Psychotherapy as a Treatment for Dissociative Identity Disorder
To be sure, there are many approaches to the treatment of dissociative identity disorder including massage therapy. However, the best treatment for DID appears to be psychotherapy.
What is Psychotherapy?
In this article, we shall discuss psychotherapy, aka talk therapy, the modality people most often think of when the treatment of dissociative identity disorder. Psychotherapy is certainly the go-to treatment option and it comes, as we shall see, in flavors and types.
Administered by psychiatrists, psychologists, and other mental health professionals offer therapy, as a form of treatment.
This type of treatment uses psychological methods to aid people in changing their behaviors, emotions, and thoughts that cause them distress and problems. Psychotherapists administer therapy alone or with medications depending on the struggles the client goes through during treatment.
During a psychotherapy session, a client talks to a licensed mental health professional and they help them to identify and change troubling thought patterns. Also, in these sessions, the therapist begins to form a relationship with their client to build trust while they analyze their client’s problems and offer suggestions on how their client can overcome their emotional difficulties.
The Primary Functions of Psychotherapy
Psychotherapy has primary goals. We shall examine five of these goals and what each means and entails.
To Help You Know Yourself Better. Few people know about themselves as those who have entered and remained in therapy until they have resolved what drove them there. Psychotherapy forces you to take a long, hard look at yourself with all your shortcomings and triumphs. This accomplished feat, through hours of discovering who you are, involves talking about all aspects of who you are as a person.
To Alleviate Psychological Pain. Most people who enter therapy are suffering from life circumstances that drove them into a therapist’s office. This pain is just as real as physical pain and hurts in fashions that keeps one from working, living, or loving appropriately. Psychotherapy eases this pain by allowing the client room to express hidden emotions that the person dare not approach on their own.
Helps in Understanding the Psychological Issues At Play. Before entering therapy, the client may or may not understand what is happening to them. All they recognize is the symptoms but not the underlying causes or how to correct the problem. Psychotherapy not only allows the person to dissect their problems, but to understand that they are not their diagnosis and eventually move past what is hurting them.
Helps the Client Learn Better Coping Mechanisms. People who enter therapy have devoted their existence to avoiding their pain and use unhealthy coping mechanisms such as substance abuse or detrimental dissociation. Psychotherapy teaches the client better coping mechanisms such as establishing and maintaining boundaries and practicing mindfulness.
Helps the Client Establish a More Accurate Understanding of Their Past and Their Future. In the therapist’s office, in the presence of their trusted therapist, clients face their past head-on and must work through the accompanying emotions. After grieving the past, the client is then ready to move on into the future. Most therapists will encourage their clients to dream and make plans for the future as they are working through their issues. This instills hope and aids in the healing process (Kuei et al., 2019)
Other Types of Therapy
Therapy comes in many flavors and forms. For the purpose of this course, we shall examine a few types of therapy; especially the ones that impact the treatment of dissociative identity disorder. It is critical to note that the first step in any of the following therapies is to stabilize the client, especially those with dissociative identity disorder to lessen or prevent suicidality.
Cognitive Behavioral Therapy (CBT). CBT is a form of psychotherapy that is effective for a wide range of psychological problems. Studies have shown that CBT leads to significant improvement in functioning and quality of life.
The core principles on which CBT is based include the following (this list is not all-inclusive).
• Psychological problem’s main cause is faulty or unhelpful ways of thinking.
• Psychological problems are tend to worsen with unhelpful behavior and learned patterns.
• Psychotherapy can alleviate psychological problems by learning better ways of coping.
The entire purpose of CBT is to learn new behaviors by changing thinking patterns.
Dialectical Behavioral Therapy (DBT). DBT is a modified form of CBT and is primarily used to treat older adolescents with chronic and debilitating self-harm and suicidal thoughts and increased conflict with other people. DBT is used to treat depression, eating disorders, bipolar disorder, post-traumatic stress disorder, and complex trauma. DBT is helpful in treating DID because it treats accompanying and cooccurring mental health disorders. Dialectical Behavioral Therapy teaches communication skills and how to manage painful emotions which causes conflicts with others with a focus on mindfulness and emotional regulation.
Eye Movement Desensitization and Reprocessing (EMDR). This form of therapy involves the use of eye motions and sometimes tapping to engage traumatic memories along with the physical and emotional sensations that accompany them. This form of therapy will not be suitable for most people with dissociative identity disorder because it can allow too many harsh memories to surface at once causing great distress to the client. However, those who have achieved stability may benefit from this form of therapy especially if they have become stuck in their therapeutic process.
Internal Family Systems Therapy (IFS). Developed by Richard Schwartz in 1980, IFS observes patterns in how people describe their lives and the conflicts they experience with subpersonalities that they have inside of them. According to this model of treatment, the subpersonalities that each one with its own viewpoint. Also involved in internal family systems therapy is the notion of a core self which one must access first because this is the host in a dissociative system. The therapy is meant to bring peace among the families of alters in a DID system (and other people as well as we are all made up of parts). IFS promotes internal connection and harmony to bring peace and balance (Schwartz, 2013), (Schwartz & Sweezy, 2019).
