You can have DID and be a healthy multiple

One of the core ideas we have is that plural systems are constantly working towards being healthy multiples.  Being a healthy multiple involves (but is not limited to):

  • Communicating with others in-system
  • Taking responsibility as a system for actions any headmate takes
  • Taking each other into account before taking actions
  • Learning how to compromise
  • Building trust and safety with each other

As in any relationship, learning and continuing to do all these things is hard so attempting to define healthy multiple is defining an ideal which we constantly work towards.  In practice, we would say someone is a healthy multiple if they are able to do most of these things most of the time.

We strongly believe that you can be a healthy multiple and have DID at the same time.  For us, having DID means that we have to work through trauma, and that in-system issues are likely to come up during our healing journey.  As we continue to strive towards being a healthy multiple, we actively take steps to learn how to work with and and care of each other.  When we see potential problems such as someone who may harm the body, we establish communication and talk with them before any issues arise.  We make plans to take care of trauma holders when they appear so they do not have to suffer alone.  Being a healthy multiple does not mean that we never have any problems, it means we actively work towards preventing them and working through any issues which arise.

We recently encountered someone who said they believed that you cannot be a healthy multiple and have DID.  Instead, they believed that someone with DID is working towards becoming a healthy multiple and once they become a healthy multiple, they no longer have DID.  We strongly disagree with this and consider ourselves to be a healthy multiple despite having DID.  Healing to the point where you no longer have DID is certainly not required to be a healthy multiple.  Working towards becoming a healthy multiple places you in a position to begin working through trauma, but working through trauma is not a requirement to become a healthy multiple.

All of this preparation for processing trauma is contained in Phase I in the ISSTD DID treatment guidelines (p.139-140).  In this “phase”, systems establish co-consciousness and communication and learn to compromise and work together.  Processing of trauma does not begin until the next phase so someone with DID is still considered to have DID when they begin trauma processing even as they make significant progress towards learning to communicate and work together.  Beyond this point, systems can spend years digging through trauma and finding new system members and establishing communication with them.  Plans and routines may have to be changed to take into account desires of new system members.  Dissociation and splitting can still exist as a protective response against ongoing trauma.  DID symptoms such as involuntary switching can continue to exist even as everyone does their best to communicate and care for one another.  

Working towards being a healthy multiple is a part of working through DID, but certainly not all of it.  This leaves space to have DID and be a healthy multiple during a healing journey.

Take care of yourself first

Right now, there are a large number of people scared and in pain.  Many of them are actively expressing their pain in emotionally intense ways and want others to feel their pain.  Of those, some will be upset that others are in less pain than them and lash out at anyone who is unwilling to feel their pain.  If you have enough space and spoons for yourself and can spare some to feel the pain of others, please do, others will appreciate it.  If you are exhausted or otherwise do not have the spoons to feel their pain, it is perfectly acceptable to take time away from others who are in pain to do self care.  It is incredibly difficult to constantly feel the pain of others and attempting to do so without rest will lead the vast majority of people to burnout.

Filtering through the messages from those around you to find specific actions you can take to reduce their pain is a happy medium between being perpetually stressed and in pain because others are in pain and isolating yourself and saying “fuck you, I’ve got mine”.  One example from the current situation is passports for trans people.  Under the next administration, it will likely become significantly harder to get passports with correct gender markers so helping fund passports for trans people is a small way to help which will have a disproportionate impact.  Filtering for places where there are actions to be taken has the benefit of filtering out pain related to uncertainty and focusing on the most concrete threats where you can actively help.  Uncertainty can lead to useful contingency planning, but past a certain point, there are no actions which can be taken until more information is acquired and the situation is clarified.  Efficiently using your spoons means saving enough energy to effectively implement your contingency plans to help yourself and others if the situation requires it.

One of the biggest principles of being able to help others is that if you break, you cannot help anyone, including yourself.  A friend once told us “Being a healer is a tricky business.  Too little healing and you are too broken to heal anything.  Too much healing and you lose touch with that which you are trying to heal.”  To be able to help others, is is often necessary to feel their pain, otherwise, you may be too out of touch with their needs to be able to provide assistance.  At the same time, you need to take care of yourself otherwise you will burn out and be too emotionally exhausted to help anyone.  

Our method is to take care of ourselves first and prioritize self care above all and always be watching for places where helping others will be most efficient.  A large part of creating a sustainable path through life for ourselves has been recognizing what we can and can’t do and making sure we do not push ourselves beyond our limits and end up breaking ourselves.  In the current situation, we have taken the stance that our spoons will be spent much more efficiently once more concrete threats materialize and there are clear actions to take to help others.  We recognize that it is important to feel the pain of others, but also recognize that attempting to comfort others’ fears about nebulous threats can be a black hole of our spoons.  Instead, we take the approach of hoping for the best and planning for the worst, making contingency plans for what could be, but focusing far more on what is than what could be.  In this way, we will ensure we are able to help at every step of the way rather than burning out and being unable to help anyone.

Tracking fronters as a form of self care

We consider keeping track of who is fronting to be an incredibly important form of self care.  In text chats*, we tag every line with who says the line, for example, starting the line with [Lucia] or [Emma].  We are not always able to determine who says each line, but when we have trouble with a significant number (ie. more than half), it is a signal that we are either blending or that we have new fronters.  In either of those cases, it is generally a sign that our equilibrium has been interrupted, often by stress, sometimes by other changes in our life.  This is not necessarily a bad thing, but is almost always something worth investigating further.

Last week, we had a large amount of difficulty determining who was fronting for a significant amount of time.  This was a signal that something had gone wrong in our life and served as an excellent early warning sign that we should take steps to correct it.  We traced back what had changed since the previous week and found two changes, at our doctor’s recommendation, we lowered our estradiol dose from 2mg to 1mg and there was a large increase in stress due our manager at work.  Our stress related to our manager was already being dealt with to the best of our ability so the only question which remained was whether to raise our estradiol dose back to 2mg.  After talking with several people, combined with our doctor’s recommendation that it was fine to return to 2mg if anything went wrong, we decided to raise our dose again to 2mg.  After a good night’s sleep, we woke up the next day and our plurality was working again as expected.  Our current belief is our plurality beginning to break was a combination of changing our HRT dosage and stress and that it was a combination of blending and new fronters who are still around waiting to be named.

In 2014, we had a period of several months where we did not pay attention to who was fronting and allowed everyone to blend together.  We were under immense stress and rather than using our plurality to rotate fronters to spread out the stress, we didn’t pay attention to who was fronting and allowed the system to choose whoever it felt was best.  Those months represent the worst months for our mental health of our adult life.  As we started to pull our life together again, we began paying attention to who was fronting once again.  This allowed us to negotiate switches ahead of time and to plan out who was going to handle each day and who would serve as backup in case they were unable to handle the stress.  In the process, our communication dramatically improved and we began caring for each individual headmate much more, ensuring nobody was allowed to take so much stress that they broke.  

