With the release of the new movie “Split”, there has been a lot of talk surrounding the topic of Dissociative Identity Disorder (DID). Although the movie portrays the DID character as a villain, we may fail to consider the matter from the perspective of those who have this disorder.
One of my clients is a lovely woman whom no one would ever suspect as having Dissociative Identity Disorder. She has spent most of her adult life in therapy but until we began working together, she could not find a therapist who understood what she was going through. Through the years, she had been diagnosed with anxiety and depression, and was prescribed medications that didn’t help and eventually, she self-diagnosed with derealization/depersonalization. She recently shared with me how DID impedes her functionality in a social context. Although she is married with children and lives in a comfortable income, she was feels incredibly isolated and despite her desire to socialize and build friendships, she is afraid to take the opportunity when presented because of her DID. She told me:
Sometimes it is as simple as going to my in-law’s house for dinner. In such a small intimate affair, I’m so afraid that they might see through me this time. The same thing happens when I run into people at the grocery store. Can they see through me? When I talk to people I ask myself who am I supposed to be? It is like when I still was involved with my kid’s school. I went with the school to the beach as a chaperone and I had to share a room with another mom. We got to talking about our lives and I felt like I had to be someone else. When she asked about my childhood, I felt like I was making up a story or a telling lie. It makes it so it hard to be around anyone. I’m never sure what to say and later I may not remember what I did say. I feel like everyone can see my shame and guilt all over me.
Regardless of social and economic background, DID clients share many of the same problems and symptoms. For example, it is not uncommon for those with DID to find drawings, notes, or entries in their journals in a handwriting they don’t recognize and don’t remember writing but know they must have. They may miss time and one minute they are in one place and the next they are in another with no recollection of how they got there. They may hear voices inside their head telling them to do things or commenting on things that they are doing, or when looking in the mirror they may not see or recognize the person looking back at them. They may meet people on the street who they don’t know but who greet them and call them by a different name.
Finding a therapist who is adequately trained or experienced in working with DID clients can be an extremely daunting task. This is generally due to a lack of knowledge about the disorder, or even in some cases a lack of belief that DID is real may lead to an incorrect diagnosis. It is not surprising then when looking for a therapist, people with DID do so with apprehension.
Following is a script that demonstrates what clients say it is like for them when they make the initial steps towards treatment, and what it is like for me to begin our work together.
The Client: I know something is wrong with me. Things haven’t been right for a long time and they are getting worse. I lose things, I have things in my closet I don’t remember buying, people I don’t know walk up to me and call me a name I don’t recognize. I get calls or texts from people I don’t know. I am one place and the next thing I know I am another place and I don’t know where I’ve been. Sometimes I hear voices in my head. I feel like I’m going crazy but I’m afraid to tell anyone because they might think I’m crazy too. Maybe they will lock me up or institutionalize me. I need help and don’t know what to do and I’m really scared.
I make an appointment with a therapist and now I have butterflies in my stomach. What do I say? How much do I say? What if the therapist tells me I’m crazy or schizophrenic? Well, I’ll try to keep the appointment, but I won’t tell her everything. I’ll say just enough to maybe get some answers and maybe get some medication. I keep forgetting things and missing appointments, so I’ll write the appointment on some paper and stick it to the refrigerator.
The day of the appointment arrives and I wake up late. I know there is something I’m supposed to do today but can’t remember what. I think I have an appointment. I go into the kitchen to get some coffee and was sure I put a reminder note on the refrigerator. It’s not there. Oh no. Where was I supposed to be? Where did that note go? I remember. I have a therapy appointment today in two hours. I rush and take a shower and get myself together to go. I’m a nervous wreck and feel like I’ve been sabotaged again while I sleep.
When I get to the appointment I have to wait a few minutes until I am called into the therapist’s office. I hear a voice in my head saying, “You are an idiot. I told you not to come. Don’t you know this time they are going to lock you up. They’ll never let you out!” I try to ignore the voice. Then I hear my name called. A lady is greeting me and she is bringing me into her office. She seems friendly enough and smiles at me. Okay. Maybe this isn’t so bad. Maybe she can help me. Then I hear the insistent voice, “keep your trap shut!”
Actually this isn’t my first time to try therapy. I’ve done this before and every time it’s a bust. I start to tell the therapist what is going on but then get afraid. The last time I went I was told I was psychotic and should be hospitalized. I’m not going to do that. I was hospitalized once before, labeled as schizo something or other, and given a ton of medication, but nothing changed. Meanwhile, that voice is telling me to stop talking. I back up, try to make me seem less crazy but as I inch my way forward in the session, I can see that maybe she gets it. I really need help.
The Therapist: I walk out to greet my new client. When she made the initial contact by phone, I recall how distressed she seemed and how difficult it was for her to talk about what was going on. She did tell me she thinks she dissociates sometimes and has been having trouble finding a therapist who can help her. I told her that I do have experience working with people who dissociate and that we could talk about it more when we met. We made the appointment and now I invite her into my office. I can see how nervous she is and so, gently, carefully, I work towards making her more comfortable. She is hesitant but I wait, listen, ask some questions to get a better feel of what she is experiencing. I can see something in her eyes and gestures that indicate that there is more than she is willing to say. I can also see that she is testing me and is cautious when I ask her questions about her external and internal world. I make no judgments and know that if I make the wrong move therapeutically or say the wrong thing, I may lose her.
Now, several weeks into treatment, I can confirm that she has DID. She meets all the criteria and I have met a few of her alter personalities. This is not new to me. I know that as her trust in me grows there may be other personalities or alters that surface. The work goes slowly but that’s okay because there is a lot of work to do and getting to know her alters is only one part of that work. This is only the beginning. The goal is to help her heal from the pain and suffering she endured as a child and possibly all her life. Because she is DID, the goal is also to help her have better internal communication so that she can live something akin to a normal life.
Meeting my first DID client was startling; one moment I was talking with an adult and the next a gum-chewing 5-year-old. The best I knew how to do was follow my instincts and respond to the “child” in my office. Eventually the child yielded to the adult, but I had no idea how to proceed beyond that. To find help, I went to the International Society for the Study of Trauma and Dissociation (ISSTD); an organization headed by the top experts in the world on trauma and dissociation that provides training, workshops, webinars, as well as an active listserv to connect with others who have expertise in working with DID for advice and support.
Since that time, much of my energy as a clinician has been devoted to learning how to work with this unique set of people who are survivors of trauma that was often severe and repeated. Working with DID clients can be complicated and it requires commitment and patience. It pulls from all that we learned in graduate school about genuineness, acceptance, and non-judgment. It requires empathy, curiosity, creativity, and a willingness to be open-minded. It also takes extra time and effort to get the special training required to work with DID clients. But, in the end, it is worth the effort. In my experience those DID clients who stay in therapy are some of the hardest working clients and the work with them can be among the most rewarding of clinical experiences.