Given that therapists generally receive no training in treating DID, I searched some Internet
sites for “Treatment of DID” so as to get an idea of what they might find.

For example, here is one site: https://my.clevelandclinic.org/health/diseases/17749-
dissociative-disorders. With respect to treating DID, it says:

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“Your therapist can help you understand what you’re experiencing and why.
Therapy also gives you the space to explore and understand the different
parts of your identity that have dissociated, and ultimately, to integrate
them.

Dissociation is your body’s way of distancing you from an intolerable
experience, which is an effective survival strategy in the moment — but
over time, chronic dissociation can form separate identities from your
“core” or “main” personality, leading to the symptoms of DID.

Besides helping you understand the reasons behind your dissociation,
your therapist can help you deal with dissociative states and develop
useful coping mechanisms.

Your treatment plan will be based on your own unique needs, but may
include:
 education about dissociation and DID
 body movement therapy to release trauma that’s held in the body
 relationship support
 trigger management
 impulse control
 mindfulness and self-awareness
 coping methods to tolerate difficult emotions

Some specific therapies used to treat DID include:
 cognitive behavioral therapy (CBT)
 dialectical behavioral therapy (DBT)
 eye movement desensitization and reprocessing (EMDR)”
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Generally speaking, the information is ok as far as it goes. But, it fails to give practical
guidance for novice therapists. It neglects to clarify two key points a therapist must keep in
mind. In brief, one must know to whom you are speaking as the therapist, and one must
know the common issues that need to be addressed in DID treatment.

First, include DID as part of one’s index of suspicion in meeting with patients. This
doesn’t mean to have it as the main or primary focus in your index of suspicion. An
index of suspicion is simply maintaining a reasonable awareness of potential diagnostic
considerations. Given that studies indicate that DID is as common as schizophrenia,
you should keep it in your index as much as you keep schizophrenia in your index.

If you, as the therapist, suspect that you may be speaking with a DID individual,
you must assume and conduct yourself based on the fact that you may be speaking to a
host as well as a group of alters. The approach you take needs to include the view that
you are possibly talking to far more than the individual you see in front of you. Why is
this so important? It is because a DID individual is a composite system made up of the host and all the alters. An awareness of the composite nature of such a system is key to establishing the initial
therapeutic alliance with the parts you are able to engage. Therapy is not circumscribed to just one part – host or otherwise. The key point in DID therapy is to engage the alters when and as they present.

To establish and nurture such a therapeutic alliance, be clear in your own
understanding. If you are talking to the host or a single alter, there are others also
watching, listening, and evaluating you. Maintaining awareness of this paves the way to
invite the parts that may be in the background to consider engaging directly or indirectly,
as they deem necessary, with the therapist in psychotherapy. The decision for a
background part to engage is connected directly to how safe they feel within the
therapeutic alliance/environment. This critical point is frequently missed or ignored by
those who deny even the diagnostic criteria of DID that is laid out in the DSM.