What We Wish Our Doctors & Therapists Understood
Trying to Bring Alters Forward
Alters usually come forward because of triggers. Early on in a therapeutic 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 those in front of you.
“I will only work with the Host” will completely shut your client down.
Connected to the point above, some therapists will try to ‘set up expectations’ for how their sessions with their clients will go by saying they will only want to work with the host of the system or only want to work with one alter. This is an immediately invalidating, frustrating, and a huge waving red flag to the system that the person doesn’t understand at all what it’s like to have DID, especially in a therapeutic environment. Having DID, you already are going to a therapist for help because you likely are not to a point where you have control over switches and need their help. You are going there and know you are going to be talking about hard topics – trauma from your past. And now they’re asking for you to be able to control your triggers and any emotional responses and ensure that no switches happen, or they’ll refuse to work with that alter that switches in if someone gets triggered due to speaking about something traumatic in therapy? Of course, that may not be what they mean, but how could a therapist not expect a new client to potentially have those anxieties? How incredibly invalidating and frightening is that, and how much do you think that would make someone NOT want to open up or be vulnerable in therapy? Once again – the best approach for a therapist – especially someone working with a system they haven’t worked with before – will be to work with, connect with, and help whoever is in front of them at the moment. It might be harder and more complicated, but that’s the disorder, and that’s the case they’re taking on by accepting a client with DID.
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 coexist in harmony functionally and healthily while actively staying multiple. This often includes bringing down daily amnesiac barriers and raising communication between alters.
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
DID has always been shrouded by stigma. Unfortunately, this has only developed and morphed over time. First, it was primarily through religious terror and fear-mongering, then by horrible misrepresentation in the media, and now the newest stigma our community is facing and often struggling with is the internet and its ‘portrayal’ of our disorder. Don’t get me wrong – that the internet is the current ‘monster’ we’re fighting doesn’t mean the others have gone away or disappeared. They’re still very much there. However, it’s a very new and big aspect that people struggle with in our community – especially when going to professionals.
Let’s get one thing straight – 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, however, there have been some severe negatives to come along with it. 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, which is incredibly disappointing. 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 of 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.
We are dealing with differing opinions, comfortability levels, and reactions to therapy.
With different alters come different feelings towards therapy. Therapy is a very vulnerable thing and can feel very invasive. Systems exist in many ways to keep information hidden from the alters within the system, so therapy can feel very threatening to that. Many alters will feel very threatened by therapy and very resistant to it. Therefore, it’s important for therapists to understand that people with DID/OSDD are dealing with not only their own feelings around therapy but also other alters within their system and their conflicting emotions and reactions to therapy. Those can be very volatile and hostile. Alters can retaliate for things they don’t like (or threaten to), and that can make others in the system afraid to open up in therapy. There are so many complexities to living life with DID/OSDD, and these are things that need to be approached with understanding and care.
You might not have the necessary training, and we know that.
What we don’t need is for you to try to teach yourself and power through if you can do the work to try and find us someone who has the training to help us better. The best way you can help us is to find someone with the necessary training to transfer our care. In the meantime, you can provide care and educate yourself because care in the meantime is better than none at all, but do the work to reach out to providers to transfer your client to someone with further education because clients deserve someone who is a specialist if they have a complex disorder.
These are trauma disorders.
Ignoring the trauma and trying to focus only on the surface-level symptoms will only go so far. You’ll miss the underlying roots of the issues and never get deep enough to solve anything. There are no shortcuts to these disorders.
DID/OSDD are disorders that inherently come with co-morbids.
You will never see a patient who only has DID/OSDD. You cannot only be treating that disorder. You must also be identifying and treating the co-morbids that come along with DID/OSDD, and many systems will have several that may take time and trial and error to identify. DID/OSDD are not ‘alter disorders’, though they are so often focused on that way because that’s what sets them apart. At their root, they are trauma disorders and should be treated as such, with all the complexities that that brings. The alters are just an added layer of complexity to it, but putting all your attention and focus on the alters will completely ignore the problem and likely make the patient feel negative about the experience.
Not all of us can show up for therapy.
The papers and notes we bring are not neurotic, they are absolutely individuals takes that one personality may have to bring along and present. It is important to realize that each and every individual has their own struggles and often their own compartmentalized slice of the trauma, meaning they have different needs, goals, and focuses.
If there is a particularly non-verbal or introverted alter, it is very unlikely they will be present or willing to talk with a medical professional. In these cases, people with DID will write down the needs, concerns, and topics that may need to be brought to a doctor or therapist. This is a common way of organizing the information that different identities present daily so each personality’s individual problems and efforts can be heard and properly treated.
One personality may struggle with an eating disorder, while another may have the compartmentalized traumatic memories of an assault, and each one may need individual therapy pertaining to their personal experiences, even if one or the other does not or can not present during an appointment. Likewise, one personality may be willing to attempt healing, while another may not, and it is respectful to understand this and work with this phenomenon, not expecting cohesive and consistent healing for some alters, even if other alters are able to achieve this.
Even if the whole is thriving, certain alters may still struggle heavily with individual problems, and sometimes, the only way to help is through a game of telephone, sending the problems and feelings in via notes or recollections from alters not involved.
Some days, it may be difficult for a person with DID to show up at all, if they are presenting as a person who is particularly unwilling or unable to communicate with medical professionals, and it should be a consideration when it comes to rescheduling missed appointments.