INTERNAL
SELF HELPERS OF
PERSONS WITH
MULTIPLE
PERSONALITY
DISORDER
M, Ann Adams, R .N.P., M .N .Sc.
M. Ann Adams, R .N.P., M.N.Sc., is a Nurse Practitioner at the
Adolescent Treatment Center of St . John 's Medical Center
in Springfield, Missouri and a Counselor at The Shealy
Institute, also located in Springfield, Missouri.
This research was done through The University of Arkansas
for the Medical Sciences in Little Rock, Arkansas.
For reprints write : M. Ann Adams, R . N ., M.N .Sc., #15 Hale
Street, Eureka Springs, Arkansas 72632.
ABSTRACT
In the past, Internal Self Helpers (ISHs) of persons with multiple
personality disorder (MPD) have been described by a small number
of therapists . This study broadens the base of information relating to
ISHs . Forty respondents who collectively had been therapists for a
total of 690 MPD patients participated in the study . The findings
of this study suggest that a) ISH occurrence within MPD clients is
not uncommon ; h) ISHs can be valuable assets in the therapeutic
process; c) therapists differ in their explanations of and beliefs about
ISHs, as well as the manner in which they relate to and utilize ISHs;
d) ISHs are reported to be mostly knowledgeable, reliable, and
helpful ; e) ISHs demonstrate a wide variety of abilities ; and]) while
there is no one explanation regarding the etiology and nature of
ISHs, therapists most commonly tend to describe ISHs as possessing
unifying centering, and protective functions within MPD persons.
INTRODUCTION
Several categories of conscious psychological structures
or organizations have been observed clinically in persons
with multiple personality disorder (MPD) . The name Inter-
nal Self Helper (ISH) was developed by Ralph Allison (1974,
1977, 1980) to describe entities, which, according to his
observations, functioned primarily as helpers in MPD sys-
tems . While such entities were described in earlier writings,
Allison was the first to categorize this phenomenon . Later,
several authors briefly examined the concept of ISHs and
theorized about the etiology and role of such entities
(Watkins, quoted in Beahrs, 1982 ; Kluft, 1985 ; Curtis &
Fraser, 1984 ; Fraser, 1985 ; & Comstock, 1985) offered fur-
ther descriptions/observations of their clinical experiences
with Internal Self Helpers.
Not unlike many arenas in the study of the mind, the ISH
concept is abstract and rather illusive . On the other hand,
while ISHs of individual persons with MPD are in no way
138
identical to one another, they have been described clinically
by therapists as having similar characteristics . Unlike the
host or alter personalities who have been described as having
limited subjective knowledge of the complete life and one
another, ISHs were identified as highly knowledgeable of
both the life events and the dynamics of the system of
personalities within the individual suffering MPD . ISHs were
described as knowledgeable in an objective rather than
emotionally identified manner . Furthermore, ISHs func-
tioned within MPD systems in a predominantly helpful
manner, at times exhibiting insight and abilities which were
useful in the therapeutic process.
While a theoretical understanding of the ISH concept is
not thoroughly developed at this time, there are analogous
although quite different observations to which the ISH
concept bears some resemblance in the history of modern
psychiatry . Freud (1938) contributed the concept of the
unconscious mind as potentially holding the entirety of
memories of the life experience . Jung (1959) elaborated on
this even more in proposing the existence of the collective
unconscious within the unconscious psychic energies . Jung
(1965) explored within his own mind the possibilities of a
consciousness within the unconscious mind . He stated that
he was able to identify and personify an aspect of his mind
which communicated the images of the unconscious to the
conscious mind . He also pointed out the benefits of bringing
the contents of this entity into consciousness.
Similarly, and perhaps even more specifically, Roberto
Assagioli (1984), in developing the theoretical base for
Psychosynthesis, a type of therapy closely related to Existen-
tial therapy, proposed "the existence of a spiritual self and of
a superconsciousness which are as basic as the instinctive
energies described by Freud" (p . 193) . He distinguished
between the "Self' and the "personal self ' or ego which is the
result of life experiences and development . The "Self ' is
central, on-going, and "unaffected by the flow of the mind-
stream or by bodily conditions : and the personal conscious
self should be considered merely as its projection in the field
of the personality" (p . 19) . This image is that, perhaps, of an
initial nucleus of Self, which, given life experiences, devel-
ops an ego or personal self . The therapeutic focus of Psy-
chosynthesis is ultimately to facilitate a re-identification and
uniting of the personal self with the contents of "Higher, "
more knowledgeable Self.
