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Ralph B. Allison:
A RATIONAL PSYCHOTHERAPY
PLAN FOR MULTIPLICITY

Delta „r den tredje och sista artikeln om multipla
personligheter.  Tidigare artiklar har varit inf”rda i nr 6/77
(When the Psychic Glue Dissolves) och nr 2/78 (On Discovering
Multiplicity).  V„sentliga delar av den behandlingsplan som
beskrivs nedan har anv„nts av andra terapeuter med gott
resultat.  F”r de som f”rs”ker hj„lpa patienter med multipla
personligheter, f”rest†s denna behandlingsplan som en allm„n,
men bell logisk, skissering av de faser som m†ste upptr„da f”r
att den naturliga helande processen ska fortg† hos en patient
med multipla personligheter.

The severe mental disorder in which individuals cope with life's
problems by splitting off a portion of their consciousness, thus
creating several different alter-personalities, has been
approached in different ways by those therapists who have
written of their work.  However, since most case reports in the
literature are concerning the first such patient the author ever
treated, the treatment methods were naturally based on their
prior training and experiences with non-dissociated patients. 
Only one article given broad guidelines for therapists, and yet
those authors focus mainly on what to avoid doing (Bowers, et
al. 1971),

Between the years 1972 and 1978, the author personally treated
36 patients with multiplicity, the condition which allows one to
make alter-personalities.  He was the primary therapist for all
patients.  Twenty-four, or 2/3, were brought to the desired goal
of total personality fusion or integration.  The other 12, or
1/3, dropped out of treatment, left the area, or died.  During
the years I was working with these patients, it became evident
that any patient's successful treatment plan had to include
certain basic ingredients which I will outline below.

For the purposes of literary clarity, I will refer to patients
In the feminine gender, since 85% of my patients were women. 
The few men treated had all been involved in serious legal
problems, several having spent decades in various prisons.  From
their stories, one can speculate that many more male multiples
find their way to prison than to private psychiatrists' offices.
 They are there in greater numbers than 15% suggests, but one
would have to do case finding in courts, jails and prisons to
find them.

TYPES OF ALTER-PERSONALITIES.

Before outlining the therapy plan, it is necessary to understand
the nature of the several types of alter-personalities, or ego
states, which may be manifested when active treatment with
hypnotic techniques is undertaken.  The most common reason for
such a patient coming to treatment is because of the behavior of
a very negative hostile personality, the "Persecutor."  This one
was created at an early age when the patient, as a young child,
became angry at a beloved parental figure who did something to
hurt her mentally or physically.  The child could not accept the
responsibility of having such anger and repressed it, creating a
nucleus for a hostile alter-personality.  Subsequent episodes
generated more anger, which was again repressed, until the
complex of angry feelings and paranoid attitudes became
sufficiently empowered and dissociated from the rest of the
unconscious mind that it could come out, control the body and
express the child's anger.  This often occurred with amnesia for
the event on the part of the original personality, or ego.  Then
the child was chastised and punished for being so naughty. 
Since the child remembered nothing about the incident, she
became angry at the "unfair" accusations and fed the energy
supply of the Persecutor even more.  Thus a vicious cycle was
established which was continued into adulthood.

Most commonly the next emotion to be repressed and dissociated
is the erotic sexual drive, mixed with anger from a child
molestation or rape.  This is likely to create a hostile seducer
who, in the case of a woman. uses sexual seductiveness as a tool
for controlling and degrading men, just as the girl-child was
controlled and degraded by the mate seducer, an example of
identification with the aggressor.  This Persecutor mixes sex
with anger and sexualizes all relationships she has, but never
in a loving way.

When two such Persecutors have been created, the control
mechanism is now out of balance, since the original personality,
the one the patient was born with, is now outnumbered. 
Therefore, a "Rescuer" alter-personality must be created, often
from an imaginary playmate.  This one may also express righteous
indignation toward exploiters of the patient, but not the
murderous rage of the Persecutor.  The Rescuer may be a smooth
talker to get the patient out of legal difficulties and may take
control of the body to prevent suicide or homicide which a
Persecutor is about to commit.  There may or may not be amnesia
for the Rescuer's actions, as there is nothing emotionally
objectionable requiring repression.  The patient will state that
she just found herself doing an act which got her out of the
difficulty, but didn't know why she thought to do it. It was as
if she was watching someone else operate her body for a while as
she extricated herself from the difficult situation.

