Dissociative Identity Disorder: Treatment Perspective – Part 1

Once a dissociative identity disorder (DID) diagnosis is confirmed through psychological interviews and testing, a treatment strategy is formulated. 

Dissociative parts have their distinctive ways of surfacing in different individuals: a slight tilt of the head; rolling of the eyes backwards; a lowering of the head; a sudden side glance; a slightly longer blink of an eye; unprovoked screaming or shouting; just closing their eyes; identified by different names; or suddenly speaking in a different tone or voice. These are just a few examples. These parts would normally surface when the stress tolerance of an individual has been breached.

Due principally to the high hypnotisability of DID clients, hypnosis had been the preferred mode of treatment in my caseload. In fact, most clients are unaware of their innate capacity to put themselves into a trance state. Those who are co-conscious with their dissociative part(s) since their childhood days (i.e., they are fully aware when a part is out), have normalised their experiences, and think that everyone moves through life in a similar manner. A few develop a phobia towards the appearance of these parts and remain fearful, but are unable to suppress them whenever they reach an intolerable level of personal stress. Those, who are not co-conscious when their dissociative parts appear, invariably possess gaps in their memories. Often, these spintered memories are hidden deep within the subconscious of the person. In order for the practitioner to access and identify the fragmented subconscious memory of the client (i.e., the different non-co-conscious personality parts), hypnotherapy is employed. Without access to a client’s subconscious memory, integration of his fractured memories with the main memory system, for healing to take place, would be difficult, if not impossible.

Due to the switching of various dissociative parts in their memory system, it is not uncommon for a client to develop a headache, at times severe, after a counselling session, when he reverts back to his normal self. 

A highly dangerous personality part and one of the most malignant is the suicidal part. The other being the physically violent variety. Suicidal parts are not immediately identifiable, unless other co-conscious parts are aware of them and talk about them, or they self-confess when they are out. A suicidal part invariably believes that if he follows through with his suicidal ideation, he will only kill ‘himself,’ and the other parts, including the person, will live on. This is obviously a dangerous fallacy. When a suicidal part dies, life is also terminated, and in most cases, without the person realising a fatal self-harm decision had been made. So, handling a suicidal part becomes a delicate affair. When a suicidal part comes forward in a counselling session, the correct procedure would be to request the person to come forward before the client leaves the session. A case in point was when an inexperienced counsellor allowed the suicidal part to leave the counselling session, the client committed suicide that evening. 

​It would not be safe to assume that whatever information transpired in a treatment session is ‘the whole truth and nothing but the truth,’ especially in the case of a DID client. The fact is, due to the severity of abuses, and for some, the prolonged period of mistreatment, covering up, subterfuge, and exaggerations on the clients’ part, are common. Hence, what is spoken, most of the time, cannot always be taken at face value during the treatment process. I maintain that psychologists and counsellors are not detectives, and we work with whatever our clients present within each session. In most cases, misinformation will surface later when the client has experience a certain level of healing; to substantiate or further disprove the information originally disclosed. I had a client who called me up on the phone 6 months after the termination of counselling, to confess that several ‘facts’ she had disclosed in the counselling sessions were untrue. Once the memory system had been fully integrated, as far as is possible, the client is more comfortable handling the facts and issues of their abuses.