Comunicación entre Alters. Referencias.

Hablemos del mito de que «no es posible conocer a los alters, se comuniquen o se sepa de ellos«.
Esta es una creencia anticuada y reduccionista, después de todo, varios modelos de terapia se centran en crear comunicación y coordinación interna.

La comunicación entre alters, aunque está entorpecida por la disociación, puede suceder tanto de forma interna (pensamientos, emociones, voces, sensaciones, ideas, impulsos, conversaciones), como de forma externa (escritos en cuadernos, notas pegadas, palabras en el cuerpo, mensajes con otras personas, mensajes de voz, videos, notas en el celular o computadora).

Puedes también consultar las referencias del uso
del término sistema, fusión y co-consciencia,
que contemplan esta comunicación,
conocimiento y coordinación.



Nevertheless, a fundamental tenet of the psychotherapy of patients with DID is to bring about an increased degree of communication and coordination among the identities. No obstante, un principio fundamental de la psicoterapia de pacientes con TID es lograr un mayor grado de comunicación y coordinación entre las identidades.
Helping the identities to be aware of one another as legitimate parts of the self and to negotiate and resolve their conflicts is at the very core of the therapeutic process. It is countertherapeutic for the therapist to treat any alternate identity as if it were more “real” or more important than any other. The therapist should not “play favorites” among the alternate identities or exclude apparently unlikable or disruptive ones from the therapy (although such steps may be necessary for a limited period of time at some stages in the treatment of some patients to provide for the safety and stability of the patient or the safety of others). Ayudar a las identidades a ser conscientes unas de otras como partes legítimas del yo ya negociar y resolver sus conflictos es el núcleo mismo del proceso terapéutico. Es contraterapéutico para el terapeuta tratar cualquier identidad alternativa como si fuera más “real” o más importante que cualquier otra. El terapeuta no debe “tener favoritos” entre las identidades alternativas ni excluir de la terapia a las aparentemente desagradables o perturbadoras (aunque tales pasos pueden ser necesarios durante un período de tiempo limitado en algunas etapas del tratamiento de algunos pacientes para brindar seguridad y estabilidad del paciente o la seguridad de los demás).

Journal of Trauma & Dissociation. International Society for the Study of Trauma and Dissociation. Guidelines for Treating Dissociative Identity Disorder in Adults, Third Revision. 2011


Do assume that some others inside can hear you even when one part is on the outside, or can be sent a message. This applies even when the presenting part is deaf, catatonic, or a baby. You can talk through the presenting part to others in the system.

When multiples begin therapy, they often do not have very good internal communication. It is important to assist them in improving this communication.

Talking with a multiple is like talking with a family whose members usually do not get along

Do not expect the person who is multiple to be consistent or to have internal harmony. At the start of therapy, most multiples have internal battles for control. The front person often has little or no control over switching. The parts may fight to be “out”, or may push others “out” in order to stay inside. Decision-making is difficult, and decisions made by one part will be reversed by another, until internal communication and problem-solving have been learned.

Hoffman, W., & Miller, A. (2018). From the trenches: A Victim and Therapist Talk about Mind Control and Ritual Abuse. Routledge.


If inner conflicts are minimized, DID alters can learn to cooperate like a well-coordinated soccer team; where all the players work together for a common goal. Each member of a soccer team has a particular position, using a specific skill set. This is directly analogous to a cooperating DID system.
Si se minimizan los conflictos internos, los alters del TID pueden aprender a cooperar como un equipo de fútbol bien coordinado; donde todos los jugadores trabajan juntos por un objetivo común. Cada miembro de un equipo de fútbol tiene una posición particular, utilizando un conjunto de habilidades específico. Esto es directamente análogo a un sistema TID cooperativo.

Yeung, David. Engaging Multiple Personalities. Volume 1. Contextual Case Histories. (2014) Preface.


Una dificultad común al principio es la aparición de amenazas internas cuando trata de comunicar con partes suyas. Habitualmente proceden de una parte muy dominante y crítica. Dichas partes, como se expuso en capítulos anteriores, solo están intentando protegerle reaccionando con los patrones rígidos y limitados de respuesta que conocen. Estas partes necesitan ayuda para aprender formas más eficientes y empáticas de proteger y tratar con el miedo, la cólera y la vergüenza. Lo más fácil es empezar, si es posible a dialogar con una parte con la que se sienta más cómodo.

Boon, Suzette/Steele, Kathy/Van der Hart, Onno. Vivir con disociación traumática (Biblioteca de Psicología) (Spanish Edition). Desclée De Brouwer.


of the presence of other personalities has been widely reported in the empirical literature on DID. Such awareness is a common occurrence in DID. Moreover, many patients who have DID hear or see what some personalities say or do when they are ‘‘out.’’ Many clinicians have incorrectly assumed that a person who has DID can never be aware of the activities of another personality.
La conciencia de la presencia de otras personalidades ha sido ampliamente reportada en la literatura empírica sobre TID. Tal conciencia es una ocurrencia común en DID. Además, muchos pacientes que tienen TID escuchan o ven lo que algunas personalidades dicen o hacen cuando están «fuera». Muchos médicos han asumido incorrectamente que una persona que tiene TID nunca puede ser consciente de las actividades de otra personalidad.

