This question, of what to look for in a therapist for DID, is a question I have asked myself as well for many years. There are clearly certain basic qualities any therapist needs in order to genuinely help their patients, but for survivors of any dissociative generating trauma and those with DID in particular, there are special concerns when considering working with any therapist.
A therapist treating DID individual needs dedication to the process, which is rarely a short term journey. It requires empathy toward the patients, positive commitment in the goal of helping another human being escape the clutches of past trauma intruding into the present, and the key ingredient of courage to do this difficult work. One thing I am confident about is that having a Master’s degree, a Ph.D, or an MD trained in providing psychotherapy, is not a guarantee that the therapist possesses any of these qualities regardless of their educational and training qualifications.
One critical aspect of DID therapy is that the depth of trauma for those with DID is beyond any conventional understanding because it is tied to the age at which the abuse occurred. Generally speaking, DID results from intense ongoing abuse that occurs at age of 5 or younger. This is not to say that other dissociative disorders do not arise when traumatic abuse occurs after that age. They do. But, it usually doesn’t result in DID but rather in another of the dissociative disorders. Because the trauma that expresses itself as DID happens to very young children, the vicarious trauma a therapist may experience is something one cannot prepare in advance for. Therefore, courage is required – the courage to keep your own heart open, to keep your own mind still, to be fully present with your DID patient as they process their trauma.
Since the 1950s, biochemistry has created specific drugs for treating the symptoms of anxiety, depression, and even delusional thinking. This has misled the public, general therapists, and even some specialists, into believing that drugs will one day adequately cover whatever we need to treat mental health disorders. Unfortunately, the more sophisticated the successes in biochemical pharmacology, the more psychiatry mistook treating symptoms for curing mental illness. This engendered a bias to rely more and more on pharmaceutical approaches to symptoms rather than to actually solving the root cause of any particular mental health problem. In fact, this approach often leads to long term misdiagnoses – and similarly long term incorrect treatment – because it easily conflates treating different disorders based on addressing primarily or only the symptoms they may have in common. It’s estimated (WebMD) that individuals with dissociative disorders have spent seven years in the mental health system prior to accurate diagnosis. This is common, because the list of symptoms that cause a person with a dissociative disorder to seek treatment is very similar to those of many other psychiatric diagnoses.
The term PTSD was first listed in the DSM classification manual in 1980. Although known to many through a few books and movies (The Three Faces of Eve as well as Sybil), it was the public attention that resulted from acknowledging the impact of war related trauma on veterans returning home that highlighted the consequences of experiencing ongoing trauma. I remember seeing a page in National Geographic showing a veteran suffering from PTSD. He was standing in front of a display of 15 bottles of pills that were supposed to help his war-trauma induced PTSD. DID, which was termed MPD even as far back as DSM-II in 1968, is now seen as a form of Complex PTSD that further engenders an internal household of multiple alters.
When looking for a psychiatrist to diagnose and/or treat DID, the chances are that you will be told one of two things. First, that DID is a “controversial” disorder, meaning that its very identification as a disorder is in question. If you find someone that acknowledges the validity of DID as a diagnostic category, you will likely be told that there are no qualified therapists to help you. You will likely get similar answers from the clinical psychology departments at Universities and from social workers with psychotherapy training. In some places, you might find a therapist with training in EMDR and CBT, approaches that are sometimes recommended (by their practitioners) for the treatment of DID.
From my point of view, EMDR and CBT are tools. When recommended for treatment of DID, it means nothing more than saying for a surgeon, a scalpel or surgical excision is one way to treat breast cancer. Depending on the circumstances, it might be helpful and it might not. I think that the qualities discussed in this extended post, if present, will push the use of any therapeutic tool to be more positive than otherwise.
A hopeful trend does seem to be emerging. Slowly, very slowly, some psychiatrists, psychologists and social workers with psychotherapy training are shifting towards understanding and adopting the theory that most mental health problems, including addictions, come from trauma and neglect.
Given that studies show there is about 1% DID in the general population (approximately the same rate as schizophrenia), why does DID so rarely show up in medical records statistics? DID diagnoses are seldom found in medical records statistics because they are missed and misplaced into other diagnostic categories, most commonly mischaracterized as Bipolar, Schizophrenia, or Borderline Personality Disorder.
Psychoses, neuroses and personality disorders are not well defined psychiatric syndromes with clear parameters differentiating one disorder from another. We must remain open to the possibility that current symptoms of anxiety, panic, depression, self destructive behavior, dysphoria, risk taking behavior, emotional lability (rapid and, to outsiders, often exaggerated changes in mood), and even some psychosis may be the result of past trauma rather than being simply the patient’s current circumstance.
To avoid the massive amount of time, effort and financial resources we are wasting due to the difficulties for someone with DID to be accurately diagnosed, we need to train specialists in psychiatry, psychology and social workers to be able to recognize and diagnose accurately a case of DID. This means looking at the constellation of symptoms, not simply stopping at the symptom that has a corresponding pharmaceutical “solution.” With that, those patients could then be triaged to specially trained therapists in the field of trauma and dissociation.
