 You can understand that, I think, Jackie, you could, how they may create another person to defend their vulnerable self and put their vulnerable self in hiding or compartment and let the other person function or take charge because it's a protective process. Definitely, it is yeah. ac yn fawr, ddweud, os yw amnesiant yn rhanolion, yn ymweld ydych chi'n fyddai'n credu i ddweud fwy yma, ddych chi'n ddweud beth yw ar yw, a ddweud hynny ddweud, oes yn ymddi'r gweithio chi'n amlwgodd. Mae Gwyrddol Gweithio'r Llyfridd, ychydig i'r ysbyt yng Nghymru. Roedden nhw, yn gweithio'r ysbyt a'r ysbyt yn ddweud yn ysbyt. Ysbyt yng nghymru. Ysbyt yng Nghymru. Welcome back to Episode 72 of the Therapy Show behind closed doors with myself Jackie Jones and the delightful Mr Bob Cook. I feel delightful today so that's fine. I'll take ownership of that term. That was a good one to pick then and what we're going to be talking about in this episode. He's working with multiple personality disorder. Yes, yes, yes. So back in the day I started training to be a psychotherapist in 1985. I did a cancer courses, one of the first cancer courses, sorry, certificate in cancer courses in 1984, started training to be a psychotherapist in 1995 at MetaNor Psychotherapy Training Institute in London. Did a whole training in transaction analysis then in 1992 I started to get interested in integrative psychotherapy. So around that time I started to get interested in what was called multiple personality disorder. It sort of became a specialized subject for me. I was very, very interested and I started and that fact I had two multiples. Well, I work in those days were called multiple multiples if you like people who were so fragmented they had different different selves put it that way. If we look at where we are now I don't know 32 years later of this. I was thinking about this before I came on air. When did the term multiple personality disorder start to be discarded at a new term of dissociated dissociative identity disorder start because that's what we call the whole term multiple personality disorder now dissociative identity disorder. I don't actually know. Maybe it was about 10 years ago. So when people talk about dissociative identity disorder as a sort of continuum. In my book, the really fragmented more psychotic end of it is multiple personality disorder. And then on the other end of it, more on the neurotic side of life, we all to extent have fragmented parts of ourselves or dissociated parts of ourselves that we have utilized in terms of coping mechanisms. But we talk about the really fragmented fragmented more psychotic end of the spectrum. That's what I would call multiple personality disorder. So when I'm talking about this in the podcast, I'm talking about the real end of the health continuum where you know the individual is so fragmented and so defended that they have developed different selves. That's really what was called multiple personality disorder. Would we generally see those in the therapy room? No, no, that's what I was thinking. Because this they usually that that that order that you're talking about, they usually have had or do have a life psychiatric history. And they usually on high medication, or they are dealt with in the community, if you know, in a way where they'd have psychiatrists that have different resources. And not only would you not see them in psychotherapy room, particularly, I don't know, well, it could be argued by many people that psychotherapy isn't particularly helpful for that end of the spectrum of dissociative identity disorder. So the answer is no. And back in 1992, when I was working with people highly fragmented, I did work, I think with people who were not necessarily right. Well, they were pretty towards the end of it, because you could argue that when somebody presents with such a fragmented sense of self, which is a different not sorry, which is a different self, we defended to cope with from the trauma that they the psychosis going on. So, you know, I did work with people, I think, who were the way they defended against the deep trauma was to create another self. Yeah. And clearly that way of coping against the trauma what comes with it is amnesia, losing time, forgetfulness of memory, high denial, fragmentation, disavowment of the self, where they're so unintegrated, that they create these entities or these selves. And if you work at that level, you'll probably find quite a lot of quite a number of selves. Yeah. I've watched films on it, but I don't really know anything else about it other than Well, part of the most famous book written back in there was a book called Sibyl. Yeah, that's what the one that I was thinking. Yeah. There's been some films or documentaries. There's been some very dramatic film, I think, about 2015. I can't remember what it was called, but it was, it was about, it was a more dramatic film about, you know, the self. Or was it called Split, I think. Right. Or Split. I didn't particularly enjoy it. There were some very good documentaries. Richard Erskine did a very good documentary on working with multiples. And if one of the, is it the Belgium Mental Health Award in 2012 or something, so which I've actually still got, may not be, might be earlier than 2012. So there are the, there are some resources around. I think I learned a lot on, you know, training with Richard and also doing or treating people at that level of dissociation, denial, fragmentation, unintegrated, split off parts of the self and how it was a way of coping with extreme trauma. Yeah. And I know in other podcasts we've spoke about, you know, integrating the self and, you know, that works well in psychotherapy. Would that, would that work with somebody with disassociative identity