Dell, P. F. (2006). A new model of dissociative identity disorder. Psychiatric Clinics of North America, 29(1), 1-26. doi:10.1016/j.psc.2005.10.013


Tras varios meses de trabajo el paciente comienza a cuidarse un poco mejor, durante un largo periodo deja de hacerse daño. Siguen presentándose flashbacks ocasionales que lo asustan y generan inquietud interna. La relación entre las partes ha mejorado, pero el debate de si hablar o no sobre la experiencia de la violación sigue activo.

Anabel González; Dolores Mosquera. Trastorno de identidad disociativo o personalidad múltiple (Psicología) (p. 100)


In the IFS approach, it is believed that it is the nature of the mind to be subdivided into “parts.” DID is simply a more extreme manifestation of this concept. According to this model, there are no “bad” parts; as we develop, our parts develop too. The overall goals of IFS therapy are to achieve balance and harmony within the internal system and to increase positive and purposeful communication among the self and other parts (subpersonalities)
En el enfoque IFS, se cree que la naturaleza de la mente es subdividirla en “partes”. DID es simplemente una manifestación más extrema de este concepto. Según este modelo, no hay partes “malas”; a medida que nos desarrollamos, nuestras partes también se desarrollan. Los objetivos generales de la terapia IFS son lograr el equilibrio y la armonía dentro del sistema interno y aumentar la comunicación positiva y decidida entre uno mismo y otras partes (subpersonalidades)

Haddock, Deborah Bray. (2001) The Dissociative Identity Disorder Sourcebook (Sourcebooks) . McGraw-Hill Education. Kindle Edition. (p. 83) 2001


I didn’t know Bonny, obviously, but we had communicated. At Dr Laine’s instigation, Bonny had opened a new Word document on our home computer and written a little welcome message and introduction about herself. When she’d finished she’d left the page open on the screen. The next time she’d returned to the machine there was a message from Judy. Then one from Ken. There was even one from me! That was before I acknowledged the DID.
No conocía a Bonny, obviamente, pero nos habíamos comunicado. A instancias de la Dra. Laine, Bonny había abierto un nuevo documento de Word en la computadora de nuestra casa y había escrito un pequeño mensaje de bienvenida y una introducción sobre ella. Cuando terminó, dejó la página abierta en la pantalla. La siguiente vez que volvió a la máquina había un mensaje de Judy. Luego uno de Ken. ¡Había incluso uno mío! Eso fue antes de que reconociera el TID.

Noble, Kim. All of Me: How I learned to live with the many personalities sharing my body. 2012


Access is gained to the more easily reached alters, agreements or contracts are established across as many alters as possible against interrupting the therapy abruptly, against suicide and self-harm, and against as many dysfunctional behaviors as the patient is ready and willing to curtail. Communication and cooperation among the alters is fostered, and increasing numbers of alters are brought into the therapeutic alliance. Further work is done with regard to the informed-consent process.
Se accede a los alters de más fácil acceso, se establecen acuerdos o contratos entre tantos alters como sea posible contra la interrupción abrupta de la terapia, contra el suicidio y las autolesiones, y contra tantas conductas disfuncionales como el paciente esté dispuesto y dispuesto a reducir. Se fomenta la comunicación y la cooperación entre los alters, y un número cada vez mayor de alters se incorporan a la alianza terapéutica. Se está trabajando más en relación con el proceso de consentimiento informado.

Kluft, R. P. (1999). An Overview of the Psychotherapy of Dissociative Identity Disorder. American Journal of Psychotherapy, 53(3), 289–319. doi:10.1176/appi.psychotherapy.1999.53.3.289


Michelle lives out her life in quite a few different organizations of existence. Some of them know about each other and communicate with each other, and some of them do not. There is one part of her, John—who experiences himself as a five-year-old boy—who often comes to sessions, explaining with the greatest of tact why Michelle couldn’t come herself. John is the peacemaker and the unifier.
Michelle vive su vida en bastantes organizaciones diferentes de existencia. Algunos de ellos se conocen y se comunican entre sí, y otros no. Hay una parte de ella, John, que se experimenta a sí mismo como un niño de cinco años, que a menudo viene a las sesiones y explica con el mayor tacto por qué Michelle no pudo venir ella misma. John es el pacificador y el unificador.

Howell, E. F. (2005). The dissociative mind. The Analytic Press/Taylor & Francis Group.


The best hope you have of improving is to bring all these aspects of yourself together, first by communicating with each other, then by remembering everything each of them is doing, getting rid of the amnesia. We call that co-consciousness.
La mejor esperanza que tiene de mejorar es reunir todos estos aspectos de usted mismo, primero comunicándose entre sí, luego recordando todo lo que cada uno está haciendo, deshaciéndose de la amnesia. A eso lo llamamos co-conciencia.

