The Treatment of Multiple Personality Disorder or what today is called Dissociative Identity Disorder, is a complex and sophisticated process.
The client who presents with MPD will have had a traumatic and disturbed history.
Their therapy profile will be one of a fragile persona which is usually characterized by fragmentation and disowned parts of the self.
Indeed, with this type of character, the Therapy will be long term and complex by nature.
In its essence, the Psychotherapist, will be dealing with the client’s many and varied parts of their Personality which may be difficult and in some cases almost impossible to reach.
For the therapist there will be many Transferential processes that will occur ,and Supervision is a necessity.
Virtually every aspect of treatment depends on the strength of the therapeutic alliance which must be cultivated globally and with each individual alter or parts of the self.
In the face of severe Psychopathology, painful material, crises, difficult Transferences and the likelihood that, at least early in treatment, the alters or parts of the self may have grossly divergent perceptions of the Psychotherapist ,and test him or her rigorously, the patient’s commitment to the task of therapy and collaborative co-operation are critical.
This emphasis is implicit in a general treatment plan which has 12 steps, many of which are over-lapping or ongoing rather than sequential.
STEP 1.
Involves the development of Trust and is rarely complete until he end of therapy. Operationally it means ‘enough trust to continue the work of a difficult therapy’.
STEP 2.
Includes the making of the diagnosis and the sharing of it with the presenting and other personalities. It must be done in a gentle manner, soon after the patient is comfortable in the therapy and the therapist has sufficient data and/or has made sufficient observations to place the issue before the patient in a matter-of-fact and circumspect way. Only after the patient appreciates the nature of his situation can the true therapy of MPD begin.
STEP 3.
Involves establishing communication with the accessible Alters. In many patients whose Alters rarely emerge spontaneously in therapy ,and who cannot switch voluntarily, hypnosis or hypnotic technique without hypnosis may be useful.
STEP 4.
Upon gaining access to the alters, step 4 concerns Contracting with them to attend treatment and to agree against harming themselves, others, or the body they share.
Some helper personalities rapidly become allies in these matters, but it is the therapist’s obligation to keep such agreements in force.
STEP 5.
History gathering with each alter is step 5 and encompasses learning of their origins, functions, problems and relations to the other alters.
STEP 6.
In step 6, work is done to solve the alters’ problems. During such efforts prime concerns are remaining in contact, sticking with painful subjects and setting limits, as difficult times are likely.
STEP 7.
Involves mapping and understanding the structure of the personality system.
STEP 8.
With the previous seven steps as background, therapy moves to step 8 which entails enhancing interpersonality communications. The therapist or a helper personality may facilitate this. Hypnotic interventions to achieve this have been described, as has an internal group therapy approach.
STEP 9.
Involves resolution towards a unity and facilitating blending rather than encouraging power struggles. Both hypnotic and non-hypnotic approaches have been described. Some patients appear to need the latter approach.
STEP 10.
In step 10, Integrated patients must develop new intrapsychic defences and coping mechanisms, and learn adaptive ways of dealing interpersonally.
STEP 11.
Concerns itself with a substantial amount of working-through and support necessary for solidification of gains.
STEP 12.
If all steps are actually achieved then follow up and Psychological support will be absolutely necessary and essential.
In Conclusion, my experience working with these type of clients very few will complete the 12 steps.
Usually full integration of the disowned parts of the self will be too hard to bear, and the loss and grief of the different parts of their self will be too overwhelming,for this full integration, in some cases hospitalisation is often needed.
For most MPD clients an understanding and a better way of communicating with the different parts of the self could be seen as Psychotherapeutic cure, certainly this option will enhance their life.
Bob Cooke 1994