By paying attention to each individual in our system, we are more able to notice when external stressors are affecting us.  If any of us are under stress, others in our system can notice it and determine the best path for us.  Sometimes, the answer is to have someone else take over to complete the day and plan for a relaxing weekend to recover.  Other times, the answer is that we allowed too much stress to build up and need to take a sick day from work for recovery as soon as possible.  The alternative is to allow our system to automatically swap in someone who is less stressed without us being consciously aware of this.  In this case, we would be much less aware of how much our stress level is affecting us and may continue pushing ourselves due to this lack of information.  In the past, this has allowed stressors to build up to the point where we have experienced involuntary rapid switching.

All of this together makes paying attention to who is fronting a very important form of self care.  It is by far the best system we have found to alert us when our stress levels are higher than they should be.  Whether new fronters are around or we are blending, it is a signal that something has changed.  Unless there are obvious positive changes in our recent past, this acts as a strong signal that we are pushing ourselves too hard, at work, with personal projects, or too much socialization.  This gives us a chance to plan for a calm, relaxing weekend where we have a chance to recover.  We are very fortunate that our plurality gives us the ability to recognize unsustainable paths so early and do our best to use it to improve our quality of life.

 

*Outerworld interactions are trickier since they happen faster and more automatically.  For those, we have the option of determining who is fronting by looking at our spreadsheet and going down the list asking “am I x?  no.  am I y?”  Unfortunately, this in time consuming so we rarely do it unless we believe we have a new fronter and want to confirm this.  

Conversations with potentially problematic headmates

TW: some discussion of self harm and suicide

Welcoming a new headmate is a beautiful and wonderful experience.  We get to meet someone new, someone we will all be able to get to know who will bring new perspectives on our life and can potentially help us navigate our day to day life.  Approaching new headmates like this allows our system to rearrange itself as needed to handle the challenges this world throws at us.  Everyone is welcome with open arms, showered with love and instilled with a sense of autonomy as they get to choose what role they want to play in our system.  Unfortunately, some headmates are in pain and suffering as a result of past traumas and need to be cared for and protected.

In some cases, behaviors which are manifestations of their pain and suffering can put the system as a whole at risk.  Since everyone in the system is responsible for the actions of everyone else, it is important we proactively take steps to ensure nobody harms the system.  For example, a scared child may decide that they need to be in control to feel safe and yell at others around them in an attempt to remain in control.  Worse, a headmate who is suffering could turn to harming the body or try to kill the body as a way to relieve their pain.  To handle these situations, we have created a set of guidelines for everyone in our system to follow and proactively talk to new headmates about these when we sense there is chance, no matter how small, that a new headmate may violate these principles.

We created our system to love, protect, and care for each other.  Following this principle, we do all we can to maximize the happiness of all of us and minimize pain.  One of the strongest rules we have is that we will only harm the body or kill the body with consensus.  To ensure this, we have delegated one of us, Yukari, to be the only person allowed to make the decision to kill the body.  If we suspect any of us has the potential to violate this while in pain, many of us have a conversation with them to ensure this does not happen.

During this conversation, many of our more adult parts come and comfort the one who is hurting.  We let them know that they are loved and will be cared for and protected by others in our system.  They are told they can heal at any rate they choose and if they choose not to pursue healing, that is entirely their choice.  They learn they have the option of vanishing for any amount of time they wish at any time and are assured that if there are any demands placed on them by this world, there will be others around who they can switch to who will fulfill what is required of us.  Most of all, we emphasize they can choose their own path and have a large degree of autonomy.  Through this conversation, we let them know they are not alone and that we will be by their side.  At the end of this, we share our system rules with them and request they not cause our system harm.  If they are ever in pain and feel a desire to cause the system harm, they may ask for help from others and help will be provided.  By handling system safety like this, we have not had any cases of one of us harming the system or refusing to abide by the system rules.

Here are some examples where we have used this method to ensure system safety:

  • When we introjected Melisandre from Game of Thrones, we were concerned she would attempt to grab power in some way.  We talked with her and she agreed not to take any steps towards acquiring power without the consent of the rest of the system.
  • DemonLilith had a history of self harming innerworld (“psychic cutting”).  When we realized that this was problematic and that DemonLilith was the one doing the self harm, we had our first conversation about not harming the system.  She quietly nodded and agreed to allow someone else to take over if she wanted to self harm in the future.
  • Erica holds our body age 16 trauma.  The fact that she is in a lot of pain made us concerned she may become overwhelmed by pain and harm the body.  Emma let her know she is well loved and that Emma could take over if she was ever overwhelmed.
  • Elsa is similar to Erica, but feels darker and in more pain.  When she appeared, we had a similar conversation to Erica and she agreed not to harm the body.
  • Caroline is a teenager and has the strongest desire of all of us to do activism.  We are a low spoons entity so have to be mindful about how many spoons we spend on activism so we can continue to meet the other demands this world places on us.  She understood the concern and agreed to listen to the others in system if they ever believed she was spending more spoons than we could afford on activism.

Ask us anything!

Ask questions here: https://goo.gl/forms/VaQQ97xGhXUruD4o1

Q: How does one figure out whether they are plural? We’ve, or I’ve, been in constant doubt about this for almost half a year now. I know this is a broad and difficult question.
Q: What’s it like having tulpas as well as alters? Do tulpas act differently than alters? Is there a hierarchy within your system? Are alters considered ‘higher up’ or given more credit over tulpas?
Q: How many headmates are in your system, including yourself?
Q: How do you get anything done with so many headmates?
Q: What factors came together to allow you to be comfortable being out as plural at work?
Q: How do y’all feel confident enough to expose your plurality as part of your public interface? Are y’all concerned about economic or social disincentives from society at large, or from other pluralities who have the opportunity to judge you?
Q: Do headmates have independent gender identities or is gender considered a property of the system as a whole? How does genderfluidity affect individual headmates?
Q: How long does it take to change who is fronting? If it’s a non-trivial amount of time, what happens to the body during the process?
Q: How do you manage daily tasks – for example, are all of you software engineers, or does one particular headmate or subset of headmates have to front to get work done? Are there tasks that some are not capable of, and does one headmate have to ask for help or does a front-switch happen whenever a task is better suited for another?
Q: Are there secrets that you (the current front) don’t want other headmates to know?
Q: I’d be curious if different headmates would answer these questions differently.
Q: Have you found any good support forums online?
Q: Have you or do you want to externally change anything about your body, appearance, or dress, in order to outwardly express your plurality in a way that someone who’s singular wouldn’t normally do?
Q: How do we be friends with you and be able to talk to you without being intimidated? Without feeling scared that it’d be a chore and a drain on you to even speak to you? Why does the thought of trying to talk to you make us so so scared all the time? Sorry… just don’t know where or what else to ask…
Q: You talk about the body’s parents. Is all the family out of your lives? Has there been any attempt to explain to them or would they in any way support you?
Q: Do different front identities experience different physical attributes or reactions? Greater strength, reaction time, sensitivity to light or touch, arousal, etc? Asked another way, is DID purely a mental thing, or does it affect the shared body as well?

