Integration

Integration of alters (parts) in Dissociative Identity Disorder, as well as the need for integration in all humans during personality development.

Integration is an ongoing process that an individual can choose to work on throughout their life. The methods are detailed in Dr. Sielgel's work. This page however, will focus on integration and unification which can be used for all trauma caused disorders. Integration is the undoing of all aspects of dissociative dividedness that began as a result of childhood trauma.

When an old trauma is floating around the mind causing havoc, there is only one way to stop it and that is to consciously address it. Ignore it and it will stay astray, but when it's no longer ignored and is brought into focus by the mind, then the individual is able to create a make-shift pathway so the mind and brain can communicate. Once a unprocessed trauma events is recognized through a maze of deflection and semi-permeable boundaries, the mind and brain can finally communicate adequately and continue the process they are designed to do, which is to move unprocessed trauma events to the hippocampus (of the brain) and process them into memory. Learning about structural dissociation will help in the understanding of this process.

Changing mental processes
Mindfulness is acting with a purpose and focus that leads to awareness of mental processes. Both mental and emotional changes can be created through mindfulness, leading to physical changes in the brain. We can literally manipulate our neural pathways and stimulate growth in the brain, and if performed correctly these changes can heal damage due to unprocessed trauma. It's important to understand that without mindful work needed change will not occur, but with it we can perform almost magical changes in the mind.

Integration
Think of integration like putting a puzzle together that can't be solved without taking the pieces of life experience that led to dissociation, and fitting them together. To make the whole, unprocessed trauma events must moved from the mind to the brain and reassociated with related memory. Bits of unprocessed trauma events belonging to the different senses and various emotions are fed through the hippocampus to the cerebral cortex where they become integrated. In this way they move from the unconscious to the conscious mind or in other words, from dissociated to associated. There are integrative milestone that have been given labels such as coconsciousness, coparticipation, copresence, and so on, but these natural paths through the integrative process.

Unification
To put it simply, unification (also called fusion) is the way the normal, untraumatized and dissociated mind works, and what all minds strive for. The ISSTD defines unification as the point in time when two or more alternate identities experience themselves as joining together with a complete loss of subjective separateness.

Three phases of integration
The most common aspects of any three phase treatment plan involves establishing safety, stabilization, symptom reduction, and working with and integrating unprocessed trauma events. Identity integration and rehabilitation consume the final phase. The phases do overlap, perhaps due to some parts of the personality lagging behind others, but the main focus will normally fall on one phase at a time.

Phase I - overcoming the phobia of dissociative parts
This first phase involves internal feelings of empathy for all parts of the personality, as well as developing cooperation, understanding and acceptance that all parts together make up the one personality of an individual. This sounds easy, but in reality a great deal of energy is spent dealing with external triggers and inner conflict between parts. The ISSTD guidelines stress this is the phase to "minimize behaviors that are dangerous to an individual or others in their lives, as well as poor thinking that makes the individual vulnerable to revictimization by others. Other behavior that is addressed is relationships, eating disorders, violence, aggression, and risk-taking. Intervention directed at individual parts involves challenging maladaptive thinking and behavior. Parts that identify with the abuser can be particularly difficult to manage.

"Ultimately overcoming the phobia of dissociative parts should involve unification which is the bringing together of two or more parts." The entire process moves toward decreasing structural dissociation and getting the individual to understand that all the parts make up the whole. Many choose to end their work at this point, for various reasons, and opt for cooperative arrangement. Individuals with dissociative identity disorder, due to the strength of the dissociative boundaries around their states are more likely to desire integration as compared to those with other specified dissociative disorder who are overwrought with emotion.

Phase II - overcoming the phobia of unprocessed trauma events
This phase requires the individual learn to deal with external triggers. There is also a great deal of work done to help the individual accept all the various parts of the personalty. The word accepts has multiple meanings, but overall the parts have to learn to care for one another no matter what the parts have done and currently do. The work also involves overcoming attachment issues to people in the past and present. One of the most difficult tasks that is taken on in this phase is overcoming the fear of unprocessed trauma events and actually integrating the bulk of them. Once unprocessed trauma events are processed and shared among the parts of the personality there is still work to be done. Once unprocessed trauma events are moved from the mind to the brain and processed as memory, then the sharing of memories is called synthesis.


 * Synthesis: Synthesis is when a traumatic memory is shared across all parts in their system.


 * Realization: Once synthesis is successful, it needs to be followed with a full awareness that one has experienced the trauma, and that the trauma is indeed in the past. Thus the patient gives the traumatizing event a place in his or her personal autobiography."


 * Personification: Synthesis is followed by the realization that the trauma memories belongs to the individual. This is called personification.  Strong emotions are experienced in this phase while traumatic material is emerging. It's affects come in the form of shame, horror, terror, rage, helplessness, confusion, anger and grief.


 * Narrative: Through this work an individual can transform their unprocessed trauma events into comprehensible and coherent narrative, rendering dissociation unnecessary. This work is still not sufficient for unification, but that work is addressed in phase III.  During this phase the individual will move spontaneously back and forth from phase II to phase I.

Phase III - Integration (unification) of the personality and overcoming the phobias of normal life
In the first two phases the individual has learned to overcome the phobia of other parts in the system, phobia of the trauma memories and has accepted they were abused as a child.

Phase III involves going beyond the integration of trauma memories by sharing them with all parts of the personality. Expect painful grieving, relinquishment of long-held beliefs, and a struggle to adapt to new ways. The individual will learn to spread emotions across all parts of the personality in order to deal with the onslaught of emotion that they will experience in this phase such as shame, horror, terror, rage, helplessness, confusion, anger, and grief. Trauma manifestations can occur for up to 27 months (some report much longer) after unification is thought to be secure, but the goal of having a normal, non-dissociated mind will come eventually. During this phase the individual will move spontaneously back and forth from phase II to phase III with new unprocessed trauma events emerging at the same time the individual is doing phase III work. Upon unification the individual generally keeps the skills and attributes of the various dissociated parts of the personality.

Beyond unification
This is the type of integration work that goes beyond unification and many who have never had a dissociative disorder have benefited from Dr. Siegel's nine domains of integration.

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