Dissociative Identity Disorder Treatment: Note to Therapists
Recently I heard a familiar story from someone struggling to understand her dissociative disorder but unable to get any direct answers or explanations from her therapist, who is exercising caution because she doesn't want to reinforce the dissociation. While this is an understandable and common concern for clinicians treating Dissociative Identity Disorder, there is a vast difference between psychoeducation and fostering further fragmentation. When you refuse to fully invest in the former you leave your clients ripe for the latter. If for no other reason than that, Dissociative Identity Disorder treatment must include psychoeducation.
If you do not educate your clients about their disorder, someone else will. And that someone may or may not have a solid understanding of what Dissociative Identity Disorder is and what it is not.
If Dissociative Identity Disorder Treatment Doesn't Include Psychoeducation, Your Clients Will Seek Knowledge Elsewhere
Are you aware of the vast amount of misinformation and myth floating around, most readily available on the internet, about Dissociative Identity Disorder? I urge you to take to your nearest search engine and see for yourself the pervasive illusion of knowledge that follows this disorder around like a virus. Granted, some of that comes from your peers in the mental health profession. But that's another issue altogether and, for the purposes of this discussion, I'm assuming that if you're treating Dissociative Identity Disorder you have the knowledge and skills to do so. With that assumption firmly in mind, I submit to you that you have a duty to educate your clients. When you withhold information from them because you don't want to reinforce dissociation, all you're doing is forcing them to look somewhere else for the answers they're seeking.
If You Don't Provide Comprehensive Dissociative Identity Disorder Treatment, Who Will?
Ask yourself, who do I want educating my clients about Dissociative Identity Disorder? Entertainment media? Mass produced paperbacks featuring sensationalist case histories? Online forums and chat rooms? Those are all potential teachers for people who cannot get answers from therapists treating Dissociative Identity Disorder. And while there's real research value in all of those sources - I've learned more about the mythology surrounding DID from the internet than any other place, for instance - they're a poor substitute for the psychoeducation every DID therapist should be capable of providing as a part of Dissociative Identity Disorder treatment.
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Gray, H. (2011, March 17). Dissociative Identity Disorder Treatment: Note to Therapists, HealthyPlace. Retrieved on 2020, June 4 from https://www.healthyplace.com/blogs/dissociativeliving/2011/03/dissociative-identity-disorder-treatment-note-to-therapists
Author: Holly Gray
I've been dealing with D.I.D since I was 5, I just watched your video on Youtube about negotiating with alters. I was wondering, I can physically see mine, I can interact and talk with them, and my therapist at first wanted to dismiss the D.I.D diagnosis because of this. I explained to her that I lose large gaps of time and other friends have told me that my voice and personality changes. I'm so frustrated because for the past 2 months they've told me they will put me on medication, but things just keep getting worse and they never do. I'm glad to know that somewhere there are other people going though what I am.
You said you were wondering ... do you mean you're wondering if seeing and interacting with alters is something others with DID experience too? If so, then the answer is yes. Some people have zero awareness of and communication with their other self-states. Some, like you, can see them and talk with them. And there's a range of experiences in between. There are a lot of misconceptions within the mental health community (and the public at large too) about DID and it's not unusual to come across a therapist who has rigid beliefs about how DID presents. One of those rigid, erroneous beliefs is that people with DID have never been and are never aware of their personality states or able to interact with them. Curiously enough, the opposite is also a popular mistaken belief - that people with DID know about their personality states and have always known about them, can communicate with them, etc.
But this is a dissociative disorder we're talking about here. Dissociation by nature impedes awareness in various ways and by varying degrees. So the level or type of awareness/communication one has with their other self-states is not a reliable indicator of whether or not one has DID.
Thanks for commenting, James. Glad you're here. :)
I hope that a lot of therapists read this! I completely agree with you--it is so affirming to read this.
I mean I will be 30.
I have known of my Dx since I was 20 yrs old and I will be 20 in June. I have not been treated once for it. I am all over the place with no clue. My alters are all over the place to. We can not even identify who is who because there are so many and I think I am poly fragmented from this life. I could use any help that would be sound help but I can not find it anywhere. I am falling apart at the seams.
I am so sick adn tired of hearing therapists say "I don't do that", referring to handling cases with multi's. We're not that much harder to help than other clients. It's just like counselling many clients in one body.
I recently started with a new counsellor and she's referred me to MH services int he hospital because she's worried she's not trained enough to deal with the personalities and make sure I get as much help out of her as possible. At it means is I need to be willing to help her learn and stuff and I so am. So I am tired of being shuffled around as the "case" no one wants! I don't want to heal my DID I want to work on the trauma that caused it and maybe one day the personalities will decide to intergrate, but i'm fine with being multi! And the team is fine with being around too!
