The Cocoon
Ahhh therapy. That safe cocoon where you can exhale, put your feet up and share anything that’s on your mind, weighing on your heart or woven through your soul, all while a deeply compassionate, wise individual, aka the therapist, offers unwavering, unconditional “positive regard” and holds space for you inside the cocoon. Therapy is a judgement free zone after all, albeit a higher priced one and with more limited hours than the Planet Fitness gym that’s just around the corner. You should expect nothing less. In essence, when you enter therapy, you are a caterpillar becoming a butterfly. It’s wondrous and magical almost. Unless, of course, it isn’t.
Most clients view their therapist as a compassionate sage, having an arsenal of skills complemented by innumerable ingenious interventions designed to help them heal their wounds. Clients rightfully expect their therapists to steadfastly believe in their ability to overcome virtually any adversity life has dropped in their paths. It is here, in this safe haven, that you expect to process and release all the trauma stored in your cells. It is here that you seek to finally heal those attachment wounds that feel older than you are. And it is here that you will practice new ways of being within the context of this “safe enough” relationship. In fact, it is the relationship itself that is the vehicle for healing.
Echoes in Silence
Ideally, the therapeutic relationship would always feel consistent and safe enough. But numerous things from minor miscommunications and annoyances to much larger issues have the propensity to unravel therapy. This risk is inherent for anyone seeking care for any reason, and most often what goes wrong is repairable with a little time and effort. But it can be particularly convoluted when you are living as a system.
Many of the things that go awry require the ability to bring it to the therapist’s attention and verbally explain and explore the circumstances. “Have you talked about it with them?” “Just tell them. I’m sure they’ll be open to it.” “Use your voice.” These are some of the most common pieces of advice you’ll get from others. To be sure, singlets struggle with this advice all the time. “What if my therapist gets angry?” “What if they abandon me?” “What if my fears are actually true??”
In general, people struggle with using their voice in vulnerable situations. When you are living as a system, it becomes even more complex. Part of you might be adept at having difficult conversations, and another part might even be incredibly diplomatic and highly capable. But other parts of you might be terrified, others skeptical, and still others angry. Protector parts of you might sense inherent danger, as they thumb through their invisible rolodex of all the historical instances where difficult conversations or displeasing another person led to being hurt in unspeakable ways. Ready to spring into protective action, these are the parts of you most likely to block the ability to “just talk it out” by using some well known strategies to thwart conversations and work in therapy. Some examples of common strategies used by protectors are:
Your mind suddenly going blank. There are no thoughts or words to speak out loud.
Your throat constricts to such a degree that speech production is impossible.
Being overcome by a sudden, overwhelming, foggy, lightheaded or dizzy feeling.
Loud noise filling the headspace. It may sound like many voices at a packed event: you can hear the sound of voices, but can’t make out words or what they’re saying.
Internal loud screaming, wailing or crying that is too distracting to think or speak through.
Internal arguing too loud or distracting to think through OR that causes internal conflict and doubt about whether to proceed.
Internal threats creating fear of retribution if you do proceed.
Sudden inability to maintain your train of thought or remember why the conversation is even important in the first place.
Inexplicable fatigue and exhaustion; becoming so sleepy that you give up trying to talk at all.
Sudden ambivalence or other strong emotion that beckons you to bail on the conversation.
Overwhelming feelings of shame or embarrassment that silence you.
Intense fear of being perceived as too needy, difficult or burdensome.
Although they are trying to help, protectors struggle to know the difference between then and now, so their efforts to be helpful can inadvertently sabotage us. Taking some time to learn about the ways in which your protectors can unwittingly disrupt or undermine therapy can be beneficial. When you’ve compiled your own list of ways your protector parts do this, you can deliver it to your therapist early on in your therapy. Ask them to be aware of these underlying dynamics so that in times of struggling to communicate or silence they can ask you about each specific item on the list. This can help both of you identify what’s happening in the moment and strengthen your ability to work through it. Otherwise, a therapist is likely to ask, “what’s coming up for you?” and, unable to voice it, your answer is likely to be,“nothing”- if you are able to get any words out at all.
By being aware of the methods your protectors employ, and making sure your therapist knows about each of them, you are more likely to be able to successfully work through it. This puts you in a better position to tackle some of the issues we’ll explore below.
All that said, let’s peruse some of the more common stumbling blocks that have the propensity to derail therapy and identify some ways to get it back on track.
Minefields in Therapy
1. The Power Differential
Let’s just put it out there: The therapy relationship rarely feels equal. Even if you are a therapist yourself, there will still be a power differential. Also, as an aside, hats off to the therapists of therapists. As clients we can be especially adept at avoidance. It is much easier to ‘talk shop’ than roll up our sleeves and dive into the inner world we’ve been phobic of for so long. It takes a special and skilled human to remain aware and sensitively maneuver through that dynamic.
