Commentaries on US Tara Episodes

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Episode 7:  Alterations

The theme of the episode is authenticity and identity, being one’s self vs. not being oneself, or presenting one’s self as a false self. Tara says to her video diary, “A lot of people just want to be rescued from themselves. They wish they could be airlifted from their skin and dropped into someone else’s. Me, I just wish I could stay the same for a whole week.” In contrast to Tara’s often heart-breaking pursuit of continuity and stability, her sister Charmaine hopes to effect dramatic changes in herself by having “corrective surgery” on her disfigured breasts. Tara agrees to be her postsurgery “boobie buddy.” Max drives Charmaine to the hospital. En route, Charmaine again denies the reality of DID: “It’s not a disorder; it’s a weakness. She does it to herself.”  She calls herself the best sister in the world for trying to help Tara face reality as she (Charmaine) sees it. Later, to Charmaine’s dismay, Buck, not Tara, is at her side when she awakens after surgery. Buck takes Charmaine home. At first, Buck refuses to soften his quasi-obnoxious, macho persona. He turns his back on Charmaine to watch extreme fighting on TV, cleans a large revolver, and denies that Marshall is “his son,” proclaiming that if Marshall were his son, he would be a real “pussy hound.” As Charmaine berates Tara, Buck says, with crude but telling sympathy, “That lady’s got problems. The rest of us got to hold it down as long as we can.”  Finally, Buck agrees to wash Charmaine’s hair while Charmaine sits in the tub (which Tara used to do for her). Charmaine recalls that the two of them used to play a beauty shop game outside when they were kids and that one time they got in trouble for their use of the hose.  For the first time, Charmaine witnesses Tara switch. Buck transitions to Tara, who is instantly disgusted by the taste of cigarettes in her mouth. Tara clearly has no recall of what had happened while Buck was out. Tara asks apprehensively if Buck was “horrible.” “No,” says Charmaine, “He was a pretty good boobie buddy.”

Marshall consults his ‘wise,’ older sister about his crush on Jason. He tells her, “Jason’s ignoring me.” Kate reflexively says to “ignore him right back.” After further such coaching by Kate, Marshall ‘plays hard to get’ and successfully attracts a phone call from Jason. When Marshall bemoans the apparent need for game-playing and misrepresenting his true feelings, Kate tells Marshall, “Don’t ever be yourself; it’s the kiss of death.”

Meanwhile, Max is making secret efforts to understand his wife. After Dr. Ocean refuses to answer his repeated phone calls, Max rushes into her office between appointments and tells her that there is “a new alter.” “It wasn’t Tara,” he insists, it was “a weird poncho goblin, like an animal.” Dr. Ocean indirectly reveals an important fact that has only been peripherally apparent until now—she is quite inexperienced with regard to treating DID. Max is startled when she says, “I’ve really been educating myself a lot about this stuff lately.” She then naively reassures Max that “whimsical” child parts may be active at night. Max will have none of it. “Tinkerbell is whimsical” he says, “This little f***er pisses on people!” Nevertheless, Max succumbs to his wish to be reassured when Dr. Ocean asks him to come to Tara’s next therapy session, and says that he trusts her. Dr. Ocean closes by saying, “I think having a professional and a loved one working together in tandem can be very productive.” That night, while Tara is sleeping over at Charmaine’s, Max meets with Heidi Sawyer, Tara’s boarding school roommate. Heidi tells Max that she thinks her former boyfriend (Trip Johanssen) raped Tara. This idea is a belated realization for Heidi. At the time, she had heard from her friends that Tara slept with Trip, but both Trip and Tara denied it. Heidi never spoke to Tara again. Since then, however, Heidi has realized that rape is a better explanation of what she remembers from that night, given that Tara came home that night looking like she had been “knocked around,” and had no memory of what had happened.

The next morning, Tara comes home to shower and change. She listens attentively to each family member as they catch her up on what they did the day before. Max claims that he got together with a friend and went to the gym. Tara tells Max about Buck and Charmaine, but she does not tell Kate or Marshall: “I never lied to the kids about a transition before. I told Max though; I know he’d never keep anything from me.” Max remains silent about the “poncho goblin,” his visit to Dr. Ocean, and his investigations into Heidi Sawyer and Trip Johanssen.

