What Therapists Need to Know About DID: Working With Child Parts of the Patient

It’s difficult for me to listen to my kids. (My inner children, not my daughter). Most of the younger parts are in a great deal of pain. There are a few that want to play, laugh and connect with others, but most of them are suffering. Some of them cry, and it often sounds horrible. They wail in pain, scream, sob, or whimper. Some scream for help; others can’t talk or move. A few of them have a very limited vocabulary, writhe in pain, shake and have seizures, go into a catatonic state, or think they’re dead. I’ve been trying to ignore them my whole life, so that I can avoid the memories and not realize what happened to me.

The child parts of a person with multiple personalities (DID) are stuck in trauma-time. These parts went through the abuse for me, so I could survive and function. DID creates this problem where the parts that function in everyday life try to ignore, push back, and hide the younger ones. They often despise the children because they hold all the painful memories and need so much help. Many older parts are afraid of their neediness and suffering. We’re aware they have horrible stories to tell, so we don’t let them come out and relive them. It rarely happens now, but they used to take over frequently when I was a teen and in my 20s. Over the years, we got better at keeping them quiet, which was not necessarily a good thing. Now that we have providers we trust, we’re able to let them talk more. Sometimes they’ll talk to my therapist for a little while, or they’ll talk to me and I’ll tell her what I’m hearing. We’ve even let the angry teens come out in session, which was very healing for them because our therapist met their anger with patience and compassion. This helps others inside treat those parts with compassion too. The functioning parts don’t like the idea of losing control to the child parts. We’ve noticed, after being in therapy for years, that people can get stressed out by seeing these parts relive the abuse. We try to keep them back for the wellbeing of others as well as the shame that it causes us. If we let them out for too long, they’re more likely to go through a flashback because they’ll be in control of the body, so we put a lot of energy into keeping them back. We try to protect friends and family from their pain too. We’ve slowly let them talk to T more and more because we decided she’s safe. Sometimes we’ve been highly stressed or in crisis and had no choice. As we learned to let them speak, and as I finally started to believe them, their suffering has lessened a bit.

Therapists need to know that they should never try to re-parent these child parts. This seems like common sense, but I had two therapists do that, and they hurt us a great deal. One of these therapists has since lost her license to practice because of it. It was difficult for me to report her, but four years after she was unethical with me, another therapist told me she hurt someone else. That therapist had heard of her. In fact, many therapists in the area knew about her having dual relationships with clients, but they couldn’t prove it. I had emails, so the licensing board forced her to surrender her license and ended her career. I feel bad that she lost the career she had for many years, but I couldn’t let her hurt more vulnerable patients. She brought that upson herself, something she still doesn’t seem to understand. You can’t take on a parenting role with clients. No therapist can give an abused person a happy second childhood, and if they try, it will always backfire. It was her job to know this. We take ethics courses in grad school that are clear about this, just in case it escapes some people’s common sense.

When working with a client with DID, you must always keep the whole person in mind. This may be difficult when the patient is switching. DID can be distracting and overwhelming for a therapist, especially if they’re not used to working with complex dissociative disorders. If a client switches to a child part in your office, you can work with the part, but try to hold back the instinct to care for them. Child parts sometimes try to elicit caregiving, because they’re stuck in trauma-time and have often been neglected. They’re hurting and never got the help they needed. It’s extremely difficult when most therapists are natural caregivers. This is where my previous therapist went wrong, and then she crossed the boundaries of therapist/patient in huge ways. Therapists may end up spending lots of time playing with or talking to child parts that want to connect, but this isn’t a good idea. It may seem like it’s what they need, but it won’t help the patient. People with DID are overwhelmed by needy and suffering younger parts on a daily basis, and they need to learn to take care of them. This may sound harsh, and to be honest I thought the treatment book was uncaring when I first read that. Now that we’re further along in our healing, we realize that it’s very important to be able to take care of the children inside. This isn’t to say that therapists can’t have positive and supportive interactions with the child parts. I think it’s important because it establishes trust throughout the system. However, spending extended time with younger parts will eventually destabilize the patient and won’t lead to healthier coping.

You could think of it like the kids are black holes of neediness. (Some of them inside resent that I said that, but it’s true). If we don’t heal the source of our pain, we will continue to suffer endlessly. A therapist could play with child parts every day for years, and it won’t really do anything for the patient. There’ll still be countless other parts stuck in shame, fear, and rage. Older parts that function in the world will still experience extreme anxiety and depression. The client needs to learn how to support, listen to, and have compassion for these parts that are hurting. The treatment book and my therapist taught me that. We had to gain a sense of mastery over our inner world. This means we had to believe that we could take care of all parts of ourselves.

Healing does not happen in a vacuum. Someone with a degree in counseling who’s read the right treatment books still can’t fix themselves, I know that all too well. We needed a safe person to witness our pain. We continue to need that as we realize what happened to us. We have trauma upon trauma upon trauma, so it’ll take a long time. But now that we have a stable foundation, my therapist and I have seen massive amounts of progress.

After having multiple therapists act unethically towards us, we were very wary of therapy. Now that we have a safe therapist, we can tell her our story, and it’s freedom for many of the ones locked away in pain. T never judged us, and she never reacted to the things we told her. Sitting with her, and a few other providers we trust, is the root of our healing because we’re finally safe. The most important thing any therapist can do for a trauma survivor is help them establish safety in their lives. The most crucial issues to focus on when treating a traumatized client are safety, shame, and self compassion. If you’re a victim of abuse and reading this, ask yourself if you’re working on these things. Once a client can feel safe in therapy, they can translate that to the rest of their life. This isn’t easy to do, because the world doesn’t feel safe to a trauma survivor. Victims of trauma often mask this underlying feeling with distractions like drugs, alcohol, food, relationships, exercise, work etc., but that’s still the core issue.

