David: Paula, here are a few audience questions:

imahoot: Do you feel that when someone is very much in the healing process, that they unconsciously begin the integration process?

Paula McHugh: Yes, I do think so. It just kind of happens because there's not so much need for protection and barriers and the amnesia is gone.

debb: Do you think people are ever 'cured' or do we dissociate for life.

Paula McHugh: Yes, people are cured. They will always be susceptible to stress, so they have to watch out when they feel stressed because they know how to split, and it can happen again.

But that's not the end of the world. You just deal with the new person until they're OK. They will probably decide you don't need their help anymore. Alters formed after total integration do not have the hold on their life the way alters who had been there for years did. They're just there to help for a while.

dendroaspis: How do you define "cured"?

Paula McHugh: Cured is total integration which remains stable for 3 years. It's all the alters together - into one being. No one is lost, they are just all there in a different way, they don't have to share time anymore, everyone is up front all the time but in an organized, calm way.

David: Is splitting a conscious act on the part of the individual or is it something that happens unconsciously?

Paula McHugh: Totally unconsciously. These are children, and they feel trapped, desperate, and terrified. Somehow, they tap into an ability in the brain to split away to be in the trees or asleep, while someone else takes over. It's not conscious and I think it's a survival skill.

The other options are to go crazy - or kill yourself. So it's better to let our unconscious take over.

David: Here's the next question Paula.

deli: Once the personalities come together, what's the next step?

Paula McHugh: A long step. It's getting used to the idea of being a singleton. Like there's only Pepsi in the icebox because no one else buys milk, so you have to remember to buy the milk. But people tell me they feel "right," they feel good, calmer, less afraid.

They also have to get used to being alone. That's kind of sad for them for awhile in between feeling better.

danalyn: You say it takes 4-8 years for integration. How many hours a week of work is that?

Paula McHugh: I think it's necessary to have therapy twice a week - and room for crisis sessions in between. Sometimes a 2 hr session if memory work needs to be done. It's arduous - but DID people are persistent. They are also in a lot of pain and want some relief. They do feel relieved after they do memory work and the nightmares stop.

David: Here's an audience comment:

dendroaspis: I guess that if a poor person wants to integrate, they are out of luck. I'm having no luck even getting a doctor.

David: That can be pretty expensive. My guess is many people can't afford that, especially if they don't have insurance. What then?

Paula McHugh: It is expensive, but people seem to think it's so important to them, that they will give up just about anything to have their therapy.

whalevine: How will we know we are ready to integrate?

Paula McHugh: You will know because it will feel right and it won't be so scary. If you're wondering, it's probably not time. All the memory work has to be pretty much done or the integration just won't work.

insight: There is total amnesia with some people with multiple personality disorder. In my case, I am co-conscious in the background when an alter takes over. Do you work with many clients with co-consciousness DID?

Paula McHugh: Yes, I do. There are many faces and many forms to DID. They are all different and all similar. There is not just one right way.

Pam: How does one deal with very self-destructive alters and keep themselves safe?

Paula McHugh: Everyone has to work together to be as aware as possible when the alter is really down or depressed or hurt. Sometimes a protective place - a beautiful room - inside can feel safe for them. Most of all, I believe that alter needs to be heard in therapy. They need to get the worries out in the open, so they can dissipate. That takes a long time. So in the meantime, whatever you all can do to be aware of what he or she is doing -- will help.

David: I have a question. How does one explain to others who are important to them that they have Dissociative Identity Disorder; that there are alters inside of them?

Paula McHugh: Do you mean outside family or friends?

David: Yes, exactly, friends, family.

Paula McHugh: Gently --- and in a questioning tone, especially RESPECTFULLY like - "do you think it might be possible?", "what do you think happened when you didn't remember the week-end?" NOT judgmental or critical --- just soft and gentle.

Also, it's hard for family members because they are probably in denial too, but that's a whole other discussion.