Understanding and Treating Dissociative Identity Disorder: A Relational Approach

Understanding and Treating Dissociative Identity Disorder: A Relational Approach

Understanding and Treating Dissociative Identity Disorder: A Relational Approach

Understanding and Treating Dissociative Identity Disorder: A Relational Approach

Synopsis

Building on the comprehensive theoretical model of dissociation elegantly developed in The Dissociative Mind, Elizabeth Howell makes another invaluable contribution to the clinical understanding of dissociative states with Understanding and Treating Dissociative Identity Disorder. Howell, working within the realm of relational psychoanalysis, explicates a multifaceted approach to the treatment of this fascinating yet often misunderstood condition, which involves the partitioning of the personality into part-selves that remain unaware of one another, usually the result of severely traumatic experiences.

Howell begins with an explication of dissociation theory and research that includes the dynamic unconscious, trauma theory, attachment, and neuroscience. She then discusses the identification and diagnosis of Dissociative Identity Disorder (DID) before moving on to outline a phase-oriented treatment plan, which includes facilitating a multileveled co-constructed therapeutic relationship, emphasizing the multiplicity of transferences, countertransferences, and kinds of potential enactments. She then expands the treatment possibilities to include dreamwork, before moving on to discuss the risks involved in the treatment of DID and how to mitigate them. All concepts and technical approaches are permeated with rich clinical examples.

Excerpt

One of my patients told me that for as long as she could remember, she had always used “the ‘we’ of me” when referring to herself in her own mind. She never really thought much about what this meant; it was just one of those things. As far as she remembers, she did not hear voices as a child or overtly switch identity states (to her knowledge or to the observation of others). Even though she did derive substantial benefit from several decades of psychotherapy, she still did not know that she had dissociated identities. All she knew was that she had struggled for many years to overcome an extraordinarily difficult childhood. When her dissociated identities began to emerge in psychotherapy with me, her conscious life transformed. Although in many ways profoundly more painful, her world was now much richer, even if more complicated, with so many “people” in it who had much to say to her, to each other, and to me. The phrase she had always used to describe herself—“the ‘we’ of me”—now made sense.

This is the case with many who are dealing with dissociative identity disorder (DID). They have lived confusing, often crisis-ridden, terrifying, and quite routinely painful—even if sometimes outwardly successful—lives. Frequently, they had no idea of what was really the matter with them until some revelatory crisis took place. Some, for example, have broken down when their own child or a young relative reached the age at which they had been abused. This triggering event caused them to be flooded with unbearable memories that had been previously dissociated. One such person, before her breakdown, would openly speak without affect of how her brother-in-law had continuously raped her as a child. She proudly thought she was strong to have withstood such duress. It is true that she, or at least her defenses, were strong up to a point—the point at which her biological child became the age at which her own brutal childhood abuse began. For other people, the trigger for breakdown is different. Those who have used addictions to quell and mask unbearable feelings of horror and pain, terrifying memories, and internal voices may find that achieving sobriety unleashes the voices, the nightmares, and the undeniable presence of the dissociated parts of themselves. If they are lucky enough to be in therapy . . .

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