One of the most commonly cited treatment orientations for Dissociative Identity Disorder is psychodynamically aware psychotherapy. This approach often eclectically incorporates other techniques, while still understanding the client according to the psychoanalytic model. For example, cognitive therapy techniques can be modified to help patients explore and alter their dysfunctional, trauma-based belief systems, and can be modified to fit dissociative clients.
According to John Turkus M.D.:
"The heart of the treatment of dissociative disorders is long-term psychodynamic/cognitive psychotherapy facilitated by hypnotherapy."It is often the case that survivors need three to five years of intensive therapy work with this approach.
The goals of this approach are:
- Symptom stabilization
- Control of dysfunctional behavior
- Restoration of functioning
- Improvement of relationships
- To prevent further fragmentation and
- To facilitate integration of the different states of consciousness.
This approach to treatment aims to resolve the dissociative episodes and to integrate the alter personalities into one fully functioning personality. This might involve recall and exploration of previous traumatic experiences that seemed to be responsible for particular splits in the client's personality. Psychoanalytic approaches suggest that the dissociative experiences may be alleviated or better controlled if the client is made aware of them and helped to work through them. This is done by breaking down the barriers that were developed in an attempt to prevent the client from exchanging information from one alter to another (or to her). The client needs to become aware of the alter personalities and begin to accept their presence in her life. Finally the client needs to learn to react to stress and conflict in a more adaptive way. The therapist needs to attend to the client's feelings of depravation and her sense of internal conflict, as well as to her experience of alter personalities and history of trauma.
Developing a cognitive framework is an essential part of stabilization. This involves sorting out how an abused child thinks and feels, undoing the client's damaging self-concepts, and learning about what is "normal." Stabilization is a time to learn how to ask for and seek help and build support networks. The stabilization stage may take a year or longer -- as much time as is necessary for the patient to move safely into the next phase of treatment.
The clinician needs to carefully reframe DID as a creative survival tool rather than as a disease or stigma. The client needs to be guided to a place where she can accept each of her alters and develop a healthy respect for each of them as a part of her internal system. Each alter must also be treated equally by the clinician, whether it presents as a delightful child or an angry persecutor.
In the second stage of treatment the client would learn mastery over and detoxification of her traumatic experiences. This needs to be done slowly enough so not to disrupt her ability to function optimally. Stage three is where the work of integration begins. Interpersonal problems are resolved and the therapeutic dynamics and the transference issues take on classic psychoanalytic patterns. According to Richard Kluft, it is in this phase that the client would be helped to learn to live without the intrusions of alter personalities and would learn to make decisions and to experience feelings on her own without reservation or fear.
Enabling the client to retrieve and rework early trauma is often referred to as abreactive therapy. Abreactions are a way in which the client might be able to release her trauma induced, emotional pain and allow her dissociated trauma to flow back into the "normal memory track." An abreaction might be described as "the vivid re-experiencing of a traumatic event accompanied by the release of related emotion and the recovery of repressed or dissociated aspects of that event" (Steele & Colrain, 1990). Hypnosis might help the client to safely contain the abreaction and to release the painful emotions more quickly. This type of work needs to be done skillfully and cautiously, in a way that prevents retraumatization and gives the client a feeling of mastery. The reworking of the trauma involves the client sharing her "abuse story," and disabling unnecessary shame and guilt (Kluft, 1993) Throughout this level of work, the integration of memories and may occur. This is where the client may begin to substitute healthy coping skills for dissociative ones; and begin to learn new life skills.