If the first splitting off of a Persecutor is before the age
when the personality is fully formed, about the age 8, the
emotional trauma which caused the creation of the Persecutor may
also drive the original personality into retreat in some deep
recess of the mind.  Then a substitute for the original
personality must be formed, a False Front personality.  This one
is known to the family as the patient, but she is very neurotic,
with many phobias, spells of depression and poor coping
abilities.  This one has the tendency to splinter, thus creating
many "ego-states" or personality fragments, each with very
limited characteristics.  This False Front personality will,
most likely, be the one who comes for help to the
psychotherapist, with complaints of depression, headaches and
blackouts.  She is very fragile, being an alter-personality
herself, and having very little depth and substance to her.

In such a case, the original personality is fixated at the age
level when the first split occurred, usually between the ages of
two and five.  She is described by the other personalities as a
very frightened and shy little one, but one who is pure at
heart.  She will not come out until therapy is underway when she
feels she will not be endangered by the adults in the real
world.  Often, she feels one or both of her parents are so
unworthy of trust and love, she must reject them, as they
rejected her, and she will adopt a person in today's world, such
as a nurse, as a substitute parent.  This is much more than
psychoanalytic transference.  The adult in today's world is her
parent in her mind and must behave in such a way that the
patient can grow through the dependency phase into one of adult
independence and freedom from this parental figure.  It is not
wise for the primary therapist to accept this role, as the role
of a therapist in quite different from that of a parent. and one
person cannot do both well.

The other psychic entity  which  may  show  itself  during 
therapy  is  one  I  have  come to call the Inner Self Helper or ISH.  This Is an entity which
is the same as the Transpersonal Self of Assagioli (1965) or
Jung's Philemon (1965).  We all have one but the multiple
disconnects hers from the rest of the psychic apparatus so that
it can operate as the Master Rescuer and Guide.  It is much more
than the superego of Freud.  One ISH's self-definition is as
follows- "I have many functions.  I am the conscience.  I am the
punisher, if need be.  I am the teacher, the answerer of
questions.  I am what she will be, although never completely,
for she has her emotional outlets whichI do not need.  But she
will have my reasoning ability and my ability to look at things
objectively.  I will always be here and I will always be
separate, but the kind of separateness which is yours, a oneness
with a very fine line of distinction.  An emergency backup,
perhaps.  I must be the ability to know.  If I am gone, she is
just a body.  She can send part of me off and leave a small
portion.  But if all is taken, she in a shell.  Now my function
is overseer to the dump.  I am kept busy sorting out the
different messes and problems created between the
alter-personalities.

The ISH has no date of creation; it has always been there since
birth, as the spiritual side of the personality.  It can only
love.  It knows all of the past history of thepatient, In this
lifetime and in others.  It is aware of the helpers above it,
one of whom has the answer to any question.  It has no sense of
personal sexual identity, but uses whatever sexual designation
the main personality chooses for it.  It is willing to talk to
the therapist, but usually it will only answer questions and
give instructions.  Seldom can the therapist engage an ISH in a
social discussion.  The length of time an ISH can be out, in
control of the body, is about 20 minutes, as its physical
functioning is very draining on the patient.  Therefore. it will
only come out at times of extreme emergency or on the request of
the therapist.  It never willcome out to prove its existence to
a doubting Thomas, since it knows it exists and sees no need to
prove it to anyone else.  To conserve energy and guarantee
accuracy, it may pass on messages in written form via automatic
writing in the patient's diary.

THE PSYCHOTHERAPY PLAN

The therapy plan can best be understood as being composed of
eight intertwining stages, which usually occur in the order
listed below:
1.	Recognition of the existence of the alter-personalities
2.	Intellectual acceptance of having multiple personalities
3.	Coordination of alter-personalities
4.	Emotional acceptance of being multiple
5.	Elimination of Persecutors
6.	Psychological fusion
7.	Spiritual fusion
8.	Post- fusion experiences.

