THE ROLE OF METAPHOR IN THE TREATMENT OF DISSOCIATIVE IDENTITY
DISORDER: LISTENING TO THE MULTIPLE VOICES OF SHARED EXPERIENCE
by
KATELYN AUTUMN FISTER

Bachelor of Arts, Simon Fraser University, 2006

Thesis
Submitted in Partial Fulfillment of the Requirements for
the Degree of

MASTER OF ARTS IN COUNSELLING PSYCHOLOGY

in the
FACULTY OF GRADUATE STUDIES
TRINITY WESTERN UNIVERSITY

October 2019
© Katelyn Fister, 2019

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Abstract
In this study, the Listening Guide (Brown & Gilligan, 1992), a voice-centred relational
methodology, was used to explore the therapeutic application of metaphor in the treatment of
dissociative identity disorder (DID) from the perspective of both client and therapist. Two
client-therapist dyads, as well as a former therapist, participated in individual interviews
exploring their subjective and shared experiences of using metaphor in therapy. Through
analysis of the interviews, eight voices were identified. These voices are organized into two
overarching categories: 1) voices of trauma and dissociation, and 2) voices of healing and
integration. Relationships were observed among the various voices of dissociation, as well as
between the voices of dissociation and those of trauma and healing. These relationships reveal
natural links between clients’ metaphors of trauma, dissociation, and healing. The clients’ core
metaphors of dissociation – Hope’s beehive metaphor and ‘Reace’s mansion metaphor –
illustrate the complex relationships that exist among these three metaphorical constructs. The
beehive and mansion metaphors represented the individuals’ subjective experiences of DID and
were used as the main organizers of the healing process across all three phases of treatment: 1)
establishing safety, stabilization, and symptom reduction; 2) confronting, working through, and
integrating traumatic memories; and 3) identity integration and rehabilitation (International
Society for the Study of Trauma and Dissociation [ISSTD], 2011). Importantly, the therapists
were open to hearing and engaging with clients’ own metaphors of dissociation, which opened
possibilities for healing. The clinical implications of these findings are discussed, with a focus
on how this research may inform current treatment guidelines for DID (ISSTD, 2011).
Key-words: dissociative identity disorder, metaphor, treatment, Listening Guide

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Table of Contents
Abstract ........................................................................................................................................... ii
Table of Contents........................................................................................................................... iii
Acknowledgments........................................................................................................................ viii
Chapter 1: Introduction ................................................................................................................... 1
Dissociation and Dissociative Identity Disorder ......................................................................... 3
Diagnostic criteria.................................................................................................................... 4
Epidemiology........................................................................................................................... 5
Etiology. .................................................................................................................................. 6
Metaphor ..................................................................................................................................... 7
Metaphor in psychotherapy. .................................................................................................... 8
Implicit and explicit therapeutic metaphors. ........................................................................... 9
Chapter 2: Literature Review........................................................................................................ 11
Treatment for Dissociative Identity Disorder............................................................................ 11
Expressive therapies. ............................................................................................................. 12
Explicit metaphors................................................................................................................. 15
Case Studies of Dissociation: Therapeutic Uses of Metaphor .................................................. 19
Phase 1: safety, stabilization, and symptom reduction. ......................................................... 20
Phase 2: trauma processing.................................................................................................... 25
Phase 3: identity integration and rehabilitation. .................................................................... 28

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Summary and Critique........................................................................................................... 31
Research Focus.......................................................................................................................... 31
The Listening Guide Methodology ........................................................................................... 34
Paradigm considerations........................................................................................................ 35
Rationale................................................................................................................................ 36
Participants ................................................................................................................................ 38
Recruitment ............................................................................................................................... 39
Data Collection.......................................................................................................................... 41
SCID-D-R.............................................................................................................................. 41
Listening guide interviews..................................................................................................... 42
Analysis Procedures .................................................................................................................. 44
Transcription.......................................................................................................................... 44
Listening guide analysis. ....................................................................................................... 44
Steps of analysis................................................................................................................. 46
Listening for the plot. ..................................................................................................... 46
I poems. .......................................................................................................................... 46
Listening for contrapuntal voices. .................................................................................. 47
Composing an analysis................................................................................................... 49
Rigour and Quality .................................................................................................................... 50
Reflexivity. ............................................................................................................................ 50

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Representation. ...................................................................................................................... 53
Consequential validity. .......................................................................................................... 55
Ethical Considerations............................................................................................................... 57
Chapter 4: Composing an Analysis............................................................................................... 60
Plot Summaries ......................................................................................................................... 60
Hope....................................................................................................................................... 60
Penelope................................................................................................................................. 61
Rob......................................................................................................................................... 62
‘Reace. ................................................................................................................................... 63
Julia........................................................................................................................................ 64
A Multiplicity of Voices ........................................................................................................... 64
Voices of trauma and dissociation......................................................................................... 66
Disconnection, division...................................................................................................... 66
Internal division.............................................................................................................. 67
Disconnection in external relationships. ........................................................................ 70
Hiding/escaping, going away, nonexistence. ..................................................................... 74
Not knowing, darkness, silence. ........................................................................................ 79
Trauma, brokenness. .......................................................................................................... 84
Voices of healing and integration. ......................................................................................... 89
Connection, relatedness. .................................................................................................... 89

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Internal connection......................................................................................................... 89
External connection........................................................................................................ 93
Coming out, being present and alive, having a sense of agency........................................ 96
Becoming aware, knowing, voice. ................................................................................... 101
Healing, wholeness. ......................................................................................................... 106
Listening for metaphor: key findings. ................................................................................. 113
Beehive. ........................................................................................................................... 113
Mansion............................................................................................................................ 117
Usefulness of metaphor.................................................................................................... 120
Chapter 5: Discussion ................................................................................................................. 123
Strengths and Limitations........................................................................................................ 124
Key Findings and Clinical Implications.................................................................................. 126
Implications for Future Research ............................................................................................ 133
Concluding Thoughts .............................................................................................................. 134
References................................................................................................................................... 136
Appendix A: Agency Contact Letter: Project Overview ............................................................ 145
Appendix B: Therapist Information Form (Dyadic Understanding) .......................................... 147
Appendix C: Client Information Form (Dyadic Understanding)................................................ 149
Appendix D: Diagnosis Confirmation Form............................................................................... 151
Appendix E: Hope’s Plot Listening ............................................................................................ 154

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Appendix F: Pictorial Representations of Hope’s Beehive Metaphor ........................................ 158
Appendix G: Pictorial Representations of ‘Reace’s Mansion Metaphor.................................... 159

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Acknowledgments
Most importantly, I would like to express my gratitude to Hope and ‘Reace. This thesis
would not have been possible without your willingness to share your heartfelt stories of
dissociation and healing. Thank you for inspiring me with your honesty, creativity, and strength.
Your voices have touched me deeply. It is my sincere hope that your expressions of experience
will transform all those who take the time to listen to your words.
I would like to thank my supervisor, Dr. Janelle Kwee. Your unwavering belief in my
ability to complete this project was a constant source of motivation. Thank you for your
continual encouragement, patience, and direction throughout this process. I also wish to express
my appreciation to Dr. Rick Bradshaw. Your dedication to helping individuals with complex
trauma and dissociation has shaped my development as a therapist (and person). Thank you to
my research collaborator, Chelsea Conron, for your involvement in this project. I was inspired
by your unique voice and transformative spirit.
Finally, I would like to acknowledge my loving and supportive husband, Nick, and my
three incredible children, Luca, Matteo, and Dominic, who provide endless inspiration. Your
voices speak directly to my heart.

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Chapter 1: Introduction
To debate the reality or unreality of alters, voices, or parts of the mind is to miss the point
– that this metaphor resonates powerfully with how these . . . [individuals] feel about
themselves. By entering into this metaphorical communication, the therapist has a
powerful tool for encouraging health and promoting healing and a sense of integrated
identity. (Waters & Silberg, 1998a, p. 136)
Metaphor appears to be the natural language of trauma and dissociation (Way, 2005).
Severely traumatized and dissociative clients seem drawn to metaphor, naturally engaging in this
form of communication to describe their own experiences of dissociation. It offers clients a
medium through which to “say the unsayable,” facilitating the expression of preverbal
experiences, traumatic memories, and dissociative processes (Way, 2006, p. 28). Recognizing its
powerful effects, clinicians have begun to incorporate metaphor into the treatment of dissociative
identity disorder (DID). Metaphor has been used to facilitate a variety of treatment goals, across
all three phases of trauma treatment: 1) safety and stabilization, 2) trauma processing, and 3)
integration. Importantly, “by understanding, teaching, and using metaphors, clinicians can help
their patients restore relationality and language to the isolated, silenced subjectivity at trauma’s
core” (Way, 2005, p. 15).
Although case evidence supports the idea that metaphor is a valuable and effective tool
for promoting safety and stabilization, trauma processing, and integration, this area of study
requires further exploration. To date, no systematic research on the therapeutic use of metaphor
in the treatment of DID has been conducted. Current recommendations are based on the
professional opinions and clinical anecdotes of therapists working in the field. Additionally,
existing research does not adequately address therapy process. There is limited information on

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how metaphors emerge and evolve over the course of treatment, especially between client and
therapist. Finally, the case studies largely represent the clinician’s perspective on metaphor and
dissociation. The voices of clients have not been adequately represented in the literature.
The purpose of this thesis was to extend this literature by exploring the use of metaphor
in the treatment of DID from the perspective of both client and therapist. Specifically, I1 used
the Listening Guide (Gilligan, Spencer, Weinberg, & Bertsch, 2003) to explore this topic with
five participants – two clients and three therapists. Using this voice-centred relational
methodology, it was possible to describe participants’ subjective and shared experiences of using
metaphor, both within and across different phases of treatment, to achieve various therapeutic
goals. With a focus on therapy process, I explored the origin, evolution, and therapeutic
functions of core metaphors that emerged from the narratives. These metaphors spoke to
participants’ subjective experiences of dissociation and healing and were used over the course of
therapy.
The existing literature on the role of metaphor in the treatment of DID is reviewed in
Chapter 2. In Chapter 3, I describe how I implemented the Listening Guide method to conduct
and analyze the five qualitative interviews. An in-depth exploration of the findings that emerged
from the analysis is carried out in Chapter 4. Finally, Chapter 5 includes a discussion of the key
findings and implications for practice.
Before reviewing the literature, it may be instructive to first develop an understanding of
the major constructs that are explored in this study: DID and metaphor.
1

Although use of first-person pronouns deviates from the publication standards of the American

Psychological Association (VadenBos, 2010), it is consistent with the Listening Guide method of
conducting qualitative research. Therefore, personal pronouns, such as I and we, are employed
throughout this thesis.

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Dissociation and Dissociative Identity Disorder
The term dissociation is derived from the Greek term “dis” (off) and “sociare” (unite or
connect). It is defined, in the Diagnostic and Statistical Manual of Mental Disorders, as “a
disruption of and/or discontinuity in the normal integration of consciousness, memory, identity,
emotion, perception, body representation, motor control, and behaviour” (5th ed.; DSM-5;
American Psychiatric Association [APA], 2013, p. 291). On a descriptive level, the International
Society for the Study of Trauma and Dissociation (ISSTD; 2011) characterizes the process of
dissociation as the lack of connection between information and self-attributes – feelings,
memories, and physical sensations – that should normally be integrated. According to Janet’s
original formulation of the concept, dissociation is the failure of the personal synthesis of
meaning structures, “brought about not only by psychological trauma, but also by other
conditions (e.g., vehement emotions, temperamental variables, debilitating illness)” (Liotti, 1999,
p. 292).
Considered to be a psychological defense mechanism with psychobiological components,
dissociation is one way people insulate themselves from overwhelming stress or pain (ISSTD,
2011). In traumatic situations, dissociation can be adaptive because it interferes with the normal
process of perceiving an experience and integrating it into memory (Haugaard, 2004). Once the
trauma is over and a threat no longer exists, however, dissociation can begin to interfere with life
functioning. Dissociation is considered maladaptive when: an individual is not aware of, or able
to control, his or her dissociative responses; the dissociative responses occur in inappropriate
situations; and the intensity and duration of the dissociation is disruptive to his or her life
(Haddock, 2001). Thus, dissociation can be seen as “a normal process that is initially used

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defensively by an individual to handle traumatic experiences [that] evolves over time into a
maladaptive or pathological process” (Putnam, 1989, p. 9).
Diagnostic criteria. The DSM-5 (APA, 2013) includes five diagnoses under the
classification of dissociative disorders: a) DID; b) dissociative amnesia; c)
depersonalization/derealization disorder; d) other specified dissociative disorder; and e)
unspecified dissociative disorder. DID is characterized by two or more personality states that
alternately take control of the individual’s behaviour with inability to recall important personal
information. With dissociative amnesia, one is unable to recall autobiographical information
regarding an event or period of time (localized), a specific aspect of an event (selective), or his
or her identity and life history (generalized). Individuals with depersonalization/derealization
disorder experience clinically significant depersonalization (i.e., feelings of being estranged
from one’s body or mental processes), derealization (i.e., experiences of unreality or
detachment from one’s environment), or both. The diagnostic categories of other specified
dissociative disorder and unspecified dissociative disorder both apply to cases in which the
symptoms of dissociation do not meet the full criteria for any of the dissociative disorders (e.g.,
chronic and recurrent syndromes of mixed dissociative symptoms). In order to make the
diagnosis of specified dissociative disorder, however, the clinician must state the reason that the
criteria are not met for any of the dissociative disorders. If no reason is provided, the
unspecified category is used.
The large majority of literature on dissociative disorders has focused on DID and the
related diagnoses of specified dissociative disorder and unspecified dissociative disorder
(formerly referred to as dissociative disorder not otherwise specified; DDNOS). The DSM-5
(APA, 2013) defines the following diagnostic criteria for DID:

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1. Disruption of identity characterized by two or more distinct personality states, which
may be described in some cultures as an experience of possession. The disruption in
identity involves marked discontinuity in sense of self and sense of agency,
accompanied by related alterations in affect, behaviour, consciousness, memory,
perception, cognition, and/or sensory-motor functioning. These signs and symptoms
may be observed by others or reported by the individual.
2. Recurrent gaps in the recall of everyday events, important personal information,
and/or traumatic events that are inconsistent with ordinary forgetting.
3. The symptoms cause clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
4. The disturbance is not a normal part of a broadly accepted cultural or religious
practice. Note: In children, the symptoms are not better explained by imaginary
playmates or other fantasy play.
5. The symptoms are not attributable to the physiological effects of a substance (e.g.,
blackouts or chaotic behaviour during alcohol intoxication) or another medical
condition (e.g., complex partial seizures).
Epidemiology. In its current treatment guidelines, the ISSTD (2011) notes that “DID
and dissociative disorders are not rare conditions” (p. 117). Studies of the general population
indicate a prevalence rate of DID of one to three percent (Murphy, 1994; Waller & Ross, 1997).
Not surprisingly, a higher prevalence of the disorder has been found in clinical populations. In
clinical studies, a prevalence rate of one to 20 percent has been described (ISSD, 2005). Due to
difficulties in diagnosing DID, however, “many cases of DID and related disorders are still being

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missed, misdiagnosed, and inappropriately treated” (ISSD, 2005, p. 72). This information
suggests that DID is even more common than indicated by current epidemiological data.
Etiology. The connection between early childhood traumatization and maladaptive
dissociation is well documented, “especially severe and repeated traumas of physical, emotional,
or sexual character” (Diseth, 2005, p. 84). Dissociative symptoms have been found to correlate
with traumatic histories of significant sexual abuse and/or physical abuse (Coons, 1996; Dell &
Eisenhower, 1990; Hornstein & Putnam, 1992; Macfie, Cicchetti, & Toth, 2001; Tricket, Noll,
Reiffman, & Putnam, 2001), as well as war trauma (Cagiada, Camaido, & Pennan, 1997).
Dissociation has also been associated with parenting styles described as neglectful (Brunner,
Parzer, Schuld, & Resch, 2000; Ogawa Sroufe, Weinfield, Carlson, & Egeland, 1997; Sanders &
Giolas, 1991), rejecting, and inconsistent (Mann & Sanders, 1994). In addition to these
traumatic childhood experiences, “events that have not necessarily been defined as major trauma
(e.g., repetitive losses of attachment figures, peer rejection, observation of domestic violence,
medical procedures, chronic living instability, emotional abuse) have nevertheless been found in
the backgrounds” of individuals displaying dissociative symptoms (ISSD, 2004, p. 124). In
samples of dissociative adults, the documentation of reported trauma and maltreatment is
notable, ranging from 68 (Brand et al., 2009) to 97 percent (Putnam, Guroff, Silberman, Barban,
& Post, 1986).
There are a number of etiological models concerning the development of the alternative
identities in DID (Kluft, 1984; Nijenhuis & van der Hart, 1999; Putnam, 1997; van der Hart,
Nijenhuis, Steele, & Brown, 2004). Many of these theories posit that “alternate identities result
from the inability of many traumatized children to develop a unified sense of self that is
maintained across various behavioural states, particularly if the traumas occur before the age of

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5” (ISSTD, 2011, p. 122). From a developmental perspective, DID does not arise from a
previously unified mind or “core personality” that becomes fractured by trauma. Instead, DID
results from a disruption of “normal developmental integration caused by overwhelming
experiences and disturbed care-taker child interactions . . . during critical early developmental
periods” leading to the development of discrete, behavioural states (ISSTD, 2011, p. 123).
Secondary structuring of these behavioural states occurs over time and results in the
characteristics of the specific alternate identities. These identities help children cope with a
variety of life events and experiences, including traumatic situations (Haddock, 2001). As
children proceed through adolescence and adulthood, alternate identities may diverge in number,
complexity, and sense of separateness.
Metaphor
The original Greek meaning of the term metaphor was “to carry something across” or “to
transfer.” In dictionaries and textbooks, metaphor is commonly defined as a comparison
between two things, “based on a point of resemblance” or similarity (Billow, 1977, p. 82). It
refers to taking a word, image, or concept that denotes one thing and using it to describe another
(Burns, 2007). A client who describes depression as a “heavy cloud” or “sinking pit” is using
metaphor to express his or her internal experience.
Current definitions of metaphor and symbolism emphasize their connective function.
Lakoff and Johnson (1980) define the “conceptual metaphor” as a metaphorical system that
explains one area of experience (abstractions, nonsensory experience, uncommon experience)
through another area of experience (body, earth, sensory information, common experience). By
drawing on common experiences of everyday life, the unfamiliar is illuminated. In this sense,
“metaphors operate not just as comparisons, but as connections between that which is understood

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well . . . and that which is hard to understand” (Way, 2006, p. 27). They serve as
“multidimensional structures [that] characterize experiential gestalts, which are ways of
organizing experiences into structured wholes” (1980, p. 81).
The definition of symbolism carries similar meaning. Derived from the Greek word
symballien, the term symbol means to “throw, bring together, connect.” Through the use of
symbols, previously unrelated parts are combined to create a new whole (Sperman, Gibney, &
Darlington, 2009). The verb symbolize reflects “the process of moving between old and new
meanings” (p. 440). It involves differentiating, reordering, and synthesizing elements of
experience into a personally meaningful whole. The definition of symbolism also carries a
curative meaning. According to Sperman and colleagues, “that which destroys is diabolical,
whereas that which heals is symbolical” (p. 440).
Metaphor in psychotherapy. In psychotherapy, various forms of figurative
communication, such as metaphor, symbolism, and imagery, are used to deepen meaning and
facilitate healing (Seiden, 2004). Metaphor acts as a powerful vehicle for communicating
therapeutic interventions “because a metaphor symbolizes a person’s experience, thereby
providing both an expression and a representation of the inner emotional world” (Pistole, 2003,
p. 232). In this way, metaphor can illuminate an intuitive understanding of experience, providing
a concrete representation of the client’s subjective narrative. Once illuminated, metaphor can be
used to explore, understand, and transform a person’s inner experience safely and creatively
(Burns, 2007). Similarly, metaphor and other forms of symbolic communication such as images,
drawings, and figurines can facilitate expression when words fail and promote “integrative
functionality” (Sperman et al., 2009, p. 446). Through imagery, clients are able to “express and
change the meaning, intensity, and intractability” of difficult experiences (Gerity, 1999, p. 17).

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As a form of interactive communication, metaphor also encourages shared understanding and
collaboration within the therapeutic relationship (Seiden, 2004). It provides the client and
therapist with an opportunity to “exercise and deepen [their] bond,” introducing a common
language with which to understand and approach clinical material (Seiden, 2004, p. 642).
From the above discussion, it is clear that metaphor serves a number of clinically useful
roles, such as highlighting experience, creating possibilities for understanding and healing, and
facilitating interpersonal communication. In light of its therapeutic utility, it is not surprising
that, on average, three metaphors per 100 words are used in a single hour of therapy (Ferrara,
1994, as cited in Perry, 2007). Because therapy is a language-based process of healing that relies
heavily on the effective communication between client and therapist, “it behoves the therapist to
be familiar with language structures, such as metaphor, that best facilitate the client’s process of
change” (Burns, 2007, p. 4).
Implicit and explicit therapeutic metaphors. Metaphor is often used to make explicit
comparisons in therapy when “psychotherapists move intentionally to figurative and comparative
language in talking with their patients” (Seiden, 2004, p. 638). In exploring a client’s
relationship to a new woman, for example, Seiden (2004) notes: “She’s a bit of a butterfly, isn’t
she?” (p. 639). In this example, the therapist employs metaphor in an attempt to evoke meaning,
deepen the therapeutic exchange, and speak the client’s language. Clients also use metaphorical
language in the discussion of their own experiences and problems (Burns, 2007). Examples of
client-generated metaphors include: “I’m stuck in a hole,” “I’ve reached the end of my rope,”
and “I feel like an empty vessel.” In both cases, metaphor is used in the verbal description,
exploration, and resolution of clinical issues.

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Unlike verbal modalities, expressive therapies, such as drawing, sculpting, and dance, use
metaphor to implicitly communicate clients’ experiences (Pistole, 2003). With expressive
therapies, metaphor makes it possible to communicate indirectly, engagingly, tactfully, and
empathically (Seiden, 2004). For instance, a sculpture created in art therapy may serve as a
metaphorical representation of the client’s anger towards her abuser (Gerity, 1999). In this
context, the client’s experience can be accessed and explored indirectly. Engaging in the
metaphor of art making makes it possible for individuals to express and change the meaning of
their experiences when words fail (Sperman et al., 2009). In such instances, healing occurs on a
nonverbal level. Nonverbal mediums are particularly useful with clients who have experienced
trauma, as verbal reasoning and speech production are inhibited (van der Kolk, 2002). These
approaches are also helpful in addressing early childhood experiences that occurred before
language development (Gerity, 1999).
Depending on the client and his or her particular concerns, both implicit and explicit
metaphors may be employed over the course of therapy. It is important for the therapist to adapt
to the needs and preferences of each client, modifying his or her use of metaphor accordingly
(Burns, 2007).

