Psychological Therapists
The therapist’s role will be an important part of the client’s life; at times feeling like the most important part. The developing relationship between client and therapist underpins the foundation of the therapy, leading to change. The way in which attachment issues and other developmental stages, which were missed or heavily contaminated by an 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 in order to survive, challenging and questioning every aspect of therapy. The therapist must be prepared for this.
Although the therapist’s primary training remains the foundation of the work, learning about complex dissociation, its roots, development and the issues which present in adulthood will also be necessary. Continuing professional development and some adaptions to the way in which you work are likely to be needed and will add to your toolkit of therapeutic skills. Clinical supervision with someone who is experienced in working with DID will make the journey easier for the therapist and ultimately for the client.
In the early days of therapy, the most important tangible element is allowing the therapeutic relationship to develop slowly and steadily whilst establishing boundaries such as the frequency and length of sessions, where you will meet, contact between sessions and, if this is allowed. It is much better to start with very narrow parameters allowing the client to feel metaphorically held, knowing exactly what is allowed and what 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 achieved 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 genuinely offered with clear boundaries, specifying the reason.
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 addressed 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 therapist’s ability to remain grounded and reliable whilst being able to stay connected but not over involved will be the foundation for the client’s ability to work with and accept the different parts and their history. This will help to enable a level of integrated living which is both acceptable to and achievable by the whole system.
