WORKING WITH THE INNER SELF HELPER (ISH) DURING AND AFTER THERAPY Workshop Manual for The 12th Annual Fall Conference of The International Society for the Study of Dissociation Orlando, Florida September 14, 1995 by Ralph B. Allison, M.D. I. Multiple Personality Disorder (MPD) vs. Dissociative Identity Disorder (DID) If a child under the age of seven is treated so harshly that she must dissociate to survive, the first entity to become separate is that child's Essence. ("The spiritual nature of human beings, and regarded as immortal, separable from the body at death." Also known as the soul or spirit.) The Essence assesses the nature of the dangerous situation and then creates the first alter-personality, a "False-Front," to replace the Birth Personality (BP) as the one to be in executive charge of the body. This False-Front alter-personality is designed by the Essence to behave in such a manner that the abusive person (usually a parent) will cease his/her abuse, and the child can survive to adulthood. The BP is then "hidden" in the recesses of the patient's mind, unavailable for social functioning, until the person is well into psychotherapy with a trusted and ethical therapist. This creates a clinical condition that should be called MPD. When the first dissociation occurs before the age of seven, the Essence will then take on the role of Inner Self Helper (ISH), which is akin to fireman, policeman and repairman, as she is responsible for keeping her "charge" alive into adulthood. (Since the Essence/ISH has no gender, she is unconcerned about the gender-based words used to describe her tasks.) From then on, the ISH is a spiritual being, separate from the patient's "emotional mind," who can talk to the False-Front alter-personality inside her head, advising her on how to deal with the problems of living. If the first dissociation occurs after the seventh birthday, the BP is usually sufficiently mature to withstand the assault and will maintain social control of the body. In that case, the Essence will manufacture the type of alter-personality that will meet the protective needs of her "charge" so that the person can continue living longer. In this case, the ISH will not appear naturally, and this function can only be accessed artificially under hypnosis. This creates a clinical condition that should be called DID. II. Types of Alter-Personalities Seen in MPD A. False-Fronts: These are the alter-personalities that are designed for everyday social functioning. They are created by the ISH as "computer programs" with a limited array of abilities, which are seen as essential for survival in that family at that time. They therefore become obsolete as the family structure changes and the child grows up physically, socially and educationally. Each immature False-Front is replaced by a more mature one, in time, but it "stays on the shelf" until integrated during psychotherapy in adulthood. Usually, these alter-personalities will not be able to process negative emotions such as anger. If the abuse continues, they will develop anger, which they cannot deal with, so the ISH must then create an alter-personality able to be angry. This leads to the subsequent development of the Persecutor alter-personalities. B. Persecutors: These alter-personalities are designed to accept, hold, process and express forbidden negative emotions, since the False-Fronts have no capacity for such feelings. They see the abuser as the enemy of their host personality and of themselves. They commonly make themselves as clones of the abuser, illustrating the defense mechanism of "identification with the aggressor." The reasoning behind this move is that, if one is the abuser, then one cannot be killed by that abuser. So they make an abusive alter-personality who is just like the hated parent, for example, and who does to others exactly what the hated parent has done to them. It is with these Persecutors that most of the reconstructive therapy time must be conducted, so that they can be neutralized and then integrated with the BP. C. Helpers: When a Persecutor has been created by the ISH, it will inevitably cause such social trouble that the patient, or others, are in danger of physical harm. In that case, the balance of forces is maintained by the ISH creating a specific Helper alter-personality who is assigned to clean up the mess of that Persecutor. Its primary role is usually suicide prevention, and it is the one who can be called on by medical staff to aid in assessing suicidal risk or taking action when a suicidal attempt has been made. Other Helpers will be created to attend school or go to work. D. Handicapped: Some alter-personalities will be developed with "useful" handicaps, such as deafness to avoid hearing parents arguing. E. Identifiers: Some alter-personalities will be developed by identification with other persons, such as playmates or helpful caretakers. These may be confusing to understand until one learns the nature of the person identified with and their relationship to the patient at that earlier date. III. Characteristics of the Inner Self Helper (ISH) A. Prime Directive of the ISH is to keep patient alive until her Life Plan is completed and fulfilled. The ISH will prevent suicide in any way possible. B. Has no date of origin; has always been present. C. Can only agape love; is incapable of hatred. D. Has awareness of and belief in "The Creator." E. Is aware that the Celestial Intelligent Energy (CIE) put