Thanks for commenting.
Honestly, I'd prefer a therapist refuse me than attempt to help me when they don't have the requisite knowledge and skills to do so. Having said that though, I understand the enormous frustration and desperation that often goes along with trying to find a qualified DID therapist. And while I totally and completely agree that we shouldn't be that much more difficult to help than other clients with serious mental illnesses, I believe that treatment providers must have more than a cursory understanding of DID in order to truly be of help. If a therapist doesn't know how dissociative memory works, for instance, they can do more harm than good.
We would do everything to treat a illness to the body even if it meant the person who was ill was overwhelmed, scared and so on with the information. It seems with DID is specific because it seems already itself to be in controversy among those who treat it, you end up with a question about disclosure that would not be there otherwise. I think that is why there is so much misinformation. We can argue about this treatment or that for this or that for any illness or disorder but DID is argued about its very existence by the very people who treat it and I would say this would be the reason so many are fearful to educate, as well as be educated.
The very real problem is once DID is maladaptive the person like me needs help and education and getting it seems to be luck for many. I think a good amount of healthy debate is good but among treating professionals to have the kind of open disregard they have had for one another around the subject of DID does no one much good. I have seen interviews and I wish it was the exception of both sides of the issue with people smirking, laughing, ignoring etc etc the other and that has to trickle down to education or the lack of it.
I don't really care what anyone wants to call DID. Or if they want to say parts, moods, alts, fragments, insert another word here. Just come to some general common ground so you as the health professional can educate yourself so I can get the help I need, including the education I need.
I may be looking at it to simply though. But I can't ignore what seems to me to be the glaring reason why there is so much misinformation out there about DID.
The matter of psychoeducation of psychiatric patients is going on to stir up many controversies and dilemmas among professionals of Mental Health Service. The same is of value of Dissociative Identity Disorder (DID), as subtype of dissociative derangement. Although most of psychiatrist agree with this reason, there are few of them that carry out in daily practice. Therefore sticks the efficacy of treatment to people with mental health diseases. The preliminary condition for a successful psychiatric recovery is the information of patient or his blood relations for the main nature of mental sickness. Otherwise, whichever of psychiatric approach in treatment of mentally ill patient would be partial. This failure in current psychiatric treatment should increase, besides others, the number of parapsychiatric treatment from magicians healer. And the circle would sacrifice before all psychiatric patients.
Hi Dr. Ferati,
Thanks for sharing from your perspective as a mental health practitioner.
"Although most of psychiatrist agree with this reason, there are few of them that carry out in daily practice."
Yes, that certainly seems to be the case. And it's a shame. It's awfully hard to learn to navigate life with a disorder you don't understand. That really should be obvious to anyone with half a brain. Why so many therapists continue to keep their patients in the dark is beyond me.
Thanks Caroline...interesting. I'll keep a look out for it.
It is fairly new. Peter Cummings has just finished a training manual and will be giving trainings this year. The practice of the technique is simple, and remember I am only a layman. You take a three foot dowel and the therapiust holds one end and the client the other. The therapist has the client check her body for pain, etc. Then asks the client to get a picture of the abused child in her mind and describe the scene as it changes. While the client is talking, the therapist keeps a gentle pull on the stick, and guides the client through the scene as wisdom dictates. A more detailed explanation is in my book, "Coming Present: Living with MPD/DID and How My Faith Helped Heal Me" by Xulon press. Peter will be coming out with more detailed info soon also. The process helps the client build healthy attachments. Hope this helps.
Would you mind elaborating on this a little? I've not heard of it.
"Personally I got lots of help from a technique called attachment-repair, developed by Peter Cummings, LCSW"
I am curious why therapists try to make us think there is something fundamentally wrong with us. Is it possible that we are normal? Human beings use less than 10% ?? of their brain??? What is the percentage of multiples? Just curious?
I find myself doing many things at one time. Anyone else have this issue? Sometimes it becomes a problem when we can not sleep. We all want to do different tasks so we sit... think. Type on this site.
I stumbled onto your blog by mistake, I must say you are doing a great thing for education of a totally misunderstood way of life. It is a hard life to say the least, but a way of life just the same. The trick is to find balance within - all must get along - find a way to have order - at least agree to LIVE successfully...
Thanks for reading and taking the time to comment.
I don't see Dissociative Identity Disorder as a way of life. For me it is a disorder, and while it certainly has it's positive sides, overall it's maladaptive and problematic to be so fragmented and compartmentalized. Still I do think it's important to normalize dissociation and hopefully most therapists treating DID try to do exactly that. While I wouldn't say DID is normal by any stretch, I do believe it's an extreme manifestation of what everyone experiences. And in that sense, yes, we are normal.