Commentary:
Do therapists with little or no previous experience with DID attempt the treatment of a person with DID? Because few therapists have the requisite training and experience to treat DID, it is extremely common for persons with DID to be treated by a ‘rookie’ DID therapist. Although this is often a necessity (due to the small number of experienced DID therapists), this is far from an optimum treatment situation. In fact, professional organizations routinely urge that therapists seek immediate consultation and get training as soon as reasonably possible if they undertake the treatment of a case that is outside their area of expertise. In the absence of such immediate consultation and training, it is recommended that the therapist transfer the case to a therapist who is competent to treat that particular disorder. Thus, as a ‘rookie’ DID therapist, Dr. Ocean should have immediately obtained consultation about DID and sought out training with regard to treating the disorder. There is a strong possibility that no matter how well intentioned and intelligent Dr. Ocean is, her lack of knowledge about DID will lead to misunderstandings, missteps, and misadventures in the therapy. As usually occurs in these situations, Dr. Ocean clearly cares about Tara and has formed a strong and supportive therapeutic relationship with Tara (and Max). However, Dr. Ocean’s lack of training about DID may seriously hinder Tara’s therapeutic progress.

How common is the behavior of Tara’s husband—that is, investigating what is going on with the alters and what really happened in the past? The partner of a person with DID inevitably has strong urges to try to discover what happened in his loved one’s childhood and to learn what is going on with the alters in the here and now. That said, it is far better for these urges to be resisted and, perhaps, discussed with the partner’s therapist. Such ‘investigations’ can easily generate unexpected and unfortunate consequences. Additionally, when these investigations are conducted in secret, they involve deception that inevitably undermines the marital relationship. The secrets of a person with DID (usually hidden away in alters) protect him or her from intolerable and painful information. The disclosure or unearthing of those secrets is always inherently destabilizing for the patient—sometimes disastrously so. DID patients often suffer so much guilt and shame about what has befallen them that they react to the outing of their secrets in self-destructive ways, including self-injury and suicide attempts.  For these reasons, it is best that the patient’s family members not try to ‘dig up’ the patient’s secrets.

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Episode 8: Abundance

Several characters deal with soaring anxiety. Max is anxious and agitated about “the new alter.” Over the weekend, he besieges Dr. Ocean with phone messages asking for an expedited therapy session with him and Tara. In one message, Max promises Dr. Ocean not to tell Tara about the new alter—and then promptly does so a few minutes later when Tara asks what is bothering him. Tara is very distressed to hear that she has a “new alter.” She becomes even more upset when she realizes that Max and Dr. Ocean have talked about this behind her back (see Episode 7 above). She insists that Max tell her everything. Max tells her that the new alter is different from the others. “It’s animalistic, pure id [Freud’s term for the part of the unconscious mind that is motivated purely by basic urges and instincts], I guess.” Tara is horrified, “You’re making me sound like an evil rabid squirrel!” Unable to contain his anxiety, Max bluntly tell Tara, “Yeah, well it’s kind of like that—but the size of you.” Tara rushes to the bathroom, vomits in the toilet, and immediately switches to Alice.

Shortly thereafter, Alice dramatically enters the kitchen and tells the family, “Somebody’s got puppies in the oven! I…am with child!” After the kids leave for school, Max confidently tells Alice that she can’t be pregnant because Tara has an IUD. Alice says she doesn’t believe in IUDs and that God helped her get pregnant. Later, Charmaine monitors Alice while she takes a home pregnancy test. Alice promptly interprets the negative result (i.e., unchanged pink screen; no plus sign) as evidence that she is going to have a girl.

Alice and Charmaine comfortably hang out together while Alice paints. Alice comments that she wishes Tara had taught her to paint (indicating there may be communications among the alters about which we have no knowledge). Kate comes in, announcing that she has just been fired from her job. Kate had confronted her boss about his making sexually-charged comments to her in front of the entire wait staff of Barnaby’s. Kate told her boss that his generation is “too serious,” that his text message about her Latin test was “funky,” and that they should end their relationship—whereupon he fired her. Unfazed when Kate tells her about it, Alice asks Kate when she last had her hair done. Alice then takes over as hair dresser and cosmetician for Kate and Charmaine. She refers to Charmaine by various endearing nicknames (e.g., “Trixie,” “Baby Bird”). Alice teaches Kate about men’s underlying emotionality and neediness. “Never humiliate them,” she says. Instead, women “should use vocal tones that are a half-note higher” because that “makes men feel safer and stronger.” Later, Kate follows Alice’s advice and convinces her boss to give her back her job.

