With these
caveat, therapist should be prepared to handle SP in a direct way, when
clinically warranted. If some SPs continue to haunt a patient’s life and would
not “settle down” or “go back to sleep”, they might need to be directly
contacted and appropriately handled - again, provided that both for the patient
and therapist. Occasionally, there might be clinical situations on an
outpatient basis where encounter with SPs occurs spontaneously and inevitably,
or even by necessity. Before I present a case material in one of the last circumstances,
I would like to state the conditions for handling SPs in a psychotherapeutic
setting.
The therapist must have established a good therapeutic alliance with an
identified SP that he/she intends to handle. SPs should also be cooperative
enough to maintain the therapeutic structure. The host personality must
be certain that the SP is not excessively disruptive or aggressive so that the
therapist or patient is never in any physical danger.
The
conditions in which the handling of an SP may be appropriate and therapeutic
can be summarized as follows.
An SP has been appearing frequently enough in the patient’s life for an extended period, and a continuation of that pattern in the near future is expected.
The SP is sufficiently cooperative with the therapist, and the host or SP itself can assure the therapist that any physically aggressive or disruptive behaviors can be avoided (or the therapeutic process should be suspended if any of such behaviors occur).
An SP has been appearing frequently enough in the patient’s life for an extended period, and a continuation of that pattern in the near future is expected.
The SP is sufficiently cooperative with the therapist, and the host or SP itself can assure the therapist that any physically aggressive or disruptive behaviors can be avoided (or the therapeutic process should be suspended if any of such behaviors occur).
The access
to the SP should be initiated tentatively at the beginning, and the process
should be postponed or given up if the patient’s functional level, such as the
level of agitation and frequency of the switching among parts of his
personality appear to be getting out of control.
The rationale for handling SPs that meet these conditions is as follows. If an SP establishes some communication with the therapist, the aggressive nature of the SP can be gradually modified and “detoxified,” probably in a similar way that traumatic memories are abreacted and become less salient through exposure therapy or eye movement desensitization and reprocessing (EMDR). Although there are many ways of explaining neurologically how exposure techniques work (Myers & Davis, 2007), I would like to consider the curative process of dissociative cases from the standpoint of memory reconsolidation (Okano, 2015). SPs are parts of an individual’s personality that have never had enough chance to express their feelings. Through experiences of expressing themselves, SPs’ traumatic memories can be reorganized, hopefully in such a way that they would no longer be reminisced intrusively or automatically.
The rationale for handling SPs that meet these conditions is as follows. If an SP establishes some communication with the therapist, the aggressive nature of the SP can be gradually modified and “detoxified,” probably in a similar way that traumatic memories are abreacted and become less salient through exposure therapy or eye movement desensitization and reprocessing (EMDR). Although there are many ways of explaining neurologically how exposure techniques work (Myers & Davis, 2007), I would like to consider the curative process of dissociative cases from the standpoint of memory reconsolidation (Okano, 2015). SPs are parts of an individual’s personality that have never had enough chance to express their feelings. Through experiences of expressing themselves, SPs’ traumatic memories can be reorganized, hopefully in such a way that they would no longer be reminisced intrusively or automatically.
Clinicians
should keep in mind that SPs should be treated in the most respectful manner. As
the TDSP suggests, the therapist should … [treat them]… by acknowledging and
respectfully addressing them”(p.312). If a clinician uses the words “shadowy
personality” to talk to them, these SPs should be given an explanation for such
a way of calling and try to get them understand that there is no pejorative
meaning and ask them if they prefer being called to in different way.
In this paper I would like to present a case
material in which such a direct contact with an SP was required.