DISSOCIATION, Vol . 11, No. 3: September 1989
PURPOSE AND OBJECTIVES
The purpose of this study was to answer the question:
How do therapists describe their experiences with Internal
Self Helpers of persons with Multiple Personality Disorder?
The objectives of the study were as follows:
1. Determine the extent to which therapists encounter
Internal Self Helpers when working with MPD clients.
2. Elicit beliefs of therapists relative to the [SI-i phe-
nomenon.
3. Investigate the nature of the therapeutic relationship
between therapists and ISHs.
4. Elicit experiential and informative data from thera-
pists which can assist in clarifying the nature of ISHs.
5. Investigate relationships between therapists' beliefs
and encounters with ISHs.
6. Obtain non-structured opinions, ideas, theories, and
comments from therapists concerning the ISH phe-
nomenon.
METHODOLOGY
Design
The design of the study was descriptive in nature, using .
a questionnaire as the design instrument.
Sample and dissemination
The subjects were therapists of MPD persons . Persons
assumed to fit this definition were selected non-randomly
fr om lists of presenters at ISSMPD conferences, a
listing of ISSMPD members, and several persons
known to be such therapists . Introductory letters
and investigator-designed questionnaires were sent
to 100 persons assumed to be therapists of MPD
persons . The introductory letter included opera-
tional definitions MPD therapists and ISHs.
Internal Self Helpers : Portions of psychic Belief
energy within the MPD person which primarily
serve as helpers in MPD systems . Unlike host or
alter personalities, ISHs demonstrate objectivity
and possess information which frequently spans
the entire lifetime and experiences of MPD per-
sons . ISHs are said to possess mental capabilities
which far surpass that of the host or alter person-
alities . ISHs have also been referred to as "Cen-
ters "or "Centrals, " and have been found at times
to be beneficial in the healing/therapeutic proc-
ess . In this investigation ISHs were to be differen-
tiated from other "helpers" or "helper personali-
ties" who are more limited in knowledge and
capabilities than ISHs.
MPD therapists : Any person who served as the
primary therapist for at least one MPD person .
Instrument
The inst rument consisted of a five-section questicnt-
naire . Items of the questionnaire were designed to meet the
specific objectives of the study ,. Most items reflected com-
ments and descriptions of ISHs as found in the literature.
Section A elicited background data from the therapist.
Section B related to therapist's beliefs about and experi-
ences of the ISH phenomenon . Section C requested thera-
pists to supply information relating to their experiences with
one specific to ISH . In Section 1) therapists, who had worked
with more than one ISH, were requested to generalize
Section C information to "most ISHs ." Section E elicited
therapist 's opinions relative to the etiology and nature of
ISHs.
RESULTS
Forty-five questionnaires were returned . As five of the
respondents materials did not meet the eligibility require-
ments for inclusion in the study, these questionnaires were
excluded.
The participants
The findings from Section A (background data on
therapists) revealed that all 40 participants had been the
primary therapist for at least one MPD client . Each of the 40
therapists acknowledged having heard of the 1SI l phenome-
non in persons with MPD . Professionally, these therapists
represented 18 (45%) psychiatrists, 15 psychologists (37 .5%) ,
three social workers both within and outside of these catego-
ries, (7 .5%), and one nurse (2 .5%) . Twenty-one (52 .5%)
women and 19 men (47 .5%) participated.
Geographically, the therapists responded from all ma-
jor regions of the US ; 15 states . Two participants responded
from Canada, and one from Holland . The ages of the
TABLE 1
Comparison of Therapist Beliefs with Two Groups
of Respondents
Therapists
`Group I **Group II
Responses (n=25) (n=11)
Yes 17 2
No 2 7
Uncertain 6 2
Essential 13 3
Useful but not
necessary 12 7
Other 0
1 39
(Group I, n=25) Therapists who reported numbers of ISHs to he 30% or
greater than the numbers of MPD clients.
(Group ll, n=11) Therapists who reported numbers of ISIIs to he less
than 50% of the numbers of MPD clients.
Each MPD person
has an I51I
Involvement of
the ISH in the
therapeutic process
is:
DISSOCIATION, Fol .3,September
therapists ranged f rom 29 through 70.
Collectively these 40 therapists had served as primary
therapists for 690 MPD clients (average = 17 .3) . The major-
ity, 23 (59%), had worked with MPD clients for over five
years ; 10 of these therapists had been doing so for 10 or more
years.
