Treatment

Clinical experience and research have shown that this disorder is treatable
to full remission, and therefore the prognosis is more hopeful than with
some other psychiatric disorders. The negative side of treatment is that it
takes a long time, usually five to seven years and in some cases longer. The
guidelines for treatment established by the International Society for the
Study of Dissociation call for psychotherapy two to three times a week for
several years.

The initial goal of psychotherapy is stabilization, to stop any destructive
behaviors such as suicide or other forms of self-harm. The intermediate goal
is to become aware of the alters, counsel their individual needs, and then
bring about cooperation and communication between alters to make daily
functioning more effective. The long-range goal is to bring about the integration
of all split personalities into one unified personality. Integration is
the combining of all aspects of the self, even the ones that may seem destructive
or feel great pain. The goal is not to get rid of certain alters, as every part
is an aspect of the self and needs to be integrated into the self.
Part of treatment consists of recounting and processing the memories of
abuse. Ignoring past abuse is not helpful. However, this memory work needs
to be done slowly and carefully, going at a pace that does not overwhelm the
client. One goal is to keep the client functioning as normally as possible in
daily life. Mistakes have been made by therapists who go too fast, too far, and
who focus on talking about memories without addressing other needs, such
as helping clients stabilize, encouraging cooperation and communication
of alters, gradually integrating alters, teaching toleration of uncomfortable
emotions, and instilling new coping mechanisms other than dissociating.
The therapist should not suggest to the client that he or she was abused but
should let the client discover this on his or her own.
Hypnosis may be used as part of the treatment, but it is not required. Experienced
trauma therapists talk easily with the various alters and usually
learn to recognize the different parts with little trouble. The switch between
alters most often, but not always, is subtle and not dramatic. Psychiatric medications
are often used as an adjunct to talking therapy, to help with the
symptoms accompanying DID such as depression and anxiety. As DID is a
disorder caused by personal experience, it is not cured by medications.
What does not work is ignoring or denying the presence of alters, focusing
only on the present and ignoring the past, trying to get rid of so-called
bad alters, and exorcising alters who are psychological entities. Obviously, a
person with DID will succeed best in counseling with a psychotherapist who
is experienced and has specialized training in the treatment of trauma disorders.