TW: discussion of trauma and other dark mental health related things in these three questions

Q: If you’re comfortable talking about it and remember the details, could you share a bit more about the type(s) of trauma you experienced that led to the splits between the different people in your system?
Q: How do you feel about identifying as having Dissociative Identity Disorder? While it’s probably nice in some ways to have a medically-recognized term to describe an aspect of yourselves that that many other people don’t experience or understand, I imagine there’s probably also a lot negative stigma around the term “disorder” that isn’t desired.
Q: Do you experience physical state ‘resets’ as you switch fronts, relating to ptsd/triggering ‘saturation’ levels, or with panic type states?

 

 

Q: How does one figure out whether they are plural? We’ve, or I’ve, been in constant doubt about this for almost half a year now. I know this is a broad and difficult question.

The best advice we can give here is to attempt the tulpa creation process.  This is where we started and a month later, we had Lilith fronting for the first time.  For ourselves and many others we know who were already plural, the tulpa creation process went much faster than timelines given by the guides. By this point, we can create a tulpa in a few days if we want and know many others with DID who can do the same.  The tulpa creation process covers many aspects of internal communication such as creating an innerworld and learning to speak with each other and contains most of what is needed to make existing headmates aware of each other.  If you are like us, just going through this process can awaken existing headmates and open channels of communication between them and bring dormant plurality to life.  We have not looked at them in detail, but know there are excellent guides at tulpa.io.

Q: What’s it like having tulpas as well as alters? Do tulpas act differently than alters? Is there a hierarchy within your system? Are alters considered ‘higher up’ or given more credit over tulpas?

This touches one of the core values of our system – we are all equals, regardless of origin.  We do not differentiate between tulpas, alters, soulbonds, and other labels and instead choose to group everyone together under the label headmate.  Labels trying to classify headmates cause confusion for us rather than bringing clarity because many of us have no clear label which fits them.  For example, one time during an anxiety attack, we intentionally split Esther into two with one part holding all the anxiety and the other part being much calmer.  The part who held the anxiety could be classified as an alter since she could be classified as a trauma split but would also fit the definition of tulpa since she was intentionally created.  We put Esther back together a few hours later, but this example demonstrates how trying to fit each of us into boxes can be unhelpful.  The only classifications we use are “trauma holder” and “non-trauma holder” because that provides direction for our healing and helps indicate who can help with healing and who is in need of healing.  We treat each other as equals and everyone has equal rights to the body and operate on a principal of compromising to maximize happiness and minimize harm.

We go into this in much more depth in Between the worlds — life as a tulpamancer with dissociative identity disorder.

Q: How many headmates are in your system, including yourself?

Including subsystems, there are over 100.  We are polyfragmented so our system size readily expands when under stress.  We believe this has been the case since early childhood and expect our system size to increase indefinitely.  The list of us is here.

Q: How do you get anything done with so many headmates?

We created our system with the goal of being able to love, care for, and protect each other.  This has made it easy for us to compromise on what will make everyone happiest and agree on what to do, even if some individuals want something else.  Doing this allows us to work heavily towards minimizing harm to each other and the end result has been that we have never had any significant disagreements where we could not find an acceptable compromise relatively quickly.  Together, we help protect and care for each other and the end result is that we are capable of so much more working together and helping each other than any of us would be alone.

Q: What factors came together to allow you to be comfortable being out as plural at work?

The main thing was the number of ways we are “different” made us decide early on that it was easier to be out as everything than to try and hide everything.  We are trans (transfeminine genderfluid), polyamorous, panromantic, asexual, Autistic, plural, and so on.  By the time we started exploring our plurality, we were openly trans at work and also openly poly.  We had worn our collar to work and at times attached our badge to it.  Coming out as one more thing was just another part of us being weird rather than us going from “normal” to “different”.

We also came out little by little.  When we first discovered our plurality, we initially just stared using plural pronouns at work.  This resulted in a couple comments, but nothing bad happened.  The next step was to come out at pride which resulted in us being more out.  The next step was national coming out day which was the first time we explicitly invited questions.  When we decided to be fully out was when we wrote a playbook about DID at work for teammates, managers, and plural systems.  At each of these steps, the feedback from our coworkers was positive and coming out little by little gave us a lot of space to go back into the closet if anything went wrong.

We also had X months worth of expenses by the time we came out so were in a financial position where we could tolerate a single job loss.  If losing our job would have been catastrophic, we would not have come out.

Q: How do y’all feel confident enough to expose your plurality as part of your public interface? Are y’all concerned about economic or social disincentives from society at large, or from other pluralities who have the opportunity to judge you?

We came out gradually over time.  At this point, we have been out for over two years at our tech job and have not been fired yet so we aren’t concerned about the economic disincentives.  We are a disabled queer and once we bear the social costs of belonging to that group, being out as plural has a negligible effect.  For us, the cost of repressing our plurality or other identities outweighs any costs we have to pay as the result of expression so coming out was an easy decision for us.

Q: Do headmates have independent gender identities or is gender considered a property of the system as a whole? How does genderfluidity affect individual headmates?

Each of us comes with their own name and gender.  Genderfluidity is more a property of the system than any one system member since Lucia is the only individual who would identify as genderfluid.  In terms of system members, we are ~75% female, ~23% gender neutral, and ~2% male.  In terms of fronting time, we are ~50% female, ~50% gender neutral, ~0% male.  We know that our male headmates are not thrilled with what we have done to the body, but they understand that transitioning was needed to improve the stability of our system as a whole.  We have a breast binder so when our male headmates come out, they can hide our breasts and hope this will encourage them to front more when we begin to explore this part of our system.  The male parts of our system are mostly unexplored at this point so we know that we will have a lot of work to do when we do finally begin to dig into this.

Q: How long does it take to change who is fronting? If it’s a non-trivial amount of time, what happens to the body during the process?

