DID/MPD: Working Within the Multiple System

Our guest, Anne Pratt, Ph.D., is a clinical psychologist at the Traumatic Stress Institute. Her expertise centers around psychological trauma and Dissociative Identity Disorder (Multiple Personality Disorder). The discussion focuses on getting your alters to work together.

David Roberts is the HealthyPlace.com moderator.

The people in blue are audience members.

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David: Good evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com.

Our topic tonight is "DID/MPD: Working Within the Multiple System". Our guest is therapist, Anne Pratt, Ph.D., a clinical psychologist at the Traumatic Stress Institute, a private mental health organization devoted to research, treatment, and training of other professionals in the area of psychological trauma. Dr. Pratt has worked in the field for fifteen years, and has extensive experience with Dissociative Identity Disorder. If you are unfamiliar with DID, MPD, here's a link for a further explanation of dissociative identity disorder (a.k.a. Multiple Personality Disorder).

Good evening, Dr. Pratt, and welcome to HealthyPlace.com. We appreciate you being our guest tonight. I can imagine that having several alters within can become very disrupting, making it difficult to live a "normal" life. Because everyone in the audience tonight may not be DID/MPD, but may be just friends or family members, can you give us a description of what it's like living in a fragmented way?

Dr. Pratt: Good evening. I will try! People with Dissociative Identity Disorder differ considerably from each other, so this description won't fit everyone with DID. People with DID who do not have what is called co-consciousness (awareness of what is happening when other alters are out) experience significant disruption in their lives, through amnesia, and through finding out that they have behaved in ways that they don't usually behave.

David: And the result of this is what?

Dr. Pratt: Sometimes a person with DID is called a liar because people accuse them of doing things that they deny doing. Sometimes they are viewed as weird or flaky because their behavior is so variable. Their internal experience is that the world is kind of unpredictable, difficult to navigate at times.

David: Tonight, we want to discuss getting your alters working together towards a common goal, whether it be healing or just everyday living. Is that even possible or reasonable to expect that to happen?

Dr. Pratt: Oh, yes. It sure is. When people can get their alters to agree on things, life gets much easier and less disrupted. It's a difficult goal for many to reach, but not impossible. Alters were created because there were things that were too hard for one person to accept what happened to them. So, the barriers between alters, barriers between knowing what one or another is thinking or doing, are there for a reason. When the barriers get in the way, though, and disrupt one's life, it is more helpful to have openness within the system.

David: Is this something that can only be accomplished in a therapeutic setting?

Dr. Pratt: I don't think it can only be accomplished in therapy, but if the therapist is experienced in dealing with dissociation, it sure does help. I expect that many people accomplish this outside of therapy, but we therapists, just don't know that much about it because we only see people in therapy.

David: A moment ago, you used the term "openness within the system". What does that mean?

Dr. Pratt: By that, I mean "internal communication," or communication among alters. Internal communication is the first step toward cooperation.

David: How does one accomplish internal communication amongst the alters?

Dr. Pratt: For many people with multiplicity, it is a difficult task. This is because, as I said earlier, the barriers between alters are there for a good reason, self-protection. But for others, it is relatively easy. If the person wants to establish communication, but can't "hear" others inside, they might start by writing to each other in a journal.

I'd like to add, that if you contemplate doing this, please check it out with your own doctor. This isn't a good idea for everybody at different stages of treatment.

Others, who can hear each other, might start trying to have conversations about their different needs and wishes. It's a little like getting any group of people to work together. You find ways to get the word out, and then you take care to listen carefully to each other.

David: As you can imagine, we have a lot of audience questions. Let's get to a few and then we'll continue with our conversation:

Dr. Pratt: Sure.

saharagirl: How can one get alters to work together when they have different loyalties?

Dr. Pratt: Saharagirl, that's a good and important question. I think that different loyalties are one of the primary reasons why this doesn't happen quickly or overnight. Alters (and the "host") need to respect each others' loyalties, needs, and wishes. Like any group of people who experience conflict, this is not easy. But if those who are trying to accomplish internal communication and cooperation keep emphasizing respect for everyone's point of view, it will help. Even those alters who have seemingly self-destructive points of view have them for a reason. If their reasons are understood and respected, it will build a bridge to working together toward mutual goals.

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Chandra: I have a seven-year-old alter that cuts me after I do anything that she perceives is not safe. How do I deal with that?

Dr. Pratt: Chandra, you bring up another common problem and one which makes working together really difficult. Obviously, it's really important to help this little one feel safe, to help her define what she needs to feel safe, and to assist her in getting that safety. It's not an easy or a short-term problem, but when she starts to feel safer, she will be more able to relax and let older ones make decisions. Even if they feel a little risky to her. I guess the short answer is, negotiate (easier said than done, I know).

David: I know that this is sort of controversial, but just so we know and understand where you are coming from Dr. Pratt, is "healing" to you the same as "integration" of the personalities, or is it getting the alters to work and exist together?