No matter who you are, whether you are walking into a brick and mortar office or logging into Zoom, the air is often thick with an unmistakable sense that your therapist is wiser than you and has their shit all together (Spoiler Alert: they don’t). By default, the therapist is in a position of authority. Most people feel at least mildly unnerved by that fact in the beginning. If you are a trauma survivor, especially a survivor of developmental trauma, the simple fact that the therapist is in a position of authority can be wildly triggering. Authority figures were rarely if ever safe during trauma time, and they most certainly were not safe enough to use your voice with.
Thinking a lot about the power differential is pretty common. Noticing that you feel unsafe and are fawning in response to that is equally common. After all, it’s likely that your survival was dependent upon being “perfect” and quiet (which includes ‘not telling’). As a result, it makes sense that you feel inclined, if not pressured, to remain silent. Rather than ignoring the power differential, pretending it doesn’t exist, or forging on in spite of it, dedicate some time early on in the relationship to talking about it.
Addressing the Power Differential
Sometimes it’s hard to find words and having scripts at the ready can help. Below are statements you can use when broaching the topic with your therapist. Use what resonates or create your own:
“This relationship feels inherently unequal, and I’m wondering if we can talk about that. Historically, ‘authority’ hasn’t been safe for members of our system.”
“I’m/we’re worried that we are going to do or say something wrong and that you’ll be upset. That feels scary for a few reasons, but especially because you’re in a position of power relative to us in this relationship.”
“I’m worried about being judged by you.”
“How do you navigate the power differential inherent in the relationship between you and your clients, especially those who have trauma related to people in positions of power?”
“Some of my parts are scared and intimidated by people in authority. This might silence us at times in our work with you. How can we work together with this dynamic?” Note: this is a great time to deliver your list of your protectors’ strategies.
“I feel intimidated/scared/triggered by people in positions of authority and it occurs to me that you are in a position of authority in here.”
These are just a sampling of things you can use to explore the power differential in therapy. Be sure to ask your system mates what concerns and questions they have for and about your therapist. You can do this by asking inside and seeing what comes up, calling an internal meeting, or writing notes to them and waiting for their reply. It can help to set a time limit to ensure you receive responses before the session you plan to address this dynamic in. You will likely add more as you learn more about yourselves, so keeping a running list that you can bring into your sessions at any time is helpful.
2. My Therapist just said WHAT?!
As much as therapists try to be sensitive and compassionate, they’re still human and some make comments that can sound derogatory, judgmental or both. Sometimes the wording might feel okay, but the tone is off and disrupts your system’s trust. For example, in response to describing a relatively benign event in the course of illustrating a point, our therapist once responded by looking somewhat exasperated, rolling her eyes and spitting out the words, “Oh he’s so DID!” For background, the person referenced did not have DID or any other dissociative disorder, which is part of what made the statement sound even more derogatory towards folks that do have DID (like us). The tone of her voice, which sounded edged with disdain, coupled with the statement itself, set off a flurry of internal activity amongst the parts that sounded something like:
“I’m sorry, WHAT?” “She did not just say that?” “What’s with the tone?” “WTAF was that??” “That’s not nice!” “Uh, okay, so she’s supposed to be an ‘expert’ at treating DID and that’s how she talks about it or people with it? “ “Yeah, peace out she can f* right off. We’re not talking to her.” “What does she really think about us?” “This just feels really bad.” “What does she really think about people with DID?” “She thinks it’s bad and we’re bad and damaged for having it.”
And, as you can imagine, the internal dialogue only went on from there. In moments like this, it’s hard to know what to say. A factual statement -if anything - may be all that comes to mind. We were so caught off guard that a bewildered factual statement was all we could muster: “He doesn’t have DID.” She responded with a shrug and stated, “DDNOS then.” <Insert face palm here.> Not exactly the response we were hoping for.
After that session, we couldn’t stop thinking about it. The eyeroll and tone of voice didn’t feel good. As we reflected, we realized that there was a pattern of statements that she had made that we interpreted as judgmental and biased against people who struggle with dissociation. At the same time, we were able to hold the possibility that we were misinterpreting it. The only way to know for sure was to address the overarching problem: an air of judgment that was taking up space in therapy and making it difficult to feel safe enough.
We chose to address it as a system, noting that multiple parts were concerned about several statements she had made across a series of sessions. We provided examples, like the one above, and noted that it felt like she was being judgmental. To her credit, she thoughtfully reflected on our statement and the examples provided. In terms of one example, where she had exclaimed “Oh that’s so primitive!” she offered that she meant it was coming from a person’s primitive brain function. Given the context, the explanation was plausible, although the tone of voice she used at the time didn’t quite fit. Admittedly, we were not able to challenge that in the moment. She eventually shrugged and noted, “Am I judgmental? I guess I am.”