Keyes, D. (1981). The Minds of Billy Milligan. New York: Bantam Books


Ross (1989) uses the metaphor of a corporate business structure to describe the process of establishing co-consciousness. Bearhs (1982) speaks of symphony orchestra in which the conductor rather than the CEO must insure cooperation and communication within the organization. My multiple patients have referred to their personality systems more often as families.
Ross (1989) usa la metáfora de una estructura comercial corporativa para describir el proceso de establecimiento de la co-conciencia. Bearhs (1982) habla de orquesta sinfónica en la que el director, en lugar del director general, debe asegurar la cooperación y la comunicación dentro de la organización. Mis múltiples pacientes se han referido a sus sistemas de personalidad más a menudo como familias.

Rullo, Anthony J. Multiple Personality Disorder. Two Cases in Progress. 1993


What was not clear to us was how safe Jodi was from cult abuse in the present. The fact that Jodi was not losing much time seemed hopeful. But we began to receive communications from the others inside that she still was not safe.

O. B. Epstein, J. Schwartz, & R. W. Schwartz (Eds.), Ritual abuse and mind control: The manipulation of attachment needs (pp. 57–141). Karnac Books.



Every individual with DID has at least one alter who is exceptionally good at communicating with those on the inside. You may think of this alter as a sort of manager of the other personalities. Because the communicator/manager has awareness of at least most of the other personalities, this alter is in a good position to help those personalities share with each other and sometimes with those on the outside. The communicator/manager is able to keep everyone on track and to ensure the safety and well- being of the other alters. The communicator/manager may also keep some of the inside activity and conversations away from the personality who is out so that that personality is able to function.


Cada individuo con TID tiene al menos un alter que es excepcionalmente bueno para comunicarse con los de adentro. Puede pensar en este alter como una especie de administrador de las otras personalidades. Debido a que el comunicador/gerente tiene conocimiento de al menos la mayoría de las otras personalidades, este alter está en una buena posición para ayudar a esas personalidades a compartir entre sí y, a veces, con los de afuera. El comunicador/gerente puede mantener a todos encaminados y garantizar la seguridad y el bienestar de los otros alters. El comunicador/gerente también puede mantener algunas de las actividades y conversaciones internas alejadas de la personalidad que está afuera para que esa personalidad pueda funcionar.

Alderman, Tracy, Ph.D., Marshall, Karen, L.C.S.W. Amongst Ourselves: A Self Help Guide to Living with Dissociative Identity Disorder. 1998. New Harbinger Publications.


Alters can be helped to overhear and view one another in action. Initial preoccupation with their differences from one another ultimately yields to an appreciation of their connections and commonalities. This awareness moves them toward better communication, collaboration, mutual empathy and identification, and ultimately toward integration.
Se puede ayudar a los alters a que se escuchen y se vean unos a otros en acción. La preocupación inicial por sus diferencias entre sí finalmente da paso a una apreciación de sus conexiones y puntos en común. Esta conciencia los mueve hacia una mejor comunicación, colaboración, empatía e identificación mutua y, en última instancia, hacia la integración.

Kluft, Richard. (2006). Dealing with Alters: A Pragmatic Clinical Perspective. The Psychiatric clinics of North America. 29. 281-304, xii. 10.1016/j.psc.2005.10.010.


Estos límites amnésicos definirán los flujos de comunicación que existen entre las personalidades. Su permeabilidad necesita ser modificada si se esperan cambios en el sistema mental. El terapeuta debe llegar a conocer las personalidades o de lo contrario el paciente será mínimamente entendido y la estructura defensiva seguirá siendo desconcertante.

Fine CG. The tactical-integration model for the treatment of dissociative identity disorder and allied dissociative disorders. Am J Psychother. 1999 Summer;53(3):361-76. doi: 10.1176/appi.psychotherapy.1999.53.3.361. PMID: 10586299.


My own stance is to tell the patient explicitly that the model I work with is one that aims to facilitate the development of internal communication and democracy. I explicitly use this political metaphor, emphasising that it is not my role to impose a solution, or to take sides. Therefore, the fundamental task for the personality system is to decide whether there is an internal consensus to proceed with therapy and what the goals might be.
Mi propia postura es decirle al paciente explícitamente que el modelo con el que trabajo es uno que tiene como objetivo facilitar el desarrollo de la comunicación interna y la democracia. Uso explícitamente esta metáfora política, enfatizando que no es mi papel imponer una solución o tomar partido. Por lo tanto, la tarea fundamental del sistema de personalidad es decidir si existe un consenso interno para proceder con la terapia y cuáles podrían ser los objetivos.

Mollon, Phil. (2011). Dark Dimensions of Multiplicity (pre-publication version) In: V.Sinason (Ed.) Attachment, Trauma, and Multiplicity. Routledge. London. 2002/2011


Whether you have DID or DDNOS, you can only find out what traumas happened to you and resolve them by communicating with your inside parts and working through the memories they contain.

Above all, remember that when you hear your insiders’ voices, they are communicating. They need you to communicate with them. This might be quite difficult, at first. You begin by listening. In many mind-controlled personality systems, the person on the outside is not designed to communicate directly with the insiders, just to  be influenced by them without knowing it, thinking their voices are demons or hallucinations or crazy thoughts, and their emotions are just moods, or that everyone has a “busy mind”.

