Among DID individuals, the sharing of conscious awareness between alters exists in varying degrees. I have seen cases where there has appeared to be no amnestic barriers between individual alters, where the host and alters appeared to be fully cognizant of each other. On the other hand, I have seen cases where the host was absolutely unaware of any alters despite clear evidence of their presence. In those cases, while the host was not aware of the alters, there were alters with an awareness of the host as well as having some limited awareness of at least a few other alters. So, according to my experience, there is a spectrum of shared consciousness in DID patients. From a therapeutic point of view, while treatment of patients without amnestic barriers differs in some ways from treatment of those with such barriers, the fundamental goal of therapy is the same: to support the healing of the early childhood trauma that gave rise to the dissociation and its attendant alters.

Good DID therapy involves promoting co­-consciousness. With co-­consciousness, it is possible to begin teaching the patient’s system the value of cooperation among the alters. Enjoin them to emulate the spirit of a champion football team, with each member utilizing their full potential and working together to achieve a common goal.

Returning to the patients that seemed to lack amnestic barriers, it is important to understand that such co-consciousness did not mean that the host and alters were well-­coordinated or living in harmony. If they were all in harmony, there would be no “dis­ease.” There would be little likelihood of a need or even desire for psychiatric intervention. It is when there is conflict between the host and/or among alters that treatment is needed.

Conflict in DID patients is usually quite evident. A system full of clashes is usually playing out a power struggle internally that is manifesting externally. In some cases, dictatorial alters may have an iron­clad control over the information flow and behavior of the system as a whole. In addition, because of their strong individualistic feelings, some alters may appear to behave in a callous or selfish way with no regard for the needs of the host and the other alters. This can result in one alter hijacking control of the body for a time, short or extended, for the pleasure/intentions/wishes of that one alter alone. The result is usually the host’s experience of time-­loss, one of the key markers for DID and one of the primary causes for seeking therapy.

Such a hijacking alter may think, “I don’t care that others in the system are tired and may need to sleep. It is my time, and I want to go out. I want to have a good time at the bar.” For example, I had a patient with one alter who regularly took off to have fun cruising around with motor­cycle gangs. She totally disregarded the safety of the system, the boundaries of her support network, and the host’s appointments to see me. I would note that this kind of conflict can occur even in the context of a patient with some level of co­-consciousness.

It is not uncommon for a patient’s host or front to vehemently deny the presence of alters despite clear evidence in diaries, letters, and even recorded messages of alters talking. This is the opposite of co-consciousness – at least with respect to the host. It must be terrifying, not merely disconcerting, for an individual to realize that an alter, another inside part of that same individual, can so completely take over the executive functions of the system to the point that they establish a functioning separate life in the outside world. In fact, I have had patients whose alters would, on occasion, establish a completely separate existence for a few months at a time using that alter’s name. In one case, the alter established her own residence in a different apartment, connected with a different social milieu, and, in that case, earned money as a sex trade worker.

I know hosts who have staunchly fought against such recognition of alters and even the idea of co-consciousness. One cannot blame them. The fear is so intense that I sometimes had patients leave therapy rather than work with the recognition. As a result of those experiences, I learned to sometimes withhold revealing or confirming a DID diagnosis so as to avoid scaring the patient into abruptly terminating therapy. In my judgment, it was occasionally justified to delay confirmation of the diagnosis at least until the foundation of a genuine therapeutic alliance was established.

With respect to cases where the alters are completely hidden from one another, one must tread gently. When the presence of alters is pointed out, some DID individuals may take a long time to be convinced that there are indeed other alters co­existing in that same physical body. As a therapist, do not push the point about alters or co-consciousness as a path to healing. It is not a debate to win or lose. Again, if there weren’t problems, then the patient wouldn’t be in therapy.

The question for the therapist is how to gently promote co­-consciousness. First, one must prepare the patient to hear the news that there are alters inside. You must wait until you have confidence that the message is not going to create uncontrollable panic in the host. Establishing a therapeutic alliance with the host is absolutely critical to this. As the therapist, you may or may not have met some or all of the alters directly. Establishing a therapeutic alliance with alters that you have met, or with whom you can otherwise communicate, can strengthen the host’s ability to hear the news.

Remember that the amnestic barriers arose for very good reasons. Breaking them down without permission invites further trauma. So, make sure the news is given in a way that makes clear that as a therapist you can help bridge the amnestic barriers when the different parts are ready. One helpful analogy for promoting co­-consciousness might be to note that you, the therapist, might be frightened to walk down a dark street alone but would feel much safer walking that same street if you had a friend (or two or three) with you. Even if that friend was also scared, the companionship would be helpful to both you and your friend. Please use the analogy with respect to your own fears about walking down dark streets, not theirs. They will understand the point.

This analogy was quite helpful to some of my patients that had very young alters with similar but not identical trauma memories. The point was not to encourage or even suggest integration. Instead it was to allow each of those alters to know that they were not alone, that there were others inside that could truly understand. That can be the beginning of a friendship within the community of alters. Once that first companionship among alters arises, it can be referenced when talking to other alters that are still blocked by amnestic barriers.

In this way, you can encourage the direct experience of feeling safer through the experience of co-consciousness. It is a step­-by­-step process. The patient may feel like they are treading on thin ice in terms of their fear and panic. The simple answer is to encourage them to go very slowly, just as you would when walking on thin ice. When you walk on thin ice, you do not know for certain if it is strong enough to hold you. You go inch by inch, testing and seeing what happens. It is the same here.

A not uncommon experience of one alter starting to consider the possibility of companionship with another alter (though not yet safety) is when they become aware that their traumas had strong similarities to the traumas of another alter or perhaps several alters. This is akin to the analogy of walking a dark street together rather than alone. In addition, when there is the experience of a frightened alter witnessing the emergence of a protective alter in the outside world, both alters can begin to appreciate their respective roles in the system. In this case, it might be the frightened alter identifying a danger and the protective alter reacting to that identification and fulfilling its function. This is again a prelude to developing a sense of safety and can occur more easily when the alters begin to become aware of each other. When this takes place without re-traumatization, this is the beginning of seeing the possibility of healthy teamwork that is a mark of healing.