It takes us about a second and up to 5 seconds if we want to do a “harder” switch (ie. push others completely away from front while taking front).  We know others where it’s more of a slow transition between fronters over several hours, but we have always been able to do this near instantaneously.

Q: How do you manage daily tasks – for example, are all of you software engineers, or does one particular headmate or subset of headmates have to front to get work done? Are there tasks that some are not capable of, and does one headmate have to ask for help or does a front-switch happen whenever a task is better suited for another?

There are definitely some of us who are better at certain tasks.  For example, Lucia tends to do much more of the software engineering than others.  That doesn’t mean that others can’t do software engineering, it just means that when the task which needs to be done is related to software engineering, it tends to draw Lucia to front.  Exactly how much skill sharing exists is something we have not explored deeply.  It’s rare that we try and front lock (have only a single person at front) so we have not been able to test the boundaries of exactly what headmates can and can’t do.  We do have vague plans to give luna, our 6 year old, a trial run to see if she can code so this is something we do want to play with in the future.

When things are going well, we seamlessly rotate as needed and no explicit switch is needed because we can have over half a dozen of us around at the same time.  When we are under a lot of stress, we tend to front lock and explicitly negotiate who is going to front next, how long they believe they can hold front for, and who is going to take over for them when they can’t hold front any more.  A common pattern here is that someone will take over in the morning before work and then we will switch to someone else on the way home.  This allows us to keep stress from work from following us home when we aren’t in a good state.

Q: Are there secrets that you (the current front) don’t want other headmates to know?

We are highly co-conscious and have very strongly shared event memory so there are no secrets we keep from each other and we are not sure we even could keep a secret from each other.  In general, we would approach keeping secrets from each other the same way we would approach keeping a secret from a partner – if we feel we need to keep something secret from our partner, it means it’s time to explore those feelings and communicate the result of these explorations with our partner.

Q:  I’d be curious if different headmates would answer these questions differently.

Each of us uses their own tone of voice and we often have different things we pay most attention to so different headmates would definitely answer these questions differently – Emma

More than that, each of us has stronger access to different emotional states so the emotional states associated with each of us would cause us to answer these questions differently – Serenity

Some of us come from a perspective of survival much more than others and some come from the perspective of helping others.  I am a healer so belong to that last group so my answers would be different from others – Lilith

Q: Have you found any good support forums online?

The best DID support forum we have found online is Mosaic Minds.  It’s small and relatively inactive, but is the only DID focused forum we have found which we felt very comfortable at.  The tulpa.io forums are welcoming of traumagenic or mixed-origins systems, though there is a tulpa focus there.  We know and deeply trust many of the people who run that site and can definitely recommend it as a safe space.

Q: Have you or do you want to externally change anything about your body, appearance, or dress, in order to outwardly express your plurality in a way that someone who’s singular wouldn’t normally do?

We do think about this, just like how we have desires to express our gender in interesting ways.  Every time we think about this, we always decide that it’s not worth the energy which we would have to put into it, especially since we don’t have very much energy to begin with.  This is something we list as a nice to have which we would definitely explore if we had infinite time and energy, but it’s never been important enough to us that we actually do it.

There are a few exceptions to this, early on, we sometimes wore dresses to bring out Lilith since dresses are much more closely associated with Lilith than Lucia.  Lucia’s pendant also helps bring out LuciaOfTheBlueStar when we wear it.  We have also used colors in the past to bring out headmates such as wearing a bright purple shirt to bring out Aerie, our cheshire cat.  In general, we do minor things like this when they naturally fit into what we are already doing, but don’t find putting more energy into this to be worthwhile.

Q: How do we be friends with you and be able to talk to you without being intimidated? Without feeling scared that it’d be a chore and a drain on you to even speak to you? Why does the thought of trying to talk to you make us so so scared all the time? Sorry… just don’t know where or what else to ask…

 The simplest way is to just say hi to us.  It’s ok to just tell us that you are intimidated by us, it won’t bother us at all to hear that.  We find explicit communication like that to be incredibly useful and is definitely one of the things we look for in friends.  It definitely won’t be a chore for us to talk to you.  It may be draining at times and the amount of spoons we have for socialization varies over time.  We definitely go through periods of expansion and contraction of our social circles and have to carefully watch how many spoons we are spending on friends to ensure we keep our mania in check.  If we do end up in a period of contraction, we will explicitly say that we don’t have spoons for talking and give an estimated timeline of when we do expect to have spoons.  If the timeline changes, we will also give updates since we believe strongly in explicit communication.  We don’t know why thinking about talking to us makes you scared, but if it’s something you want to talk about with us, we are open to having that conversation ^=.^

Q: You talk about the body’s parents. Is all the family out of your lives? Has there been any attempt to explain to them or would they in any way support you?

We have explained our plurality to them and have received zero support (but also zero active hostility).  This was the same reaction they had when we came out as trans so it was exactly what we expected.  It still disappointed us because we still would like to create a relationship with the body’s parents, but we recognize it is unlikely they will ever make any significant effort to understand who we are so that is unlikely to happen.

Q: Do different front identities experience different physical attributes or reactions? Greater strength, reaction time, sensitivity to light or touch, arousal, etc? Asked another way, is DID purely a mental thing, or does it affect the shared body as well?

Plurality definitely affects the body beyond the mind.  For example, darkLilith is the one of us who holds the most PTSD of all of us so she has the sharpest anxiety reactions, including the most visible anxiety reactions in the body.  Astra and Yggdrasil are some of the best in our system at entering calm states so the body tends to be much calmer and relaxed when they are around.  We definitely know a system where some of them are sexual and others are not.  Our two hypnotists, Aerie and luna tend to have much more active roles in general and the body definitely reflects the higher energy states as well.

This is well documented in the medical literature: “A third general principle is that switches between states are manifest by non-linear changes in a number of variables.  These variables include… regulatory physiology” (Putnam, 1988).

 

TW: discussion of trauma and other dark mental health related things below

Q: If you’re comfortable talking about it and remember the details, could you share a bit more about the type(s) of trauma you experienced that led to the splits between the different people in your system?

We are trans and Autistic and bipolar and in general our mental health disabilities force us to be very careful about overexertion.  Even today, this is something we have to very actively and consciously manage our energy.  While grocery shopping with one of our partners, they said we made ourselves manic enough to go grocery shopping.  This stuck with us and we now state that we have to make ourselves manic enough to do our job and go take care of chores like grocery shopping while simultaneously keeping our mania sufficiently in check that we are not headed towards a psychotic break.