That left us in an interesting position. Even people who are supposed to be ‘safe enough’ can be judgmental. The person we see for therapy acknowledged that she is, at least at times, judgmental. The question, then, for us became: Can we ultimately subscribe to the renowned adage, “what other people think of me is none of my business” or is therapy so inherently unsafe that progress is forever stymied? Going all the way inside, discussing it as a system and listening to all forms of communication from the parts (verbal, written, sensory, visual) was instrumental in ultimately guiding our decision.
The process that went into working on this situation, rather than the ultimate outcome, is really the salient point here.
Process for Addressing Miscommunication or Upsetting Events in Therapy
Evaluate what was said. Notice in the moment how it makes you and other parts feel.
Address it as much as you are able to in the moment.
If you are not able to address it in the moment, be gentle with yourself(ves) and know that very often not speaking up is a trauma response.
Remind yourself(ves) that you employ your provider and you have a right to ask questions and express yourself(ves).
Take time to check in with your headmates about how you might follow up.
Are there several examples of something upsetting that was said that needs to be addressed?
Is there a pattern?
Ask all parts to weigh in and set a deadline for when you need to know.
Select a time that is before the session you plan to address it in.
Once you have focus, write a list that includes specific examples and statements that you want to make to your therapist.
E.g. “We’re really nervous to even talk with you about this” followed by why.
Remember that naming the feelings or overwhelm can make those feelings more manageable.
Before session, request that all parts who are good at communicating and navigating emotion laden conversations be there to help. Request that parts who are triggered by these conversations stay someplace safe in the inner world, perhaps with a caretaker part.
When session arrives, bring your list of ways protectors can interfere and make sure your therapist has their copy handy before starting. Remind them to be aware of the items on that list during the session.
Bring your list of examples and statements into your session and read from it as needed.
If you notice any signs that you are beginning to dissociate and lose your footing, ask capable parts to step in and assist.
After session take time to evaluate how it went.
Reflect
Journal
Make art that expresses feelings about the session
Meet with your parts and discuss it.
Follow the rules of your system for making decisions (eg. if there is any follow up is needed, how will you proceed?)
3. Only the “Host” Can Speak In Therapy
This rule tends to make most parts want to scream in objection. The reality is that some therapists still have ‘rules’ that only the ‘host’ or ‘core’ should speak in therapy. These therapists overtly request that all other parts speak through the host. This is problematic for numerous reasons, not the least of which is that in many systems the host’s ability to translate for parts is not yet even established. That makes abiding by the rule an impossibility.
The notion that only the host or core can speak likely engendered from the therapist’s training. Historically, training suggested that speaking directly to alters would only “encourage this behavior.” First, to be clear, DID and OSDD are not “behavior problems.” They are bona fide dissociative disorders, and as such the person may not have any control over who fronts when. Secondly, this construct completely ignores the fact that DID and OSDD are the brain’s brilliant solution to surviving the most unfathomable traumatic experiences. That is something to be celebrated. Parts (aka alters) are precisely what allowed us to survive and they hold many keys to healing. Refusing to speak with them is akin to treating a shattered leg with a band-aid. It’s just not helpful.
Some therapists will instruct you to “watch it all on a screen” and translate or tell them what you see. This is often an attempt at decreasing emotional activation and/or dissociation by creating distance. It’s also often highly problematic. Not everyone can do this, and even if they are able to, not everyone wants to. Your preferences and desires for your therapy are paramount and always need to be considered and prioritized. Certainly, we all want and need our providers to point out where some of our coping strategies are no longer beneficial, but this is still possible when multiple parts communicate directly with the therapist. It is not mutually exclusive.
The concept of ‘all parts are welcome to speak in therapy’ has nuance that is easily missed by both therapists and clients alike. Not speaking directly to alters is categorically unhelpful. Trying to do full individual therapy with each and every alter is also categorically unhelpful. It would also take a lifetime if not longer. There is balance where parts can share time in therapy and reap great benefits. It does not “encourage maladaptive or increased dissociative behavior,” in fact, it typically does the opposite. As parts are able to process trauma and learn more about the present day and the real impact of their actions, they are able to grow and heal. Many clients report an increase in internal communication and feel more settled and capable.
It is by talking directly with parts that they learn new ways of coping and living in the world. It is by talking directly with parts that therapy can progress. All parts who want to be seen and heard, need to be seen and heard. In fact, even some that don’t want to be seen and heard, need to be seen and heard.
Addressing the Host Only Rule
First, meet with your parts.
You can follow a process similar to the one outlined in the previous section above.
Ask all parts to voice their opinions and thoughts on why speaking directly to the therapist is important.
If possible, ask someone to be a record keeper and write down the thoughts and opinions shared in the meeting. Be sure to include why they feel not speaking directly to the therapist is detrimental.
