Helping to keep the person you are supporting safe, alongside managing daily living will be a big part of your role, working within realistic and sustainable boundaries .How you are able to do this may be governed by your agency’s or organisation’s policies and these need to be shared with your client. While your client will always be the expert on themselves it helps to understand how dissociation develops, the role it filled while they were being abused and the consequences in later life.
Understanding the connection between how abuse annihilates trust and the ability to form healthy relationships in childhood and the way this is still affecting your client in the present allows you to stay grounded when that person is pushing you away as it suddenly feels too frightening to trust you; or what may feel like being accused of something but you are not sure what has happened. Some of the most challenging times will be when you feel things are going well and your relationship with your client is beginning to feel more solid. This is often a trigger for the defence roles to become active as it can be a new experience and perceived as dangerous.
It is unnecessary to know the individual part’s stories but a level of basic understanding provides a context that helps you to stay connected when a switch occurs. Learning to respond age appropriately and accept whoever is out can help the whole system to begin to feel validated, more grounded and remain functional.
Learning to trust is a long painful process that you can be an important part of by demonstrating a solidness, openness and continuity.
Your client may share what sounds like impossible things but within ritual and organised abuse those things were all too possible; some may have been presented through illusion and lies but the child has no way of knowing this and it is not helpful to ask. If your client was used in these settings there may be certain dates like Halloween when they become very distressed and need more support. If this is available it needs to discussed and clearly defined exactly what it consists of and for how long.
It might be necessary to use hospitalisation at certain times this again needs to be talked through in calm periods; why you have to do this and what your role will be at those times. Check out with your client to see what else might be possible to prevent this becoming inevitable.
Using age appropriate language is essential as a three old can be very capable but will not be able to understand if she is talked to as though she is the adult who might have been in the body a few minutes before. For your client to become more stable, grounded while developing the many skills she will have been denied the opportunity of doing during the abuse years your dependability will play an important role. Of course there will be times when things have to change, go wrong at the last minute and this will be tolerated more easily if you have an open and honest relationship with you client.
Supporting someone with DID can at times be challenging but if you can stay clear as to what you are able to offer and sustain it can also be a very enriching experience.