Beginning to communicate with your insiders It is essential for the front person to learn to communicate with the other parts. Many multiples lack this skill. A lifelong habit of looking outward and not speaking with the voices is difficult to overcome for the front person. But it can be done.

Miller, Alison. Becoming Yourself: Overcoming Mind Control and Ritual Abuse. 2014. Karnak.


Because of the “information gap” inherent in the diagnosis, it is crucial to develop internal communication skills early in DID treatment, as well as the ability to observe intrusive feelings and physical phenomena and interpret these as communications from parts, rather than be frightened or ashamed of them.

Building Trust Inside

Trust begins to build with increased internal communication and experiences of mastery and competence. All their lives, the young parts have longed for someone who would hear, believe, and protect them—someone strong enough to keep the “bad people” away.

Fisher, Janina. Healing the Fragmented Selves of Trauma Survivors. Overcoming Internal Self-Alienation. (2017) (p. 26)


En este modelo, a los pacientes con TID se les enseña primero habilidades de regulación de impulsos y afectos, así como habilidades de comunicación y cooperación entre estados del yo disociados. Solo después de que se establece la seguridad, los síntomas se estabilizan y la coordinación adecuada y se produce la cooperación entre los estados del yo de modo que, en la Etapa 2, el trauma puede procesarse con más detalle, trabajando a través de sentimientos, pensamientos e impulsos basados en el trauma.

Brand, Bethany & Loewenstein, Richard & Spiegel, David. (2014). Dispelling Myths About Dissociative Identity Disorder Treatment: An Empirically Based Approach. Psychiatry. 77. 169-89. 10.1521/psyc.2014.77.2.169.


One issue might be the degree of communication and co-consciousness between parts thought necessary for one’s definition of functional. While therapeutic work on developing co-consciousness and communication has frequently been promoted by DID therapists, this has only been portrayed as a step along the way towards integration (Kluft, 1993). Rivera’s stance (p. 41 & p. 122) moves towards seeing communication and co-consciousness as a therapeutic end in itself, but still with the goal of developing a functional “I”. Un problema podría ser el grado de comunicación y co-conciencia entre las partes que se consideran necesarias para la definición de funcional. Si bien los terapeutas del TID han promovido con frecuencia el trabajo terapéutico sobre el desarrollo de la coconciencia y la comunicación, esto solo se ha presentado como un paso en el camino hacia la integración (Kluft, 1993). La postura de Rivera (p. 41 & p. 122) se mueve hacia ver la comunicación y la co-conciencia como un fin terapéutico en sí mismo, pero aún con el objetivo de desarrollar un “yo” funcional.

Clayton, Kymbra. (2005). Critiquing the Requirement of Oneness over Multiplicity: An Examination of Dissociative Identity (Disorder) in Five Clinical Texts. E-Journal of Applied Psychology. 1. 10.7790/ejap.v1i2.21.


Areas of agreement included a belief that self-plurality can be both psychologically healthy and psychologically problematic, depending on the level of communication among the different voices; an understanding of selves as active processes and modes of experiencing rather than passive and reified ‘things’; and a belief that, in therapeutic practice, acceptance and empathy need to be extended to all the voices within clients’ psychological worlds. Las áreas de acuerdo incluyeron la creencia de que la autopluralidad puede ser tanto psicológicamente saludable como psicológicamente problemática, según el nivel de comunicación entre las diferentes voces; una comprensión de sí mismos como procesos activos y modos de experiencia en lugar de «cosas» pasivas y cosificadas; y la creencia de que, en la práctica terapéutica, la aceptación y la empatía deben extenderse a todas las voces dentro de los mundos psicológicos de los clientes.

Cooper, Mick & Mearns, Dave & Stiles, William & Warner, Margaret & Elliott, Robert. (2004). Developing self-pluralistic perspectives within the person-centered and experiential approaches: A round table dialogue. Person-Centered and Experiential Psychotherapies. 3. 176-191. 10.1080/14779757.2004.9688345.


El trastorno de identidad disociativo se puede confundir con la esquizofrenia u otros trastornos psicóticos. Las voces interiores, comunicativas y personificadas del trastorno de identidad disociativo, en especial de niños (p. ej., «oigo a una niña llorando en un armario y a un hombre enojado gritándola», pueden confundirse con las alucinaciones psicóticas .Las experiencias disociativas de fragmentación de la identidad o de posesión y la pérdida de la sensación de control sobre los pensamientos, sentimientos, impulsos y actos se pueden confundir con los signos de los trastornos formales del pensamiento, como la inserción o el robo del pensamiento. Los individuos con trastorno de identidad disociativo también pueden referir alucinaciones visuales, táctiles, olfativas, gustativas y somáticas que, por lo general, se relacionan con factores postraumáticos y disociativos, como los flashbacks parciales. Los individuos con trastorno de identidad disociativo experimentan estos síntomas como causados por identidades alternativas, no tienen explicaciones delirantes de los fenómenos y a menudo describen los síntomas de una forma personificada (p. ej., «me siento como si alguien más quisiera llorar con mis ojos»). Las voces internas persecutorias y despectivas del tras-torno de identidad disociativo asociado con síntomas de depresión pueden llevar al diagnóstico de depresión mayor con síntomas psicóticos.