disorder? Yeah. Well, the theme working, working is of course integration. Yeah. That's the end goal. Yeah. Does it, can it work? That's not what we're talking about. Full integration. Probably not. Probably the working goal would be, for me, it would be that they know the different fragmented parts of self, so that they know that Joan exists or Polly exists or Frida exists, and they can talk to the different parts. They can talk to the different selves in a co-operative way so they can function. That's so interesting. Probably that would be a working. Thing is, if you start, how can I explain this, but if they, if you start working with a goal which is, say somebody has got, I don't know, let's have 10 different selves and each self is protecting different developmental levels of trauma. Yeah. It's been a way the person has coped so they could function as best they can today. Yeah. So certain selves might appear to help the person function in difficult situations, for example. If you start or have as a goal that they have to say goodbye to that part of this, that, you know, that self, say goodbye to Polly or say goodbye to Frederick or say goodbye to Alexander, they would find the grief to overwhelming. It's really interesting, really, because probably a agenda being hospitalised. Yeah. Multiple levels of grief. Because my understanding, and like I said, it has only been through watching films and things, is that they are real people with their own personality and look at it. Different voices and different actions and hold themselves differently. It's not like I like a lion in the morning, but I don't like getting up early. No, there'd be no I. That's why. Yeah. And the way to look at it is developmentally. So in other words, the other, in this case, has been created to protect from the traumas. The traumas at different developmental levels. Yeah. And these people in multiple languages will be called altars, ALTRS. So Fred might be an alter. Gene might be an alter. Joan might be an alter. But they were created at a certain amount, you know, at a certain time in their history, to protect the person from trauma. Yeah. So, for example, if somebody's been, you know, repeatedly sexually abused, they might create a warrior. Yeah. Yeah. Yeah. Warrior would take the abuse instead of the real self, for example. Um, so it's a coping mechanism. Yeah. So if you're working with a multiple, you would, one of the really good things to do is a psychological map. So he might start off with, I don't know, three. So say, you know, Frederick Alexander and Jane, and then he'd do a map where, you know, we'd look at what Jane might have another name called the servant or, you know, Frederick might be called the warrior and X might be called something else. And they would all be created to protect the self from trauma. Yeah. That's what they were created for. At different times. At different developmental times. Of the person's life. Yeah. Yeah. The different traumas they went through. Yeah. And usually, you may, it wouldn't be uncommon at all to find younger altars. So we had, say, Jane, Frederick and Alexander as the T, you know, older altars. You might find teenage altars, or you might find altars which were created at the age of seven or eight to deal with the younger trauma. Yeah. And so you need to, I used to always find it important to do a map because I couldn't keep it all in my head. Yeah. Understandably. I might find out there's 10 altars. And are they all connected? Yes, but no, no in terms of amnesia. In other words, he's usually a host, what we call a host altar, which can talk to some of the old tars, but, well, say there's nine, nine, nine altars can talk to perhaps nine altars and they'd become the chief mediator for time. But even, even then you might find other altars that the host altar didn't know about, as you do the therapy. Yeah. With civilised, I think it was 64 altars, but it was a high number anyway. It was a lot, yeah. Yeah. And like you say, all different ages in different sexes, you know, a female doesn't necessarily have all female altars. There's male there as well. Yeah. Yeah. And many of the altars don't know about the other existence of the other altars. Yeah. And as you do the therapy, they may start to meet. But the dialogue nearly always went through the host altar. So if you say James, the host altar, they would need to talk to Jack and Fred, and then they would introduce Jack to Fred. And that would be the level of communication. And all the time you are in fact, one of the clinical goals is that there would be a level of integration where they start to know about each other. And they can start to learn to mediate and talk to each other. So clinically, they would have dialogue, which would mean there would be hopefully more healthy internal dialogue. So the more they can talk to each other and know that the different parts are there, the more they can have it. In a dialogue, you're starting to move more towards not only the person knowing the host knowing the existence of these altars, but can help them talk to each other. And therefore, starting to understand what was probably so ununderstandable to them. It's so interesting what the mind can do to protect us when you think about it. It's amazing. And like you said, amnesia comes with it, so when the one person and then it's turning to another one, they don't remember anything about the last person that they were. Yeah, and another really big characteristic working with multiples is that they lose time. So they don't know where. They wake up, perhaps going, no, wake up, sorry. I'm using wake up in the clinic, because they'll find themselves, say, on a train going to Scotland, but they don't know how they got there. Example. Or