Ideas people have about integration are often vague. Some of these ideas are romantic, others scary but usually they include imagery that doesn’t tell us how integration is supposed to work and ends up being inaccurate. That is why we will look into the basic elements of integration and explain the meaning of synthesis, realization, personification and presentification. Once we understand the elements we can start seeing them in our therapy. Celebrating progress is only possible when we recognize progress. It should also eliminate every fear that is based on a false understanding of integration and convince those who advocate against it.
Synthesis
Synthesis is a mental action that links aspects of an experience that belong together and differentiates between them to create cohesion and coherence.
The elements involved are
- the body (what we sense, see, smell, taste, hear, movement and other physical experiences like stress responses)
- our emotions (that can include different emotions with different intensity at the same time)
- our thoughts (including our memory, expectation and fantasy)
- and behaviors (things we did as well as impulses we never followed, things done to us)
So if synthesis goes well I can sit in my favorite chair and eat chocolate ice-cream as follows: I can look at it and see how dark and chocolaty it is, link the sense of holding a spoon and the movement of putting that spoon in my mouth, then the taste and a sigh of pleasure while I lean back. I can link my satisfied feeling with the bite of ice-cream, the sense of relaxing in my favorite chair and the thought that I have a free evening and all work is done. I can remember times when I had chocolate ice-cream before but also differentiate that this time is unlike the time when I was 16 and unlike last week. I can notice my impulse to take another spoonful and the expectation of it being cold and yummy.
All these elements get linked to create a big picture. The experience is complex and includes satisfied feelings and a comfy chair I have feelings about, a time of day with the whole history of the day leading up to this moment etc. not just the act of eating ice-cream floating in space. And throughout the experience I am aware that my spoon is white, but I recognize that it doesn’t matter, it is just a detail that doesn’t define the situation.
Failed synthesis in trauma
Usually most of synthesis is automatic. But when we experience trauma our integrative capacities are low and linking and differentiating within the situation doesn’t happen or only partially happens. Structural dissociation is a specific failure in synthesis where parts of a person synthesize different elements of the situation but get divided so that even later, linking the elements is impossible unless there is cooperation. Without synthesis we can’t create a cohesive picture and the experience doesn’t get ‘filed’ properly. Elements of it can get triggered and haunt us.
With lower synthesis I might feel numb about my ice-cream situation. I might not remember what it tasted like, only that it was cold. I might not know how the body felt, what emotions I had, maybe I only know that I like my comfy chair a lot and forget all about the context of the day and that I felt so accomplished. It might feel like there really only was one time in my life I had chocolate ice-cream because the memories got mashed together without differentiating and, something surprisingly common, I might be fixed on the white spoon as a key aspect although it didn’t really matter for making sense of the situation.
You might recognize the pattern when you think of your own trauma memories. The aspects mentioned above were not linked, so there are puzzle pieces missing from the experience or we can remember them, just not at the same time and in proper relation to each other.
Synthesis in trauma healing
Part of integrating trauma is finding the different puzzle pieces and putting them in their place within the experience, linking them and differentiating from other experiences. It isn’t done in a day and it is usually intertwined with other elements of integration. Our Ts will ask us questions to guide our attention toward missing puzzle pieces or point out links between aspects to help us discover the different qualities in a safe way. Digging rarely helps but there are usually plenty of triggered moments that bring up fragments of the situation and then we can try to see where that piece fits in the big picture. It is a multi-dimensional puzzle. We are looking for the answer to the question: What was it like, in all its aspects?
Some things naturally link together more easily than others. Taste and smell are close, but linking more abstract things can be harder. It is a special achievement to link words to the different qualities of experience. Words allow us to speak about something that is otherwise just a shapeless mass inside. Once we link the emotions and sensations to the words we can speak about an event differently, our words start to fit with the rest of our expression and our inner experience while sharing.
The therapeutic tools for trauma processing are meant to support synthesis. It is done slightly differently depending on the technique but you can notice the effort of linking elements of the experience together while going through the trauma memory in a structured way to provide safety. Connecting the dots to create the big picture needs a lot of integrative capacity and there is an element of re-experiencing during the linking. Therapy for complex PTSD often takes longer, because there is not enough integrative capacity to make it work that way. Then our Ts can help us to link one aspect after the other in small doses so we can cope with it. It takes more time, it can still give us good results.
