The Tactical-Integration Model for the Treatment of Dissociative Identity Disorder and Allied Dissociative Disorders

By Fine, Catherine G. | American Journal of Psychotherapy, Summer 1999 | Go to article overview

The Tactical-Integration Model for the Treatment of Dissociative Identity Disorder and Allied Dissociative Disorders


Fine, Catherine G., American Journal of Psychotherapy


The ebb and flow of the diagnosis of Dissociative Identity Disorder (DID) and other dissociative conditions has led to the evolution of theories and treatment modalities to resolve the fluctuating and ephemerous symptoms of these conditions. This paper summarizes the structured cognitive-behavioralbased treatment of dissociative disorders that will foster not only symptom relief but also an integration of the personalities and/or ego states into one mainstream of consciousness. This model of DID therapy is called the tactical integration model; it promotes proficiency over posttraumatic and dissociative symptoms, is collaborative and exploratory, and conveys a consistent message of empowerment to the patient.

The diagnosis of Dissociative Identity Disorder (DID), a chronic, complex dissociative psychopathology accompanied by disturbances of identity and memory (1,2), is increasingly acknowledged according to a current survey by Rossel (3). Nonetheless, it remains a controversial diagnosis in the field of psychology. The diagnostic dispute over this trauma-based disorder (4) is neither new, nor readily settled. The phasic nature of the emergence of the diagnosis of DID in the medicopsychological literature spans centuries (5,6). The diagnostic interest of medical professionals and its ebb and flow is as much a function of the rise of new theories and conceptualizations in psychology (magnetic somnambulism, hypnosis, mental disaggregation) as it is a reflection of the sociopolitical climate of the time (feminist movement, Vietnam War, False Memory Syndrome). Each contextualized reemergence of this dissociative diagnosis brings with it a more complete understanding and perhaps a novel perspective on a disorder where the afflicted patients struggle with multiple-reality disorder (7,8) and live under the influence of various self-generated hypnotic realities. It is within these mutable realities that DID patients attempt to problem solve and function.

This malleable psychological background underscores the need for cautious and planful interventions (9,10). A successful therapy will, by intent, bring to the forefront what is hidden, be it conceptualized in terms of personalities, conflicts or alternate realities. DID patients' overwhelming life experiences then need to be metabolized and reabsorbed and reprocessed by them through contextualized abreaction and subsequently processed into their main stream of awareness (10-14). For the DID patient to emerge with a sense of completeness and wholeness requires cautious disequilibrating and frequent restabilizing of the system of mind with sequential and overlapping revisiting of both traumatic and nontraumatic material.

A few models of DID therapy have emerged as facilitating this meticulous process of integration. These are the tactical-integration model (10,13,14), the strategic integration model (15), and a personality-based ego-state model (16). The first two models are geared to promoting the complete integration of the individual as a whole, the latter aims for a functional and satisfactory cohabitation of the various personalities and/or ego states. It is important to recognize that when working with DID, two things stand out with respect to the organizing treatment models: 1. even though the therapist's preferred model of treatment is relevant, particularly to the therapist, the disorder itself will impose the therapeutic interventions (17,18); and 2. the therapists need to be fluent in the traditional psychodynamic and cognitive perspectives (12) aided by a clear understanding of hypnosis and the rules governing trance states to best help this patient population negotiate their own stability@ Attention to the structure and assumptions (10,12) that underlie the tactical-integration model are further elaborated in the following section.

The foundational blueprint from which the tactical-integration model emerges is a modified cognitive-therapy module (10-12,14) where the more structured and purposive the therapy work is, the better it promotes a sense of safety, predictability, and consistency for the patient. …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

The Tactical-Integration Model for the Treatment of Dissociative Identity Disorder and Allied Dissociative Disorders
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Author Advanced search

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.