Anticipating Life After Integration
It Is Possible
Truth. It does happen! People are able to integrate their dissociated personalities that have been separate for a very long time behind an amnestic curtain. And true, it takes many years in psychotherapy with a skilled clinician for this process to complete itself thoroughly. This being stated, not all persons with Dissociative Identity Disorder (DID) will move forward after long-term treatment with a single, unified personality. That is their choice in the event that integration of solidified ego states (aka-alter personalities) does not ever spontaneously occur. Sometimes a person’s internal system will opt for co-consciousness with a sense of respectful agency for internal personalities. People living without multiplicity (roughly 99% of the general population) may have understandable trouble with this notion. And surely for persons living with internal multiplicity, the concept of integration can be scary.
Passing The Vibe Test
My first DID client, Darlene**, was a surprise to me, as is the case for most clinicians not steeped well enough in graduate school courses and supervised professional experience in the treatment of the dissociative disorders. Darlene was a physician in her late 40s who knew she was a multiple when she arrived self-referred to my private practice. She had stopped therapy for several years after moving to a different city post-residency. Right away after Darlene’s intake appointment, I began seeking consultation with a DID expert and sought further educational experiences regarding complex trauma and dissociation to continue to treat her in my private practice.
It was initially very difficult work for me to keep my countertransference in check; often I privately found myself feeling both sad and enraged while thinking about the injustices she had experienced as a child. As Darlene unpacked her life history to me, I learned that her alcoholic father used her for sex from the ages of three through thirteen, and then… “he lost interest in me.” Darlene’s mother knew all along and did nothing to protect her. Living in a chaotic household also rife with domestic violence and poverty, Darlene made it out of impoverishment by earning an academic college scholarship and doing quite well in her studies. She paid her way through medical school by prostituting her body. Being a sex worker was the job of one of her alters inside. During her college years, another alter personality would go to bars occasionally and pick fist fights with men after they came on to her. By the time Darlene had entered into treatment with me, she had made peace somewhat with the different ways of being herself inside, but she had no access to consciously embodying the vulnerable feelings she and I made note of early on. The streaming tears running down her straight face… she would cry and not know where the tears came from, who inside was crying, or even what crying tears felt like emotionally.
It seemed as though Darlene had invested much self-esteem in her disaffected presentation and high career accomplishments. Even though I had tried to help her understand it wasn’t necessary to recount her early life troubles at the onset of therapy, she soldiered through telling me about her shocking history. Thankfully I passed the vibe test as her new helper because I didn’t appear to be easily rattled as she later told me. I was actually surprised that confronting her trauma so early on in treatment via the history taking process didn’t derail or destabilize Darlene’s adaptation to daily life, but it was clear to me the price she (the one out front) paid for consciously knowing much of her story.
For many years we worked together in therapy to understand how and why she had come to live dissociated inside and function under such overwhelmingly stressful circumstances beginning as a toddler. Developing internal multiplicity was how “her body-mind’s wisdom” survived and adapted thereafter. We worked together over time to understand the alliances and divisiveness amongst and between her alter personalities, respectively, to create a more peaceful and collaborative internal system, updated for the current life circumstances. We worked through Darlene’s disgust toward some of her alters, and their corresponding mistrust and rage toward Darlene too. When the time was right, we intermittently addressed her traumatic wounding, so that she could know and understand her felt sense of pain, release it, and come to a new understanding of its meaning in the context of whom she intended to become for all of her selves. It certainly was not a linear process. We needed to toggle between trauma confrontation, and containment of her internal discomfort coupled with building emotional tolerance and other skills building for years.
Creating Heart Space For A New Normal
Toward the end of her therapy (a period of more than a year or so), we began discussing what life would be like after integration of her system of personalities. In Darlene’s case, all of her alters integrated before the last year of therapy, save for two of them. She retained co-consciousness with a sense of personal agency with these two. The first one she created initially for the purpose of functioning optimally at work when there was an emergency, and the other alter personality would come forward for running marathons and training. It’s quite interesting that her system thought it best to retain these two personalities as separate and distinct, the only ones created outside of experiencing clear defensive threat. During our many discussions about life after integration, we talked about how Darlene would use her time/energy management because there came to be an emerging massive internal silence and solitude--which was a very big change. I held space for Darlene as she mourned the loss of many alters, and she decided to make meaning of these changes by feeling into a sense of them in her heart space. They had not been banished, “killed off” or died; their functions were now to support the body in a different way, a way that felt right for her. In one of our later sessions Darlene remarked, “I don’t have multiple personality disorder anymore. I’m a family of three loved ones inside now.”
The plan going forward included a new definition of self-care without loads of internal energy spent on dealing with the dynamics of internal victim, rescuer, and perpetrator. Darlene was taking the risk to make new friends and develop new interests. For the first time in her life she was able to feel soothed by physical touch from a massage therapist. These kinds of endeavors met the challenge of the new and voluminous space that she acknowledged inside her. There were no more warring voices or crying from inside to manage. Darlene no longer had the adrenaline rush from flashbacks, or the spacey high from endorphins dumped into her system from dissociating—she worked hard in her therapy to leave those automatic, reliable escapes behind her. She was able to let go of hooking in to key drama-inducing people. Saving it for one of our last regular sessions, Darlene told me she was worried that I would suggest she stop running long distance and training for marathons due to the endorphins her body was gifted after long runs. We had a big, hearty laugh together over that one as I grinned, “Hell no! Keep on running the marathons, Darlene. You’ve earned those endorphins fair-n-square each time you intentionally push through together!”
Where To Turn For More Information
I feel fortunate to have assisted Darlene and her others inside on their journey in therapy, and I will always hold a special place in my heart for them. I also hold deep respect for all persons who find a way to overcome overwhelming obstacles to embody their own mental health. If you would like information about the understanding and treatment of complex trauma and dissociation, please visit the International Society for the Study of Trauma and Dissociation (ISST-D) website by clicking the button below.
**Note: Disguised identity information of my actual client has been used.
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