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Got parts?
An Insider's Guide to Managing Life Successfully with Dissociative Identity Disorder
By A.T.W. Loving Healing Press
Copyright © 2005 Loving Healing Press
All right reserved. ISBN: 978-1-932690-03-3
Chapter One
Self Care
Self Care ... Self Care ... Self Care ... The importance of self care cannot be stressed enough. Good self care is absolutely critical for your recovery.
This therapeutic healing work-recovering from trauma, and learning how to manage your multiplicity and the work to re-integrate your System-is the hardest, most grueling, most painful work you will ever do. It is also what will give you the greatest chance at a better, healthier, more satisfying, and functional life.
Taking good care of body, mind and spirit is a critical factor in how the rest of your healing work goes.
If you are not used to taking good, well-rounded care of yourself, you may not be certain what self care involves. Here is a list of some things that self care includes:
Commitments to not attempt or commit suicide; commitments to no self-violence, and no self-harming behaviors.
Proper nutrition and the right amount of food for good health.
Adequate rest and enough sleep.
Good, basic hygiene and grooming.
Seeking medical attention when it becomes necessary, and taking medically required drugs as prescribed (not stashing them, failing to take them, or altering the prescribed dosage), and not misusing or abusing drugs,alcohol, or any mind-altering substances.
Establishing and maintaining a safe, clean, pleasant living environment.
Having or developing a network of safe, supportive people.
Learning safe, healthy ways to relax and to reduce and manage stress.
A regular program of physical activity and exercise appropriate to the physical body's current condition, abilities, and the System's interests.
Finding or creating opportunities to nourish wounded spirit and emotions.
Cultivating time and opportunities for fun activities, hobbies, and for play.
Self care includes the general goal of regarding and treating your body in a loving and tender and gentle way and learning to respect 'the skin you're in', especially if this not something you are accustomed to doing; a sometimes forgotten aspect of self-care may include a program of (ahem) 'personal self intimacy'.
Therapeutic Benefits of Outside Interests and Activities
A very important part of your healing process is to participate in activities that bring you meaning, or peace, or good feelings, or help build you up. Seemingly small, simple activities can produce great benefits, including increased self-esteem, self-confidence, and feelings of self worth and well-being; and sometimes these 'smaller' goals are more easily achieved.
Interests and activities outside of therapy help trauma recovery and reintegration to lose some of their overwhelming nature and puts them into a perspective of being only parts of the rest of your life and the life you are creating for yourselves.
Increased social contact helps to combat depression and fights against the desire to isolate ones' self. A network of safe, healthy contacts can widen your support base when you need companionship, or someone to bat ideas around with-not necessarily about anything related to therapy. It helps to have someone to laugh with or share something in common. You can draw strength from other people.
Volunteering can do wonders to boost self-esteem as you realize that, in the middle of all this hard healing work you are doing in therapy, you can still reach out beyond your own pain and do something for someone else.
In most activities, there is generally some level of physical movement /activity/exercise. This can provide health benefits, and improve your overall fitness in ways other than an exercise routine.
Activities could include coaching a softball or Little League or soccer team; having a pet, or pet-sitting for others; building or refinishing furniture; belonging to the quilting group at the local church or attending Wednesday night bingo at the auxiliary, being a part of a book club; taking a yoga or Tai Chi class; attending some form of organized worship services; volunteering at your child's school, or at a local organization whose work you believe in ... these are only a few examples.
Calculated challenges, like calculated risks, can lead to growth, progress, success-which leads to taking on other challenges, which lead to growth, progress, more success, which leads to ... taking on still other challenges, which leads to more growth, progress, and success, which leads to ... Challenging one's self and learning and growing creates an upward spiral of positive expansion of health and well-being, instead of a downward spiral of negativity and isolation.
Self Care and Boundaries
Self care also involves setting appropriate and healthy boundaries and the sometimes difficult choice of avoiding people or places which are abusive, toxic, unhealthy, negative, dysfunctional, or which will undermine the System's progress.
Sometimes this relates to one's own issues.
