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Section 8
Treatment Interventions for Dissociative Identity Disorder

Question 8 | Test | Table of Contents

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In the last section, we discussed transference.  This section will covered working with transference in multiples, principles of treating transference, and precipitants of transference reactions, as well as techniques for keeping the client straight and being real with the client. 

In this section, we will discuss ‘talking through.’  ‘Talking through’ or talking to the personality system as a whole can be an effective and useful technique in working with a DID client.  As I describe some methods of ‘talking through,’ you might consider how it can be useful in making contracts, in establishing principles or boundaries, in informing the client about events affecting the therapy, and in working with the client in times of crisis. 

First, however, I would like to ask you to consider the following.  By assuming all personalities are listening in the session forces the therapist never to make interventions or remarks that he or she would not wish all of the personalities to be aware of.  This becomes the basis of ‘talking through.’  ‘Talking through’ is a technique to ensure that as many alters as possible are actually listening. 

♦ 5 Steps for ‘Talking Through’
First, let’s discuss the steps for ‘talking through’ to ensure that as many alters as possible are actually listening.  Do you recall my colleague George from the last section? 

Step 1: When George implements ‘talking through,’ he begins by stating, "I want everyone in there to give me their full and undivided attention.  I want everybody listening."  George preferred to repeat himself several times.  George had no way to know whether all of the alters were listening, but he found that enough became tuned in to achieve the desired effect. 

Step 2: George also specified that if any alters were unable to listen, then someone else in the system should take responsibility for informing them of what they need to know. 

Step 3: After he feels he has the personality system’s attention, George tells the client what he wants to communicate.  George stated to me, "Some clients will become silent and motionless.  Others may appear particularly attentive.  These are good signs that you have the system’s attention. 

Step 4: Then you might want to repeat your message several times at different levels of abstraction. In other words, reword your message so that it can be understood by each personality." 

Do you think it may also be helpful to ask some of the adult alters to help the child alters understand whatever it is they need to know? 

Step 5: Finally, you might consider, as George does, inviting all the alters who have questions or comments to come ‘out’ and speak directly.  It should become clear pretty quickly whether you have gotten your message across. 

♦ Advantages and Obstacles of ‘Talking Through’
Next, let’s examine some advantages and obstacles of ‘talking through.’ to ensure that as many alters as possible are actually listening  You might find the advantages to talking to the personality system as a whole somewhat obvious.  ‘Talking through’ saves time and energy.  ‘Talking through’ addresses the client as a whole.  Therefore, it fosters internal cooperation and coconsciousness, which, as you know, will help lead to eventual unification of the personality system.  ‘Talking through’ may also help you reach alter personalities that you may not even suspect exist.

A major obstacle of ‘talking through’ that I encounter is when the personality who is ‘out’ during the ‘talking through’ process is an amnesic host personality who may not accept his or her diagnosis.  Would you agree that talking through an unaware host to the rest of the personality system may produce strong feelings of depersonalization or passive-influence phenomena? 

For example, my colleague George treated an amnesic host who became upset on a number of occasions and told him to stop it because he was causing the client discomfort.  George stated, "I responded by asking the host to relax and listen quietly.  Often the host will go into a trance-like state during the process of talking through and will be amnesic for much of the content.  Would you agree that it is therefore worthwhile to make sure that the host has also heard the message directed to the larger system?

♦ Application of ‘Talking Through’
In addition to steps for ‘talking through’ to ensure that as many alters as possible are actually listening and advantages and obstacles of ‘talking through,’ let’s examine an application of ‘talking through.’  An example of how another therapist, Evelyn, used ‘talking through’ involved a newly diagnoses DID client.  The client’s name was Nancy, age 32.  Evelyn was not familiar with Nancy’s personality system.  Nancy reported that she kept finding herself in the parking lot of her old employer, miles away from where she was supposed to be at that hour.  Nancy’s current employer had threatened to fire her if she continued to be late for work. 

In therapy, Evelyn was unable to elicit an alter who took responsibility for these actions.  Evelyn decided to ‘talk through’ Nancy, the amnesic host, to the personality system as a whole.  Evelyn explained that she did not know many of them yet, but that collectively she would require them all to make sure that they made it to work each day on time.  Evelyn continued to explain that it was necessary to keep a job if they as a group were going to be able to remain financially independent and continue in treatment. 

Evelyn later stated to me, "The mini-arguments ceased.  At a later point, I met the alter who was responsible for these episodes."  When I asked Evelyn about this alter’s reason for being in Nancy’s former employer’s parking lot, Evelyn responded, "'He had been dealing drugs in the parking lot." 

In this section, we discussed ‘talking through.’  ‘Talking through’ is a technique to ensure that as many alters as possible are actually listening. 

Dissociation in Posttraumatic Stress Disorder Part I: Definitions and Review of Research

- Carlson, E. B., McDade-Montez, E., & Dalenberg, C. (2012). Dissociation in Posttraumatic Stress Disorder Part I: Definitions and Review of Research. Psychological Trauma: Theory, Research, Practice, and Policy, 4(5), 479-489. Retrieved May 9, 2019, from https://www.ptsd.va.gov/professional/articles/article-pdf/id39378.pdf.

In the next section, we will discuss memory assembly.  We’ll first identify characteristics of memory fragmentation, and then we will examine two techniques for memory assembly.  The two techniques for memory assembly that we will discuss are the affect bridge and the memory bridge.
Reviewed 2023

Peer-Reviewed Journal Article References:
Brand, B. L., Myrick, A. C., Loewenstein, R. J., Classen, C. C., Lanius, R., McNary, S. W., Pain, C., & Putnam, F. W. (2012). 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, 4(5), 490–500.

Gazzillo, F., Dazzi, N., Kealy, D., & Cuomo, R. (2020). Personalizing psychotherapy for personality disorders: Perspectives from control-mastery theory. Psychoanalytic Psychology. Advance online publication. 

Goodwin, B. J., Coyne, A. E., & Constantino, M. J. (2018). Extending the context-responsive psychotherapy integration framework to cultural processes in psychotherapy. Psychotherapy, 55(1), 3–8.

Hardy, K., Meyer-Kalos, P., Adams, C., Elliott-Remes, R., & Gingerich, S. (2021). Brief report describing the integration of two psychotherapy evidence-based practices within coordinated specialty care services for early psychosis. Psychological Services, 18(2), 164–169.

Herman, J. L. (2012). Review of Special issue: Guidelines for treating dissociative identity disorder in adults (3rd revision); Rebuilding shattered lives: Treating complex PTSD and dissociative disorders; and Understanding and treating dissociative identity disorder: A relational approach [Review of the books Special issue: Guidelines for treating dissociative identity disorder in adults (3rd revision), , Rebuilding shattered lives: Treating complex ptsd and dissociative disorders, , & Understanding and treating dissociative identity disorder: A relational approach, by International Society for the Study of Trauma and Dissociation, J. Chu & E. Howell]. Psychoanalytic Psychology, 29(2), 267–269. 

MacIntosh, H. B. (2015). Titration of technique: Clinical exploration of the integration of trauma model and relational psychoanalytic approaches to the treatment of dissociative identity disorder. Psychoanalytic Psychology, 32(3), 517–538. 

QUESTION 8
What is a useful assumption regarding remarks and applicable interventions in a therapy setting with a DID client? To select and enter your answer go to Test.

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