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Chapter 2: Literature Review
In this literature review, the role of metaphor in the treatment of DID is examined. The
review begins with a brief description of a phase-oriented treatment approach for DID.
Examples of implicit and explicit therapeutic metaphors used across treatment phases are
discussed. Case studies illustrating the therapeutic functions of metaphor are also explored.
Finally, rationales for the present study are outlined.
Treatment for Dissociative Identity Disorder
Current treatment guidelines recommend a phase-oriented approach for complex traumarelated disorders, such as DID (ISSTD, 2011; Kluft, 1993; van der Hart, Nijenhuis, Steele, &
Brown, 2004). The most common treatment approach consists of three phases: 1) safety,
stabilization, and symptom reduction; 2) working directly and in depth with traumatic memories;
and 3) identity integration and rehabilitation. Each of these phases is summarized below.
In the first phase of treatment, there is a focus on establishing a therapeutic alliance,
creating a therapeutic holding environment, and educating clients about their difficulties and the
process of treatment. Initial work with DID clients also involves addressing major selfdestructive behaviours, and other issues that may endanger their physical or psychological
wellbeing, through the use of grounding and self-soothing skills and the negotiating of safety
agreements. A variety of treatment interventions are used during this phase to assist clients in
stabilizing. Typical interventions include: psychoeducation concerning the disorder, techniques
to improve internal communication and co-consciousness among alternate identities, and
strategies for safely communicating as well as containing symptoms (ISSTD, 2011).
During the second phase, clinical work involves remembering, tolerating, and integrating
past traumatic material. According to the ISSTD (2011), active processing of this material aims

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to bring “together aspects of the traumatic experience that have been previously dissociated from
one another: memories and the sequence of the events, the associated affects, and the
physiological and somatic representations of the experience” (p. 143). Through this work,
clients gain a sense of control over the traumatic experiences and their reactions to them, and
develop a better understanding of their personal history and sense of self.
In the final phase of treatment, the focus turns to helping clients make additional gains in
internal coordination and integration. Specifically, individuals may continue to fuse alternate
identities, achieving a more solid and stable sense of self, and improve their basic life
functioning. As clients work towards integration, “they usually develop a greater sense of calm,
resilience, and internal peace” (ISSTD, 2011, pp. 144-145). Additional work in this phase
involves dealing more effectively with current life problems and addressing the grief and loss
associated with the traumatic past.
Expressive therapies. According to the ISSD (2005), expressive modalities such as art
therapy, poetry therapy, movement therapy, and psychodrama are “very helpful to DID patients,
as they are uniquely responsive to nonverbal approaches” (p. 123). These therapies facilitate the
communication of inner experiences, allowing clients to safely express their underlying thoughts
and feelings. The nonverbal creations of this expressive engagement (e.g., artwork, writings,
music) can act as a concrete record of the “internal system of alternate identities” (ISSTD, 2011
p. 161). They can also provide “vital information about current stressors, triggers, safety issues,
past traumatic experiences, and coping strategies” nonverbally, long before it can be accessed
verbally in treatment (2011, p. 161). In fact, expressive therapies can support a variety of
treatment goals, across all three phases of trauma treatment: 1) safety and stabilization; 2) trauma
processing; and 3) integration. Specifically, the ISSTD (2011) notes:

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Nonverbal psychotherapeutic approaches . . . facilitate improved concentration, realitybased thinking, internal organization and cooperation, problem-solving skills, and
utilization of containment techniques. Creative therapies may promote insight, the
sublimation of rage and other intense feelings, and the working through of traumatic
experiences and can assist with integration goals. (p. 161)
Many clinicians also advocate for the use of expressive therapies with dissociative
clients, discussing their therapeutic utility with this population. Dawson and Higdon (1996)
describe the advantages of using expressive therapies in the treatment of DID, including:
constructively approaching the mutual hostility and lack of recognition between alternate
identities; facilitating a variety of forms of expression among the constellation of identities; and
increasing the internal cooperation process and integration. The authors note that, as teamwork
is continued through expressive therapies, individuals may “progress to an increased quality of
life through cooperation and perhaps will even begin to consider eventual personality fusion” (p.
242). Dawson and Higdon use case material to illustrate the clinical applications of expressive
therapies. For example, they describe a case in which self-portrait activities were used to capture
a client’s internal system. This case material will be explored in greater depth in a subsequent
section of the literature review.
Haddock (2001) also discusses the role of art therapy in the treatment of dissociation.
She notes the benefit of using art as a method of communicating memories or other information,
especially with nonverbal parts. For some parts, “art is a way of communicating things they do
not feel able to communicate verbally” (p. 157). Like others, she describes how art assignments
can help alternate identities to work together and begin to share thoughts and feelings.
Collaboration is further enhanced by having the system as a whole work on art projects about a

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specific issue or time in the client’s life. Interestingly, Haddock states that art can assist clients
in working through stuck points in therapy, allowing them to “switch gears” and illustrate the
issue at hand (p. 158).
In her book Creativity and the Dissociative Patient, Gerity (1999) reflects on the use of
expressive modalities, such as drawing, sculpting, and puppetry, in the treatment of dissociation.
Focusing on the reparative effects of expressive modalities, she makes a connection between the
preverbal nature of early trauma and the nonverbal imagery of art therapy. In her work with
dissociative individuals, “art therapy provided a place where the patient was able to return to the
memory of early bodily traumas, now held within imagery, and provided the tools to express and
change the meaning, intensity and intractability of the imagery” (p. 17). In addition to
addressing traumatic experiences, Gerity uses expressive therapies to facilitate awareness,
cooperation, and integration among clients’ internal systems. For example, she describes one
client who drew herself as an apartment building to depict the various roles and relationships
within her internal system. The central goal of art therapy, from Gerity’s point of view, is the
development of a “healthy, cohesive sense of self” (p. 14).
Across expressive modalities, metaphor is used as an implicit method of self-expression,
communication, and healing (Gerity, 1999). The metaphor of art making allows dissociative
individuals to express underlying thoughts and feelings, improve internal communication and
cooperation, and work through traumatic experiences in a nonverbal, safe way. Through the use
of nonverbal mediums, “metaphor can say the unsayable, can reach across gaps in memory, or
permit expression where speech has been directly or indirectly forbidden” (Way, 2006, p. 28).
Unsurprisingly, severely traumatized and dissociative clients seem drawn to the language and

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metaphor of expressive therapies, using art materials in a reparative manner. An adult survivor
of childhood sexual abuse shares the value she found in art therapy:
[T]he day I put my hands into the clay and started creating a head of a person who is very
dear to me, something magical happened within me. I felt a deep connection to a deep
part of myself. I could put all of myself into this clay – my love, my anger, my fears, and
create a thing of beauty. My soul could be validated in an object that I could touch, feel,
look at and feel a deep sense of self-worth and even self-love. And this, after all is the
overall goal of my rehabilitation – to learn to cherish and love myself – from this
everything else flows . . . when I created my clay head, I said, wow, I can do this. I didn’t
think I could. Maybe there are other things I can do. (Gerity, 1999, p. 14)
From both a clinical and first-person perspective, it is evident that expressive mediums
are particularly useful in the healing of trauma and dissociation. Recognizing the implicit
presence of metaphor within the expressive modalities, the therapeutic value of metaphor in the
treatment of DID is illuminated.
Explicit metaphors. Metaphorical communication is also used explicitly in the
treatment of dissociation. This mode of communication involves the explicit discussion of
various metaphors, symbols, and images within therapy (Seiden, 2004). Such discussions often
include a combination of client-generated, therapist-generated, and collaborative metaphors
(Burns, 2007). Metaphor may be introduced as a way to: illustrate what the course of therapy
will be and how the alternate identities might work together; conceptualize the client’s internal
system; encourage understanding of the ideas of teamwork and cohesiveness; safely process
traumatic material; express confusing, overwhelming, or upsetting emotions; and promote
integration (Waters & Silberg, 1998a; Waters & Silberg, 1998b). In fact, many clients already

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use metaphorical communication to describe their own experiences of dissociation (Silberg,
1998; Waters & Silberg, 1998a; Way, 2006). By engaging with clients’ metaphors, the therapist
can help “move them into an increasingly mature concept of themselves and how they have dealt
with trauma” (Silberg, 1998, p. 115).
During the educational phase of treatment, metaphors may be introduced as a way to
illustrate what the course of therapy will be and how the alternate identities might work together.
For example, the metaphor of a sports team can be used to explain the importance of working
together to achieve a common goal. With this metaphor, the individual contributions of each
teammate or alter are also recognized. Over the course of therapy, this metaphor can be
employed to further promote communication and cooperation within the internal system (Waters
& Silberg, 1998a). Similar social metaphors include the “orchestra” (Braude, 1995) and
“business” (Kluft, 1993). With children and adolescents, recipe metaphors have also been used
to “set the stage for a cooperative approach” (Waters & Silberg, 1998a, p. 143). Individuals are
reminded that the outcome of the recipe depends on the proper combination of various
ingredients, each with its own special flavour.
Many clinicians have used the ego-state model, developed by Watkins & Watkins (1997),
to explain the concept of dissociation in metaphorical terms. The segmenting of normal ego
states into dissociative identities is often conceptualized as a creative process that involves the
strengthening of internal barriers in response to trauma (Wieland, 1998). Using the concept of
personality segments, clients are invited to draw their dissociation as a wheel, pie, or flower.
Each segment of the chosen item represents a different part of the internal system. Clients are
then asked to depict the level of dissociation between the parts by creating divisions between
each of the segments; the greater the division, the stronger the dissociation. This metaphor can

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also be used to facilitate communication and cooperation among alternate identities, as clients
are encouraged to reduce the barriers between each segment. In doing so, they move “down a
continuum from maladaptive dissociation toward adaptive differentiation” (Crawford, 1990, p.
421).
Other authors, such as Crawford (1990), have used the ego-state model to describe
dissociation as a “family of self” within the individual. Similar to family therapy, the goal of
treatment is to resolve conflicts between dissonant parts of the personality and achieve a kind of
“internal diplomacy.” The term “inside family” has been used in other contexts to describe the
client’s internal system. This metaphor may prove to be particularly helpful in promoting a
sense of cohesiveness once the parts have some ability to communicate with one another.
According to Waters and Silberg (1998a), understanding that the inside parts are like a family
helps to emphasize that “the parts must get along and must learn the negotiation and mediation
that families use to solve problems” (p. 147). Establishing a caring, cooperative inside family
may be of special importance to clients who grew up in disruptive, abusive homes.
A number of images have also been utilized to enhance and manage communication
within the internal system. For instance, Krakauer (2001) assists clients in creating “private
rooms in the hall of safety, the conference or meeting room, and the theatre” (p. 51). Fraser
(2003) uses similar metaphors in his clinical work. Specifically, he has clients imagine a
meeting table in a safe room. All the parts are invited to take a seat around the table, with each
ego state bringing its own sense of identity and body image to the meeting. A microphone or
spotlight is then placed in the centre of the table to encourage parts to speak and a video screen is
presented for safely viewing traumatic events. In her work with dissociative children, Shirar

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(1996) has clients visualize a neighbourhood with houses, walkways, “telephones in every house,
and an intercom system inside the house with a speaker in every room” (p. 176).
Team and business metaphors have also been employed to help clients work through
traumatic material. Waters and Silberg (1998a), for example, invite the parts involved in a
particular trauma “to participate in the exercise together as a team” (p. 157). Other members of
the internal system are encouraged, if feasible and appropriate, to watch, listen, and learn from
techniques that may assist them in expressing their feelings. They are asked to support, comfort
and cheer on those parts doing the trauma processing. Examples of coaches, cheerleaders, and
spectators of sports events are used to “emphasize the importance of building team spirit,
endurance, and strength in their successful recovery” (p. 157). Alters who are too young or
unable to tolerate the intensity of the traumatic expression are kept in an internal safe place with
a parent figure nurturing them. Finally, in order to avoid potential sabotage by aggressive parts,
“no harm” contracts may need to be established.
Numerous metaphors have been developed to promote integration. Using images of
union, merger, and rebirth, Kluft (1982) ensures that all alternate identities are preserved by
joining into one personality. Shared activities, such as dancing and embracing, are proposed.
Clients are asked to imagine the internal parts embracing until they are joined. According to
Kluft, dissociative clients seem to prefer “images of light or highly lyrical images of streams
joining into a river, or the snow on many mountain peaks melting and flowing together into a
lake” (p. 236). As an illustration, he describes how the “beaming up” imagery seen on Star Trek
is used to facilitate childhood fusion rituals (Kluft, 1985). Shirar (1996) has clients choose an
imaginary place, such as a meadow or beach, for two parts to join together. She then guides
them through the joining process, describing the parts merging “from the feet up to the head and

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from the tummy all the way to the backbone” (Waters & Silberg, 1998b, p. 173). Other
clinicians introduce the image of a rainbow to facilitate integration experiences. The various
colours of the rainbow, representing different alternate identities, are blended together in a
“ceremonious mixing of paint colours” (Waters & Silberg, 1998b, p. 175). Finally, Satir
encourages clients to host a “parts party” in which other individuals are typecast to play the
different parts of the self. The ultimate goal is to complete an “integration ritual.” During this
exercise, the client stands in the middle as each part shares its feelings and offers itself to the
host. Once a part is accepted, it is “successively anchored to the host in a symbolic “necklace of
hands” around the shoulders” (Crawford, 1990, p. 427).
Based on the various examples provided in this section, it is clear that metaphor is being
used extensively in the conceptualization and treatment of DID. On a descriptive level, these
examples demonstrate the many ways in which metaphor is employed over the course of therapy
to promote understanding, communication, and healing. To more deeply appreciate the
reparative effects of metaphor on a practical level, the exploration of case material is required.
Case Studies of Dissociation: Therapeutic Uses of Metaphor
To further illustrate how metaphor is used in the treatment of individuals with DID, a
selection of case studies is included in this section. The cases provide an in-depth look at how
metaphor brings about understanding, connection, and healing in the hearts and minds of
dissociative clients. In an effort to demonstrate the various therapeutic functions of metaphor,
the cases are organized according to treatment phase. The selection of cases is representative
of children, adolescents, and adults, capturing dissociation across the life span. It also includes
examples of both implicit and explicit metaphors.

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Phase 1: safety, stabilization, and symptom reduction. In the initial phase of
treatment, social metaphors, such as the athletic team, are often used to establish a common goal
for therapy. Waters and Silberg (1998a) introduced the metaphor of a soccer team to educate a
client on dissociation and explain the course of treatment. Joan, an 8-year-old with DID, was
told that working cooperatively with her internal system was like playing soccer successfully, “as
each position (symbolic of each alter) is equally important in playing the game well, scoring, and
having fun” (p. 143). In order to play the game, all team members need to watch, listen, and
follow their positions. Over the course of therapy, helpful alters were assigned the roles of
“coaches” and “referees” and the importance of fair play was emphasized.
Selecting a metaphor that relates to the client’s own experience increases the likelihood
that he or she will understand the meaning of dissociation and the significance of integration.
This was the case with one client who had an obsession with television news shows. The
therapist explained that his dissociative system was like Channel 7 – “someone does the
research, someone edits, and someone presents the news on camera” (Waters & Silberg, 1998b,
p. 172). Even though not all members of the news room appear in front of the camera, they are
all required to run a successful news show. This explanation gave some of the more covert alters
a feeling of confidence and importance, helping them appreciate their contributions. By the end
of therapy, the client used the metaphor of “being on air” to aid in moments of integration.
As she explains the process of dissociation, Wieland (1998) incorporates clients’ own
descriptions and images into the discussion. For example, when one of her clients likened the
process of dissociation to the branching of a tree, Wieland had the individual draw a picture of
this image. The client drew a tree with the trunk dividing into two branches, with additional
splits in each of the branches. She went on to label the divisions, based on the traumas she had

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experienced. This approach helped the therapist develop a better understanding of the particular
individual’s dissociative structure, while also making the explanation personally meaningful for
the client.
Often, individuals with DID “have an almost instinctive awareness of what the natural
course of therapy will be” (Waters & Silberg, 1998b, p. 169). This awareness is captured in the
metaphorical language they use to describe the experience of dissociation and the goals of
treatment. The following essay written by a 10-year-old girl illustrates how metaphor is used to
describe dissociation and the positive potential for integration:
A[n] inside part is like a friend. They are helpful sometimes. Sometimes they distract
you or do wrong things. Sometimes in life they join into one, but they will always be
here. There can be little ones and big ones. They come in all different ages. Some are
playful, some are not. It’s very surprising to know you have an inside part, but it’s
perfectly fine to have an inside part. When you get hurt, they will make you feel better.
Some are very creative. Some are humorous. Inside parts have feelings too. They are all
good at different things. They have different preferences. I was very startled when I
found out I had inside parts. . . . If you go to a therapist it won’t be so serious. One day
they will all come together and they won’t be separated. (Waters & Silberg, 1998b, p.
169)
Creative activities, such as poetry, are useful in helping clients portray their internal lives.
One DID client, “E.,” wrote the following poem to describe her inside family:
MY INSIDE FAMILY The
Darkness surrounds me But
The light still shines Down.

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The far seems farther away.
But there they are.
My friends, My family,
Held together. We, the moon
in the sky.
Through something connects
Our hearts,
It’s something that can’t
Be explained. (Waters & Silberg, 1998a, p. 161)
The metaphors found in this poem capture the client’s subjective experience of dissociation,
providing the therapist with a detailed account of her inner world. Over the course of therapy,
these metaphors can be used to deepen understanding and promote healing.
Other expressive activities, such as sculpting clay, also provide dissociative clients with
an opportunity to share their internal experiences. In one case, Mr. R. was asked to make some
kind of expressive rending of the way it felt to live with DID. Using terra-cotta clay, he formed
a bust of himself, which consisted of a head plus a wide, elongated structure. The bust
represented how “he feels like he is trailing some huge and embarrassing outgrowth. And
although the outgrowth . . . is obvious to others, it is literally a secret kept from himself”
(Dawson & Higdon, 1996, p. 243). Not only did the art activity allow Mr. R. to share his
experience of DID, it also provided him with an outlet for expressing strong feelings concerning
the disorder.
A number of metaphors have been used to facilitate understanding and communication
among alternate identities. In her work with a dissociative teen named Betty, Wieland (1998)

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introduced the metaphor of a table as a way to understand the internal system. She invited Betty
to find a safe place where she could “put a table and then gather the parts of her around the table”
(p. 148). After looking inside, the client describes the following scenario:
The table is a rectangle and there is a figure at each end and three empty chairs on each
side. This is weird, at one end is a plastic shell of my body that has nothing inside, at the
other end there is an invisible version of me. Along the side no one is in the chairs but
there is an object on the table in front of each chair. In front of the first chair is a picture
of my mother, in front of the second chair is a picture of my stepfather, and in front of the
third chair there is a vase of flowers. The invisible part of me moves around the table
sitting in the different chairs. As I sit in each of those chairs, I pick up and hold in front
of my face whatever is the object in front of the chair. The other side of the table is
empty. (p. 148)
The therapist used Betty’s internal description to make connections between her past abuse,
introjected parts, and shifting behaviours in session. This exercise facilitated mutual
understanding of the client’s inner world, minimizing some of the internal confusion.
Waters and Silberg (1998a) describe a case in which one 11-year-old girl with DID
imagined an internal TV set with a VCR to help her parts communicate. The internal
communication system consisted of play and rewind buttons, tapes, and speakers. She could
keep the system “on” at all times, “but if she missed something, she would rewind the tape to
learn what happened” (p. 146).
Artistic activities have also been used to promote communication and respect among
alternate identities. In the case of Lance, a 24-year-old recently diagnosed with DID, his “artist”
alter offered to draw portraits of each member of the internal system. Once the portraits were

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completed, the therapist invited the “artist” to describe the strengths and personal resources of
each alter. During this time, the other alters were asked to listen to the descriptions. After
listening in, “the alters seemed to be impressed by her efficient completion of the task, as well as
complimented by her lucid descriptions of them” (Dawson & Higdon, 1996, p. 255).
Imagery can also be useful in changing internal perceptions regarding introjected ego
states, thereby facilitating more internal cooperation. Lemke (2007) provides a clinical case
description of Kelly, an adult client with an introject ego state of her abusive mother. This ego
state was extremely verbally abusive to Kelly and the rest of her internal system, so much so that
she was too scary to be drawn. Instead, she was represented in any artwork as the letter ‘A.’ Not
only did this ego state represent a rageful mother but also a traumatized child who had her hair
pulled out by the roots as a form of punishment. When the system was ready to have ‘A’ drawn,
the ‘artist’ part drew a very intense and dishevelled image. A suggestion was made to the system
to have the ego state “drawn less scary” (p. 64). In other words, “could they tend to the wounded
child hidden by the rageful front” (p. 65). The new image depicted ‘A’ in a gentler manner, with
softened facial features and long, intact hair. According to Lemke, the gesture of restoring her
hair “fostered more trust between the introject part of this ego state and the rest of the system as
they seemed to be ‘looking out for’ the traumatized part of her, a goal they now all had in
common” (p. 65).
Similarly, Lamagna and Gleiser (2007) describe a case in which visual imagery was used
to build a secure internal attachment among self-states. Julia, a 24-year-old with complex PTSD
and DDNOS, discovered an abandoned and feared self-state that held both anger and despair.
Due to this disowned self-state, Julia was having difficulty taking care of her emotional needs.
In therapy, she used the image of a “high wooden fence” to symbolize the dissociative barrier

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that existed between her and the “angry part” (p. 39). When the therapist asked if there was a
way to safely “enter into communication” with this angry part, using the image of the fence, Julie
visualized opening the fence and “just looking at that part” from a distance. Through this careful
observation, she noticed that the part was upset and in need of comfort. She felt the urge to
embrace and soothe that part of herself. In doing so, she was providing internal caregiving to the
part that held “concentrated reservoirs of intense affect” related to the abuse and neglect she
suffered as a child (p. 39). This process encouraged the development of trust and empathy
between two previously estranged self-states.
Phase 2: trauma processing. Expressive activities can be especially effective in helping
clients work through disturbing material. They allow memories and feelings to be expressed in a
nonverbal and safe way. For example, in order to share and process an abusive incident, one
client worked with the various members of his internal system on joint drawings of the event.
The parts who remembered the abuse drew the scene in detail, including “how the men appeared,
what colors they were wearing, and the form of the car that had transported them” (Dawson &
Higdon, 1996, p. 261). As the drawings progressed, the core personality was asked to absorb the
experience and empathize with the parts who had been subjected to the abuse. Through this
activity, the client seemed to gain a better understanding of the incident and a deeper
appreciation for the other parts of himself.
In working through her past trauma, one 14-year-old dissociative teen drew a symbolic
picture of how she felt toward her “alcoholic, neglectful, and abusive parents” (Waters &
Silberg, 1998a, pp. 161-162). Her picture consisted of palm trees being struck by a hurricane,
depicting the rage she felt toward them. After completing therapy, she drew the palm trees

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again. This time, the picture conveyed a hopeful outlook towards the future, with a bright sun
covering the page and a smiling image of herself in the centre.
Shirar (1996) describes the case of a young dissociative girl who used the image of a tree
stump with all its branches cut off to represent her trauma. Each branch symbolized a separate
traumatic experience, and the splitting of internal parts. As therapy progressed, the client was
able to imagine the tree being “grafted” back together. This new picture represented the
integration of her internal system.
Some therapists also have clients write play scripts, recounting past traumatic events and
depicting wished-for reconciliations. For one dissociative child, “a play about the aftermath of
her father’s murder of her mother (which she had witnessed) eventually contained themes of
anger resolution, forgiveness, and faith” (Waters & Silberg, 1998b, p. 177). Listening to a tape
of this play helped her work through conflicting emotions surrounding the tragic event, allowing
some healing to take place.
In her detailed case description of a dissociative client named Jenny, Gerity (1999)
provides numerous examples of creative materials being used to process traumatic experiences.
At the beginning of art therapy, Jenny created a smooth clay mound, which she “attacked with
what looked like vicious abandon” (p. 24). Through this activity she was able to discharge some
of the rage she felt in response to being “abandoned” by her psychiatrist and others in her life.
As therapy progressed, Jenny constructed Mr. Mad, a fire-engine red puppet. He was “forever
rapping his hard little head on the table in annoyance, giving himself headaches” (p. 32). Mr.
Mad was able to express some of the things that Jenny longed to say but didn’t dare. When
asked, in a group therapy session, why he was so mad, he stated that “because he had grown up
in a completely mad family, where everyone was mad all the time, that was what he learned to

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be” (p. 32). Over time, some of the other puppets helped Mr. Mad learn how to experience
different kinds of feelings, such as happiness. Speaking through another puppet, Jenny described
the experience of being raped by her neighbour at the age of six. The puppet, known as Joy, then
began to weep as the therapist patted her on the back. Afterwards, both Joy and the therapist
“decided that Jenny was grown up now and didn’t have to do anything she didn’t want to” (p.
45).
Clients also use explicit metaphors to describe their experiences of trauma. One
individual likened the experience of traumatic dissociation to a beehive full of black syrup.
Specifically, the client notes:
My hurt and pain is stored in a beehive, in honeycomb form with lots of different
compartments. The syrup is not golden, however, it is black and oozes, it is disgusting. I
am the one who lives outside of all of that. The others they are covered in the ooze. Me,
I live in nowhere. (Schwartz, 2000, p.4)
This vivid metaphor captures the darkness and isolation present in the client’s life. Over the
course of treatment, this imagery can be transformed to encourage hope, healing, and wellness.
In another case, a dissociative individual created a metaphor to represent the process of
working through traumatic material. The client described trauma processing as the act of going
into the basement, where the abuse occurred, and rescuing the child alters. Together with the
therapist, her adult part was able to return to the scene of the traumas and help the frightened
children (R. Bradshaw, personal communication, January 31, 2011). This metaphor gave the
client a sense of purpose in facing the traumatic incidents from her past.
In addition to these client-generated metaphors, Kluft (2012) describes a case study in
which he introduced the image of a “magical, cleansing stream” to facilitate shame reduction (p.

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151). The client, a successful lawyer named Gwen, had an extensive history of sexual trauma,
including years of incest and exploitation. This trauma led her to believe that her “orifices were
irretrievably filthy and soiled” (151). Through the presentation of increasingly detailed and
intimate images that involved “exposing these parts completely to the cleansing power of the
stream,” Gwen reported feeling “clean for the first time in her life” (p. 151). This procedure not
only resolved feelings of shame but also served to “open the gates of memory,” facilitating
further trauma processing.
Phase 3: identity integration and rehabilitation. According to Waters and Silberg
(1998b), “the part-to-whole relationships in desserts, where various ingredients come together to
make a final whole, is a particularly powerful way to describe the concept of personality
integration” (p. 172). This metaphor was used with a client who identified pumpkin pie as her
favourite dessert. During therapy, references were made to her alternate identities coming
together “as one delicious pumpkin pie.” When one resistant alter named Lucy decided to join
with the others, the client reported that “Lucy was the pumpkin added to the pie, and the
pumpkin pie tasted scrumptious!” (p. 172).
Creative modalities, such as art, are also powerful tools through which to alter or amend
internal imagery. Pictures, collages, and sculptures can be used to “depict the ongoing process of
integration or can be incorporated into a fusion ritual” (Waters & Silberg, 1998b, p. 174). In the
case of Jane, an 8-year-old girl with DID, a picture of “the love lines” connecting her and her
alters was used to promote fusion. As she drew the picture, emphasis was placed on the alters’
individual strengths being combined and reinforced through the “love lines.” Through the
connections, the parts were able to come together as one and experience life simultaneously.

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Pam, a DDNOS teenager, also used art to depict her growth and integration. She drew a
picture of a kite, with each part choosing a favourite colour and design to put on the kite. During
an earlier phase of therapy, one of her parts had played the game of “He loves me, he loves me
not,” pulling off the petals of daisies as she questioned the love of her abusive father. This part
drew a large, intact daisy in the centre of the kite, which symbolized the resolution of that
conflict. She also placed a spider on the kite to represent a continuing need for protection.
Integration took place as Pam focused on her picture, while her therapist “told an integration
story about Pam and her parts joining together and soaring high, like the kite, free of abuse and
fear” (Waters & Silberg, 1998b, p. 175).
The joint construction of picture collages has been used to encourage integration. In one
case, the therapist instructed the client to work with one of his alters to create a collage out of
magazine images. Both parts were asked to choose pictures of things that the other might like.
The activity was designed to help them “see things through the eyes” of the other part (Dawson
& Higdon, 1996, p. 261). Working together on this project strengthened the connection between
the client’s core personality and the identified alter.
Through a combination of art and puppetry, Jenny, a 40-year-old DID client, elegantly
expressed her integration process. Drawing a picture of an apartment building, she illustrated
how the various puppets she had made to represent her internal system were joined together.
Gerity (1999) provides an in-depth description of Jenny’s picture:
Mr. Mad and his family live at the very top of the apartment building. On the next floor
down, Joy, Carey, and Little Carey live. On the floor below we find Lisa and her baby,
swinging his bottle out the window by his teeth. Below her are Eric and Lita, and at the
ground floor we find Jenny guarding the front door. Scattered throughout the building

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are shuttered windows, as yet not revealing who lives behind them. On a separate piece
of paper, split off from the building itself, is the basement (or the unconscious) where we
find Jenny’s mother, Margaret, with her spiky-haired guard, Sebastian. Margaret has
what looks like an unusually large collection of goods and supplies: blankets, jars and
bottles of food and drink, drawers and cabinets of hidden contents, as well as a
refrigerator and freezer. (p. 84)
By drawing her inner world, Jenny was able to make sense of how the parts of herself all fit
together. Adopting the role of puppeteer, she had a repertoire of roles to use and could
consciously choose when and how to employ them, “enacting the workings of a healthy sense of
self” (pp. 85-86).
Poetry is another powerful medium through which to express the process of integration.
In an effort to capture her healing journey, an adolescent wrote the following poem:
I come to you now, and bring nothing in my hand.
I bring myself to you wiped away from anger.
I come to you today free from abuse and pain.
I come to you now and give to you my love.
I come to you this day showing how I changed.
So, now that I am here empty handed,
but with a fulfilled heart,
Take me under your wings and wrap me in your innocence . . . I
am now FREE. (Waters & Silberg, 1998b, p. 189).
With feelings of freedom and hope in her heart, this client was ready to reclaim her childhood
after having achieved successful integration.

