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UNDERSTANDING THE REALITIES OF DID: The value of a research Project

by Martina Platten Copyright 2004



I recently completed an MSc in Integrative Psychotherapy at the Sherwood Psychotherapy Institute in Nottingham. Integral to the programme was to do a research dissertation in an area that interested us in the field of psychotherapy. My title was ‘An Exploration into One Client’s Perspective of Living with Dissociative Identity Disorder and the Impact of Therapists’ Responses’. The following is a summary, some of it verbatim, of the research I undertook.


More than a decade ago I became fascinated by what was then known as Multiple Personality Disorder, now known as Dissociative Identity Disorder. The story of Sybil (1973) in part stimulated this interest but I was keen to go beyond just watching a film dramatisation (1976) and reading a biography. I wanted to gain a much better understanding of this presentation.


When I met and became friends with ‘Katherine’ [not her real name], I was continually amazed, and continue to be so, by the capacity of the human mind to have done something so creative and remarkable to protect itself and survive from unimaginable horrors. The phenomenon of dissociation was not a new concept to me, having experienced and worked through some dissociative distress myself. To appreciate that the mind could go much further and create new ‘identities’ was therefore not hard for me to grasp.


At the onset of my training in psychotherapy I was already aware that this would be the area I would focus on for my research project, specifically how it would be formulated was not yet in my mind. It was my continuing friendship with Katherine that determined where the focus would be directed.


As I learnt more of Katherine’s story and her struggle to be healed from the traumas she had experienced during her childhood, teens and early adulthood, I was constantly impacted by her tenacity as she clung to the belief that she could move forward and no longer be so affected by the consequences of the abuse perpetrated against her. Katherine was already in therapy with her current therapist when I got to know her.


This had developed over time, with various struggles, to become a healthy therapeutic relationship within which she had grown and begun the healing process. She had not always had such positive experiences in individual therapy and, even whilst I knew her she had been to conferences, which included therapeutic group work that had been devastating for her.


As we talked about her experiences, what developed over time was an awareness of much ignorance and lack of acceptance for DID clients by some therapists or therapeutic groups. Stimulated by her frustration and hurt, I read around the subject and was struck forcibly by what appeared to be a lack of client perspective about the process of therapy for them.


Many theories, opinions and guidelines were given by therapists on how to work with this client group. Apart from biographies that were often a historical narrative of the abuse and reasons for the development for the DID, there appeared to be little that specifically addressed the impact of how therapists respond to DID clients, from the clients themselves. I knew then that I had found the heart of the research.


It was the lack of voice, and what was experienced, at least by Katherine, as marginalisation, for the DID person that was so compelling. Inevitably, the direction and methodology of the research would have to reflect this by being collaborative and working alongside the DID client, so as not to repeat a pattern. Katherine was enthused and, once I had established that there was good evidence for having a single story narrative in research, our minds were made up. So began the journey into Katherine’s world of DID, her experiences of therapy and the impact that it has had on her.


These were my motivations for undertaking such an area of research and were confirmed to me by a significant gap in the psycho-therapeutic literature and research market in the seventy or so books and articles that I surveyed in an extensive literature review. This covered an overview of the historical beginnings of interest in the subject and then looked at some of the clinical and narrative literature available.


Encouragingly, recent material is just beginning to address this issue. Benatar (2003) states that if, as some believe, ‘all personality disorders are at bottom variations on dissociative processes, our DID patients may be our most informed teachers’ (2003:12). If this is so, then there needs to be much more than a statement of belief but documented experiences and accounts from DID clients and the impact of therapy on them.


The dissertation then followed with a section that developed a rationale for the methodology used; collaborative, with Katherine, using Participatory Action Research and a Narrative Methodology that were based on Atkinson’s (1998) and Etherington’s (2000; 2001; 2002) approaches. It also discussed the debate in qualitative and quantitative research and located this within the Integrative Psychotherapy tradition.


This methodology section also described the procedure for establishing the research project, how the data would be analysed and paid considerable attention to the ethical issues paramount to such a project. The conclusion to all this, which space does not permit expansion on, was that such a methodology would offer a unique insight into one person’s worldview of living with DID and the impact that therapists make on her.


The Findings and Discussion formed the main body of the research with verbatim comments from Katherine included. It did not give a narrative of her upbringing and the details of the abuse that caused her to develop DID. What was significant in the data and important for Katherine to give voice to was her experience of therapy, as a DID client, and what the impact on her has been, both positive and negative.