American Psychiatric Association – APA. (2014). Manual diagnóstico y estadístico de los trastornos mentales DSM-5


Alter personalities create relationships internally as an avenue for safety in a world that is not a safe place. Hence, the patient’s cognitive style for investigating external objects and relationships becomes invested purely within the self, encapsulating a myriad of memories condensed into self-objects, affects, and object connections. Alter personalities may remain in their original form, multiply, or grow as maturation progresses. The hierarchy of the nervous system translates into the parallel memory systems, which may or may not intersect for communication between alter personalities. In fact, Bowlby (1958) suggests that alternative parallel paths of development occur in psychopathology. Las personalidades alternativas crean relaciones internamente como una vía para la seguridad en un mundo que no es un lugar seguro. Por lo tanto, el estilo cognitivo del paciente para investigar objetos y relaciones externos se invierte puramente en el yo, encapsulando una miríada de recuerdos condensados en objetos del yo, afectos y conexiones de objeto. Las personalidades alternativas pueden permanecer en su forma original, multiplicarse o crecer a medida que avanza la maduración. La jerarquía del sistema nervioso se traduce en sistemas de memoria paralelos, que pueden cruzarse o no para la comunicación entre personalidades alternativas. De hecho, Bowlby (1958) sugiere que en la psicopatología se dan caminos paralelos alternativos de desarrollo.

Elin, Mark R. 1995. A developmental model for trauma. In Dissociative Identity Disorder: Theoretical and treatment controversies, edited by Lewis M. Cohen, Joan N. Berzoff, and Mark R. Elin. Northvale, N.J.: Jason Aronson


I tried my own style of psychotherapy with these patients by first strengthening their host personality’s adaptation, as well as communication among altered personalities. I attempted to identify and work with the leader of the altered personalities in order to create a good balance among them. This helps the process of integration of the various personalities of each patient.
Probé mi propio estilo de psicoterapia con estos pacientes fortaleciendo primero la adaptación de la personalidad del anfitrión, así como la comunicación entre alters. Traté de identificar y trabajar con el líder de los alters para crear un buen equilibrio entre ellos. Esto ayuda al proceso de integración de las diversas personalidades de cada paciente.

解離性同一性障害(多重人格)の原因と治療について An Analysis of the Causes of Dissociative Identity Disorder (Multiple Personality) and Their Psychotherapy 町沢静夫 Shizuo Machizawa


The role of psycho-education as integral to the therapy, the importance of being aware of all parts or self-states, the need to increase internal communication between parts, and the role of processing trauma experiences are addressed in each clinical study.

The therapist working from this model would focus on decreasing the thickness of the barriers between the egostate selves. As an individual—child or adult—becomes more aware of other aspects of the self, barriers thin, internal communication increases, and eventually free movement between ego-states could occur.

For the child therapist, this model emphasizes the importance of communication between the varying aspects of the self. Whether this is done by use of a pie diagram, drawing pictures of the varying parts of self, or imaging different aspects of the self, emphasis is on communication between the parts. The child is encouraged to have the parts that experienced the new safer or more valuing experiences tell the younger parts that are still caught in the old unsafe or devaluing world about the “now” world.

Wieland, S.. (2015). Dissociation in Traumatized Children and Adolescents: Theory and Clinical Interventions: Second Edition. 10.4324/9781315740430.


En la tercera sesión, quedó muy claro que varios alters se habían comunicado en el diario y con varios miembros de la familia. También quedó claro que el alter de nombre Fredo (un apodo corto de Alfredo, el nombre del esposo separado de Madeline) y Andrés (el nombre de uno de los primos de Madeline) eran muy hostiles e introyectados de agresión y odio hacia Madeline.

Martínez-Taboas, A., & Rodríguez-Cay, J. (1997). Case study of a Puerto Rican woman with dissociative identity disorder. Dissociation: Progress in the Dissociative Disorders, 10(3), 141–147.


The PITQ measures capacities developed throughout the stages of treatment for DD, including affect tolerance; impulse control; PTSD and dissociative symptom management skills; internal communication and cooperation among self-states; ability to tolerate fully knowing about and experiencing emotional and sensory experiences related to trauma; integrating selfstates; and increasing ability to view self and others in an integrated, realistic way that is not dominated by trauma-based perceptions. Therapists estimated what percentage of the time (0 – 100%) their patient is capable of demonstrating each capability.
El PITQ mide las capacidades desarrolladas a lo largo de las etapas del tratamiento de la DD, incluida la tolerancia afectiva; control de los impulsos; PTSD y habilidades de manejo de síntomas disociativos; comunicación interna y cooperación entre estados del yo; capacidad de tolerar completamente conocer y experimentar experiencias emocionales y sensoriales relacionadas con el trauma; integrando estados del yo; y una mayor capacidad para verse a sí mismo y a los demás de una manera integrada y realista que no esté dominada por percepciones basadas en el trauma. Los terapeutas estimaron qué porcentaje del tiempo (0 – 100%) su paciente es capaz de demostrar cada capacidad.