Of the 40 participating therapists, 90% (36) reported to
have had direct contact with greater than 348 ISHs . In
addition, these therapists reported indirect communication
with greater than 302 ISHs . Some therapists wrote in "+"
signs or "many" instead of numbers . Emu (10%) of the
participants denied any contact with ISHs.
Prior to their first encounter with an ISH, 67% (21) of
the 36 therapists had heard of the ISH phenomenon ; 33% .
(12) had not . In their first encourr ter with an ISH, 67% (24)
of the therapists reported that the ISFI emerged spontane-
ously ; while 13 .5% (5) were hypnotically requested and
13.5% (5) were requested by non-hypnotic means . Six per-
cent (2) respondents circled "other," without specif ying
methods .
Beliefs and experiences
In Section B, 100% (40) of the respondents agreed with
the statement that "The ISH can be a valuable asset in the
therapeutic process ." Sixteen (40%) of the therapists con-
sidered this involvement to be "essential" ; while 23 others
(57 .5%) deemed the involvement to be "useful, but not
necessary ." One therapist (2 .5%) found the involvement to
be "variable ."
To the proposition that "Each MPD person has an ISH, "
50% (20) of the therapists responded, "yes" ; 27 .5% (11)
were "uncertain" : and 22 .5% (9) answered "no ." Respec-
tively, 50% (20) responded affirmatively to a belief that MPD
persons "may have more than one ISH, " 27 .5% (11) re-
sponded "no "; and 22 .5% (9) were uncertain on this issue.
In expressing beliefs about non-multiples, 57 .5% (23) of the
therapists believed that "each unitary person (non-mul-
tiple) has a part of themselves which is similar to the ISH";
while 30% (12) were "uncertain" ; and 12 .5% (5) responded
"no ."
The 36 therapists who reported direct contact with ISHs
were divided into two groups (Table 1) . The 25 therapists
(69 .4%) who reported numbers of ISHs oc-
curring in 50% or more of their number of
MPD patients were in the "high occurrence"
group ; those 11 therapists (30 .6%) who re-
ported ISH contacts in less than 50% of them
MPD patients were in the "low occurrence "
group . When comparing these groups in
relation to two areas of belief (i .e ., universal-
ity of ISH occurrence in MPD persons, and
the degree of usefulness of ISHs in the thera-
peutic process) it can be seen that therapists
beliefs seem to be related to the contact with
greater numbers of ISHs, as well as the de-
gree of perceived ISH usefulness . The corn-
parisons, however, do not provide the direc-
tionality of this relationship . That is, they do
not demonstrate whether or not "believing"
therapists tended to find more ISHs, or if the
therapists who experienced greater numbers
tended to believe more in ISH occurrence in
MPD persons.
Encounters with .ISHs
Participants were asked to describe their
encounters with ISHs in two ways . In Section
C of the questionnaire, respondents were
instructed to "select one specific ISH," and
answer questions regarding that particular
ISH . Thirty-six participants responded rela-
tive to 36 ISHs (single ISH) . In Section D the
therapists who had worked with two or more
ISHs were requested to generalize an identi-
cal set of questions to "most ISHs ." Thirty
therapists reporting on greater than 340 ISHs
responded in this section (most ISHs).
Therapist/ISH relationship
The information in Table 2 demonstrates
TABLE 2
Therapeutic Relationship Between Therapist and ISH
Therapist
n=36
 
n=30
Therapeutic *Single **Most
Relationship Description ISH ISHs
Method of contact
 
ISH emerges spontaneously 53% 37%
ISH emerges through
therapist-induced hypnosis 44 40
ISH is non-hypnotically
requested 50 40
ISH sends messages through
host or alters 31 23
Nature of the therapist/ More like a peer or 64% 60%
ISH relationship co-therapist
Similar to that with host or
personalities 28 27
Other 8 10
Therapist seeks advice Frequently 53% 50%
from ISH
Upon occasion 36 43
Rarely 8 7
Never 3 0
*{"Single ISH," n=36) Reports of 36 therapists of 36 ISFIs.
"('Most ISHs," n=30) Reports of 30 therapists on >340 ISHs.