For those trained in the profession of medicine, it is much like
dealing with any patient with a physical disease.  There must be
a correct diagnosis made, which is then explained to the
patient.  The patient must accept the accuracy of the diagnosis
to agree to cooperate in the treatment plan.  Since the main
psychological defense mechanisms used by multiples are denial,
repression and dissociation, an approach of openness, education
and expectation of active participation is needed to counteract
these tendencies.

1. ) Recognition of the Existence of Alter-Personalities.

The patient must be informed, gently but truthfully, of whatever
the therapist finds out, such the the reason for the blackout
spells and who comes out in the trance.  The patient may ask the
therapist to find on why she insulted her best friend during a
blackout.  When the therapist induces a hypnotic trance and
calls for whatever part of the mind knows the reason, some
alter-personality will come out to explain or confess. 
Video-taping, audiotaping, and quick developing photographs can
be used to record the appearance of this entity.  When the
patient returns to consciousness, these records can then be
shown to the patient when she is ready and willing to learn the
facts.  An internal dialogue (Allison, 1974) can be requested,
out loud, between the main personality and the one who knows
about the event.  In this way the therapist learns almost as
much as the patient does about the attitudes and moods of the
alter-personalities and the relationships between them. 
Automatic writing may be the easiest way to establish such
cross-comnmunication and also provides a permanent record of the
various alter-personalities' handwriting.

Regardless of what mechanical methods are used to show the
patient the data available to the therapist, no amount of
convincing evidence is ever enough to really persuade the
patient that this is not all a fantasy (which it is, from
another point of view. ) But confrontation must be done so that
the patient is allowed to be aware ofhe same data which is
available to the therapist.  Eventually, this will lead into the
second stage of treatment.

2. ) Intellectual Acceptance of Having Multiple Personalities.

As the patient comes to trust the therapist and realizes that
the therapist is honestly reporting that alter-personalities are
working while the patient is unconscious, she will develop an
intellectual acceptance of being multiple.  This is a very
difficult diagnosis for most patients to accept, and any doubt
expressed by relatives or friends will be seized upon to
undermine the therapist's opinion.  She does not really believe
it, but is willing to act as if it is true.  This is the point
when definitive psychotherapy can begin.  As the therapist
identifies the Persecutors. the patient superficially accepts
their existence and agrees to do whatever the therapist advises
in order to eliminate the danger of bodily harm they represent.

The most efficient way to proceed with psychotherapy is under
age regression or revivification.  First, one must make a list
of the ages important in the creation and strengthening of the
most dangerous persecutor.  To do this, the patient is asked to
close her eyes, relax and let one index finger be raised by the
part of the unconscious mind that knows these ages.  As the
therapist counts from zero to the patient's current age, the
ages indicated by the finger raising are noted on paper.  Then,
the patient is asked to grow younger, while the therapist counts
backwards from the current age, and to stop at the age at which
the therapist stops counting.  This age is the first one
indicated by the finger signal and, when the therapist asks
firmly to talk with "the five year old Margaret, " it is often
as if one is really talking to a five year old child who wonders
why she is in the strange doctor's office but can be encouraged
to tell how she thinks Mommie and Daddy are being so mean to her.

The purpose of the therapeutic interchange is to identify the
conflicting feelings  or mistaken ideas engendered by the early
stress situation.  Then the therapist must act as the child's
counsellor, helping her to come to a better resolution of her
conflicting feelings and attitudes.  To do this requires some
ingenuity on the part of the therapist.

One example of what can be done is shown by the case of a woman
whose aunt had the patient sexually stimulate her, the aunt's,
body while playing "Doctor and Nurse."  The patient, age
regressed to six, said she knew this was wrong and hated the
aunt for making her do it.  But the aunt had paid her 25› (1
Swedish crown) each time she did it.  The ambivalence between
the hatred of the aunt and the greed for the money had to be
resolved.  The patient was asked to visualize the aunt in a
chair in front of her, and the money paid to her in a bowl in
her hands.  She was then told that it was necessary for her to
give the money back to the aunt.  When she finally realized the
need to give up her greed for the money, she threw the bowl into
the chair and could then go on to the next episode, at age seven.