Brand, Bethany & Classen, Catherine & Lanins, Ruth & Loewenstein, Richard & McNary, Scot & Pain, Claire & Putnam, Frank. (2009). A Naturalistic Study of Dissociative Identity Disorder and Dissociative Disorder Not Otherwise Specified Patients Treated by Community Clinicians. Psychological Trauma: Theory, Research, Practice, and Policy. 1. 153-171. 10.1037/a0016210.


Relating specifically to working with DID and people with very defined parts, Dr. Korn sees herself as constantly doing group therapy with the presenting client. She is always working toward increasing someone’s coconsciousness and to bring parts into communication, observing that “People need help with scooping up and then stitching together the components of experience.” Dr. Korn maintains that the therapeutic relationship is everything in terms of creating a safe container for the work between the provider and their client. This relational container is essential for undoing the aloneness, and offering co-regulation that allows people to be courageous enough to approach the material that’s been unapproachable.
Refiriéndose específicamente al trabajo con TID y personas con partes muy definidas, la Dra. Korn se ve a sí misma haciendo terapia de grupo constantemente con el cliente que se presenta. Ella siempre está trabajando para aumentar la coconciencia de alguien y traer partes a la comunicación, observando que «las personas necesitan ayuda para recoger y luego unir los componentes de la experiencia». El Dr. Korn sostiene que la relación terapéutica lo es todo en términos de crear un contenedor seguro para el trabajo entre el proveedor y su cliente. Este contenedor relacional es fundamental para deshacer la soledad y ofrecer una co-regulación que permita a las personas tener el coraje de acercarse al material que les ha sido inabordable.

Jamie Marich. Dissociation Made Simple: A Stigma-Free Guide to Embracing Your Dissociative Mind and Navigating Daily Life. 2023.


The alters may be few or many, of various ages, including older than the body, same- or cross-gendered, hetero- or homosexual, alive or dead, with either or both coconsciousness and copresence to varying degrees, which may not be commutative (i.e., may be one-way), communicating not at all, or through hallucinations, or through direct thought transfer, manifesting different physiological signs in the body when out, clustered in various arrays of dyads, subgrouping, layers, purposes, and so on.
Los alters pueden ser pocos o muchos, de varias edades, incluso mayores que el cuerpo, del mismo género o cruzados, heterosexuales u homosexuales, vivos o muertos, con coconsciencia y copresencia o ambas en diversos grados, que pueden no ser conmutativos. (es decir, puede ser unidireccional), sin comunicarse en absoluto, o a través de alucinaciones, o a través de la transferencia directa de pensamientos, manifestando diferentes signos fisiológicos en el cuerpo cuando está fuera, agrupados en varios conjuntos de díadas, subgrupos, capas, propósitos, etc.

Paul F. Dell. Dissociation and the Dissociative Disorders (p. 301). Taylor and Francis. Edición de Kindle.




Coconsciousness is a term that has been used in the dissociation field since the 19th century, when dyspyschism was a major model of the mind (Ellenberger, 1970; R. P. Kluft, personal communication, April 1, 2013). The term refers to the degree to which parts are aware of each other internally. If the amnesia barriers are quite impermeable, there is little coconsciousness. If the amnesia barriers are thin and permeable, the parts may be said to be highly coconscious. A patient’s parts may vary in how much coconsciousness they have with some parts versus other parts (Kluft, 1984a).

In contrast, copresence, a term introduced by Kluft (1984b) to address important nuances not captured by the term coconsciousness, refers to the degree to which a patient’s parts can be forward in the body, executive, and aware of their presence in, for example, the therapist’s office at the same time. A part is said to be present when that part experiences itself seated in the chair in the therapy office, is observed by the therapist to be present at least in executive control of part of the body, and is using the first-person pronoun, “I.” Sometimes it happens that the therapist observes that one part seems to have control of the mouth, or mouth and head, but not the rest of the body.



Coconciencia es un término que se ha utilizado en el campo de la disociación desde el siglo XIX, cuando el dispsiquismo era un modelo importante de la mente (Ellenberger, 1970; R. P. Kluft, comunicación personal, 1 de abril de 2013). El término se refiere al grado en que las partes se conocen internamente. Si las barreras de amnesia son bastante impermeables, hay poca coconsciencia. Si las barreras de amnesia son delgadas y permeables, se puede decir que las partes son altamente coconscientes. Las partes de un paciente pueden variar en la cantidad de coconsciencia que tienen con algunas partes versus otras partes (Kluft, 1984a).

