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Section 11
Self-harm in DID Clients

CEU Question 11 | CEU Test | Table of Contents | DID
Social Worker CEUs, Psychologist CEs, Counselor CEUs, MFT CEUs

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On the last track we discussed the internal self-helper of the DID client.  The techniques on this track can be productive for finding your client’s internal self-helper and working with your client’s internal self-helper.

On this track we will discuss working with internal persecutors.  According to Putnam, internal persecutor personalities are found in the majority of DID clients.  The persecutor personalities usually direct their acts of hostility toward the host personality.  The various forms of harassment and the client’s reactions to them constitute a major source of torment for a DID client.  

In personality systems that contain persecutor alters, would you agree that the therapist must engage and work with these personalities?  They will not go away spontaneously, and they cannot be exorcised.  On first meeting, they will be fearsome, loathsome, demon-like entities totally committed to the malicious harassment and abuse of the client.  In the long run, they often prove to be one of the therapist’s strongest allies and can play a major role in the healing of the client. 

3 Forms of Internal Persecution
First, let’s discus forms of internal persecution. 

#1 - Voices
Among the most common manifestations of internal persecution are critical and condemning voices usually heard by the host personality.  These voices will berate and belittle the client, threaten or urge suicide, and sarcastically and gleefully taunt the client about their total control over him or her.   

Hosts who are unaware of or unwilling to acknowledge other alters will react to these voices with terror and/ or despairing resignation at their apparent imminent destruction.  The voices can also distract and disturb a host at times when he or she is attempting to concentrate on a difficult task.  Some multiples refer to this experience as "jamming."  The clients are often reluctant to admit the existence of voices, lest they be thought to be "crazy."

#2 - Direct Injury
Direct injury to a client’s body is usually the form of internal persecution that disturbs therapists most, although many patients regard this as less troublesome than some other forms of persecution.  

#3 - Suicide
Suicide is an ever-present issue with multiples.  The internal persecutors may be threatening to commit suicide themselves, threatening to kill the host, or urging or commanding the host to kill himself or herself.  The host may also be considering suicide as the only way of ending the ceaseless torment.  

What little data there is, suggest that the overall lethality in comparison to the number of attempts and gestures may be relatively low.  That does not mean that a therapist can ignore the possibility of suicide.  However, the therapist must come to terms with a high background level of suicidal ideation within the personality system.  I have found that suicidal gestures are frequent, yet serious attempts are not uncommon.  Frequently these are aborted by other alters.  But most multiples seem to teeter continually on the knife’s edge of destruction through the early stages of therapy.

Have you found that self-mutilation by persecutors to punish the host or other alters is also common?  The host may "wake up" to find that he or she is covered with blood or injured in some fashion.  The host may also find threatening notes or even more graphic warnings of future mutilation.   For example, one client, Jenna, age 28, found a threatening message written in her own blood on her bedroom wall.  Jenna’s episodes of self-mutilation were frequently triggered by disclosures in therapy of past trauma. 

The warnings or messages left by Jenna’s persecutors often explicitly specified that any further revelations would be met with more injury or death.  Needless to say, such experiences often stifled Jenna’s attempts to remember or reveal the past.  Blocking past memories is, of course, one of the primary functions of the persecutor personalities.

Persecutor personalities may harass the client in other ways.  Do you find that disruptions of the client’s family, social, and occupational life are common?  Many multiples become socially isolated because the persecutors deliberately alienate their friends.  Persecutors can make a client’s family life difficult, resulting in divorce and in rejection by their children.  Other forms of social sabotage may involve huge debts for the client or legal problems resulting from the behavior of the persecutor alters. 

I find the latter is more common in male DID clients.  A particularly virulent form of sabotage involves the persecutor personality’s setting the client up for rape or physical abuse.  Disruption of therapy is another form of harassment undertaken by the internal persecutors.  Internal persecutors may prevent the client from attending sessions in a number of ways.  They may threaten to harm the patient if significant information is revealed to the therapist, and in some cases they may threaten to harm the therapist unless the host withdraws from treatment.

Origin and Functions of Internal Persecutors
Next, let’s examine the origins and functions of internal persecutors.  Therapists working with their first cases of DID are often baffled by the apparent hatred of the persecutors for the host or the client as a whole.  There seems to be no justification for the intensity of their malevolence or for the unremitting hostility and violence wreaked upon the poor, defenseless host.  

"What did she ever do to you to deserve this?" one therapist demanded of a persecutor after his client was hospitalized for esophageal ulcerations caused by the persecutor’s swallowing a corrosive drain cleaner.  The persecutor, who was in no apparent discomfort (although the host was in significant pain), replied, "She is a total loser and deserves to die."  

Do you find that this is typical of the rationale given by internal persecutors to justify their harassment and self-mutilation?  They usually express extreme contempt toward the host.  

In many instances, persecutors contain the energy and affects that the depressed and apathetic host cannot sustain.  Often, this is why they are so contemptuous of the "weak" and "wimpy" host.  Would you agree that your client’s internal persecutors serve a number of important functions within the personality system, and that acknowledging and understand­ing these functions could help to develop an alliance with them?  

The persecutors also function to maintain the silence and secrecy that have surrounded the past abuse.  Would you agree that initially this may also have been a life-protecting role?  Internal Persecutors may protect the past by threatening the client and/ or the therapist with disastrous consequences if past trauma is revealed, and by creating such an uproar in therapy that the therapist never has a chance to focus on the past.

