Re:DID protocols - many questions

Some therapists emphasize "model building" for treating DID (Dissociated Identities Disorder) patients. One model emphasizes the following points:

1. Dissociated identities were created and exist in contexts.

2. Contexts trigger, support, or inhibit the identities.

3. It is important to recognize, record, replay, and repeat context signals many times in therapeutic situations.

4. People experiencing DID need to learn a key "bind" that maintains DID.*

*Memories and beliefs about traumas and events are often distorted and make focusing on lost (dissociated) experiences intolerable.

Self-blame, guilt, and shame are often induced by others. For example, a person may have been manipulated, conditioned, drugged, and forced to do something, then made to FALSELY remember that they "wanted" to do the unacceptable behavior that he or she really DID NOT WANT to do. At other times people have been made to FALSELY believe that they did something that they really did NOT do.

The BIND is that the person, without understanding the context, unfairly believes his or her own behaviors were freely chosen. Contexts trigger identities (sets of behaviors), however, feelings of guilt and shame arise to prevent fully remembering, understanding, and integrating the identities and events.

Relief from distress may be a matter of repeatedly staying with the self-exploration in a safe and understanding environment. Some models build in a plan to routinely remediate the pre-conditioned tendency to block out the awareness (dissociate) and avoid the emotional pain.

Inexperienced therapists may feel frustration with people with DID, because they often seem to temporarily lose therapeutic accomplishments (that’s hard on the therapist’s ego). Experienced therapists look for opportunities to kindly bridge the divide between present awareness and lost (dissociated) experiences.

Usually DID will not be recognized by EMDR or other clinicians. There is also the possibility that screening for dissociation that overly emphasizes the self-report methods will not accurately assess some dissociated patients. They may not have sufficient integration of dissociative episodes to report them.

Training in indirect and non-verbal dissociative assessment techniques may be useful for many therapists. Though EMDR therapists seem to have a variety of concepts and methods (e.g., differential responses to bilateral stimuli) that may facilitate assessment of dissociation.

Replies:

Re:DID protocols - many questions, by Dispersion, 08/31/03 Re:DID protocols - many questions, by , 08/31/03 Treatment of DID with Neurotherapy, by , 09/01/03 Re:Treatment of DID with Neurotherapy, by Sandra Paulsen Inobe PhD, 09/02/03

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