The beginning of understanding: part 1

Like most people, I didn’t intend to do this work. I fell into it. My training, over four years, touched on sexual abuse for a single session, and never mentioned dissociation. I had never heard of dissociative identity disorder. My understanding of mental health generally was vague and I erroneously believed that people with mental health difficulties wouldn’t end up coming to see me. Surely they would go to see a psychiatrist, not a lowly, just-qualified counsellor? I don’t quite know what I expected—I just had this stereotype that people with ‘proper mental health difficulties’ would be treated well (and therapeutically) by the NHS, and I would end up seeing people with self-esteem issues, relationship difficulties, or depression. I was incredibly naïve. I suppose I also believed that people with ‘mental health difficulties’ would present as obviously ‘crazy’. It never occurred to me that something as scary-sounding as ‘dissociative identity disorder’ would come in the form of a completely normal-looking, normal-sounding, normal-acting professional. I was very entrenched, from total ignorance really, in thinking of people in terms of their labels, and it was a shock to realise that I wasn’t seeing people just as people. I hadn’t realised how insidious that kind of prejudice can be.

My first dissociative client turned up looking for help and talked in general terms about ‘struggling a bit’ with depression and anxiety. I’d been working as a volunteer counsellor for a while with a local charity who took referrals from the GP as well as directly from clients, and I had worked confidently and competently with people with a range of issues—moderate eating disorders, sleep difficulties, sexual abuse, domestic violence, divorce. So there was nothing in that first session that unduly alarmed me or made me feel that this wasn’t a client that I should be taking on. She was a professional, a primary school teacher; she was married; she had two children. It would be fine.

And for a little while, it was fine—apart from a nagging doubt I had, a sense that I couldn’t quite ‘find’ her. It was as if, every time we got anywhere near her feelings, suddenly I was chasing phantoms. It was a strange experience. I couldn’t quite pinpoint her, track her down, figure out ‘where’ she was. She took me by surprise in lots of little, seemingly inconsequential ways—an out-of-place remark, a contradictory comment, a certain way of looking at me, that seemed for a minute as if it wasn’t quite her. I couldn’t put my finger on it for a long time. After the first few weeks, I began to find it hard to concentrate in sessions—not a problem that I’d had with any other client. It wasn’t that I was bored or disengaged. I just felt myself falling into a wispy, mental fog. It was alarming. I would realise that, for the last few seconds, I hadn’t quite been there. I took it to supervision with a growing sense of panic, that maybe it was me, that I wasn’t cut out for this work, that maybe I wasn’t a very good therapist. I felt deskilled, and I didn’t even know why.

It wasn’t even that we were talking about anything particularly difficult. I could see that my client was desperately trying to engage, that she wanted more than anything to find the words, but, as she herself described a number of times, her mind went blank when she came into the therapy room. In my head I wondered what it was about me that was having this effect on her. I began to seriously doubt myself. In supervision, I began to not even really be able to describe what the sessions were like, what we were talking about or what our focus was. It was bewildering, but at a really, really subtle level. I felt uncomfortable, that I didn’t want to talk about this client, because somehow—and I didn’t know why—I felt a little bit ashamed of my incompetence.

Then, in a session about 3 months in, I made a comment—and I can’t even remember what it was, just an everyday empathic response—and the strangest thing happened. It was as if someone had pressed a button, and my client had been teleported away and replaced with someone else. After three months of meeting with someone week in, week out, you get to be quite familiar with them. You begin to anticipate what they’re going to say. You become used to their facial expressions, how they hold themselves, what they find amusing, how they avoid certain topics. And some throwaway, empathic comment from me suddenly flicked this switch and I was sat opposite what felt like a total stranger.

Previously my client had adopted the same posture every week for most of the session: shoulders a little hunched, sitting forwards slightly whilst at the same time apparently trying to sit as far back in her chair as possible, gaze averted downwards and to her right while she talked to me. I was used to the lack of eye contact and the lack of vitality in her voice and in her face. I understood that she felt anxious, and, most of the time, hopeless. And then all of a sudden, after this single, inconsequential comment, it was like lightning had struck and she sizzled with energy. Her spine stiffened, she leant forward and looked me straight in the eye, defiantly, as if she were about to fight me. I instinctively wanted to take a step back, put my hands up to defend myself, back off and apologise. There was a globulous feeling in my throat that I tried hard to swallow down. I was momentarily alarmed. Where had this come from? It was like someone bursting into the room.

She talked for a few minutes with an urgency and an insistence that I had never previously seen. Her words came out fast and slightly garbled, with high emotion. It was like a dam breaking. I sat, mainly in stunned silence, and let her pour forth. And then, as quickly as the dam broke, so the waters dried up again. Her posture collapsed, she looked down and to the right, let out a long, helpless breath, and for a moment looked slightly confused. She shrugged, as if I’d asked her a question and for a moment I wondered if I had. I felt even more disoriented than she looked.