her in charge of teaching this person how to live and move forward properly. F. Is able to work on the inside of the patient's mind, as co-therapist, while the human therapist works on the outside. G. Knows all about history of patient and can predict short term future. H. Possesses no personal sense of gender identity, but will assume either gender the therapist is comfortable with. I. Talks intellectually instead of emotionally, carefully chooses precise words, speaks in short concise sentences; prefers to answer questions; gives enigmatic instructions. ("Teach her humility today.") J. Avoids using slang; does not have the capacity for put-downs or guilt-trips. K. Is aware of patient's past lifetimes. IV. Stages of Psychotherapy of MPD A. Recognition of the existence of the alter-personalities. As the therapist identifies the alter-personalities, he must inform the patient of what he is seeing, with minimal emotional overlay. The patient must be informed as to what she is doing publicly, so that she will intellectually know what is causing her social and psychological problems. Use of Inner Dialogue is useful, with alter-personalities talking to each other while the patient is in trance. Sometimes the ISH will then have a chance to talk to the alter-personalities, and tape recordings of this "conversations" can be used by the therapist to reinforce therapeutic recommendations. As acting out is part of the therapy process, the ISH will only intervene if the acting out will either hurt her "charge," or cause the therapist undue stress or bodily harm. SPECIAL TECHNIQUE: TOUCH ON THE FOREHEAD: If a hostile acting out Persecutor alter-personality is endangering the therapist, he can bring out a Helper by touching (not hitting) the patient in the middle of the forehead with one finger. This will activate the "frontal chakra" that is the "site" where the ISH resides. The ISH can then more easily take charge, usually by sending out the appropriate Helper alter-personality to stop the dangerous behavior. B. Intellectual Acceptance of This Condition. If the patient commits herself to therapy and develops a strong positive relationship with the therapist, she will tend to accept what he says about what he sees during her amnestic spells as "probably true." She will accept his statement that he is meeting with alter-personalities with an attitude that "if he says so, it must be true," but she will not believe it "in her gut." She agrees with the therapist's statements "as if" they are true, because she doesn't want to argue with him. After all, he is the expert, so he ought to know what he is doing. During this preliminary phase, the therapist will be trying to gather as much information as he can about the history of his patient. But he must remember that each of the alter-personalities has been "programmed" differently by the ISH and not all will have been designed to tell the truth. Some will have been programmed "to get the doctor's attention." In that case, the alter-personality will tell an outrageous story that is guaranteed to keep the doctor interested, but the story will be stretched far beyond any credible limits. Double checking from other sources will be essential before the therapist commits to any action based on that story. This must be done discretely, as therapy can come to a standstill if the therapist decides to become a detective. Other alter-personalities, such as the Helpers, will tell the truth about what is happening now, whereas the Persecutors will hide and distort their reports of their acting out. The Persecutors want to be known for what trouble they can cause, but they don't want to give the therapists enough information to force him to put limits on their activities. Accurate history of early abuse may be very difficult to get without guidance from the ISH. The therapist must remember which of the alter-personalities were in existence when the abuse took place that created a certain Persecutor. The Persecutor was not yet created, so she would not be a credible historian. Her balancing Helper was not yet made, either, so she would only know from the "community memory." The ISH was around and knows what happened, and she is the final resource if none of the alter-personalities will give a straight story. But the ISH will always prefer that one of the alter-personalities involved in the historical episode give her own history, as that is needed for corrective therapy to be done. The ISH can tell the therapist which alter-personality needs to tell the story, and then the therapist has the responsibility of calling out that alter-personality and persuading her (but not bullying her) to divulge the information he needs to understand why the Persecutor under review was created. The alter-personality to do this reporting is the False-Front one that was in charge of the body at that time, and therefore was the one assaulted by the abuser at that time. Sometimes that particular False-Front alter-personality is available to be called out and quizzed, but sometimes it will be necessary to get her in an age-regressed state. It is essential that all therapists of MPD feel comfortable age-regressing their patients, and all patients with MPD are easily hypnotized and age-regressed. The therapist is the one who guides the patient to the correct time and place. He then acts the appropriate role so that the facts of the abusive situation can be described in sufficient detail to explain