Alice and Max go to therapy together. This is the first time in eight episodes that an alter other than Tara has come to therapy. Alice is unrelentingly upbeat. Dr. Ocean is friendly, but is beginning to seem more and more ineffectual. After the therapy session, Max asks Alice to wait in the hall and he charges back into the therapy room and declaims angrily, “Nothing got done today. Nothing!” Dr. Ocean replies with equal irritability, “You told her about the new alter and she transitioned immediately. She’s afraid there’s no way you could love something that far out.” Max explodes, “She’s got that f***ing right!” Dr. Ocean tells Max that Tara’s insecurity about him has caused Alice to become pregnant. “Alice made a baby to keep you.” Alice comes back in, retrieves Max, and they leave. Dr. Ocean collapses into her chair, muttering: “S**t!”

Alice and Max attend the evangelical Hell House performance (which includes Marshall as one of the “homos”). Max gets into an argument with Alice. She tells him that he has been “relentless” with his pursuit of information about Tara and her alters: “You’ve gone and brought Gimme out!” Max asks who Gimme is, and Alice says, “You don’t know. You have no idea what you’re playing with.” That night, Max awakens and finds Alice sobbing on the bathroom floor. Her period has come and Alice is devastated because she thinks she has had a miscarriage. Max holds her, saying “I love you, Alice.”

Commentary:
In earlier episodes, Charmaine was rejecting and contemptuous toward her sister’s diagnosis of DID. Why does she now seem to be so accepting of Alice? This is an important point. When skeptics or rejectors of the diagnosis of DID are recurrently exposed to DID phenomena, they often mellow (admittedly, some skeptics remain unyielding in their rejection of the diagnosis—and are too often contemptuous and even abusive toward persons with DID). Here, however, we see a more benign outcome. The origins of Charmaine’s mellowing outlook were evident in the preceding episode (see Episode 7 above) when Buck took on the role of “boobie buddy” after Charmaine’s breast surgery. Initially, Charmaine and Buck’s interactions were bumpy and difficult, but they increasingly got along together, with Buck becoming less reactive to Charmaine’s skepticism, and Charmaine, in turn, becoming a bit less skeptical of DID. Buck even nurtured Charmaine by washing her hair (just like Tara used to do). During that event, Charmaine witnesses, for the first time, a highly visible switch from Buck to Tara. Now, in Episode 8, Charmaine and Alice interact comfortably for several hours. Several things appear to be happening. First, Charmaine’s anxiety about DID appears to be decreasing. Second, she finds herself less and less able (and, perhaps, less and less wanting) to deny the reality of Tara’s DID. Third, Charmaine (and Kate) are exposed to an alter’s positive aspects. Alice is quite loving and helpful to both of them. We might even say that the three of them are bonding.

Why does Alice develop a fantasized pregnancy? What is going on here? The heart of the matter is that DID is a collection of strategies for denying and avoiding extremely uncomfortable realities and providing alternatives that are more tolerable, at least for the moment. Fantasy is a major DID coping strategy; alters are each built upon a greater or lesser degree of fantasy. The basic fantasy that underlies alters is that “terrible things did not happen to me.” We also know that Alice believes she went to Radcliffe. Buck believes he is a Vietnam veteran. T believes she is 16. Earlier episodes have shown that switching often serves to avoid anxiety. Here, Alice becomes ‘pregnant’ when Max is dumping his anxiety about Gimmee on Tara—leaving to feel like “an evil, rabid squirrel.” Dr. Ocean tells Max that, “Alice made a baby to keep you.” This is a reasonable interpretation given the vehemence of Max’s reactions to Gimmee (and the danger that Max might reject Tara). Aside from her fantasized pregnancy, however, it is notable that Alice is helpful and very loving toward Charmaine and Kate. Thus, amidst the apparent ‘weirdness’ of DID, positive things are happening—Alice is nurturing both Charmaine and Kate. Alice’s healthy interpersonal behavior can be contrasted with that of Max and Dr. Ocean—both of whom, like Tara and Alice, are dealing with their own anxieties about Gimmee. Max dumps his anxiety on Tara and Dr. Ocean. Dr. Ocean, in turn, avoids dealing with the issue of “the new alter,” and then tears into Max when he berates her (“Nothing got done today! Nothing!”) for avoiding the matter. After one more blast of anger and anxiety from Max (about his not being able to love someone as extreme as Gimmee), Dr. Ocean deals with her own anxiety and discomfort by rejecting Max (i.e., she tells him that he needs his own therapist). It seems clear that Dr. Ocean’s anxiety and discomfort are rooted in her shame over her therapeutic inadequacies, failures, and her continuing uncertainty about what to do in her treatment of Tara. We are left to wonder whether all this may foreshadow some disruption in her work with Tara.

