Does the ISST-D believe your alters are real?
How should therapists interact with the many alters of a DID/OSDD patient?
There’s a lot of fearmongering out there about therapy, and the way therapists will treat the alters in a system.
Common fearmongering statements are:
- That therapists will ignore every alter other than the “host”/“core”/“original”.
- That therapists will refuse to interact with any alter other than the “host”/“core”/“original”, and won’t help other alters even if they are in distress.
- That therapists will be focused on “destroying” or repressing all alters other than the “host”/“core”/“original”.
- That the ISST-D guidelines say that alters are not real and should not be treated as real.
If your therapist is doing any of the above, you should immediately leave and seek a therapist who will actually follow the treatment guidelines.
The ISST-D is a guide for therapists to use while treating patients with DID/OSDD.
It talks very clearly about how a mental health professional should treat alters.
The ISST-D states that a therapist must:
- NOT refuse to talk to any alter.
- Treat all alters as real and valid.
- Treat all alters as their patients (not just the “host”/“core”/“original”).
It states that a vital part of the healing journey is helping the alters communicate and cooperate.
Which means that their patient would never begin to heal, if they did the things that fearmongers say they do.
Again, if your therapist is doing ANYTHING that concerns you, you should seek a new therapist and potentially seek legal aid.
The following are some relevant quotes from the ISST-D guidelines.
“Clinicians must accept that successful treatment of DID almost always
requires interacting and communicating in some way with the alternate identities. Ignoring alternate identities or reflexively telling identities to “go back inside” is frankly countertherapeutic"
- This means that a therapist must not ignore or reject any alter who wishes to speak with them.
"The development of internal cooperation and co-consciousness between identities is an essential part of Phase 1 that continues into Phase 2. This goal is facilitated by a consistent approach of helping DID patients to respect the adaptive role and validity of all identities, to find ways to take into account the wishes and needs of all identities in making decisions and pursuing life activities, and to enhance internal support between identities.”
- This means that the therapist should help the patient’s communication and cooperation with all alters. Which requires the therapist to accept all alters as real and valid, and to help the alters accept each other as well.
Breaking down denial can only happen if the therapist is not fuelling denial by ignoring or rejecting the reality of the patient’s alters. (In this situation “patient” refers to the body and includes every alter inside the body/system.)
“Although the DID patient has the subjective experience of having separate
identities, it is important for clinicians to keep in mind that the patient is
not a collection of separate people sharing the same body. The DID patient
should be seen as a whole adult person, with the identities sharing responsibility for daily life. Clinicians working with DID patients generally must hold the whole person (i.e., system of alternate identities) responsible for the behavior of any or all of the constituent identities, even in the presence of amnesia or the sense of lack of control or agency over behavior (see Radden, 1996).”
” Taken together, all of the alternate identities make up the identity or personality of the human being with DID.“
- These parts are talking about how all alters are part of a whole. This may seem impossible to you, or you may feel like this is saying that alters aren’t real, but that is not the case.
The theory of Structural Dissociation says that no one is born with an integrated personality. As a normal stage of childhood, the separated personality states integrate. If repeated ongoing trauma prevents the normal integration, then you end up with DID/OSDD.
But that’s a conversation for another post.
In regards to therapy, these sections are telling the therapist that they should not encourage further dissociation and differentiation between the alters.
(This is also seen in the section that relates to patients naming and describing their alters, as seen in this linked post.)
And more importantly, that they should help the patient learn system responsibility. That is, to take responsibility for the actions of all alters, and increase communication and connection between the alters.
Truly understanding that you are all part of a whole is vital to the later stages of the healing journey, and understanding of that should come with time, so it’s ok if you don’t understand yet.
(See this linked post for more discussion about this.)
” It is countertherapeutic for the therapist to treat any alternate identity as if it were more “real” or more important than any other.
The therapist should not “play favorites” among the alternate identities or
exclude apparently unlikable or disruptive ones from the therapy (although
Downloaded by [208.78.151.82] at 09:20 21 October 2011 Journal of Trauma & Dissociation, 12:115–187, 2011 133 such steps may be necessary for a limited period of time at some stages in the treatment of some patients to provide for the safety and stability of the patient or the safety of others).“
- This part very specifically tells the therapist to treat all alters fairly, and not to focus more on one alter than any other.
That the therapist should not try to avoid alters that the therapist “doesn’t like”.
It also implies that the therapist should not say negative things about any alters to the other alters, as this would be playing favourites.
It does state that the therapist and patient may agree that a specific alter should temporarily step back from therapy for the good of the system, but that it is not considered appropriate to “cut out” an alter from therapy on a longer-term basis.
”… it is countertherapeutic to tell patients to ignore or “get rid” of identities (although it is acceptable to provide strategies for the patient to resist the influence of destructive identities, or to help control the emergence of certain identities at inappropriate circumstances or times).“
- This part is very clear and easy to understand.
It says that therapist should never try to get rid of alters, no matter what, but that the therapist should help the patient (referring to the DID/OSDD system as a whole) learn coping mechanisms which will help the system/patient live a coherent and functional life.
In addition to mitigating the destructive tendencies of a destructive alter, this may relate to things such as preventing little alters from fronting at work or at a nightclub, or helping a protector learn to front in safe spaces rather than only fronting in protective situations.
All quotes taken from https://www.isst-d.org/wp-content/uploads/2019/02/GUIDELINES_REVISED2011.pdf
