A Survey of Practices and Recommended Treatment Interventions Among Expert Therapists Treating Patients With Dissociative Identity Disorder and Dissociative Disorder Not Otherwise Specified

摘要

Little empirical evidence exists about the treatment of dissociative identity disorder and dissociative disorder not otherwise specified. Thus, we must rely on the clinical literature, which advocates a staged course of treatment. A survey of 36 international experts in the treatment of dissociative disorder (DD) was conducted to learn what treatment interventions they recommended at each stage of treatment. These highly experienced therapists recommended a carefully staged treatment consisting of three phases. In the initial phase, they advocated emphasizing skill building in development and maintenance of safety from dangerousness to self or others and other high-risk behaviors, as well as emotion regulation, impulse control, interpersonal effectiveness, grounding, and containment of intrusive material. In addition, they recommended specific trauma-focused cognitive therapy to address trauma-based cognitive distortions. They uniformly recommended identifying and working with dissociated self states beginning early in treatment. They advised the use of exposure or abreaction techniques—albeit modified to not overwhelm these complex dissociative patients—balanced with core, foundational interventions for the middle stage. The last stage of treatment is less clearly delineated and more individualized. Unification of self states appears to occur in only a minority of patients with DD. This study provides directions to pursue for future training and research on DD.