably at least one or two other people, besides your therapist and doctor that understand that you are working on healing from trauma. These support people don’t have to be experts in DID – if they are just willing to spend some time with you when you need a safe distraction from your healing work, that will be helpful. Please don’t lean on lay-support people for the heavy issues. Leave the complicated treatment issues for your therapist to work with – your support friends are not therapists, so be very careful about not pushing them too far or demanding too much of them.
4. Once you have recognized at least one or two other parts, work on building communication with these parts. Internal communication is one of the very most important factors in DID therapy, and the sooner you can interact cooperatively with your other parts, the better your healing progress will happen. Approximately twenty of the articles in the Discussing Dissociation blog reference tips for building internal communication. This link groups these articles together. Learning how to talk to your other parts is the most important factor in your healing.
5. Connecting with your internal landscape. What can you see inside? Can you see the other insiders? Do you have an internal safe place? Internal visualization work is an important skill as it builds a way to connect with your insiders. Even if you can’t see the others inside, there will likely be someone else who can. Maybe ask if that insider will draw a map of your system for you? The sooner you can see inside, the better. And of course, if you see insiders that are not in positive, healthy, clean living conditions, you and other helpers in your system will need to do something to help them.
6. Working on limiting or preventing self-destructive impulses and self-injurious behaviors. Learning how to address self-harm urges is particularly important for your stabilization and progression in therapy. You have already been hurt enough – adding more hurt may feel like it helps you to cope in the short-term, but using behaviors such as cutting or burning is not any more helpful than using a shot of whiskey or a hit of cocaine. Explore better ways to cope with your intense feelings, develop more grounding skills, build positive containment strategies, and methods to reconnect with the here-and-now. A grouping of articles about preventing self-injury can be found here.
7. Live in a safe place both inside and out. If you live in a violent environment, address this issue as quickly as you are able. If you are continuing to be abused or sexually assaulted in any way, your dissociative walls will stay strong, and your system will have greater trouble trusting you and your treatment team. Of course, when anyone is fearful of abusive repercussions, it is much harder to disclose the real issues. Dangerous environments can include everything from domestic violence, abusive parents, organized perpetrators, to internal system perpetrators and angry introjects. Building more and more current-day safety is vitally important for your overall healing process. If you aren’t safe, make this a priority in your therapy process. Building an internal safe place is also critically important. However, please remember that in order to build an internal safe place, you have to have a genuine belief that safety can happen, at least part of the time. Making an internal safe place for your insiders is much more difficult when you are still concerned about external safety.
8. Start building options for positive self-comfort, self-soothing activities. The therapy process can be so very painful and emotionally difficult. Having a variety of options to do that are comfortable, safe, gentle, soothing, and stabilizing is important. What can you do when you want to have a break from the hard work of therapy? What can you do when you need some quiet space to think – or to not think? When you are hurting, what can you do that will help you to feel better? Soothing your pain in ways that help your healing (vs. using self-destructive options) is an important skill to develop.
9. Create healthy options for expression of feeling and emotion – use art, music, journaling, collage, blogging, forum posting, sculpting, painting, poetry, play therapy, sand tray therapy, scrapbooking, etc. DID therapy involves processing a lot of flashbacks, violent images, intense feelings, overwhelming thoughts, body memories, body pain, etc. Building a repertoire of artistic avenues to describe your feelings and experiences will be very helpful. You might not always have words that you can use so it is important to find non-verbal ways to safely express what you feel.
10. Create your own personal space. In this space, let it be ok for your insiders to come out, to be themselves, to be out in the body, and to exist. Out in the world, and when you are around other people, most of your daily life will be about keeping your insiders tucked in and acting socially inappropriate. But somewhere in your private time, your insiders will need time to surface, to know that it is ok for them to come out. Having the freedom to switch without reprimand is important as each of your insiders will need to do some personalized healing work of their own.
Not 11. Please note: I am specifically not including memory work or skills to do memory work in my top then list of DID 101 skills. The reason for this is that if you are just beginning DID therapy, it can be very destabilizing to focus on heavy-duty memory work. Yes, of course, doing trauma work is an important part of your overall healing process, but in the beginning of this journey, you need to build these basic skills before you begin to put a lot of energy into memory work. It is much safer and more stabilizing to have these foundational therapy skills in place before focusing on the trauma content of DID therapy.
DID therapy is intense, long-term, exhausting, and difficult. But your healing is worth it. As you truly address the painful conflicts, unmet needs, and internal confusion caused by your years of trauma, abuse, and neglect, you will feel better within your own self.
I wish you the very best in your healing journey –
Kathy Broady LCSW