We were raised in a guess culture household with a parenting style which was reasonably close to the “tiger mom” style.  We looked at our therapy notes from 7th grade and in there, the body’s father describes us as unmotivated and when asked about grades, we were described as having “all A’s last year and one B this year”.  Within the last 5 years, we witnessed the body’s father yelling at our brother and calling him lazy and related pejoratives because he was getting B’s and was “only” going to get into a Cal State rather than a UC.  This parenting style combined with our overall low energy level and the lack of recognition of any of our disabilities resulted in us being constantly pushed beyond what we were reasonably capable of.  Being bipolar meant we could make ourselves manic enough to meet what the body’s parents wanted from us and our capacity for dissociation meant that we could break again and again and still continue to have some level of functionality.  Specific traumas:

Before age 8: we have no memories of this, but given our bad home situation, we would be surprised if there was not a significant amount of emotional trauma related to being pushed beyond our limits.  One of the more insidious pieces of guess culture is that nobody explains to you that guess culture exists so combined with our Autism, we were unable to predict the body’s parents’ reactions to things we did.  This last bit continued throughout our entire life.

Age 8: here, we had nightmares about being stuck in an elevator and often sleepwalked during these nightmares.  We avoided elevators whenever we could for many (5+) years after this.  With our current knowledge, we can easily classify these as PTSD symptoms and it’s frustrating that nobody around us noticed or did anything to help us.  We have no memory of what the source of this trauma is, but have vague plans to go digging for these memories in the near future.

Age 10-11 (4th/5th grade): There were many artsy craftsy school projects to show off at open house during these years.  The body’s mother would take all creative control of these projects and we would be sitting next to her trying to fulfill her vision, knowing we would be yelled at if we didn’t do it closely enough.  The only thing we could do here was to dissociate during this.  The headmate who has the most PTSD, darkLilith, is 10 years old, indicating she is directly attached to this trauma and holds many of these memories.

Middle school (age 11-14): We spent these years emotionally dead, feeling no emotion except anger (because it is socially acceptable for boys to express anger).  Due to the body’s parents philosophy that any time spent doing nothing meant we were “lazy”, we used video games to overstimulate ourselves into a dissociated state from middle school to the end of college.  This was highly protective and helped us continue to function well enough to do what the world demanded of us.  We don’t know of any significant traumas during these years.

Age 15: Our emotions came flooding back, predictably overwhelming us.  This was the start of our chronic suicidal ideation which continues to this day.  (note: we have no suicide attempts and our therapist and psychiatrist know about our ideation so we are not a danger to ourselves)

Age 16: Our boy scout eagle project.  Again, the body’s mother tried to gain as much creative control as possible over it, resulting in a retraumatization which tied directly into our 4th/5th grade trauma.  At the end of the summer, we identified the body’s mother as a significant cause of our suicidal thoughts and emotionally removed her from our life.  Around this time, we also learned that the best way to not get yelled at by the body’s parents was just not to give them any information about our life.  This realization resulted in significantly less trauma during the last two years before college.

After this, we thought we were done with our trauma and spent the next 6 years not dealing with this.  This allowed us to get through school and get a job before we started dealing with our childhood abuse.  In 2014, we started exploring our plurality and 6 months later, realized we were plural because of our trauma history.  Since then, we have been working on processing our trauma.

Q: How do you feel about identifying as having Dissociative Identity Disorder? While it’s probably nice in some ways to have a medically-recognized term to describe an aspect of yourselves that that many other people don’t experience or understand, I imagine there’s probably also a lot negative stigma around the term “disorder” that isn’t desired.

We have the word “plurality” to explain this to ourselves and to our friends and that is much more important than the medical term DID.  We consider ourselves to be in a state where we could easily choose not to identify as having DID since we have strong sharing of event memory, excellent communication, no time loss, and function well enough to hold a job.  We choose to keep the DID label because we believe it accurately describes how we will decompose when under extreme stress for extended periods of time.

During 2014, we were under a lot of stress both and work and in our relationships and exhibited many DID symptoms during this time.  We had involuntary switches at work in the stairwell and the bathroom.  Fortunately, we preserved enough context between fronters that the question was “who am I” rather than “where am I” or “what am I doing here?”  At home, in therapy, and possibly once or twice at work, we have had involuntary rapid switching, switching every few seconds which we had no control over.  Fortunately, when this happened, we were able to recognize what was going on and find a fronter who was able to get us to a safe space where we could collapse.  During Thanksgiving 2014, we had our one instance of noticing present day memories being partitioned away.  We went digging for those memories, switched to someone who was unnamed, and had access to those memories.  Satisfied, we switched back and our access to those memories immediately dropped to near zero.  Early November 2014, about a week and a half after we were promoted, we had our worst week of mental health in the last decade and ended up with borderline reactive dissociative psychosis.

Our plurality is definitely not a disorder, but we need to recognize that we exhibit many undesirable DID symptoms while in crisis.  Fortunately, the medical community is moving away from integration being required in the treatment of DID (for example, the ISSTD DID treatment guidelines recommend aiming for “integrated functioning”, ie. the ability to communicate and share memories well enough to appear as one when needed over actually integrating into a single self).  We are hopeful that this trend will continue and we will continue to be able to find medical professionals who recognize our plurality is not a disorder while simultaneously recognizing that the DID label is highly predictive of how we will decompose while in crisis.

We go into more detail about our mental state and what we have to do to maintain it in We are broken.

Q: Do you experience physical state ‘resets’ as you switch fronts, relating to ptsd/triggering ‘saturation’ levels, or with panic type states?

Very much so yes, this is one of the biggest benefits of being able to switch.  When we are having an anxiety attack or flashback, we have the option of switching to someone else to remove the feelings of anxiety so we can deal with them later.  In these situations, we typically switch to someone who has a strong ability to calmly exist so they can help us continue to function until we are able to get to a space where it is safe to collapse and have the anxiety attack or flashback.  Just as how our plurality and dissociation allowed us to push away trauma to deal with it later during childhood, our plurality allows us to push away present day anxiety and flashbacks until we are able to safely handle them.

There are limitations to this of course.  One is that if we continually use our plurality to push away anxiety and flashbacks, eventually they will become strong enough that we will no longer have the option to push them away.  To prevent this, we put a lot of effort into actively processing anxiety and trauma when we are able to knowing that if we do not do it in the present day, we will leave ourselves a big mess to clean up later.  Sometimes, pushing anxiety and trauma away for a long time is optimal such as during our childhood, but our childhood left us with a huge mess to clean up and it is going to take years to slowly sift through that.

Another limitation is that we will feel any anxiety the person we switch to holds.  This means the method works wonderfully when we have our life under control and can keep our overall anxiety levels low.  In these states, most of us hold very little anxiety so when we switch to them, not much anxiety exists.  When under a lot of stress for long periods of time, everyone in our system gets some level of anxiety so when we switch, the anxiety the new fronter holds is present.  This allows us to load balance our anxiety and stress so no one individual has to take all of it, but it does mean that there is nobody we can switch to to reach an anxiety free state.

