Dissociative Identity Disorder

Treatment
A review by Brand, Lowenstein, and Spiegal (2014) a debate about whether or not contemporary treatment methods for dissociative identity disorder are effective or harmful. In general, they found that treatment can be highly effective and beneficial, but it must be done carefully. This treatment should be trauma-informed and phasic. An example of phasic would be stabilization, working through the trauma and memories, and reintegration. With dissociative identity disorder part of the phasic treatment may involve becoming actively aware of other identities, providing specific roles to each which caters to their strengths, and consolidating as many as possible (but not getting rid of all of them).
The American Association for Marriage

and Family Therapy (n.d.) also summarizes the most common treatment methods. Psychotherapy, which includes cognitive-behavioral therapies, is often used in individualized settings to assist with the integration of different identities. This should usually involve finding techniques for the individual which are effective in helping that person work through their trauma and for managing their stress in ways beyond simply dissociating. While less common, family therapy and group therapies are also used. Family therapy can be effective in helping families of the patient be more understanding, patient, and supportive. Group therapy has been occasionally found effective for some patients in providing a non-judgemental support network; however, it has also been found ineffective for others. Medications may alleviate some comorbid symptoms, such as depression and anxiety. More controversial treatments, such as hypnosis, has also been found effective as an adjunctive treatment.
Jacobson, et al (2015) interviewed 13 patients diagnosed with dissociative identity disorder to identify effective and ineffective counseling techniques and therapist qualities.

They specifically found 17 factors which influenced effective treatment, including pacing, structure, coping skills, hypnotherapy, grounding processes, self-disclosed insight, client-centeredness, modeling, and identifying and assigning alter roles. For example, grounding processes which participants spoke about included being able to listen to meditation tapes recorded by the therapist or even calling the therapists voicemail simply to hear their voice. Hearing the voice would remind them of a sense of calm and security which is provided during therapy sessions. The techniques echo the above conclusions as well, but this study also emphasized the importance of a therapist being human. This would involve modeling appropriate emotions, such as enthusiasm; sharing enough so that the client would recognize the empathy of the therapist; and even showing sincere emotions when they are moved, including the therapist even tearing up. These helped build a positive and supportive -- but professional -- relationship, and is further improved when there are clear boundaries provided.
In essence, effective treatment will be trauma-informed, phasic, and structured with proper adjunctive methods tailored for the individual. Teaching individuals techniques for stress management and for coping with alters has proven an integral part of this as well. Finally, a therapist who specializes in dissociative identity disorder and who exercises empathy and genuine human care, builds a positive and supportive rapport, but sets professional boundaries is vital for the

process.
Conclusion
Dissociative identity disorder is a complex and often misunderstood disorder. Being polysymptomatic and exhibiting a myriad of manifestations from person to person contributes to the confusion surrounding it. While it is highly controversial as a diagnosis, it is nationally and internationally recognized by professional bodies and diagnostic manuals. Despite thoughts that treatment is actually harmful, empirical research demonstrates this is not the case. However, treatment must be executed carefully and holistically.
More research needs to be done on the etiology, symptomatology, and treatment of dissociative identity disorder. There is considerable confusion surrounding DID even within the literature and continued efforts to dispel myths will be essential. Lastly, one of the most important strides in the future will be developing consistent and agreed upon diagnostic criteria for DID, so that individuals can be efficiently and accurately diagnosed and treated.