A therapist could have a long term relationship with a client for treatment of other diagnoses such as Borderline Personality Disorder, substance abuse, eating disorders, depression, suicide, panic attacks, phobias, Post-Traumatic Stress Disorder (PTSD), child abuse, etc., before the dissociative disorder gets correctly diagnosed. Rather than cause further trauma by referring them to another therapist specializing in dissociative disorders, after the original therapist has treated the client for years, the therapist can assess and diagnose early in the treatment. It is always a good idea to have an assessment period even if the therapist specializes in the treatment of dissociative disorders because it may take time to uncover whether the client has been cult abused or is still involved in a cult. The latter would be grounds for terminating therapy.
It is always a good idea to have an assessment period even if the therapist specializes in the treatment of dissociative disorders.
Therapists also need to be willing to help clients go into a trance, whether with guided imagery or hypnosis. State Dependent Learning Theory teaches us that a person who is traumatized often goes into a trance and represses the memory of the trauma into the unconscious. Thus the client needs to go into trance to reach the memory of the abuse. A client can present with no memory of child abuse or awareness of any dissociative parts and the therapist can facilitate the client into a trance and discover that there are parts that hold the memories of the abuse. Anyone who has been abused as a child has a higher risk of having MPD or DDNOS.
Many therapists have MPD or DDNOS and do not become aware of it until they are treating these clients or until they have been assessed with a trance to find subpersonalities or ego states. If the therapist has a dissociative disorder, he needs to work through his memories and integrate those parts as much as possible before treating clients with dissociative disorders. It is very difficult for any therapist to do this work without going through some extensive therapy. By focusing on his own inner child and working through his childhood deficit he can then tolerate the emotional depth and strong dependence these clients need to transfer on to him.
MPD clients are often extremely sensitive to the therapist’s incongruities. Clients often have extreme fears of abandonment and are very vulnerable to narcissistic injuries or disruptions in the relationship with the therapist. These clients often have different age or sex subpersonalities that have dual diagnoses, e.g., a thirty year old woman can have a teenage boy alter that has a borderline personality and the therapist might be talking to the adult woman when the younger alter takes offense to what the therapist says.
The therapist needs to be able to work with the client’s fear of psychosis or work through a psychosis. If the therapist is not a psychiatrist, he needs to work closely with a psychiatrist for medications and hospitalizations. The therapist needs to be trained in hypnosis and dissociative disorders so he is able to empathize with the client’s feelings of fear and threat about having other parts. The more centered the therapist can be because of confidence in his training, the better. The best training after learning the basics is the experience of working with MPD or DDNOS clients and consulting with more experienced therapists.
It is important for a therapist to normalize the possibility of MPD when introducing the notion to a client.
I use many generalizations such as the diagnoses themselves for the sake of training and presenting information, but each client is unique and can teach the therapist a great deal. Each person has her own self that has a natural tendency toward actualization and fulfillment. Some of these clients have been so injured at so young an age that their potential for self‑realization is debatable and they are untreatable for a variety of reasons.
It is important for a therapist to normalize the possibility of MPD when introducing the notion to a client. One way is to give the example of people passing out when they have extreme physical pain. Likewise, people split or dissociate when they suffer from a trauma such as physical, emotional, or sexual abuse as a child. The client needs to be informed that a person can undergo trauma and develop separate parts that might also have repressed the memories from their consciousness or awareness. These parts can be so separate that they have their own identities and personality characteristics that vary in body image, age, sex, and other ways. MPD is a very creative way to cope with extreme traumas in childhood. Many MPD clients are geniuses and Dr. Braun has shown how each alter uses a different part of the brain.