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Episode 9: Possibility

In a therapy session, Dr. Ocean discusses “Gimmee,” the “new alter” with Tara and Max. Tara is upset that Max and Dr. Ocean have been speaking without her knowledge; she feels betrayed and “sold out.” Dr. Ocean suggests that “Gimmee” may serve to keep painful truths away from Tara. Max suddenly blurts out that he has discovered the name of the boy who is thought to have raped Tara when she was at boarding school. Tara becomes angry and storms out of her therapy session saying, “I can’t deal with this.” Dr. Ocean is left talking to herself (and probably feeling inept). On the street, Tara explains to Max that her secrets must be hidden from her for a reason. She tells Max that he needs to stop being John Wayne; i.e., the brave “cowboy” who rides into town and brings law and order. “I am not your town,” Tara protests.

Kate again fakes illness to get out of work and confides in Tara, “I wish I could get away like you do.” Tara, completely fed up, resonates with Kate and proposes that she and Kate leave town for a girls’ “get-away.” En route, Tara tells Kate that she drives “like an old lady” and Kate reminisces about learning to drive. Tara says, “I took you out driving,” but Kate corrects her, “No, Buck took me out driving. Remember?” Tara begins to share her marital concerns with Kate; Kate says, “Let’s not stress!” and proposes that they check into a close-by hotel and spa. Upon their arrival, Kate notices a tattoo parlor on the premises, and proposes she be allowed to “get a tattoo in honor of girls’ night.” “Absolutely not!” says Tara, “You’re 15.” Meanwhile, back at home, Marshall and Charmaine are chatting. Charmaine is trying to be appropriate but characteristically slips into overdisclosing her sexual behavior. 

At the spa, Tara and Kate crash a party for Pharmaceutical reps. They meet two men and are momentarily intoxicated by the male attention. Tara soon realizes that Kate has disappeared, and goes searching for her. She finds Kate making out with an older guy in a hot tub. Kate rapidly pulls Tara away from the hot tub. When the two women are alone, Tara quietly and appropriately confronts her daughter: “What are you doing? You don’t even like this guy.”  Kate becomes angry and accuses her mother of similar indiscretions: “You do the same thing all the time. Charmaine told me that you were all over this skinhead at the Sugar Shack.” Subdued, Tara replies, “That was T.” Kate confronts her immediately: “Mom, I hate to break it to you. The same person that is here right now is the same person that was at that Sugar Shack.” Kate then runs back to her pharmaceutical rep in the hot tub. Tara wilts, and there is an immediate switch. T comes out and changes into a swimsuit, jumps into the hot tub between Kate and the man, puts her arm around the man, and starts flirting with him.  Kate is upset, and T leaves quickly.  Kate’s upset soon transforms into concern. She goes looking for T and finds her in the tattoo parlor, about to have the word “SLUT” tattooed on her hip. Knowing that her mother would be mortified by this tattoo, Kate tries to intervene. As her intensity and concern escalate, Kate says, “Hey, that’s Mom’s body, Mom’s blood, Mom’s teeth, Mom’s hair… That’s Mom’s DNA. You’re a visitor and you know it.” The moment the tattoo artist begins, Tara “comes to,” saying “Owww!” Kate quickly sees she is no longer dealing with “T”, and asks, “Mommy?” In the end, mother and daughter get matching tattoos on their hips. They return to their hotel room where they watch movies in bed and bond. Tara reveals that Kate’s father has a tattoo, too, but won’t say where it is.  

Meanwhile, Max continues to dig for information about Trip Johanssen (whom he was told raped Tara while she was at boarding school). At the Johanssen offices, Max meets Trip’s brother, who informs him that Trip works in the company's Chicago office. Max repeatedly tries to call Tara (who does not answer) and eventually leaves her a voicemail, saying that he is sorry and that he will stop digging for information. 

The relationship between Marshall and Jason continues to develop. Marshall is becoming increasingly obsessed with his appearance and naively begins a workout regimen (e.g., push ups, running). Charmaine and Marshall discuss this pursuit briefly as Charmaine comes over to borrow a shirt from Tara’s closet for her big date. Later, Jason comes over; he and Marshall drink liquor together and watch a movie on Marshall’s bed. Noticing the pirate ship that Tara has painted on Marshall’s ceiling, Jason marvels about how Marshall’s mother is “there” for him (unlike his own “terrible mother”). Jason falls asleep and Marshall kisses him; Jason wakes up and reciprocates. Jason leaves later. The viewer is left unsure as to what happened between the boys, but when Max comes home, Marshall is quiet, dreamy, and given to little smiles. Max empathizes with him, saying, “You’ve got it bad… There’s nothing like love.” 