Dr. Pratt: I think that everyone needs to define healing for themselves. I cannot dictate my idea of what healing is to another person. I personally believe that doctors have made too much of the idea of integration. Many multiples, if they are able to cooperate internally and are not losing time or missing what is going on when others are out, can live completely satisfactory lives without trying to integrate. If someone chooses to work toward integration, that is certainly their option. If they choose not to, I would support that decision too.

asilencedangel: I have a very angry alter in the system who is both mentally and physically disruptive and violent. I have been trying to contract with her, or reach her in some way, but have been unable to. Do you have any suggestions in obtaining a contract or communication with her?

Dr. Pratt: Asilencedangel, you are describing one of the most difficult problems to address. I would make the same suggestion, though, with perhaps the added encouragement to persist, and keep on persisting.

The way to open communication with alters who seem opposed to the goals of the rest of you, is to discover his/her goal (like the goal of Chandra's 7 year old alter was safety, even though she was doing something that some would define as unsafe) and try to make suggestions about how to reach that goal that both of you can agree with.

It's not easy and I won't pretend it is. However, the key is definitely, "I disagree with your method, but I think we may have something we do agree about." It's usually keeping safe, not getting too close to others, not remembering. That's what "destructive" alters are usually after.

David: If one can't consciously watch over the other alters, how can you work with them?

Dr. Pratt: This is where the help of a therapist sure comes in handy. A therapist experienced with DID and dissociation can help the person's alters begin to feel some trust, and begin to come out to the therapist. As that happens in the very beginning, sometimes the therapist is the conduit for communication between alters. That's not a good way for treatment to proceed, however, and the goal should be to help alters communicate with each other through written, or ideally, internal words. As soon as possible.

Falcon2: How do you teach alters to do specific things when you are not co-conscious?

Dr. Pratt: Falcon2, I guess the answer is, you try to communicate and really try to listen. What do the others need or want? What do you want of them? If internal communication isn't happening yet, you keep trying, and in the meantime, get help from a therapist or a written journal to try to communicate that way. I don't know if you can teach alters to do specific things. But you might be able to ask them to do "x" for you if you can do "y" for them. For example, they will refrain from drinking, if you can give them some time for recreation for themselves.

David: Here are a few audience comments on what's been said, so far, tonight. Then we'll continue on.

katmax: I am co-conscious and it has taken long time and lots of good therapy. I have seven alters.

Sonja: The alters I have can't agree on anything!

cherokee_cryingwind: I am a survivor of incest with six alters, one of which, used to be very destructive.

David: Besides the journaling, what other ways are there to establish a workable system of existence with your alters?

Dr. Pratt: I think that the help of a therapist is really useful in helping people develop internal communication and cooperation. Sometimes the therapist is the one who can most easily recognize the common goals, from alters who seem to have very different goals indeed.

David, as is so often the case, there is lots of expertise in the room, and it certainly isn't all mine! These comments illustrate how much good information multiples can get from each other.

David: I agree :)

We B 100: I've found, that allowing alters to have their times, they tend to work better together and communicate more to the others.

Dr. Pratt: I would have to underscore what We B 100 said, that giving alters their own time to do their own thing is a very positive step. Sometimes the trouble increases in a multiple's system because different parts' needs aren't being met. Everyone, multiple or not, has different needs, and in a multiple, meeting the needs of alters is one way to keep everyone settled down and willing to work together.

David: Regarding "meeting your alters needs," here's an audience comment, then we'll go to more questions:

toomany: Just like outside children, you give them a little and it goes a long way.

Dr. Pratt: :)

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David: One of the common questions we are getting, Dr. Pratt, is how long should it take to obtain a peaceful coexistence with your alters?

Dr. Pratt: I wish I could answer this to everyone's satisfaction. I'm not sure I can. I think, if the person has alters who are doing highly destructive, scary things (like intensely suicidal or self-injurious behavior, severe addictions or eating disorders, to name a few, it may take a few years to get it all settled down. Sometimes more than a few. If, however, the individual's life is only mildly disrupted by the multiplicity, treatment can help things settle down dramatically in maybe six to eighteen months. Not everyone with multiplicity experiences these very difficult adaptations. There's a lot of differences among multiples.

milo: Does gaining cooperation and communication with your alters, whether through therapy or simply journaling, always have to involve rehashing the past?

Dr. Pratt: Oh, Milo, what a good question. The short answer is, No. But I'm not good at short answers! The goal of internal communication and cooperation might be accomplished with almost NO rehashing of the past. But the reasons why alters do various things, and the reasons why one has alters to begin with, will probably mean some thinking about and talking about the past. That's as short as I can do it!

Kimby: Where is the Traumatic Stress Institute located and do they work with SRA/DID individuals?

Dr. Pratt: TSI is in South Windsor, Connecticut. The psychologists at TSI do work with these folks.

jewlsplus38: The 'core' has recently had to feel intense grief for the first time and has buried herself again. We are at a loss as to what to do to try get her back. Our job, up until now, has been to teach her how to live, and we feel very alone. Did we give her too much?