Meet with your therapist. Be sure to share the list of ways protector parts may derail the conversation and ask the therapist to be aware of this dynamic throughout session.
Ask your therapist why they have the rule that only the host can speak.
If it is because they believe it will somehow make you “worse,” suggest a trial period of a couple of months of speaking directly to parts and then reassess.
Realistically, anyone engaged in trauma therapy will have variations of how they feel and function, regardless of whether they are a singlet or plural. This fact needs to be acknowledged.
If it is because they don’t have the skillset, ask them if they are willing to seek consultation or training.
Share the list of thoughts from your system meeting. Include the benefits of parts speaking directly, as well as the detriments to parts not being able to speak directly.
Negotiate.
After session reflect on the session itself.
What was said?
How do you and your parts feel?
Conduct a follow up system meeting to discuss and follow your system’s decision making process as is relevant.
4. Final Fusion As The Only Acceptable Therapeutic Goal
Let’s take a brief moment to define integration and fusion, as they are often confused. Integration is to ‘blend into a functioning whole.’ For example, to ‘integrate’ your trauma history would mean that the memories are part of your conscious chronological history that you are able to recall and experience as a past event. Integrating parts would mean reducing amnestic barriers and increasing cooperation so that they can function as a cohesive, cooperative system of parts. Fusion, on the other hand, is the ‘joining of two or more things to form a single entity.’ This is when parts come together to such a degree that there is no longer any real distinct definition between them. It is, in essence, becoming a singleton, aware of aspects of the one self. Now that we have those working definitions…onward.
One of the biggest places of disconnect in therapy for DID and OSDD is this idea, typically held by therapists, that the only ‘valid’ or ‘acceptable’ goal is final fusion. There are numerous flaws with this mindset, not the least of which might be that, for a multitude of reasons, some systems may not ever be able to reach that state of being. And that is okay!
The goal post in therapy is for the client to set, and for the therapist to assist in charting a path to get there. As the client, it is important to remember that this is your life and you are the one living it. What you want, need and desire is of utmost importance. This can be tough to wrap our heads around given that growing up we were taught and shown the exact opposite. But it is important to get to a place of embracing that your goals are your own and no one else can define them for you.
Some systems desperately want final fusion. They want to know what it feels like to be a single entity, with all the memories and talents of all parts woven into one single being. If that is you, this section will not feel relevant or resonate, and that’s okay. If that is not you, this section is important.
Someone might try to suggest that your rejection of final fusion is flawed, disordered or maladaptive. In our opinion, the person saying something like this does not have a solid understanding of functional multiplicity or client self-determination. There are many reasons why people might choose functional multiplicity. Here is a sample:
It saved your life.
You experienced functional internal cooperation and it feels really good.
You love your system mates and enjoy interacting with them.
You appreciate yourself as a system and value it.
You feel whole as a system and can’t imagine living any other way.
You have reached a place of working well together and enjoy it.
You want to reach a place of working well together and see what it’s like before making any decisions.
Whatever your reasons are, they are yours and they are valid. So, what to do when your therapist isn’t on the same page…
Talking About Treatment Goals
Similar to other processes, meet with your parts first.
Make note of everyone’s thoughts and feelings about final fusion, why they do or do not want it. Be sure to bring this with you to session.
Agree on a way to remember that you all employ your therapist, this is your life and you get to live if the way you choose to live it.
Have an opening statement that is scripted that you can use in case you have trouble getting started.
Agree to hear the therapist’s reasons and rationales
Agree to respond thoughtfully.
Agree to be persistent in getting your needs met.
As with other processes, make sure your therapist has the list of ways in which your protector parts might undermine this conversation and ask them to be aware of it and help you should one of your protectors step in.
Use your opening statement which might be something like, “We wanted to use today to talk about final fusion as a goal, because we are not on board with that.”
Refer to your list
Remember to listen
Negotiate
Follow up with reflection and a system meeting.
A Few Final Thoughts
Don’t hesitate to seek input from other systems or your supports for any one of these minefields as well as any others you might stumble upon. Hearing how others have navigated similar issues can be a great comfort!
The list of minefields in therapy covered in this blog is by no means exhaustive, nor are the strategies exclusive. Our hope is that in laying out some of these issues, you will have some strategies to rely on and avoid some of the pitfalls that are unique to systems. The only thing that really matters is your healing, however you define that for you(s).
Important Acknowledgement
We want to take a moment to acknowledge that engaging in therapy is a privilege that not everyone has access to. There are many barriers to accessing care. For example, providers who don’t accept insurance, insufficient or nonexistent financial resources, being uninsured or under insured, living in areas that lack skilled providers, lack of access to the technology necessary for telehealth services, long waitlists and more. This social justice issue deserves attention and resolution at the legislative level.
Thank you, so helpful, I have had so many of these types of situations over the years!
This is so interesting and relevant and well written! Thank you for taking the time to write it. ❤️