the origin of the Persecutor under evaluation. Usually, the age of the abuse will have been mentioned by one of the alter-personalities already interviewed, so the therapist need only ask the patient to go into trance and go back in time as he counts backwards. He then counts backward from the present age of the patient to the age when the abusive situation occurred and asks her to be that age when she opens her eyes. Usually, the patient will then open her eyes, and orient herself, as if she had not been there before. She will act as a child of that age, and will think the calendar on the wall must be wrong. The therapist can then discuss with his "young patient" whatever bothers her at the moment, and she will tell him the facts of the abusive situation. All that is being said by this age-regressed False-Front alter-personality is being orchestrated from behind the scenes by the ISH. The ISH tells the patient that this person is one to be trusted with these family secrets, since she has usually been threatened with death if she ever tells anyone. The ISH tells the patient what details to explain, and only allows the patient to explain the broad outline of the abusive situation, as too many details would overwhelm the alter-personality. When the alter-personality has given the therapist enough for him to know how to conduct further therapy, the ISH will terminate the session, often by making the alter-personality sleepy. She will then ask if she can go now. That type of comment is the ISH's signal that the story has been told, and the therapist is then to "age-progress" the patient to the chronological age. It is important for the therapist to avoid pushing or bullying the patient to give a full description of the abuse situation. Only the framework is needed for the therapist to understand the meaning of the situation to the patient. The ISH will not let her remember more than the skeletal details at that time. Sessions like this will need to be done over and over, to collect the information about the various abusive situations that the therapist needs to know about so that he can conduct his sessions without further traumatizing his patient. Without this information, he could easily stumble and set up situations where he would be introducing subjects that would be very traumatizing to the patient, but he would have no idea why. The ISH is the one who is orchestrating which Persecutor alter-personality will be on stage at any one time. The ISH will send out that Persecutor to harass and bother the therapist over and over again, and it is she who will be behind the suicide attempts. When the therapist has done his work and understands the origin of that Persecutor, he can then conduct the necessary corrective actions (as described below). Then, in the waning days of the reign of that Persecutor, the next Persecutor will be shoved forward by the ISH. She will scream her introduction to him just as he is finishing therapy with her predecessor. The therapist will then know who is due to be on stage for him to deal with next, and he need waste no time asking question about which Persecutor should be his "primary" patient next. C. Coordination of Alter-Personalities. All during this introductory phase of therapy, the therapist has been negotiating with the various alter-personalities and introducing them to each other. What needs to be developed is a cooperative enterprise, with each of the alter-personalities aware of the others and of their own roles and responsibilities. Not only does this prolong the life of the patient, by setting up the best suicide prevention procedures, but it dissolves much of the amnestic barriers that has been separating the various alter-personalities. That is therapeutic in itself. No longer can the excuse of ignorance of what is going on be permitted for any alter-personality. The Helper alter-personalities are the main group to be organized. The ISH may bring into the arena Helpers who retired long ago, but who are still able to counteract one of the powerful Persecutors. The ISH also has the ability to create new Helpers, if no old ones are available for recall to duty. All of these Helpers need to have clear assignments from both the ISH and the therapist, each of who will have a different, but complementary, view of the situation. D. Emotional Acceptance of Multiplicity. At some point while the patient and therapist have been busy conducting this phase of therapy, events will happen in the life of the patient that she cannot ignore and gloss over any more. These will involve people in her inner circle of friends, possibly, people who she knows would not lie to her. One of them might tell her that she insulted them, but the patient has no memory of the incident. Or the patient might find some dirty hitchhikers in her car, and she knows she would never let anyone that filthy get into her car! Such situations that occur apparently spontaneously outside the therapy hour finally cannot be ignored by the False-Front alter-personality whose role it is to be the "identified patient." Actually, what has happened is that the ISH has set up these situations to happen as they did, for the sole purpose of convincing her "charge" that the therapist's diagnosis of MPD was absolutely correct. This "gut feeling" of the accuracy of the diagnosis is essential to keep the patient in therapy, as the time for therapy to really hurt has come. Now that therapy will be painful, the