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Summary and Critique. Collectively, these case studies provide sufficient evidence to
indicate that metaphor has the capacity to bring understanding and healing to the lives of
individuals with DID. Throughout the therapy process, it appears to play a significant role in the
treatment of dissociation. On both an implicit and explicit level, metaphor contributes to greater
self-awareness, therapeutic engagement, and personal growth. This information suggests that
metaphor serves multiple therapeutic functions across all three phases of treatment.
Although the therapeutic value of metaphor in the treatment of DID is evident, this area
of study requires further exploration. Given the complexity of DID, it is not surprising that
numerous metaphors are employed to address a range of clinical issues. However, it remains
unclear what metaphors are most useful for specific therapeutic tasks at different points in
treatment. For example, what metaphors best represent trauma and the processing of traumatic
material? In what ways are these metaphors helpful in therapy? The question of what type of
metaphor, implicit or explicit, is best suited to particular clinical issues also remains unanswered.
Current recommendations are based on the professional opinions and clinical anecdotes of
therapists working in the field. In order to provide better care to those living with dissociation,
these issues need to be evaluated in a more systematic fashion. Additionally, current research
does not adequately address therapy process. There is limited information on how metaphors
emerge and evolve over the course of treatment, especially between client and therapist. In light
of its therapeutic benefits, an important goal of future research is to determine the most effective
ways of using metaphor with dissociative clients.
Research Focus
In this chapter, I have described existing literature on metaphor, as it applies to the
treatment of DID. It should be evident from this research that metaphor plays a powerful role in

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the conceptualization and treatment of dissociation. Whether implicit or explicit, metaphor
appears to be the natural language of trauma and dissociation (Way, 2005). It offers clients a
medium through which to “say the unsayable,” facilitating the expression of preverbal
experiences, traumatic memories, and dissociative processes (Way, 2006, p. 28). Importantly,
“by understanding, teaching, and using metaphors, clinicians can help their patients restore
relationality and language to the isolated, silenced subjectivity at trauma’s core” (Way, 2005, p.
15).
Case evidence supports the idea that metaphor is a valuable and effective tool for
promoting safety and stabilization, trauma processing, and integration. The literature, however,
is limited to single case studies. To date, no systematic research on the therapeutic use of
metaphor in the treatment of DID has been conducted. Moreover, most of the literature on
metaphor and dissociation focuses on therapeutic outcomes. Case reports typically stress the
positive effects of metaphor on DID, without specifying how healing occurs. As a result,
valuable information concerning therapy process is overlooked. Finally, the case studies largely
represent the clinician’s perspective on metaphor and dissociation. The voices of clients have
not been adequately represented in the literature.
The present study was designed to address these limitations. The main goal of this
research was to explore the use of metaphor in the treatment of DID from the perspective of both
client and therapist. Using language as a tool, I intended to bring to life the subjective and
shared experiences of individuals with the disorder and the professionals who treat it. Multiple
cases were included in the investigation, allowing for comparisons of themes and voices across
each client-therapist dyad and the sample as a whole. Therapy process was also examined in the
study. Specifically, I explored how metaphors are created, how they evolve, and what

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therapeutic functions they serve over the course of therapy. I used the following research
questions to guide my exploration:
1. For individuals who have been diagnosed with DID, what are their experiences of using
metaphor in therapy?
2. For therapist working with DID clients, what are their experiences of using metaphor in
therapy?
3. How is metaphor used at different phases of treatment to address clinical issues?
4. How useful is metaphor in the treatment of DID, from the perspective of both the client
and therapist?

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Chapter 3: Method
As noted by Morrow (2005), it is common practice for qualitative researchers “to make
their worldviews, assumptions, and biases explicit to assist the reader in understanding the
researcher’s stance vis-à-vis the research” (p. 210). In this spirit, I will summarize my personal
stance. My methodological perspective is largely informed by my clinical work, in which I place
central importance on clients’ subjective experiences and feelings. In working with marginalized
individuals, I endeavour to give voice to those who have been traditionally silenced or ignored
and bring about social transformation. As a clinician, I am also interested in working
collaboratively with individuals to improve their experiences in therapy and overall life
functioning. In light of my clinical background, it is not surprising that I am naturally drawn to
qualitative inquiry. This approach not only enables the researcher to understand the meanings
people make of their experiences but also facilitates the in-depth examination of psychotherapy
process (Morrow, 2005).
Through the use of the Listening Guide, the present study was designed to explore the
therapeutic application of metaphor in the treatment of DID from the perspective of both client
and therapist. The intention of this research was to illuminate the lived experiences of
individuals with the disorder, privileging their voices in the discourse on metaphor and DID.
This knowledge has the potential to enhance the quality of care of individuals with the disorder,
improving therapy process and outcome.
The Listening Guide Methodology
The Listening Guide is a qualitative, relational, voice-centred, feminist method of
analyzing interviews (Woodcock, 2005). It differs from other methods of analysis in that “it
places emphasis on the psychological complexities of human beings through attention to voice”

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(p. 49). Using the language of music as a metaphor for voice, this method “provides a way of
systematically attending to the many voices embedded in a person’s expressed experience”
(Gilligan et al., 2003, p. 157). The researcher seeks to hear the harmony, dissonance, pitch,
tonality, and rhythm of a person’s unique and multilayered voice. By entering into relationship
with the participant and tuning into the multiple voices expressed within his or her story, the
researcher gains understanding of the complexities of human experience (Tolman & BrydonMiller, 2001).
Notably, the Listening Guide brings into focus the relational and cultural contexts that
influence a person’s voice (Way, 2001). During analysis, an effort is made to understand what
type of relationships and cultural expectations are influencing the stories of participants. The
method is also relational in the sense that the researcher and the research question are brought
into relationship with the participant’s spoken experience “by identifying, exploring, and making
explicit our own thoughts and feelings about, and associations with, the narrative being
analyzed” (Gilligan et al. 2003, p. 160). The subjectivities of both the participant and researcher
are experienced, noted, and used to guide the research process, creating an opening for shifts in
the way questions are asked and voices are listened to.
Paradigm considerations. As a qualitative methodology, the Listening Guide (Gilligan
et al., 2003) is rooted in constructivist and transformative paradigms. A constructivist paradigm
has “a relativist position that assumes multiple, apprehendable, and equally valid realities”
(Ponterotto, 2005, p. 129). Recognizing that “there are as many realities as there are participants
(plus one: the investigator),” the constructivist researcher is interested in capturing the subjective
experience and unique voice of each participant (Morrow, 2005, p. 213). The researcher is also
seen as an active co-constructor of the meanings that emerge during data collection and

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interpretation, participating fully in the research process (Morrow, 2005). As such, the
researcher often documents his or her personal insights and emotional reactions to the stories
being told, incorporating this material into the data set. This reflexive awareness makes explicit
“the relationship between the interviewee’s voice and silences and the researcher’s voice,
silences, and interpretation. In this way, the voices are differentiated” (McLean Taylor, Gilligan,
& Sullivan, 1995, p. 29).
The Listening Guide method also reflects elements of a transformative paradigm.
Although this paradigm shares some similarities with the constructivist perspective, it is defined
by its commitment to social justice and ending oppression (Morrow, 2005). Given its feminist
grounding, the Listening Guide “provides space to hear those who have been traditionally
silenced” (Woodcock, 2005, p. 49). Themes of resistance and oppression, as well as voices of
strength and resilience, are often the focus of Listening Guide research. Transformative
researchers who use Listening Guide methodology “consciously and explicitly position
themselves side by side with the less powerful in a joint effort to bring about social
transformation” (Mertens, 2010, p. 21).
Rationale. The Listening Guide (Gilligan et al., 2003), a voice-centred relational
methodology, was used throughout the interview and analysis process of the study. This method
was selected for a number of reasons. The Listening Guide is useful when one’s research goal is
to develop in-depth insights into the psychological complexities of human experience within
particular relational contexts. In the present study, this approach facilitated the exploration of
individuals’ first-person narratives of dissociation and healing, “using language as a tool . . . to
plumb the depths of this experience to glean meanings that are not otherwise observable”
(Morrow, 2005, p. 211). This methodology also recognizes the “layered nature of the psyche,

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which is expressed in a multiplicity of voices,” providing a way to “systematically attend to the
many voices embedded in a person’s expressed experience” (p. 157). This understanding of the
human psyche is congruent with the lived experiences of individuals with DID who experience
the self as having multiple parts. Consequently, the Listening Guide is uniquely designed to
capture the multiplicity of voices through which participants express their experiences of
dissociation. The relational nature of the research is also consistent with the Listening Guide
methodology. Focusing on therapy process, I was interested in understanding how metaphor is
used in the context of psychotherapy to treat dissociation from the perspective of both client and
therapist. Thus, in this study, the subjective and shared experiences of client-therapist dyads
were explored in-depth.
Notably, the Listening Guide method also provides space to hear the voices of those who
have been silenced or disempowered. The voices of individuals with DID have been repeatedly
silenced not only by the trauma they have experienced but also by the skepticism surrounding the
disorder. Within the clinical community, there is an ongoing debate over the existence of DID.
The view that DID is “due to fantasy proneness, suggestibility, suggestion, and role-playing,”
rather than factors such as traumatization and disrupted attachment, denies the validity of the
disorder and contributes to narratives of oppression (Reinders, Willemsen, Vos, den Boer, &
Nijenhuis, 2012, p. 1). At its core, this skepticism reflects our “cultural reluctance to face child
abuse” (Barringer, 2006, p. 3). Thus, the Listening Guide was chosen for this study, in part,
because it privileges participants’ unique and multilayered voices, illuminating their individual
experiences of trauma, dissociation, and healing. It is hoped that, by taking part in this study,
participants felt empowered to speak out about the realities of healing from severe, chronic

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childhood trauma. Their voices, if listened to, have the potential to contribute to improvements
in the understanding and treatment of dissociation.
Participants
In this thesis, I explored the experiences of two client-therapist dyads, as well as the
experience of a former therapist. The client participants were two adult women in their early
sixties, residing in the lower mainland region of British Columbia. Both women had a confirmed
diagnosis of DID and were engaged in some form of ongoing psychotherapy. At the time of the
study, one client had been working with her therapist for two years, while the other had been
with her therapist for three years. Regarding overall length of treatment, Hope and ‘Reace had
been participating in therapy for 11 and 28 years, respectively. Additional information on the
two clients who took part in this research, including their trauma histories and treatment
experiences, is included in Chapter 4.
Eligibility for participation in this study was dependent on individuals meeting the
Diagnostic and Statistical Manual of Mental Disorders IV-TR (4th ed., text rev.; DSM-IV-TR;
American Psychiatric Association, 2000) diagnostic criteria for DID. The Structured Clinical
Interview for DSM-IV Dissociative Disorders-Revised (SCID-D-R; Steinberg 1994, 1995), a
clinician-administered structured interview, was used to assess DID. Further information on this
assessment is provided in a later section of this chapter.
Individuals were also required to be engaged in ongoing therapy in which some level of
safety and stability had been achieved. Treatment must have addressed any major selfdestructive behaviours and other issues that may have jeopardized individuals’ physical or
psychological safety. Although stabilization was a requirement for participation in this study, it
was expected that some alters may show signs of comorbid conditions or self-harming

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behaviours, as these issues are observed in more than 50% of DID cases (Putnam, 1989). Such
cases were not excluded from the study.
In order to participate fully in the research process, participants were also required to
have at least one alter who was co-conscious or aware of other members of the internal system.
The SCID-D-R (Steinberg 1994, 1995), as well as therapist feedback, was used to determine
level of co-consciousness during the screening phase of the investigation. Some level of coconsciousness was necessary for participation in this study, as individuals were required to
engage in self-reflection and discuss the use of metaphor in the treatment of their dissociation.
Co-consciousness between alters tends to increase as individuals move beyond the safety and
stabilization phase of treatment into trauma processing and integration (ISSTD, 2005).
Exploring the use of metaphor in the treatment of DID, from the perspective of both
client and therapist, necessitated the involvement of participants’ primary therapists. This
inclusion criterion was introduced with the intent that the focus of the study be on the subjective
and shared experiences of the therapeutic application of metaphor. The therapist participants
included two current female therapists and one former male therapist. In terms of clinical
experience, Julia, Penelope, and Rob had six, nine, and 35 years of experience, respectively. All
participants used an integrative approach to psychotherapy, and had training and experience
specific to trauma and dissociation. These therapists all used Observed and Experiential
Integration (OEI), a neurologically-based trauma therapy (Bradshaw and Cook, 2008) with the
clients in this study.
Recruitment
This thesis was conducted as part of a larger project on metaphor and DID. In the second
study, Conron (2012) used an arts-informed, feminist-relational approach to explore the role of

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metaphor in the subjective experience of DID. Recruitment occurred concurrently, providing
participants with the option of taking part in either or both of the studies. Individuals with DID
were recruited from a population of clients accessing counselling services at agencies and private
practices in the Fraser Valley of British Columbia. These organizations were used to recruit
participants because they serve clientele that fit participant criteria. This purposeful sampling
method, known as intensity sampling, helped the researcher obtain cases in which the
phenomenon of interest (DID) is strongly represented (Mertens, 2010). In the context of
qualitative research, purposeful sampling is an appropriate procedure for identifying
information-rich cases.
An initial contact letter, outlining the research project, was provided to prospective
recruitment sites (see Appendix A). For those organizations that demonstrated interest in the
study, advertisements in the form of posters and brochures were given to staff members and
placed directly in the counselling centres. The advertisements included both a description of the
study and contact information (see Appendices B and C). Interested participants took part in an
initial screening interview over the telephone to ensure that they met the eligibility criteria for
the investigation. Respondents who met the criteria for inclusion were scheduled for in-person
interviews to assess: DID symptoms; level of co-consciousness; informed consent issues; and
current levels of functioning. Once consent was obtained, interviews were also scheduled with
participants’ primary therapists to gather additional information on levels of DID symptoms,
stabilization, and co-consciousness (see Appendix D).
Through these recruitment efforts, two individuals with DID, along with their primary
therapists, agreed to participate in the present study. After the individual interviews with each
member of the client-therapist dyads were completed, it became clear that Hope’s narrative

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included meaningful descriptions of therapy process that occurred with her previous therapist. In
an effort to capture this experience from a shared perspective, I inquired about the possibility of
bringing the former therapist’s voice into the research. Hope endorsed this option, and an
interview was conducted with her former therapist. Therefore, in total, five participants took part
in the study. In light of the study’s qualitative design, this sample size allowed for an in-depth
exploration of information-rich cases, facilitating deeper understanding of complex therapeutic
processes and human phenomena (Morrow, 2005).
In the aim of transparency, it is important to note that both of the client participants in the
present study were former clients of the second reader of this thesis, Dr. Rick Bradshaw. The
ISSTD (2011) notes that the process of diagnostic interviewing with persons with DID is
challenging. Because of their “early trauma and attachment difficulties and the resultant distrust
of others, . . . traumatized patients may be very reluctant to reveal an inner, hidden world to a
clinician” (p.124). The client participants’ involvement in the research was likely influenced by
their pre-existing connections with Dr. Bradshaw, establishing levels of safety and trust that
allowed the interviews to take place.
Data Collection
SCID-D-R. Prior to the data collection interviews, the SCID-D-R (Steinberg, 1994,
1995) was administered to each client participant. The SCID-D-R is a 277-item interview that
assesses five symptoms of dissociation: amnesia, depersonalization, derealization, identity
confusion, and identity alteration. The majority of items have follow-up questions concerning
the experience, specific examples, and an estimate of frequency and impact on social and
occupational functioning. The SCID-D-R provides: a) diagnoses for the five DSM-IV
dissociative disorders, including DID; b) a score for each of the five dissociative symptoms; and

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c) a total score. These scores are determined by the frequency and intensity of symptoms. The
assessment takes 45 to 180 minutes or more to administer, depending on the individual’s
responses. The SCID-D-R has good reliability and discriminant validity (ISSTD, 2005). Total
scores on the instrument have been shown to have a correlation of .78 with the Dissociative
Experiences Scale (Boon & Draijer, 1993).
Listening guide interviews. Following the assessment phase, each member of the clienttherapist dyad was individually interviewed, using a semi-structured format. The interviews
were conducted in the same place where the client usually received treatment. This setting was
selected for the following reasons: to allow the client to feel more comfortable without having to
adjust to a new setting; to minimize the introduction of new stimuli that may be threatening or
triggering; and to provide contextual cues for the parts of self that typically participate in
therapy. The interviews lasted approximately one hour for each individual. All interviews were
digitally recorded. This information was stored on a password protected computer, which was
kept in a locked cabinet in my home office.
At the beginning of the interviews, I briefed participants on the nature of the interview
and reiterated aspects of informed consent. I then inquired about their experiences of using
metaphor in treatment, using the following questions:
1. How do you experience DID? What does it look or feel like on the inside?
2. Where did this image come from – you, your therapist, both?
3. At what point in therapy did this image emerge? What phase of treatment were you in?
4. What other images/metaphors/symbols have you used in therapy? When did they first
emerge? How were they used?

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5. In what ways have these images been helpful in therapy? In what ways have they been
unhelpful?
6. How have you and your therapist used these images together in therapy? How have the
images changed over time?
7. What images/metaphors/symbols best represent misunderstandings or ruptures with your
therapist? What images best represent repairs with your therapist?
8. What images/metaphors/symbols best represent communication and cooperation within
your internal system?
9. What images/metaphors/symbols best represent trauma or the processing of traumatic
material?
10. When you think of integrating, what images come to mind? In what ways have you and
your therapist used these images in therapy?
A similar set of questions was presented to the therapists, asking them to reflect on their
experiences of using metaphor in the treatment of DID.
Given the relational nature of the Listening Guide (Gilligan et al., 2003), the interview
process was guided by attention to relationship. Specifically, I was intentional in my efforts to
establish rapport, create safety, and provide emotional support. I honoured participants’ “unique
personal language” with which they characterized their internal systems, incorporating their
terms into the interview questions (ISSTD, 2011, p. 121). Additionally, I varied the sequence
and pace of the questioning, depending on participants’ responses. All participants were given
opportunities to reflect and respond fully to each question, before additional questions were
asked. Following the interviews, I debriefed the process with each participant and addressed any
questions or concerns that arose.

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Analysis Procedures
As previously mentioned, the Listening Guide method (Gilligan et al., 2003) was used in
the analysis of interview data. The paradigmatic assumptions underpinning the Listening Guide
were discussed earlier in this chapter. The following is a description of the analysis procedures
of this method, and its applications to the present study.
Transcription. I personally transcribed all of the qualitative interviews. In order to
maintain respect for participants’ voices, a verbatim transcription approach was used (Gilligan et
al., 2003). Specifically, I included pauses, false starts, misspoken and repeated words, and
unfinished sentences. Para-verbal aspects of voice, such as sighs, laughter, crying, and
inflections, were noted in brackets within the text. I also used para-verbal cues to code for
perceived emotion and possible switching between parts of the self. The following passage,
taken from ‘Reace’s interview, illustrates this approach:
Um, before (abrupt upward shift in volume, possible switch) . . . I, I’ve been doing one
eye integration since 2003 and prior to that, and even along the earlier stages . . . I’m
getting a little bit dizzy right now because I’m clearly doing something internally. Um
and it’s hard to stay anchored to a conscious place (laboured tone, searching for words)
when this happens (breathless, laughing). It drives me crazy!
All transcripts were edited for identifying information, including names of people and
places. In an effort to honour their voices, the client participants were invited to choose a
personal identifier to represent themselves in this study. The therapists were assigned a
pseudonym to protect their anonymity.
Listening guide analysis. The Listening Guide method involves a series of four
sequential “listenings” or steps of analysis for each interview (Doucet & Mauthner, 2008). The

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analysis is centred on a set of basic questions about voice: “Who is speaking and to whom,
telling what stories about relationship, in what societal and cultural frameworks?” (Gilligan et
al., 2003, p. 159). According to Gilligan and colleagues (2003), each listening amplifies another
facet of a person’s voice “in a manner similar to listening to and following the oboe through a
piece of music and then listening again, this time following the clarinet” (pp. 159-160).
Engaging in multiple listenings allows the researcher to both hear nuances of the individual’s
expressed experience and uncover “important themes and relationships that emerge from the
data” (Woodcock, 2005, p. 50).
In this approach, the first two listenings are more prescribed, whereas the later listenings
are guided by the specific research questions. The listenings of each step are documented
through underlining the text, using different coloured pencils for each listening, as well as
through notes and interpretative summaries recorded by the researcher (Gilligan et al., 2003).
Through this process, the researcher remains connected to the interview and documents evidence
for later interpretations.
This method of analysis is “enhanced by work within interpretative communities” in
which multiple listeners engage in the listening process (Gilligan et al., 2003, p. 161). A
relational approach to analysis allows for the exploration of different reactions, identifications,
and interactions with the stories being told. For this reason, an interpretative community was
formed in the present study, through the inclusion of additional listeners. In addition to the
primary researcher, the research team consisted of the thesis supervisor, Dr. Janelle Kwee, and a
research collaborator, Chelsea Conron, who conducted the second study in the larger research
project on metaphor and DID. Each interview was analyzed by at least two members of the
research team.

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Steps of analysis. The four main steps of analysis include: listening for the plot, “I
poems,” listening for contrapuntal voices, and composing an analysis. A description of how
each of these steps was implemented in the present study is provided below.
Listening for the plot. In the initial stage of analysis, the researcher listens for the various
stories being told by the speaker. This process is guided by the basic elements of plot: what,
when, where, with whom, and why (Gilligan et al., 2003). Repeated images and dominant
themes are recorded, as well as contradictions and absences in expression. Additionally, this
step involves identifying personal responses to both the stories being told and the person telling
them. Each member of the research team was invited to first complete her own plot listening and
then share it with the team. Discussions of the different plot summaries and personal responses
served to both deepen understanding and develop clarity, enriching the complexity of the
analysis process. These shared conversations directly informed the overall analysis of the
interview data. A brief plot summary of each participant’s interview is provided in Chapter 4.
For a more comprehensive example of a plot listening, see Appendix E.
I poems. In the second step of this method, the researcher focuses on the first-person
voice in the narrative, listening for the “I” who is speaking. In doing so, the researcher is able to
detect distinctive patterns of the first-person voice and hear how the person speaks and feels
about him- or herself. At this point, “I” phrases are underlined in the text and pulled together to
create a poem. Gilligan et al. (2003) describe how the I poem is intended to “pick up on an
associative stream of consciousness carried by a first-person voice, cutting across or running
through a narrative rather than being contained by the structure of full sentences” (p.163).
Because of their dissociation, it is not surprising that the client participants used several
different pronouns – including, but not limited to, I, we, she, and they – to speak about

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themselves in their interviews. These pronouns represent the multiple voices or parts of the self.
Thus, in the present study, the concept of I poems was modified to better reflect the subjective
experiences of the clients. Specifically, I identified all pronouns relevant to their personal
experience, along with associated verbs and meaningful words, and constructed “I/We” poems.
This process is illustrated in the following passage selected from Hope’s interview:
I remember I was about two or three going into my dad’s store. And he sold gardening
things for farmers on the prairie. And he had this cone-shaped honeycomb in there. And
something bad happened so I went inside. We went inside. She went inside.
Capturing the voices of multiple parts of the self, the I/We poem for this passage speaks
to Hope’s experience of hiding or going “inside.”
I remember
I went inside
We went inside
She went inside
Listening for contrapuntal voices. This stage of listening involves attending to, and
interacting with, the multiplicity of voices within a person’s expressed experience. The
researcher first identifies the different voices in the interview that may speak to the research
question. After listening for these voices through separate readings of the text, underlining each
expression of experience in a different colour, the focus of analysis then shifts to the
relationships among the various voices held within the speaker’s narrative. Listening for
contrapuntal voices is an iterative process in which the researcher works to “fine-tune” the
identification and definition of voices that illuminate “some meaningful aspect of the text”
(Gilligan et al., p.168).

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As the primary researcher, I developed a deep understanding of participants’ narratives
through repeated and thoughtful listenings of the interviews. For this reason, I initiated the step
of listening for contrapuntal voices by creating definitions of possible voices. I then introduced
these potential voices to the other members of the research team for consideration. Through
collaborative discussion and exploration of the interviews, the definitions of these voices were
refined to best capture participants’ expressions of using metaphor in the treatment of DID.
During this step of the analysis, we identified eight voices. These voices are organized
into two overarching categories: 1) voices of trauma and dissociation, and 2) voices of healing
and integration. Each voice has a counterpoint or an opposing voice. For example, participants
describe experiences of both trauma and healing in their stories. These contrapuntal voices
reflect the continuum of dissociation and the women’s movement along it. Descriptions of how
the women have progressed from severe dissociation to more integrated functioning are evident
throughout the narratives of both clients and therapists. An in-depth exploration of the eight
voices heard within participants’ expressed experiences is carried out in Chapter 4.
In creating definitions of the voices, we made an effort to remain attuned to similarities
and differences in participants’ expressions of experience across interviews. When differences
were identified, the researchers modified the definitions of existing voices to better reflect the
experiences of all participants. For example, as we engaged in the process of relational analysis,
we discovered that the therapist participants expressed certain voices differently than their
clients. This difference in expression is apparent when participants speak in a voice of not
knowing. For the client participants, this voice reflects the confusion and the lack of awareness
surrounding their experiences of trauma and dissociation. In contrast, the therapist participants
convey a sense of “not knowing” in a manner consistent with their role as helping professionals.