The following week, it happened again, but this time it was different. This time it was as if the whole spectrum of the British summer were appearing on her face in quick succession: it was sunny, then cloudy, then rainy, then still. And when she spoke, this time she didn’t look at me, but everything about her suddenly seemed ‘little’—overwhelmingly vulnerable and appealing. She didn’t say anything. I just felt an enormous pull on the inside of me to reach out to her, to look after her. I sat, not saying anything, not doing anything, slightly nervous, utterly bewildered, but reminding myself to breathe. I wondered why I felt like I did. The silence became oppressive, even though it probably only lasted ten seconds, and for some reason I found myself saying, ‘Hello’, which as soon as I’d said it seemed like the stupidest thing in the world to say.

‘Hello,’ she said back, all shy and coy and fidgety. My conscious mind didn’t understand what was going on, but somehow, instinctively, I knew that my client had become a younger part of herself. ‘How can I help you?’ I said gingerly and quietly, trying to pace myself to her. ‘I’m frightened,’ she said. ‘What are you frightened of?’ There was a flash of terror on her face and she said, ‘I don’t want them to hurt me.’

Who? When? How? At one level, possibly at the level of my right brain, I understood what was going on, but I couldn’t explain it to myself logically. Somehow I engaged her into a gentle dialogue. She told me about ‘them’. She told me about what they did to her. She wasn’t overly distressed, and in many ways she was quite matter-of-fact about it. She was utterly convincing. I felt the reality and the immanence of what she was saying. We talked for maybe ten minutes, in which I tried to just attune to her and be a sensitive, empathic presence. I tried just as hard not to let my sense that I was incapable and incompetent interfere with what was happening. And then, after about ten minutes, from a room elsewhere in the building, there was a distant thump as a door slammed shut. My client startled, looked at me for a moment—so it seemed, in abject terror—and then it was as if shame just gobbled her up and she disappeared. She looked down and to the right again and sat there in a kind of frozen, appalling silence. Again, it was such a distinct shift that it was like someone had skipped forwards on a playlist right in the middle of the song.

I still didn’t understand what was going on. So I continued the conversation we had been in. I asked her the last question I’d put to her, just a few seconds previously. She looked up at me quickly and again something flashed across her face. I immediately felt that I was being stupid, and I wanted to retract my question. I had a strong, strong sensation of embarrassment that came out of nowhere. ‘You what?’ she said, as if I had asked the most ridiculous thing. I repeated the question, slowly and gently. She just looked at me. It seemed that she didn’t have a clue what I was talking about. Suddenly, I doubted myself. Had we really just been talking about that? Or had I imagined it? I had a mild rush of panic, and the thought flitted across my head that I was going mad. But then I caught myself, and realised that I had never felt like that with any other client. As therapists, we are trained to wonder why—to step back, to mentalise, to consider what is going on rather than just being caught up in it. So I took a breath, sat slightly further back in my chair, and said to myself silently: ‘Something is going on here, and it’s not just me.’

My client seemed all sheepish, a bit embarrassed, like she had just been caught red-handed. After a little while I said to her, ‘It seems that I’ve just been talking to you about some things, but you don’t remember?’ Her eyes flashed up at me again, with what I sensed as a mixture of fear and shame. ‘It’s ok,’ I said, ever so gently. Then a pause, but nothing came back. ‘Does that happen a lot?’ I said. I don’t even know why I asked that question: it was an instinctive question, not a logical one. I sensed that the answer would be ‘yes’, and I sensed, again in an intuitive way, that there was something going on here—something that I didn’t have words for—that would explain why I had struggled for three months to ‘get through’.

Suddenly, like a party popper, out came her words. ‘It happens all the time. People will be talking to me and I can’t remember what they’ve been saying. I used to think I was just forgetful. But it’s not that. It’s like they can be talking to me and I know rationally who they are but it’s as if I’ve never met them before in my life. And sometimes I can hear myself talking to them and it feels like I’m not me, talking. I don’t know what I’m going to say next. I say stupid stuff. Other times I just don’t know where I’ve been for hours at a time. It’s like I’m just not there. I think I’m going mad.’

For the first time in three months, I felt that we had a connection. There was this sudden, brutal honesty—vulnerability—and inside I just wanted to breathe a massive sigh of relief. I suddenly grasped it—not in a way that I could have articulated in words, but intuitively—that I had been bumping up against an invisible forcefield that was intended to keep me out because there was this ‘something else’ lurking behind it: shame, or pain, or something unbearable, and that it was so strong that even my client couldn’t connect to it.

It was near the end of the session and there was a sense of relief in the room, as of a dark secret being confessed, but that it was all alright. I knew I didn’t understand what was going on, but I also knew that we had made progress, and that I wasn’t mad, incompetent, or useless. By chance I had a peer supervision group during the week. I mentioned what had gone on, describing it as best I could with unformulated ideas and inadequate words, talking about my confusion, what had gone on for me, how I’d felt disoriented and as if I had gone temporarily mad. I talked about the ‘switch’, although I didn’t use that word. I talked about the disconnection between us, the broken narrative of abuse, when it came. Two people in the group jumped in with trite, shallow responses that left me feeling unreasonably irritated, and perhaps a little blamed for not being a good enough therapist. And then a third person spoke up, hesitantly. ‘It sounds to me like dissociation,’ she said, simply.

‘What’s that?’ I said.

And that was the beginning of understanding.