For instance, if a part has an addiction to alcohol, and has made the healthy choice not to drink, it would be more difficult to keep this contract/self care boundary if they work as a bartender or bar waitress, or are at places with family, friends, or co-workers where alcohol is being served.
Though it would not be impossible to remain non-drinking, until self and System are healthier and more re-integrated, being in environments where alcohol is sold or served might not be the healthiest choice.
Likewise, there is no good reason to continue to choose to be around or interact with (except minimally, if absolutely necessary) people who do not practice their own healthy behaviors. You do not have to remain in the company of people who disrespect you or who treat you neglectfully or are abusive.
Sometimes this self care issue relates more to what is external to us.
Though not always the case, sometimes people around us, even the ones who say they love us and only want the best for us, in fact do not want us to change or get healthy. Though hard to understand and accept, there are reasons this can be true.
As people get healthier, they make changes that reflect they are no longer satisfied Living and believing and behaving as they did before. Those who live with them or interact closely with them are then faced with having to adjust and change, too. It will change the status quo, and likely the comfort levels of everyone. Almost all change brings with it an uncomfortable transition time both for the person making the change, and for those around them. Some people are unwilling (for a variety of reasons) to accept the changes and new choices we are making. Sometimes these changes-even though they are healthy ones-might be so disconcerting and upsetting to relationships that others may be unsupportive, or even consciously or unconsciously sabotage the new situation.
The fact that others may not know for certain we are multiple can complicate matters. All the same, the dynamic remains the same whether a person is DID or not. We have a right to choose not to jeopardize our healing and re-integration to accommodate someone else's comfort level.
As hard as it may be to remember and to act on this, you-all have a right to do whatever it is you need to do to get better as long as it is not abusive to anyone else.
Other important components of self care and boundaries
Making self care your first priority
This is not selfish, regardless of what you may believe or what you may have been told. It also does not imply you should neglect your children, spouse or partner, family pet, job, or other obligations.
However, if you do not give top priority to good care of your physical, mental, emotional, and spiritual health, you will not have the reserves needed to do your healing and recovery and System re-integration work; nor will you have the wherewithal to be there for anyone else in your life. These inner reserves depend on your strength, stamina, resiliency, and inner clarity and calmness.
Doing this therapeutic work takes a lot out of a person-although of course, in the end, you are healthier and more 'filled up' with what will enable you to create a better life for yourselves. As you take ever-better care of yourselves, and progress in your recovery, you will perhaps be able to spread yourself more into other areas.
In the beginning and until you are more stable, it's important to make choices that do not put your health, safety, and progress in jeopardy, and it is especially critical to set what boundaries you need to in order to stay on track with health and recovery.
You need to set limits and learn to say "no"-and being able to stick with your "no" under pressure.
This can be very, very hard to do sometimes. Sometimes we are so entrenched in old habits of always saying "yes", always doing, always volunteering to take things on, always accommodating others, always being 'on', always feeling the pressure (from without or within) to 'perform', that we may not realize today we have the choice available to us to decline these things.
Old habits may be rooted in the need to stay safe, to feel in control, or to believe we are important, or to make other people think we are 'good' or 'ok' or 'make them like us'. It feels really good to feel needed and important and indispensable, especially if those are not things which you necessarily believe about yourself.
Most of us do not like to disappoint other people, or have them be angry or upset with us. Yet as we set boundaries and say "no" if that is what we need to do, sometimes that happens.
Hopefully, however, as you continue to do this healing work, you will come to understand you-all have intrinsic worth separate from what you do (or don't do), the roles you take on (or choose to not take on), and how other people regard you.
It really is ok to take care of yourself, including not over-extending yourselves. It is ok to begin to set boundaries. It is ok to say no sometimes. It is not just ok, but necessary to set limits.
Though it is important to resist giving in to pressure to go against your boundaries, it is also important to remember boundaries are not set in stone. They are there to protect your progress toward health. Boundaries sometimes shift over time, depending on your well-being and where you are on your life and healing path. Boundaries may need to be tighter or more strict in the beginning as you practice setting and keeping them, and as others are getting used to your different choices and behaviors. Some time down the road, you may be able to set boundaries with less rigidity and more balance.