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Therapist expressions of this voice include: speaking in a tentative manner about some of their
insights, acknowledging the limitations of their knowledge, and leaving room for alternative
explanations.
Once the eight voices were identified, we completed separate listenings for each
contrapuntal voice. Within our interpretative community, there was resonance among the
multiple voices of listeners. Questions regarding the coding of voices, although infrequent, were
explored until agreement was reached. The exploration of different interpretations involved
considering alternative viewpoints, completing additional listenings, and engaging in
collaborative problem solving. These discussions deepened my understanding of participants’
expressed experiences, as each listener’s voice amplified distinct aspects of the stories being
told.
Composing an analysis. In the final step, all the listenings are brought together to create
an overall understanding of the speaker in relation to the research question. The researcher
synthesizes what has been learned through the entire analysis process so as to “not reduce or lose
the complexity of a person’s expressed experience” (Gilligan et al., 2003, p.169). At this stage,
the descriptions of multiple participants may be examined together to identify similarities and
differences in emergent themes across the entire sample.
After the third listening was completed for all of the interviews, the primary researcher
conducted the final step of analysis. During this stage, comparisons were made between the
themes that emerged across each client-therapist dyad and the sample as a whole. Similarities
and differences among participants’ expressions of using metaphor in the treatment of DID were
explored and documented. Importantly, in the process of completing this step, it became evident
that the context of the research questions needed to be modified. Through the use of the

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Listening Guide, an inherently relational method of analysis, “we actively bring ourselves and
our research question into relationship with the person’s spoken experience . . . creating an
opening for that person to shift our way our listening [and] the questions that we ask” (Gilligan
et al., 2003, p.169). Listening to participants’ narratives, I heard descriptions of how metaphor
facilitated understanding and healing not only within the context of therapy but also outside of it.
For the client participants, in particular, metaphor seems to lies at the heart of how they
understand themselves and experience the world. For this reason, descriptions of metaphors that
were used in a healing capacity, or to better understand the self or an experience, were included
in the results of this thesis. In listening for and engaging with the client’s own metaphors, the
therapist has a “powerful tool for encouraging health and promoting healing and a sense of
integrated identity” (Waters & Silberg, 1998a, p. 136).
Rigour and Quality
According to Morrow (2005), the standards for evaluating the trustworthiness of a study
should reflect the researcher’s paradigm. Below I describe the criteria used to asses the rigour of
this thesis and the steps taken to ensure these criteria were met.
Reflexivity. Engaging in critical self-reflection, the reflexive researcher develops an
“emerging awareness” of how her personal experiences and reactions are influencing the
research process (Morrow, 2005, p. 254). The Listening Guide method is especially sensitive to
the relational nature of research. It is based on the idea that “voice depends on resonance or
relationship in that speaking relies on, and is affected by, being heard” (Gilligan et al., 2003,
p.157). In this view, the research relationship is central to understanding the multiple layers of
meaning in a person’s expressed experience. Each step in the analysis process “requires the
active presence of the researcher and an acute desire to engage with the unique subjectivity of

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each research participant” (p. 159). For this reason, the voice of the primary researcher was
explicitly brought into the research process throughout each stage of this thesis.
Working reflexively with the narratives being analyzed, I sought to identify and explore how
my own subjectivities influenced the co-construction of knowledge (Mauthner & Doucet, 2008).
I used the following questions – to which the Listening Guide incorporates attention (Way, 2001)
– to guide my own self-reflective process:
1. Who is listening and what is the nature of his or her relationship with the speaker,
especially with respect to power?
2. Which voices are being heard - the speaker’s, the researcher's, both?
3. What are the researcher’s personal reactions to what is being spoken?
4. How do the researcher’s biases and life experiences affect how he or she hears the
voices?
In an effort to properly document these self-reflections, I kept a journal to record my thoughts,
feelings, and reactions to participants’ narratives over the course of the study. Through
journaling, I was able to continually reflect on the ways in which my beliefs and experiences
shaped my analysis of the data. I also used the journal to document how my interests,
contributions, and understandings grew and changed throughout the research process. The
following example is representative of the personal reflections documented in my research
journal:
Reading a thesis on the topic of trauma this morning stirred up strong feelings in me. In
particular, the part that talked about trauma being a taboo subject that people do not want
to discuss – in essence, the idea that society as a whole does not want to acknowledge the
depth and breadth of abuse and neglect present in our world. It reminded me of Hope’s

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feelings of confusion, pain, and injustice when she talked about the support available to
cancer patients, but not those affected by trauma. There is a sense that survivors of
trauma are invisible – no one is willing to see their pain or provide appropriate care and
support. I felt such a deep sadness fill my chest – my heart ached for all those unseen
trauma survivors. Soon after, I noticed a strong feeling of determination rise up within
me. Things can change, I thought. We can make a difference through this project. We
can draw attention to the realities and needs of individuals with complex trauma and
dissociation. I know this is one of the main reasons why Hope agreed to participate in the
study. Inspired by her hopeful and determined spirit, I wrote a poem entitled Hope
Realized:
I feel your sadness,
I hear your cries,
Living in a world that fails to recognize,
Children’s fear and pain,
Wounds that still remain,
Imprinted on the soul,
Invisible to most,
Secretly hoping and outwardly searching,
For another pair of kind eyes,
A haven to rest inside,
To be seen,
To be heard,
Love beyond words,

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Speaking from a place of wisdom,
Deep within,
Sharing your voices,
Will help the healing begin,
Transforming this world,
One heart at a time,
Your story means so much,
You are truly one of a kind,
Just like the dragonfly,
Vibrant and free,
Living a full life,
Finally allowed to be.
In addition to journaling, I regularly engaged in reflexive conversations with my research
team. The Listening Guide analysis was carried out within an “interpretative community,”
which promoted the “exploration of the different connections, resonances and interpretations”
that each listener brought to the process (Gilligan et al., 2003, p. 161). Our team dialogues were
an opportunity to share observations, provide insights, and ask questions, as we continually
reflected on how our own subjectivities were influencing our interpretations of the interviews.
Representation. A qualitative researcher strives to fairly represent the experiences of
participants and views “participants, rather than researchers, as the authorities on participants’
lives” (Morrow, 2005, p. 254). The Listening Guide offered a way of understanding each
participant’s experiences of using metaphor in treatment, as well as the meaning of these
experiences for the participant. Conducting multiple listenings helped to ensure that distinct

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aspects of each participant’s subjective narrative were not overlooked and that “no single
representation of a person’s experience” was used to “stand for that person” (Gilligan et al.,
2003, p. 159). The strategy of member checking was also used to achieve the standard of
representation. In preparation for the member checks, I created a detailed report of the findings
that emerged from the four listenings. Each participant’s report included the following material:
plot listening; I/We poem; description of voices and metaphors; and implications of the research.
An in-depth member check interview was conducted with each of the participants in this thesis to
ensure that the researcher’s interpretations meaningfully reflected the participant’s experiences.
The interview included both an individual discussion with each participant and a collaborative
dialogue with both members of the client-therapist dyad. During the individual discussion, we
reflected on the research findings together. Participants were invited to provide feedback on how
the findings fit or did not fit their experiences. The collaborative dialogue involved the sharing
of voices and themes that emerged across each client-therapist dyad.
The feedback provided during the member check interviews was overwhelmingly
positive. The participants informed the researcher that the findings were consistent with their
subjective and shared experiences of using metaphor in the treatment of DID. For Hope, in
particular, the language of “voices” resonated with her subjective experience of dissociation,
providing her with a new way of describing the self. In her own words, she expressed feeling
“thrilled at the simplicity” of organizing her experience into eight voices. These findings
signified to her: “I’m one. I can function in an integrated kind of way with eight voices in my
experience.” Additionally, the client participants revealed that, through the process of reflecting
on and giving voice to their subjective experiences of self and healing, they developed greater
self-awareness and experienced feelings of accomplishment. For example, ‘Reace revealed how

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the initial interview offered her “the gift of metaphor” in that it “opened [her] eyes” to how much
she uses metaphor for healing. She also expressed how, at this stage in her healing journey, she
can look in the mirror and say: “I like you. I care about you.” During the second part of the
interview, participants described how the collaborative dialogue between client and therapist
facilitated the sharing of meaningful information regarding therapy process. For instance, Julia
noted that the I/We poem was both moving and therapeutic. For her, it was “so empowering for
the client to hear the therapist’s account” of their shared experience in therapy. Overall, the
member checks provided participants with the opportunity to share valuable feedback that both
enriched the findings and clarified questions that emerged during the analysis. This feedback
was incorporated into the final results of this thesis.
Consequential validity. The primary goal of transformative research is to increase
“consciousness about issues of power and oppression” and bring about social transformation
(Morrow, 2005, p.253). A truly transformative researcher positions herself “side by side with the
less powerful,” giving voice to those who have been traditionally silenced (Mertens, 2010, p.
21). As previously noted, the voices of individuals with DID have been repeatedly silenced not
only by the traumas they have experienced but also by the controversy regarding the disorder. In
giving voice to client participants’ experiences of trauma and dissociation, this thesis speaks out
about the realities of child abuse and neglect, maltreatment within the mental health field, and
alienation from society. Within the narratives of both women are descriptions of severe
childhood trauma, such as the sexual abuse ‘Reace suffered at the hands of her father, as well as
experiences of being disregarded, feared, and invalidated by individuals within the clinical
community and those outside of it. Voicing these truths is essential to creating change on several
fronts: from facilitating healing for the survivor, to further legitimizing the diagnosis within the

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profession, to calling us to take a stand against the abuse of children in our society. This
transformative position is echoed by Barringer (2003):
The abuses suffered as children by most DID clients are beyond many people’s
understanding; much of the abuse is so severe that we cannot seem to wrap our minds
around it. We perpetuate an abusive environment and continue to effectively silence the
victim when we deny its existence, enabling the perpetrator. For the survivor to heal we
must provide an accepting, benevolent environment in which the survivor is free to speak
his/her truth. When shared, we must not shrink in horror at the survivors’ experience, no
matter how horrifying it may be. To do so also serves to silence the survivor. (p. 30)
Encouragingly, the present study also calls attention to the internal resources for healing
and growth that exist within individuals with DID. The purpose of this research was to give
voice to participants’ lived experiences of dissociation and healing. In listening to their
expressions of experience, it is apparent that metaphor lies at the heart of how they understand
themselves and experience the world. For Hope and ‘Reace, metaphors are a natural source of
self-understanding and healing that originate from an inner place of creativity. When therapists
can uncover the metaphors of their clients, they access a “powerful tool for encouraging health
and promoting healing and a sense of integrated identity” (Waters & Silberg, 1998a, p. 136).
Listening for and engaging with clients’ own metaphors of dissociation privileges their
experiences, mobilizes agency, and activates internal resources for healing and growth. This
knowledge, which emerged from participants’ first-person narratives, has the potential to
enhance the quality of care of individuals with DID, improving therapy process and outcome.
Through the dissemination of this research, it is my intention to represent the voices of those
living with the disorder in the discourse on metaphor and DID.

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Ethical Considerations
The purpose of this research was to explore the experiences of individuals with DID, a
particularly vulnerable population with a history of interpersonal trauma (ISSTD, 2011).
Knowing this, the interviews were designed to explore participants’ current experiences with
metaphor in the context of psychotherapy. They were not intended to surface traumatic material
from the past. Questions that did touch on the subject of trauma (e.g., what
images/metaphors/symbols best represent trauma or the processing of traumatic material?) did
not require participants to reexperience traumatic events. Instead, they asked participants to
reflect on salient metaphors used in therapy to address the trauma. Before proceeding with
questioning, aspects of informed consent were reviewed. In particular, participants were
reassured that they had the freedom to choose to respond, or not to respond, to any of the
questions presented to them throughout the interview.
In order to facilitate safety during the interview process, the client participants were given
the option of having their primary therapist accompany them. Hope chose to have her therapist
sit in on her interview, which seemed to enhance well-being and encourage the open expression
of experience. Throughout the interviews, I used my clinical skills to provide emotional support
and assist with grounding when client participants felt emotionally activated. The following
excerpt, taken from ‘Reace’s interview, is one example of how I supported participants
emotionally during moments of distress:
‘Reace: I’m 61 years old and haven’t found somewhere to fit (crying).
...
Interviewer: Do you want to give it some time?
‘Reace: No, I’m okay (teary voice).

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Interviewer: You’re okay?
‘Reace: Yeah. I can move on.
Interviewer: Yeah. We don’t have to, though. Right?
‘Reace: Yeah (deep, shaky breath).
Interviewer: Because what you’re experiencing, even right here in this room, matters.
And your tears matter. I’m not just here to do research, right?
‘Reace: Mhm.
Interviewer: Part of the reason why I wanted to do this research is because I care about
people. And I do care about you, even though we’ve just met.
‘Reace: Thank you.
Interviewer: You’re welcome.
‘Reace: (takes another deep breath, appears calmer)
As an additional safeguard, both the researcher and the client’s primary therapist were available
immediately following the interview to debrief the experience and offer emotional support.
The clients provided no indication that the research was harmful. They did, however,
report that the experience was both personally meaningful and empowering. For Hope, the
experience of feeling heard and understood through this research was deeply impactful. She
revealed this felt experience during her member check interview when we were reviewing her
I/We poem:
You took the lead in the poetry and said I got it. I’ll walk you out of this trauma. Take
my hand and I’ll take you into the light, the joy, the good people. Because you
understand, I can face tomorrow.

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At the end of the interview, she also shared the following: “Someone reaching the point of pain
causes me to gasp out loud, knowing that someone understands. I want to rest in the knowing
that you will carry the knowing.”
As previously noted, participants also described how their involvement in the research
contributed to greater self-awareness and feelings of accomplishment. Examples of these
benefits were provided in an earlier section of this chapter. Finally, participants expressed how,
through the sharing of their personal narratives, they felt empowered to contribute to
improvements in the treatment of trauma and dissociation. ‘Reace, for example, noted how the
opportunity to help “teach healers” how to “reach people with major trauma” was both a
motivating force for participation and the most rewarding aspect of the research experience.
Similarly, for Hope, participating in this research was an opportunity to help survivors of
childhood trauma:
My deep desire is to help those, including myself, who have experienced child abuse and
neglect to be free, to find some peace in present life circumstances, and to bring
awareness to child abuse in order that child abuse and neglect may be eradicated forever.

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Chapter 4: Composing an Analysis
Participants’ willingness to share their heartfelt stories of dissociation and healing,
together with their insightful descriptions of the therapy process, offers an in-depth
understanding of how metaphor can serve as a meaningful, effective tool in the treatment of
DID. In this chapter, I present an analysis of the many voices, metaphors, and themes that
emerged from the interviews of the five individuals – two clients and three therapists – who
participated in this study. The Listening Guide method provides a basic frame for presenting the
findings. First, a brief plot summary of each participant’s narrative is provided. The individual
voices embedded in participants’ expressed experiences are then examined. Returning to the
research questions, what has been learned about metaphor in the treatment of DID is discussed.
Consistent with the Listening Guide practice of examining different voices in relation to one
another in order to illuminate the complex nature of human experience, the relationships between
the various voices expressed in this study, both within individual narratives and across
interviews, are documented throughout this chapter.
Plot Summaries
Hope. When I read Hope’s narrative, I feel like I am on a journey of self-discovery and
healing. It reveals the creative mind of a woman who learned to escape from the pain of a
traumatic childhood by creating an inner hiding place where she could keep herself safe (i.e.,
bumblebee hive). There seemed to be some level of awareness, at least on an unconscious level,
that she might have this “certain thing” called dissociation. This is captured in the artwork she
created, long before she entered therapy (e.g., painting herself into walls). However, you can
feel her struggle to come to terms with the fact that she started to dissociate in order to cope with
a traumatic past. Feelings of self-loathing leap off the page, as she repeatedly blames herself for

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her disorder and even refers to herself as a “leper” at one point. The road to self-acceptance has
been a long one, paved with the constant support and care of her therapists who have shown her
what real love is. In fact, there is a theme of being ignored and unloved by society due to her
traumatic past and method of coping. Over the course of therapy, she begins to internalize the
therapist’s strength, concern, and empathy and direct it towards herself, which helps her relate to
the other parts within her internal system. At this point in her journey, there is an incredible
sense of hope for a “full life” – wanting to be an adult/mother/grandmother and enjoy the simple
pleasures of her current age, while also continuing to be sensitive to the needs and desires of the
younger parts inside. She seems committed to continuing her “group therapy,” as the parts
develop greater communication and cooperation skills. By the end of her interview, I see a
transformed woman. She is now able to celebrate her creative gifts (artwork, poetry, metaphors)
and use them as a vehicle to express her subjective experience of healing and growth.
Penelope. In listening for the plot, I hear Penelope describing her client’s increasing
ability to direct her own healing as she moves towards integration. She speaks positively about
the gains that Hope has made in therapy over the past three years, taking every opportunity to
highlight how she is “doing a lot of the work by herself” (e.g., facilitating “group therapy”
internally among her parts to increase dialogue, conflict resolution, and integration). In
describing the therapy process, it is evident that she endeavours to work collaboratively with her
client. From adopting the client’s “honeycomb” metaphor of dissociation to using her love of
nature as a “calming piece” to drawing a “picture of a feather” to build on one of her metaphors,
Penelope consistently demonstrates a commitment to honouring Hope’s experiences and
supporting her goals in therapy. In her view, individuals with DID are “so creative that they’re
like metaphor mountains.” Capitalizing on this creativity, she talks about using metaphors with

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Hope to review progress, normalize experiences, increase understanding, and promote healing.
It is apparent that she takes a fluid, flexible approach to using metaphors, depending on the
presenting issue and the goal of therapy. In an effort to “unite the parts,” for example, she
describes working with Hope to “get the kid parts to have slumber parties internally.” At the
same time, she warns about the potential of metaphors to distract from the “deep work.” She
also expresses doubt regarding the lasting impact of some of their metaphors (e.g., “none
significant . . . we share it and then it’s gone”).
Rob. Within Rob’s spoken experience is the story of an open therapist who is willing to
be shaped and impacted by his client, so genuinely that it transforms his work with other clients.
He describes how, over the course of therapy, Hope developed “brilliant” metaphors for both
DID (“honeycomb”) and trauma processing (adult parts going back to “rescue the child part”).
Inspired by her ideas, he began using these metaphors in his work with other clients. He talks
about how important it was that “she came up with them.” Because her metaphors originated
from “such a real experience” on the inside, he found that “they immediately resonated” with
other people with DID: “It was like they just couldn’t find the words or the picture and then it
gave them a gift.” Woven throughout his narrative are examples of connection within the
therapeutic relationship, including a “really deep moment in therapy” when Hope realized she
had the ability to “calm herself.” His response to her revelation captures both his attunement to
her experience and his unconditional support: “I was just reinforcing that. That’s amazing.
That’s a huge monumental shift in her whole inner world.” The theme of generativity is also
apparent in Rob’s narrative when he provides suggestions to other therapists working with this
population. For example, he states that “clients with DID naturally have the ability to do
imagery and metaphor . . . so just asking for that image as you work with them.” Tuning into his

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words, I hear a message of hope (“we can still work with it”) and resolve (“okay, let’s try
something else . . . let’s try a different approach”). This message is reflective of his dedication to
helping those living with the effects of trauma and dissociation.
‘Reace. Speaking in an active voice, “Reace describes her efforts to make “movement”
in her healing journey. She talks about how, after years of “living deep, deep inside” an inner
world of dissociation (“a great, big mansion’), she has “come outside” and is attempting to
connect with the world around her – to “find somewhere to fit.” This process is ongoing, as
‘Reace continues to struggle with feelings of nonexistence and despair. She describes how body
therapy has been the greatest healing influence in her journey. Before she began doing “body
work,” she experienced trauma as a “wound,” which manifested itself in the body without any
“conscious awareness.” Through body therapy, her “body began to open” and she started to “get
in touch with feeling” and “have recall.” As “feelings began to arrive,” she was able to access
her imagination – “that deepest, brightest place where I am” – to create healing from within.
‘Reace reveals how she experiences considerable healing through imagery, noting that many
images “come to [her]” through her dreams. In one dream, for example, she recalls walking
through a cave full of lions. In her mind, this dream represented the experience of processing
trauma. Her use of imagery to promote healing speaks to her resourceful and determined nature.
In her story, there are many examples of self-directed healing, from “going up into the attic to
play and have friends” to “building bridges” from both sides to facilitate internal connection.
‘Reace indicates that these images were not discussed in therapy or, if they were, she does not
remember. Saddened by this “missed opportunity,” she notes that she is now more intentional
about using imagery in therapy. In doing so, she is able to experience “the best of both worlds”
– inner creativity and relational support.

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Julia. Julia’s narrative describes her practice of attunement in the therapeutic
relationship. She explains how she “gets a sense” of what ‘Reace is experiencing, based on her
facial expression and body language, and then she “feels that feeling . . . in [her] own body.”
The language of attunement is prominent in her spoken experience, including such examples as:
“I’m trying so hard to be present with her . . . [to] help her to be seen” and “once I start saying, ‘I
see it,’ whatever little spark in there that says, ‘I know I’m here,’ gets validated.” In listening to
her words, I hear a profound desire to both connect to and validate ‘Reace’s experience. Using
the metaphor of dancing, Julia demonstrates her ability to be attuned in the moment to moment
process of therapy: “When I see her in a little girl place, I’ll relate to her more like that . . . I’m
following her movements.” The theme of privileging the client’s experience is present
throughout Julia’s story. This theme is especially apparent when she talks about using ‘Reace’s
language (“she’s calling it unvalidated, so I’m calling it unvalidated”) and embracing her
metaphors (“because she treats it as physical, I treat it as physical”) in their work together.
Additionally, speaking in a tentative manner about some of her insights, Julia reveals how she
values ‘Reace’s wisdom regarding her own experience. As a developing therapist, she
demonstrates a keen desire to better help individuals with complex trauma and dissociation by
engaging in self-reflection and seeking out learning opportunities.
A Multiplicity of Voices
Given the complex nature of the phenomena under investigation – dissociation and
healing – and the fact that participants were asked to describe their experiences holistically, it is
not surprising that their words often reflected multiple voices at once. Because the Listening
Guide considers the multiplicity of voices in a person’s expressed experience, it “allows for the
possibility that one statement may contain multiple meanings, and therefore may be underlined

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multiple times” (Gilligan et al., 2003, p. 165). I endeavoured to capture all of their voices and
accurately reflect the complexity of their experiences. Many factors influenced how participants,
especially clients, spoke about their experiences. Examples of these factors include: the part(s)
of the self that was speaking, the degree of insight surrounding a particular issue, and the amount
of healing that had taken place in relation to the experience in question.
The voices that emerged from the four listenings primarily reflect different aspects of
dissociation and healing. Expressions of trauma were also apparent in participants’ experiences.
Listening to the stories being told, I perceived relationships among the various voices of
dissociation. I also detected relationships between the voices of dissociation and those of trauma
and healing. These relationships, which are highlighted throughout this chapter, reveal natural
links between participants’ metaphors of trauma, dissociation, and healing.
As I listened to participants’ descriptions, I heard examples of both implicit and explicit
metaphors. Interestingly, a number of metaphors were embedded in participants’ language. The
Listening Guide method allowed me to hear both types of metaphors, including the embedded
ones, and explore how participants used them to facilitate healing. It also became apparent that
participants employed both core metaphors, which spoke to clients’ subjective experiences and
were applied over the course of therapy, and practical metaphors, which were utilized in the
moment to capture certain experiences or accomplish specific tasks. Examples of core
metaphors include the beehive metaphor and the mansion metaphor. In contrast, the broken tree
metaphor and the weeping willow metaphor represent practical metaphors.
As discussed in Chapter 3, participants’ narratives included descriptions of how metaphor
facilitated understanding and healing not only within the context of therapy but also outside of it.
These descriptions are evident in ‘Reace’s interview, for example, when she describes using

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metaphor to create healing from within. For the client participants, in particular, metaphor seems
to lies at the heart of how they understand themselves and experience the world. For this reason,
descriptions of metaphors that were used in a healing capacity, or to better understand the self or
an experience, were included in the results of this thesis. Engaging with the client’s own
metaphors opens possibilities for promoting healing and integrated identity within therapy
(Waters & Silberg, 1998a).
Listening to participants’ descriptions of their experiences of using metaphor in the
treatment of DID, I identified eight voices. These voices are organized into two overarching
categories: 1) voices of trauma and dissociation, and 2) voices of healing and integration. Each
voice has a counterpoint or an opposing voice. For example, participants describe experiences of
both trauma and healing in their stories. These contrapuntal voices reflect the continuum of
dissociation and the clients’ movement along it. Within the narratives of both clients and
therapists, I heard descriptions of how the clients have progressed from severe dissociation to
more integrated functioning.
Examples of the eight voices heard within participants’ expressed experiences are
provided below. The voices of trauma and dissociation are presented first, followed by the
voices of healing and integration. This organization is intended to capture participants’
movement from dissociation to integration.
Voices of trauma and dissociation. These voices reflect various aspects of dissociation,
as well as trauma and other damaging experiences.
Disconnection, division. This voice represents internal division between parts of the self,
as well as disconnection from people and things outside of the self. Identifying markers of
internal division include having multiple parts or facets of the self and creating inner walls or

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barriers, as well as a lack of communication and cooperation between parts. Disconnection in
external relationships is apparent when participants speak about therapeutic ruptures, harmful or
rejecting interpersonal experiences, and alienation from society.
Internal division. The majority of participants used the language of internal walls or
barriers in their descriptions of dissociation. In Hope’s interview, for example, she describes her
experience of dissociation as having “walls” between parts of the self. Using the metaphor of a
beehive, she talks about how these walls interfered with awareness of other parts within the
system, as well as communication between them:
There was a time when [in] the honeycomb each part didn’t know each other part so they
all had their own walls. . . . They all had their own section of the hive because everyone
had a different feeling . . . . It was very enclosed . . . . There were years where we did not
communicate with each other (laughs sheepishly).
When invited to discuss their perspectives on DID, Hope’s therapists not only explained
dissociation in terms of internal walls but also made specific reference to her beehive metaphor.
In her interview, Penelope defines DID as “different sections of someone’s personality that are
sometimes walled off from others.” The following excerpt from Rob’s narrative builds on this
definition, providing a more detailed description of internal division:
I think it’s a sealed-up portion of life that’s occurring in a developmental spectrum. So, I
think that someone experiences overwhelming events and, in order to not be continually
overwhelmed, they have to package it somewhere. They have to seal it up and that
includes what they were thinking, feeling, sensing in their body um, the relational sort of
dynamics and everything were all like captured and then put away somewhere or walled
off. . . . It’s kind of like a room – a building or structure of some kind with some rooms.