 I find that the host personality’s relationship to the persecutor is similar to the concept of a "trauma membrane," in which a survivor of a catastrophe is protected from intrusive or inquisitive inquiry by relatives or close friends.  The trauma membrane serves to keep noxious reminders of the experience at a distance.  The persecutor alters often serve as an DID client’s "trauma membrane."  Therefore, would you agree that these alters and the personality system as a whole must be convinced that the therapist is a healing agent and that it is safe to allow him or her behind the shield?

Relating to Persecutors
In addition to forms of internal persecution and origins and functions of internal persecutors, let’s also discuss relating to persecutors.  I find it helpful to remember that all of the personalities, persecutors included, have a role and a place in the patient as a whole.  Ethically, the therapist should relate to all of the personalities with honesty and respect, though this does not mean indulgence.  

However, since they are part of the patient as a whole, they have more power to influence the outcome, for better or for worse, than the therapist does.  Instead, I talk with them, bargain with them, contract with them, and try to make friends with them.  It often seems surprisingly easy, until one remembers that most of them are really like frightened children filled with rage and an infantile sense of omnipotence.  They welcome the attention and relief that a therapist can bring to them.  

Clearly, many therapists initially avoid their clients’ persecutor personalities.  Some therapists are afraid to have them come out in sessions and often seek ways to banish, exorcise, or suppress them.  I usually try to get them to appear and stay "out" for at least 15 minutes during a session.  They may emerge roaring, but often leave meekly.  Simply keeping them "out" for a period of time seems to deplete their energies.  

Repeatedly, I have had the experience of having a ferocious persecutor tell me that he or she is getting tired and has to go now. When a persecutor comes out, I try to find out all I can about his or her origin and present role in the personality system.  You might consider asking questions such as When did he or she first come?  When did he or she first start to come out?  What was his or her original purpose?  What is his or her role now?  I try to get him or her to tell me all about his or her relationship with the host and with other alters, and I empathize with this alter as with any other.

It is important to validate the existence and importance of persecutor alters—to recognize that they represent needs, feelings, hopes, and fears.  One of the common fears is that you may attempt to do away with them.  Consider reassuring them that this is not so.  You might state, "I have neither the power nor the wish to kill you off.  I know that in some way, at some level, you are doing what you are doing because you believe that it is necessary to help the client."  Consider reminding your client’s persecutor of their past and of the fact that they originally came to help the client deal with what he or she could not face on their own.

As you already know, internal persecutors may seem to be functioning as a trauma membrane to protect the host from the recovery of painful memories.  Would it benefit your client to assure the persecutor that the therapist will work with him or her to allow the host to "remember" the material in a way that is tolerable for the personality system as a whole?  Perhaps you might ask the persecutor’s advice about how this may be accomplished.  

One of the dynamics of the internal persecution process is the persecutor’s attempt to transfer back to the host and other alters some of the trauma and affects that he or she originally absorbed to protect the client.  It is often done in a childish attempt at recapitulation of abusive experiences.  One persecutor personality of a DID client I treated stated, "I took all that crap for her and now she’s going to feel what it was really like." I felt I needed to help this persecutor understand that there were other ways for the client as a whole to re-own the painful memories and affects.

In many instances, the host is actually abusing the persecutors.  Usually this is through an unknowing suppression or a dimly aware rejection of the persecutor.  Helping the host acknowledge the persecutor’s existence, and the fact that the persecutor part represents needs and feelings, often helps to lower the intensity of the internal conflict.  Ultimately, the patient as a whole needs to re-own and reabsorb all of the persecutors. Fortunately, the persecutors, despite their apparent attempts at annihilating the client, are often willing to give up the pain they contain and work with the others.  Many of these destroyers become healers at a later stage in the therapy.

Levels of Persecutors
Like ISH personalities, internal persecutors often exist at a number of levels in the personality system.  As a given persecutor begins to mellow and becomes cooperative, he or she will tell the therapist about another persecutor lurking in the background, who is "10 times worse."  The therapist should question these estimates of malignancy, as they are usually derived from the persecutor’s infantile omnipotence and rage.

The increasing "anger" of the deeper levels of persecutors stems from the fact that they are usually the guardians of more traumatic layers of dissociated memories and affects. If the patient is layered (and many MPD patients are), then the therapist must work through each layer, dealing with the alters at each level. This can be a monumental task. On the other hand, after working through a number of layers, the therapist will have a good idea of who and what to expect in subsequent layers.

Peer-Reviewed Journal Article References:
Brand, B. L., Myrick, A. C., Loewenstein, R. J., Classen, C. C., Lanius, R., McNary, S. W., Pain, C., & Putnam, F. W. (2012). A survey of practices and recommended treatment interventions among expert therapists treating patients with dissociative identity disorder and dissociative disorder not otherwise specified. Psychological Trauma: Theory, Research, Practice, and Policy, 4(5), 490–500.

Carpenter, R. W., & Trull, T. J. (2015). The pain paradox: Borderline personality disorder features, self-harm history, and the experience of pain. Personality Disorders: Theory, Research, and Treatment, 6(2), 141–151. 

Homan, K. J., Sim, L. A., Fargo, J. D., & Twohig, M. P. (2017). Five-year prospective investigation of self-harm/suicide-related behaviors in the development of borderline personality disorder. Personality Disorders: Theory, Research, and Treatment, 8(2), 183–188. 

Online Continuing Education QUESTION 11
What is one of the most common forms that an internal persecutor takes? To select and enter your answer go to CEU Test.

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