Every episode like this must be worked through to a proper
conclusion, to eliminate the hold the alter-personality has in
the patient's mind, as a means of providing away of expressing
negative feelings.  The feelings must be modified from negative
to at least neutral ones such as pity or tolerance.  No episode
can be ignored or further therapy will be stalled until it is
resolved.

During this phase of therapy, the patient must be introduced to
the ISH, be advised of the wisdom of the ISH and urged to submit
to its guidance at all times.  She may see the ISH as a harsh
parent at first, but since it always gives advice with love,
eventually she will learn to submit to its will and thus solve
many problems as they arise.  The therapist and ISH must talk
often enough to be able to work cooperatively in all projects. 
The ISH is the co-therapist 24 hours a day, 7 days a week and
therefore can take a tremendous burden off the shoulders of the
therapist.

3. ) Coordination of the Alter -Personalities.

The therapist must introduce the personalities to one another
and develop coordination between the Rescuers.  Often several
have been working parallel but are unaware of each other. 
Suicide prevention is a first priority item, and one Rescuer
will have that major duty.  She must know who to call and where
to go in case of suicidal acting out.

The positive side of Persecutors must be sought.  If one is
found, then age regression therapy can be used to deal with the
conflicts creating the negative side.  T'hen it might be willing
to convert to a Rescuer and eventually blend in with the
original personality.

In case of violent behavior, the touch on the forehead procedure
first described by Odencrantz (1968) can be used.  Whenever an
alter-personality is acting or threatening to act violently, an
attendent should touch a sensitive spot in the midforehead with
a finger, just above the eyebrows and call for a Rescuer to come
forth to control the body.  Nurses and relatives should be
taught this simple but effective method of aborting dangerous
acts.

On a hospital ward, where one personality wants to elope, the
therapist can get the ISH to agree to cause the patient to faint
as soon as she passes through the outer door.  After twice
finding herself on the floor in the hospital corrider, the
Persecutor decides to stay on the ward.

4.)  Emotional Acceptance ofBeing Multiple.

Since denial is the first psychological defense mechanism, the
evidence leading to a logical conclusion that the patient has
created alter-personalities is, at first, denied by her. no
matter how overwhelming the evidence mnay seem to others. 
However, as therapy progresses, inevitably the balance of forces
between personalities changes so that a more complete
disorganization of the personality develops.  The Persecutor
become more active and more independent, with less attempt to
keep the patient out of serious trouble.  This process will lead
to acts of which the main personality is unaware, which are in
stark contrast to the main personality's code of conduct.  The
evidence for this destructive behavior becomes so overwheelming
that the patient can find no other explanation than that the
Persecutor has done the foul deed.  The deed itself comes about
in the normal course of living and cannot be contrived by a
therapist trying to convince the patient of the existence of
alter-personalities.

Once the breakthrough to acceptance comes about, a chain
reaction occurs.  The patient becomes a very active partner with
the therapist in organizing the treatment activities.  Although
frightened of what she will find, she wants to know more about
those entities she has created, so silent internal dialogue with
them, writing notes to them in her diary, and other ways are
used voluntarily to break down the barriers previously created
by the dissociative process.  The patient 's curiosity about the
nature of her psychic siblings must be supported and directed by
the therapist.

The ISH is finally seen as the Wise One who can safety be obeyed
in all matters.  That entity replaces the therapist as the one
to ask questions of when the therapeutic hour is over.  But the
ISH may place seemingly impossible demands on the therapist in
each hour, such as "Teach her tolerance" or "Show her it is safe
to have friends."  These tasks seem very difficult at the time,
but the patient needs only to be exposed to a short
demonstration of human goodwill to get the message she needs
that day.

