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18. Sequential steps to improving integrative capacity by working with parts
As outlined in the two cases in this article, there are somewhat sequential steps to working with parts and improving integrative capacity, as follows:
enhance reflective thinking and capacity to mentalize;
promote compassion and understanding;
identify when and why parts/voices appear:
- when do they appear - what is the function/purpose/goal?
- what are they trying to achieve; what purpose do they have?
- how do they appear or respond to the moment? Are their coping strategies working or are there other ways that work more effectively (as in the case above)?
link impulses/urges/reactions with triggers to traumatizing events;
explore how parts experience therapy (or whatever is happening with the client in the moment);
promote collaboration and cooperation:
- engage parts, help them feel they have an important role in achieving a better functioning;
- model new, more effective ways of communicating and relating between parts,
> What does this part think about what is going on?, What do you as the adult think about what is happening? Are there any other parts that feel differently than you do?, Can we listen to them too?
> If parts are less developed and separate: What do you experience when you respond from the perspective of that part of you?
Introduce an Adult perspective. If the adult part can be present most of the time while being aware of and compassionate toward other parts, there can be better integration and less switching in the more dissociative cases.
Introduce common goals that are shared, accepted, and make sense to the whole system.
Prepare clients for future difficulties with parts of themselves, given that work is ongoing. The process may not always go as smoothly as the client wishes for. This normalizes therapeutic challenges, helps the client hold the dialectical tension between acceptance of where parts are and the need for change and avoids going back to conflictual responses between parts. Helping the client anticipate potential problems supports them in being more open and understanding to challenges from parts of their system (e.g., hearing critical comments or commands to self-harm, or voices that wish to avoid thearpy).
These steps can be followed in all cases where integrative failures are present. The main differences in the work will be related to the degree of development and autonomy of parts. In clients without serious dissociation, parts will be less developed, and dissociative phobias will not interfere as much as they do in dissociative BPD cases. Although there is still conflict in these clients, the work tends to flow more smoothly, with less resistance. Some issues can be solved by simply helping clients understand what their symptoms are related to, introducing adaptive information that was not available before, and working with and integrating core traumatizing experiences that are preventing better functioning. In dissociative BPD cases, dissociative phobias and barriers will be stronger and it may take considerably longer to begin resolving conflicts. Psychoeducation and cognitive work are not be sufficient in themselves, and integrating traumatizing experiences is not always possible due to the fragility of the client’s inner structure. The more amnesia the client has for the traumatic past and the less realization, overall, the more the therapist understands the client has more limited integrative capacity and needs to go slower.]
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