Treatment

Clinical experience and research have shown that this disorder is treatable to full remission, and therefore the prognosis is more hopeful than with some other psychiatric disorders. The negative side of treatment is that it takes a long time, usually five to seven years and in some cases longer. The guidelines for treatment established by the International Society for the Study of Dissociation call for psychotherapy two to three times a week for several years.

The initial goal of psychotherapy is stabilization, to stop any destructive behaviors such as suicide or other forms of self-harm. The intermediate goal is to become aware of the alters, counsel their individual needs, and then bring about cooperation and communication between alters to make daily functioning more effective. The long-range goal is to bring about the integration of all split personalities into one unified personality. Integration is the combining of all aspects of the self, even the ones that may seem destructive or feel great pain. The goal is not to get rid of certain alters, as every part is an aspect of the self and needs to be integrated into the self.

Part of treatment consists of recounting and processing the memories of abuse. Ignoring past abuse is not helpful. However, this memory work needs to be done slowly and carefully, going at a pace that does not overwhelm the client. One goal is to keep the client functioning as normally as possible in daily life. Mistakes have been made by therapists who go too fast, too far, and who focus on talking about memories without addressing other needs, such as helping clients stabilize, encouraging cooperation and communication of alters, gradually integrating alters, teaching toleration of uncomfortable emotions, and instilling new coping mechanisms other than dissociating. The therapist should not suggest to the client that he or she was abused but should let the client discover this on his or her own.

Hypnosis may be used as part of the treatment, but it is not required. Experienced trauma therapists talk easily with the various alters and usually learn to recognize the different parts with little trouble. The switch between alters most often, but not always, is subtle and not dramatic. Psychiatric medications are often used as an adjunct to talking therapy, to help with the symptoms accompanying DID such as depression and anxiety. As DID is a disorder caused by personal experience, it is not cured by medications.

What does not work is ignoring or denying the presence of alters, focusing only on the present and ignoring the past, trying to get rid of so-called bad alters, and exorcising alters who are psychological entities. Obviously, a person with DID will succeed best in counseling with a psychotherapist who is experienced and has specialized training in the treatment of trauma disorders.

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