Chapter 11. Basic Attitude for the Treatment of Dissociative Disorder (5)

I then asked the clinician further. “By the way, suppose that one of your female patients comes into your office with her small daughter. During her visit, she patient slips out for the bathroom and you are left with her anxious-looking little girl. What would you do? Would you be bewildered or at a loss? I don’t think so. You simply talk gently to that girl, telling who you are and reassure her that everything is OK. It is not so much different from the way you address to a child personality of your client who suddenly pops up in the session”. The young clinician nodded.
Of course I understand how non-specialized clinicians feel when they witness switching of DID for the first time. I confess that I almost panicked when it happened to me. One of the perplexing things is that what seems to be happening is beyond our common imagination and we simply do not know how to deal with the situation. A part of our mind would say that the patient should be “acting” and is playing a trick on us, whereas another part of our mind says that we should treat it as real, and we do not know how far we should “go along with” the patient.
However, the patient is not acting. Different identity shows up as a different person with his own mind. All we should do is to go by the patient’s subjective experience, as much as it makes clinical sense to do so. Some experienced (but not with dissociative patients) clinician says “I treat the patient’s different identities as just metaphors. Therefore, I always keep addressing to the host personality and ignore other identities.” If a clinician goes along with this type of policy, however, he would talk to the child personality as follows. “You are really feeling like you are a small child. What makes you feel like doing so?” Clinicians who are psychoanalytically trained tend to hold this type of view. But to specialized clinicians it is too obvious that this would not make any clinical sense, as the young girl would not understand what is being said.
Again, when different identity appears, the subjective experience is that of the other person. It is practically like you wake up suddenly and find yourself facing with someone unexpectedly. There is nothing metaphorical about, or at least as far as you are aware of.