Sarah E. Olson was diagnosed with dissociative identity disorder (DID) in 1992. Using session transcripts and letters she faxed to her therapist, Howard Asher, PsyD, she fully documented four years of intense therapy process in Becoming One: A Story of Triumph Over Multiple Personality Disorder, first published in 1997, and translated into Japanese in 1999.
Sarah began leading online support groups for survivors of childhood sexual abuse in 1992, and has spoken with thousands of survivors, including many formally diagnosed with DID. To further that end, she created The Survivors Forum on CompuServe in 1997. Sarah recognized even then that support for posttraumatic stress (PTSD) in veterans was woefully inadequate, and provided a private section of The Survivors Forum for them. She now curates PTSD resources for trauma survivors with a focus on child abuse survivors and veterans on her blog Third of a Lifetime, as well as on Twitter and Pinterest.
In November 2014, she published an updated ebook version of Becoming One with a revised title: Becoming One: A Story of Triumph Over Dissociative Identity Disorder. She currently is working on the follow-up book, Becoming One Every Day: Living Purposefully With Dissociative Identity Disorder, to be published in late 2015.
GoodTherapy.org recently had the privilege of engaging Sarah in conversation about cultural perceptions surrounding mental health in general and dissociative identity in particular, as well as her experiences in therapy.
1. Why do you think there is such a social stigma around mental health and mental health treatment?
People fear what they don’t understand. Mental illness has long been either shamed or ignored, or sensationalized in the media. Often people are unwilling to admit that someone in their family is struggling, or they discount the severity. The person affected internalizes these negative messages, and may not speak out for fear of losing a job, insurance, or state aid. Compounding this reluctance is the fact that mental illness treatment is expensive, sometimes hard to find, and seldom a quick fix.
The plight of Iraq and Afghanistan war veterans has served to bring PTSD into public awareness in the last ten years, but PTSD affects far more than just military personnel. Survivors of child abuse and neglect, rape, domestic violence, war crimes, and traumatic accidents are all at considerable risk. But the stereotype now of “PTSD = dangerous and unstable” is, unfortunately, the first leap the news media make when a veteran commits suicide or uses violence against others. That promoted stereotype does all veterans a grave disservice, and increasingly attaches stigma to anyone else diagnosed with PTSD.
2. Why did the therapy process work for you?
For 20 years, I tried both individual and group therapy with various therapists. I’ve documented that several therapists actually knew some of my alters [alternate identities] by name, and could accurately describe them. Not once in 20 years did any therapist suggest this was odd, or mention the word “dissociation,” or indicate that it was anything other than “an inner child” or even “cute.”
When I met Howard Asher, PsyD, 23 years ago, I was about to give up. I knew something bad happened in my childhood, but could never articulate it in a way that made sense. I knew since age 3 that I had people inside of me who often talked to me, or at me. I knew some of their names. But I thought everyone experienced voices and wondered about lapses of time. Part of me thought it was normal. Another part was convinced it was crazy, and I fought an exhausting battle every single minute to not let anyone else discover the crazy dissociative things I constantly experienced in my life.
The “False Memory” folks strive to implicate overzealous therapists as implanting unspeakable false memories in their most vulnerable clients. It’s another insidious stereotype that does a great deal of harm to people trying to find help. I didn’t get the key to my childhood from Dr. Asher. My two sisters, one of whom was routinely abused with me, set that in motion. I have corroboration from a sibling who was there with me of just how bad it was when we were very little. I also salvaged letters, poems, and diary entries written long before I knew Dr. Asher that were buried in old filing cabinets and dresser drawers. These writings evidence that someone inside knew a lot of my history well before my sisters and I began discussing it openly.
Unlike earlier attempts, my therapy process with Dr. Asher produced continuous benefits for me as the reality of my childhood came into sharper focus. I learned to sit with fear and to process it, rather than to just block it. I (eventually) accepted that I wasn’t crazy, and that I no longer needed to fight that battle to conceal it. I experienced trust with another human being for the first time ever. I absorbed valuable lessons about the power of empathy, compassion, and generosity. I experienced clarity and healing unlike anything I’d ever known before. It was never easy! But it was real and lasting.
3. Tell us more about your experience in therapy, to whatever degree you are comfortable.
My experience with Dr. Asher changed everything I knew about therapy at that point in my life. He insisted that therapy is a partnership and that I had as much say in it as he did. I spent a year trying to convince him I really was crazy. He spent that year demonstrating why, with what I endured in my childhood, what I believed was crazy actually made the most sense. He was the first person to whom I ever entrusted my darkest secrets, and I’ve never regretted it. I was able to hear some hard truths for the first time, from him.
