cont. from

4. No matter who was out or internally influenced the child at the time of the inappropriate behavior (alter, fragmented personality, ego state), the child still has to be held responsible for his or her behavior.

   It is my general position that the dissociative child needs to be accountable for his or her behavior. Understandably, this will present conflicts of responsibility and ownership of behavior in the initial phase of therapy in which the identification of the dissociative system is unknown and amnestic barriers are still present. Therapist and parents can use judgment and flexibility in determining the degree of the child's accountability for inappropriate behavior by weighing many factors.

   One critical factor to weigh in determining consequences is this question: "Is this behavior linked to a traumatic incident which the child is remembering and therefore acting out?" For example a child's inappropriate sexual behavior with a peer or a much younger child may be rooted in his or her own unresolved trauma. It is important that the therapist explores with the child the underlying dynamics and the motives of the behavior. The therapist assists the child to deal with the traumatic memory of sexual abuse and stresses to the child the serious legal and social consequences of sexually inappropriate behavior. The therapist, then, helps the parent understand the motives of the child's behavior.

   Nevertheless, the parent would need to set up necessary environmental precautions to prevent or greatly reduce the opportunity for the child to sexually engage with or abuse another child, such as playing only in supervised areas, prohibiting sleepovers, or allowing only structured activities with peers outside of the home. These restrictions give the child the message that the sexually inappropriate behavior is unacceptable, and the child will have to learn ways to control future sexual impulses in order to be allowed more freedom with peers.

5. When the child denies a witnessed, problematic behavior, the parent gives the firm message that the child needs to sort out with the alters what occurred as the parent provides an understanding atmosphere.

   Even though dissociative children are encouraged by parents and therapist to engage in coconsciousness and cooperation, the child may not always have an awareness of a destructive behavior exhibited by an alter. Restrictions should be accompanied by the strong message that the patient needs to do an internal check to find out what role an alter may have played in the behavior. This encourages inner communication, the eroding of amnestic barriers, and cooperation. The child's task is to learn to work together with the alters to control any impulses.

   When a parent is faced with a child's denial of a witnessed behavior, the parent should calmly instruct the child to go to his or her room and explore internally what may have occurred, and later they will discuss the behavior and consequences. One astute adoptive mother of an 8-year-old DID girl told her when conflicts occurred between her and her alters, "It's not up to me to fix it. You have go inside and fix it!" The adoptive mother understood her limits and encouraged her daughter to fix her conflict with her alters, and to arrive at an agreed solution. This approach worked well to minimize jealousy, competition, and resentment among the child's alters, and to encourage communication, cooperation, and conflict resolution with them.

   Another factor in evaluating the child's denial and accountability for his or her actions is to consider if the child is manipulating to avoid responsibility for behavior by blaming an alter for the actions. The author knew one 10-year-old DID girl who would frequently try to fool the author and the child's parents by pretending to be her male alter in order to blame him for her misbehavior. When she learned that it did not matter if it was her or her male alter, but that there were clear consequences for the misbehavior, her attempts to deceive her parents and the author decreased. In addition, her male alter was instructed to come out and take control, if needed, to prevent the child from getting into trouble and being grounded. The child and her alters had to work out together a way to deal with projection of blame, internal conflicts, and accountability for the misbehavior.

6. The therapist, child, and parent confer and identify internal helpers who are requested to assume control if the child or an alter attempts to engage in destructive or abusive behavior.

   The author has instructed alters to be "watchers" and to take over, if needed, to prevent the child from engaging in destructive or aggressive behavior. Parents need to be aware who the "watchers" are and encourage them to take executive control or warn the parent if the child is going to engage in destructive or abusive behavior.

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Written: 01/2003. Reviewed 05/2006