Working with DID is extremely complex. To be effective, the DID therapist must be willing to use a variety of techniques, be flexible in their approach, and have a good understanding of systems work, family systems therapy, communication theory, cognitive therapy, psychoanalysis, behavior modification, reality therapy, client centered therapy, etc, etc, etc. In other words, you will use everything you ever learned, and you will still need to learn more. You will need to learn about addictions, sleep disorders, eating disorders, brain disorders, physical illnesses, nutrition, psychopharmacology, art therapy, music therapy, movement therapy, massage therapy, sex therapy, theology, dream analysis, etc., etc., etc.

Obviously, no one person is going to be professionally trained in all of those arenas, so use adjunct therapists and doctors as much as you can. If other specialists are not readily available, it is your responsibility to do as comprehensive treatment as possible. Work hard to provide your clients with thorough treatment that allows for deep and creative healing – they will need it and most definitely deserve it.

The reasoning is this: severe and prolonged trauma and abuse affects absolutely every aspect of the person. There will not be one area of their life that has not been scarred in some way by the effects of abuse. The damage caused in each part of the body, brain, mind, or spirit will have a domino effect on other parts of the body, brain, mind, and spirit. Everything gets entwined with everything else. Separating any one particular issue out and isolating it away from everything else may lead to a false impression of what is actually happening in the whole. In fact, there are layers upon layers upon layers of interacting complexities and hidden unknowns.

While acknowledging the reality that so many different disciplines must be integrated to complete the healing of severely traumatized people, AbuseConsultants.com will focus on how to do effective DID psychotherapy. Meanwhile, the therapist often stands in the center of the hub of healing activity and must be mindful of all the areas of need within their dissociative clients.

The following list depicts the areas of therapeutic expertise needed to work with dissociative disorders and to heal or change the various negative effects of prolonged, severe abuse. If you would like to learn more about any of these issues or techniques, click here for a clinical consultation.

How to recognize dissociative symptoms
How to diagnose Dissociative Identity Disorder (DID)
Treatment issues in the early stages
Treatment issues in the middle stages
Treatment issues in the late stages
Integration issues
The importance of blending
How to encourage co-presence and decrease problematic switching
How to lower amnesiac barriers
How to eliminate time loss
How to improve internal communication and inner dialogue
How to get to know the internal system
How to explore the possibility of ongoing current abuse
Ongoing treatment issues with people who are currently being abused
Gaining safety from current involvement with organized perpetrator groups
Working with self injury issues
How to manage suicidal ideation
How to manage homicidal ideation
How to make effective contracts with the individual and/or the system
How to process trauma and abuse memories
How to safely process their intense emotions and feelings
How to work with blocked, repressed, or dissociated emotion
How to work with internalized anger
How to distinguish excessive fear from realistic fear
How to hear the different levels of communication presented at the same time
Visible and audible clues to know when someone has switched to another part
How to learn the language of each individual client – the telling without telling
How to decipher the cryptic clues you are given in session material
How to recognize irreconcilable conflicts that cause the need for splitting
How to make sense of the system as a whole
How to understand the purpose, function, and necessity for each part
How to transform the trauma-based learning into healthy behavior
Working with child parts
Working with teenage parts
Working with adult parts
Working with the host of the system
Working with perpetrator introjects
Working with the core system parts
How to gain external stabilization for the client
How to gain internal stabilization for the client
How to improve internal safety
How to decrease system conflict and internal fighting
How to eliminate the power of triggers
How to recognize programmed messages and statements
How to reduce, overcome, and eliminate the power of programming
How to restructure and challenge unconscious beliefs
How to recognize cognitive distortions
Working with cognitive distortions
Working with trauma re-enactments and “acting out”
How to work with time distortion and time confusion
How to recognize the existence of overlapping “time zones”
How to re-orient dissociated parts to the current time, place, date, etc.
How to gain a clear, sequential awareness of time and events
Clarifying what is real, what is not real, what is fact, what is not fact
Separating actual trauma memories from imposed, false, or screen memories
How to work with body memories
Techniques to address the male / female confusion
How to reconnect with the physical body, physical feeling, and physical awareness
Helping the client to feel proud of, pleased with, and happy with their body
Working with sexual abuse issues
Working with physical abuse issues
Working with emotional abuse issues
Working with neglect issues
Working with ritual abuse issues
Working with commercial exploitation issues
How to recognize childhood prostitution and child pornography issues
Working with trauma-related addiction issues
Working with trauma-related eating disorders
Working with trauma-related depression
Working with trauma-related bipolar
Working with trauma-related anxiety
Working with trauma-related phobias
Working with trauma-related sleep disorders
Working with trauma-related detachment issues
Defining the role of the spouse, friends, and other support people
Defining who the perpetrators are or aren’t
Defining what abusive actions and violent behavior are or aren’t
Defining what victimization is or isn’t
How to move the client past learned helplessness to responsible behavior
Typical complications in familial relationships with DID people
Typical complications in social relationships with DID people
How to improve the client’s dysfunctional or ineffective social/relationship skills
The importance of the DID parent to protect their children from ongoing abuse
Teaching appropriate parenting skills – not allowing a repeat of dysfunctional / abusive parenting
How to work with medical issues and physical complaints
Learning the effects of trauma on the brain
Teaching independence and self reliance
How to improve their daily functioning skills
Teaching the importance of employment and/or daily productivity
Working with spiritual issues
Working with philosophical issues
Using art in your sessions
Using music in your sessions
Using journaling in your sessions
Using collage in your sessions
Using play in your sessions
Using psychodrama in your sessions
Using physical movement in your sessions
Using metaphor in your sessions
Using cinema therapy in your sessions
Using bibliotherapy in your sessions
Using safe physical touch in your sessions
Using safe food in your sessions
How to work with internal visualizations
How to work with kinesthetic communication
How to build trust and rapport with the entire system
How to handle accusations, transference, and anger directed at the therapist
How to respond to the “are you a programmer?” issue
How to offer reassurance and comfort
How to recognize unhealed wounds
How to manage the crises and ongoing chaos
How and when to set appropriate limits and boundaries
Managing your own countertransference issues
Maintaining your own self care

We hope that AbuseConsultants.com will become a training resource for you or any other therapist you know. Please do not hesitate to contact us if you need your own support during your work with severe trauma and abuse. We know how hard the work is for everyone.

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