they find themselves in bed with John, but then they don't know how they've gone, got to that situation. There are people usually who are highly traumatised, a really traumatic history. They're usually people who are highly promiscuous. They're usually people who have high amnesia. People who are fragmented often can be quite psychotic and high levels of dissociation and depersonalisation. But if you help them, help them understandable. In other words, if they can start making meaning of the different selves and they can talk to each other and create internal dialogue, they can get some understanding about functioning in a different way than they did before, for example, which can be more healthy. That's what I'm saying. I think the treatment of multiples at this level is more about that they can function more healthily as a team, if you like, yeah, rather than separate entities who didn't even know about each other. But we generally wouldn't see this in the therapy room? Not really. I mean, there's not many... Not so many with 10 different personalities anyway. There's not really many training, psychotherapy trainings that even cover this. Really, they covered dissociative identity disorder and they would train therapists in terms of health continuum, looking at traits of dissociation, traits of... But would they teach them right up to the top where you're looking at real fragmentation and multiple? It's like we're talking about here. Well, they might mention it, but I don't know how much they talk about the treatment of of working with type of cryotab properly because they not really possibly be working with that type of person. Unlike you, you started off this podcast. It's about being highly trained in that area. It's not like any one of us can just jump into doing, I would imagine it's quite overwhelming and there is a team that works with the person. That's what I mean. I bought... There's not that much written. I bought a very good book in 1993. So it's an old book by somebody called Cluffed, K-L-U-F-T, called Multiple Personality Disorder, which gave me a sort of treatment plan for working in the ways that I'm talking about here. One thing that's a useful read because it explains traits of dissociation, it explains how a person can be so fragmented that they actually create many different selves to cope with trauma and how you can treat them. Yeah. K-L-U-F-T, Multiple Personality Disorder. It's one of the best books on that I wrote, but it's an old book, 1992. I'm sure there's been others written since then on this subject, but that was one of my favourite books. An interesting read, I would imagine. Yeah, it is. On another dimension at all, when we're talking about trauma, people defend against trauma in many, many different ways. If there's multiple traumas, multiple type rapes, multiple levels of assault, you can understand there, I think Jackie could, how they may create another person to defend their vulnerable self and put their vulnerable self in hiding or compartment and let the other person function or take charge because it's a protective process. Definitely, it is. Particularly if there's amnesia involved in it, it's like I don't need to deal with this because Betty sorted that out and I don't need to go there. It's like I said, it amazes me what the mind can do. The mind is such a wonderful, wonderful instrument, especially in terms of protectiveness of the self. I think all the work I did with those types of people, one of the best things I did or learned to do was how different parts of the self become a team because then they could function in more healthy ways. It wasn't that I never went down the road and I don't think many people did, by the way, which is to say goodbye to these different parts of the self because it's too overwhelming. Yeah, and that's a really nice way of putting it because it's not about integrating them. It's about knowing that they're all there and working as a team. That's the way I went. Yeah, it sounds like fascinating work, though. Yeah, and it was because you are dealing with people being so violated, so graded, so traumatised. It's hard work in the sense that you go the extra mile, raining, you're listening to the most hideous histories. You need a lot of supervision and a lot of therapy yourself. Very rewarding, but when I look back at my professional career, I would say I'd work with two or three people and two particular people I can think of and what I'm talking about here. It's real courage to work at this level. I'm not just talking about the fact that I'm talking about actually the person. It takes a lot, lot of courage. You're there. Yeah, yeah. Well, something's flashed up. It takes a tremendous lot of courage. I was very fortunate to have the training I had and it was an amazing part of my life working with that type of population. I know you were saying then, looking at the client rather than you as a therapist, but for you as a therapist, it must have impacted on you. Tremendously working with people like that. Like you say, hearing the trauma and how it affected them and the fact that for protection, they had multiple personalities and everything. That's heavy going stuff for the therapist. Yeah, and with both with the people I think about, everyone in groups, psychotherapy groups and that for lots of different reasons. Because they needed many levels of protection and you couldn't do the work that I did in an hour. Yeah. So, you know, plus and also there's a lot of things you would have to put in place to work in the ways I'm talking about. But it enriched my career and I think was to say more acceptance, it was exhausting. One thing I would say, you need to have a high level of training to work at this level. Yeah. And