It may take some time to learn what your limits are. Be gentle and patient with yourself during this learning process. This is like learning any new skill-it takes time, and there is a learning curve-and there are likely to be errors in judgment along the way. Don't give up ... keep after it. With practice, this process has the potential to get somewhat easier and more natural after a while.
Medical/Health Care Issues
Good care of the physical body is very important to your overall recovery. The physical body has need for more than just food and water, rest and sleep, exercise and physical activity, clothing and shelter. The physical body also requires attention and monitoring in order to maintain energy and vitality and good health. Sometimes there are medical conditions such as asthma, high blood pressure, high cholesterol, heart conditions, diabetes, ulcer, or such, which require treatment.
Sometimes past trauma issues make seeing a health care provider (doctor, dentist, eye doctor, gynecologist, internist, physical therapist ...) or having medical tests or procedures done, very, very difficult because of triggers, fears, or trust issues.
It is very important-for a number of reasons-for your health care provider(s) to know of your diagnosis. Especially early in your healing process, or if there is a lot of uncontrolled switching, or until your System has a good amount of co-consciousness and is working well together, knowing your diagnosis (DID) can be valuable (and enlightening) information for your practitioner who may be baffled by seeming inconsistencies or other phenomena which will make more sense once they have this additional information. Once they realize they are treating one physical body, but perhaps more than one patient, and as they learn a few basic things about DID, they can move toward a better understanding of how to best serve your over-all, (collective) health care needs.
If your clinician is not familiar with dissociative disorders, and with DID in particular, you might want to enlist the help of your therapist in briefly explaining the basics to him or her if you are at a loss to answer their questions or concerns. You will need to sign a release of information for this.
The step of revealing this intimate piece of information involves taking a calculated risk, but remember these are individuals who (should) have your welfare and best interests in mind, and the dividends realized from disclosing this information can be worth taking the risk.
Remember that health care professionals are bound by confidentiality and a professional code of ethics. Remember too, you have done nothing wrong, and you do not have any reason to be ashamed.
It has proven helpful for other Systems to have a standard letter written for all your health care providers-ones you see presently, and any new providers you may see in the future. This letter will, among other things, tell them your diagnosis (Dissociative Identity Disorder-'multiple personalities'), and if there is a secondary diagnosis, such as Post Traumatic Stress Disorder; it will also inform them about your trauma history, and if that manifests in any ways that would be helpful for them to know so they can better work with you.
In this letter, you can also mention any special needs or concerns you have, and let them know what you need from them to make medical/health care appointments (exams, procedures, etc.) easier so you can take the best care of your body's health that you are capable of taking. (There are a couple sample letters in Appendix B. They can give you ideas how to write to your own medical/health care providers, and things you might say. They are only examples; you can tailor them to your own particular needs and situations, or write an entirely different letter.)
Most doctors and health care providers are pleasantly surprised and appreciative of your candor and your proactive approach to taking care of yourselves.
One idea for handling the stressor of medical appointments and treatment might be to ask an understanding and supportive friend or family member who knows your diagnosis to accompany you to office visits and appointments for medical procedures. Let your health care provider know this ahead of time, and why you need this, and seek their permission and cooperation in this being allowed. Many doctors are sympathetic, and do not have a problem in accommodating this request within reason.
A plan that has been of great benefit to other Systems is to find who inside is best capable of ensuring medical/health care needs are being taken care of. This designated part will be the one who goes to all medical appointments, the one who will communicate with health care providers, and the one to undergo exams and procedures. Other parts must agree not to come out during medical visits/ procedures, and must agree not to interfere with or block or hinder the part who has agreed to fill this role on behalf of the System. You may need to write up a contract to this effect, and have everyone in the System sign the contract.
Look for a part who has suffered no primary trauma, or whose therapeutic issues do not involve medical/body-care triggers or fears or anxieties or other related difficulties. It could also be a part who has already worked through trauma-triggers that might still impede others in the System from being able to take care of medical/ health needs. This is an instance where we recommend that one part takes on the role, and other agree not to interfere.
(Continues...)
Excerpted from Got parts? by A.T.W. Copyright © 2005 by Loving Healing Press . Excerpted by permission.
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