Carolyn Spring Publishing
Reviewer Ben Scanlan
In Out of the Depths, Jo Ringrose attempts to tell the journey of a single client with multiple personality disorder (dissociative identity disorder (DID)) from the perspective of the therapist, in a fictional story based on her experiences of working in both private practice and a forensic setting.
The book gives a brief case history of Mary, a thirty year-old woman who self harms, took an overdose twelve years earlier, and has previously had inpatient treatment for an eating disorder as well as other brief experiences of psychotherapy. Over the eighteen chapters, each one based solely on a therapy session, we are introduced to Mary, and her different aspects, as she struggles to understand what’s happening to her and why she’s struggling with life. We learn that she suffers blackouts, and it becomes apparent that two aspects of her – of different ages – harbour memories of difficult experiences of which Mary has no conscious knowledge.
The style adopted is dualistic in nature as there are two aspects covered within each session: primarily there are the interventions of both Mary and Jo, along with the ‘immediate’ thoughts Jo has surrounding her concerns, potential avenues of exploration, or presenting a reason for her choices. There is additional information given, generally theoretical and in relation to basic psychotherapeutic thinking, but also expanding on the theory in relation to DID.
Other aspects and techniques used within the book include using journals to let the different aspects of a client speak. This is only introduced at chapter eight, to demonstrate how a client can allow the other aspects of themselves to speak and be heard between sessions. This kind of insight may not be hugely revolutionary, but the timing and use of questioning is thought provoking. I liked the format, as there are very few books out there which give an insight into such practical techniques in a ‘fluid’ sort of way.
Possibly the biggest learning is the lack of space and the silence within the relationship. Whilst this may be a stylistic point – after all, reams of white paper don’t tend to sell – it feels more like an instructional point, relating to the ability of clients with DID to understand and tolerate emotions within silence. And this flies in the face of a lot of theoretical concepts as I understand them, as the way Ringrose presents it can be quite instructional. As a therapist she advocates, and is directional to confirm, affirm, and reassure the different aspects of Mary, and to allow an emotional maturation from an emotionally much younger client, which she anchors in her ‘theoretical’ notes alongside the narrative from the sessions.
This book isn’t overtly arguing for anything, nor does it deliberately set out to provide answers or techniques in an educational manner. This adds to the readability of the book; it wasn’t draining to read, nor difficult to access. The readability also allows an emotional side to come out, very indicative of the relationship between Mary and Jo, as well as softening – without losing – the realism of handling traumatic childhood sexual abuse.
One strand within the book that I struggled with was the idea that it would be possible, almost easy, to work with and re-integrate two other aspects of the self inside eighteen sessions. This requires a suspension of disbelief that is quite large, and potentially sets up both therapists and clients for expecting huge, dramatic changes on a constantly upward trajectory. There is a clear reason for this, a more ‘accurate’ depiction of several years worth of sessions would be awkward and lack any depth, so the decision is warranted, but my concern is that it could be misunderstood as suggesting an ease of ‘treatment’ that is unrepresentative of DID.
On a wider point, this book is a stand-alone part of the literature offered by the Positive Outcomes for Dissociative Survivors (PODS). It’s clear that there is a significant population within the UK who have different aspects of themselves, and that these clients may not be best served by ‘conventional’ psychotherapy practices that tend to provide the foundation of therapy, irrespective of the theoretical stance adopted. This book is extremely useful both in highlighting what can happen within sessions, as well as providing a practical view on how the therapist may be challenged with a client who has previously un-diagnosed DID. I would encourage any therapist to consider reading this, but advocate strongly for anybody working, or thinking of working, with people who may have dissociative identity disorder to make this part of their library.
Ben Scanlan is an Existential Psychotherapist and Coach in private practice. He has worked in the NHS, in sport and the charity sector and has an interest in working with men and suicidal clients.