Por el contrario, la copresencia, un término introducido por Kluft (1984b) para abordar matices importantes no captados por el término coconciencia, se refiere al grado en que las partes de un paciente pueden estar adelantadas en el cuerpo, ejecutivas y conscientes de su presencia en, por ejemplo. ejemplo, la oficina del terapeuta al mismo tiempo. Se dice que una parte está presente cuando esa parte se siente sentada en la silla en la oficina de terapia, el terapeuta observa que está presente al menos en el control ejecutivo de una parte del cuerpo y está usando el pronombre en primera persona, “ I.» A veces sucede que el terapeuta observa que una parte parece tener el control de la boca, o boca y cabeza, pero no el resto del cuerpo.

Lanius, U. F., PhD, Paulsen, S. L., PhD, & Corrigan, F. M., MD. (2014). Neurobiology and treatment of traumatic dissociation: Towards an Embodied Self. Springer Publishing Company.


After trauma processing, spontaneous integration may take place. If the spontaneous integration of a dissociative state has not taken place, it will be necessary to help the child with this by specifically focusing on integrating this dissociative state. Through internal communication the child can change the name and the function of the dissociative state to adapt to a more acceptable role. Integration can also be explained with metaphors like a soccer team. The team can only win when all parts of the team work together. Activities supporting the process of integration are: visual experiences (i.e. the painting of a rainbow in which several colors flow together) or tactile experiences (i.e. taking different colors of clay and building a ball out of it) whereby each color symbolizes a single part, fusion rituals or figures in the sand tray symbolizing the different dissociative states come closer, hold hands (Waters, 1998). Waters (2016) describes symbolic drawings of integration as well as the use of EMDR during the integration of dissociative states.

Agarwal V, Sitholey P, Srivastava C. Clinical Practice Guidelines for the management of Dissociative disorders in children and adolescents. Indian J Psychiatry. 2019 Jan;61(Suppl 2):247-253. doi: 10.4103/psychiatry.IndianJPsychiatry_493_18. PMID: 30745700; PMCID: PMC6345132.


We have been asked whether activating ego states doesn’t increase dissociation. Paradoxically, ego state therapy does not increase dissociation. It decreases it. If an ego state is split off during trauma in childhood, that entity retains the feelings of the experience and the thinking of that moment in time. It does not grow up with the rest of the personality. It is as if that ego state were encased in a cocoon in which time had frozen and stood still. Communication and interaction between ego states increases boundary permeability and growth, resulting in reduced dissociation.

Michelson, L. K., & Ray, W. J. (Eds.). (1996). Handbook of dissociation: Theoretical, empirical, and clinical perspectives. Plenum Press.


This process was more than just a blending of the minds. It was a process of each pairing finding a common ground and creating mutuality. They would find something in common, spend time working together, sharing tasks and developing ways to best communicate with each other. When the two were comfortable with being together, they would create a space where they could work simultaneously.

Haynes, Jeni; Blair-West, George. The Girl in the Green Dress (pp. 374-375). Hachette Australia. Edición de Kindle.


This book has been the result of that cooperation and demonstrates the efficacy of this means of resolution. Increasingly, therapists who work with multiple personalities report more than one type of resolution. In the case of the Troops the first-born is dead and the decision is to maintain multiplicity. The developing resolution for the Troops has meant increasing awareness of each other and a sharing of those important and traumatic experiences that resulted in the development of multiple persons. Communication among the Troop members has been enhanced, and there is evidence of an increased ability to cooperate and work together. This book became both the catalyst and the vehicle for encouraging healthier working relationships among Troop members.

Chase, Truddi. When Rabbit Howls (p. 364). Penguin Publishing Group. Edición de Kindle.


However, unless we concurrently understand MPD as an interactive system, we are at risk of destroying an adaptive construction without providing a useful replacement. We can lift the barriers to internal communication by hypnosis in order to retrieve encapsulated memories. We then flood the patient with a past she has well understood to be excruciating (Loewenstein, 1988). If, on the other hand, we understand how the MPD system works in its variety of levels, we can use the organization to support orderly change (Kluft, 1985).

Sinnott, J. D., & Cavanaugh, J. C. (1991). Bridging paradigms: Positive Development in Adulthood and Cognitive Aging. Praeger.


Myth. Patients talk to their alters like talking to regular people, like seeing them outside as separate persons.

Patients with DID often communicate with the alters internally as a conversation within their heads in an internal or alternate world, as communication happens with a distinct person in their mind even when they are not apparent [9]. This aspect of the condition causes a mix-up of the condition with schizophrenia, often confusing these alters as auditory hallucinations when they are like loud thoughts of a person instead of extrasensory perception or hallucination. They may also use other means of communication to talk to the other alter when that alter is the dominant alter, like journaling, writing post-it notes, videos, blogging, etc.

Schema therapy is another potential option for patients with DID. This form of therapy integrates cognitive behavioral therapy with experiences and other interpersonal elements. Its purpose is to increase the level of consciousness among the dissociated parts, improve communication and functioning, and address past traumatic memories [18]. It addresses the dissociated parts of patients as different modes of a human, rather than separates states, which aids the patient in appropriate normalization [18].

The main aim of treatment involves increasing coordination and communication among identities, facilitating the processing of traumatic memories, and integrating separate identities [9]. A study of 36 international experts on DD also recommends a core set of foundational treatment techniques to be used across all stages of treatment [14].

