[CN: this post is very much pro Integrated Functioning and can cause difficult emotions in people who insist in seeing DID as ‘many people in one body’]
There are 2 main ways to approach inner work with dissociative parts. One is based on building relationships between parts, the other is based on resolving the structural separation between parts that causes problems. Both are important but it seems like the first one is more commonly known because it overlaps with ego state work for non-dissociative people and it is where we start in the stabilization phase. ‘Structural’ integration is specific to structural dissociation and gains importance in later phases of treatment.
The relational approach
In the relational approach the main focus is on getting to know who the other parts are and building trust through communication and cooperation. Typical exercises that support this approach are:
This will help us to reduce the impact of amnesia and the chaos of everyday life. We get better at organizing our system and manage conflict through discussion and compromise. It stabilizes the way we cope with the effects of structural dissociation. Strong inner relationships can lead to better co-regulation between parts and more support for everyone inside.
The integrative approach
The integrative approach targets the dissociative barriers between parts and it is based on integrative actions. The main focus is to make information available across the barriers that separate parts and to find common ground that can be accessed by everyone. It will impact how parts experience themselves and the world around them. Typical tasks that support this approach are:
- Orienting parts in time and space (Presentification): Trauma parts learn that the past happened a long time ago, functioning parts learn that they have a traumatic past
- Orienting parts within the system (Personification): Parts learn that there are other parts and they all belong to the same system of parts that make up a whole person.
- Orientation in the reality of life (Realization): Parts learn that the person they are has a life that is complex, has its own timeline, and needs to be managed. The outside reality is real and different from the inside reality.
- Connecting the puzzle pieces of our life (Synthesis): Pieces of memory, skills and abilities, feelings, body sensations and thought, needs etc are collected and connected to create new meaning and a shared set of functions that everyone can access.
The exercises that matter here are
- grounding with dissociative parts
- reality-checks with dissociative parts
- discrimination between past and present with dissociative parts
- group containment
- every attempt of integrating parts by understanding their role for the system and allowing them to work out how to update their role to present-day needs (check the index for articles on integrating specific types of parts)
- exercises that work with dissociative barriers like raising the barriers, sharing or blending
- …
They target the effects of trauma and structural dissociation and are meant to bring lasting change in how parts perceive themselves and the world around them. That resolves stress responses and some of the old drive to act in certain ways, and introduces new ways to function in the new reality.
I believe that it needs both approaches for successful inner work. The integrative exercises are a lot easier when we have a trusting relationship with other parts. It needs cooperation and trust for them to allow us to guide them in any way. When we introduce a reality-check of the outside world today, they need support to cope with the big news that life has changed. If we count communication across dissociative barriers as relational work, it already has an impact on the separation between parts. These processes are not strictly separated. They might just hold very different value in different situations. Agreements and compromises are not final solutions, they just manage the situation. That makes them ideal for the phase of treatment where we are trying to reduce chaos and manage symptoms. Integrative actions will resolve problems in a more lasting way and change life considerably. Focussing on them actively eliminates symptoms and struggles long-term.
Unpopular!
It seems to me that some people with DID are very focused on relational approaches and managing the inner life together as a group or inner family. Most of the effort goes into communication and working out agreements on how to live life. Integrative approaches are less talked about and they can sometimes even be deeply rejected. Why?
The integrative approach looks at the system from a different perspective. It does not follow the subjective experience (many people in one body) and instead understands us as one person with many parts who are separated by dissociative barriers. There is only one body. Parts are separated along the lines of action systems or BASK elements of a situation, therefore the functions of a whole person are split up among parts. No part has access to all of the functions (memories, skills, stress responses, psychological functions, control of the body etc). The parts need to switch to make all of the functions available at different times. This is the scientific way to look at DID. It also feels deeply uncomfortable when we are invested in the idea of being ‘many people’ because that is our felt sense of reality at the moment. Parts can feel threatened in their very existence when they learn that they are not independent and not someone entirely different. Everything that sounds remotely like it is integrative in the way it impacts us might get rejected
Why does it matter?
Dissociation comes with problems. There is a constant ‘too much’ and ‘not enough’ that happens, when we separate inner functions.
One example is time management. There is enough time for one life. It is ‘not enough’ time for every part to have their own separate life that is deeply fulfilling. We will always have to compromise and we will always discuss how to use our time (and spend a lot of time on that) when we avoid a more integrated view of our life and who we are. It does get better when we don’t lose so much time on being disoriented or on disagreeing with each other. A more unified life fits into a normal life-time. What we want to do and can do on a specific day is reduced to the time frame and energy that we as a collective have and is not a multitude of that. The length of a day starts to make sense.
Another example are our needs. They are always too much. The ‘too much’ is created by the dissociative barriers that keep some needs stuck in the past where they cannot be met. Other needs are split into opposing extremes and stored in different parts and the separation keeps them from balancing each other out in a healthy way. That is how we get stuck with extremes that feel overwhelming. We are not meant to feel the need for rest and the need to be active separately but simultaneously. When the separation stops they can start to take turns. The intensity of needs goes down dramatically when they are integrated (similar to the intensity of trauma-related emotion that goes down after trauma processing). We have talked about power struggles between parts that move into opposite directions. They come to an end through a structural integration of needs and goals. Needs find their place in how we function and as they become common ground they don’t feel like having to fight for survival anymore. They normalize.
Relational approaches prepare us for bigger changes but they cannot provide the structural changes. We need to work on the structural dissociation and its impact on our life to get a lasting relief and to recover.
Not every therapy approach is aware of the integrative actions that are needed to help us with our structural dissociation. Communication is not enough. Compromises are not enough. The kind of therapy with parts that is helpful for non-dissociative people is not enough. Relational approaches are just the first steps and not a goal in themselves. They create a foundation for more structural changes in how we function. Nobody can tell us how much integration we will be able to achieve. Every integrative action that we manage will bring relief to a tense situation. They are not the enemy. We might realize that we waste our time and energy when we stick to relational approaches only and keep trying to compromise on things that are not meant for compromises. There are more and different techniques out there than having another team meeting. We start with the relationship. Then we move into dismantling the dissociation piece by piece in our own time. That way we move from merely coping with structural dissociation into resolving it.