The Therapeutic Alliance
There is nothing more important in the progress and success of psychotherapy than the therapeutic alliance. A study conducted in 2018 covering more than 30,000 clients found a hearty and consistent positive link between the therapeutic relationship and positive client outcomes. This finding was consistent across all counties and treatment modalities used (Fluckiger et al., 2018).
The therapeutic alliance shows the collaboration and partnership between the client and their therapist. This alliance has received three features that include:
• Alignment of treatment(s) they will use.
• Agreed upon treatment goals.
• An emotional bond between the client and their therapist.
The description of mutual agreement and alignment describes shared decision making where the therapist offers suggestions and information and develops the treatment goals and processes for their client. The client shares their thinking on subjects relevant to their lives and mental health challenges being able to share these experiences because they feel safe and connected due to the therapeutic alliance.
With a good therapeutic alliance, the client can face any memory and work through the reasons they are feeling badly. With the treatment of dissociative identity disorder this alliance is crucial.
One last note on the therapeutic alliance. If you do not believe your client can get well, it is time to pass them to someone else. The client will absolutely know how you feel reading it in your body language and other clues and will fulfil your thoughts and will not make progress.
Integration
The subject of integration is much misunderstood among clinicians and clients alike. In the movies and on television, integration involves all the alters in a DID system suddenly coming together to form one cohesive person. However, this is impossible as the client has missed the developmental milestone where they become integrated from the disintegration of early childhood.
Naturally dissociated in early childhood (before ages 7-9), these children have imaginary friends and pretend. As their brain matures, if there is no interference, they will integrate their parts into one cohesive person.
However, if the child learns to use dissociation as a coping mechanism to hide inside from the abuse they are enduring, they will not integrate and miss a vital milestone in the development of their sense of self.
Integration is not as it seems according to popular media. Instead, integration is, at its core, the full acceptance by the client that all their alter’s feelings, thoughts, trauma, memories are their own. It is during integration that the person with DID learns to take responsibility for their actions, no matter which alter is in control.
Integration is not a sudden event but rather happens over time in the office or at home. The client accepts reality as a better place to live than in the fantasy prone dissociation they have used all their lives.
No one dies as a result of integration, neither is anyone forced to comply with the integration process. Alters, who were separate from the whole received an invitation to join the core self as a part of the whole which will cause them to find the safety they have always wanted.
To help you to understand integration better, read the Orchestra Illustration of Integration.
The Orchestra Illustration of Integration
There was once an orchestra who wished to make beautiful music together. However, there was a problem, they could all play their individual instruments very well, but they were all playing different musical pieces as they couldn’t agree on what to play.
The result was a chaotic cacophony of noise that pleased no one.
Then one day, one member of the orchestra had a wonderful idea, they would hire a maestro to lead the group.
The orchestra looked for a long time to find the perfect maestro who believed in them and would help them play together to end the chaos. Finally, they found a maestro who cared about them and wanted to help.
The first day, when the maestro raised his baton and began to attempt to lead the orchestra. Although they had sought him out, the orchestra ignored him for the most part and played their own musical choices. The sound was noise that hurt the maestro’s ears.
The maestro did not give up. Each day he would get up on his pedestal, pick up his baton, and advise all who would hear him about how to play one same musical piece. Day after day, the maestro taught the orchestra.
Then one day, after hard work and cooperation, when the maestro picked up his baton, the orchestra cooperated together and played a beautiful piece by Bach. The entire orchestra and the maestro were in tears not just because the music was lovely, but because they understood that they were one cohesive orchestra.
One day the maestro passed his baton to the original leader of the orchestra and left them to play music together.
The orchestra, though made up of many parts, worked as a whole to become popular playing their lovely music together.
The maestro is the therapist and the orchestra is their dissociated client.
References
Flückiger, C., Del Re, A. C., Wampold, B. E., & Horvath, A. O. (2018). The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy, 55(4), 316.
Kuei, T., Tsai, M., McLeod, H. J., White, R. G., & Kanter, J. (2019). Using the primary process emotional–behavioural system to better meet patient needs in psychotherapy. Clinical psychology & psychotherapy, 26(1), 55-73.
Maldonado, J. R., Butler, L. D., & Spiegel, D. (2002). Treatments for dissociative disorders.
Schwartz, R. C. (2013). Moving from acceptance toward transformation with internal family systems therapy (IFS). Journal of clinical psychology, 69(8), 805-816.
Schwartz, R. C., & Sweezy, M. (2019). Internal family systems therapy. Guilford Publications.
Subramanyam, A. A., Somaiya, M., Shankar, S., Nasirabadi, M., Shah, H. R., Paul, I., & Ghildiyal, R. (2020). Psychological interventions for dissociative disorders. Indian journal of psychiatry, 62(Suppl 2), S280.
U.S. Department of Health and Human Services, National Institutes of Health, Reviewed January 2023. Psychotherapies. Retrieved from: https://www.nimh.nih.gov/health/topics/psychotherapies#part_2490
Wedding, D., & Corsini, R. J. (2013). Current psychotherapies. Cengage Learning.