The therapist’s role will be an important part of, feeling at times the most important part of, the client’s life. The developing relationship between the client and therapist underpins and is the foundation of the therapy leading to change. How attachment issues and the other developmental stages that were missed or heavily contaminated by the abusive childhood are negotiated contribute greatly to the quality of life the client is able to experience in the future. A child who has experienced repeated abuse over a prolonged period will have developed heightened senses to survive; these will challenge and question every aspect of therapy, and the therapist must be prepared for this.
The therapist’s primary training remains the foundation of the work but learning about complex dissociation, its roots, development and presenting issues in adulthood will also be necessary. Continuing professional development to add to your toolkit of therapeutic skills and some adaptions in the way you work are likely to be needed. Clinical supervision with someone who is experienced in working with DID will make the journey easier for the therapist and ultimately for the client.
To allow the therapeutic relationship to develop slowly and steadily while establishing the boundaries is the most important tangible element in the early days of therapy. Frequency and length of sessions, where you will meet, contact between sessions and, if this is allowed, exactly what it means. It is much better to start with very narrow perimeters allowing the client to feel metaphorically held and know exactly what is allowed and to expect. You may need to go over these many times for those parts who have not been to therapy before and are not privy to what has been agreed, offering to write them down if this feels appropriate.
Boundaries and any changes to them may need to be returned to at the different stages of therapy. This is done through discussion and negotiation with the client not suddenly and unilaterally imposed. There might be times when intensive contact is necessary for a brief period of time, this can be beneficial but only if it is boundaried, clear, for a specific reason and genuinely given.
The early part of therapy will focus on working to stabilise the client partly through psycho education and helping to maintain daily living, being a parent, going to work etc, while understanding how difficult this may be. At the same time working with different parts towards developing and using the 5Cs of compassion, communication, collaboration, co-operation and connection among and between themselves. It is important to work with the outside part/s as well. As they have had to manage daily living this may be perceived as coping well and being more developed than they are. By watching and copying other people these outside parts have learnt how to behave, what to do, what behaviour might be expected of them in particular circumstances etc but they have still missed out on an organic healthy emotional development during the shared traumatic childhood of the whole.
Trauma will be acknowledged and dealt with at the level it presents but will not be worked with at a deeper level until some of the stabilisations skills and techniques are established offering the foundation for future work.
Involving supporters in the therapy might play an important role for some clients, others may not want this.
The groundedness and reliability of the therapist while being able to stay connected but not over involved will be the foundation for the client’s ability to work and accept the different parts, their history and integrate it at the level they want and are able to.