Synthesis within DID/OSDD
With DID the puzzle gets more complicated. We are not just trying to link pieces of one traumatic situation, the puzzle is our whole life and our job is linking parts of our personality across time and situations to gain a coherent and cohesive sense of self. The goal is to increase function through more flexible responses to present situations.
Without synthesis across parts
Different parts have synthesized different pieces of our life. They hold the abilities for different actions, different fragments of our memories that produce different expectations for the future and therefore different motivation and goals, different skills or knowledge and a different sense of who they are etc.
As long as an activated part matches the situation there is no problem. But often we would need access to other options and they are not available because they are dissociated.
It could mean acting in a child-like way when the situation demands an adult. But it could also mean struggling to take part in social interactions during recess because we can’t link our skill set used for school and learning with the ability for playful interaction and the process of eating all at the same time, so we end up only doing one of them when it would need all.
We will also find ourselves in situations where we don’t differentiate between past experiences and the present and parts re-enact the puzzle pieces they have access to eg in flashbacks or defensive strategies. It can keep us stuck in abusive situations because we don’t link present abuse to the present or maybe we only link some kinds of experiences and not others, so our understanding of a situation is only partial and we might not realize there is abuse happening. We might also not register safe relationships because we fail to link our defensive response to the past and think it belongs in the present situation
Most conflict within a DID system is based on a lack of linking, so different parts follow different goals in a specific situation because their interpretation is limited and differs.
Without access to all the puzzle pieces that make up our life and that shape us as a whole person we will always experience that something about us or our behavior is off, that our decisions are not based on a full picture of what happened and is happening and that we are limited in the way we can respond. How dysfunctional this is depends on the links we do have and can vary widely between systems.
Synthesis for integration
To heal we are back to the basic principles of linking and differentiating. No parts will get mashed together. We are only creating links between the aspects of life and experience different parts hold to create a bigger picture. The imagery of fusing parts ‘supernaturally’ has not served patients well, it is misleading when it comes to the inner actions that are actually needed for integration. It is not about making only one experience count or reducing any aspects of who we are. We link things, so that we can be all of it and know that this is Us. The understanding of who we are shifts, from a sense of unrelated selves who build a group that more or less works together to a realization that we as a person are a system of these different units that are linked together and make up who we are as a whole. We can mentally follow ourselves through different ages and situations and notice the different units active and put the puzzle pieces together. While single parts of us failed to adapt to change because they were stuck within the few aspects they alone linked together, the whole system of linked parts can adapt and therefore it can change over time, grow, learn from experiences and build a different kind of life for the future.
Theory and real life
Synthesis is easily explained. It takes a lot more time and effort to actually reach it. For DID it takes years. The steps toward integration will sound familiar, they are all the small things we work on in therapy. Acceptance, getting to know each other, cooperation based on our strengths and weaknesses, switching more intentionally to manage life, sharing, blending etc. Trauma work will be an important part of the process when the time has come, because quite a lot of the puzzle pieces we will link together will be about trauma, the knowledge spread over different parts. These pieces need to find their proper place in the past while other aspects traumatized parts hold can find a place in the present. That is what happens when they take on a new role or job within the system. There is sorrow and grief in the process, but it is also how to overcome sorrow and grief.
This kind of linking needs integrative capacity, too. We can only link as much as we can manage. Some will not achieve high levels of synthesis which is why making full integration a fixed goal is not adaptive. In real life systems differ in how much synthesis can be achieved. It is not necessary to link everything to create a more functional life though. We can still work on growing our capacity over time by increasing our resources.
With progressing synthesis the picture every single part can see will change; it will be more complex, more grounded and more diverse. Sometimes whole world-views will be turned upside down with access to additional information. Usually the view of oneself changes considerably. It is a huge achievement, inner work we can be proud of. It is also more difficult than the imagery of somehow just fusing parts together. There will be no lasting fusion unless we have done enough of the linking and differentiating before. Instead of fantasizing about somehow melting our selves together it would help a lot more to focus on the hands-on work of synthesis to achieve integration.
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