Overall, the episode shows an increasing level of compassion between the characters: Max understands Tara’s desire for him to leave her secrets alone. Kate seems to understand Tara’s disorder with increasing sensitivity. Max clearly empathizes with Marshall’s lovesick state. The only character who does not exhibit genuine compassion is Gene (Kate’s creepy boss), who delivers food for Kate (who is supposedly sick) and steals a picture of Kate from the family’s refrigerator. We are unclear what this means, but his actions suggest that his boundaries are poor, he is preoccupied with his own gratification, his judgment is clouded by his obsession with Kate, and he is “up to no good.”

Commentary:
In this episode, Kate and Tara have two poignant confrontations.  In their argument at the hot tub, Kate confronts her mother about T’s behavior at the Sugar Shack as coming from “the same body that is here right now” (i.e., “Mom’s body”).  Later, Kate becomes upset after Tara walks away and goes to find her.  She discovers that her mother (as T) is about to have the word “SLUT” tattooed on her hip.  She protests to T and tries to call out Tara.  What is the significance of the comments/interventions that Kate makes in these two incidents?  In both, Kate is sending the message to her mother that what she does in other alters is the “same person”, and that what her alters do to the body is being done to her mother’s body. Over these two episodes Kate is growing up a little (maybe a lot), and moving from self-absorbed pseudo-sophistication to a more compassionate and caring stance toward her mother.

Kate appears to be moving from almost total self-centeredness (similar to T’s superficiality and manipulativeness) to a more mature stance that is modeled on Tara when she is functioning at her best. Kate becomes increasingly aware of both T's and her own self-destructiveness and leaves her irresponsible momentary fling in order to track down her mother. This is an impressive maturational leap for someone who recently has been giving advice to Marshall on how to be successfully fake, and who had assimilated Alice's recommendations about manipulating others, but could barely take a step on her own behalf without shooting herself in the foot. In a period of minutes, Kate breaks out of her usual ‘false self’ adaptation to become a risk-taking and intimate ‘true self’ who reaches out to her mother.
           
Kate begins to step up to the plate at the hot tub when she calls her mother out, insisting that the person who is with her at the spa now (i.e., Tara) is the same person who was at the Sugar Shack making out with the skinhead (i.e., T).  She is essentially saying, “You are ultimately responsible for the behavior of your alters” (in this case, T.). On the other hand, Kate’s hot-tub confrontation of her mother is also a manipulative adolescent counterattack to end her mother’s loving, correct, and quite well-delivered confrontation of Kate’s inappropriate behavior. Note that upon delivering her counterattack, Kate wheels away from her mother and returns to her inappropriate behavior (i.e., she climbs back into the hot tub with her older man). One is left to wonder just who it is that is not taking responsibility for her own behavior in this instance, Tara or Kate or both?

In the later incident at the tattoo parlor, Kate tells T (who is grandiosely flaunting her “SLUT” tattoo template), “you are tattooing mother’s body.” Clearly, Kate recognizes something more fully than either T or Tara can grasp, that there is only one body here. Kate is clearly demonstrating a growing sophistication in her understanding of her mother’s DID. Although she does not acknowledge that Tara’s body is also T’s body, her words are undoubtedly impactful. Kate has sent an important message to Tara: T resides in the body of her mother. Kate is the first person to take the stance toward Tara which contemporary therapists find most effective: compassionate confrontation of the DID patient with an often unwelcome fact: what the alters do affects the person as a whole, or, as therapists often insist, “You are all in this together.”

Urging Tara to accept responsibility for her alters and their behavior is good therapy, an intervention which should be administered repeatedly by Dr. Ocean, rather than by Kate. Why isn’t Dr. Ocean making this type of intervention? Although Dr. Ocean’s interpretations about the different functions of the alters’ behavior have merit, we continue to see that Dr. Ocean is somewhat disoriented in her approach to Tara and her mental disorder. Dr. Ocean lacks training and expertise in working with DID. She is seeing Tara without having learned how to treat DID, which is considered ethically questionable by many mental health professions. Dr. Ocean has made no direct interventions that ‘tell’ Tara she is just one person (who is responsible for the behavior of ALL of her).  In any successful therapy of DID, the therapist communicates (to whichever alter or alters are currently ‘out’ and/or listening ‘from inside’) that all aspects of the person belong to each and every alter. An effective DID therapist teaches the client to develop a respectful awareness of what other alters are thinking and feeling. One essential therapeutic goal is to promote increased communication among all of the alters. This fosters mutual collaboration which allows the client to gain increasing control over her parts and more control over ALL of her behavior.