Beyond his skill in dealing with dissociative issues, I credit the fact that he audiotaped all of our sessions from day one as the reason my therapy moved at a relatively rapid pace. He gave me a duplicate session tape to take home and listen to, to ponder, to write about. In the first year when I was still actively denying that I had alters—still clinging to the idea that I was merely crazy, or just making all of this stuff up—it was difficult to dispute the conversations he had with them on tape. It was often shocking to listen to those tapes, having not been “there” during the session. The information provided by my alters in these sessions opened other doors of discovery for me, in ways which speeded up the process considerably.
Dr. Asher also encouraged me to write to him between sessions, both as a form of processing the session, and to reveal new insights as I wrote. I sent him hundreds of faxes (and later, emails) during the first four years of our therapy. Healthy boundaries have always been maintained. He seldom replies directly to my writings; I know they will be discussed in the next session. He stated in our first session that he was not the person to call at 3 a.m. with an emergency. I’ve never done that, but there were times of crisis when I wrote to him at 3 a.m. about what I was experiencing and what I thought it meant. Writing it out this way had a calming effect, and we both then had a record of what transpired to discuss later.
I can’t emphasize enough that DID patients need much more therapy time than 50 minutes a week. All of our sessions were 2 hours in duration, and recorded. Sessions were usually once a week, but in times of crisis sessions occurred two to three times per week. Early in the DID therapy process, with so many barriers to break down, and resistances by disparate internal forces, I often was just getting to the meat of the session by the end of the first hour. The second hour was always the most productive, by far. The work was then strongly enhanced and reinforced by being able to listen to the tape between sessions.
4. Why do you think there is such controversy regarding DID integration among professionals?
Far too many clinicians still deny that DID even exists, although it’s been described in the DSM‘s [Diagnostic and Statistical Manual] various iterations for decades. Of those who agree it is real, the main controversy is often that they insist on complete integration as the only goal. What really should be the goal is the highest level of functioning for the client, however that is achieved.
For some, partial integrations achieve enough internal cooperation that the person functions fully and better than ever before. Some may integrate into a type of “committee” that represents all factions and interests in a manageable number of internal people. Some DID clients will never entertain the idea of integration in any form because they see it as a betrayal to inside people who saved their life, or because they don’t see multiplicity as any kind of “disorder.” They believe, as long as some semblance of order and safety is achieved, that they already operate at peak performance, and that there is nothing to “fix.”
When a therapist approaches a DID client with rigid notions of integration, especially early in the relationship, it can rupture any therapeutic alliance already formed. It may be viewed as manipulation, which is a hot button for DID clients. It may also be assumed that the therapist is impatient to “fix” the problem. Some people with DID fear strongly that integration is tantamount to killing off their insiders. Or the idea of not having insiders presenting themselves the way they always have can be terrifying.
Above all else, a therapist needs to understand and accept that no integration will occur if it’s being forced on the therapist’s timetable. No one inside integrates unless they absolutely want to do so. It cannot be forced or pretended, but in complex transference relationships, the client may believe it will please the therapist to do just that. It creates an eventual setback that did not need to occur.
My own view of integration has evolved since 1997, when I fought for and experienced what I believe was complete integration. I knew life differently during that period. I felt stronger, safer, and more confident. I stopped losing time completely. I was able to accomplish goals that previously had eluded me. But in 2000 my father (who was not an abuser, but was in some ways an enabler) died, and my integration fell apart.
I spent the next eight years in the darkest of depressions, struggling to get back to that “becoming one” ideal. Since 2009, I’ve operated mostly seamlessly as a committee of five key alters. I function well, although I still have dissociative symptoms in times of extreme stress.
I realized that I could spend the rest of my life trying to achieve that “oneness” again, or I could use my present level of internal cooperation to achieve new, highly desired goals. I believe that making good on those goals may be integrative in itself, but I can live well with myself as I presently am even if I never “become one” again.
5. What do you wish people knew about DID that they might not?
DID is an elaborate and brilliant defense mechanism manufactured so that a child can reconcile the truly awful things happening to her with the fact that the people doing the awful things are often her primary caretakers. She learns early on how to guard secrets, and to “act normal” due to overt threats made, and the fear instilled as part of her abuse. She compartmentalizes everything to the point where a part of her can exist in the day-to-day world, truly unknowing and unaffected by the heinous things happening to her the rest of the time.
What I wish people knew is that most of the time they will never know they’re speaking to someone with DID. The defenses are so elaborate and layered that it takes a tremendous amount of trust to let insiders be seen and identified. Or the alters operate so seamlessly that no one other than a trusted therapist will be able to detect a change.
People with DID can successfully finish school, have careers, often have children (and are no threat to them whatsoever), and look like “normal” people. They don’t do party tricks and switch to another alter on command, especially to strangers. They are seldom dangerous to others in the way movies, and some court cases, have stereotyped them to be. It’s far more likely that any danger will be directed inwardly, and that is a big part of therapeutic work.
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