During the last years I have started to work more as a therapist with people who suffer from the effects of structural dissociation.

Structural dissociation develops because a person has experienced so much insecurity and powerlessness at a young age that the personality has became fragmented. Instead of experiencing the personality as a whole, the personality in these people is made up of different split-off parts.

These split-off parts may still have some contact with each other (cPTSS) but may also be so far apart that a person can disappear into the split-off parts. Someone may then suddenly ‘change’ into a younger version of themselves or appear to become another person. The latter happens to someone who suffers from DID (Dissociative Identity Disorder), formerly also called Multiple Personality Disorder. This is a very serious disorder that is difficult to treat, let alone recognise. Sometimes a person has had ten years of mental health care and collected a whole list of diagnoses, without recognizing structural dissociation as the basis for the problems. In fact, it is not so long ago that treatment methods were developed for this. Unfortunately, there are still psychiatrists and psychologists who reject the phenomenon of dissociation. The most well-known and worldwide applied method is the three-phase model, developed by Onno van der Hart and others. I’m using this model in my work.

I also have to get rid of the fact that by seeing the mainstream films on e.g. Netflix, DID gets a malignant character. Often someone is portrayed as one moment innocent and shy, and the next moment a ruthless killing machine. This sketches a distorted picture. Most people with DID are extremely vulnerable and especially destructive towards themselves.

It is challenging to work with this problem, especially because it takes a lot of time and trust to let the split-off parts ‘come out’ in order to work with them. There is often an enormous amount of shame involved. Just because they don’t show themselves doesn’t mean they don’t do something in the background. Often every question I ask is followed by an inner discussion between all the parts, and for me as a therapist it is navigating between all the inner conflicts, without often knowing what conflicts are at stake. It is as if you are a peace mediator between several parties, without knowing exactly which parties are there and what their agenda is.

It requires an enormous attunement, endless patience and compassion for all the split-off parts and the person himself. The resulting behaviour can be extremely destructive, but the intention behind it is to keep the immense trauma energy under control.

The most challenging is that things are concealed because of so much shame, or a phobic fear of rejection. I sometimes hear from colleagues that someone can be in therapy for years while abuse or mistreatment is still taking place, without being told or recognized. This is explainable because during the abuse ‘hidden’ parts are active, which do not show themselves during the therapy.

Sometimes I intuitively feel that something is wrong but I do not have the means to make it discussable. This can make me feel enormously powerless. I want to help but I can’t. The only thing that remains is to keep working on trust and safety to invite those extremely anxious child parts to tell me what is going on. And to let all the other protective parts around it experience it and to make sure it has no consequences.

And in the meantime I get to deal with my powerlessness myself. I follow supervision and intervision for that. This is also the reason why I go through my own inner process so deeply with the help of a body-oriented psychotherapist. The more I clean up my own ‘shit’, the better I can guide people in recovering from it. I notice that I am starting to reap the benefits of this more and more.

Despite these challenges and the terrible stories that lie beneath it, working with this group is beautiful and satisfying. Especially because people can experience an enormous growth when they slowly but surely come out of the dissociations and they become more and more aware of the inner parts. And even when possible, it leads to integration and healing.

Elsewhere on my website I have elaborated more about the symptoms of structural dissociation.

In order to further train myself in working with this target group, I follow the post-master training at the Centre for Late Effects Early Childhood Trauma (CELEVT).

If you recognize things of your own in here, and you haven’t found the right help yet (cashier to the wall), please contact me.

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