Understanding and Treating Dissociative Identity Disorder

The Use of Attachment Theory in the Clinical Dialogue with Patients

“…These sudden disruptions are difficult to understand on the basis of previous exchanges. The conflicting activation of the defense and the attachment system together with the activation of controlling strategies lies at the root of many traumatic transferences and countertransferences (Howell, 2011). Efforts to control emotional storms might be achieved by becoming a dominant partner who is bullying and coercive in intimate relations.…”

Resonance in the Dissociative Field: Examining the Therapist’s Internal Experience When a Patient Dissociates in Session

“…Contemporary theory reformulates the therapist's dissociative countertransference as an emerging state of resonance with the patient-a reflection of her intentional presence and attunement to that which is unwelcome (Howell, 2011;Siegel, 2010). Relational analytic trauma theorists conceptualize the unwelcome and unbidden in the dissociative field as dissociated self-states, parts of the patient's (or therapist's) self that are defensively split off from the conscious day-to-day experience of oneself.…”

“…Relational analytic trauma theorists conceptualize the unwelcome and unbidden in the dissociative field as dissociated self-states, parts of the patient's (or therapist's) self that are defensively split off from the conscious day-to-day experience of oneself. Current thinking in the field of relational psychoanalysis suggests that the only way to access this dissociated content is by way of the intersubjective therapeutic relationship, and more specifically, the therapist's internal and subjective experience of the patient (Bromberg, 1998(Bromberg, , 2003(Bromberg, , 2011Davies & Frawley, 1991, 1994Howell, 2005Howell, , 2011Levenkron, 2009;Stern, 2003Stern, , 2010. These theorists argue that dissociated aspects of the patient's self will become enacted in the therapy relationship, and then be available for symbolic formulation in the mind of the therapist as the therapist engages interpersonally with the patient.…”

“…In these moments, the patient is most in need of an attuned other to promote a sense of safety and co-regulation of traumatic affect, however, dissociation intrudes upon the therapy dyad, foreclosing intersubjectivity. Emerging theory and research from the intersecting fields of interpersonal neurobiology, trauma and dissociation, and relational psychoanalysis suggest that even in a dissociative state there is a capacity for interpersonal resonance and attunement (Hopenwasser, 2008;Howell, 2011;Sands, 2010). Accordingly, the therapist's painstaking presence and willingness to enter into a patient's dissociation can promote states of resonance and understanding in the dyad, strengthening the working alliance rather than leading to withdrawal and disconnection.…”

Adapting Dialectical Behavior Therapy for the Treatment of Dissociative Identity Disorder

“…Many other valuable accounts of DID treatment exist, and were also used as references in assembling a picture of consensus practice (Boon, Steele, & van der Hart, 2011; Chefetz, 2015; Cloitre, Cohen, & Koenen, 2006; Howell, 2011; Kluft, 1999; Loewenstein, 2006; Putnam, 1989; Ross & Halpern, 2009). Our adaptation of DBT for DID introduces several therapeutic interventions and strategies which are drawn from consensus DID treatment and would be applicable in Stage 1, including “mapping the alters”, “grounding”, “containment” and “safe place” imagery.…”