David: One of the common questions we are getting, Dr. Pratt, is how long should it take to obtain a peaceful coexistence with your alters?
Dr. Pratt: I wish I could answer this to everyone's satisfaction. I'm not sure I can. I think, if the person has alters who are doing highly destructive, scary things (like intensely suicidal or self-injurious behavior, severe addictions or eating disorders, to name a few, it may take a few years to get it all settled down. Sometimes more than a few. If, however, the individual's life is only mildly disrupted by the multiplicity, treatment can help things settle down dramatically in maybe six to eighteen months. Not everyone with multiplicity experiences these very difficult adaptations. There's a lot of differences among multiples.
milo: Does gaining cooperation and communication with your alters, whether through therapy or simply journaling, always have to involve rehashing the past?
Dr. Pratt: Oh, Milo, what a good question. The short answer is, No. But I'm not good at short answers! The goal of internal communication and cooperation might be accomplished with almost NO rehashing of the past. But the reasons why alters do various things, and the reasons why one has alters to begin with, will probably mean some thinking about and talking about the past. That's as short as I can do it!
Kimby: Where is the Traumatic Stress Institute located and do they work with SRA/DID individuals?
Dr. Pratt: TSI is in South Windsor, Connecticut. The psychologists at TSI do work with these folks.
cree_ation: I take fluvoxamine, and I was wondering what role, if any, does fluvoxamine have on treatment of DID?
Dr. Pratt: I'm sorry, Cree_ation, I'm a psychologist and not a psychiatrist, and I don't feel qualified to answer those questions.
jewlsplus38: The 'core' has recently had to feel intense grief for the first time and has buried herself again. We are at a loss as to what to do to try get her back. Our job, up until now, has been to teach her how to live, and we feel very alone. Did we give her too much?
Dr. Pratt:Jewlsplus38, I think you are most likely doing a great job. I would guess that, if all her life she has dissociated strong feelings, the process of learning to feel them for the first time is going to be on-again/ off-again. Offer support when she reappears, and keep her life in order while she is away. I can't say for sure, but you sound very caring and careful, and I think you are probably on the right track.
oak: How does one work with alters who refuse to be drawn out to talk with either the therapist or other alters?
Dr. Pratt: Oak, that's a tough question. It reminds me of my first question tonight and the answer is very similar: Make sure that there is safety for those alters. If you (or anyone inside) has an idea about what those alters might need in order to feel safe, then I would try to create that safety. And make sure that it is communicated to them that it is up to them. They can come out when it feels right to them.
JoMarie_etal: Prior to about six years ago, we were at least communicating and cooperating to some extent. Then something terrible happened to us and it totally destroyed all trust inside and out. I have been trying to reestablish some communication and cooperation, but everybody went into their own protective shells and there is extreme resistance to any kind of cooperation. In fact, there is a lot of energy going into disrupting day-to-day living. Is there any way of reestablishing the communication and getting everyone to work together again?
Dr. Pratt:JoMarie_etal, you are also describing one of the hardest situations to deal with. A new trauma on top of all the old has to be one of the hardest things for all of your alters to cope with. They were partially convinced that cooperating and communicating (breaking down the barriers among them) was a good idea, and then something awful happened and they went back to what they know best.
It comes back to safety again, and perhaps, a strong dose of not blaming. I wouldn't blame any of them for what happened or for pulling back. Try to make it safe to be out again, safe to be talking together again, and stress that everyone has the same goal: keeping safe and not letting bad stuff happen. Then try to focus on ways that everyone can agree to accomplish that goal. Best of luck.
Wind: How do you feel about locking away a destructive alter for a period of time in order to gain co-consciousness?
Dr. Pratt: Wind, I'm not sure I understand. I do know someone who has had some success with locking away destructive alters, but I have never suggested it, or witnessed it myself. If there is a place where the destructive alter can wait safely, apart from others, I guess that's the direction I would go in. But again, without knowing you and the particular circumstances, I'm in the dark, so it's kind of guessing on my part. Talk with someone you have confidence in and who knows your situation well.
David:An audience member says she talks with a DID friend by phone almost nightly. Her friend switches a lot and she wants to know how she can contact the core/main person to continue the conversation?
Dr. Pratt:If possible, that is something she should talk over with her friend. If it is okay with her friend, she might try saying something like: "I was talking to "X" about "Y." I am happy to talk to you later on (if that's true), but right now I'd like to finish what "X" and I were talking about. Is that okay with you?"
You have to be cautious because traumatized people are sensitive (and most DID people have a history of severe trauma). They will perceive rejection in the smallest comments. So, I'd first recommend talking it over with the friend and asking for her suggestions. And perhaps talking it over with the alters and asking them for their suggestions so that, the conversation can be more fluid and less switchy for the caller.