patient must be fully committed to change and willing to give up everything to get well. Only if she and the therapist are together in accepting the diagnosis of MPD can they both do their parts in the difficult times that lie ahead. E. Neutralization of Persecutors. During this phase the therapist must conduct organized age-regression psychotherapy, which is the key method for neutralizing the Persecutor alter-personalities, who are the ones making most of the trouble in the community and treatment center. SPECIAL TECHNIQUE: HYPNOTIC AGE-REGRESSION All patients with MPD are highly hypnotizable persons, so they should be able to age regress easily. Usually they will do a full "age revivification," during which they will appear to be the child they were at the age specified by the therapist. The therapist must be the one to structure the age-regression sessions and must have an outline and a plan in mind, on paper. To start, he can ask the patient to go into trance and then let one index finger rise when he mentions an age at which a major traumatic event occurred which caused the creation of an alter-personality. He can start at either zero (birth) or the patient's current age and count forward or backward, watching for her finger to rise. If he writes down the ages when the finger rose, then he will have the list of ages he must address in age-regression sessions in the future. It is best to start with the youngest age first, so that the therapist can learn the family style, the types of abuse suffered, and the way in which the patient responded to this abusive behavior by caretakers. If he makes an error that will sidetrack therapy, the ISH will come out, interrupt, and politely advise him on how to proceed more appropriately. The ISH is managing the drama from behind the scenes and knows which alter-personality should be out when, so cooperation between the therapist and the ISH is essential for this process to work as it should. For each Persecutor alter-personality, there is a step by step process that should be followed, once that alter-personality is the one involved in the neutralization procedure. Leaving out any of these steps will make the entire process useless and the alter-personality will be reactivated later on. ABREACTION = the expression of forgotten material in the presence of a therapist. With the False-Front alter-personality present, at the age of creation of the designated Persecutor alter-personality, the therapist discusses with that False-Front just what has been going on in the life of the young patient at the time leading up to the creation of the Persecutor. She will tell him, as a family friend, just what the trouble is, who the abusers are, and what the conflict situation involves. The therapist then can act like a psychotherapist of a child having such a problem, being careful to use words and actions that fit into the age-regression situation. For example, the therapist might be acting the role of the kind family doctor talking to an eight-year-old child. He must remember that, for the child, her parents may be sitting in his waiting room for her to come out, so he must talk accordingly. The therapist must always be mindful of the emotional age of his patient, even though she is in an adult body. The therapist could be talking to a two year old child or a six month old infant. REFRAMING = Finding a more positive point of view of the conflict situation. The therapist must propose a view that will encourage the patient to neutralize her conflictual feelings. He must suggest at least a neutral way for the now-adult patient to view her role in the abusive drama. If he can't think of one, he should consult with the ISH who will suggest some alternatives the patient can accept. SPECIAL TECHNIQUE: Freezing the Frame and Reading the Abuser's Mind With the patient in an age-regression trance state and reliving the traumatic situation, it is possible for the therapist to suggest a number of ways for her to review the situation. A common misconception of the "child-patient" is that she did something bad that gave her abusive parent a good reason to punish her so severely. She assumes that the parent is acting appropriately in this "disciplinary" action. To give the "child-patient" a different viewpoint, one that is hers and not the therapist's, the therapist can ask her to relive the abusive scene as it unfolds, but to freeze the frame as she sees the abuser approaching her, ready to "punish" her. She is then instructed to go into the abuser's mind, read his thoughts and become aware of what emotions he is feeling at that moment. Inevitably, and without any prompting from the therapist, the "child-patient" will report that the abuser is angry at some other adult in the household, is drunk and angry at being rejected or put down, and is displacing that anger onto the defenseless "child-patient." This new insight that the abuser was not really angry at her, or disciplining her, is usually enough to change her attitude about the abuser. No longer does she hate him for disciplining her so harshly, as she realizes the other factors that drove him to such excessive behavior. The main improvement is the elimination of the self-condemnation and guilty feelings the "child-patient" has carried all these years about herself being the cause of the "well-deserved" abuse. She sees the abuser as another human being who is upset, intoxicated, mean, mentally ill, or whatever