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
January 11, 2009
A fun and creative way to increase system communication and overall system familiarity is to make a scrapbook displaying pages that describe each of the people in your system. Getting to know your system is an absolute essential part to your healing and recovery, but doing system work doesn’t have to be drudgery. A system scrapbook can be a wonderful treasure and a priceless keepsake for many years to come. It can help create and solidify nice memories for you.
This exercise is similar to making any other personal scrapbook or souvenir album or photo album. You will need a scrapbook, or a notebook, or a binder full of paper. Have a wide variety of writing utensils available, ie: pens, pencils, crayons, markers. Allow for different colors to be used. If you want to get creative with your pages, you could also set out scissors, glue, glitter, strips of fabric or cloth, stencils, rubber stamps, yarn, buttons, dried flowers, photos, ribbons, pretty papers, etc.
Invite each and every one of your internal system parts to design their very own page or two or three about themselves.
The pages are to be created by each of your individual system people to introduce and describe themselves, their activities, their interests, their friends, their history, etc. They each can each decorate and design their pages however they so choose. Encourage your parts to creatively display as much information about themselves on their pages as they are comfortable. It’s also good to include drawings, or photos, or collage, or poems, or lists of information, or “Facts about Me”, etc. The sky is the limit with creative expression!
The purpose of this exercise is to assist your system in getting to know themselves and each other, to increase system communication, and to lower amnesiac barriers between the different parts. As everybody fills out their own personal pages, they are providing a good visual summary for the others in the system to get to know who they are, what they like, what they don’t like, who they know, etc.
There is a particular personal fulfillment in being able to creatively express who you are as an individual. The same principal applies to internal parts as well. Having this freedom of expression is a great way to encourage other levels of communication, and being recognized as an individual within a system is also an important emotional need. The self-worth of each of your internal parts can increase just by being recognized as a valuable part of your system.
Completing a personalized page will be a challenge for many insiders, as they often do not know what they like. It’s ok to let the pages be filled out gradually – there doesn’t have to be a time limit or a rush for completion. In fact, the longer you allow this exercise to continue, the better. Some of your insiders might have to look around in the outside world to find more things that they enjoy. Many of them won’t be used to the idea of “liking anything”. Having the freedom and encouragement to explore, and to pick and choose for themselves will be a very new – and possibly unsettling – but positive experience for many of your internal parts. The entire design side of this exercise could be a totally new experience for most of your parts.
Of course there will be those who are resistant to telling anything at all about themselves to anybody, even to other insiders. These parts do not need to be forced to participate. There will be plenty of other folks that find this exercise to be a fun and creative way to meet each other. Encourage as much of your system as possible to participate in making their own page, and remind everyone to keep looking through the other pages.
View the amount of participation and interest each insider shows as an emotional barometer. The amount and intensity of interest your parts show in completing their pages and looking through other pages will absolutely parallel how comfortable, interested, and willing they are to participate in overall system communication.
This project can be rather involved, and may take days, even weeks, to complete. That’s ok! Hopefully more and more insiders will get involved over time. And as you do ongoing work in your healing process, you will continue to meet new insiders. As those new parts surface, encourage them to add their pages to your scrapbook as soon as they are ready to do so.
Another value in this exercise comes in your working together as a team. Some of the older parts will probably have to help the younger ones. Who is comfortable being near the kids? Everyone will have to take turns. Who gets to go first? Some parts will have to share when they both want to include the same item on their page, and as a system, you’ll have opportunities to problem-solve the various dilemmas. If someone makes a mistake, who will comfort them or assist them? If someone breaks a crayon, will they get in trouble? If these parts see someone new in the scrapbook, will they try to communicate with that new person on the inside? The actual process of learning to work together as a group in creating such a valuable system book is invaluable.
Please do not show this book to anyone you do not completely trust as there is no need to set yourself up for uncomfortable situations with people who are not open to understanding dissociative disorders. This system treasure book is primarily intended for you to get to know you and all your other inside peoples. It is a good therapeutic exercise and I’m sure your therapist will be very interested in seeing it as well.
Get creative, and have fun!
Kathy Broady LCSW