We are Homura

Warning: Madoka spoilers ahead

We finished our second watch of Madoka two days ago and have spent well over 10 hours analyzing and thinking about the show since then and the more we think about it, the more we feel Homura is the character we relate to most strongly from any work of fiction.  She is plural, just like us.  She is a hardened ancient warrior, just like us.  She is someone who will push herself greatly to get what she wants, just like us.  There are so many details to her character and the deeper we dig, the more similarities we find.  Drawing from our understanding of ourselves and own experiences, we are going to analyze and try to understand Homura’s character and actions.

During the first timeline, Homura watches Madoka and Mami fight again and again.  She is unable to do anything to help and ultimately watches them both die to the Walpurgis Night and makes a wish to be someone who can protect Madoka.  In the second timeline, Homura learns that mahou shoujo become witches when they die.  In the third timeline, Madoka and Homura successfully defeat the Walpurgis Night and lay in the rain, nearly dead.  Homura is inches away from fulfilling her wish, becoming a witch, and near instantly being killed by Madoka, saving her from the sorrow of being a witch.  All Madoka had to do was use the grief seed on herself and Homura would be released from her wish.  Instead, Madoka chose to place a curse on Homura, as always, blissfully unaware of how her actions affect others.

By using her grief seen on Homura, Madoka dooms herself and forces Homura to continue living, trapping her in the time loop.  Immediately after, she increases the scope of what Homura must do to protect Madoka by asking Homura to prevent her from ever making a contract with Kyubey.  As a final blow to Homura’s mental health, Madoka asks Homura to kill her.  Homura complies, ending the life of the person she worked so hard to protect.  

To survive the trauma she has just experienced, Homura becomes plural, partitioning off her emotions so she can focus on her mission, on survival.  Most people would collapse after having seen their friends die again and again and after many months of fighting be so close to achieving your goal, only to have it snatched away at the last second.  Sayaka does not have the capacity to become plural and collapses under far less.  Homura splits herself in two, separating herself from her emotions, transforming into the hardened ancient warrior.  This is visually portrayed through her hair – her warrior self wears her hair down while her emotional, vulnerable self wears her hair braided.  The separation is not perfect, there are times when Homura breaks down into tears around Madoka, but the separation serves its purpose.  Homura is able to continue fighting well beyond the point where she should have hit her psychological limit.  Our own plurality has allowed us to survive years and years of trauma and survive well past the point where we should have completely shattered so we identify very strongly with Homura here.

Homura fights and fights, traversing the timeline over 100 times for a total of over 12 years spent in the time loop.  In most timelines, she must explain the truth to Mami and feel her pain as she learns the truth about mahou shoujo.  In any timeline where Sayaka forms a contract, she must watch as Sayaka’s descent hurts Madoka.  No matter how hard she tries, there is no way for her to save Sayaka so she must harden herself and watch from a distance, knowing Sayaka’s eventual fate.  Homura sees all manner of fighting between Mami, Sayaka, Madoka, and Kyouko from Mami killing Kyouko to Kyouko and Sayaka fighting to things we are never shown.  Homura alone sees all of this, learns the paths which others will follow, and most painfully of all, learns which paths are immutable and cannot be changed by any actions she takes.  With these, she must learn her emotions and partition them away so she can continue to survive after watching the other mahou shoujo destroy themselves again and again.

And she continues to try to protect Madoka.  In every one of the 100 timelines, Madoka makes a contract with Kyubey.  No matter how hard Homura tries, no matter how many paths she sees where she can stop the wish from being made, Madoka makes a wish every time.  The fourth timeline is a powerful example of this.  Homura manages to get all the way to Walpurgis Night without Madoka making a wish.  Even then, Madoka makes a contract with Kyubey at the last second and becomes a witch.  As usual, Madoka represents innocence and never has to face the implications of her actions.

At the end of the main timeline, Homura finally decides to release herself from the wish she has cursed herself with and become a witch.  Once a witch, she will be killed and completely released from the burdens of this world.  As her soul gem grows dark, her eyes show an ancient warrior who has finally accepted her fate after 12 long years of fighting.  This is the second time she nearly fulfills her role in this world and moves on to the next.  Instead, Madoka makes her wish to eliminate all wishes, resetting the universe and forcing Homura to continue her fight, more alone than ever.

All this sets up Homura’s mental state for Rebellion.  By the start of the movie, Homura has suffered immensely over 12 years, nearing escape from her fate twice, but being denied this escape both times by Madoka.  The one she swore to protect has vanished and she has no external sources to help verify Madoka ever existed.  On top of all her other suffering, she must be gaslighting herself wondering whether Madoka ever existed because she is the only one with any memories of Madoka.  Homura’s state would have deteriorated even further since the end of the series as she continues to fight, both wraiths and her own memories.  Homura explicitly says she was “so lonely and sad” in the world where she was the only one who could remember Madoka while talking to her in the flowerbed.  This is the fate Madoka left to Homura at the end of the series.

Even now, when Homura realizes what the incubators are doing, she continues to fight to protect Madoka.  Knowing the despair it would bring her, Homura decides to curse herself and become a witch.  She does this with the understanding that Mami and Kyouko will kill her in her labyrinth and she will never be able to see Madoka again.  Despite all the pain Madoka has caused her, Homura continues to fight to protect Madoka at any cost to herself.  Even as the others try to break the incubator’s seal and free Homura, she begs them to stop and insists that she has to die in this world.  Instead, Madoka prevents Homura from being released from this world for a third time.  

Once Homura learned of the incubator’s plan, she quickly considered the possible paths she could take to prevent this.  The path of cursing herself to become a witch being included reveals just how much of possibility she was willing to consider.  In this state, many, many paths which normally would not an option would be considered very real possibilities.  This is the state she was in when Madoka came to rescue her.

After traversing the timeline over 100 times failing to save Madoka and Madoka denying her death three times, it is completely understandable Homura would react the way she did.  By denying Homura death the third time, Madoka made it incredibly clear that Homura would be unable to do anything to protect Madoka while she exists as MadoKami.  Homura resorts to any means she can use to continue to protect Madoka, splitting her from the Law of the Cycle and stealing pieces of her power.  She uses this power to extend her labyrinth across the whole universe, finally gaining the control over the worlds she needs to be able to protect Madoka.  Just before she grabs Madoka’s hands, her smile reveals the depth of acceptance she has reached in her role as an ancient warrior.