Tohid, H., & Rutkofsky, I. H. (2024). Dissociative Identity Disorder: Treatment and Management. Springer Nature International Publishing.


The therapist then serves as a mediator between conflictual ego states, striving to improve internal communication, conflict resolution, and compromise. The goal of therapy is a synthesis of new styles of internal diplomacy that allows increased acceptance of the disparate motivations and specialized functions of various ego states.

The therapist models and encourages validation of each ego state, while seeking to help the client develop enhanced internal cooperation in solving problems and managing affect. Ego states are urged to forego acting out in favor of increased tolerance and support of each other’s legitimate roles and functions. A strong values emphasis is present in this form of therapy. promoting the preference of «partnership” over adversarial styles of internal relations. No ego states are dismissed or rejected in reaching solutions to conflicts, and the therapist repeatedly suggests that since no ego state can possibly be eliminated, the development of peaceful co-existence is the only strategy that can lead to satisfactory adjustment. In addition to this emphasis upon improved relations between ego states, treatment also focuses upon resolving the particular problems, distresses, distortions, and impairments of individual ego states.

Bloch, J. P. (1991). Assessment and Treatment of Multiple Personality and Dissociative Disorders. Professional Resource Press


Although it is sometimes necessary for the therapist to first work with certain alternate personalities, this should only be a transition for the host to eventually assume the central role in internal communication.

The development of internal cooperation and co-consciousness between personalities is an essential part of early phase treatment that then continues into the middle phase. The therapist must emphasize the adaptive role and validity of all personalities and encourage the host to find adaptive ways to accommodate the wishes and needs of all personalities.

In patients with DID, family/systems theory is applicable to the internal family of alternate personalities or identities. Using this framework, there are no bad personalities, only personalities that are compelled to behave in a particular way because of past events and in reaction to or to compensate for the actions and behaviors of other parts of the personality system. Increased internal communication, collaboration, and empathy are the key elements of this kind of family/systems work with patients with DID.

Chu, J. A. (2011). Rebuilding shattered lives: Treating Complex PTSD and Dissociative Disorders. John Wiley & Sons.


Working with shame in dissociative parts. Shame is a major reason parts remain phobically avoidant of each other. Thus, shame is a barrier to internal communication, cooperation and, ultimately, integration. The therapist should carefully explore the role of shame in keeping parts separate.

Dissociative patients have overlapping and conflicting undertows that may be felt by the therapist. Dissociative parts often communicate implicitly when they are “behind the scenes”—that is, when they are not in complete executive control.
Therapists often feel these unspoken undercurrents, these persistent threads of feelings and urges. For example, therapists may feel confusion or fogginess, a strong pull to distance or caretake, lassitude or hopelessness, sexual tension, anger, dread, sadness, or a sense of not really knowing the patient even after many months.

The treatment plan would therefore include improving emotion regulation; resolving shame defenses; changing maladaptive schemas; helping the patient develop more flexible and realistic mental representations of self and others; understanding the functions of dissociative parts; promoting inner communication and resolving conflicts among parts, especially the conflict between attachment and defense that perpetuates disorganized attachment patterns; and focusing on what happens in the therapeutic relationship as a particular way to address many of these issues.

Treating Trauma-Related Dissociation: A practical, integrative approach (1st edn) (Norton Series on Interpersonal Neurobiology) Kathy Steele, Suzette Boon, Onno Van Der Hart W.W. Norton & Company, 2017).


As therapy progresses, and as more internal communication and cooperation is established within the system of alter personalities, the protectors will usually gain influence and control and will be able to intervene more effectively to suppress or redirect violence aimed at self and others.

Development of Communication and Cooperation

The fostering of internal communication and cooperation is also an ongoing process right down to the fmal integration. Much of the groundwork, however, is laid early in the course of treatment. There are four primary aspects: (1) development of internal communication; (2) establishment of cooperation around common goals; (3) development of an internal decision-making process; and (4) the facilitation of switching.

Once this process is under way, the patient will be able to function at a significantly higher level than was previously possible. Internal communication and cooperation can compensate for many of the amnesic gaps and thereby provide a sense of continuity that has previously been unattainable. The cooperation around common goals begins the task of replacing division with a form of unity. The development of an internal decision-making process within the patient continues the task of creating internal cohesion. Facilitation of switching relieves some of the internal tension and struggles among the personalities for »body time,» which constitute a major source of internal conflict. It also further promotes cooperation as alters practice handing control over behavior back and forth to each other.

Putnam, F. W. (1989). Diagnosis and treatment of multiple personality disorder. Guilford Press.



Multiplicity exists on a continuum, and according to Kluft (1988b) the degree of multiplicity experienced by any one individual depends on the amount and severity of the trauma, the degree of dysfunction, the amount and quality of the internal communication among part-selves, and the degree to which the different alters or «parts» cooperate.

Schwartz, H. L. (2000). Dialogues with Forgotten Voices: Relational perspectives on child abuse trauma and treatment of dissociative disorders.

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