Consultation and Training

TREM Questions and Answers

Working With Consumers in Groups Who Have DID - Maxine Harris

If you lead TREM groups with consumers who have experienced sexual and physical abuse in early childhood, the chances are great that at some point you will have a woman in the group who experiences Dissociative Identity Disorder (known to the lay public as multiple personality disorder). Working with consumers who dissociate actively in group or respond to group material with the emergence of an alter personality can be challenging for group leaders, confusing for other group members and embarrassing and disorienting for the consumer herself. Here are some suggestions that might prove useful to TREM leaders for assisting consumers with DID to participate fully in the groups.

1. Since dissociation is almost universal among trauma survivors, leaders should spend a few moments in the introductory session discussing the experience of "spacing out" and give group members tips for how to handle their own loss of presence in the group. Techniques that help a woman to focus, to be aware of her body and to be aware of her surroundings are useful for all group members. In the context of this discussion leaders should explain that DID is an extreme form of dissociation and should inform the group members, with the DID consumer’s permission, that a member of the group experiences alter personalities. If one of these personalities should emerge in the group, the member will be assisted in returning to her central personality with the help of one of the group leaders who may escort her from the group briefly in order to help her return to her central personality.
2. Remember, TREM groups are for adult women. A child or a male alter should always be escorted from the group.
3. An adult female alter may remain in the group while a co-leader sits next to her and helps her to return to her central personality, perhaps by touching her hand or talking to her softly.
4. Group leaders should not address an alter personality directly in the group and should not shift the group’s focus away from its agenda in order to work individually with the consumer. If the consumer needs individual attention, a group leader should quietly escort her from the room.
5. After a consumer leaves the group, the remaining leader should comment briefly on what just occurred and ask other members if they feel safe. Members should return to the group agenda and should not spend time processing the dissociative episode. To do so often prompts dissociation in others and may cause other members who also experience DID to present an alter to the group. The phenomena of competing or “dueling” alters can be disconcerting for all group members and for leaders.
6. When the member returns to the group, she should be welcomed back and members should continue with the group’s agenda.
7. Leaders can help a member to remain present in the group by addressing her central personality frequently by name. Although the group leaders do not usually call on members for comments, leaders can help to ground a woman with DID by invoking her name and calling her back to consciousness in the group.
8. Members can help themselves to stay present in the group by holding onto a charm or a small object and touching the object throughout the group.