When Treating Dissociative Identity Disorder, What Do You Do First?

One of the toughest challenges therapists face when they begin to work with clients who are DID is deciding where to begin. The first thing you want to do after you’ve assessed and diagnosed them is to carefully explain the concept of “parts” and the physiological mechanisms that create them. I say carefully because it might scare them to hear you talk about parts as a piece of their difficulty. I introduce the topic by saying, “We all have parts. I have parts. You have parts. The woman in the office next door has parts. Parts are a fact of all of our lives.” Then when I have normalized the concept of parts, I begin to explain how their parts work.

The purpose is to give clients insight into exactly what’s going on with their bodies, as well as their psyches. There is nothing more frustrating than having a dilemma and not understanding it. Obviously if clients can begin to understand what is going on, they begin to feel more comfortable with the process.

What I do is explain exactly what the parts are: that they are neural bundles that form and become distinct personalities that split off from the adult or “Going On With Normal Life” part.

I then tell them how severe trauma shuts down the Corpus Callosum so that the left brain and the right brain are not communicating. For example, just about every DID client has an Angry part. This is the part that unconsciously gets kicked off if something upsetting happens. These people will find themselves suddenly overly angry for what those around them might see as no good reason. The client will get as angry at the person standing in front of them as they were at the person that abused them in childhood. They cannot make the distinction between the two because the corpus callosum is not functioning and the left and right sides of the brain cannot communicate.

So you want your clients to understand the parts in their head and explain what those parts do to them. I use a chart that has the different characteristics of the parts and show clients which description on the chart matches up with the part they are experiencing when they are dissociating. You want to do that so they can understand what is happening to them—why they go unconscious, why the parts take over, and how the parts get triggered. These triggers are experiences or emotions that appear to be similar to what they experienced when they were being abused. When the emotion comes up, the parts come up. The parts are behaving in the present as though the abuse that happened years ago is occurring right now.

When you begin treatment by explaining the nature of the parts and the neurological basis for the problem they are experiencing, it begins to give the client a mechanism for understanding themselves and they can begin to feel at least a modicum of control.