So how do you help a trauma survivor feel safe? It’s a gradual process. Obviously you begin by building rapport and trust. You help them build coping skills, and you help them tackle small goals so they can start believing in themselves. The more empowered they feel, the safer they feel.

You also need to establish safety before attachment. If child parts attach to a therapist too soon, it causes internal struggles within the client that will destabilize them. Older parts are ashamed of the younger parts’ pain and neediness, so they get angry and/or afraid when child parts try to elicit caregiving from the therapist. Increasing the internal battles within a system is the opposite of what you want to do. A therapist needs to work on safety plans, empowerment, containment, internal cooperation, self compassion, and coping skills that help stabilize a client before they work with child parts and memories. If a therapist moves too fast and tries to pull at memories too soon, the client could destabilize and end up in crisis. It’s important to check with other parts to make sure they’re ok with a child part telling their story about a memory. It’s inevitable that younger parts will attach to a therapist, but the patient must learn to cooperate with parts and feel comfortable with coping skills for intense emotions before this happens. The treatment of OSDD and DID requires a 3 stage approach: 1) stabilization 2) memory work with parts 3) realization/integration. These stages can each take a long time, and sometimes you must go back to stage 1 or 2 while in a later stage.

Stabilization and safety can be achieved in many different ways, and it’s based on what the client needs. This is what helped me stabilize and feel safe: 1) A therapist with good boundaries 2) trust 3) quitting alcohol 4) movement like swimming and other exercises 5) writing 6) a treatment team that supported me and taught me it was safe to ask for help 7) safety plans for crises 8) self sufficiency and building/finding resources. I’m lucky to have people in my life that care enough to research my condition and listen to me in times of suffering. Even my doctor has taken the time to learn more about me. I know that’s something I’ve deserved all along, but since I was in treatment for years and never got that, I’m all the more grateful for it now. My providers taught me that it was ok to ask for help, and they wouldn’t judge me or punish me for doing so. This is huge for a trauma survivor. We spent decades torn between desperately needing to tell our story and also fearing that people would despise us when they heard it. I was told by my abusers that no one would believe me if I told, or they’d think I was bad. My mother always said I was horrible and disgusting, so many parts believed that therapists and doctors would think the same thing if we told them. Now we see that we’re strong and resilient, and that people will listen to us and believe us.

Establishing safety took a long time, and most of it was a lot of hard work on my part. I give my providers a lot of credit for their consistency and patience, but I give myself the most credit because I’ve survived hell and have worked hard to stay alive. When I was a therapist, I realized that most people just want a quick fix. There is no easy or simple solution to healing years of trauma. It takes time, perseverance, and trust in yourself. I think that for me, trusting myself was the hardest part. I needed someone else to believe in me before I could believe in myself, and I needed that person to be safe and consistent.

There have been some very difficult days, but I got through every one of them. Sometimes I needed to ask for help, and that’s ok. I learned to have hope when others didn’t give up on me. This was difficult for me because the therapist who lost her license suddenly abandoned me after 8 years. She got burned out by trying to parent my little ones and still seeing me decompensate. It’s not easy to be a therapist and listen to such painful stories, to see a client you care about suffer so much, but it’s important to never lose sight of the goal. You want your client to learn to accept and work with all their parts, and to do that they have to learn to take care of themselves. Sure, we sometimes felt hurt by our therapist when we felt like she was shifting the burden solely onto us to heal the little ones. However looking back on it, we never truly felt like she did anything wrong, not like the previous therapist. We knew that she had our best interests in mind, even though we sometimes wanted more help from her. She did what she had to do, because we slowly became less resistant to listening to and supporting our kids. If our therapist had always been there every time we felt our kids needed her, then we would have never figured it out for ourselves.

There have been many days where the pain feels overwhelming, when the crying won’t stop inside, and it just gets louder and louder. But somehow we survived those days, just like we somehow survived all of the abuse. We learned to try and help anchor our parts to the present. We have things in our bedroom that remind us it’s the present day. We work on talking to them and validating their pain. I tell them they went through so much for us, and we’re grateful. We tell them it’s horrible to experience what they did, and we know they’re hurting. I ask myself what I’d do for a traumatized child, and then I do what I can for them. It helps that I understand trauma, and I’m a natural caregiver. Once we had safe people in our lives, we were able to find the strength to begin healing our most wounded parts. There are still many parts inside locked away in pain, and sometimes it feels overwhelming, but we’ve gained that sense of mastery over our worst and most intense emotions. We believe that we can survive anything, and most of us are now committed to working as a team. This is how you heal DID. Through safety comes strength and peace.

3 thoughts on “What Therapists Need to Know About DID: Working With Child Parts of the Patient

  1. This is articulated so well. I can really relate to this as I am currently engaged in this process of working to build connection with my inner parts. It feels like a tug of war at times – both an internal battle of needs, wants, and fearful resistance as well as an external battle of perceptions of trust, safety, and care from my therapist. Thank you for sharing.

    Liked by 1 person

    1. Thanks, I’m glad it resonated with you. I know what you mean, the battles are painful. I guess what helps me, despite it being counter-intuitive, is to lean into the uncomfortableness and pain. Not easy tho! Good luck on your journey, may you find peace as well.

      Liked by 1 person

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