Dr. Pratt: Jewlsplus38, I think you are most likely doing a great job. I would guess that, if all her life she has dissociated strong feelings, the process of learning to feel them for the first time is going to be on-again/ off-again. Offer support when she reappears, and keep her life in order while she is away. I can't say for sure, but you sound very caring and careful, and I think you are probably on the right track.

oak: How does one work with alters who refuse to be drawn out to talk with either the therapist or other alters?

Dr. Pratt: Oak, that's a tough question. It reminds me of my first question tonight and the answer is very similar: Make sure that there is safety for those alters. If you (or anyone inside) has an idea about what those alters might need in order to feel safe, then I would try to create that safety. And make sure that it is communicated to them that it is up to them. They can come out when it feels right to them.

JoMarie_etal: Prior to about six years ago, we were at least communicating and cooperating to some extent. Then something terrible happened to us and it totally destroyed all trust inside and out. I have been trying to reestablish some communication and cooperation, but everybody went into their own protective shells and there is extreme resistance to any kind of cooperation. In fact, there is a lot of energy going into disrupting day-to-day living. Is there any way of reestablishing communication and getting everyone to work together again?

Dr. Pratt: JoMarie_etal, you are also describing one of the hardest situations to deal with. A new trauma on top of all the old has to be one of the hardest things for all of your alters to cope with. They were partially convinced that cooperating and communicating (breaking down the barriers among them) was a good idea, and then something awful happened and they went back to what they know best.

It comes back to safety again, and perhaps, a strong dose of not blaming. I wouldn't blame any of them for what happened or for pulling back. Try to make it safe to be out again, safe to be talking together again, and stress that everyone has the same goal: keeping safe and not letting bad stuff happen. Then try to focus on ways that everyone can agree to accomplish that goal. Best of luck.

Wind: How do you feel about locking away a destructive alter for a period of time in order to gain co-consciousness?

Dr. Pratt: Wind, I'm not sure I understand. I do know someone who has had some success with locking away destructive alters, but I have never suggested it, or witnessed it myself. If there is a place where the destructive alter can wait safely, apart from others, I guess that's the direction I would go in. But again, without knowing you and the particular circumstances, I'm in the dark, so it's kind of guessing on my part. Talk with someone you have confidence in and who knows your situation well.

David: An audience member says she talks with a DID friend by phone almost nightly. Her friend switches a lot and she wants to know how she can contact the core/main person to continue the conversation?

Dr. Pratt: If possible, that is something she should talk over with her friend. If it is okay with her friend, she might try saying something like: "I was talking to "X" about "Y." I am happy to talk to you later on (if that's true), but right now I'd like to finish what "X" and I were talking about. Is that okay with you?"

You have to be cautious because traumatized people are sensitive (and most DID people have a history of severe trauma). They will perceive rejection in the smallest comments. So, I'd first recommend talking it over with the friend and asking for her suggestions. And perhaps talking it over with the alters and asking them for their suggestions so that, the conversation can be more fluid and less switchy for the caller.

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Grace67: What do you suggest for people on the "low end" of Dissociative Identity Disorder who have such a hard time believing themselves and what is happening in their lives? I am thirty-three and recently diagnosed. My alters do not have the depth of other's alters, yet are each their own. I struggle daily with believing myself (we are co-conscious, although there is little dialogue, there is no amnesia).

Dr. Pratt: Grace, the tendency to disbelieve one's own experience is not limited to people like you describe yourself, who are at the "low end." Disbelief is rampant in society and rampant in the consciousness of every survivor of interpersonal trauma. Just like society, survivors and those who work with them, do not want to believe that it could be true. And DID-like symptoms, or Dissociative Identity Disorder, are part of the picture that we don't want to believe is true.

In some ways, one's disbelief protects one from having to believe it too much, all at once. So stay calm, know that you will probably move from believing in your experience to disbelieving, to being unsure, to believing again. It's part of the experience of surviving interpersonal trauma.

David: Grace, so you know that you are not alone, here are a few audience responses to your comment:

jewlsplus38: I have over eighty alters, and I still go through small amounts of time where I wonder if I made it all up.

JoMarie_etal: We call that disbelief a form of denial and to make it not feel so terrible. Joking about floating down the Nile in Egypt helps to realize that it is a common thing.

engberg: I am in total denial of my DID and don't even want to discuss it with my therapist because I don't want to admit it. I want to lead a normal life now and I feel like if I get into things, I will be too overwhelmed and won't be able to handle it.

Dr. Pratt: Denial is a necessary part of living with a history of trauma.

David:Thank you, Dr. Pratt, for being our guest tonight and for sharing this information with us. And to those in the audience, thank you for coming and participating. I hope you found it helpful.

Dr. Pratt: I have really enjoyed this chance to listen and talk with everyone.

David: Thank you again, Dr. Pratt and everyone in the audience. I hope you have a pleasant rest of the evening.

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Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.

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