140
DISSOCIATION, Vol : September i 989
~1
TABLE 3
Descriptions of ISHs as Given by MPD Therapists
Therapist
n=36 n=30
Therapeutic Relationship Description
*Single
ISH
**Most
ISI3s
Refer to themselves or are Different from alters 75% 67%
described as :
Separate entity/entities 39 30
Somewhat mystical 36 37
More powerful than the alters 33 28
In charge of system 16 20
Same as alters 8 13
Have the ability to : Intervene in crisis situations 78% 73%
Create separations in the system 36 20
Begin, stop and regulate abreactions 36 33
Advance or regress ages of host and alters 22 20
Exhibit knowledge : Nearly total recall of life experiences 56% 43%
Total knowledge of life experiences 42 30
Beyond that of host and alters 33 27
Age-appropriate knowledge 25 23
Exhibit delusional thinking : Never 75% 70%
Occasionally 11 27
Less with therapy 6 3
Frequently 0 0
Report information accurately : Most of the time 56% 70%
All of the time 42 27
Upon occasion 0 0
None of the time 0 0
Give advice which is helpful : All of the time 31% 33%
Frequently 67 60
Upon occasion 3 10
None of the time 0 0
In relation to objectivity/ Primarily objective 81% 63%
subjectivity : Primarily subjective 6 7
Equally objective and subjective 14 17
Other 0 7
("Single ISH," n=36) Reports of 36 therapists of 36 ISHs.
*("Most ISHs, "n=30) Reports of 30 therapists on >340 ISHs .
141
DISSOCIATION, Vol . II . \o . 3:Septemher 1989
various aspects of the Therapist/ISH relationship . Thera-
pists encountered ISHs, even the same ISH, in several ways,
i.e ., through spontaneous emergence of the ISH, hypnoti-
cally induced emergence, non-hypnotic request, or through
messages sent through the host or alter personalities . One
ISH used written communication with the therapists.
When asked to describe the nature of the ISH/therapist
relationship, the majority of therapists (64% single ISH,
60% most ISHs) reported that their relationship with ISHs
is "more like a peer or co-therapist," in contrast to the
manner in which they related to the host and alter person-
alities . In addition, many therapists (53% single ISH, 50%
most ISHs) stated that they frequently sought advice from
ISHs .
While all therapists did not relate to ISHs in the same
manner, all but one therapist stated that they sought advice
from ISHs . Some therapists sought advice more frequently
(53% single ISH, 50% rnost ISHs) than others, who did so
upon occasion (36% single ISH, 43% most ISHs), rarely
(8% single ISH, 7% most ISHs), or never (3% single, 0%
most ISHs).
Descriptions of ISHs
From the data collected, the majority of ISHs are de-
scribed by the participating therapists as "primary objective"
(81% single ISH, 63% most ISHs) entities who had "nearly
total recall of life experiences" (56% single, 43% most ISHs)
and who reported information accurately "most of the time"
(56% single, 70% most ISHs) . The majority of ISHs (75%
single, 70% most ISHs) "never" exhibited delusional think-
ing . Furthermore, advice which was given to the therapist
was "frequently" (67% single, 60% most ISHs) helpful.
While ISHs describe themselves in a variety of ways, the
therapists reported that the majority (75% single, 67% most
ISHs) of the ISHs referred to themselves as "different in
nature from the alter personalities ." While some ISHs had
reportedly demonstrated abilities which ranged from regu-
lating abreactions to altering the ages of alters or host
personalities, the majority (78% single, 73% most ISHs)
were described as having the ability to "intervene in crisis
situations ."
Table 3 describes the results of sections C and D . In
these two sections more than one selection per question was
permitted . The percentages from these sections represent
the frequency of selection of each item by the therapists, and
will not necessarily equal 100% responses per question.
Some questions in these sections were not answered by all
participants.
Therapists ' opinions on ISH nature/etiology
Section E elicited interesting responses . Recurrent
themes referred to the "observing," "objective," "hyper-
intellectual," "and protective" nature of ISHs . The ISH was
referred to as an "organizing center," "a unifying element,"
and as "a link in memory" providing continuity in an other-
wise disorganized psyche . Again, the "healthier core of the
personality, the core-consciousness," the "center" were some
of the terms used to describe ISHs.
Several therapists included more metaphysical descrip-
142
Lions such as "hyperintellectual and inhuman" ; "invincible
part of the human spirit" ; part of the patient's unconscious
which is in contact with even "Higher Helpers" ; "a personal-
ity fragment used for communication with the Higher Self,
one's own spirit or soul" ; "guardian of the spirit" ; "a special
entity" ; "aspects of the spirit of God" ; "an old soul from built
up lifetimes "; and "likened to Jane Robert's Seth II ."