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In listening to Penelope’s interview, it is evident that she has adopted a collaborative,
client-centred approach to working with Hope’s beehive metaphor of dissociation. The
following quotation embodies the spirit of this approach: “My client uses the honeycomb so I
kind of think of it as that.” Rob also acknowledges Hope’s personal metaphor of DID in his
interview, describing the “honeycomb metaphor [as] just brilliant.” A more detailed discussion
of how the beehive metaphor was used collaboratively in therapy to promote healing and
integration can be found in the connection, relatedness section of this document.
Similar to Hope’s description of the beehive with its “various sections,” ‘Reace talks
about living in a mansion that was divided into two sides. Each side of the mansion was further
divided into separate living spaces, such as attics and meeting rooms. These spaces held
different parts of the self. This metaphor is summarized in the following passage:
There used to be this great big mansion and I lived in one half of the mansion. And I had
this great bog dog and . . . he was a protector. . . . There were children upstairs in bunk
beds. . . and we could play. And then, on the other side, there were all these grownups
and it was time to do grownup lessons. . . . It was headache city. It’s just too much
information. And that was where the memories would um start to seep through. And
over on the other half of the house I didn’t have any memories. Total dissociation.
Listening to ‘Reace’s interview, it is apparent that she also experiences dissociation as
disconnection between mind and body: two aspects of the self. She provides an example of this
type of disconnection when she speaks about the physical manifestation of the trauma she
experienced as a child: “My body had this violent reaction, but my brain didn’t remember.” This
particular experience of disconnection is further illustrated in ‘Reace’s description of how it felt
when “some adult said it was time to go to the other side” of the mansion:

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I physically felt the pressure and like there was an opening and I was moving into more
of my own body. And I could feel that internally. But the sense I got up here in my
head, disconnected from my body, was that I was moving to the other half of the
mansion.
Taken together, her words give the impression that her mind and body were divided between the
two sides of the mansion; her mind resided on the side where she experienced “total
dissociation,” while her body dwelled on the other side with the trauma “memories.” Crossing
over to the other side of the mansion meant “moving into” more of her body.
When asked about her understanding of DID, Julia was the only participant in the present
study who did not discuss the concept of internal walls. Instead, she conceptualizes dissociation
in terms of multiple parts or facets of the self: “I think of facets of a person . . . . It’s sort of like a
faceted crystal, like in the Latin sense of the word “faces.” So, it’s like one whole, but there are
different faces. So when the light is coming in this way, they’re expressing out of this part of
them (uses hands to demonstrate how light can shine down and illuminate one facet of a prism).
Elaborating on this description, she explains how she can see ‘Reace dissociating in
therapy:
She’ll say, “It’s like you’re in a different world.” How I get it is that she’s seeing me
from a different part, so I think of it as different parts. And when I see her seeing me, I
can see different facial expressions and reactions . . . for example, when I go over to this
side I often think I’m looking at a very young part.
The above quotation illustrates the process of therapeutic attunement, as Julia tracks and
responds to her client’s shifting internal state. The “very young part” that Julia sees emerging in
therapy is reminiscent of the “little person inside” that ‘Reace mentions in her interview.

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Although she does not make specific reference to inner walls in her narrative, Julia uses
the language of internal division to describe dissociation when she reflects on her client’s
subjective experience of DID: “She talks about having pillows – like she built pillows in her
brain to protect herself. So, she sees the dissociation – like the division between awarenesses –
like pillows.”
Disconnection in external relationships. All of the participants spoke to the experience
of disconnection in the therapeutic relationship. This voice is evident in Hope’s interview when
she talks about “pushing [her therapist] away” due to fears that he was “a harmer.” At that time,
she viewed her therapist as broken, likening him to a tree that was damaged by lightning:
I thought my therapist was a harmer (scoffs). I have (sighs) such guilt around that. . . . It
seemed like he was broken at one point. And I used to look at this tree as I drove down
the road. And he was this strong tree. And then, one time, lightning hit that tree and the
tree broke. And I thought that was like him. And I said, “You’re like that tree.”
Hope describes her therapist’s response to her metaphor:
He described his own tree (laughs), but not right away. I think he just let me say my say
and then later showed me what his tree was. It was like a weeping willow and it did two
things: it wept with people and it comforted people. People could sleep under it, and it
was cool shade and stuff.
Describing her own experience of disconnection within the therapeutic relationship,
‘Reace recalls a harmful encounter with a therapist who “invalidated” her experiences. She uses
the language of “being plateaued” to convey the disconnection she experienced in this
relationship:

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I went to see um a woman in Vancouver. . . . I started to get in touch with my feelings
and that seemed to annoy her. She brought it back to head talk. . . . She said don’t get me
to testify for you. I’ve got nothing nice to say about you (harsh tone). I didn’t speak it,
but I had the thought: lady, you’re the last person on the planet I would ask (angry tone).
And I never went back. . . . But you see she’s the doctor so she knows. I’m just this
lowly person, which I have enough trouble with.
The therapists in the present study also had an opportunity to share their views on
therapeutic ruptures. In Julia’s experience, ruptures occur when there is misattunement within
the therapeutic relationship: “I’m just not connecting. I’m not getting there. I’m not finding a
way . . . to be on their side.” Listen as she reflects on a moment of misattunement in her work
with ‘Reace:
I have to watch myself to not talk too much . . . I think I can tell when it’s too much
because she’ll start to be like, “Wow. Oh, wow.” And she’ll try to be all respectful. And
I can tell that I’ve just gone off and she’s sort of trailing . . . or she’s going, “How does
this relate to what I was dealing with?” – which was total overwhelm – and, “Why are
you talking?”
For Penelope, misunderstandings within the therapeutic relationship can occur without
warning, especially when certain memories are triggered or different parts emerge. Using the
metaphor of a bomb, she describes the experience of “getting blasted” during therapy with Hope:
[It’s] like an explosion with a long, long fuse. Because sometimes we’ll be doing
therapy, and it’s like the smallest thing, and one part will just pick up on it and it will just
light the fuse. And you’ll have no clue. And you’ll just be sitting there and, all of a

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sudden, she’ll be like yelling at you and like really mad or you’ll get these emails . . . so
it’s kind of like a bomb going off because you don’t see it coming.
According to Rob, therapeutic ruptures involve a mutual wounding. He acknowledges
the damaging, and sometimes lasting, effects that these experiences can have on both client and
therapist:
There’s a connection like a rope. . . . Where the cord frays and there’s sort of like two
hanging on. . . . And even though you read articles about how you have to have some
kind of shattering or separation in order to mend it, and it’s the mending that makes the
relationship stronger, it’s still hurtful and I’m aware of that. It’s hurtful on both parts. . . .
I don’t know if you can always totally recover from that.
Beyond the therapeutic relationship, both Hope and ‘Reace provided examples of
disconnection in their intimate relationships, particularly with family. For instance, after looking
into the therapist’s “kind eyes” and experiencing feelings of “amazing love” and “wonderful
acceptance,” Hope realizes that she was never able to share these positive emotions with her
family of origin or her husband:
We never said those things in our heart before to our dad or our mom or our sisters or
brothers or anybody. Or even . . . we tried with our husband but he always said he didn’t
want to look in our eyes.
In ‘Reace’s interview, she discusses how disconnection has characterized her relationship
with her mother. Reflecting on her childhood, she recalls that “my mom would be mad at me
and I never understood what I did wrong.” At one point in her healing journey, ‘Reace attempts
to work through the unresolved feelings she has concerning her mother. She describes that
experience here:

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It was time for me to let go of my mother because she wasn’t really ever there for me
(exhales loudly and begins to cry). It was a dream. . . . There was a mother bird and she
was flying so hard (words broken with tears). She was trying so desperately to keep up.
And then, all of a sudden, she fell and it was like she let go. She died. . . . I felt like there
was this huge loss in here (points to her chest).
Sadly, both of the client participants in the present study also identified experiencing
alienation from society. Hope, for example, uses negative, self-blaming language to describe
how different she felt from other people because of her experiences of trauma and dissociation.
The following quotation exemplifies these feelings of differentness and self-loathing:
What happened to make us choose to create holes that would take us to safety when all
around us we saw other people living other ways of living? And we felt despicable, as if
we should not . . . we felt like a leper (disgusted tone) and as if we had some kind of
disease.
In ‘Reace’s interview, she reveals her struggle to “fit in somewhere” – to find her place in
this world, to experience a sense of belonging. Feelings of disconnection from society are
apparent in the following passage from her I/We poem:
I want to be included
I notice
I stand on the side
I’m invisible
I’m tired
I’m just fed up
I’m really sick of it

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I want to be seen
This theme is also present in her description of a recent encounter she had at the pool:
There’s no room for me. I’m looking at this mother and daughter and they’re taking up this
entire bench. And out of my mouth comes, “Boy, do you ever need a lot of room.” And the
mom looked at me and started moving things over. And she looked a bit embarrassed. . . . I sat
down my bag and said to them, “I’m just trying to fit in somewhere” (serious tone). And I’ve
been saying that a lot lately. . . . I’m 61 years old and haven’t found somewhere to fit (crying).
Hiding/escaping, going away, nonexistence. This voice captures experiences of going
inside and escaping from reality, as well as feelings of nonexistence. In describing the
honeycomb metaphor, Hope makes several references to going inside and hiding in “holes,” as
illustrated by the following examples:
We had this very much fear about things called holes because the holes were a place to
hide, and in the hive of the honeycomb they hid. So, it usually felt frightening when we
had to go in there for some reason. To let the other part out, I guess. . . . What I sense is
the expression of that honeycomb being (sighs) a safe place, but also a frightening place
because we didn’t understand why that part had to go in. And so holes, ever since we
were very little, became a very frightening thing.

Interviewer: I can understand why that would have been confusing, though, to have a part
almost just disappear or go away and not really understand what was happening.
Hope: Um, yeah. Essentially stop exist-, stop living. And, in that context, didn’t
experience time. Time stood still.

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Hope also discloses real life experiences in which she hid in holes, suggesting that her
honeycomb metaphor of dissociation originated from these experiences. Listen as she describes
her earliest memory of the honeycomb metaphor:
Interviewer: Thinking back to the when you first imagined the honeycomb . . . where did
that image come from? When do you first remember thinking about it and using it?
Hope: Huh! I wasn’t going to tell you that (laughing).
Interviewer: You don’t have to if you don’t want to.
Hope: Well no, but . . . I remember I was about two or three going into my dad’s store.
And he sold gardening things for farmers on the prairie. And he had this cone-shaped
honeycomb in there. And something bad happened so I went inside. We went inside.
She went inside.
Her I/We poem for this excerpt is particularly striking, capturing the voices of multiple
parts of the self:
I remember
I went inside
We went inside
She went inside
Descriptions of escaping from reality are also evident in Hope’s story. The following
examples demonstrate how she expressed her internal experience of dissociation through her art,
long before she entered therapy and learned she “might have this certain thing.”
I can remember writing a poem about being in a roller-skating place and the lights are
twirling. I’m twirling and the lights are moving around and . . . I felt like I can escape. I

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actually consciously remember escaping to that place . . . an inner life of creativity that
would release me from the pain of the present.

There was no identity. I think that was what I needed to say all of this time. I need to say
there was no identity in my person experience . . . I would just go into this wall. I even
found myself painting myself into walls.
The following description, which mirrors Hope’s experience of feeling trapped and
unable to live her life, reveals another aspect of this voice:
Some kids brought this beautiful . . . dragonfly to me and it was dead. It was about six
inches across, the wing span, and had beautiful florescent wings. And I felt like that had
been me before, just trying to live my life with my husband and stuff. And the dragonfly
kept crashing against the walls and finally died. And they brought it to me and I thought
(exhales) I totally feel like the dragonfly.
This metaphor serves as a powerful illustration of the loss of self that she experienced in her
relationship with her husband.
In describing her experience of dissociation, ‘Reace makes several references to going
inside and hiding in the mansion: “I stay in seclusion, hiding.” She also talks about experiences
of nonexistence, which are characterized by feelings of nothingness, powerlessness, and
detachment from reality. These feelings are captured in the following quote: “I was empty.
There was nothing . . . I was completely, entirely amnesic and totally dissociative out here with
the world . . . I lived deep, deep inside of me.” Similarly, Julia explains how ‘Reace “talks a lot
about not having been here” in therapy.

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‘Reace makes a particularly potent allusion to powerlessness, as she gives voice to her
experience of living inside the mansion:
Interviewer: And when things started to feel overwhelming and it started to physically
hurt, do you remember if you would go back to the other side of the house? Were you
able to go back when you wanted?
‘Reace: Hmm, no.
Interviewer: It wasn’t up to you?
‘Reace: It wasn’t up to me. It would just happen.
The following excerpts from her I/We poem further reveal the nature of ‘Reace’s
dissociative experiences:
I lose it
I just completely go “poof”
...
I went blind
I didn’t want to see
...
I dissociated
I, I dissociated
...
I went blank
Her words reveal that disconnection from reality is central to her subjective experience of
dissociation.

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The therapist participants can be heard using this voice in their narratives when they
describe their clients’ experiences of dissociation. The following passage, taken from Rob’s
interview, captures Hope’s experience of feeling trapped, helpless, and cut off from the world:
I don’t know whether it’s a metaphor or a real event, but she talked about drowning and
being underwater and then breaking out through the ice and, you know, being present.
And like being terrified of that and seeing other bodies under the water, under the ice. . . .
If it was a real thing, it was also metaphorical in the sense that she realized she had
broken out of that – broken through the ice and come up and was alive.
In her interview, Julia recalls a particularly powerful metaphor that ‘Reace used to depict
her dissociative response to overwhelming terror:
Julia: I remember one image that she used that really resonated for me and I think of now
when someone gets completely overwhelmed. She said, “My head snapped off.” That
was it. She lost her head, right? And it was gone. That was how traumatic it was. And
when she said that, I really got it. I was like, yeah, completely overwhelmed. You can’t
even be here anymore. You’re gone, right?
Interviewer: Can you recall when that came up in therapy?
Julia: When she was talking about it, we were doing a session around early childhood
trauma and she was processing it. It was being buried alive in a coffin. “The dirt, the
dirt,” she was saying.
Interviewer: And do you remember how you responded to that metaphor?
Julia: I think my mirror neurons went off, you know? It was like, “Yes, that was absolute
terror and nothing could have kept you here.”

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Not knowing, darkness, silence. For the client participants, this voice reflects the
confusion and the lack of awareness surrounding their experiences of trauma and dissociation.
In Hope’s interview, this voice includes references to living in darkness or the beehive being
very dark. Before entering therapy, for example, she recalls: “We were still in the dark. . . . The
honeycomb really was dark. . . . It was dark. It was so, so, so dark.” Listen as Hope explains
what life was like at that time:
There was no knowledge of the parts then. . . . I wasn’t aware that different parts would
come out at different times . . . Each part didn’t know each other part . . . . There [was]
lots of darkness and confusion. . . . We didn’t know what [the honeycombs] were . . .
[and] we didn’t understand why that part had to go in. . . . It was a frightening place.
Hope’s expression of fear and confusion in response to her early experiences of
dissociation is echoed in her I/We poem:
We didn’t know
We had this very much fear
They hid
We had to go in there
To let the other part out, I guess
I, I think that’s how
I don’t
I wasn’t aware
...
We didn’t understand

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Reflecting on her healing journey, ‘Reace acknowledges that, despite having “glimpses
and feelings and terror and memory trauma,” there are aspects of her abuse that remain outside
of her conscious awareness. She wonders if these memories “perhaps [reside] in the other side
of the mansion.” The following passage exemplifies her current struggle to “get strong enough
to actually remember” the trauma she suffered as a child:
‘Reace: It just doesn’t seem real. I, I still sense my own terror of that man and um (sighs
deeply) . . . and I don’t remember. I remember I was his mistress and my bedroom was
next door to my mom and dad’s. And my mom would be mad at me and I never
understood what I did wrong. And I don’t remember him coming into my bedroom at
night. I just don’t remember.
Interviewer: So, there is awareness of bits and pieces.
‘Reace: Yeah.
Interviewer: Ok.
‘Reace: But I don’t have that collective opening and I know it’s for a reason.
Her words reveal the protective nature of her dissociation, as well as the need for both careful
pacing and well-developed ego strength in her healing.
This voice is also apparent in ‘Reace’s narrative when she talks about experiencing things
physically in her body without having any “conscious awareness.” For example:
‘Reace: The first time I had recollection of that – but not on a conscious level – was
[when] I had to get my uterus removed . . . I had a violent reaction . . . and what I did was
release that memory. But it didn’t come to conscious awareness. It came to a certain
level of awareness where my body had this violent reaction, but my brain didn’t
remember.

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Interviewer: You didn’t know why.
‘Reace: No. I just had this – just like the MS – I had these reactions. And um like going
blind and the tic douloureux and the walking disability . . . and my body did all that, but I
didn’t know why it was doing it.
The I/We poem for this passage captures how trauma is experienced in the body, separate
from the mind, speaking to the core of her experience:
I had a violent reaction
I . . . release[d] that memory
I had these reactions
I didn’t know why
The above descriptions illustrate how the voice of trauma co-occurs with the voice of not
knowing in ‘Reace’s narrative.
Both women also revealed experiencing a lack of awareness of parts, and between parts,
within their internal systems. The following quotations from Hope’s interview are powerful
examples of “not knowing” and the feelings of surprise and confusion she experiences in
response to this lack of knowledge:
When you go back to that place . . . when, when we go back there, we get surprised that
person doesn’t know the other parts or what’s been happening. They may have a sense of
the busyness of the honeycomb (laughs), but they don’t know what’s going on.

Right now, we’re dealing a lot with the adult parts who came because there was no
knowledge of the parts then . . . there were adult parts that just kept making parts. So it’s

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a confusing time right now with the older parts because the older parts should know in
my mind. . . . That they are part of the whole.
Listen to the uncertainty in ‘Reace’s voice as she attempts to determine who in her
internal system is responsible for developing a particular metaphor:
Interviewer: And then the wave metaphor that captures what it feels like when you switch
from one part to the next . . .
‘Reace: I . . . that’s kind of something out of my conscious control. I don’t know who . . .
I don’t know (sighs). I’ll take ownership. Which part of me developed that? I really
don’t . . . I don’t know.
The experience of not having words or a voice to express themselves is also captured in
this category. For Hope, the darkness and confusion of the beehive meant that she could not
communicate about her inner experience of trauma and dissociation:
The words, the words are hard to find because in the beginning there were no words . . .
There were never any words that really could comprehend the . . . immensity of the pain .
. . it was dark, it was so so so dark. . . . If you can’t see in the dark, you can’t get out and
describe what’s going on for you.
Hope’s words echo Way’s (2006) description of this experience: “Within the black hole
of dissociation and trauma, language fails” (p.34).
The silencing impact of trauma is also clearly evident in the women’s stories. ‘Reace
provides a particularly poignant example of how she internalized her abusers’ message of “don’t
tell” in the following passage:
There was . . . an aspect of me that would take . . . the part of me that my father had
gotten his sperm all over . . . into the water and . . . let the stream clean her. And um we

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had this rule that she never told me what happened so I never saw what he did to her . . .
and I think, you know, that’s a very large responsibility for such a little person – to have
to do all that and not to be allowed to tell. And I even told her that. Like that’s what
everyone else said to me. You’re not allowed to tell. And I even told myself, “You’re
not allowed to tell.”
In contrast to the clients’ use of this voice, the therapist participants convey a sense of
“not knowing” in a manner consistent with their role as helping professionals. In listening to
their interviews, this voice is evident when they speak in a tentative manner about some of their
insights, acknowledge the limitations of their knowledge, and leave room for alternative
explanations. In the following description, Rob not only recognizes the limits of his
understanding but also demonstrates how to engage in meaningful clinical work by focusing on
the client’s experience:
And I don’t usually do that. I don’t usually say, “Where, when, who was there, what year
was that.” And if they question me and say, “Was that real? Did that happen?” then I
say, “I don’t know.” And even if you were processing a nightmare image, we can still do
some work because it still somehow represents your inner experience. And it’s
disturbing to you so we can still work with it.
This example demonstrates how, in privileging the client’s subjective experience, the therapist
honours the client’s voice and opens possibilities for healing.
I also hear Julia speaking in a tentative manner, as she discusses her conceptualization of
DID. Listen as she both takes into consideration her client’s view of dissociation and
acknowledges the challenges of tracking and responding to her client’s shifting internal state:

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I don’t think of it like she’s divided and that she’s got walls and can’t see. It’s more like
it’s a lack of awareness. Although she sees it more like that, so maybe it is. I don’t
know. Like she sees the pillows in between and all that. But I think of it more like: if I
experience it with you and show you and share the experience and validate it, then you
know it’s there. But I need to actually go there with her and that can be hard to do
because I don’t always um . . . it’s so hard to track, right? Like you don’t always know
what you’re doing while you’re doing it.
Trauma, brokenness. Trauma memories, impacts of trauma, and brokenness in response
to trauma are all aspects of this category. In her interview, Hope does not share many details
about her past or the traumas she has suffered. She makes reference to them using ambiguous
phrases, such as “something bad happened,” “the psychologist who hurt me,” and “I knew
something wasn’t right in our family.” Notably, Hope’s decision to discuss her traumas
indirectly may have prevented the memories and feelings from overwhelming her during the
interview process, allowing her to reflect on the material without having to relive the
experiences.
In addition to the ambiguous phrases, Hope also uses the language of “darkness” to
describe her internal experience of trauma:
The only parts that we really don’t like to do is when it’s dark still . . . parts, experiences,
memories. And the parts that were really dark, like we had a mother in us and a father in
us. We went one time and realized we had a mother and father in us that were our mother
and father. And we went to our first therapist and we said, “We’re going to die because
we don’t want them in us” (solemn tone). . . . The mother came last year and really yelled
at our new therapist and broke her heart (exhales). She came when something scary was

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about to happen and she thought she would defend us. And our therapist said that was
okay to do, but we still think she’s not really allowed to do that. And she was about to
kill us the night before, like drive into a wall (serious tone). And (sighs) so we think
when we see the picture of her that we drew, we find that very scary still. That picture
would say so much to us. That’s still an unresolved part. I think you might know that
when people are still in the middle of things there’s still darkness, but . . . there’s more
support so that hard part that comes out can get some help.
In listening to Hope speak about trauma in terms of “darkness” and “dark parts,” it is evident that
her experience of trauma is closely related to the not knowing, darkness, silence category. That
is, the parts that hold on to the trauma memories are “still in the dark,” and the unprocessed
memories in the honeycombs make it “dark” and “scary.”
Although she keeps her discussion of it brief, Hope does mention a specific traumatic
event involving “holes” in her narrative:
There was a hole that I drove by and the abuser came, took us to the back of the school,
and took h- her to the back of the school and made her do some things. And then he
drove us past this manhole. So, holes were good and bad. We thought we would go in
that hole and then no one would find us.
Rob provides a description of how the “ideas of holes” may relate to Hope’s experiences
of trauma:
She kept alluding to this thing with holes. And she couldn’t even grasp what that meant
or why it was there and why the idea of holes was so important. And then she talked later
about holes in the ground, in the basement, because she was taken to a basement and

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abused. And just something about holes . . . and I don’t know whether they were like
bodies in a grave . . . because she alluded to that, too.
These excerpts suggest that some of Hope’s traumatic experiences took place in a hole.
However, she also identifies how holes were “good” because she thought “we would go in that
hole and not one would find us.” This description is similar to her account of hiding inside the
beehive in her father’s store: “Something bad happened, so I went inside. We went inside. She
went inside.” The concept of holes being both “good and bad” is also reflected in her
explanation of the beehive metaphor. She describes how it was a “safe place” because holes
were a “place to hide” but also a “frightening place” because “the memories are in the
honeycombs.” Thus, it appears that, within Hope’s subjective experience, holes are associated
with both trauma and safety.
In contrast, ‘Reace provides candid descriptions of the trauma she has endured
throughout her life, from the sexual abuse she experienced at the hands of her father to the
satanic ritual abuse she lived through as a child. Reflecting on the complexities of her “life
trauma,” including its physical manifestations and intergenerational nature, she tearfully
discloses: “I can’t believe I’m still so loaded after all these years.” This revelation reflects the
severity of the trauma she has experienced and the intensity of the therapy required to treat it; the
healing process is ongoing.
In the following passage, Julia demonstrates how she works with the part of ‘Reace that
“holds all that” trauma. Listen as she portrays the abusers’ actions as an attempt to “murder”
‘Reace’s soul:
There’s still a deeply traumatized, abused part that thinks that she’s evil . . . the part that’s
been told she’s evil . . . I see something come out in her eye where she’s kind of distant,

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kind of untrusting . . . like she starts to think I can see her and I’m evaluating the badness,
right? So, I asked her today, “Is there any part of you that fears you might harm them or
do something bad at the same time you’re having all this happiness?” And right away
she says, “Yes . . . it’s like the little girl in me who had the hand holding the knife.” So
then, we worked through that again. And I said – talking to her grownup self in the here
and now – “They were trying to murder you. Murder your soul, your spirit. They were
abusing you too . . . they were trying to kill you.”
In another example of therapy process, Julia uses the metaphor of a physical injury to
validate the emotional wounding ‘Reace experienced in her marriage:
Julia: She was apologizing for her divorce . . . for going through with the divorce of her
husband who was extremely physically abusive to her and also sexually abusive to her
kids. She went to him and apologized to him, while the person that he cheated on her
with was there . . . I heard her out about it and then I said, “Betrayal in marriage is about
one of the worst wounds a person can receive. If you can imagine being stabbed in the
arm, would you apologize to him for that – for him stabbing you in the arm?”
...
Interviewer: And did that help shift things a little bit, did you find?
Julia: Yeah, it did. It got her back to sort of a more integrated mode.
Julia was not alone in her use of this type of metaphor. ‘Reace, for example, likens
trauma to the “open wounds” she suffered during “the [satanic] rituals.”
Interviewer: What images, metaphors or symbols best represent trauma for you?
‘Reace: Open wounds.

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Interviewer: Okay. If it feels okay to, can you describe what that wound might look like?
Would it be really deep? Would it be . . .
‘Reace: Um they used to tie me on a table for the rituals and sometimes they couldn’t get
the bleeding to stop. So, they tied my feet and hung me upside down. And, and they
stuffed me to get the bleeding to stop.
...
Interviewer: It sounds like, since a lot of the trauma from early on when you were young
was physical in nature, now when you think of trauma in general you think of a wound.
‘Reace: Yeah.
Throughout her narrative, ‘Reace speaks of experiencing trauma in her body. Its physical
impacts are apparent when she describes suffering numerous “reactions,” including multiple
sclerosis, blindness, and tic douloureux. These physical reactions occurred without any
“conscious awareness” of the traumatic experiences, highlighting the relationship between
‘Reace’s voices of trauma and not knowing.
In her interview, Penelope explains how the metaphor of an “external injury” can be
useful in educating clients about trauma:
I just think of like an external injury. That’s what I use with a lot of my clients because
it’s visual and people can identify with it. So, like a bad injury. And sometimes injuries
get kind of closed off and infected and you get a whole bunch of disease. And you have
to go back in and it’s extremely painful . . . but you’ve got to clean it out or it just leads to
further issues.
Similar to Julia’s description of trauma, Rob moves beyond the physical to discuss the
spiritual impacts of trauma:

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I see trauma as a tearing . . . almost like a tear in the person or, even in some cases, the
soul. And I think that it’s something that is a wounding that, on one level, makes the
person vulnerable. On the other level, it sort of pushes them into the presence of a higher
power.
Voices of healing and integration. These voices reflect participants’ experiences of
healing and integration.
Connection, relatedness. This voice captures elements of internal connection among
parts of the self, as well as connection to people and things outside of the self, such as therapists,
loved ones, nature, God, and culture.
Internal connection. In Hope’s story, there are many examples of communication and
cooperation between her parts, especially as she continues to engage in “group therapy.” She is
clearly working diligently to “unite our self and bring us to wholeness,” as evidenced by the
following three examples:
There’ve been a lot of parts to be found so that those parts could then say their trauma.
And then, and then the parts could unite and say hello to each other and reacquaint
themselves. . . . We call it group therapy (laughs), which is another metaphor.