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Episode 10: Betrayal

The episode begins with Tara making a video diary entry. She says that at the tattoo parlor (see Episode 9), for the first time, she noticed that “I wasn’t there, but I could actually hear what T was hearing before I transitioned.” In addition, she had seen Alice in the kitchen with her, offering her ingredients to improve a dish that she was cooking. Tara describes these experiences of awareness as “incredible.” Later, in Tara’s therapy session, Dr. Ocean explains Tara’s experience as “co-consciousness” (simultaneous awareness of parts for each other), and says it is “quite a breakthrough.” Tara had previously been without any awareness of what transpired when other alters were out. Tara seems genuinely pleased and excited. Then, without any warning, Dr. Ocean says that since Tara has made progress, this might be a good time for her to see another therapist who specializes in DID. At first Tara thinks she means adding an additional therapist, but Dr. Ocean tells Tara she would actually be “seeing another therapist instead of me.” She tells Tara that they will have four more sessions “to help with the transition.” Tara looks stunned and says, “You’re breaking up with me. You’re just giving up on me.” Dr. Ocean denies this and tries to reframe it as “not the end of our relationship, but a graduation.” Tara, clearly not ready for a graduation, sarcastically says, “OK, just what I need—more transitions.” Her passive resignation to decisions and circumstances not to her liking, seen in other episodes, is striking in this instance.
           
Afterwards, Tara drops off trash bags to Max, who is preparing a wealthy woman’s garden for a social event. Tara tells Max about Dr. Ocean’s abrupt termination. Devastated, Tara expresses confusion. She wonders why Dr. Ocean felt the need to end her therapy just when she was making progress. Max is furious with Dr. Ocean. He curses angrily and exclaims, “We need her. Why’d she do that? What are we going to do now?”

Kate continues to feel uncomfortable with her creepy boss, Gene. While talking with him in his office at Barnabee’s, she spots a photograph of her in his desk drawer (the very photograph that Gene had stolen from the Gregson’s refrigerator in Episode 9). He tells her it is for when they are apart; he then offers her a photo of himself for the times when they cannot be together. Kate barely contains her disgust, and says that she does not want the picture back.  She quickly leaves his office. Later, Kate talks with another co-worker about Gene’s bizarre behavior. The co-worker tells Kate that Gene routinely makes advances or takes liberties with new employees, and that perhaps Kate could file a sexual harassment suit. Kate sees Gene flirting with a new employee, which further deepens her disgust with Gene.

Meanwhile, Charmaine has persuaded Tara to meet her at a spa to have massages together. Charmaine looks forward to the massages as a treat, but, foreshadowing events to come, Tara is hesitant and states that she doesn’t like to be touched by strangers. She also tells Charmaine about Dr. Ocean’s termination. Tara is clearly very upset, hurt, and preoccupied with this clumsy and painful rejection. Charmaine brushes off Tara’s concerns, and remarks that if people who went to therapy would get a massage every week instead, the world would be a better place. Charmaine remains predictably unpredictable in her support of Tara. But Tara will not be distracted from her immediate concerns. She persists and asks why Dr. Ocean “dumped” her: “She was the first therapist I could trust and now I have to start all over again with someone else.” Charmaine retorts that maybe Tara was “too much” for Dr. Ocean, “I mean you are a handful, Tara. There are four of you, plus Ocean. That’s not a relationship. It’s an orgy.”  

Tara lies down on the table for her massage, and is nonplussed that she has to put her face into a confined area, a towel-padded hole in the table surface. Within seconds of being touched by her masseuse, Tara abruptly sits up, gasping for breath. Alarmed, her massage therapist rushes off to find Charmaine. When they return, they find Tara, who has switched into Gimmee, crouching on the floor, huddled under a sheet that covers her head and body like a hood and poncho. She is moaning and growling. When Charmaine tries to calm her, Gimmee screams, runs through the spa, pulling down the drapes that divide the masseuses’ cubicles and knocking over a table. When “cornered,” she abruptly switches to T, who angrily pushes away both Charmaine and the massage therapist and tries to intimidate the others who just witnessed what had occurred. Charmaine is genuinely scared and shaken. She offers the spa staff a lame excuse for Tara’s behavior, explaining that her sister has a phobia of touch. Charmaine tells T to leave Tara alone for awhile.

