General
orientation
So far, I have
described a hypothetical process wherein different types of SPs are formed, using
some diagrams in order to make my points. I move on to discuss briefly how
understanding this process could inform therapists in handling SPs in their clinical
settings. The
International Society for the Study of Trauma and Dissociation (ISSTD)
recommends a phase-oriented treatment for DID (ISSTD, 2011). Generally, the approach
to the SPs focused in this study would fall under Phase 1, or “stabilization
and symptom reduction.” When a SP is attempting to express itself, allowing it
to do so in a safe and supportive environment may reduce the patient’s sense of
urgency and stress, as well as their persistent hearing of voices. However, contact
with an SP can also be considered a component of Phase 2 (“confronting, working
through, and integrating traumatic memories”; ISSTD, 2011), as it has
connotations of abreaction for both the SP and host personality and may allow
for working through the trauma memory, given that the SP’s verbal expressions
might be a reprocessing of some traumatic memories.
The
therapeutic approach of parts of personality equivalent to SPs, such as “persecutory
EP” ( van der Hart, et al., 2002) and “controlling EP” (Nijenhuis, 2017) have
been well discussed by their authors. Primarily, TDSP provides us with a quite informative
and accurate guideline in its description of “working with persecutory parts of
personality” (pp.311-313) and large part of my following discussion goes along
with it. Perhaps the most important initial part of the treatment includes
patient’s education. It is very useful to inform main parts of personality of the
nature of their SPs. TSDP states; “All parts of the patient should be educated
early in therapy as to the function of persecutory parts within his or her
personality system”(p.312) . the TSDP also stresses the importance of letting
the patients know “protective function” of these parts of personality. Compared
with other non-SP personality states, SPs are more difficult to access because
they often resist being called into therapeutic situations. As TDSP (2002) states,
SPs are “often unwilling to participate in therapy directly, and work “behind
the scences” to sabotage progress, which they regard as dangerous, as a threat
to a precarious balance of the inner system”(p.312). Partly in response to the
SP’s negativistic attitude, therapists also tend to be loath to handle them,
given their penchant for being destructive, aggressive, and revengeful.
One of my
patients (a teenage girl with DID) stated as follows; SP is kind of like a group of those who are taken away a chance to
voice their feeling. They were stopped from voicing whatever they feel,
especially anger. Other parts are not programmed to get angry, and that gets on
their nerves. Oh, that’s why they don’t bother to attend the inner meeting. They
know it’s not worth it, as they are going to be voted down by others anyway ….
In his discussion
of the therapeutic approach to the “controlling EP”, Nijenhuis stresses; “it
would be important to fully include all dissociative parts in the treatment”(p.530).
He also underlines that it is therapeutic to emphasize to other parts “how
important he [the controlling EP] and the other dissociative parts were”(p.530).
I fully agree with his even-handed and accepting approach to all the parts of
personalities, especially as whatever the therapist does or say can potentially
be observed behind the scenes by SPs. In a sense, a therapist could always be
facing SPs, at least indirectly in any clinical setting. However, as to whether
or not the therapist should directly address the SP is a difficult question, there
is no single answer. As TSDP (van der Hart, et a,. 2002) states “… [W]hether or
not the therapist should attempt to work directly with these parts … depends
upon the degree to which these EPs affect the personality system as a whole
early in therapy.” Keeping Safety in the patient and therapeutic relationship
is the name of the game in any therapeutic approaches of dissociative patients.
When an SP is expected to easily go out of control or become agitated to a
degree that the therapist cannot subdue or control them, any attempt to contact
the SPs directly in a therapeutic setting would be deemed inappropriate or
untherapeutic. The therapist should not be to blame if he become rather
protective of non-SP parts and try to keep them away from SPs if they are very
instigating and destructive. I consider that it is very important to listen to
the voices of non-SP parts of personality regarding how they can be confused
and threatened by the SPs, and stressing SP’s protective nature and suggesting
that they should be empathic with SPs should not deter them to ventilate their
negative emotions toward SPs. Although I cannot agree more with TDSP (2002) ‘s
stance that “the therapist must not avoid these parts, but rather be fully
engaged with persecutor Eps in order for treatment to be successful”(p.313), it
does not exclude a possibility that when SPs choose to stop being active and
become dormant, they sometimes should be left untouched and be given a space so
the patient’s functional level is secured. Again, whether or not to deal with
SPs directly/indirectly depends largely on a therapeutic context and the
clinician’s high level of judgement is required.