The drive to get well i at its peak now.  Anyone who tries to
keep the patient in the sick role is rejected, be he lover,
spouse or parent.  Some patients feel they must move out of the
home where their partner has been a willing caretaker, if they
see as as only meeting the need of the caretakers to keep them
sick.  Many previously valued relationships may be sacrified if
they seem, to the patient, to stand in the way of recovery. 
This may focus much more attention on the relationship with the
therapist, to the exclusion of all other relationships.  The
demands for the therapist to meet all needs the patient has
expected from parents, spouse and friends may be very intense,
and the therapist must clearly define his/her role at this time
without rejecting the patient altogether.  The other problem is
the hostility the family members may have developed towards the
therapist when the patient starts standing up to them, wanting
to change rules of conduct they have lived with for years. 
Their own unconscious guilt about their part in creating the
problems leading to their child's severe emotional problems may
very well be displaced onto the therapist who will then be
blamed for "putting all those thoughts in my daughter's head
about her having other personalities.  She was perfectly alright
until she went to that crazy doctor."  This, of course,
counteracts the fact that these very same relatives were the
ones who brought her to the doctor because of her abnormal
behavior.  This displacement of parental guilt feelings must be
recognized and understood for what it is.

5. ) Elimination of the Persecutors.

At some point in the therapy focused on each Persecutor, the
therapist will feel that all the psychological work has been
done that can be done, both in age regression and in developing
new and positive relationships with people in today's world. 
But the Persecutor is still there, trying to seriously harm or
even kill the patient and possibly others.  The threat of legal
prosecution may he hanging over the patient's head because of a
Persecutor 's misbehavior.  The patient may beg the therapist to
get rid of the Persecutor, who is no longer needed or wanted.

But how do you get rid of a Persecutor? First. the therapist
must conceptualize that it is possible to amputate a part of the
mind, just as it is possible to amputate a gangrenous foot, and
for the same reason, to save the patient's live.  The next step
is to design a ritual which symbolizes what the patient wants to
happen, the expulsion of negative emotional energy from her
entire being.  Some patients will have their own ritual, which
they learned from their families, and all the therapist need do
is tell them to get started expelling the Persecutor in any way
they feel will work.

For the majority of patients who do not know what to do, I ask
them to do what I call "The Bottle Routine."  The essential
steps in this ritual, which is done with the patient in a light
trance, are as follows:
a)	Have an object, such as a bottle. ready but placed out of the
patient's view.
b)	Tell the patient to go inside her head but still maintain
control over her body.
c)	Instruct her to go to the high level where her ISH is and
combine with the ISH, thus being able to utilize its power to
get rid of the Persecutor.
d)	Have the patient envision a beam of pure healing energy
coming in through the top of her head, energy which can help
push out the Persecutor.
e)	Ask her to completely enclose the Persecutor in this energy
and start shoving her down out of her head.
f)	The therapist stands at the side of the patient and tells the
patient to shove the Persecutor out her shoulder and arm.
g)	While giving this instruction, the therapist cups his/her
hand on the side of the patient's head, as if shoving something
down, and tells the patient that he/she will help her push out
the Persecutor.
h)	While moving the hand down the patient's side, the therapist
intones that the Persecutor is being pushed out of the head,
brain. eyes. ears, mouth, neck, shoulder, arm, elbow, wrist and
hand.  Before getting to the hand, place the bottle or other
object in the patient's hand.
i)	When the therapist's hand touches the patient's hand, the
therapist firmly tells the patient to push into the bottle all
of the negativity which has been called by the name of the
Persecutor and to keep pushing until it is all gone.  When the
patient has gone through what appear to be appropriate
contortions, possibly with yelling between the Persecutor and
the primary personality, she will give one last squeeze of the
hand on the bottle before giving it up to the therapist.  If she
keeps prolonging the final push, the therapist can tell her that
he/she will count to three, when she can get the last of the
negativity out of her.  When the bottle Is finally rejected, it 
is thrown away in the trash, with the comment that it will never
again be used by humans.  Only with such comments can the
patient know the therapist is sincere about the meaning of the
ritual.
j)	After this, the patient may be tested, if the therapist has
any doubts, by trying to call out the Persecutor.  Usually, the
patient will report that the head is now quieter, the Persecutor
to gone, and any testing would just sow seeds of doubt without
any purpose being served.  If the preparatory psychotherapy has
been done, and the patient truly wants to be well, there will be
no psychic entity by the Persecutor's name to be called forth. 
All the other personalities will, most likely, be left intact
and can later report what they saw happen to their departed
sibling.

