Note: this is an excerpt from the New Training Manual for those who support survivors that will be published next year. Used with permission.
Healing from Dissociation: Some Steps in the Process
People don’t dissociate when they realize they no longer need it. The issues that cause dissociation to continue include emotional conflicts that the dissociation solves (such as how to continue to live with an abusive parent or spouse; or the desire to prevent torture or punishment of the self or loved ones by an abusive cult).
To heal, these conflicts will need to be resolved over time, as trust is built. This normally happens within the context of a safe counseling relationship, supported by the survivor’s “community” or people who are safe and supportive that they interact with.
The goal in healing is to allow some attachment to individuals who do not hurt the survivor, while the tasks of building the skills for doing inside work and developing safe support are worked on. As the survivor builds trust and confidence, and feels safe, they will often share more of their internal reality with the counselor. This is a collaborative process: the client is encouraged to share without feeling judged or criticized.
As trust and safety are experienced, some of the deeper issues the survivor struggles with will often come forward. The survivor may fear attachment within a relationship, and may sabotage relationships that support healing (by acting hostile; withdrawing; forgetting appointments, or pushing “hot buttons” for supporters). As healing progresses, and internal parts come forward to “meet the counselor” or friends of the survivor, they may project feelings onto others that they themselves experience. Examples can be when one part of the survivor cares about and trusts the therapist, but another part comes out that is hostile, convinced the counselor is trying to “trick” them into trusting, or will eventually hurt the survivor. This is a form of re-experiencing in the present emotions and feelings that are caused by past events, and the survivor will need help in sorting out what is past, and what is present, reality in relationships.
If the client is seeking reparenting, they may discover that if they are in crisis, the counselor responds more quickly; and may develop constant “crises” in order to receive attention or support. If this occurs, the counselor can address this directly, provide compassionate feedback regarding the behavior, and develop a plan with appropriate boundaries that will meet the needs of both the survivor and the counselor.
Early Phase of Working with a Survivor
Many survivors will state that their goal is to “integrate” and “get better”; often as quickly as possible. What many counselors and survivors do not realize is that healing – and the process of integration – begins during the first session with a therapist or prayer minister and continues over time. It is a process, not a “point in time”.
Early in counseling, safety issues will always take first priority. Because many individuals with severe trauma and DID struggle with self harm issues and/or feeling suicidal, it is a good idea to ask directly: “Do you ever want to hurt yourself?” or “Do you ever feel suicidal?” during the initial history. If the individual indicates they struggle with these issues, a full suicide risk assessment should be done, and a plan to prevent acting on these impulses developed. This will include a list of who to call if they feel this way (including crisis help lines); and referral to a mental health professional if you do not have clinical training.
If the survivor has an eating disorder that has caused their weight to go dangerously low, there may need to be planning done, that includes hospitalization if the weight goes below a certain point. The survivor may need to attend alcoholics anonymous, narcotics anonymous, or in a program to help them give up addictive behaviors, if present.
The counselor should also assess whether abuse is still ongoing when an individual presents with DID. This includes asking whether their spouse ever physically beats, slaps, threatens, rapes or otherwise hurts them; or whether there are threats or physical abuse from family members if the individual is living at home. At times, the individual with DID may initially be unaware that they are currently being abused, and over time, this information will be shared as trust is built. It is important to do safety planning, and provide referrals as needed (such as to a women’s shelter, etc.), to provide physical safety for the individual.
Emotional safety is also important. The survivor may need to learn skills in setting healthy and appropriate boundaries in order to feel emotionally safe. This may range from helping someone recently divorced from an abusive spouse realize that they can arrange to have a friend with them when their spouse comes by to pick up a child in a joint custody arrangement, to helping a survivor decide how much contact, if any, they wish to have with an extremely abusive family of origin.
Beginning education about dissociation and DID, if these are present, should be done as well. Many times, individuals struggling with DID will believe that the symptoms they experience (such as hearing internal voices, losing time, or acting like completely different people) mean that they are “crazy” and they will be afraid. Helping the individual you are working with understand what causes dissociation, and that it is a treatable disorder with a good prognosis, will help relieve some of this anxiety. Take time to answer the questions and concerns that are often raised.