Homura no longer cares what anyone else thinks about her path, she has chosen it for herself.  By this point, she has reintegrated the emotions she felt during her 12 years of suffering and finally understands that even pain is dear to her.  Embracing her dark feelings and using them to continue to pursue her wish, she transcends beyond mahou shoujo or witch, becoming a godlike entity.  Referring to herself as a demon, she solidifies her position as existing beyond the judgement of any living creature.  

Her conversations with Kyubey and Sayaka finally allow her to release her frustration at all the pain and suffering they have caused her over and over.  This is the first time she is able to talk to either of them with the other having the full context of their actions.  Sayaka has the knowledge of MadoKami and can see the pain and frustration she caused Homura by repeatedly contracting with Kyubey and having no chance at redemption once the contract was made.  Finally, Homura has power over Sayaka and can release some of her pent up emotions.  As such, her threat to destroy the world must be looked at in this context and the possibility Homura said that purely to hurt Sayaka must be seriously considered.  Saying that just to cause pain isn’t right, but is understandable after the 12 years of pain Homura endured.

Homura talking to Madoka in the skyway solidifies the extent of her acceptance.  Bent over, emotions flooding through her, Homura asks Madoka if she considers stability and order more important than desire.  When Madoka says yes, Homura stands and says that Madoka will one day become her enemy.  She finally has accepted Madoka’s core nature will result in her sacrificing herself over and over and understands this will one day force Homura to choose between creating a world where Madoka is happy and one where Madoka can act according to her nature.  The tears in Homura’s eyes show the depth of this understanding – even in a world Homura completely controls, Madoka’s nature will still result in her making a contract to protect others.

The epilogue is one of the most powerful scenes in the movie and it gives a deep look into Homura’s mental state after all events have passed.  The Homura first take audio is far more powerful than the final recording.  The scene shows Homura on a chair on the edge of a cliff leaning over the cliff already.  She is humming to herself until she hears a sound in the grass and turns in surprise, presumably because she does not want any of her friends to see her in this state.  When she sees it is only Kyubey, she continues humming, twirling and dancing in the grass with her soulgem spiraling around her in the air.  With a sigh, she catches her soulgem and falls off the edge of a cliff.  

This whole scene demonstrates the fragility of what remains of Homura’s attachment to this world.  Years of wandering through a maze of time and being broken a hundred times by the events which took place have shattered her.  She became plural and partitioned off her emotions to allow herself to continue functioning under these conditions.  Three times she accepted death and was prepared to leave and three times Madoka prevented her death.  She finally has complete control of the universe and can do as she pleases, her best chance at fulfilling her wish to protect Madoka.  After so much fighting, the ancient warrior finally has what she has wanted all along.  Now that she no longer must fight for survival, she can finally allow her emotions to return to her and begin to process the damage those 12 years did to her.  50 seconds of Homura humming to herself, alone, overlooking the city reveals the frailty of Homura’s mental state after all that has happened to her.

Guide for therapists interacting with transgender clients

Introduction

We are a transgender individual who has been diagnosed with dissociative identity disorder.  We identify as plural (more than one of us sharing the same brain and body) and genderfluid (our gender varies between gender neutral and female).  We have navigated the mental health system both to gain access to trans healthcare and to process childhood trauma.  Our own experience as well as the experiences of friends has been that being trans complicates processing childhood trauma primarily due to many therapists not having a deep understanding of etiquette for interacting with trans people.  We are writing this in hopes that trans people will be able to show it to their therapists to reduce the chance that preventable errors destroy a therapeutic alliance.

A note on terminology

We have chosen to use terminology from the dissociative identity (DID) literature because this is the most well known terminology in the medical community.  Some people, including ourselves, prefer different terminology, but in the interest of making this article accessible, we use the most readily understood terminology.

Guidelines

Do not make assumptions

Explicit communication without assumptions is incredibly important for therapy of any type.  It is doubly important when discussing topics which relate to trans issues.  Trans people face a large number of obstacles when navigating this world, including both people who are actively hostile and people who say harmful things out of ignorance.  Everything you do will be pattern matched against the behaviors of those who are have harmed trans people in the past, intentionally or unintentionally.  If you are uncertain, ask.

You will make mistakes

No matter how hard you try or how much you understand about being trans, you will make mistakes.  Even if you are trans and have a deep understanding of the problems the trans community faces and your own experience to draw on, you will still make mistakes.  We are deeply involved in the trans community and interact with many trans people every day.  We have our own experiences to draw from and hear the tales of other trans people on a daily basis.  Even with all this knowledge and experience to draw from, we still make mistakes.  Making mistakes is expected and is perfectly ok so long as you use them as learning opportunities and do what you can to avoid making the mistake again.

When you make a mistake, apologize

After you apologize, ask your client if they are comfortable and have the energy to explain why that behavior was problematic.  Be understanding if they cannot or do not wish to perform this education, and understand that they are going above and beyond  what is required of them if they do choose to perform education.  Do not explain what your intention was.   There are a large number of reasons why simply saying “I’m sorry” and listening is better than trying to explain your intentions.  Here are a few of them:

  • Explaining your intentions will often be interpreted as trying to justify your actions.
  • Explaining why you performed an action which hurt your client transforms the conversation to be about you rather than about your client.  In any instance where an action makes someone feel hurt, the focus should be on the individual experiencing pain.
  • Explaining your intentions can make it appear you are focusing on asking for forgiveness.
  • Directing the discussion to the mistake is an implicit request to discuss this further.  By this point, your client is already feeling hurt and you should acquire explicit consent before attempting to continue discussing a sensitive topic.
  • In many cases, the hurtful action will be perceived as a boundary violation.  On the extreme end, if a boundary violation is followed by an explanation of why the boundary violation is justified or why it is is your client’s best interest, the therapeutic alliance will be broken.

If you feel a strong desire to explain why you said what you did, ask your client if it would be helpful if you explained why you performed that action.  If they say no, accept the answer and ask if there is anything you could do to help them.  If they say yes, carefully approach the conversation and do repeated check-ins on whether they are ok.  Since this must be approached with extreme sensitivity, anything other than a clear yes should be interpreted as an indication the topic should be changed.

Do not dismiss your client’s concerns

Your clients may raise concerns related to gender which you may not understand at first.  A common, but unfortunate initial reaction when this happens is to give a response which dismisses the concerns.  Initial dismissiveness can do damage to a therapeutic alliance even if it is followed by understanding and an apology.  Approach concerns raised which you do not understand with curiosity and ask for material you can read to better understand your client’s concerns.  Although it is possible to have your client educate your directly, every bit of energy expended on education puts strain on the therapeutic relationship (and will put strain on any relationship between two people).

