Professional literature about DID lists a number of ‘phobias’ that classically appear in DID therapy and that patients have to overcome. The phobias that are usually listed are the phobia of
- attachment and attachment loss (both, but showing in opposite parts)
- thought/feelings/memories/wishes associated with trauma
- other dissociative parts
- traumatic memory
- change and healthy risk-taking
- normal life
- intimacy (emotional and sexual)
Roughly speaking, that makes three phobias for phase 1, one phobia for phase 2 and another three phobias for phase 3. These phobias maintain the structural dissociation because the deep fear we experience keeps us from doing the things that would help us heal.
The patient: a coward?
In early DID literature, these ‘phobias’ were understood as a form of resistance, avoidance and escape strategies so we, as clients, wouldn’t have to face difficult feelings. Some scientists choose to read it in a way that puts a heavy prejudice on patients. They claim that we as patients are basically too lazy to face fears and difficulty and that is the whole problem. We have to stop avoiding the truth and that is the whole solution. Lived experience tells another story.
The patient perspective
Do we really chicken out when we withdraw from inner experiences and outside actions? In reality, the experience overwhelms our ability to regulate ourselves and we either step back from it or we get retraumatized by it. Usually, our mind-body system just uses the off-switch to protect us from overwhelm and we dissociate. It is not a conscious decision and the automatic response makes sense. More full-on exposure does not lead to a greater ability to regulate ourselves.
Capacity
Our own understanding of the term ‘capacity’ is the range of experience where we maintain the ability to regulate ourselves and return to a stable state again after a stressful event. When events are within that range, we are able to integrate the event into our view of ourselves and the world. Once we learn how to regulate ourselves better, we create a wider range for things we can integrate. At first, this new capacity will be used up to improve our daily functioning and self-care. It is invested in the present. Good self-care makes us less vulnerable to stress. We can tolerate more when we sleep properly, and that will further increase capacity. Once we have more than we need to function, our mind will use the leftover capacity to integrate things from the past that have not been dealt with. That is why it isn’t rare at all to discover DID at an older age. Life has used up all the capacity until then and a change, like children leaving the house or retirement, reduces the stressors so much that other things can finally come into awareness. Our general capacity to manage ourselves is connected to integrative capacity.
Integrative capacity?
Our own understanding of integrative capacity describes the range of knowledge, experience, understanding etc that we can build into our understanding of ourselves and the world. We return to maintaining an inner balance and containing the information without effort after the information was added and integrated.
Let’s use a weird image for integrative capacity.
We can imagine our awareness of ourselves and the world like a suitcase that we carry around with us. There was only so much we could fit into our childhood suitcase where it was integrated into our view of the world and ourselves. Some things were neatly folded and packed tightly together in there and some are spread out in the room somewhere, but they do belong to us nevertheless. We just don’t have the space in our suitcase to hold them.
When we learn regulation skills and our overall capacity grows, our suitcase also gets a bit bigger (unless we keep overwhelming ourselves with outside events to avoid it). We have free space and it acts a bit like a vacuum. If it gets big enough, it naturally sucks in some of the smaller clothes that are laying around in our room. We experience spontaneous integrative actions. Memory returns and is synthesized, we have realizations about our life or people in our life. We might have the sudden realization that we are not a young adult anymore (personification) or that abusers are old and fragile now (presentification). It needs quite a bit of empty space in the suitcase to create a natural vacuum that gets filled naturally. It takes extended periods of felt safety.
Usually, we are in therapy and we are desperately trying to stuff more clothes into our suitcase because not having them with us is actually causing trouble. So we make attempts to get things to fit into the suitcase and when there is enough space, we are able to hold on to this new (but really old) understanding and integrate it into our suitcase collection. It is very common that free space is hard to come by at first and we are happy when we can stick an additional sock in there. Over time our suitcase gets more used to being expanded but it will probably still be a struggle even later in the process because the later pieces of clothing we try to fit in are so much bigger than those during stabilization.
Integrative Capacity and Phobic Avoidance
If we return to our experience of phobic avoidance of certain realizations and inner experiences with the concept of integrative capacity and our suitcase in mind, it might all make a lot more sense. Then the new question is not if we are lazy and resistant, it is how much space we have in our suitcase and how big the items are that we are trying to get in there. It is normal not to be able to hold on to things that don’t fit. There is no capacity to integrate them. So they end up outside the suitcase again and we don’t carry them around all the time. There is no way to force it.
It is normal that we will experience failed attempts to integrate something. We have a moment of realization but then we forget it again. The sock fell out of the suitcase. There is no need to worry about it too much. That is not failure. It will fit in eventually and the realization will come back.
The most successful strategy to approach the ‘phobias’ is in tiny but consistent steps. The smallest possible step we can come up with. If a sock is too big, we try to pack a handkerchief. A classic way to approach the phobia of other parts would be daily signposting. It creates a small window where other parts are invited to listen and share, nothing deep or dangerous, but it is repeated every day. Our Ts will offer ideas on how to approach other phobias with tiny steps. They gently push against the boundary of our suitcase to make it a tiny bit bigger and then we regulate ourselves again and do normal things (pendulation). It works analogue to growing capacity for distress.
Is ‘phobia’ the right word?
The longer I am engaged with integrative processes the less it feels helpful to look at the obviously intense fear as a ‘phobia’. When I try to push a big item into my suitcase and it is not big enough but I try to force it and the stretching of the boundary turns into a ripping of the boundary of the suitcase, then I experience intense fear. Because the material of the suitcase is not synthetic, it is made of my psyche. Isn’t that fear normal and appropriate? And is the problem really the fear or is it really a matter of integrative capacity?
I have never asked myself that question until the phobia of change and healthy risk-taking became a real life topic for me and I wasn’t facing the effects of traumatic memory left and right. After I developed a keen sense for how much integrative capacity I have at any time and how big the items can be that I add to the suitcase, I encountered the first situation where I really, really wanted change but it was too big to integrate it. I didn’t lack motivation at all. It was just too big for that moment. What if we could allow that to be a reality? That big things can sometimes be too big and stretching ourselves too much hurts and causes fear and the solution is not to work on not being afraid. It is in growing our capacity to make more space. I have come to think of full-on exposure therapies for DID as lucky accidents when they work. The suitcase happened to be able to get stretched by force to fit something in and the person only got moderately hurt in the process. More pressure does not make better therapy. I do think there are better ways. The lesson of tiny steps has been with professional DID therapy pretty much since the very beginning. It also applies to the ‘phobias’.
There is no reason to be ashamed of being afraid. I truly do believe it is a natural response when our integrative capacity is about to get overwhelmed. I want to propose to think of the ‘phobias’ in DID as the effects of a full suitcase instead of a character flaw or avoidance of discomfort. We know what discomfort is, I promise. We are not lazy. There is no avoidance to avoid. We need integrative capacity to integrate new and old things. It makes more sense to approach the ‘phobias’ within a framework of integrative capacity.
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You can find the concepts of phobias in DID and the related concept of action tendencies in The Haunted Self (Steele, van der Hart, Nijenhuis)