The premise of this paradigm or protocol is that dissociative disorder clients, borderline clients with dissociative features, and structurally dissociated complex PTSD clients all come to therapy because their parts are intruding upon the consciousness of their going on with normal life selves. The presenting problem described to the therapist by the client will in some way reflect the activation of a part holding trauma-related implicit memories: depression might be a sign that a depressed child has been triggered by a loss; anxiety might be the communication from an anxious part whose implicit memories have been activated by the birth of a child; relationship difficulties may be an indication of conflict between parts about trust/mistrust, closeness/distance. Whatever implicit memories underlie the presenting problem, therapy is apt to further activate the parts because it is a promise of help from an authority figure, something for which they have been waiting many years. By its very nature, therapy will evoke impulses to disclose but also exacerbate procedurally learned secrecy. It will stimulate the yearning to trust and connect but also trigger hesitancy and hypervigilance. Closeness to the therapist and the invitation to “open up” will trigger implicit memories, and separation or distance will also be triggering.
The therapist’s job is to give both sides “a voice”:
1 At each session, as the client arrives with a presenting problem or distress of the day, the therapist’s job is first to tie that distress to a part, that is, if the client is feeling more anxious, the therapist reframes the anxiety as the child part’s nervousness or fear and expresses empathy for the part rather than empathy for the “client.” Although it may be important to spend some time listening to what the clients are feeling, it is also important to avoid reinforcing their procedurally learned “stories” about themselves and to help them become more mindful and curious about the part in distress.
2 Next, switch pronouns so that “you” now describes the adult self of the client and “he” or “she” describes the part: “Yes, she’s really scared, isn’t she? Do you know what triggered her? Or did you just wake up to find her in this state?”
3 Evoke curiosity about the part that is in distress: Is he or she very young? Are his or her feelings familiar? What is going on in the client’s life that might trigger these emotions? [Notice that there is no attempt to place the part in childhood history or in the traumatic context. The emphasis is on the part’s experience now in the context of the client’s daily life and the relationship between the normal life self and the part.]
4 Use language and tones of voice that speak to not only the adult but also to the age of that part, whether a young child, teenager, or latency-aged child.
5 Be prepared for other parts to get triggered by the attention to vulnerability: A skeptical part that questions the use of parts language, an angry part that feels condescended to, a “shutdown” part that stops talking and goes mute.
6 Notice and name parts that distract or shut down the conversation with or about a vulnerable part: “Interesting—there’s a part that thinks I’m condescending, huh? I wonder what in my tone of voice or words gave her that message …” “I appreciate the skeptical part’s questioning of what we’re doing here … that’s important.” “Notice how protective these parts are of the anxious part—they don’t want us to get too close to her.”
7 Be the voice or spokesperson for all the parts: “Remember that all parts are welcome here …” “Keep in mind this is a child—no wonder she is so upset …”
8 As the client expresses feelings and thoughts or describes physical reactions, images, or impulses (whether in parts language or not), keep reminding him or her that all of these sources of information can be communications from parts: “If this belief/feeling/impulse/image were a communication from a part, what would that part be trying to tell you?”
9 Then have the client check with the parts by asking to him or herself: “Is that right? Is that true?” If the answer is “no,” then have client invite the part to correct the statement until it is “right.”
10 Invite the client to ask inside, “Are you tired of feeling this way?” or “Are you tired of being in the past?”
11 If the answer is “yes,” then whatever interventions are offered should be framed as an attempt to help the parts. Often, especially when clients shut down or refuse to speak, our interventions are framed as attempts to get the adult back in control of the body. But that approach sends a negative message to parts that they are not welcome. The same intervention (e.g., grounding) done on behalf of the parts will be much more successful.
12 After each intervention tried, ask the client to check inside with the parts: “Does that help?” “Does this feel better or worse?” If the answer is positive, repeat the intervention or affirm the part’s feelings: “Yes, it feels good to me, too—I like holding your hand.” Or “I want to protect you.”