Sydney NLP Articles

My treatment of MPD in these papers is based on certain skills and attitudes and intentions.
It is not an exhaustive list but just some of them I've found created  greater rapport and willingness to change on the part of clients.

Skills
Rapport with all selves (as much as possible)

Adjusting the intensity of emotions to give the client control
De-intensifying memories to reduce their compelling and entrancing nature

Reducing the emotional reality of appropriate experiences both real and imaginary

Increasing the emotional reality of appropriate experiences both real and imaginary

Discovering the function of each self, as appropriate, in enhancing the well-being of the client

Negotiating between differing selves so all parties achieve their real outcome

Finding alternative ways of the selves achieving their real outcomes while respecting the limitations of each self

Teaching these selves how to “grow up” to re-orient them harmoniously to current reality

Negotiating a more functional understanding of current reality

Teaching the selves further and more effective means of self-defence

Teaching the selves to accept and respect the other selves

Teaching the selves how and under what conditions it’s OK to integrate

Teaching the selves how to de-integrate when appropriate

Building a strong organising self which they all accept and work with

Attitudes and Presuppositions
Respect for all selves

Respect for the experiences and functions of the separate selves

All selves are OK

All selves have a purpose or function

They are doing their best under the circumstances

When fear and anxiety are under control healing is faster and smoother

Healing is possible

Once the various selves realise they are not under attack from the therapist then the therapist can act as a mediator between them to reduce conflict and rebalance their functions and demands.
So Self A whose job is to keep the client out of danger might be persuaded to pay attention to the external world and less attention to something that happened 30 years ago.
Once Self A realises that current dangers are more important than old ones and hyper-vigilance is in fact a danger medically and in terms of survival skills si nce competence decreases with fatigue, then typically, Self A stops the pre-occupation with the past.
Of course it can take a few sessions to get to that point, usually after lessening the emotional intensity of the relevant memories (and it can take quite a few for the self to learn to do what is needed and also to keep doing it).
Here the overall objective of the client’s well-being is kept constantly in mind so we often ask “why do you want that?” to find the function (not purpose) of the self of immediate concern.

Negotiation and re-orientation to external reality are the two main principles behind this approach.

Also the main personality is given the task of being the organiser so that the problems end up being managerial rather than intimately absorbing. It also has the job of managing interaction with the environment, even if that only means te lling one of the others to take over..

Any other self can be given the option of running the show if they are willing to take responsibility for fulfilling the functions of the others.

Thus the issue stops being “how can I stop going crazy?” or “how can I get rid of these people in my head?” and turns into one of fulfilment rather than fear.

Supply the needed emotional state for each self
Ask the self who does have the emotion to share it or to teach this self how to have the feeling

Grow up the selves
to an age they accept (bias towards real time)
Sometimes the self doesn’t need to have a specific feeling but to realise the client is no longer that age which produced the secondary self

Strengthen the client
using the client’s body as a frame to manipulate feelings, ask the client to store the good feelings in the bones each time they are produced. This produces a growing sense of positiveness in the client. Ensure the client locates personal Values in the bones too as they are more intimate than the ephemera of emotions.

Make it last
This is of prime concern since the client need to be independent of the therapist and have all the appropriate resources on-line regardless of the context.
It’s not enough to feel good when the therapist does some magic and the client needs to be in control.
So how to ensure the stability of the resource states?
For something to be stable it at least has to exist over time enough to become stable.
Usually clients locate the resources in their gut chest or head but for longevity something else is needed.
I decided to crate a new self for Z. But what?
In her experience it seemed to me the only suitable analog of such a thing was her body. But there was a problem.
With sufficient pain whether emotional or physical we move our awareness away from our own body since that is the part of us that gives us the experience..
When you ask clients if they can feel their shoulder then ask if they can feel their elbow and so on some will just say no and others will have varying abilities to be aware of their own body.
In one study the researcher found that obese people could not even accurately locate their own stomach. They would usually point to their abdomen when asked where it was. So of course they had inferior feedback systems for knowing when to stop eating.
And so with the traumatised.
Even when the client can feel the insides of their own body this feeling can vary in such details as density pressure temperature and so forth and the client can have awareness blocked off.
Also the next question once they have developed this quite basic self-awareness is “Can you feel your hip and knee at the same time?” This can be asked about any two or more joints to give an indication of just how much of the basic self they can feel.
Their self (body) awareness may be fragmentary.
Given that the body is the most basic self we have and is the sine qua non of further development this is significant.
After a whil e traumatised people effectively forget how else to feel.
They just don’t know how to feel good anymore.
What they refer to as pleasure is no longer a distinct experience but is instead a less painful state. Their pleasure-pain conflict is subsumed by pain so it turns into a less pain – pain distinction.
This places severe limits on their recovery.
And under sufficient trauma the emotional self rigidifies in an attempt to resist the overwhelming pain and stay an integrated being.
This is a defence against total fragmentation.
So when life itself is good they have the task of relaxing enough to allow themselves to change into a happy person.
But they’re too scared to relax in case things get even worse than they have always got before. This is t he self-perpetuating nature of severe trauma. It is severe because it maintains itself and may even get worse.  Their underlying fear is loss of control over the damage done to them. To let go is to let of the pain as well. And then what could happen?  Their worst fears of course!
So the alcoholic being sober often cannot take the strain of not being a failure and reverts to the self s/he knows best. A success in the world can trigger this behaviour because it triggers the fundamental problem of being emotionally frozen at the core level of identification with the body. Emotionally there is no more fundamental level .
Or the MPD person might have a good experience but not be able to relax enough to incorporate this mode of experiencing into his/her sense of self and another self comes on line. With any luck it could be a self which knows how to be happy but this is not to be depended on.

Exercise is especially useful for increasing the strength of the body’s signals to the mind. The exercise is to be done to a point of effort. This point is to be self-regulated by the client. So long as the client makes an effort the results can be achieved. the amount of effort can affect how long it takes to take effect.
This is because effort takes more work and thus more commitment of the self to the external-normal-reality-world.
It worked well with Z by having her do them past the point of difficulty as this forced her to more fully engage with physical reality.
The preferred exercise was pushups which were particulaarly useful.
The virtue of pushups is that they induce a greater sense of an integrated self as she experienced (after getting past the feeling of extreme effort) a total self as the whole body is involved in doing them. Also there is the likelihood of falling onto our face if she didn’t pay attention or slacken off at the wrong point in the exercise. The natural response is to stop doing the pushup if it gets difficulty but following the instruction to do it past that point means she developed a will and sense of self that overrides the chaotic to and fro of the mind from one feeling / thought / personality to another.
Of course as she got stronger that point of effort moved to a higher level so the sense of self-purpose-direction lasted longer.
As she did this her life became more centred on that version of her self and what she was doing with her life rather than whatever feelings flowed through her consciousness at the time. Accepting the other selves meant they in turn left her alone more and more.
Another important exercise was for her to go swimming, especially in winter.
This repeated the psychological process except it used the warm/cold characteristics of the experience. As I said to her, ‘If it’s warm it’s on the inside, if it’s cold it’s on the outside. You are the warmest thing in the water’. So it used her skin as the border between inside and outside to further develop her sense of being one person.
The exercises grew a strong sense of a focused self. It was made easier by her not having a ‘host’ self to start with.
It seems to me there are at least two main forms of MPD;
1 where there is a host self (or sense of self) beset by others
2 where there is no host self and the person gets tossed around willy-nilly by the selves or by others’ actions and by the vicissitudes of life

Once a stronger and more peaceful organising central self develops it can be strengthened to last over time.

Sense of self-over-time is one of the mental abilities damaged by trauma.

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