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Section 5
Guidelines for Conversations

CEU Question 5 | CEU Test | Table of Contents | DID
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On the last track we discussed promoting internal communication.  Three techniques for promoting internal communication are therapist as a go-between, the bulletin board, and internal conversations. 

On this track we will discuss conversation topics and internal decision making.  Regarding conversation topics, we’ll look at basing initial topics on needs and secondary topics.  This track also provides several techniques you can implement with your client to foster productive internal decision making skills.  As you listen to this track, evaluate how these techniques can benefit your client.  Will you apply them as they were applied to Alan?

Conversation Topics - Two Guidlines

#1  Basing Initial Topics on Needs
First, let’s discuss basing initial topics upon needs.  Your client, like Alan, clearly has many needs that must be fulfilled.  Alan struggled to meet his needs.  Likewise, Alan’s alter personalities struggled to meet varying needs, which sometimes conflicted.  Have you found that apparently simple tasks such as getting the oil changed in the car or picking up laundry can become overwhelmingly difficult when a DID client like Alan who lacks productive internal communication? 

Use of the Bulletin Board technique from track three can be a productive way for clients like Alan who lack productive internal communication to meet specific needs.  For example, Alan began posting certain needs on his bulletin board along with all the particulars about how specific tasks or obligations must be fulfilled.  Other personalities can also use the Bulletin Board to post their own needs, requests or comments.  Would you agree that increasingly effective internal communication shows the personality system that there are direct and immediate benefits from working together?

#2  Secondary Topics
A secondary topic that I find appropriate for early internal communication is the filling in or relay of information that the host is missing because of amnesic gaps from switches.  From my sessions with Alan, I felt that one of the reasons he suppressed his alter personalities was because of the anxiety that he felt about what actually happened during the blank periods associated with switches between personalities.  Does your DID client have a fear that he or she engages in inappropriate or even criminal acts during their amnesic episodes? 

In spite of his anxiety over what may be happening, Alan later stated, "Not knowing what happens is actually worse than knowing the facts."  Therefore, I encouraged Alan’s alters to communicate to Alan a summary of what occurred during any extensive period in which Alan was ‘out.’  Also, I encouraged Alan to ask about what occurred whenever he lost a significant amount of time.  In what ways could your client learn more about what has been happening during amnesic episodes?  Could you perhaps refer to a behavioral contract as discussed on track 3?

Internal Decision Making
In addition to basing initial topics on needs and secondary topics, let’s discuss internal decision making.  Among the major stressors on Alan’s personality system are the conflict of interests and values and the competition for body time among alters.  Have you found that competition for time tends to increase in intensity during initial treatment?  Alan clearly already had a decision making process in place, with one or several dominant alters having imposed their will on the system.  The result was other personalities seizing control at various times to impulsively act out forbidden wishes

In the beginning, the best results Alan obtained were limited cooperation around general tasks in which most of his alters had a common interest.  For example, Alan’s initial therapeutic work regarding decision making focused on who was going to be ‘out’ during a dental appointment.  Previously, Alan had had several bad experiences in which all of the alters refused to be present while a tooth was being pulled.  As a result, Alan’s child alter was shoved ‘out’ and behaved in an embarrassing way.  Alan stated, "Later I found out that I was crying and asking for my mommy!  Can you believe that!?" 

Clearly, there was a common interest in Alan’s personality system in correcting some serious dental problems, but no alter who had the ability to arrange dental treatment was willing to experience it.  After a lengthy debate and another behavioral contract, a compromise plan to divide the experience among several alters was worked out.  For the most part, the alters were able to stick to the plan and succeeded in obtaining the necessary dental care.

If some degree of internal cooperation is to be achieved, would you agree that an effective means of communication must take place?  You might also consider ways to promote a sense of fairness or justice within the system.  However, you might find that a number of personalities are exceedingly moral with a strong sense of fair play.  I asked Alan’s alters to begin working on some of the practical problems in Alan’s everyday life. 

For example, who pays the bills?  Who makes sure that Alan gets to work each day?  Would you agree that having to formally make such decisions highlights the need for a decision making mechanism and demonstrates the nature of the process already in place?  With Alan, I worked through and examined some initial decisions in his system.  The groundwork for a cooperative decision making process already existed.  If the same is true for your client, you need only to modify the process to achieve a greater degree of internal consensus. 

Also, you might find it helpful to foster a decision making process which is along democratic lines.  By this, I mean a process with as large a representation of alters as is feasible.  Would you agree that to exclude an alter is to invite trouble?  However, it is clear that some alter personalities will remain unknown to the therapist and perhaps to the entire personality system until a later point in therapy.  So, as with behavioral contracts, any time a decision is made, all unknown alters can be invited to step forward and register their comments and opinions.  Would you agree that this technique may succeed in uncovering holdouts from time to time? 

Think of your Alan.  How can these techniques be applied in your treatment to put in place a smoothly functioning mechanism to match the allocation of resources with the person’s overall needs?

On this track we have discussed conversation topics and internal decision making.  Regarding conversation topics, we looked at basing initial topics on needs and secondary topics.  This track also provided several techniques you can implement with your client to foster productive internal decision making skills.

On the next track we will discuss control over switching.  Two ways to help your client gain control over switching are overcoming host fears and facilitation of the switching process. 

Peer-Reviewed Journal Article References:
Blasini-Méndez, M. (2019). Interpersonal postcolonial supervision: Facilitating conversations of countertransference. Training and Education in Professional Psychology, 13(3), 233–237. 

MacIntosh, H. B. (2015). Titration of technique: Clinical exploration of the integration of trauma model and relational psychoanalytic approaches to the treatment of dissociative identity disorder. Psychoanalytic Psychology, 32(3), 517–538.

Thorne, A. (1987). The press of personality: A study of conversations between introverts and extraverts. Journal of Personality and Social Psychology, 53(4), 718–726.

Online Continuing Education QUESTION 5
How can your client achieve cooperation between alter personalities? To select and enter your answer go to CEU Test.

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