Multiple Pathways to DID Recovery

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Phase One and Symptom Management

As I’ve been doing more work with our therapist, K., I’ve been reviewing some of the tools I learned at Sheppard Pratt this go around.  Some visitors who have never heard of the skills I’ve brought home have been asking for a better understanding of what I’m referring to.  Before I start sharing these skills and how I use them, I thought I’d talk a little bit about why I use them.

Sheppard Pratt follows the Triphasic Model of Trauma Treatment.  The three phases are:

1. Safety and Stabilization – Establishing safety, Recognizing symptoms, Creating emotional stability
2. Processing Trauma Memories – Done in outpatient therapy, using Phase One skills to not be stuck in avoidance or overwhelmed with traumatic material.
3. Integration – Referring to an integrated understanding of the current day, present, healed self. Trauma is part of your life story, but not the main focus anymore. This does not refer to integration of alters or parts.

[Source, Adapted from Herman, 1992]

Since Sheppard Pratt is an inpatient hospital, their main goal is to return the patient to their outpatient team with Phase One goals of safety and stabilization accomplished.

Before learning skills, safety is paramount.  In our case, we had to work with parts and our inpatient team to identify who was unsafe, their thoughts about safety, and their reasons for a lack of motivation to remain safe.  As is always the case, we discover underneath the chaos of safety issues, an immense emotional pain.  Helpling parts understand this isn’t “bad” behavior, they aren’t in “trouble”, and most importantly they aren’t alone–that we don’t have to hurt the body anymore in order to be heard–is vital.

Once risky behaviors have been identified, and there is some kind of mutual safety agreement, and safety plan in place, we can begin working on symptom management.

Many of the symptom management skills are specifically learned in Phase One of trauma treatment.

Side Note: I feel it is important to be clear, here.  I have twelve years of trauma treatment under my belt.  Even after all this time, I learned helpful tools going back to Phase One.  There has been a wealth of research on DID over the past twelve years.  I had no idea I was missing out on skills.  Many of the skills gave me a sense of power and control back over my life.

Symptom Management skills are basically lumped together under the following categories:

1. Crisis Planning
2. Grounding techniques
3. Breathing/Meditation/Imagery
4. Medications (PRNs)
5. Addressing Co-occurring Disorders
6. Hospitalization if needed to prevent harm to self or others

Besides establishing safety, the overall goals of symptom management include (1) enhancing awareness, (2) emotion regulation, (3) decreasing affect (or part) phobia, (4) building distress tolerance, and (5) enhancing effectiveness in personal relationships (and with parts). [Source]

In the upcoming posts, I plan to talk a little bit more about what each category is, and the things I learned to support our DID System find things that worked.