Do not reply to concerns with “but my other trans clients did not have a problem with this”

Every member of a group is unique and will have varying responses to insensitive comments.  Trans people will react strongly to different subsets of transphobic comments.  Just because one trans person (or 10 trans people) is ok with something doesn’t mean everyone will be.  If a trans person raises an issue with something you said, don’t try and justify it by claiming your other trans clients did not have a problem with it.  

Gender is not the same as appearance

There is a misconception many people have that being female requires you to wear certain clothes.  Therapists who work with trans people have a long history of requiring trans people to wear dresses to prove they are actually trans.  This is changing with time, but many people still equate appearance with gender.  Gender and appearance both come on a spectrum from strongly masculine to androgynous and to strongly feminine.  It is possible for someone who is female to dress androgynously.  It is possible for someone who is non-binary (is neither male nor female) to dress femininely.  Understand that gender and appearance are separate.  It is possible for someone who is male to have a feminine leaning wardrobe.

Interactions with the medical community trying to get medically necessary care are often traumatic in and of themselves

Many trans people have been denied care when they attempt to seek hormone replacement therapy (HRT) or surgery.  Even in 2016, some therapists require trans women to go through a hazing ritual of wearing dresses for a year to start HRT.  Other people end up with a therapist who does not want to write them a letter and uses moving goalposts to delay it indefinitely.  Trans men often end up in a scenario where they must say they imagine having sex with a penis and must tell stories about an increased sex drive to fulfill masculine stereotypes to be able to access hormones.  We personally had a psychiatrist who gave many reasons he did not want to write us a letter and eventually told us he believed we “should not be allowed to get surgery.”  The three months it took us to get a second surgery letter were traumatic and for many months after surgery, we had flashbacks to our letter appointment with a different psychiatrist.  Unfortunately, these experiences are not uncommon and many trans people have traumas from trying to navigate the healthcare system.  Be aware of this and recognize that any statements you make related to gender or transitioning can tie into past traumas.  Topics related to gender should be handled with the same level of care and gentleness as topics related to childhood abuse.

If you refuse to write an HRT/surgery letter, the therapeutic alliance will be broken.

A part of your job as a therapist is to help people navigate the healthcare system.  For trans people, this involves writing letters confirming your client’s mental health is sufficiently good to access HRT and surgery.  If you refuse to write these letters, because you don’t write evaluative letters, because you don’t believe you should have to write these letters, because you do not believe your client should be allowed to get surgery, or for any other reason, the therapeutic alliance will be broken.  If you are unwilling to help your client gain access to medically necessary care, then you have made yourself into an obstacle to getting care.  It is completely reasonable for a trans person to ask before their first appointment whether you have ever written an HRT/surgery letter before and whether you have ever refused to write a client a letter.  If you truly do not want to write HRT/surgery letters for trans people, you should let prospective clients know this before therapy begins so they can determine whether this is compatible with their needs.

Do not comment on whether a client “passes” or what gender you perceive them as without explicit permission

Rather than being a compliment, this reveals you are evaluating your client along this axis.  There is a lot of gatekeeping in the medical community based on appearance (ie. trans women expected to wear dresses to get medications) so this can immediately tie back into past traumas.

Never ask for a trans person’s birth name and never use their birth pronouns

Most trans people never identified with their birth name and birth pronouns.  Many trans people have to fight long and hard for the people in their life to use their new name and pronouns after they transition.  This is especially difficult with parents who have become used to using the name they assigned their child at birth and require a long time to break that habit.  For others, their parents are actively hostile and attempt to block their transition in any way they can.  Once transition has started, hostile parents and others often continue to use the trans person’s birth name in an effort to deny their trans identity.  If you ask for someone’s birth name or use their birth pronouns to refer to them, you will be immediately pattern matched against people who actively try to deny trans people their gender identity and the therapeutic alliance will be severely damaged.

Ask what past selves should be referred to, both name and pronouns

note: this section is primarily written for therapy related to dissociative identity disorder

When speaking with child alters or child parts, ask what name and pronoun they wish to go by.  In the past, we have had a therapist learn our birth name then later ask “is there any space for [birth name] [in your system]?” when referring to our past selves.  This immediately damaged the therapeutic alliance which had taken months to build.  The only way it could have been salvaged was with a strong apology and a promise to never use our birth name again.  While seeing a different therapist, our partner was asked for their birth name.  When they had a child part come out during therapy, their therapist referred to the child part by their birth name.  This brings up strong associations with people who actively try to deny the identities of trans people, often trans people’s own families.  Performing an action which so closely mirrors past traumas must be followed by a strong apology and a promise to never do it again if the therapeutic alliance is to be salvaged.

Neither childhood trauma nor multiplicity should not prevent a trans person from accessing surgery or HRT

note: this section is primarily written for therapy related to dissociative identity disorder

Many people who wish to deny trans identities point to childhood trauma and use that to argue that the trans person is “confused” about their identity.  The generalized version of this is to look for any excuse to claim a trans person doesn’t know what is best for themselves because of any comorbid condition.  Trans people spend a long time questioning their identity before they are willing to reveal this to any medical professional.  If someone says they are trans, they are trans.  Do not attempt to deny the identity of a trans person because they are multiple or for any other reason.  Furthermore, recognize that trans people are competent and can make their own medical decisions even if they are multiple or have a history of childhood trauma.  Neither childhood trauma nor multiplicity should not prevent a trans person from accessing transition related medical care.  In particular, do not refuse to write your client a HRT/surgery letter because they are multiple or have a history of childhood trauma.

Do not repeatedly try to find a causal relationship between your client’s trans status and every other issue they work on with you

Not every issue a client has is related to gender.  If you continue to try to connect issues to gender and are wrong, you will deeply annoy your clients.  If you try to connect issues to gender and are right, your client may not be ready to see the connection.  Even if many issue are connected to gender, these issues are best explored when your client is ready.  Exploring gender and connected issues is a multi year process involving internalized transphobia, relations with others, and is not a simple process.  Let your client explore what issues are related to identity at their own pace and even if you think an issue is directly related to gender, it may be best to wait until they bring it up themselves.  Bringing up a gender related topic before your client is ready can harm the therapeutic alliance and cause them to react negatively even if your connection is correct.

Final thoughts

When interacting with trans clients, you are not just working against past histories, you are working with the entire history of the trans community and ways others are harmful to trans people.  Even if your intentions are wonderful, your actions must be considered in the broader scope of society.  Actions which are harmless in isolation can destroy a theraputic alliance if it parallels actions other take while being actively harmful to trans people.  For this reason, topics related to gender should be approached very carefully and with special attention paid to ensure you do not retraumatize a client.

For further reading, see this page by the Dissociation Initiative.