seems to be the situation to her. The fact that she discovers these "facts" herself is most important. If the therapist were to suggest them to her, she would then not be sure if they were true in her case. But when she reads the abuser's mind herself, she knows that what she is getting are true facts in her case. ACCEPTANCE = "Owning" the traumatic memory and its associated emotions by the adult patient. After each story of trauma is revealed, the therapist next age-progresses the patient to the present age and explains to the adult false-front alter-personality what she described while age-regressed. He repeats the basic plot of how and why that "evil psychic sibling" was created. Then he urges her to accept the history as hers and to feel a sample of the pain she had experienced at the time of the incident. If she refuses to do so, he should consult with the ISH to find out what they need to do so that she will agree to "own" this memory and its associated Emotional Overlay. The ISH will then suggest some further action that might overcome the objections the patient has to accepting that particular abuse situation. This process cannot be rushed. DISCHARGE = Release of negative emotions from the patient. SPECIAL TECHNIQUE: THE BOTTLE TECHNIQUE: Some physical object must be available, which can be discarded afterwards, and which will not be dangerous if thrown on the floor. An empty baby food bottle is all right if there is a carpet on the floor, but otherwise the therapist should use something like an empty soft drink can, which can be crushed and thrown without much danger to people or furniture. The therapist first asks the patient if she is ready to get rid of the "anger energy" that has been stored in her ever since the trauma now brought into consciousness. If she agrees, a discardable object is put between her hands where she can hold it tightly. The therapist tells her to go into trance and imagine that she is moving all that anger energy out of the her head, arms, legs, chest, trunk and pelvis into that bottle or can. If the imagery is successful, she will appear to squeeze all her anger energy into the bottle, which will then feel hot to her, and she may throw it on the floor. What is happening is that she is being asked to form a "thought-form" that is made up of her "anger-energy" from the assault. She is directing this energy into the bottle, to fill it and the space around it with the thought-form representing her hatred of the abuser. The therapist must respect the "reality" of this ritual, and take care not to let anyone else use that disposable object for any purpose. He must be sure that it goes into the trash and is disposed of as if it were a toxic chemical container. The surest way is to place the object in a sealable plastic bag prior to placement in the trash container. Since Nature abhors a vacuum, after the negative energy is transferred to the bottle, the patient needs to be filled with positive emotional energy. The therapist does this by telling the alter-personality to open up the top of her head (her coronal chakra) and let the loving agape energy of the universe come into her head, body and limbs, to fill all the space that was previously filled with anger and hate. This "space" is now available for love energy. If this isn't done, the vacuum will be filled with anger energy overflowing from some other Persecutor alter-personality. If the therapist does not perform these steps, and feel comfortable in doing so, the patient will remain dissociated until all these steps are accomplished. F. Psychological Integration If the therapist and the ISH are working "hand in glove," the therapy is proceeding towards integration of all the alter-personalities into the BP. As each Persecutor alter-personality is presented to the therapist by the ISH, the therapist age-regresses the appropriate False-Front alter-personality and discovers the key abusive situation that made necessary the creation of that Persecutor. Having followed the steps outlined above, each Persecutor has been converted into a Helper, who is then standing on the sidelines waiting for the time of integration to arrive. When all Persecutors have been so neutralized, then the stage is set for Psychological Integration. Before that can happen, the Birth Personality (BP) must be presented by the ISH to the therapist, during a "coming out party." The BP will have been hidden away for several decades, without any personality characteristics attached to her. (They were all attached to various alter-personalities who were acting on her behalf.) The ISH must carefully bring the BP forward to meet the therapist in a safe situation, and make sure that they become close friends. The therapist must be the most gentle, kind, compassionate adult possible, as he will be the primary contact person whom this baby BP will meet. It is his views that she will accept. She will see the world through his eyes initially. The phase of "Basic Trust" is happening now, and the therapist must be ethical, trustworthy and appropriately parental. Depending on how old the BP is, the ISH will integrate into her all the characteristics of the various alter-personalities who did her work for her during the early years. She will absorb the characteristics that she would have developed in her infancy if she had been allowed to grow up normally. The therapist need not be involved in this process, other than to provide an environment, such as