In the trauma model therapy, there is a chapter on talking to the voices and it seems to be developed from DID (Dissociative Identity Disorder), that also has good application for a broad range of different mental health problems, different settings, different age of clients.
People diagnosed with DID would speak about parts of themselves most of the time, the names of the parts, the characteristics, the functions, the behavior. They have a variable degree of awareness of some parts and they talk about them. The further one is towards towards DID diagnostic, the more trauma is involved, the more dissociative symptoms are displayed, the more frequently one may experience auditory hallucinations, voices talking to each other, which ultimately brings us to those voices being structured, complex, talking to each other, talking to the person and the possibility to engage them in therapy.
Table of Contents
How do we draw the line between what is a metaphor and what is actually a mental issue?
We use the idea of parts metaphorically in normal language, but where do the lines get blurry? In a normal communication style, almost all of us use the concept of parts, “I really want to do this, but a part of me doesn’t”.
At one end of the spectrum is dissociative identity disorder, multiple personality disorder – In this case, it’s not just a metaphor. The inner child comes out, talks to the therapist, a different voice says: ‘I’m Susie, I’m eight years old. Who are you?’. And then, the inner child goes back in and the adult doesn’t even remember the conversation. Consequently, that’s not just a metaphor.
And then there’s all degrees in between. It’s all the same basket, just variations on the same approach. There’s going to be a grey zone in there. Let’s say we take the same idea and apply to anxiety or depression. Where is the agreement that there is a disorder present or simply the variation of normal is really low? That’s precisely the story in the entire mental health field. Dr. Ross explains that using a psychometric approach coupled with more in-depth investigation could draw the line in this case, arriving to a more accurate diagnosis.
Therapy for the voices & the parts
Voices would be talking to each other, keeping up the conversation and commenting on the person’s behavior. They can be kind, they can be angry. The more those voices are like separate people inside, the further out you are towards DID and the more likely you can engage the voices in psychotherapy.
Some of the main points of therapy include:
-
DID therapy – talking to the parts
-
Orienting the parts to present time
-
Assigning the parts that they all live inside the same body
-
Helping them into believing and experiencing that it’s the present and the abuse happened 15, 20, 30 years ago
In cognitive therapy of psychosis, there is an idea about reframing the voices – this is basically working with the person, explaining that the voices are not just insane for no reason. This is a dissociative, disowned, split off aspect of yourself that’s holding your feelings, your thoughts, your perceptions, but you don’t have experiential ownership for it. These are all aspects of oneself, giving the therapist the opportunity to negotiate with the voices.
A key strategy is called ‘talking through to the voices.’ This may be applied to a DID diagnosis or dissociative schizophrenia. If it’s full DID, the other parts in the background are listening and the main out-front host personality is in the front; in this case, rather than asking the voice to come to the surface and talk to you directly, you talk through to the voice, who answers in the background, and then the person passes on the answer.
One of the main concepts of this technique is building a relationship, a treatment alliance with the voice – it’s about getting the voice more involved in therapy, building a team, trying to brainstorm. Unlike psychiatry for instance, where they want to get rid of the voice, through this approach you would rather make a pleasant atmosphere for all the parts involved in there.
Other than voices, there can be physical parts of the body that are experiencing a dissociated state and disconnection. If we take a look at conversion disorders: ‘I can’t see, I can’t speak. I can’t hear.’ That’s where the ability has been taken away, just like a memory being taken away – It’s a somatic dissociation process.
For instance, in conversion disorder the limb is there, it is fine, but the central program is shut down, either motor or sensory. The idea is to figure out how to turn these programs on when they need to be on, and off when they need to be off. They’re not separate areas. There are often parts inside who are in control of these things and are doing it on purpose.
What is the relationship between the parts?
In most cases there’s some level of amnesia between parts, and people have a variable degree of awareness of some parts.
There are two terms to describe the relationship: co-consciousness and co-present.
Co-conscious means if there’s a part in the background who’s listening to the conversation, they’re aware of what’s going on when they come out to the front. The host personality will go back inside and the part that was listening in the background comes out front (the person who’s out front most of the time is called the host personality). But now the host personality is just completely blanked out and gone. Therefore, there’s no co-consciousness. But when you flip it the other way, the part is co-conscious with the host. There are different combinations and degrees of co-consciousness. You can be totally gone. Kind of ‘foggy’, kind of ‘part of it’. Or you can be co-conscious, but in the background not having any control.
Co-present means the two parts are ‘fronting’ at the same time, they’re both driving the car and they’re co-conscious. And that has different degrees to it. You can be all the way in the back, blanked out, gone. You can be in the back partially awake or fully awake, in the back but getting closer, and then in the back hardly at all co-present, and then the other part shifts out. Some real life exampled would be coming out of a blank spot in a location that you don’t recognize, you don’t know how you got there. Or people telling you about things you’ve done, that you don’t remember; people describing you acting very differently.
The process of Integration
There will be varying degrees to which the parts reintegrate with the entire consciousness, depending on the person.
That is because the parts just don’t buy it. They just think integration equals ‘getting rid of us’. Integration is way down the road, and nobody can be forced to do it.
Therefore, it could be described as a very gradual process that takes time. From a therapist’s perspective, it’s important not to stress on integration because it just creates more and more resistance, which is just the parts being smart: why would the parts ever agree to therapy that involves getting rid of them?
The focus is working on communication, cooperation, co-consciousness, forming a team, problem solving. And the parts just differentiate as a process over months, years. And then, over time, each part is integrated or fused. Hence, integration can be just one part but it’s also the whole process.
Orienting to the Present
Dr. Ross explains how he redefined treatment resistance: he encourages people to be untrusting, not buy what the authorities are saying, and to try and figure things out for themselves.
The aim in doing do is to separate between the inside world and the outside one. The outside world is what you see: ‘there’s the floor, there’s a ceiling.’ And the inside world is where you live. In the inside world, you have your own separate bodies, different ages – That’s all true. But in the outside world, there’s just one body in the present time.
The inside world versus the outside world – main points to go through and work on in therapy:
-
In the inside world, you have your own separate bodies, different ages
-
Often parts are inside and they don’t notice the time going by on the outside
-
Check it out for yourself, then you can decide: is it true or not true?
-
Do I want to be in the present year or not? Is it better? What are the advantages and disadvantages?
The ultimate goal
Truth is, integration is a matter of choice and it’s up to each person. From a DID intervention standpoint, the purpose is to have parts coexist and be co-conscious. Some people don’t want to get rid of their parts and as a consequence interrupt their treatment. And then in other cases, some people express the desire to be fully integrated. Among those, there are people who have been fully integrated for long periods of time – they’re not hearing voices anymore, they’re not suicidal – They recovered and can live a life they’ve been wanting to experience all along.
Pingback: 5 Ways to Heal Trauma: Learn From the Experts