Dissociative disorder not otherwise specified (DDNOS) and dissociative identity disorder (DID) have been studied greatly over the past decade. Experts agree that these psychological challenges are most often the results of traumatic events and clients with DID or DDNOS respond best to treatment that targets the trauma. “Cross-sectional and longitudinal data from a large, observational international sample of DID and DDNOS patients indicated decreased symptoms of dissociation, posttraumatic stress, depression and general distress, reductions in rates of self-injury, suicide attempts, and hospitalization, and improvements in adaptive functioning over 30 months of treatment,” said Bethany L. Brand of the Psychology Department at Towson University, and lead author of a new paper outlining the most effective forms of treatment for DID and DDNOS. “In this article, we use unification to describe the process of a person’s sense of self shifting from that of having multiple self-states to that of a unified self.”
Brand interviewed 36 clinicians who specialized in the treatment of DDNOS and DID. “These DD experts generally recommended a structured, stage-oriented treatment for patients with DD consisting of three basic phases,” said Brand. “In the initial phase, they advocated for emphasizing skill-building in the areas of emotion regulation, impulse control, interpersonal effectiveness, grounding, containment, challenging trauma-based cognitive distortions, and maintaining safety. Additionally, they suggested that clinicians identify and work with dissociated self-states beginning early in treatment to foster internal communication and cooperation among disavowed parts of self.” She found that the experts recommended using exposure techniques combined with core interventions during the middle stage. “The last stage of treatment was less clearly delineated and more individualized, although this may be an artifact of limited data about the later stages.” Brand said that, although full unification rarely occurs in the majority of clients with DID, the partial resolution of self-states provides direction and a foundation for future treatment.
Brand, B. L., Myrick, A. C., Loewenstein, R. J., Classen, C. C., Lanius, R., McNary, S. W., Pain, C., & Putnam, F. W. (2011, December 5). A Survey of Practices and Recommended Treatment Interventions Among Expert Therapists Treating Patients With Dissociative Identity Disorder and Dissociative Disorder Not Otherwise Specified. Psychological Trauma: Theory, Research, Practice, and Policy. Advance online publication. doi: 10.1037/a0026487
© Copyright 2011 by By Noah Rubinstein, LMFT, LMHC, therapist in Olympia, Washington. All Rights Reserved. Permission to publish granted to GoodTherapy.org.
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