Balance, I agree, is so key. And so hard to achieve!!!
I appreciate this info, even though I am not a therapist. I was diagnosed with MPD/DID about ten years ago and my therapist, thankfully, educated both me and my husband on the condition and gave me reference to AMAC and Healthyplace.com on the internet. She also gave me several books, as she felt I was able to read without triggering me, from psychologists and therapists who had treated many cases of DID. At one point I wrote a book from my journal writings about my experience, but I also have learned that I have a choice in my dissociations from now on. By that I mean I am responsible for my behavior. I am said to be integrated, but I still "drift", as I call it sometimes when I am especially stressed. I agree that education is essential, from more than one source, and that there are misconceptions in Hollywood and some literature I have come across. I think I did not realize what dissociation was what I was doing because the movies I had seen did not seem to represent my experience. I hope others will not wait as long as I did to seek professional help, because I can see progress having been made in the last ten years in treatment. Personally I got lots of help from a technique called attachment-repair, developed by Peter Cummings, LCSW. Thanks for these blogs.
Thanks for reading, Caroline.
" ... I also have learned that I have a choice in my dissociations from now on."
That's wonderful to hear. I look forward to achieving that for myself one day!
Thank you for this article. I agree that psychoeducation around DID is very important, so that DID sufferers can heal and get better, by understanding the causes and symptoms of their disorder.
I can not agree with you more.
My therapist was also worried at first about fostering more fragmentation. Me being who I am delved head first into all the information I could get. Big mistake it almost cost me ever seeking treatment because of how it is displayed in media and some social forums. Thankfully I have a therapist who re-educated herself and then was able to educate me. She deals with DID but it had been a long time since she had an active patient.
I could not fit myself into the DID/MPD box being given to me by media and forums and I think it prolonged my acceptance. Which prolonged any healing.
Now my therapist office is an absolute safe zone for me and all of me's. She took the time to educate herself more and because of that I have some hope.
Some days not so much but more then not so that is something. One movie that did seem to hit it closer to home was the one with Halle Berry. But it ended up being way to triggering for me to watch and from the few other DID people I know it was triggering for them also. It of course was not perfect but it at least seemed to try which is more then I can say for most movies that claim to be based on the life of someone with DID.
The forums seem to be for the most part almost a free for all and I am gonna say this with no disrespect intended to anyone but it some cases it sure seems "alts" are mighty convenient with behaviors they would not want to admit to. My DID is anything but and my "alts" can sometimes hurt the people I hold so dear to me. Does that mean that that all should be like me? Of course not. However bad behavior is that and if it always is when you want it to be I really have to question the validity. But if you do that on a forum, even in a respectful way it's as if you have torn someone from the path of the holy grail.
True freedom is rare. A honest free discussion about DID with reasonable critique is so very rare. It's why I come here I don't want to accept everything without
me or someone else questioning.
Thank you and I hope nothing I typed appears disrespectful. I promise that was not my intent.
Thanks for your comment.
I didn't see the Halle Berry movie, though it did look like it might be promising.
I do think forums can be extremely helpful. I see now that this post may imply that I place no value on them, which isn't the case. There is something very reassuring about hearing from other people and seeing that you're not alone. That kind of connection is powerfully healing and I hope I haven't inadvertently discounted it.
Having said that though, I will also say that when peer support is the only source of psychoeducation - whether that be forums or chats ... or blogs ;) - that's where we run into problems. And I don't think that's somehow exclusive to Dissociative Identity Disorder. Anytime we consume information from only one group, or one perspective, we can't possibly have a balanced picture. Add in the misinformation that is so easily propagated - again not exclusive to DID - and you may end up with not just an unbalanced picture, but a truly inaccurate one. If all I knew about DID was what I have learned from peer forums, chats, and blogs I would believe DID is multiple people living in one body, that I must have been the victim of nightmarish atrocities beyond anything anyone could possibly imagine, that every dream, intrusive image, or report from other system members represents absolute concrete fact ... and so on. None of which is true.
On the flip side, if all I knew about DID came from therapists, well I might believe the exact same things. Unfortunately there are a great many therapists who believe all of those things about DID and, in my opinion, have no business treating Dissociative Identity Disorder. But there are also a great many skilled clinicians who also employ this awesome thing called critical thinking. And those therapists have done so much for the field of trauma and dissociation, not to mention for me personally.
Oh and your point about personal responsibility is a good one. Plus, anytime you get large numbers of traumatized, hurting people together to talk about trauma and its aftermath - particularly on the internet where the illusion of anonymity makes it easier for us all to give free reign to our less honorable sides, you have a potent recipe for drama.
"It’s why I come here I don’t want to accept everything without me or someone else questioning."
Yes. Questioning, thinking critically ... so important.