I have observed six distinct stages of recovery in my work with Multiples (people with Dissociative Identity Disorder (DID)/ Multiple Identity Disorder (MPD) which is reflected in the development of Thrive Therapy. I have concluded that understanding the first stage, 'Becoming Multiple' is essential for effective work as it as the structure and beliefs held by the system, not the Cheif Executive Alter (CEA) (Usualy the presenting alter with the life) that define all later stages. As all Multiples have unique experience all Multiple are unique so it’s only reasonable to generalise how the system developed as each needs to be individually understood for therapy to be effective. There’s no instruction manual on how to develop Dissociative Identity Disorder (DID), it’s not like any other illness because it’s about who you are not something you have. All DID systems were created by young children trapped in abuse so there is a young 'black/white' 'good/bad' quality to them (unless they have been rebuilt following an adult following massive trauma in adulthood). Generally, the more abuse there was, the more alters came to manage it so it follows that the bigger the system the more abuse was experienced growing up in environments ranging from severe domestic abuse and/or sexual abuse in the family home, care homes to paedophile/satanic abuse rings.
The six stages of recovery are defined by observable emotions and emotional states expressed by alters as they process their trauma both individually and collectively. This means alters in a system are usually at different stages of recovery simultaneously. Since each alter processes at their own pace, age appropriately from their own perspective the same issues come up over and over again. The last to meet every stage except ‘Integrating Multiple’ is always the CEA as they are the one protected from the knowledge of the abuse. Consequently the CEA is the guide to the stage of recovery illustrated in the diagram below. As each individual alter moves through these stages to integration it is highly likely that different alters in a system will be at different stages of recovery simultaneously - it is not unusual to have 'unknown' alters in a system at the same time as 'Integrated' alters.
Unknown Multiple Getting safe.
A child has grown up in an extremely abusive environment and is now safe, either by growing up or leaving. The abuse is over but the system continues to behave as if it is continuing. Protectors still protect, Guardians still guard the memories, Pain alters still take the pain, Holding alters continue to hold their memories, Suicidal alters continue to self-harm, Stasis alters remain in stasis and Siren alters do what Sirens do etc. The individual remains stuck on 'red alert' (Flight fight/PNS) but the Chief Executive Alter (CEA) doesn't notice because it's always been like that so they don't know any different. They are observed as being constantly anxious and fearful flitting from one crisis or disaster to the next, they may be described as 'hysterical or 'moody'' as they are often overwhelmed with guilt and shame or they are just numb. They will have a big startle reflex known as hyper vigilance and blame themselves for 'everything.'
Unknown Multiples getting safe are most likely to be diagnosed with depression or ME due to the energy contained in the toxic memories empowering their alters that is unavailable to them. They are also likely to experience extreme headaches or migraines with no explanation which are actually alters trying to keep the memories hidden. They are likely to experience unexplained pain on the body which may be diagnosed as fibromyalgia when it's actually the energy in the toxic memories coming out on the body. They may also suffer from OCD and be extremely controlling of themselves, obsessing about stuff and compulsively acting out.
Becoming Aware Multiple.
It's extremely likely this stage will start with flashbacks somewhere in the system. This isn't just about CEA's, alters too have to work out that they exist in a system and not in isolation. This is very difficult to process for everybody and there may be attempts to kill the CEA which they can't make sense of....'No, Mrs Psychiatrist, I have no idea why I tried to commit suicide.'
As with all things DID the CEA is amongst the last to know that they are Multiple. Slowly it comes into CEA awareness that in addition to flashbacks, night terrors and other symptoms of PTSD they lose time, although CEA estimates of how much are usually widely under exaggerated. Other symptoms such as;- waking up in a strange town and having no idea how they got there (A dissociative fugue) thank goodness for satnavs; finding clothes they don't remember buying in their wardrobe, especially if they are in styles they wouldn't wear; people they've never met before calling them by a different name and talking as if they know them; not knowing or remembering important stuff like a wedding day or graduation come into awareness.
DID is a defence mechanism so recognising the symptoms comes in and out of awareness for a long time usually before the Multiple starts to build up a picture of their condition. This is the point a lot of Multiples come into therapy.
This stage is achieved when the CEA realises they are Multiple. It's not unusual to have been in therapy for quite some time before this happens when other alters to have done a lot of the work, and be at later stages. Their discharges will free up enough energy for the CEA's realisation. This is OK, DID is a defence against anything coming into the CEA's awareness so it's normal.
At this stage there is still likely to be a lot of distrust of alters and wanting them 'gone.' The fact is that all that has actually happened is that the presence of the system that has always been there, has come into CEA awareness. Lots of multiples obsess about what alters are doing with 'their' body, often struggling to grasp that the body is shared. This is especially difficult when there is no co-consciousness which can develop at any stage of recovery.
While symptoms of PTSD including OCD are unlikely to reduce at this stage it is helpful for Multiples to understand that they are multiple. There is a great need for patience as it is likely that the system will not yet allow any sharing of the toxic memories with the CEA. Whilst alters are discharging their memories to the therapist, alters that were in stasis are likely to 'wake up' to discharge their energy through disclosure. The process of discharge, wake up more alters, discharge is likely to go on for some time depending on how many toxic memories and alters are in the system. Each alter needs to develop an individual relationship with the therapist but as time goes on the knowledge of who she or he is will spread through the system speeding up the process.
Eventually, the CEA whose ego strength has been improving throughout therapy, will be ready to start to hear the memories. This should be facilitated by or with the therapist gently and with exquisite care. Sharing of information about toxic memories is a slow process, some memories just come into awareness, others may come directly from alters who want to share with the therapists support.
It is at this stage that alters need to be encouraged to work together towards recovery. As they evolved in extreme abuse they are unlikely to treat each other with love or respect which needs to be learned. As the system becomes more cohesive and toxic energy reduces the alters and the CEA start to develop coconsciousness and take it to a new level were they actually meet. When the CEA has learned how to use the executive power to go in between the internal and external worlds the Multiple has achieved the resolved stage.
Becoming resolved is usually signalled by the emotion anger which is experienced for the first time. Most multiples were punished if they expressed anger as children so working out that it's safe enough and the therapist isn't going to run away is a milestone. It now starts to feel safe enough to start putting the blame on the their abusers releasing more energy. It isn't unusual for the Protector to test out anger and blame first, they are usually really angry about what happened to the body and it's their job. Eventually the anger will pass to the CEA who will feel it more and more as they more towards integration.
This is the busiest time for the CEA as up until this point they will have done much less work than their alters, especially if there are a lot of alters to meet and get to know. The system learns to self soothe as the brain starts to switch into 'rest and digest' processing. As these relationships develop memories continue to pass from the alters to the CEA. As they get processed more and more energy is available for living as well as for any alters coming out of stasis. As alters get to know each other and energy is discharged alters start to Integrate. This usually starts with fragments and is in reverse order of their creation. Eventfully all alters are known, Super alters start to wind down their jobs and the responsibility for protecting passes from the protector to the CEA.
At I et al we define an Integrating Multiple when all memories are known and processed signalled by the Guardian who no longer has a job. This is very exciting, there is now very little toxic energy left so remaining alters can just 'be'. With free access to processed memory’s the CEA starts to work out who they are and develop a sense of identity.
Eventually, most if not all alters will integrate and the CEA will become a full integrate.
To talk to us about Thrive therapy, treatment for DID please contact us.