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Section 10
Self-help in Dissociative Identity Disorder

CEU Question 10 | CEU Test | Table of Contents | DID
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On the last track we discussed memory assembly.  We identified characteristics of memory fragmentation, and then we examined two techniques for memory assembly.  The two techniques for memory assembly that we discussed are the affect bridge and the memory bridge.

On this track we will discuss the internal self-helper of the DID client.  The internal self-helper is essentially a helpful alter that you may find can be useful in implementing therapeutic strategies for eventual unification and integration of the personality system.  The importance placed on identifying and working with the internal self-helper, known as the ISH, varies with different therapists. 

Some therapists, for example, emphasize the importance of incorporating the ISH into the therapy.  However, other therapists define ISH personalities in passing as "serene, rational, and objective commentators and advisors," and may not use the ISH in treatment.  It is not clear whether an ISH is a universally present alter or only occurs in some DID clients.  

Also, there may be more than one ISH present within a given multiple.  Therefore, you might find it beneficial to use the techniques on this track to work with your client’s internal self-helper.  Introduced by Frank Putnam, the techniques on this track can be productive for finding your client’s internal self-helper and working with your client’s internal self-helper.

Finding Your Client’s ISH
First, let’s discuss finding your client’s ISH.  You may find that available literature has few examples of the uses of an ISH, although a number of therapists privately report significant success in incorporating an ISH into the therapy.  My colleague, Douglas, describes carrying on a dialogue about the client with the ISH.  Douglas states that "there is no human to human relationship with which to compare this partnership.  It is so unique a relationship it has to be experienced to be believed. Internal Self-Helpers will discuss the client’s strengths and weak­nesses and tell the me what needs to be done to help the client."

Perhaps you will find it useful to use the "switchboard" technique from track 6 to substitute your client’s ISH as a therapist.  Could the use of the "switchboard" technique also help to foster inner dialogue in a manner similar to the model of the therapist as go-between we discussed on track 4?

My colleague, Douglas, believes that in the course of therapy the ISH should be identified as soon as possible. Douglas once stated to me, "The therapist must not be afraid to "horse trade" with the ISH, who will always be protective of the personalities and will see to it that therapy is provided and that the personalities will get the best deal possible.  

If the therapist becomes hindered in progress, I recommended that the therapist inform the ISH that special help is needed from that source in order to proceed with the therapy.  The internal self-helper will almost never play all of his cards at once.  The therapist must learn and understand that for the most part the ISH can do more and exert more influence than the therapist realizes.

Douglas also mentioned the stabilizing influences of internal self-helpers.  In one notable example, he described the ISH’s of two multiples commiserating with each other about their similarly angry alters.

My own experience with ISH’s has been limited.  I have met several internal self-helpers, and find that in some cases they are invaluable sources of information and guidance in working with multiples.  I certainly have not found an ISH in every multiple, although I usually do find at least one alter who is primarily focused on seeing that the patient gets appropriate treatment.  

Would you seek an ISH in the same way you seek other alters?  I find that I can ask whether there is one who sees itself as a guide, helper, or healer, and who can assist me in working with the client.  The first personality to step forward after this request is often not the ISH, so the therapist should not accept an alter’s statement that he or she is an ISH at face value.  A true ISH will prove itself in the long run.  Could your client’s other alters also help in deciding whether or not the therapist is working with a true ISH?

Working with Your Client’s ISH
I see the ISH as a guide or a source of information about the personality system and the direction that the therapy needs to take.  As Douglas had indicated, the ISH will rarely reveal more than a small amount of information at a given time, and that information may be incomplete or it may contain unstated assumptions that the therapist does not understand.

ISHs are enigmatic, leaving the therapist with the problem of deciphering their Delphic statements. The therapist can ask for clarification, but will not always get it. In general, if I believe that I am talking to an ISH, I will try to incorporate his or her advice into my interventions, but I take it with a grain of salt.  Has your client presented with Internal Self-Helper imposters who give misleading or destructive advice?

There will often be a number of ISH’s within a client, each having authority over a group or family of alters, but none having access to the whole system.  Have you found that as you move to a new level in the personality system, former ISH’s fade out or abandon therapy?  I find, that in these cases, the ISH has simply reached the limit of its knowledge or authority.  You can generally find a new helper as the therapy progresses.  It should also be noted that ISH personalities often lack staying power and cannot remain "out" for lengthy periods.

The principle embodied in the ISH is that at some level the client has an observing ego function that can comment accurately on the ongoing processes and provide advice and suggestions as to how to aid the rest of the client in achieving some insight and control over his or her pathology.  One can often find this type of function in non-DID clients as well as within one’s own self. It is important to listen to these voices of inner wisdom, but it is a mistake to view them as all-knowledge­able or all-powerful.  

When one is struggling with a difficult client, one often wishes for some miraculous intervention, and I think that this wish is what leads some therapists to ascribe omniscience to ISHs.  Would you agree that one should of course listen to the client, particularly if an ISH appears to be available, but in the long run one must use one’s own therapeutic judgement?

On this track we have discussed the internal self-helper of the DID client.  The techniques on this track can be productive for finding your client’s internal self-helper and working with your client’s internal self-helper.

On the next track we will discuss working with internal persecutors. 

Peer-Reviewed Journal Article References:
Bernecker, S. L. (2014). Helping clients help themselves: Managing ethical concerns when offering guided self-help interventions in psychotherapy practice. Professional Psychology: Research and Practice, 45(2), 111–119. 

Brand, B. L., Webermann, A. R., Snyder, B. L., & Kaliush, P. R. (2019). Detecting clinical and simulated dissociative identity disorder with the Test of Memory Malingering. Psychological Trauma: Theory, Research, Practice, and Policy, 11(5), 513–520. 

Chiu, C.-D., Ho, H. L., & Tollenaar, M. S. (2021). Relational self-evaluations in dissociation: Implicit self-rejection? Psychological Trauma: Theory, Research, Practice, and Policy. Advance online publication.

Garcia, D. J., Waugh, M. H., Skadberg, R. M., Crittenden, E. B., Finn, M. T. M., Schmidt, M. R., & Kurdziel-Adams, G. (2021). Deconstructing criterion a of the alternative model for personality disorders. Personality Disorders: Theory, Research, and Treatment, 12(4), 320–330.

Schueller, S. M., & Parks, A. C. (2014). The science of self-help: Translating positive psychology research into increased individual happiness. European Psychologist, 19(2), 145–155.

Online Continuing Education QUESTION 10
What are two techniques regarding the internal self-helper of the DID client? To select and enter your answer go to CEU Test.

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