Mental health articles

Treatment of DID

Not surprisingly, protagonists for and against the concept of DID have differing ideas about its treatment. Spanos, for example, contended that the goal of treatment is to help clients accept that their alter identities are real personalities rather than self-generated fantasies. By contrast, Gleaves contended that the opposite is true. He argued that the central goal of treatment should be to help the individual understand that the alters are in fact self-generated, not to convince them that they are real people. He argued that therapists working with people with DID should emphasize the fundamental nature of the disorder as a diffi culty in integrating various aspects of the personality rather than a profusion of personalities.

For most therapists, the ultimate goal of therapy is to integrate the various alters into one cohesive personality, a process known as fusion. In this state, the person is aware of all their behaviours and thoughts and accepts them as their own. Oke and Kanigsberg used a combination of play, guided imagery, life skills teaching, projective techniques and group therapy to help bring awareness and understanding of other selves, and through this eventually achieve cohesion between all alters. Unfortunately, the effectiveness of this and similar types of intervention, remains limited to descriptions of interventions with no outcome data, or case reports, which by their very nature tend to be positive (few therapists like to broadcast their failures widely, and most journals are biased against publishing ‘negative results’). Their efficacy or otherwise has yet to be fully investigated. A fundamental cautionary note about such efforts has come from people with DID. Many sub-personalities reject integration as a therapeutic goal, as they see integration as a form of death.

In support of this stance, Rossel  argued that in a disintegrating postmodern world, it is of little benefi t to attempt to achieve integration. Instead, the individual should be open to the experience of shifting between alters, which should be construed as a positive and comfortable experience, not a negative, destructive one.

Tags: dissociative identity disorder, treatment