We have silent terrors of um . . . not so much anymore like we have sadness that comes
over us quite a bit, but we’re able to tell her, calm her (pats her chest as she speaks) . . .
which we found doing this helps (pats her chest again).

Today we talked about this one part and we came to her . . . and we try to figure out. And
she was saying something and I didn’t know (regretful tone) . . . and now I know. And I

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was able to say I’m sorry and she was able to say I’m sorry. And, and we were both able
to connect. So, the metaphor of the honeycomb with the walls down and just the circle is
really good for that. And we, we use that.
Notably, Hope’s therapists touched on some of the same examples in their narratives.
According to Penelope, the group therapy metaphor was developed collaboratively in an effort to
encourage internal communication. Over time, Hope began to facilitate “dialogue” between the
parts herself, fostering connection and, ultimately, integration:
We came up with the notion of group therapy where all the different parts that are
capable will sit around a table. . . . The basis of group therapy is to just encourage the
client to take ownership over her own integration experience, and to increase dialogue
between the different parts. So, it started out with Rob or myself verbally calling out
different parts or asking, “Does anyone in the system have any thoughts on this, or would
they like to talk about it?” Or, if a part had an issue with another part, we’d increase
dialogue. And eventually, she kind of internalized it where her core personality took on
the role of [facilitator]. So, that’s the main thing we’re doing right now – just
encouraging the parts to talk. And they end up uniting.
Rob can clearly recall the “moment in therapy” when Hope revealed her ability to engage
in self-calming, as evidenced by the following description:
Another really deep moment in therapy was when she shared with me that she’d been in
the grocery store and she started to be frantic and have a bit of an “I’ve got to get out of
here.” So, there she was in the grocery store starting to panic and her heart rate going and
things like that and then she suddenly realized that she was going shhh, shhh, shhh and

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patting herself on her chest. And she realized that was herself calming herself. And . . . I
was just reinforcing that. That’s amazing!
Both therapists also describe how the beehive metaphor has changed over the course of
treatment to reflect progress in internal communication and cooperation. In her interview,
Penelope notes that, “As she progresses the walls disintegrate . . ., and then they’re able to
unite.” Similarly, Rob shares, “Subsequently [within] that honeycomb . . . the walls dissolve as
you move toward recovery. So, the parts start to communicate more and interact more and
cooperate more.”
Hope’s therapists provide additional examples of internal connection metaphors in their
narratives. In the following quotation, Penelope uses the metaphor of “a colony of ants” to
describe the cooperation taking place among the parts within Hope’s system:
It’s like a little colony of ants that are just working together, and all of her parts are
working really, really hard . . . they’re working really hard and they’re helping the system
to get integrating . . . to unite for a common purpose . . . like, we’re getting the kid parts
to have slumber parties internally and just really fun stuff like that. In the beginning, they
had little identities. And now, uniting them through their roles. And maybe, uniting
them as a system.
In his interview, Rob describes using images of various meeting places to facilitate
communication and cooperation with Hope’s internal system:
We’ve used the boardroom table a lot . . . or in some cases there was a castle and they
met in different rooms and in chairs up on the balcony looking out over the land. And
we’ve had gazebo-type things in gardens. I like those a lot better than the idea of the
hallway with the closed doors. It just seems too claustrophobic, and like you can’t get

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out . . . and the idea of an open thing in nature where you’re either on the beach or in a
field or garden seems to feel a lot better . . . so that was always helpful to have a place to
meet and have the parts there and meeting.
‘Reace also discusses moments of inner connection and cooperation in her interview.
Listen as she describes a particularly poignant example of internal connection involving the
“little person inside” who holds all of the sexual abuse memories and an internal caretaker part:
There was a part . . . of me that would take the part of me that my father had gotten his
sperm all over . . . into the water . . . and let the stream clean her. . . . I would take care of
her and wash her off and everything.
Although these parts established a “rule” that the abused part could never “tell” the
caretaker part about the abuse, this example demonstrates how the two parts worked together to
care for one another. One part physically cared for the little girl who was being abused by
washing her in the stream, while the other part shielded her caretaker from the psychological
damage of the abuse by “hold[ing] all that.”
Julia recalls how this metaphor has been used in therapy to strengthen connection, as
‘Reace works towards integration:
She’s got two little girls and I’ve often referred . . . to one part helping the other part.
Just kind of following along with her narrative about it because one little girl was the part
that didn’t get abused and washed the little girl that did get abused. And I’ve talked to
her about that. So how does this help you now? How does this translate now? Is there
some part of you that’s like the grownup little girl? So, we’ve kind of gone through that.
In the following example, ‘Reace explains how she uses the metaphor of “building
bridges” to foster connection between parts:

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Building bridges works. I’ve built bridges, lots of them. Actually, I’ve had dreams
where the bridges stop in midstream. . . . What happened was I ended up on the other side
and I started building a bridge to meet the other one.
This voice is also apparent in ‘Reace’s narrative when she describes facilitating
communication within her internal system. This process is exemplified in her I/We poem:
I, I have this . . . wave internally
I feel a shift
You . . . shake your head
I’ll actually self-talk
Where are we going?
What am I afraid of?
Why does someone else need to be here?
In her interview, Julia explains how ‘Reace uses the “pillow” metaphor to describe her
experience of healing within the brain:
We often use [the pillows] as targets for OEI. . . . I remember, one time, she said, “I felt
pillows.” And then she said, “Oh, I just felt something change here or something opened
up here” (points to different parts of her head, as she talks). So, she’s always referring to
it [based on] her understanding of how the brain works. Like, it’s opening up. And she’ll
add in things like chakras. So, for her it’s like blocking and opening.
External connection. For Hope, there is a relationship between different layers of the
connection voice: experiencing connection within the therapeutic relationship helped to facilitate
inner connection among her parts. In her narrative, Hope describes how experiencing
unconditional acceptance and genuine kindness within the therapeutic relationship taught her

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what real love is. Over the course of therapy, she began to internalize these feelings and direct
them towards herself, which helped her relate to the other parts in her internal system. For Hope,
the therapist’s “kind eyes” is a symbol of love and acceptance of her whole self:
We were looking into his kind eyes and he never took his gaze off our eyes. . . . We were
the sole focus of his kind eyes. . . . We went inside his eyes and his eyes came inside our
eyes. And, and we were just sitting there like there was no scary (childlike voice). His
eyes were saying kind things, like real things. . . . I didn’t feel un-whole. . . . We felt um
amazing love . . . like of wonderful acceptance. He wasn’t going to break our heart or
leave us.
In her story, ‘Reace describes how her body therapist has been an enduring source of
comfort and support throughout her healing journey. The metaphor of the “great white bird” is
reflective of this connection. She explains how this image came to her through a dream:
It was a dream . . . and there were three birds. There was one with great white wings, and
there was a little bird, and then there was a mother bird. And she was flying so hard
(crying). She was trying so desperately to keep up. And then all of a sudden, she fell and
it was like she let go. She died (sobbing). And then the great big bird, which was the
father bird – in my mind, it was Bob, who’s been my therapist for 28 years – wrapped me
in his great white wings and just held me. But I carried on, we continued in our flying.
‘Reace continues to use the image of the “great white bird” to self-soothe when she is
feeling emotionally activated:
When I’m feeling (sharp breath in, begins to get upset) in a lot of pain, I imagine the
wings holding me. . . . When I start having thoughts like (sobs), “I’m really done here. I
just can’t take it anymore,” that’s when I imagine those things.

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Her use of this imagery to comfort herself in moments of intense pain and despair speaks to her
resourceful nature. Listening to her story, it is evident that she consistently uses her creative
powers to facilitate healing from within.
Hope also provided other examples of external connection in her interview. In the
following passages, she talks about her connection to God and to nature, illuminating the healing
influences of both:
I drew this um feather and . . . it started to represent a spirit of, a spirit of God and Jesus
and how He went through all that suffering. And that part of me that got raped went
through all that suffering . . . and He understood. And we could be a whole, beautiful
feather. . . . We could look to the feather as being a symbol of one God that knew our
pain, knew our suffering.

I felt like we were not special. We were special, but in a negative way and not in a way
that anyone would love us. So, the hummingbird came in the door one day when a friend
had bragged that she had hummingbirds and (sighs loudly) I didn’t. And that was a
metaphor for me not being loved, I guess. And I was on the phone with my therapist
crying my eyes out and saying hummingbirds don’t even come to my house . . . and this
hummingbird peeked its nose in my door (voice rises in astonishment and excitement).
And so that was this humungous spiritual thing.
Hope also uses the hummingbird metaphor to embody “being a mother bird” to her
children and grandchildren, which is an example of connection to family:
The hummingbird is like a mother to me now because she devotes herself to her life of
being a mother bird and um it’s very symbolic of me. And I look at her little round head

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and I just want to hug her like a mother or something (laughs). I don’t know how to
describe it, but um she takes care, she’s devoted to her chicks, and she sees them through.
And, you know, it’s quite beautiful.
In terms of culture, Hope shares the following description of feeling connected to artists
and their artwork:
There were also like connections to artists [who] . . . started going into people’s insides. .
. . It gave me a clue, when I was looking at the artwork of say Picasso or somebody like
that, how that could exist. . . . How what was happening inside of me was real and not
made up.
Although ‘Reace is still in the process of finding “somewhere to fit,” she discusses the
ways in which she is already connecting with the world around her. This connection is depicted
in image of the “two earths” touching:
I had this dream and um there was this earth and the earth I was standing on. And this
other earth came down ever so gently and slowly. And it was so humungous in my mind.
In the dream, it filled up my entire consciousness. And the two earths touched. . . . The
world that I’d grown on, lived on since I was a baby and then there’s a new world that
came and joined [with] different people and different life experiences. . . . I want to be
included. . . . Now I go for walks and I say hello to people.
Coming out, being present and alive, having a sense of agency. This voice contains
examples of “coming out” of dissociation, remaining present, and becoming an active participant
in life. It also captures expressions of personal agency. Reflecting on the current state of the
beehive metaphor, Hope explains how the parts are now free to “come out” of the hive and
participate in life:

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Interviewer: What does it look or feel like on the inside to you?
Hope: It feels like a vast open space with all these people right now. I would call it a big
cone-shaped hive, a bumblebee hive.
Interviewer: Where do the different people fit into the cone-shaped hive?
Hope: Well (exhales deeply), depending on who is needing to be out, there is a hole in
the top of the cone-shaped hive and they come out. . . . When they come out, they don’t
feel unsafe anymore.
The language of “coming out” is also evident in Hope’s narrative when she describes
healing experiences. For example, she notes that “letting the parts out” is the first step in
“accepting the parts.” Additionally, in her discussion of the “group therapy” metaphor, she
describes how “not everyone has to show up every time because, if they did, it would get a bit
confusing . . . but they can come to therapy and they’re there.” This theme is echoed in
Penelope’s description of the “group therapy” process: “They’re all present and no one goes
away.”
Another aspect of this voice, revealed in Hope’s expressed experience, is an emerging
sense of freedom and confidence to “go out and live.” In the following passage, she explains
how the dragonfly metaphor has changed, and taken on new meaning, over the course of her
healing journey:
Hope: That dragonfly doesn’t feel like that anymore (strong, confident tone). The
dragonfly feels like a real mom and a real grandma. And is proud to be a dragonfly and
eat all the mosquitoes so they won’t bite her grandchildren.
Interviewer: What’s the biggest difference about the dragonfly now compared to back
then?

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Hope: The dragonfly flies free. The dragonfly lives. Even though I know dragonflies
only live one day, in the life of the dragonfly, she lives a full life.
In listening to her I/We poem, Hope’s vitality is palpable:
The dragonfly flies
The dragonfly lives
She lives a full life
Hope reveals that these feelings first emerged as she began participating in trauma
therapy. Using another nature-inspired metaphor, she describes how she felt like a “dancing
lamb” after processing her trauma. The image of the lamb represents Hope’s newfound freedom
to live her life:
Hope: Every time I went there, it was like I came out like a dancing lamb . . . the parts
were coming out . . . in my spirit, there was like this little lamb jumping around . . .
dancing in the meadow (excited, childlike tone), coming out of therapy.
Interviewer: When you think about the little lamb dancing in the meadow, what feelings
go along with that image?
Hope: Oh, just all the exuberance of things missed. Of years missed. Joyful like the
hummingbird who flits around and is just happy to do her work and doesn’t need (laughs)
great momentous things to happen. It’s like a freedom of expression to have confidence
to go out . . . go out and live.
From Penelope’s perspective, Hope is not only becoming an active participant in life but
also in therapy. In the following excerpt, she draws attention to Hope’s developing capacity to
direct her own healing:

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She’s doing a lot of her work by herself and so she’s kind of owning the experience.
She’s now doing the group therapy stuff internally. And so, we come and work on the
trauma pieces and then she goes off . . .
In ‘Reace’s interview, she talks about her desire to “quit hiding” in the mansion and
“come outside.” This desire is clearly evident in her description of the “two worlds” metaphor:
Interviewer: And what was the new world all about?
‘Reace: Different people, different life experiences. Not that there isn’t pain left, but
opportunities. I got to quit hiding because how am I going to meet these opportunities
when I’m hiding.
Interviewer: It’s so hard when you spend such a long period of your life hiding.
‘Reace: Yeah. Not wanting to be seen. Wanting to be invisible. Now I want to be
included. How does my brain feel? There’s enough space on this planet for me.
She explains how the dream in which “the two earths touched” coincided with her
emergence from the mansion: “[It was] about the same time when I came outside of the mansion
. . . because I was hiding in the mansion.” Emerging from an inner world of dissociation, she is
now able to participate in the world around her, as evidenced by the following excerpt from her
I/We poem:
I came outside
I come out
I actually say hello
I started walking
I go for walks
I see things

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Within her spoken experience, there are numerous examples of ‘Reace’s active
participation in life. Her words convey a strong sense of presence and personal agency: “I’m out
here. I’m taking up space . . . I’m doing it out here now. It’s not all happening in magic
internally. It used to be all magical.”
Julia can be heard using similar language in her interview. For example:
One [metaphor] we’ve used is a stage. That’s something she came up with, where she
felt like a curtain was dropping and a new person was coming out onto the stage . . . and I
remember it was really positive. She liked it. She felt like it was a new act in her life . . .
and what I remember feeling was that this person was a lot more engaged, a lot more an
agent in her own life. Like she would say, “I’m here.”
‘Reace’s ability to take action – to make a difference in her life – is especially apparent
when she describes her individual efforts to bring about healing. The following passage is
perhaps the best example of ‘Reace’s capability to direct her own healing experiences:
Interviewer: And can you think of any ways that the mansion image was helpful in any of
your therapy?
‘Reace: I like going up into the attic because there’s all the little children. There’s not so
many anymore.
Interviewer: Okay, so it helped you access those parts?
‘Reace: Yeah. I’d just go up and play and have friends.
...
Interviewer: And did you ever do that in therapy?
‘Reace: No.
Interviewer: No. Just on your own?

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‘Reace: Yeah.
Interviewer: Okay. You did a lot of work on your own.
‘Reace: I think this is the first time I’ve ever talked about the mansion and the attic out
loud. Wow, isn’t that interesting that I’m talking about it to you. It’s even coming out
now – those parts of me.
While reflective of personal agency, these words also capture the experience of “coming out” of
dissociation. During the interview, ‘Reace’s parts were able to come out and share their
experiences of living in the mansion.
Given the self-directed nature of ‘Reace’s healing, it is not surprising that this voice often
co-occurs with the voice of healing, wholeness in her narrative. This relationship is most evident
when she discusses the ways in which her own dreams and images have contributed to her
healing.
Becoming aware, knowing, voice. For the client participants, this voice represents a
growing awareness of their experiences of trauma and dissociation. Listening to ‘Reace’s story,
this voice is apparent when she speaks about her experience of “journeying” in her body and
getting “in touch with feelings.”
When I first met Bob, I was anorexic and my ex-husband had almost murdered me with
his bare hands. I was hanging on for dear life, but I wasn’t aware of it. . . . After a couple
years of doing body work, my body began to open. And it’s probably when I started to
have recall . . . as feelings began to arrive.

As I began to integrate, I began to remember what I had done to survive. . . . I can
actually in my mind’s eye see my father and his penis . . . and I know I miscarried one of

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his babies because I got it out of the toilet and handed it to my mom. . . . I have those in
here (points to head).
In these descriptions, ‘Reace explains how “journeying” in her body created “openings”
through which feelings and memories “began to arrive.” Through this process, she “began to
integrate.” Using the mansion as a framework for understanding this experience, it seems that
her body was the gateway through which she was able to enter the other half of the mansion and
begin integrating the two sides. For ‘Reace, processing the trauma held within her body resulted
in both increased awareness (which she experienced as connection between mind and body – two
parts of her experience that resided on separate sides of the mansion) and connection within her
internal system (which she experienced as integrating the child parts and the adult parts from the
two halves of the mansion).
In Hope’s interview, she describes how acknowledging that she “might have this certain
thing” called dissociation brought “light” into the beehive:
And in that therapy . . . after there was an acceptance of a possibility of some kind of
dissociation because of the abuse and neglect . . . that’s when the light started to come
into the honeycomb. And I can honestly say that each of those parts had to come out of
each of those places in order to feel that . . . see that light and see that acceptance. . . .
Now [with] the light shone on, when the [parts] come out they don’t feel unsafe anymore.
This experience reveals how the psychoeducation and acceptance Hope received in therapy were
essential to her healing. Together, they fostered feelings of safety, as well as hope: “[I] grasped
the possibility that there was a change that could be made.”
With “more light coming in,” Hope was able to “look at the scariest memories” held
within the honeycombs and make sense of the “busyness of the beehive.”

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We have knowledge now that our abuser threatened us and then holes were where we
would escape to and . . . therefore another part came out. We’re gain- gaining words all
the time (exhales) to describe what happened, and where we went, and why we were
fearful . . . and connecting the parts to know who can take care of each other now.
Through the healing she experienced in therapy, Hope developed greater awareness and, with it,
the capacity to access words and tell her story. This example reveals how Hope’s “knowing”
gave her a voice, empowering her to overcome the silencing impact of trauma.
This feeling of empowerment is amplified in Hope’s I/We poem:
We have knowledge
We’re gaining words
[We’re] connecting the parts
Additional examples of gaining a voice can be heard throughout the women’s stories.
‘Reace uses the language of “speaking my truth” to describe how, as part of her healing journey,
she has begun to express her voice. This language features prominently in her I/We poem:
I’m doing it
I’m speaking out
I can speak up
...
I’m speaking up
I’m telling
Over the course of their healing journeys, both women describe an emergent awareness
of their internal systems. The following passage from Hope’s interview illustrates the
“perception of knowing” that now exists amongst the parts within the beehive:

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Interviewer: And when the other parts are in [the honeycombs] can they hear and see
what’s happening for the rest?
Hope: Now they can. For the most part, I would say. Yeah. They’re getting more able
to connect. Hearing is not always the way they perceive each other . . . except if I say
something out loud. . . . It’s mostly a perception of knowing . . . like today there was a
metaphor of they’re just lining the inside of the brain . . . sensing, observing . . ., being a
present part.
This awareness was also apparent during the interviews when the women described
experiencing a “shift taking place” or the emergence of different parts. In the following
quotation, ‘Reace identifies that she is struggling to remain present due to a shifting internal
state:
I think part of me lost you on that one. . . . I’m getting a little bit dizzy right now because
I’m clearly doing something internally. Um and it’s hard to stay anchored to a conscious
place (laboured tone) when this happens (breathless, laughing).
In the therapist participants’ narratives, this voice captures a sense of knowing,
experience, and assurance regarding their clients’ treatment and the therapy process in general.
Reflecting on her work with Hope, Penelope explains the significance of using metaphors based
on “aspects in nature.”
Interviewer: And when you mention that theme of picking metaphors that are related to
nature do you know why? Does that really resonate with her?
Penelope: Yeah . . . I think nature for her is calming. I know, when she’s really upset, we
go out to the field and just sit there and talk. So, I think that’s why we choose more
metaphors that are related to nature. It’s also for making it more normal. Using it to

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relate to nature – well the birds do this or that – to make it seem more natural, so that she
can accept it and then move on with her healing journey.
The following passage from Rob’s interview illustrates how he used psychoeducation to
normalize a dissociative experience that Hope was experiencing in therapy:
I remember that . . . when we were fairly early in trauma processing she was terrified
when she realized that she had internalized all of the members of her family in herself . . .
so that freaked her out because then she sort of thought to herself, “What if they’re in me
and they’re watching me and they’re still controlling me?” And I said, “Well no. What
you did as a child was just go in and take what you observed. And you were a good
observer of people and relationships and things. And in order to figure that out, right,
you just created internal representations so you could figure out what was going on and
anticipate what they would likely do or say.” So, it was sort of a way of coping with or
being able to analyze internally and predict behaviours because their behaviours were
quite erratic and inconsistent. So the fact that she had a part inside that said, “I wonder
what so and so would do here,” she could predict what they would do before they did and
then prepare for it. And I think she was sort of okay with that.
Julia’s application of attachment principles in her work with ‘Reace is exemplified in her
I/We poem:
I see her in a little girl place
I’ll relate to her more like that
I try
I sort of was more gentle and careful
I’m sort of dancing

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...
I think . . . how can I reach that part?
I did that . . . with her little girl
I felt like her little girl was afraid
I felt my nurturing self saying
Healing, wholeness. This voice contains references to working through trauma, making
progress in therapy, and coming to wholeness as a person. There is a natural link between this
voice and the voice of connection, relatedness. Specifically, the healing, wholeness category,
which reflects both the healing and integration processes, coincides with the connection,
relatedness category when participants describe working together in therapy to facilitate healing
(connection to people outside of the self) and when they talk about integration experiences
(internal connection among parts of the self).
The majority of participants in the present study used metaphorical language to describe
the experience of trauma processing. Penelope’s metaphor, for example, is a logical extension of
her description of trauma as an external injury:
So, like a bad injury . . . you clean it out and you can stitch it up and make it better, but
the scar will always be there. And then it will eventually fade, but it will always be kind
of present. So that’s kind of what I think of when I think of the healing part – we go back
in and clean it out and disinfect it. And then we use caution and care and grounding to
kind of bandage it up and make sure it’s comfy . . . but you got to clean it out or it just
leads to further issues.
Hope provides a parallel description of the healing process in her member check
interview. Reflecting on her early experiences in trauma therapy, she likens Rob to a “doctor,

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stitching layers of a deep wound, layer by layer.” As she began working with her new therapist,
she notes: “I still had a scar and it still hurt.” Part of therapy, therefore, involved “Nurse
Penelope” applying “cream” to the scar to soothe the pain. She explains how, over time, the
“scar fades and you can look at your own face without cringing or being disgusted. . . . It
becomes normal and you can take care of yourself.”
Reflecting on his work with Hope, Rob discusses how she developed a “brilliant”
metaphor to represent the process of working through traumatic material:
In one session, she said, “I get it. We – our adult parts – are going back to get the child
out of that place.” She realized she had an adult part that had the ability to rescue . . . this
nurturing part that had raised her two kids. And that part had the strength to go back and
help her own child part.
He describes how he now uses Hope’s metaphor in his work with other clients:
And I said, “Wow, can I use that with other clients?” And she was fine with that. And
I’ve used it ever since. I try to use it as an explanation because people have trouble
wrapping their heads around . . . why should we go back there? Why do we need to do
that? And then I say, “Because that part of you, who is still inside of you, still feels like
he or she is in that moment – in the most intense, overwhelming moment.”
For ‘Reace, the experience of trauma processing is best captured by the following
imagery:
‘Reace: I’ve felt like I’ve done this many times throughout my life. There’s this cave –
I’ve actually done it, but in my dream, more than once – and I have a guide. And it’s full
of lions. And I walk into the cave. And I walk past all these lions and none of them
swipes at me with their paws. They just notice me and I just walk right past them. And

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they notice me . . . and I know I just have to walk still and don’t jar or jerk or move fast
or anything. And I just walk past them.
...
Interviewer: So, it sounds like there’s a lot there and you have to be very careful that you
don’t stir up too much at once.
‘Reace: Very loaded . . . it’s pretty scary being in there.
Interviewer: Yeah. Does that image change after you’re finished processing the trauma?
‘Reace: Then I’m outside the cave again.
There seems to be similarities between Hope’s metaphor of going into the basement and
‘Reace’s image of walking through the cave. Both involve entering a dangerous location, along
with a supportive figure, to complete a task and then returning unharmed.
This voice is also apparent in participants’ stories when they describe healing experiences
and making progress in treatment. In ‘Reace’s narrative, for example, she speaks of the healing
influence of body therapy. This influence is exemplified in the following excerpt from her I/We
poem:
I began doing body work
I started to have recall
I still see him
I still go
I’ve worked
I discovered
I got in touch with

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In her member check interview, ‘Reace explains that, since our initial meeting, she has
been more intentional in her use of metaphor in body therapy. She provides a recent example of
how she used the image of a baby bird with broken wings to represent the pain she was
experiencing in her spine. In her mind, the wings needed to be “reconnected, mended, healed.”
Subsequently, as she participated in therapy, she imagined “joining between the wings.” This
imagery is reflective of ‘Reace’s metaphorical understanding of trauma as a “wound” and the
corresponding metaphor of healing: mending.
Additional descriptions of ‘Reace’s healing experiences can be found in previous voice
categories within this chapter.
In listening to Hope’s story, it is evident that she has experienced healing through both
OEI and expressive modalities. She notes that, compared to other therapies, OEI was so
“relieving.”
At the beginning of the therapy session there would be a concern. And by the end of the
session, with OEI, the concern was finished (exhales deeply). And it was if I could have
incentive to go back again, even though it was really hurting to go there sometimes . . .
and when the light started to come every time I went there (laughs in amazement), it was
like, even if it was the scariest memory, there was more excitement about getting that to .
. . be out in the light . . . and then find out I was joyous inside. . . . And the holes became
less scary. They don’t scare me anymore.
In the above quotation, Hope makes several allusions to the beehive metaphor. She
explains how using OEI to process her traumatic memories helped bring “light” into the “holes”
of the beehive. This explanation of healing is consistent with her metaphor of trauma as
“darkness.” The experience of working through the unprocessed memories in the honeycombs

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transformed the darkness into light. It also brought the “dark parts” – the parts holding on to the
trauma memories – “out in the light.” Along with this transformation came a shift in the feelings
associated with the beehive; the predominant feeling of fear was replaced by “light feelings” of
safety, hope, and joy.
Hope also describes experiencing healing through her use of expressive modalities. In
the following example, she mentions how the metaphor of art making allowed her to work
through a traumatic event:
My artwork has been a way to describe my metaphors, and lately I’ve had a metaphor of
a feather. And I drew this feather, and then the feather started to represent freedom from
a, a rape I had before I’d met my husband.
Expanding on this experience through a clinical lens, Penelope describes how Hope used
art to process her feelings about the rape:
It started out with just a normal feather. And then she ended up doing a lot of artwork
where it was like an imprint. So, she carved it on a piece of wood and it progressed as we
did therapy. As we got to the more sad parts, she would dip it in red and black and she’d
get these disturbing pictures of a feather. And then she did a series of four or six, and
near the end it was starting to get a lot clearer and a lot less intense . . . as it progressed, it
got a lot more healing oriented and hopeful. So before with all the blacks and reds in it, it
almost seemed heavy. And then, as she progressed, it got lighter like a real feather. . . .
So, there’ve been lots of incidences like that where she’ll go home and draw pictures.
And gradually they’ll show integration, using our metaphors.