a safe hospital room, where the initial stages of integration can be accomplished inside the patient's mind. When this initial phase of personality integration has been accomplished by the ISH, and the BP is matured enough to spend some time in society, then the next phase needs to be organized between the therapist and the ISH. Certain alter-personalities may, in the judgement of the ISH, need to be absorbed by the BP first, and others later. At the moment, the latest False-Front alter-personality is still the socially active "patient." She may suddenly fail to function, requiring a safe hospital environment, where the integration can proceed, alter-personality by alter-personality. Exactly how this proceeds is up to the judgement of the ISH who is sending the rehabilitated former Persecutors out to announce what they are now giving to the BP as they give up their independence. The Helpers, likewise, are now obsolete, so they give her their positive characteristics, as well. When all of the alter-personalities have been accounted for, the therapist is then left with one patient and one ISH. G. Post-Fusion Experiences. Once the patient with MPD is integrated, she is one inside her mind, and still can hear her ISH talking to her about what she needs to do next. Emotionally, she is at the age where she stopped maturing initially, whether that be at age six months or six years. Now she has the full capacity of any human being to grow, learn, mature, develop and progress with her Life Plan. Since her Essence now can stop playing the role of the ISH, "she" returns to being the Essence of an integrated individual. The Essence is a teacher, an advisor, a warner of danger, a guide to proper conduct in life. The ex-multiple no longer needs an ISH, as she is not now in danger of being annihilated, as she was in childhood. She now lives in an adult world and has the rights, privileges, and responsibilities of an adult in her native society. Most importantly, therapy now takes on a completely different complexion. No longer is the psychoanalytic review of history necessary, as all the parts are now in place and history begins with the present and leads to the future. Now the patient needs the guidance any "child of that age" needs from the adults in the world around her. Her social and economic self may be in her thirties or forties, but her emotional self is still in childhood. Only her Essence is with her 24 hours a day, seven days a week. The therapist now becomes a social service organizer, a teacher of coping skills, and a feedback provider. However, the patient's Essence still is dissociated and can come out and talk with the therapist whenever the need exists. For every task that the patient has mishandled while her body was under the control of a False-Front alter-personality, as the integrated person, she now faces exactly the same types of situations so that she can cope with it as she is today. The Essence is very busy now setting up conflict situations so that her "charge" has the opportunity to face and overcome all the obstacles she faced and failed to overcome as a dissociated person. She may face another marriage to an abusive husband. She may be offered the narcotic drugs she had been addicted to. She may be faced with co-workers who are harassing and backbiting. Whatever she faced as a multiple and failed to cope with adequately, she will again face as an integrated person. But now she has the assistance of her Essence and her therapist to guide her to better resolutions. Her development through the usual steps to personal maturity cannot be hurried. It will take her one calendar year to add one year of maturity. She will have two birthdays, one for her chronological age and one for her emotional maturity age. She will have to grow up to an adult emotional age in the mid-20's before her Essence will consider her mature and ready for Spiritual Integration. By this time, she should have learned all that her Essence would have taught her in the normal course of personality development, so she and her Essence can return to the state of union that characterized their relationship at birth. H. Spiritual Integration Spiritual Integration is the combining of the Essence with the emotional mind of the ex-patient. The Essence and the person's "emotional mind" were as two metals alloyed together at the start of that person's life. The Essence's strongest desire is to return to that state of union with her "charge," and that is accomplished in this final stage of healing. This will occur quietly and without notice in an integrated person who has been listening to her Essence all along, has accepted what her Essence has told her as truthful, and who has passed all the tests in the "School of Hard Knocks." But, for the integrated person who has fought her Essence all the way, wants to do it on her own and not listen to her Essence, Spiritual Integration will be loud and boistrous inside in the mind. Such would occur if the patient and therapist are no longer in touch with each other, which is likely to happen if many years have passed since therapy began. The Essence has been working since the first disintegration to come back full-circle to be one with the integrated person now. She has worked diligently, following advice from her supervisors to finally get to this point. The Essence becomes one with her "charge," and the two will never be separated again. 

  Copyright© 2018 - Ralph B. Allison