The meaning of this ritual in very important to the patient. 
Usually, she will realize she is responsible for the creation of
the Persecutor, which had gotten too powerful for her to
control.  She also asserted herself for the first time in years
and fought a battle of Good versus Evil.  The therapist was not
the combatant, but a catalyst who helped along the process and
was a guide who taught her how to do something she never dared
try before.  The patient learned she need not be afraid of this
self-made monster and will be able to deal equally well with the
other Persecutors, when their turns come.  The patient may feel
reborn and able to deal with problems in a new way, even if she
isn't sure what those ways might be.

6.) Psychological Fusion.

When the primary personality, the one the patient is born with,
has been uncovered and is assuming responsibility for all acts
of the body, when the ISH is considered the true guide in all
matters moral and interpersonal. and when all the Persecutors
have been neutralized in some fashion, then psychological fusion
of the Rescuer personalities with the original personalities
will take place.  This process is spontaneous, since, without
Persecutors, there in no need for Rescuers, and, without a need,
an alter-personality loses strength and direction.

Prior to this final fusion, there may be times when several of
the Rescuers will fuse because their jobs are done.  This fusion
process may be very disrupting to the mentat equilibrium of the
patient, with disturbances of memory, mood, and ability to know
how to perform familiar tasks.  It may be necessary to have
someone stay with the patient full time while the internal
dynamics are changing so rapidly.

The patient usually wonders if she can still form new
alter-personalities.  The answer is, "Yes, you can, if you want
to.  But please don't."  If, shortly after psychological fusion,
the patient has a severe emotional upset, such as getting
jealous of a rival for her lover's attention, she may split off
an angry personality.  Because of the uproar this will cause,
she may have to be hospitalized, and, during the next few hours,
she will most likely become fully aware that she did split off
this angry fragment and will bring it back into the fold.

At this point the patient has one, the original personality,
with all of the positive characteristics of her
alter-personalities.  She has rejected the negative qualities,
at least for now.  She listens to her ISH and follows its
instructions.  Then catastrophy strikes.  One problem after
another comes to plague her,. just when she feel she deserves a
rest from life's problems.  But if one carefully listens to be
nature of these current difficulties, one finds that they are
almost exact duplicates, in the emotions created, of the types
of crises during which she created alter-personalities in the
past.  Only now she knows better than to try escaping from them.
 She can cope with them in a more adult, effective way.  Only
with this re-experiencing can the patient learn how to handle
these problems effectively.  The therapist is there for support
and guidance, but the ISH instructs the patient as to the best
ways to respond to each crisis.

7.) Spiritual Fusion.

When several months have gone by during which the patient
listens to her ISH, eventually there is no discernible
difference between be attitudes of be ISH and the main
personality.  When these two thought patterns are identical,
fusion of the ISH and of the main personality has come about, a
state I call spiritual fusion.  This is the last healing of the
cleavage which occured in childhood and signals the end of the
period called illness.  After that, the patient will have
problems in living and may need helpful counselling, but she is
no longer self-defined as mentally ill.  At this point she has
the capacity for as much insight as does anyone, even though she
may still make mistakes.

8.) Post - Fusion Experiences.

For an indefinite time after fusion, the process of being
exposed to old problems in new dress continues from before. 
Legal charges may have to be faced and resolved.  Marriages may
be broken or the vows renewed.  New occupational directions may
be necessary.  Many patients leave the town where they were
identified as sick and move to new surroundings where they take
on normal social roles without the stigma of once having been
multiple.  Life continues to present its problems, but now they
can cope in a more effective way and conscious way instead o