In the meantime Kate attempts to call the human resources office at Barnabee’s corporate headquarters to file a complaint about Gene. She gets lost in a frustrating automated voice loop, pressing one button after the other without reaching anyone successfully. Charmaine arrives home and tells Max and Kate about what happened at the spa and about Dr. Ocean’s “breaking up” with Tara. Max says that it sounds like Gimmee came out at the spa, but T insists, once again, that she knows nothing about Gimmee. Max responds to T’s obnoxious behavior by suggesting that she go out to the shed and “chill out for a bit.” Charmaine wants to leave for a date, but Max asks her to stay until Tara “comes back.” She agrees.

As this is happening, Jason and Marshall return home from riding bikes together. They are just beginning to talk about what happened in the bedroom between them last time. T walks up to them at this awkward and important moment. After a bit of T’s outrageous banter, Marshall suggests that she “go hang out in the shed.” T responds by teasing the boys about “wanting some alone time” with each other. Jason says that he likes T: “I think she’s funny.” Marshall again talks about their recent time in his bedroom. Jason says that he could “do that again,” but as Marshall invites him up to his bedroom, Max interrupts and asks Marshall to come inside for something “important” (to tell him about Tara’s episode at the spa and what is going on with T). T returns and persuades Jason to put Marshall’s bike away in the shed. Once they are in the shed, T provocatively starts coming on to Jason . She asks seductively if he likes girls and suggests that “maybe, you’re bisexual.”  Jason backs up a bit and says, “Maybe, I’m 16.” T retorts that she, too, is 16.

In the house, Max is explaining Gimmee to Kate, Marshall, and Charmaine. He says that Gimmee is preverbal and has no social skills—“the kind of alter that defaces murals and pees in people’s beds.” Charmaine makes a lame joke, “Well, this is fantastic. Tara thinks she’s a Rottweiler or something.” Kate asks to have a lock put on her bedroom door (so Gimmee can’t get in). Marshall decides to go out to the shed to check on T. He walks into the shed and finds Jason kissing T, who is holding Jason’s hand firmly cupped to her breast. Marshall is shocked and outraged and he kicks the door of the shed. T’s head drops as Tara seems to struggle to return and is clearly upset, apparently aware enough of what has happened to understand, but not so much that she can own the behavior of T as hers. Tara follows Marshall up to his bedroom. She says, “That wasn’t me, I would never… I wish I could protect you.” Devastated and enraged, Marshall says that he can protect himself. He makes Tara leave his room. Tara goes to Max and cries, understanding that she has done something truly terrible. Tara is even more distressed when Max tells her that Gimmee came out at the spa and that, now, Charmaine knows about Gimmee. Kate is overwhelmed and says she is going to stay overnight with a friend. Tara goes downstairs and apologizes to Charmaine.

Charmaine misses her date because of the chaos, but is kind to Tara, in stark contrast to her cruel joke earlier. Marshall returns to the shed and deliberately sets it on fire. As Charmaine prepares to leave, they all discover the shed in flames. They also find Marshall reclining in a lawn chair, watching the shed burn. He does not assist the others in fighting the fire.

Commentary:
Dr. Ocean told Tara that it is best that Tara transfer to a therapist more familiar with DID and that she, Dr. Ocean, will no longer see her. This is a huge surprise and a very painful shock for Tara. Max is angry that Dr. Ocean is abandoning them in their struggle with this difficult illness and the havoc it wreaks on Tara and their family. Charmaine says that Tara was probably “too much” for Dr. Ocean. Why would a therapist terminate with someone with DID? Is the way Dr. Ocean announced their ending typical?

Previous episodes have shown that Dr. Ocean has little, if any, experience in treating DID. Recent therapy sessions have shown her to be increasingly frustrated and overwhelmed by both Tara and Max. Dr. Ocean is caring and well-intentioned, but she is unskilled in dealing with the complexities of DID (and its accompanying interpersonal complications). Sadly, Dr. Ocean’s good intentions did not cause her to undertake training in the treatment of DID and/or consultation from an expert in DID treatment. Clearly, Dr. Ocean has been overwhelmed by clinical complexities that are beyond her current competence or skill-set.  We are not shown how she arrived at her decision to terminate treatment with Tara and transfer her to a specialist, but she comments that her clinical supervisor concurs with this decision. In itself, such a transfer of care is appropriate and therapeutic because it makes it more likely that the patient will receive a higher level of care. The problem, however, is not the decision, but how Dr.Ocean carries it out (i.e., via a sudden announcement that she will terminate her care of Tara in four sessions, and refer her to a specialist). 