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Metaphorical descriptions of integration experiences, often referred to as fusion, are also
captured in this category. For example, Hope discusses how participating in “group therapy,”
under the guidance of her therapist, facilitates integration:
And the therapist comes into the group with me and understands the parts. She helps me
see that it’s okay to have an ending of a part. I’m going to use today’s example, like the
ending of a part where the part doesn’t know that they are part of the whole . . . and the
therapist shows that part that they can carry on. . . . When we try to talk to each other,
there’s an awkward moment. And the therapist says how we could do that, gives a clue
how we can say, “There’s a whole.”
Penelope also speaks to this experience in her narrative, using the language of “uniting”
to describe the integration process:
The main thing we’re doing right now is just encouraging the parts to talk. They end up
uniting. Like we had one time where – it was like six months that we were doing a lot of
work – she walked in and she said, “It’s gone.” I think the part didn’t disappear, but just
evaporated into another part.
‘Reace’s account of the integration process evokes the image of embracing:
I talk out loud with that part of me. I grieve out loud with that part. Do some gestalt and
um come to an agreeable understanding. And then um make amends and bring that part
in (voice softens). And then I go home and be quiet with myself for a while. . . . To
accept that part, that life experience.
In her interview, Julia uses the term “joining” to explain this process:

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I think what she was saying was that this is integration. . . . She was referring to it as a
new part of her that was joining. She wasn’t just becoming that part or anything like that.
It was more like joining.
Participants’ metaphors of uniting, embracing, and joining are similar to the fusion
images used by Kluft (1982) in which all alternate identities are preserved by merging into one
personality.
In this section, I have described the findings that emerged from the four listenings of
participants’ descriptions of their use of metaphor in the treatment of DID. Overall, the
participants described using multiple metaphors, both collaboratively and individually, over the
course of treatment to promote understanding and healing. In their descriptions of therapy
process, the voices of clients and therapists seemed to be in harmony with one another,
demonstrating the therapists’ attunement to and respect for the clients’ subjective experiences.
Specifically, the therapists were open to hearing and engaging with clients’ own metaphors,
which opened possibilities for healing.
Additionally, in listening to the client participants’ stories, I perceived relationships
among the various voices of dissociation: division, disconnection; hiding/escaping, going away,
nonexistence; and not knowing, darkness, silence. I also detected relationships between the
voices of dissociation and those of trauma and healing. These relationships reveal natural links
between clients’ metaphors of trauma, dissociation, and healing. The clients’ core metaphors of
dissociation – Hope’s beehive metaphor and ‘Reace’s metaphor – illustrate the complex
relationships that exist among these three inner metaphorical constructs. These core metaphors
are examined in detail in the following section of this chapter.

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Listening for metaphor: key findings. In listening to their stories, it is evident that
participants used multiple metaphors to accomplish various therapeutic tasks over the course of
treatment. Although examples of practical metaphors were noted in participants’ spoken
experiences – such as Hope likening her therapist to a tree that was damaged by lightning to
express her fear that he was a “harmer” – many of the metaphors were reflective of core
metaphors. These metaphors spoke to participants’ subjective experiences and were used over
the course of therapy. Two core metaphors of dissociation that emerged from the narratives
were: Hope’s beehive metaphor and ‘Reace’s mansion metaphor. In this section, the origin,
evolution, and therapeutic function of each of these metaphors is summarized, from the
perspective of both client and therapist. Other metaphors pertinent to the mansion metaphor are
also discussed. Finally, the usefulness of metaphor in the treatment of DID is considered.
Beehive. Hope reveals that, as a young child, she physically hid inside a “cone-shaped”
beehive in her father’s store when “something bad happened.” Internalizing this experience, she
created a “bumblebee hive” – an inner place of safety to which she could escape. This revelation
suggests that Hope’s internal metaphor of dissociation originated from a physical experience. In
his interview, Rob shares his thoughts on the origin of the “honeycomb” metaphor:
Rob: I think the idea of the honeycomb was that there were holes sitting on the surface
but some of them were covered over. So, she had probably seen a honeycomb . . . seeing
that some of the little paper-thin things are sealed over and other ones are open. And
they’re all sort of connected, but some of them are open and able to be fully connected
and some of them are still fairy separate.
Interviewer: It really fit her internal experience.
Rob: It did.

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Before she began treatment, Hope experienced the beehive as a “dark” and “scary” place.
She describes how the “memories” were held within the honeycombs, and the parts had to “stay
in their various sections” of the hive. At that time, “each part didn’t know each other part, so
they all had their own walls.” For Hope, the beehive was “a safe place but also a frightening
place” because “holes were where we would escape to” without knowing “why that part had to
go in.” Once she entered therapy and learned about the “possibility of some kind of dissociation
because of the abuse and neglect,” the “light started to come into the honeycomb.” With greater
awareness and acceptance, the parts were able “come out and get some help.” As she engaged in
OEI “to relieve us of the sad memories and hard things” and “group therapy” to “unite our selves
and bring us to wholeness,” the image of the beehive began to shift. Hope now describes the
beehive as “a vast open space with all these people.” The image of the “honeycomb with just
circles and . . . no walls” is reflective of the progress she has made in her healing journey. The
complex and evolving nature of the beehive metaphor is represented pictorially in Appendix F.
Hope’s therapists provide corresponding descriptions of how the beehive metaphor
changed over the course of treatment. Rob, for example, explains how, “with the honeycomb,
the walls dissolve as you move toward recovery, so the parts start to communicate more, and
interact more, and cooperate more.” This explanation is echoed in Penelope’s narrative:
My client uses the honeycomb, so I kind of think of it as that. Where it’s just different
sections of someone’s personality that are . . . walled off from others . . . and it’s just
helping to integrate them. They start off with thicker walls and, once you start to do the
work, the walls kind of shrink and then they’re able to unite. . . . [Hope] has done various
art projects showing the walls, and then, as she progresses, the walls disintegrate and it’s
just like a little image.

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In her interview, Hope identifies how the beehive metaphor served multiple therapeutic
functions at different stages of treatment. She notes that the metaphor was initially introduced
“in the first year” of therapy, during trauma processing. At that stage, it was “used for safety and
for explaining how it all worked.” Listen as Hope describes the metaphor’s therapeutic utility
and how her therapist responded to it:
Hope: It was okay if they all had their own section, and we could describe it. There were
words you could use to describe a honeycomb, where you couldn’t maybe describe it if
you had to describe a feeling because everyone had a different feeling. Also, because it
was something we thought of like, I think, when we were really little, it felt as if it was
mine . . . as if it wasn’t something that somebody outside was making up. It was a real
thing within our self.
...
Interviewer: When you brought it up and described it to your therapist, how did he
respond and how did he help you use it?
Hope: He was very happy there was some kind of (exhales) way . . . and so that
encouraged us that we were on the right track. That the whole experience of having an
explanation to describe where they resided was better than saying they didn’t exist. . . .
The therapist didn’t deny any of the parts; he just said, “Welcome!”
Rob offers a similar account of this experience in his narrative:
I think we were quite a way into trauma processing. And she was recognizing which
parts were still separate, and which ones had joined. And which ones she was aware of,
and which ones she was sort of feeling on some level, but not really – they weren’t really

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defined. And so, I think it was a way to say, “Okay. We know there are these parts, and
some of them are more connected than others.”
Hope’s use of the beehive metaphor to conceptualize her internal system is also evident
in her artwork:
I put each one of my parts in a honeycomb and drew them. . . . And I have it on computer
flash where if you click on one of the honeycombs, the part comes up. And it shows the
picture of the drawn person first and then underneath describes when they came.
Rob provides a description of the beehive graphic, as well:
She created that graphic representation where you can roll the mouse over and then each
cell has a vision of what the alter looks like – if it’s a tiny child or an infant or a teenager
– and then some sort of connection to what the pet peeves, and needs, and perceptions,
and relationships are, for that part.
Both of Hope’s therapists discuss how the beehive metaphor has proven useful in
reviewing the ongoing process of integration. Penelope notes, for example: “Using the
honeycomb . . . we just look at the different parts and how some of them have integrated and
kind of melded together.” Rob describes this practice in greater depth in the following excerpt:
The idea of going internal and recognizing what state the different honeycombs . . . are
in. Which ones are connected? Which ones are still disconnected? Recognizing the
strengthening that occurs when two or three of them are all connected. How they can
now access creativity all of the time instead of just when you go into your child state or
where you can now access your adult self-calm, nurturing parent state when you need it
with your child.

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Another therapeutic function of the beehive metaphor is revealed in Hope’s narrative
when she talks about using it in “group therapy” to promote integration:
It’s like a meeting. It’s like meeting each other. We, we do introductions and we try to
say names, if there are names and. . . . It’s amazing because it’s like group therapy where
you get intimate really quickly (laughs). You don’t have to talk about, you know, “I like
your dress” or anything like that (laughs). Sometimes you do, if it’s a child. So today we
talked about this one part and we came to her . . . and we try to figure out. And she was
saying something, and I didn’t know (regretful tone). And now I know. And I was able
to say, “I’m sorry,” and she was able to say, “I’m sorry.” And we were both able to
connect. So the metaphor of the honeycomb with the walls down and just the circle is
really good for that. And we use that.
Mansion. ‘Reace explains how her metaphors, including the mansion, originate from her
creativity: “They come from internally . . . they’re from my feelings, my experiences.” Before
she started body therapy, she describes feeling “empty” on the inside: “There was nothing.” As
“feelings began to arrive,” she was able to access her imagination – “that deepest, brightest place
where I am” – and create healing from within. Interestingly, ‘Reace reveals that her metaphors
often arise from her dreams: “That’s how I see things and things come to me.”
At the beginning of treatment, ‘Reace explains how she was “hiding” in the mansion: “I
was completely, entirely amnesic and totally dissociative out here with the world . . . and I lived
deep, deep inside of me . . . and that’s where everything was.” She experienced the mansion as
very divided. She lived in one half of the mansion with her dog, Mandrake, the “protector” and
her “little friends” with whom she played. On that side, she “didn’t have any memories.” It was
“total dissociation.” In the other half of the mansion, “there were all these grownups and it was

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time to do grownup lessons.” She recalls feeling overwhelmed by the amount of information,
describing it as “headache city.” It was on that side of the mansion that “the memories would
start to seep through.” As she participated in body therapy, “the openings began,” and she
“started to remember” what and she had “done to survive.” Through this process of
“journeying” in her body, ‘Reace was able to emerge from an inner world of dissociation and
reconnect with the world around her: “I came outside of the mansion. . . . I’m out here . . . I’m
doing it out here now.” A visual summary of ‘Reace’s mansion metaphor is presented in
Appendix G.
In her narrative, ‘Reace describes how she used internal imagery, such as the mansion, to
facilitate her own healing. Initially, she developed the mansion metaphor to conceptualize her
subjective experience of dissociation. She then utilized the metaphor to foster feelings of safety
and connection internally. This resourcefulness is captured in the following quote: “I like going
up into the attic because there’s all the little children . . . I’d just go up and play and have
friends.” The image of ‘Reace coming “outside of the mansion” also served as a marker of
progress in her healing journey. Although she never “talked about the mansion out loud” with
any of her therapists, it is apparent that she was employing it therapeutically.
In her member check interview, ‘Reace revealed that she feels “sadness” when she thinks
about not making use of the mansion metaphor in therapy, describing it as a “missed
opportunity.” She reports that, since our initial meeting, she has been intentional about using it
in body therapy. For example, she describes how, in a recent session, she used the image of the
mansion to promote integration. Specifically, she imagined the mansion with its two halves, as
she “did a body split down the middle.” As she engaged in body work, she was “working to
integrate” the two halves.

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The dream in which “the two earths touched” is closely related to the mansion metaphor.
In the dream, a new world full of “opportunities” came and joined the world ‘Reace had “grown
on” since she was a child. For ‘Reace, the new world represented “different people, different life
experiences.” She explains how this dream coincided with her emergence from the mansion: “[It
was] about the same time . . . when I came outside of the mansion because I was hiding in the
mansion and just um entertaining myself. And now I come out and I actually say hello.” ‘Reace
describes how she has used the two worlds metaphor in therapy to explore ways in which she can
connect with the world around her, such as going for walks, speaking to people, and “including”
herself in activities. Through the dream, ‘Reace was able to consider that “there is more to this
world than meets the eye, a lot more.”
In her interview, Julia describes using the metaphor of a stage in her work with ‘Reace.
It seems to relate to her experience of coming “outside of the mansion” and connecting with the
“new world.” Specifically, this metaphor conveys a strong sense of being present and in control,
which mirrors ‘Reace’s own description of this transition: “I’m out here. I’m taking up space . . .
I’m doing it out here now. It’s not all happening in magic internally. It used to be all magical.”
Julia explains how the stage metaphor was used to both reflect and further promote an integrated
sense of self:
One [metaphor] we’ve used is a stage. That’s something she came up with, where she
felt like a curtain was dropping and a new person was coming out onto the stage. I think
it was a really positive experience for her. I remember . . . I was doing OEI and she was
standing on a balance board, and it was kind of conducive to being on a stage. I
remember it was really positive. She liked it. She felt like it was a new act in her life . . .

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and what I remember feeling was that this person was a lot more engaged, a lot more an
agent in her own life. Like she would say, “I’m here.”
Usefulness of metaphor. In listening to participants’ spoken experiences, it is evident
that multiple metaphors were used, both within and across the three phases of treatment, to
achieve various therapeutic goals. Examples of these goals include: expressing dissociative
processes; conceptualizing the client’s internal system; utilizing grounding and self-soothing
skills; normalizing experiences; facilitating internal communication and cooperation; working
through trauma; promoting integration; connecting with the world; and reviewing progress. This
list of therapeutic functions is illustrative of the ways in which metaphors may prove useful in
the treatment of DID. In addition to these specified functions, participants also provided
feedback on the ways in which metaphors have been generally helpful, or unhelpful, in therapy.
Participants’ feedback, both positive and negative, is shared below.
For ‘Reace, metaphors are “all gifts from heaven.” She describes how she experiences
the world through imagery and dreams. Consequently, metaphors are a natural source of healing
that originate from her creative powers. In a similar way, Hope explains how her artwork has
always “been a way to describe” her metaphors. Since entering therapy, however, her use of
metaphor has become increasingly meaningful because “now it’s creativity with knowing.”
Listen as she describes this change:
The creativity allowed me to express in tons of metaphors . . . where the therapist could
then bring it to, “See what you did with your art? How beautiful this is or how you
interacted with yourself in this way?” And that was like, “Oh, you mean . . . it’s me!”
It’s always been creativity, but now it’s creativity with knowing.

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In recognition of this creativity, Penelope states: “I find that a lot of DID people are so
creative that they’re like metaphor mountains.” In her experience, metaphors not only “bring
understanding and clarity” but also foster connection. She describes how using collaborative
metaphors in therapy can help strengthen the therapeutic relationship:
Work collaboratively with the client and try to figure out what they like in life . . . if they
like nature, then use nature metaphors. It sounds basic, but I think finding ways to relate
to them through the use of metaphors is so powerful because it increases the therapeutic
alliance.
In his narrative, Rob reveals how Hope’s metaphors gave both her and other clients the
“gift” of expression:
It was always a helpful thing. And it was so important that she came up with them . . .
and what was great was that she had such a real experience obviously from the inside
that, when I shared her metaphors with other people with DID, they immediately
resonated with them. It was like they just couldn’t find the words or the picture and then
it gave them a gift of, “Wow, I can put that into words now.”
Some participants also identified ways in which metaphors may prove unhelpful in
therapy. Penelope, for example, warns about the potential of metaphors to distract from the
“deep work.”
A few times we’ve used metaphors, we tend to go down the garden path and away from
the issue because we get wrapped up in the metaphor. She gets excited about the birds or
the hummingbirds and we end up talking about that for 10 or 15 minutes, but it’s a good
break in therapy.

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In listening to her words, it is evident that metaphors may also provide a necessary break during
“intense moments.”
In her interview, Hope talks about the experience of reflecting on metaphors from an
earlier stage of therapy and being reminded of “sadness” and “pain” from the past. This
experience highlights the need to modify metaphors and their meanings, as individuals continue
to heal and grow throughout treatment.
Hope: Even the art I have on my walls . . . I have two dragonflies on the wall and I’m
thinking I don’t need to stay in that place of the way the metaphor described me before . .
. like I have twins in me. That is a metaphor. And those twins are my sister and me.
And I had to separate myself from the twins. So, when I go back and look at the twins, I
love them, but I don’t need to live that life as an adult. . . . Now the twins don’t represent
a happy thing for me as much as freedom from being a twin, freedom from being the
shadow of another person all the time.
Interviewer: It sounds like, unless some of those metaphors were to stay fluid and change
along side of you, sometimes they can remind you of the sadness or the badness from the
past.
Hope: Yeah.

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Chapter 5: Discussion
The purpose of this study was to explore the therapeutic application of metaphor in the
treatment of DID from the perspective of both client and therapist. The Listening Guide method
was successful in illuminating the multiple ways in which participants used metaphor to facilitate
understanding and healing both within the context of psychotherapy and outside of it.
Specifically, the participants’ narratives revealed that multiple metaphors – implicit and explicit
– were used, both within and across different phases of treatment, to achieve the following
therapeutic goals: expressing dissociative processes; conceptualizing the client’s internal system;
utilizing grounding and self-soothing skills; normalizing experiences; facilitating internal
communication and cooperation; working through trauma; promoting integration; connecting
with the world; and reviewing progress. These findings support existing case evidence on the
therapeutic value of metaphor in the treatment of DID.
The primary goal of this research, however, was to extend what is known about the use of
metaphor with this clinical population by: (a) listening to clients’ first-person narratives; and (b)
exploring therapy process. By listening to the clients’ voices, together with the voices of their
therapists, it became evident that clients’ core metaphors served as shared frameworks for
promoting healing and integration. These metaphors represented the individuals’ subjective
experiences of DID, revealing their inner constructs of dissociation (Lackoff & Johnson, 1980).
In this study, two core metaphors emerged from the clients’ narratives: Hope’s beehive metaphor
and ‘Reace’s mansion metaphor. Tuning into their spoken experiences, I heard the participants
describing how these metaphors were used as the main organizers of the healing process across
all three phases of treatment. Importantly, the therapists were open to “hearing” and engaging
with the clients’ own metaphors of dissociation. In doing so, they accessed a “powerful tool for

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encouraging health and promoting healing and a sense of integrated identity” (Waters & Silberg,
1998a, p. 136).
In this chapter, the clinical and research implications of the above findings are discussed,
along with the strengths and limitations of the study.
Strengths and Limitations
As a transformative researcher, I designed this thesis around the goal of empowering
participants to give voice to their subjective experiences of trauma, dissociation, and healing.
The women who took part in this study bravely spoke out about the realities of childhood abuse
and neglect, maltreatment within the mental health field, and alienation from society. At the
same time, woven throughout their narratives were expressions of hope, resiliency, and triumph.
These expressions of experience were particularly evident when they described using metaphor
to facilitate self-understanding, healing, and a sense of integrated identity. Participants’
willingness to share their inner worlds – to reveal the heart of their experiences of dissociation
and healing – offers an unparalleled understanding of the lived experience of DID. As coresearchers of this study, it is our shared hope that these findings contribute to improvements in
the treatment of complex trauma and dissociation.
This thesis was also designed to be transformative in the lives of participants. Both
women reported that their involvement in the project was positive and meaningful. For Hope,
the experience of feeling heard and understood through the research was deeply moving, even
therapeutic. In addition, the language of “voices” resonated with her subjective experience of
dissociation, so much so that she applied the metaphor to her current understanding of the self.
The process of reflecting on and giving voice to their experiences of dissociation and healing
facilitated greater self-understanding and feelings of accomplishment among participants. For

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example, ‘Reace revealed how the initial interview “opened [her] eyes” to how much she uses
metaphor to promote healing from within. This awareness motivated her to be more intentional
about bringing her personal metaphors into therapy, deepening shared understanding and
opening possibilities for healing and growth. Moreover, in reflecting on her healing journey,
‘Reace was able to recognize and rejoice in the progress she has made. Finally, during their
member check interviews, participants described how the collaborative dialogue between client
and therapist fostered understanding and connection within the therapeutic relationship.
The present study also has several limitations, which need to be addressed. The first
limitation reflects a characteristic of the chosen research design. Specifically, the Listening
Guide methodology is designed to bring to life the experiences of specific individuals. For this
reason, the findings that emerge from the four listenings cannot be used to make generalizable
claims about populations. Knowing this, readers are cautioned against forming quantitative
interpretations of the findings. The themes that emerged from the data may not reflect the
experiences of all individuals with DID, especially those with dissimilar characteristics and
treatment histories to the two clients who participated in this study – i.e., women in their sixties
who had achieved some level of integration. At the same time, the present research does provide
rich case descriptions of the therapeutic application of metaphor in the treatment of DID, which
may transfer to many other individuals. It is my hope that these findings inform future research
on this topic, inspiring more voices to contribute to the discourse on metaphor and DID.
Additionally, in the this thesis, I attempted to capture the shared experience of how
metaphors were created and implemented over the course of therapy by interviewing both the
client and therapist individually, and then comparing their expressed experiences during data
analysis; however, a clearer picture of therapy process may have emerged from conducting a

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joint interview with each client-therapist dyad, following the individual interviews. Although the
member check interviews included a collaborative component during which both parties had an
opportunity to reflect on shared themes that emerged from their interviews, therapy process was
not discussed in detail. Another option for exploring how metaphors are developed and
implemented in therapy involves recording and analyzing session material. This method may
have proven useful in providing in-depth information on the interactive processes that occurred
during therapy. It also offers a potential solution to the challenge of conducting research with
this population. Namely, the video analysis of session material, which does not require
participants’ active involvement in the research process, could facilitate the exploration of shared
experiences in therapy.
Key Findings and Clinical Implications
Considering the clinical focus of the research, it is not surprising that participants’
descriptions of the therapeutic application of metaphor generated a number of potential clinical
implications. The key findings and implications that emerged from the present study are
described below, with a focus on how this research may inform current treatment guidelines for
DID (ISSTD, 2011).
Metaphors were prominent in the expressed experiences of client participants, and seem
to lie at the heart of how they understand themselves and experience the world. For Hope and
‘Reace, metaphors are a natural source of self-understanding and healing that originate from an
inner place of creativity. Their metaphors find expression, on both an implicit and explicit level,
through artwork, dreams, internal imagery, and spoken language. They made use of multiple
metaphors to represent their experiences of trauma, dissociation, and healing, and natural links
exist between them. The clients’ core metaphors of dissociation – Hope’s beehive metaphor and

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‘Reace’s metaphor – illustrate the complex relationships that exist among these three inner
metaphorical constructs. These metaphors, which were described in detail in Chapter 4, have
shown to be effective in treatment and may be implemented effectively in therapy with other
clients.
Together, the above findings suggest that metaphor is the natural language of trauma and
dissociation (Way, 2005). Consequently, it is important for therapists to tune into the
metaphorical language that clients use to describe their own experiences of dissociation. By
listening for and engaging with clients’ metaphors, therapists access a major resource for
promoting healing and integrated identity (Silberg, 1998, Waters & Silberg, 1998a). In
particular, the inner constructs held within clients’ metaphors of DID present opportunities for
pursuing connected metaphors of healing and growth in therapy.
As noted above, the clients in the present study expressed their personal metaphorical
constructs not only on an explicit level through spoken language but also on an implicit level
through dreams and creative arts. For example, ‘Reace discussed how she naturally views the
world through the lens of images, metaphors, and dreams. In her narrative, there were many
examples of metaphors that originated from her dreams, including: two worlds, flying birds, and
a cave of lions. Again, it behooves therapists to inquire about, and engage with, clients’ own
metaphors of dissociation and healing. ‘Reace’s experience suggests that dreams, in particular,
may warrant exploration in therapy. Similarly, artwork, and other forms of creative expression,
may reflect elements of an individual’s internal experience, offering another avenue through
which to explore dissociation metaphorically. In Hope’s story, she described how art facilitated
the expression of her subjective experience of DID long before she had any awareness of, or
words for, her dissociation. This finding parallels the ISSTD’s (2011) characterization of the

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creative arts as an “alternative format through which individuals may safely communicate
underlying thoughts and feelings . . . long before [they] can be vocalized” (p. 161).
Several interesting, and potentially valuable, observations regarding specific metaphors
were made during the analysis process. For example, metaphors may originate from physical
experiences. As a child, Hope physically hid in a “cone-shaped” beehive in her father’s store.
Internalizing this experience, she created an inner “bumblebee hive” to create safety within.
Similarly, ‘Reace’s metaphor of trauma – open wounds – is rooted in her physical experience of
abuse as a child. Such experiences warrant exploration in therapy, as they may reveal existing
personal metaphors of dissociation or trauma.
During their interviews, participants all provided metaphorical descriptions of ruptures
within the therapeutic relationship, as well as potential metaphorical avenues for repair. The
ISSTD (2011) draws attention to the difficulties that individuals with DID have in forming and
maintaining a therapeutic alliance. Considering these difficulties, treatment guidelines suggest
that it is “helpful for the therapist to anticipate and openly discuss traumatic transference issues,
particularly negative transferences” (p. 141). Metaphors may prove helpful in expressing and
working through negative reactions and experiences within the therapeutic relationship.
‘Reace’s account of the “two worlds” metaphor illustrates how challenging it can be to
navigate between an inner world of dissociation (mansion) and outer world of reality (new world
of opportunities). She talked about her struggle to “find somewhere to fit,” as she moves out of
dissociation and into reality. For clients, this shift in focus to how they “relate to others and the
outside world” is characteristic of the integration and rehabilitation phase of treatment (ISSTD,
2011, p. 144). ‘Reace’s experience teaches therapists to be mindful of this type of struggle.