again, I was fortunate to have that and to watch I also watched, I'm thinking of Richard who trained me, Richard Erskine trained me in many different ways, watching him work with this different population. Yeah. And I've still got that video, I think it was in, I don't know when it was. I think it was in the early 2000s, which won that award. It's called Denial, I think. I've got it somewhere. It's on an old VHS tape, so it must have been years ago actually. I haven't watched it for ages, but it's highly skilled work. Amazing. Today, you know, I saw it help me for further work as well because I knew what dissociation was, I knew what fragmentation was, I knew, saw them as coping mechanisms and how to work with them. And you're working with regression all the time. That means going back to the younger parts of the south. So I learned a lot. Yeah. Yeah. Because each one of those independently can be worked on, but it's when it's all together that it becomes a different entity. Yeah. And I spent 36 years as a group psychotherapist, running two or three groups every week. And that's the venue that you could work aggressively and work in the way I'm talking about. Yeah. Time. Yeah. Yeah. Because groups do run completely differently to just working with an individual. I also used to do five day, seven day psychotherapy intensives where we could do this deep type of aggressive work. Yeah. And so the therapy intensive was started nine o'clock in the morning and end up six o'clock at night for seven days. Wow. Yeah. And that's the venue where I could do this type of work. And then of course that's come back to the groups every week where we could work on integration protection and support. I don't know of nowadays, I don't hear that here of this type of work because I think largely because there's been a movement away from group psychotherapy. I've never worked in groups, I've never run groups. Couples and individuals but not groups. Yeah. Really important venue for aggressives working with regression where you've got more time to be able to work that way. Yeah. Say 50 minutes which is a small amount of time and in some ways you might argue less protective. Yeah. Yeah. Because you do even if you know I've been in a group for my own therapy but not run a group but even if you're just an observer in the group you get so much from being there when somebody else is talking. What a vicarious feeling. Yeah definitely. Yeah. And I think you know as I learned how to be a group psychotherapist and became proficient in that I then started to learn how to run three day psychotherapy intensives and five day psychotherapy intensives because I'd learned how to do it as you know I started off you know. Three hours in a group yeah. Yeah and of course I've been in these venues myself. Yeah. Yeah. Yeah so I had the model of how to do it. I've been trained how to do it and you don't hear much in the United Kingdom. Group psychotherapy seems to have disappeared to a large extent which I think is a great loss and sadness to psychotherapy fields. Yeah because there is a need for it. I thoroughly enjoyed being in a group. I think I was avoiding therapy. I think it was easier for me to avoid therapy in a group which again is part of the thing as the you know the therapist you've got to be aware of what everybody's doing within that group. And I run groups with eight people there. Yeah. Yeah. If we move that over to treatment of multiple personality disorders where I've been talking about it, it's like running group therapy. Yeah. Yeah. Yeah. It's easy because you'd have the different contrast with different altars. Yeah. I see it's mind boggling. Yeah. And no more talk about now to you and talk I talk about oh gosh I've worked in so many different ways that it was very enriching part of my career. Yeah. And the people listening this group psychotherapy I think enriched the psychotherapy field and I wish it was more in vogue. Yeah. Maybe we can resurrect it Bob. Maybe we can bring it back again. Yeah. I'm sure that I know there is group psychotherapy around. Don't get me wrong there's somebody in our institute who's group psychotherapy but it's not as popular as it was 10, 20. I mean when in the mid 90s it was very popular. Yeah. And I'm not sure why. Individual therapy seems to be much more in the vogue than group psychotherapy was and I think there's a real place for both. Yeah. So we'll leave it there Bob until next time. Yeah. Thank you. I thank you very much for allowing me to talk about this subject because I go away feeling. I suppose I go away feeling enriched to because I'm thinking of the memories and the things that we did in the client therapy arena and quite a humbling experience because it is be prepared to work with great trauma if you're going to work with this population. Yeah. I love listening to you talking about your stories because it's so valuable. Yes we can talk about the theory behind it but when you're talking about the situations that you've been in and how you worked with them and what happened and everything else it's invaluable for me as a therapist is. Oh thank you and I know off air we just said oh what should we talk about next so I'm going to send you two titles and people listening will just have to you know come along to the next podcast next week and join the excitement of listening to what we. Definitely. Yes it's a cliff anger. We're finishing on a cliff anger. Oh what a best way to. The best way I can think of. Definitely. Until next time Bob. Thank you so much. Yeah thank you. Bye bye. You've been listening to The Therapy Show behind closed doors podcast. We hope you enjoyed the show. Don't forget to subscribe and leave us a review. We'll be back next week with another episode.