What We Wish Our Doctors & Therapists Understood

Trying to Bring Alters Forward

Alters usually come forward because of triggers. Especially early on in a therapeutic environment/relationship, it is highly unlikely that requesting an alter to come forward to speak will work. Saying “Could I speak to ____ now?” feels invasive, embarrassing, confusing, and leaves us with nothing to give because the answer is often just no, they’re not going to come to the front, and no, they’re not going to be able to communicate to the person currently fronting due to many systems not having that level of communication. Also, intentionally trying to trigger an alter to come out can be incredibly damaging and makes them come out in a triggered state. What is generally best is to communicate with the alter in front of you and accept that switches may happen, and you are not going to – especially in the beginning – have any control over that. Instead, try to help and connect with who is in front of you.

Therapy is a Controlled Environment

It’s essential to recognize that therapy will never encapsulate the entirety of a system’s life experience. It’s a tiny window looking into a system’s life in a controlled environment. Yes, you’re talking about hard subjects, but ultimately, it’s a very safe space. Triggers will likely come up in very different ways than they do in the system’s life outside therapy. (This is true for non-systems as well.) For these reasons, having your client take video logs, voice recordings, or journals when things happen in the outside world so you can review them in therapy can be very useful. You might not speak to the alters in the recordings directly, but you can hear from them and give reflections that can be written down or recorded so that those alters can reflect on them later.

There are Multiple Potential Healing Goals, and the Patient Sets the Goals

Fusion being the only goal of therapy for Dissociative Identity Disorder is very outdated to today’s understanding of the disorder. However, it’s understandable if that’s what you’ve been taught – a lot of DID education still needs to be updated, which is why we developed this site. Fusion (sometimes referred to as integration in the past) is still potentially a valid healing goal. Still, it’s just one of the healing goals available to the patient, and the patient should always be in charge of their own goals and the paths they set forward for themselves. Final Fusion and Functional Multiplicity are the two most common healing paths for systems. However, some systems also choose to simply focus on healing the trauma and don’t focus on the alter count in relation to their healing path, as illustrated in the video linked below.

Fusion is when two or more alters merge and become one new alter. The new alter is not the same as those who came before; they are their own new person, but they carry some of the memories and traits of the alters who fused. Final Fusion is one of the potential goals in the therapy/healing process and used to be considered the only goal. It aims to fuse all alters down to one identity (the thought being to “get rid of” the disorder). But, of course, the condition is much more than just the alters. Also, once the brain knows how to split, it keeps that ability. Therefore, if more trauma happens, the person could still split again, even after a full, “final” fusion.

Functional Multiplicity is the goal of learning to work together and to coexist in harmony functionally and healthily while actively staying multiple. This often includes bringing down daily amnesiac barriers and raising communication between alters.

Here is a video reviewing the different potential healing goals for DID/OSDD systems.

We Don’t Trust Ourselves

Dealing with amnesia, on top of a trauma history that may include abusers who have been (or still are) gaslighting, manipulating, and more, systems are likely to have a deeply ingrained mistrust of themselves. A front of self-confidence may mask this, but that’s often covering self-doubt. A therapist must be aware of this when asking deeply personal questions – to recognize that these things are hard for us to internalize and answer. With a history of being manipulated and gaslit, asking leading or open-ended questions can lead clients to question their sanity, motives, or intentions beyond healthy limits. Please take care in how you approach your client.

We are Very Hesitant to Open Up Due to Stigma

The internet has done many wonderful things for the dissociative community. Without the recent surge of information and awareness of DID, many people wouldn’t get diagnosed or answers. Unfortunately, there have been some severe negatives to come along with it as well. Some people have faked this disorder for one reason or another. Some have even pretended to have DID to mock people who have it. Whole communities have been made online to harass those with this disorder, and it’s sometimes gotten really dangerous.

Our community also hasn’t received unwavering support from the therapeutic community. Many therapists are wildly uneducated about DID and must be re-educated on up-to-date statistics and methods because they’re working off completely incorrect and outdated information.

All this makes it very hard for us to open up to therapists about our diagnosis. We know about the stigma our disorder had even before the online ‘blow up,’ and now it’s even worse because it’s just seen as a trend. Yet, we don’t know how to broach the topic with therapists or how they will respond or react. We don’t know the extent of what they’ve seen of the internet ‘boom,’ we don’t know their preconceived notions of the disorder, we don’t know their knowledge of the disorder or their training, and we don’t know their judgments regarding the disorder. With the current climate around the disorder, a significant concern is how a therapist might internally respond when first hearing that a client suspects or has already been diagnosed with DID.