Individuals with DID usually have serious difficulties trusting others. And yet, Tara had come to trust Dr. Ocean. She believed that she had finally found someone who understood and could help her. In addition, Tara had rendered herself vulnerable by allowing Dr. Ocean access to her alters—an enormous leap of faith for someone who had been terribly hurt by others. Dr. Ocean does not appear to appreciate the fragility of Tara’s trust and how important it is for a therapist to be slow and delicate when effecting the transfer of a long-standing DID patient. In addition, Dr. Ocean does not seem to realize that Tara is at a critical (and very vulnerable) juncture in her recovery process. She has started to develop some co-consciousness with her alters. This is an inherently scary process for Tara because it increases her contact with alters who hold so many feared memories and feelings. This is precisely the wrong moment for Dr. Ocean to announce that she is terminating Tara’s therapy and sending her to another therapist. Dr. Ocean also appears insensitive to the profound bond that Tara (and some of her alters) have developed with her. Rejection and abandonment are two of the most feared and overwhelming experiences for individuals with DID. Even the hint or suspicion of rejection or abandonment can precipitate some acting out at best (and severe psychological decompensation at worst).

Tara’s emotional and psychological equilibrium was completely undone by Dr. Ocean’s insensitive and abrupt announcement that she plans to terminate Tara’s therapy. Tara frantically tries to make sense of this rejection; she asks Max and Charmaine to help her understand what is happening. By the time that she arrives at the spa for a massage, Tara is in a precarious state (that is not helped by Charmaine’s suggestion that she was “too much” for her therapist.) Tara’s massage promptly sends her over the edge. Gimme, the young, wounded, animal-like part of Tara emerges, expressing absolutely raw, intense, and wordless emotion that was probably evoked as much by Dr. Ocean’s abandonment as by the massage itself. Of course, this is much too vulnerable a state for Tara to maintain while in a public setting. T comes out to protect Tara with all the anger she can muster. We have to imagine that T is enraged at Dr. Ocean as well. Later, T does the unthinkable: she betrays Marshall by making out with his boyfriend (thus causing Marshall to feel as betrayed by Jason and T as Tara feels betrayed by Dr. Ocean). Only after the fact, when terrible harm has already been done, does Tara manage to regain control from T.

If there is a need to end therapy with an individual with DID, the therapist should carefully (1) plan how to bring up the topic; (2) decide the best timing for proposing the termination; (3) conduct a series of respectful conversations about it; (4) thoroughly explore the meanings of the termination to the individual; (5) discuss and process the individual’s reactions over time; and (6) make a plan with the individual, not for him or her. Dr. Ocean violates these principles. Worse, she does not even give an adequate reason for why the termination must happen so abruptly.

T betrays Marshall by trying to seduce his boyfriend. How often do alters engage in such willfully destructive and hurtful behavior, particularly toward a child? It is important to remember that the United States of Tara is entertainment, not reality. Although such events are known and possible, they most certainly are uncommon. Parenting skills in individuals with DID vary widely, just as they do among all parents. About a third of persons with DID are excellent parents, but one-sixth of DID parents are abusive at least on some occasions. The parenting behavior of the remaining half of DID parents is well-intentioned but compromised (by their dissociation and/or depression, or other problematic issues), and not malevolent.  While it is true that abused individuals have an increased risk for becoming abusers themselves, this outcome is by no means universal. In fact, most abused mothers with DID (83%) never perpetrate abuse. Although we don’t know with certainty the full range of Tara’s difficulties and problem behaviors, in the 10 episodes already aired, Tara has shown herself to be a reasonably good and emotionally-available mother (notwithstanding some outrageous behaviors from her alters). Tara herself presents as a generally good and intermittently excellent parent whose main failings are passivity and failures to set appropriate limits. She tries to be permissive and loving, and wants to be loved in return. Her ability to exert parental authority and to perceive when its use would be appropriate are compromised. Confronted with her passivity and abdication, her children are often forced into parental roles. T, Alice, and Buck, on the other hand, have been periodically inappropriate with Kate and Marshall. The children have had to accommodate to behaviors that may make the audience laugh, but which are at times psychologically abusive (even if said with some degree of affection). Still, T’s highly sexualized behavior with Jason (and concomitant betrayal of her son) is such an extreme enactment that it far exceeds any other outrageous alter-related behavior shown or referred to in previous episodes. The vast majority of families with a DID family member will not encounter such extreme behavior

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