It demonstrated that for Katherine therapy has played a crucial part in her continuing healing and recovery. However, it is a therapy that supports a strong and open working alliance between client and therapist that is efficacious. Therapy that does not value this type of model is seen to be, from her data destructive, as damaging and not productive in moving forwards. The quantity of data that was provided by Katherine was extensive and so these findings and discussion were only able to reflect in part all that was expressed and raised.


Exploring Katherine’s experience of living with DID and the impact of therapists on her has been a challenging and insightful process. What has been most significant in hearing her story has been the importance of receiving therapy for her recovery and healing, without therapy this would have been an almost impossible task.


As is the case with most clients, what is pertinent for her is the quality of the therapeutic relationship and the establishment of a good working alliance. Although these are concepts that are readily accepted, particularly in Integrative Psychotherapy, what Katherine’s data presents is a perspective that highlights what a client may experience from a therapist’s interventions. For her to feel loved and, at least for a time, to be able to attach has been most significant. The data is as equally clear in what is not helpful; therapists using their potential power to profess knowledge or control in the therapy and by doing so not hearing and seeing what is most needed for the client.


What is especially painful is when the DID client is not believed or is seen as a multiple rather than a unique person with their own values and opinions. Katherine’s experience also highlights the difficulties of therapeutic group work for DID clients and leaves a challenge to the professional world, in finding formats that are safe and inclusive for the DID person.


The data demonstrates that with DID clients, whilst still maintaining a professional model there needs to be creativity, adaptability and openness. The challenge to therapists is to examine their own model of working and to explore more fully and bring into the therapy room an awareness of how marginalisation may feel. Therapists need continually to keep at the forefront of their minds the fact that DID people are often seen as a curiosity. What they do not need is to be an object of this in the therapist’s room or to be seen as a therapeutic challenge. From Katherine’s perspective, what she needs is understanding, commitment and unconditional acceptance. The client particularly needs to be valued as a unique individual and a good relationship between therapist and client developed and maintained. It is a way of therapy that is especially suited to an integrative approach and interestingly so, as DID represents an extreme loss of integration in the birth personality.


Employing a narrative methodology, with Participatory Action Research insight, had value in that a voice from a group that is often marginalized, or receives strong theoretical opinions about it, could be expressed and heard. The validity of the findings comes purely from Katherine’s experience, in that it is her story and experiences. Her story cannot be questioned, but how it is interpreted may be. Although this methodology has significant merit and value providing a unique experience of therapy as a DID client, it needs to be recognised that this is only one perspective and so cannot be taken as reality for all DID clients.


Others may have very different experiences or expectations of what for them would be efficacious in therapy. This is an area that would then benefit from further research, by collating more experiences of DID clients and the impact of therapy on them, what was helpful and healing and what was not.


Another area that would benefit from further exploration would be research into the viability and practice of therapeutic groups, which include DID; not an exclusive DID group. This is an area that Katherine has begun to think about and if her perspectives are heard, rigorous open research into the benefits of group work could be significant in the recovery journey for DID clients.


As I ended this project I could only continue to marvel at the wonders of the human mind, which was the place that began my interest and journey into Katherine’s world and experiences. As a therapist it has been invaluable in reminding me of the values that I hold and seek to maintain in my professional work with clients. Katherine’s story is a challenge in reminding me of the uniqueness of each individual and their own felt needs to journey towards healing and recovery. Those who need to develop DID for their survival bring this challenge into sharp focus.


Their struggle is often harder and more complex than most and, consequently, this is brought into the therapy room and the relationship with the therapist. We, as therapists who may choose to walk the path of recovery with this particular client group, have an enormous privilege to enter their worlds of fear and pain but often of enormous courage and hope in a different future. Will we be prepared for the challenge to walk alongside, listening and finding together a way for healing?



References


Atkinson R. (1998) The Life Story Interview: Qualitative Research Methods Series 44. USA: Sage Publications Inc.

Benatar M. (2003) Surviving the Bad Object. Journal Of Trauma and Dissociation 4(2): 11-25

Etherington K. (2000) Narrative Approaches to working with Adult male Survivors of Child sexual Abuse. The Client’s, the Counsellor’s and the Researcher’s Story. London: Jessica Kingsley Publishers.

Etherington K. (2002) Working together: editing a book as narrative research methodology: Counselling and Psychotherapy Research 2(3): 167-176

Etherington K. (2001) Doing Qualitative Research – a gathering of selves. Counselling and Psychotherapy Research 1(2): 119 – 125