What a controversial topic within the field..
I can still remember speaking to my supervisor about a client who had DID and he told me "DID is not real." I very much beg to differ. While DID is NOT a common diagnosis or anything like you see in the movies, I have had the privilege of working with numerous DID clients. There is a direct correlation between trauma and DID which is probably why I have seen so many in my career compared to others.
What is DID?
Let's first break down dissociation. Dissociation is a defense mechanism when we can't use fight or flight. It is our fail safe. Dissociation is also a continuum; on the low end we have daydream state. I think we can all relate to daydreaming in school or on a car ride. This continuum goes all the way up to black out/amnesia where client's report they don't remember their childhood or big chucks of time.
DID can happen as a result of severe abuse endured by a child. Essentially, what happens is the ego splits into parts. Your ego is your conscious self or your identity. These parts are able to protect the child from the abuse they are enduring. Often times the parts are not aware of one another and by themselves can be cataphoric.
How do you work with DID?
The most important aspect of our work together is the relationship. It is important for you to feel comfortable and to have a level of trust with me. Once this is built, we explore the different parts as they emerge. Our goal in therapy is to unify the parts together and merge them into one. This thought is often terrifying to the parts and can takes years to accomplish.
How do you know if you have DID?
Most clients are not aware that they have DID unless they have done prior work or had prior knowledge about DID. Most client's seek therapy due to trauma and/or trauma related symptoms. In discussing trauma, I explore the topic of dissociation. If you are experiencing high levels of dissociation, I administer a dissociation screener that can give us clarity on diagnosis such as DID. We then review the DSM and see if you meet criteria for the proposed diagnosis.
What does treatment look like?
Every client's journey is unique to them and their situation. Typically, we explore the following:
1. Build trust + therapeutic alliance
2. Understand & explore parts as they emerge- what do they want for the client?
3. Support autonomy and independence, but also teamwork between the parts
4. Explore pros and cons to merging between parts
5. Explore roles and allow play
6. Learn calming strategies to minimize anxiety & dissociation
7. Continue to foster EGO and who client wants to be through their collective parts
There are many modalities that will come up/be offered in our work together as the process unfolds. If you have questions or feel like you may be struggling with DID, please reach out today.