Once safety is established, the survivor will need to learn some basic skills before they begin to work on trauma memories (ISSTD, 2011). These skills include:
Learning to identify the emotions they are experiencing. Many survivors have never learned to be aware of when they are feeling emotions, or how to label them. They often describe feeling “numb” or “a little funny”, but have never been able to share “I feel sad”; “I feel angry” “I feel helpless” with someone who is safe. Learning how to be in the body, and how to identify emotions, is an important skill that can be learned. Emoticon charts can be used for this purpose; or, asking the survivor to stop and try to identify what they are feeling from time to time. Over time, the survivor will use this skill to identify the emotions they felt during trauma as it is brought up into conscious awareness, for processing.
Starting to build communication inside between parts. Studies have shown that individuals with DID who do the best work with their dissociative states (Gabbard, 2014; Steele, Boon, Van der Hart, 2017; Knipes, 2015). This is a process, with the individual first indicating when they are aware of a switch; or, they may try to depict parts using various methods such as drawing a house to represent them, and creating pictures of who lives in the house. Some survivors prefer to collage; or to use dolls to depict who is inside. Right brain activities, such as art, music or inside imagery can be used to help get to know “who is inside”. Some survivors imagine a conference table inside, and invite others to come and join them at the table, letting Jesus be in charge of the meeting.
Building communication can be encouraged through journaling exercises, with parts invited to share what they like and don’t like; or what they wish for, as well as their fears and concerns. Collages can be created on themes such as “what childhood was like”, or “my favorite things” with various inside parts encouraged to share their thoughts and feelings.
It is important that both the helper and the survivor do not “judge” these parts, regardless of the conflicts or issues they present. For example, it is not uncommon for survivors of sexual trafficking to have highly sexualized parts inside whose only reality before coming forward has been to invite sexual activity. While the individual needs to take responsibility for the actions of these parts (which are part of him or her), it is important to not apply labels such as “bad” “demon” or attempt to “get rid of the part making all the trouble”. Instead, it helps to adopt an attitude of caring curiosity, to help explore with the survivor how this part helped them cope with what was overwhelming to them. Once they realize they are not being condemned, or judged, and their concerns are listened to and addressed these parts will often quickly agree to help others inside, and can become an important part of the healing process.
Identity or Demon?
Survivors of ritual abuse will often have internal identities programmed since early childhood to believe they are “demons” (see chapter on programming for more information). This parts needs to be differentiated from actual demons (the parts will likely have a demonic attachment), and treated with compassion as a coping response to an extremely painful reality. Often, the “demons” are actually young, frightened children inside who have been given difficult jobs internally such as punishing parts who disobey, or frighting parts who talk to people outside the cult group. Attempting deliverance on alternate identity states will not work (the parts will simply not budge, laugh at the minister, or go deep inside, feeling wounded, hurt and angry, and deciding that Christians cannot help them. Helping the survivor help these parts, valuing how they helped them survive their past instead of trying to get rid of them, will promote communication, healing and stability inside.
Over time, the survivor may begin to have parts co-present, with two or more parts presenting at the same time. This can help build further trust, as the parts learn to work together and share information. Eventually, co-consciousness will develop, with the barriers between parts blurring as increasing amounts of information are shared, and parts actually “share the same mind” as they become aware of what the other is thinking and feeling, and may even blend temporarily.
By increasing communication, and working with the counselor, the traumas and conflicts that created the dissociation will eventually resolve. As the conflicts are resolved, instead of constant fighting between parts (as may be seen early in counseling), increased cooperation between inside parts occurs, with working together for common goals.
