An “Inside-Out” or “Outside-In” Approach?

Disclaimer: I have absolutely NO formal training in the treatment of DID or any other mental/emotional issues other than the “on-the-job” training that has occurred 24/7 for the last two years with my girls. So what follows is my own, ignorant, opinion. I do not intend to impugn or caricature any other methods or ideas about the treatment of DID. What follows is simply the mental framework I use.

From the little I have read about DID treatment in others, it seems that there is often an “outside-in” emphasis. The “host” is taught coping strategies and management techniques as part of a larger scheme of dealing with and treating the DID issues especially in the beginning. According to the ISSTD guidelines, these coping strategies are seen as stabilizing for the sufferer.

But as I think about this, in my opinion, it is NOT the “host” who is being triggered. Karen isn’t afraid of crowds or scary creatures in a movie or of having sex with me. So why should she be taught coping techniques? Truly as the insiders have begun to come outside to get healed, THEY are the ones who get triggered. It’s a scary world out here in their opinion. And the trigger events as I’ve written before are just the process of them becoming acclimated to the outside world and learning that the trauma is now a past event.

So since I see myself as the main healing agent for my girls, I personally have taken an “inside-out” approach to their healing. It’s nothing grand or complicated. It just means I understand that the insiders are the ones who store the majority of the trauma events and memories. They are the ones who are getting triggered as they have begun coming outside. They are the ones who are flooding Karen with all kinds of emotions for which she has no explanation. So they are the ones that I focus my attention on.

In the beginning I “stabilized” them not Karen. She may not have felt fine, but that’s because the insiders were truly the ones in upheaval. As I focused on them and brought them through the adjustment period to the outside world, the trigger events became less severe and lest frequent. The first year for us was the hardest. I had three new girls regularly in my life (Amy, Sophia and Alleylieu), and I had to help each adjust to and feel safe with me and the outside world.

Once I got my girls stabilized, we naturally morphed into the second phase of my involvement with them. Quite simply healing is in the outside world with me and my son as we flood my girls with all the things they have felt lacking for the last 40 some years. And a lot of the healing occurs just by building up a “bank” of outside experiences like those of us without DID have to judge everything against. Insiders have a truncated view of events because they don’t have the breadth and depth of experiences from which most of us can draw. When I come against traumatic events in my life, I have 43 years worth of experiences to judge them against. As my girls have been living and experiencing life on the outside for the last two years with me and my son, they are gaining “capital” to judge experiences in a similar way that I do.

Right now I spend my entire life pouring myself into Karen’s insiders. It’s hard for Karen and me, but the overwhelming part of my day is spent with Amy and Alleylieu giving them the love, attention, playtime, sense of security and belonging, and all the other things that they needed but never felt they had (see entry on meeting their needs).

So as a spouse, if your wife is triggered, I challenge you to look deeper and understand that she really is NOT triggered. There’s an insider that is triggered. As you develop a relationship with each of the insiders, and lovingly draw them into the outside world, and help them adjust and feel safe and more importantly as you satisfy the felt needs of each girl’s heart, you will help them along the path of healing far more than by focusing on your wife as much as that may seem logical. In my ignorant opinion having an “inside-out” strategy actually is about dealing with the root issues instead of dealing with the symptoms.


Sam, I Am


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