Loneliness and the sense of isolation is a pervasive theme DID clients struggle with during all stages of recovery. When reaching out for therapy it refers to feeling alone, being scared of people, and being surrounded by a lack of understanding. Other people may even be perceived as toxic and dangerous.
I thought if I don’t say anything, if I don’t allow myself to interact with people and be with people, then I am not going to get hurt again (Carol 2/1)
The fear of other people prevails in the middle stage of coming together. Stirred up by the trauma work DID clients' focus is predominantly on coping with their internal world and the emotional fall-out of past trauma. Very rarely is energy available for social contacts. This changes in the third stage. Overcoming loneliness and connecting with others becomes the centre of the recovery work.
Trauma theory has identified isolation and the severing of human connections as a main harm traumatic events cause because it not only affects the psychological structures of the self but also shatters the “systems of attachment and meaning that link individual and community” (Herman, 1994, p. 51). Like all models of trauma therapy 'Coming Together' places re-visiting, grieving, and processing of the traumatic events at the centre of recovery.
Navigating through this phase asks a lot of skill and intuition from therapists. They have to make a sound assessment of their clients' self-resources and their capacity to process material. Therapy needs to be timed and paced skillfully to avoid crises triggered by trauma processing. Therapy becomes a balancing act of approaching traumatic material gradually and carefully to prevent an escalation of post traumatic symptoms and not being too hesitant in addressing trauma and risking making therapy ineffective.
Yet, processing dissociated trauma inevitably leads to difficult struggles with emotions and knowledge about their past. Finding themselves alone while being in a state of emergency leaves them feeling out of control and with very little ability to take back mastery over their lives. Totally absorbed in their chaos, they survive rather by accident than by planned strategies.
And I was scared of the darkness, I was scared of my… I was scared of everything. Oh my God, I think the worst moment was when I was alone and when I was shaking, all the little kids were out, and no one was there to help us. And we were all alone (Ruby 1/15).
Important at this point is that DID clients have access to support and crisis services.Crisis care services, respite care, and after hour care are all opportunities to provide such support. Informing crisis services about the support needs of DID clients might be difficult at times. Research has sadly shown that many mental health workers have little or no training in the field of trauma and dissociation.
“I always had to be alone. You see it's a crisis when you start having memories coming up, and of course they are coming up about therapy and the therapist. And we have to wait till the next therapy session. And we will go back and be stuck between 8 and 4 (years), being an adult, and just flipping in and out (of different parts) for days. Now, therapists cannot always be available, but maybe some sort of back up system. It's very very difficult, I know” (Katherine 1/14).
Ideally therapists anticipate that the DID client is about to experience crisis. A sound crisis management plan that incorporates strategies for emotion regulation and distress tolerance can at times go a long way towards managing an emotional crisis. Teaching clients these strategies in advance will help them in dealing with these problematic moments and give them a sense of control and empowerment.