Helping the survivor learn skills to cope with distressing emotions is also important before approaching any trauma memories during a session. These skills can include:
- Learning to feel “grounded” (or, present in currently reality) when panic, rage or other intense or painful emotions come forward. This can be accomplished using various techniques, such as using touch (feeling a soft blanket; holding ice for a few seconds in the hands, feeling the feet on the floor); smell (smelling a fragrance; or a sharp smell such as a lemon); sight (opening the eyes if they are closed; looking around the room and identifying two objects that are blue, or any color chosen; looking out the window and describing three things seen, etc.); hearing (listening to music; describing two sounds they can hear). The main thing is that the survivor becomes aware of the present. If they seem “tranced out”, you can softly touch them on the shoulder and speak their name (get permission beforehand to do this, and explain why you will be doing it). It is best to practice these techniques together, and then ask the individual to practice them at home during the week, especially if they feel triggered or experience emotions or flashbacks.
- Mindfulness techniques: this is being aware of being present in the body, in the present moment. Doing this can be combined with thinking about a comforting or helpful scripture the survivor chooses, to help them stay in the current moment.
- Deep breathing: when someone feels anxious, they often will breathe rapidly. Learning to take slow, deep breaths while being aware of the feeling of taking air in and out can help a person feel calmer. This can be combined with grounding thoughts such as “it isn’t happening now, it’s in the past” (if a flashback is occurring) or “I can make it; this feeling won’t last forever.”
- Containment exercises: using visual imagery can help with containing emotions or memories that feel overwhelming, until they can be worked on together with a support person. This can include creating a box to place the feeling in temporarily, with the promise to open it later when someone else is present to help (this promise needs to be followed up on); or creating a room where memories and emotions can stay until they can be worked on in a safe setting.
During this early part of healing work, and throughout the healing journey, the survivor will be working on building trust with you and their support people. This includes learning how to have a healthy relationship, which is something the individual may have never experienced before. It is not uncommon for a survivor to enter into prayer ministry or counseling with behaviors learned over a lifetime to keep people away (which felt safer), and to struggle with self-sabotaging the efforts of others who care and want to help.
Learning healthy relational skills is learned by teaching (explaining what healthy boundaries are; or how to approach confrontation in a healthy way) and by modeling: the survivor will be watching you closely to see how you respond to different situations for cues on how “normal” people act, especially if they are aware that their family of origin was dysfunctional. As the survivor interacts with individuals who are not dissociative and who are safe, such as friends they develop who are not part of their past abuse, they will also have an opportunity to practice these skills. They will then begin bringing into sessions the conflicts, hopes and fears that these interactions bring up, which allows further opportunities to learn relational skills, and promote healing inside.
If the survivor is in a non-abuse marriage, and they report conflicts or the marriage is failing, you may want to refer them for marriage counseling. There are also resources available in print and online for the spouses of individuals with DID, that can help them better understand the issues. It is a good idea to have at least one or more sessions with the spouse present, when the survivor feels ready, to discuss their condition and what can be done to help support them, and to answer questions and concerns.
Part of learning relational skills will include the host/presentation learning to take responsibility as a whole for the actions of all parts. If the survivor is a parent, they will need to learn to act as an adult around their children; and learn appropriate boundaries for behaviors. This is usually accomplished over time as communication with parts is established, and negotiation with parts regarding behaviors can be done.
Dealing with Negative Self Thoughts
Most survivors of severe trauma struggle with negative messages about themselves: “I’m ugly” “I’m worthless” “I’m nothing but a whore” “Only Satan could love me, everyone else hates me” “I will never heal, I’ve been hurt too badly and there’s no hope”, etc. While healing of the issues and traumas will be how full resolution occurs, initially, the individual can practice self-compassion, or thinking positive thoughts and using images of self-compassion to help reduce the strength of these messages.
This can include “God loves me, and so does ________”, filling in the blanks with supportive people in the survivor’s life. Or, “Even if I don’t feel this way yet, I am valuable, I have skills and gifts that are unique to me” “I survived my past, and can now survive remembering it, because I have support now, I’m not alone” “Nothing is impossible with God”, etc. It can help to develop a list of these messages that the survivor keeps taped to a bathroom or other mirror as a reminder. Imagery can include taking some time to hold oneself, giving the self an internal “hug” and saying “It’s okay, I love you” “You did the best you could under very difficult circumstances, and it was good enough” “Each day, I’m healing a bit more” or other messages meaningful to the survivor.