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Clients may need help finding their way in both worlds, internal and external, and metaphor may
offer a way to navigate this experience.
Additionally, similarities between participants’ metaphors were noted. In terms of
dissociation metaphors, participants all shared images that were reflective of internal division:
beehive, mansion, and faceted crystal. With the exception of Hope, who used the language of
darkness, participants used the metaphor of a wound – either physical or spiritual – to represent
the experience of trauma. The process of working through trauma was captured in one of two
ways: mending wounds or entering a dangerous location, along with a supportive figure, to
complete a task and then returning unharmed (such as the basement where the abuse took place
or a cave full of lions). Several participants used the metaphorical language of joining,
embracing, and uniting to describe integration experiences. These examples are illustrative of
the types of metaphors that therapists can implement in therapy, in collaboration with their
clients. Finding metaphors that resonate with clients’ subjective experiences is key. Also,
natural links exist between some of the above metaphors, providing professionals with a possible
“roadmap” for pursuing healing. For example, the trauma processing metaphor of mending is a
logical extension of the description of trauma as a wound.
Descriptions of communication and cooperation metaphors involving meetings places,
such as a boardroom or castle, were also noted. Compared to these rather static images, Hope
and her therapists applied the concept of group therapy – a dynamic and enduring metaphor that
both reflects and promotes the ongoing process of internal connection. The ISSTD (2011)
recommends a consistent approach of helping individuals with DID “to respect the adaptive role
and validity of all identities, to find ways to take into account the wishes and needs of all
identities in making decisions and pursuing life activities, and to enhance internal support

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between identities” (p. 139). The metaphor of group therapy may be a useful framework for
implementing this approach.
In their descriptions of therapy process, the voices of clients and therapists seemed to be
in harmony with each other. Specifically, I heard numerous examples of collaboration within the
therapeutic relationship, as clients and therapists worked together, using metaphor, to achieve
various therapeutic goals. Despite the abundance of shared experiences, participants also spoke
of individual metaphors that were not explicitly discussed or implemented in therapy. These
metaphors, although observed in all of the interviews, were especially apparent in ‘Reace’s
narrative when she described using her own dreams and images to facilitate healing from within.
This finding highlights the importance of checking in with clients regarding their experiences in
therapy, with a specific focus on metaphor. Rob endorses this practice:
Rob: Try and ask the client about an image . . . asking for that image and then using that
image as you talk to them and work with them. Alluding to, how is that now? Where is
the boy under the ice now? Who’s in the cage? Is the cage open? That sort of thing.
Interviewer: So, adapting it to whatever you’re focusing on in therapy.
Rob: Yeah. And checking in at the beginning or the end of sessions or after three or four
sessions. How’s that going now with x (whatever x is)?
Interviewer: And if there have been shifts in that imagery that may reflect shifts within
the client.
Rob: Totally. If they get a new image, that’s great too.
Reviewing session material not only increases collaboration within the therapeutic
relationship but also helps facilitate recall of salient metaphors that were used. During her
interview, ‘Reace disclosed feeling uncertain about using certain metaphors in therapy: “I don’t

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know if we talked about it. If we did, I dissociated.” Given the inherent difficulties that
individuals with DID face when it comes to recalling experiences, it may be helpful to create a
concrete record of metaphors (e.g., diagram, picture, written description) that can be reviewed in
session. This suggestion is consistent with the ISSTD’s (2011) recommendation for using
“nonverbal process and products . . . as a visual or written record of the experiences of the
internal system of alternate identities . . . [that] may be examined at any point in treatment” (p.
161).
It was my intention that the qualitative narratives that emerged from this investigation
inform current treatment guidelines regarding the use of metaphor in the treatment of
dissociation (ISSTD, 2011). The guidelines recognize the creative arts as an “integral . . . part of
treatment for patients with DID” and delineate how such approaches can support a variety of
treatment goals, across all three phases of trauma treatment: 1) safety and stabilization; 2) trauma
processing; and 3) integration (p. 160). The findings of this thesis uphold this recommendation,
illustrating how implicit metaphors were used to accomplish a range of therapeutic tasks, both
within and across different phases of treatment. Hope’s feather metaphor is perhaps the best
example of how implicit metaphors, expressed through the creative arts, were deepened, shaped,
and expanded over the three phases of treatment to encourage internal resourcing, the working
through of traumatic experiences, and integration of the experience into the whole. The
following sequence of quotations highlights this process:
1. “She had seen a feather . . . so I drew a feather . . . we’d talk about the feather and
how resilient it was and able to float along.”
2. “She carved it on a piece of wood . . . and as we got to the more sad parts she would
dip it in the red and black . . . and get these disturbing pictures of a feather.”

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3. “As she progressed, it got a lot more healing oriented and hopeful . . . it got lighter,
like a real feather.”
Listening to participants’ narratives, it is evident that explicit metaphors were also used
extensively, throughout all phases of treatment, to promote healing and integrated identity.
Currently, the guidelines for treating DID do not present information on explicit metaphors. The
findings of this thesis suggest that the ISSTD consider expanding recommendations for using
implicit metaphors, in the context of the creative arts, to include explicit metaphors.
Another key finding that has the potential to inform treatment guidelines is the concept of
core metaphors. These metaphors represented the individuals’ subjective experiences of DID,
revealing their inner constructs of dissociation (Lackoff & Johnson, 1980). When therapists can
uncover the core metaphors of their clients, they gain access to a major resource for facilitating
healing and integration in therapy. In the present study, client’s inner metaphorical constructs
were used as the main organizers of the healing process across all three phases of treatment.
Promisingly, the ISSTD (2011) advises professionals to tune into the metaphorical language that
clients’ use to characterize their subjective experiences of DID. Specifically, the guidelines
state:
Clinicians should attend to the unique, personal language with which DID patients
characterize their alternate identities. Patients commonly refer to themselves as having
parts, parts inside, aspects, facets, ways of being, voices, multiples, selves, ages of me,
people, persons, individuals, spirits, demons, others, and so on. (p. 121)
This existing recommendation offers therapists an opening through which they can begin
to engage with their clients’ core metaphors of dissociation. These metaphors can then be used

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as organizational frameworks for a phase-oriented treatment approach, promoting a range of
therapeutic goals, both within and across each treatment phase.
In order to best represent their subjective experiences of trauma, dissociation, and healing
– three highly complex and interrelated inner constructs – the clients in the present study made
use of multiple metaphors of different varieties, including both implicit and explicit metaphors.
In light of their experiences, incorporating the use of metaphor into the treatment of DID requires
openness and flexibility on the part of therapists to assist clients in uncovering personal
metaphors that can be used to promote healing and a sense of integrated identity. Listening for
and working with clients’ own metaphors privileges their experiences, mobilizes agency, and
activates internal resources for healing and growth.
Implications for Future Research
The Listening Guide method is a “useful tool for discovery research; to uncover new
questions to pursue through focusing in on and learning from individual experiences” (Gilligan
et al., p. 169). In the present study, listening to the unique and complex voices of two women
with dissociation, along with the voices of their therapists, provided rich case descriptions of the
therapeutic application of metaphor in the treatment of DID. This research focused on the firstperson narratives of two women in their early sixties who had been receiving trauma-informed
therapy for at least 10 years. Future research is needed to both expand on and refine these
findings. For example, it is recommended that similar studies be conducted with other
participant groups, including: men with DID, younger individuals, clients in an earlier stage of
treatment, and clients engaging in other forms of treatment. Conducting research of this nature
would enhance our shared understanding and application of the results, giving voice to the lived
experiences of other individuals with the disorder.

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Additional studies can further explore how metaphors are developed and implemented in
psychotherapy by recording and analyzing session material. This method has the potential to
provide in-depth information on the collaborative processes that take place within the therapeutic
relationship. Similarly, further research is necessary to explore the recommendation that clients’
core metaphors of DID be used as organizational frameworks for treatment. Conducting a
longitudinal investigation would be helpful in determining how these metaphors are
implemented across all three phases of therapy.
In this investigation, the Listening Guide proved especially useful in capturing the
multiplicity of voices through which participants expressed their experiences of trauma,
dissociation, and healing. The relational nature of the method encouraged the open expression of
experience, while the psychoanalytic underpinnings provided a way to attend to the multiple
voices embedded in the experience. Moreover, participants expressed how the language of
“voices” resonated with their subjective experiences of dissociation. Given its voice-centred,
relational qualities, the Listening Guide is uniquely designed to explore the lived experiences of
individuals with DID. Accordingly, this method may be an effective tool for conducting future
research with this population. Considerations for future research, which emerged from the
present study, include: the use of dream imagery in the treatment of DID (with a focus on how
clients use these images to facilitate their own healing), the origins of clients’ dissociation
metaphors (exploring the idea that these metaphors may be rooted in physical or real-life
experiences), and the therapeutic application of metaphor with survivors of satanic ritual abuse.
Concluding Thoughts
Through the use of the Listening Guide – a feminist, relational method that recognizes
the layered nature of the psyche and the multiplicity of voices through which it is expressed – it

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was my intention to privilege the voices of participants in the discourse on metaphor and DID.
As we journeyed together as co-researchers of this thesis, I came to know – not just intellectually
but also experientially – that “DID people are so creative . . . they are like metaphor mountains.”
This metaphor, shared by Penelope during her interview, serves as a framework for my
experience as a researcher. The participants in this study invited me into their mountains,
revealing an inner world of creativity from which healing flows. It is my hope that all therapists
realize the internal resources for healing and growth that exist within individuals with DID.
With this knowledge, they can find ways of approaching these mountains with their clients and
mining the riches within.

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Appendix A: Agency Contact Letter: Project Overview
Dear agency coordinator,
This is to inform you of a joint research project that is being conducted by Chelsea Conron and
Katelyn Fister at Trinity Western University under the supervision of Janelle Kwee, Psy.D., and
Rick Bradshaw, Ph.D., to fulfill the thesis requirements of the MA in Counselling Psychology
program. We are interested in further understanding the role of metaphor within the subjective
experience and treatment of dissociative identity disorder (DID).
We are aware of the value of metaphor within the therapeutic context, and are interested in
further understanding how metaphor is at work with DID clients. We believe that further
unfolding the role of metaphor as a tool of communication in a research context may be very
valuable in enriching the therapeutic work that can be done with these clients, and in broadening
our understanding of this disorder.
Chelsea Conron and Katelyn Fister are each facilitating a different aspect of this research project.
Chelsea Conron is interested in exploring the use of metaphor within the subjective experience of
DID, while Katelyn Fister is focusing on the use of metaphor within the therapeutic dyad. We
invite therapists in your agency to consider being a part of this project by allowing us to place
recruitment material where eligible clients will see it, and acting as a support to those who are
interested through the research process. We also invite therapists to become involved in data
collection through participating in a qualitative interview. Enclosed you will find more detailed
information on each part of the project. We hope your agency will become as excited as we are
about the bigger picture and participate in both aspects of this project; however, we understand
that this may not be possible, in which case we ask that you consider being involved in one or the
other part. If you are unable to participate, but are aware of another organization or counsellor
who may be interested, we encourage you to pass this on to them, and we leave you with our
highest regard and best wishes for your consideration.
If your agency would like to be involved, the first step is to determine if you have clients who are
good candidates for the research. The participants of this study should be individuals who have
had a confirmed diagnosis of DID, and who are currently receiving some form of regular
psychotherapy. If the therapist has already administered a formal assessment to confirm a
client’s diagnosis, we ask that this be provided; otherwise we will conduct the Structured
Clinical Interview for Dissociative Disorders (SCID-D) with the client prior to involvement in
the study. We will also provide a treatment history form and checklist derived from the DSMIV-TR criteria, from which we can further determine eligibility for the study. The ideal
participant must have at least one alter who is co-conscious and able to be self-reflective. We
ask that participants have progressed beyond the initial stabilization phase, where immediate
crisis and denial are often a major focus of therapy, and are working towards communication and
cooperation within themselves. We do not wish to exclude those with suicidal or self-injurious
alters as long as the client is not at acute risk for such behaviours during sessions based on your
clinical judgment. For the best interest of the client we ask that the therapist be available to
continue regular treatment and support during the research.

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Enclosed you will find more detailed information on each component of the project. In order to
avoid power dynamics between therapist and client during the recruitment phase, we intend to
allow clients to be self-elected based on a poster that will be placed in a visible location in your
office. The client will be directed to contact the research team if they are interested in being
involved. After this point, they will be given a reciprocal release of information form for the
therapist to sign in order to enable the researcher to contact the therapist with further details on
determining eligibility and involvement.
If you would like to know more about this project, or wish to be involved in some way, read on,
and please contact us via phone or email at your earliest convenience. We will also be following
up with you by phone or email to further discuss your willingness for involvement.
Yours sincerely,

The Metaphor & Dissociation Research Team

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Appendix B: Therapist Information Form (Dyadic Understanding)

The following is a brief explanation of Katelyn Fister and Rick Bradshaw’s component of this
project regarding the use of metaphor in the treatment of dissociative identity disorder (DID). It
is my hope that this research will bring to life the subjective and shared experiences of
individuals with the disorder and the professionals who treat it. This knowledge has the potential
to enhance the quality of care of individuals with DID, improving therapy process and outcome.
Access to the full literature review and project proposal may be obtained upon request.
I am interested in conducting up to eight qualitative interviews with participants. In order to
capture the experiences of individuals with DID and the professionals who treat it, each member
of the client-therapist dyads will be individually interviewed, using a semi-structured format.
The interviews will focus on the use of metaphor in therapy. The main purpose of the interviews
is to gain in-depth case descriptions of participants’ subjective experiences and the therapy
process. The interviews will last approximately one hour for each individual. All interviews
will be recorded using audiotape. Following data analysis, individuals will also be invited to
take part in member checks.
All written and recorded data collected during the study, including consent forms, assessments,
and interviews, will be kept confidential and secure. Codes will be used to anonymize
participant data, eliminating identifiers on the assessment forms. In addition, interview
transcripts will be edited for any identifying information, such as names and locations. Further
details about this process can be found on the informed consent forms.
Therapist’s participation in this aspect of the larger project involves being available to discuss
the possibility of participating for clients who express interest. Therapists must complete the
treatment history form, which will be sent to them after reciprocal release of information form
has been signed by the participant, therapist, and researcher. In order to verify the participant’s
diagnosis, we will administer the Structured Clinical Interview for DSM-IV Dissociative
Disorders Revised (SCID-D). If therapists are interested in administering the SCID-D
themselves, we are more than happy to have them involved in this way. However, this
assessment will be completed by a member of the research team if therapists do not wish to do
so. As previously mentioned, availability to continue treatment as usual after the interview is
required.
In order not to exert undue influence on potential participants, we ask that therapists not speak to
clients about this opportunity until they independently express interest. We also believe it is in
the best interest of the client and the quality of the research to conduct the interview in the same
place where they usually receive treatment. This allows the client to feel more comfortable
without having to adjust to a new setting. It will act as a contextual cue for the alters that usually
participate in therapy. It also minimizes the introduction of new stimuli that may be threatening
or triggering. Timing is also important, and ideally we would like to conduct the interview
shortly prior to the client’s regular session. This helps to ensure that the therapist is available in
case of an unforeseen emergency.

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We do not foresee any major risks of participating in this study, as we do not intend to have
clients focus and elaborate on particular traumatic incidents, but rather salient metaphors used in
therapy. It is our hope that reflecting on such metaphors will enrich therapy with the client. For
further information on risks and benefits please refer to the informed consent form.
Sincerely,
Katelyn Fister

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Appendix C: Client Information Form (Dyadic Understanding)

Dear potential participant,
My name is Katelyn Fister and I am in the MA of Counselling Psychology program at Trinity
Western University. I would like to invite you to participate in a thesis research project. My
colleague Chelsea Conron and I are researching metaphor and dissociative identity disorder
under the supervision of Rick Bradshaw, Ph.D and Janelle Kwee, Psy.D. There are two parts to
this research and you have the option of participating in both parts, one part, or neither. For
further information on Chelsea’s research, please refer to Participant Information Form A.
I am interested in understanding how metaphor is used in the treatment of dissociative identity
disorder (DID). It is my hope that this research will provide valuable information to
professionals and other researchers on how to best help individuals with DID. By taking part in
this study, you have the opportunity to contribute to improvements in the treatment of
dissociation. Involvement in this research may also increase self-awareness and enrich your
work with your therapist.
Participation involves the completion of a diagnostic assessment, the Structured Clinical
Interview for Dissociative Disorders (SCID-D), which may take up to three hours, and a
minimum of one face-to-face interview (up to one hour) which will take place where you usually
meet with your therapist. The interview will begin with general introductions. Then I will ask
you different questions about how you and your therapist use metaphors, images, and other
symbols in therapy. I will also be meeting with your therapist in a separate interview to get his
or her impressions about the use of metaphor in your therapy. This interview will include similar
questions to the ones that I ask you.
After the interview your level of involvement in the research is up to you. There is the option of
reviewing the accuracy of the conclusions that I draw from our time together. You may also
wish to be involved in reviewing the thesis document before it is finalized. Be assured that all
information regarding your identity and details about you will be anonymized so that you are
unidentifiable in the final document. All other written and recorded information that contain
your identity will be kept confidential and secure. Further details about this process will be
discussed if you decide to proceed.
I ask that you take the time to consider this opportunity in order to allow each part to decide if
this is something you want to participate in. If parts of you feel uncertain, I encourage you to
discuss these feelings with your therapist. I also welcome the opportunity to personally answer
any questions you may have at any point. Please know that there is no obligation to participate
and you would be free to withdraw from the research at any time without consequence.
If you would like to know more about this project or wish to be involved, please inform your
therapist and contact me via phone or email and we can arrange a phone or in-person
consultation.

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Sincerely,
Katelyn Fister

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Appendix D: Diagnosis Confirmation Form

This form is to be completed by the therapist before commencement of the research interview.
Client Name: _____________________ Identifier (Research use only): _________________
Therapist Name: ______________________ Organization (if
applicable):___________________
Date of first appointment with client: ______________Length of treatment period:
___years___months
Number of sessions to date: _______
Please give a brief summary of your treatment history with this client (e.g. techniques &
approaches used, client’s progress, current treatment goals)
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
________________________
Were you the clinician who made the initial diagnosis of dissociative identity disorder (DID)?
___ Yes. Please specify (approximately) when you decided on this diagnosis:
____________________________________
___ No. Please indicate, to the best of your knowledge, how long the client has had the
diagnosis: ____________________________________
If you have completed any diagnostic assessment(s) please indicate which
one(s):________________________________________________________________________
_____
Is the client’s core personality aware of his/her diagnosis? ____Yes ____No
Of the personalities you are aware of, approximately what percentage of them is aware of the
diagnosis? __________
Please briefly explain how you discuss the diagnosis with personalities that are not aware/ how
you attempt to facilitate coconsciousness:
____________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
____________

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Please provide the (estimated) number of alters within the client’s system, at the present time:
_______
Of these, please provide a description of the personalities with whom you have regular contact
(e.g. name, age,
function):_________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
____________
______________________________________________________________________________
______________________________________________________________________________
________
The following is based on the diagnostic criteria for DID as outlined in the Diagnostic and
Statistical Manual of Mental Disorders: Fourth Edition Revised (DSM-IV-TR). By checking the
spaces provided you are verifying that you have observed the following at some point during
treatment. Feel free to provide clinical examples in the spaces provided:
____ The presence of two or more distinct identities or personality states, each with its own
relatively enduring pattern of perceiving, relating to, and thinking about the environment and the
self.

____ At least two of these identities or personality states recurrently taking control of the
person’s behaviour.

____ The inability to recall important personal information that is too extensive to be explained
by ordinary forgetfulness.

____ By checking here you verify that the disturbance is not due to the direct physiological
effects of a substance or general medical condition.
Please provide any additional information that you feel is important to the research:
_______________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
____________
Your signature below indicates that:

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The above information is accurate to the best of your clinical judgment.
Based on your knowledge of the current research project, this client is capable of participating
and is not at critical risk of suicide or self-harming behaviour as a result of reflecting upon their
internal system.
You will be available to support your client with treatment as usual throughout the data
collection period of this research.
_____________________________
Therapist Signature

________________________
Date

Thank you very much for taking the time to complete this form. If you have any questions or
concerns please do not hesitate to contact us.

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Appendix E: Hope’s Plot Listening
As I reviewed Hope’s transcript, I felt like I was transported back to the interview. I
could picture her kind face, which often took on a puzzled quality as she searched for words to
express her feelings and experiences. Although there were many pauses, repeated words, and
incomplete thoughts in her interview, I could sense that she was determined to be heard, to tell
her story, to make a difference. I deeply admired her commitment, and felt a spirit of
encouragement rise up inside of me – one that I tried to convey to her throughout our time
together. Admittedly, I sometimes struggled to follow her story and felt overwhelmed by the
volume of information and disjointed speech. I remember reminding myself to stay attentive and
to listen for the meaning behind the words. I bet my face also took on a puzzled quality at times,
as I furrowed my brow in concentration! There was a lot of empathy in my heart for her during
those moments. I mean, if I was feeling overwhelmed listening to her words, how much more
overwhelmed did she feel in her actual experience? Looking back now, I realize that within her
interview, there is a surprisingly coherent and insightful narrative of her subjective experience of
dissociation and the therapy process. This realization underscores the importance of listening to
the voices of individuals with DID – learning from their lived experiences – when it comes to
using metaphor in the treatment of dissociation.
I also remember feeling incredibly honoured as she shared some of her most vulnerable
and heart-felt experiences with me. Her story was so honest and real that I felt like I was living
it with her. I could feel myself standing there, in the shadows of her father’s store, watching as
that little girl slipped silently into the safety of the beehive, my heart pounding loudly in my
chest. She not only shared memories and feelings with me but also the parts that held onto them.
I remember feeling my heart ache for the little ones stuck in the badness of past memories; there

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was so much fear inside of them. Yet, there were also many playful moments when the joy and
silliness of the child parts shone through. Those moments still bring a smile to my face. And
that, above all else, is what I took away from the interview – her joyful spirit. Despite all the
trauma and challenges she has faced in her lifetime, she strives to live a full, rich life – one that
focuses on simple pleasures and dear people. She found a way to internalize the unconditional
love, acceptance, and compassion that she received from her therapists and is in the process of
learning to cherish and care for herself. Her joyful, optimistic outlook on life is truly
inspirational. I can’t wait to share her story with others through this project.
When I read Hope’s narrative, I feel like I am on a journey of self-discovery and healing.
It reveals the creative mind of a woman who learned to escape from the pain of a traumatic
childhood by creating an inner hiding place where she could keep herself safe (i.e., bumblebee
hive). There seemed to be some level of awareness, at least on an unconscious level, that she
might have this “certain thing” called dissociation. This is captured in the artwork she created,
long before she entered therapy (e.g., painting herself into walls); however, you can feel her
struggle to come to terms with the fact that she started to dissociate in order to cope with a
traumatic past. Feelings of self-loathing leap off the page, as she repeatedly blames herself for
her disorder and even refers to herself as a “leper” at one point. The road to self-acceptance has
been a long one, paved with the constant support and care of her therapists who have shown her
what real love is. In fact, there is a theme of being ignored and unloved by society due to her
traumatic past and method of coping (in addition to never feeling loved or accepted by her family
of origin or husband). Over the course of therapy, she begins to internalize the therapist’s
strength, concern, and empathy and direct it towards herself, which helps her relate to the other
parts within her internal system. At this point in her journey, there is an incredible sense of hope

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for a “full life” – wanting to be an adult/mother/grandmother and enjoy the simple pleasures of
her current age, while also continuing to be sensitive to the needs and desires of the younger
parts inside. She seems committed to continuing her “group therapy,” as the parts develop
greater communication and cooperation skills. By the end of her interview, I see a transformed
woman. She is now able to celebrate her creative gifts (artwork, poetry, metaphors) and use
them as a vehicle to express her subjective experience of healing and growth.
At various points throughout Hope’s interview, she notes that there is a trade-off when it
comes to dissociation: achieving a sense of safety through dissociation (e.g., hiding in the
beehive or escaping into holes) resulted in feelings of disconnection, loss, and powerlessness.
Thus, although it protected her from experiencing overwhelming stress and pain, it also robbed
her of personal awareness, agency, and connectedness. The contradiction of dissociation being
both protective and frightening is present in her personal narrative. When asked when she first
developed and used the beehive metaphor, Hope discusses actively hiding from her father to
avoid harm (“something bad happened so I went inside”) and notes the helpful aspects of
dissociation (“if they want you to clean your room, you’ll clean your room...that will be the other
part...the other bee part”). In fact, as a child, she experienced dissociation as a “positive thing”
and never worried about “having to not be one person.” In contrast, as an adult, she describes
herself as “despicable” and abnormal for creating parts and coping through dissociation. I
wonder if this change reflects the progression of her dissociation from a protective response to
overwhelming trauma to a maladaptive process that began to interfere with life functioning.
Notably absent from her interview is any direct reference to DID. In fact, she barely even
uses the term dissociation to describe her experience, referring to it instead as “this certain thing”
and “creating parts.” I cannot help but think that this choice in vocabulary reflects the deep

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shame and guilt she carries for creating “holes that would take us to safety...when all around us
we saw other people living other ways of living.” At other points in the interview she talks about
not wanting to accept that something was wrong with her, which she refers to as denial. Not
surprisingly, Hope does not offer much information about the various traumas she suffered. She
makes reference to them using ambiguous phrases, such as “something bad happened,” “the
psychologist who hurt me,” and “I knew something wasn’t right in our family.” Choosing to
discuss her traumas using indirect terms may have prevented the memories and feelings from
overwhelming her during the interview, allowing her to reflect on the material without having to
relive the experiences.

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Appendix F: Pictorial Representations of Hope’s Beehive Metaphor

Figure 1. Hope’s beehive metaphor, pre-treatment. Natural links exist between her metaphors
of trauma and dissociation.

Figure 2. Healing influences of treatment reflected in Hope’s core metaphor of dissociation.
Healing metaphors are logical extensions of dissociation metaphors.

METAPHOR AND DISSOCIATIVE IDENTITY DISORDER
Appendix G: Pictorial Representations of ‘Reace’s Mansion Metaphor

Figure 1. ‘Reace’s mansion metaphor, pre-treatment. Natural links exist between her
metaphors of trauma and dissociation.

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Figure 2. Healing influences of treatment reflected in ‘Reace’s core metaphor of dissociation.
Healing metaphors are logical extensions of dissociation metaphors.