Some of the more pragmatic interpretations included "a
label for a specific personality ; often to decrease our (thera-
pists) anxiety" ; "identification with the therapist ; iatrogenic";
"the only type of personality the incidence of which seems to
correlate with the therapist 's belief system . . . may prove
artifactual ."
Several therapists insisted that ISHs are "not iatrogenic . "
One stated, "If this is iatrogenic, I'll eat my license to practice
psychology ." Another respondent insisted that labeling ISHs
iatrogenic is a "function of the ego of some professionals
who need to feel they can really create something ."
One therapist cited an "all knowing alter ...objective and
mechanical" who sentenced the client to death for certain
aspects of her life . "She suicided three weeks later - hardly
a benign or helpful `ISH '!!!" Several other therapists warned
of personalities masquerading or being mistaken for ISHs.
Many therapist included names of ISHs . While some
ISH names such as Richard, Brandy, and Sarah were rather
common-sounding, others such as Archives, Observer, Hope,
Higher Self, Floating Lady, Gypsy, and Angela had more
descriptive and/or esoteric qualities about them.
CONCLUSIONS
From the findings of this descriptive study, it can be
concluded that : (a) ISH occurrence within MPD clients is
not an uncommon phenomenon ; (b) ISHs can be avaluable
asset in the treatment process ; (c) therapists differ in the
degree to which they believe that persons with MPD posses
ISHs as well as the extent that ISH participation is essential
in the therapeutic process ; (d) therapists encounter ISHs in
different ways as well as develop different types of relation-
ships with ISHs ; (e) ISHs are mostly knowledgeable, reliable,
and helpful to MPD clients and therapists ; (f) ISHs seem to
have some common characteristics, while they also demon-
strate a wide variety of attributes and abilities ; (g) while there
is no one explanation regarding the etiology and nature of
ISHs, therapists tend to describe ISHs as possessing unifying,
centering, and protective functions within the person with
MPD . The wide variety of explanations regarding ISHs leads
to the belief that therapists tend to "explain" ISHs according
to their own ideological orientation ; and (h) some therapists
believe that the ISH concept can be applied to unitary (non-
multiple) individuals.
This study represents a beginning in a formalized collec-
tion of data relative to ISHs of persons with MPD . While the
findings represent the experiences of only 40 therapists,
these were mostly seasoned therapists who had worked with
a significant number, 690, of MPD clients . Collections of
data from greater numbers of MPD therapists would further
serve to enhance and/or clarify this beginning . a73
DISSOCL4TiON, LW . 11, No, 3: September 1989
REFERENCES
Allison, R .B. (1974 ) . A new treatment approach for multiple
personalities . American Journal of Clinical Hypnosis, 17, (1 ), 15-32.
Allison, R .B. (1977) . Psychotherapy of multiple personality . Unpub-
lished monograph.
Allison, R . B. (1980) . Minds in many pieces .New York : Rawson, Wade.
Assagioli, R . (1984) . Psychosynthesis . New York : Penguin Books, Ltd.
Beahrs, J .O . (1982) . Unity and multiplicity . New York : Brunner/
Maze].
Comstock, C . (1985, October) . Internal self helpers or centers . Paper
presented at the meeting of the second international congress on
multiple personalities and dissociative states, Chicago, IL.
Curtis,J . C., & Fraser, C . A. (1984, September) .A subpersonality theory
of multiple personality . Paper presented at the meeting of the first
international conference on multiple personality/dissociative states,
Chicago, IL.
Fraser, G . A. (1985, October) . Hypnoticstrategies & techniques in MPD
therapy. Paper presented at the meeting of the Second International
Conference on Multiple Personality/Dissociative States, Chicago,
IL.
Freud, S . (1938) . The basic writings of Sigmund Freud, (A. A . Brill,
Trans .) . New York : Avon Books.
Jung, G .G . (1959) .Collectedworks of C. G. Jung, (G . Adler, M . Fordham,
& H . Read, Trans .) . New York : Pantheon Books.
Jung, C .G . (1963) . Memories, dreams, reflections, (C . Winston & R.
Winston Trans .) . New York : Pantheon Books.
Kluft, R .P. (1985) . Childhood multiple personality disorder : Predictors,
clinical findings, and treatment results .In R . P. Kluft (Ed .) , Childhood
antecedents of multiple personality (pp . 167-196) . Washington,
DC : American Psychiatric Press .
:11
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