Diagnosis and Treatment of Dissociative Disorders: Standard Course

Learning Objectives

After taking this activity, you should be able to:

1. 1 Session 1: Diagnosis Participants will: 1. be able to diagnose DID or DDNOS (ego state disorder), using the SCID-D (Structured Clinical Interview for DSM-IV Dissociative Disorders) or other diagnostic questions about amnesia, fugue, depersonalization, derealization, identity confusion and identity alteration. 2. be able to use the DES (Dissociative Experiences Scale) to screen for pathological dissociation. 3. understand and be able to recognize common clinical presentations and co-morbid diagnoses of persons with ego states or alternate personalities typical in DDNOS and DID.
2. 2 Session 2: Initial Steps, Treatment Frame, and Treatment Principles Participants will: 1. Understand the three stage model of working with trauma and its application to work with dissociative disorders. 2. Understand the importance and practice the maintenance of appropriate therapeutic boundaries in the treatment of DID/DDNOS. 3. Be able to distinguish tactical integrational and strategic integrational approaches to the treatment of DID and DDNOS.
3. 3 Session 3: Transference and Countertransference in Trauma Participants will: 1. Understand the common transference reactions of abused persons with dissociative disorders. 2. Understand countertransference reactions to working with dissociative disorders, including personal countertransference to patients currently in treatment. 3. Be able to define projective identification, recognize it in dissociative disorder transferences and countertransferences, and formulate therapeutic responses to it.
4. 4 Session 4: Resistances in Treatment; Recognizing Factitious Presentations Participants will: 1. Be able to state five characteristics of a factitious or malingered presentation of DID. 2. Be able to state two techniques for working with malevolent alter ego states.
5. 5 Session 5: Treatment Techniques I: Communicating and Contracting with Alter Egos Participants will: 1. Understand how to use autohypnotic techniques (Dissociative Table Technique) to effect inter-ego/personality communication as part of psychotherapy. 2. Be able to negotiate behavioral contracts between alter personality states. 3. Be able to use "talking through" and other techniques to encourage co-consciousness of alter personality states.
6. 6 Session 6: Treatment Techniques II: Treatment Pitfalls & Pacing, Managing Abreactions Participants will: 1. Understand and know how to avoid common clinical pitfalls of work with dissociative disorder patients. 2. Know techniques to pace the emergence of traumatic material in the therapy of DID or DDNOS patients, including fractionated abreaction and hypnotic distancing techniques. 3. Understand the place of abreaction of trauma in the treatment of DID or DDNOS patients.
7. 7 Session 7: Working with Traumatic and Recovered Memories Participants will: 1. Know the clinical factors that are associated with the production of distorted memories and the interview techniques that minimize this risk. 2. Be able to maintain appropriate therapeutic neutrality regarding the historical veracity of recovered memories. 3. Be able to state techniques to minimize successful lawsuits related to working with recovered memories of abuse. 4. Be able to state the impact of trauma and emotional arousal on encoding, storage and retrieval of memories, and the clinical implications for processing recovered memories of trauma.
8. 8 Session 8: Treatment Modalities -- Medications and Hypnosis Participants will: 1. Understand autohypnotic imagery in DID and DDNOS and be able to utilize it therapeutically for internal communication and pacing the emergence of traumatic material. 2. Be able to state the usefulness of antidepressant, antipsychotic and anti-anxiety medications in the treatment of DID and DDNOS. 3. Understand the implications of autohypnotic distortions of reality for assessing medication side effects in DID patients.
9. 9 Session 9: Integration and Treatment; Terminations Participants will: 1. Recognize clinical signs that indicate readiness for alter personality/ego state integrations in DID and DDNOS. 2. Be able to describe at least two hypnotic images for use in assisting with ego state or personality fusions. 3. Be able to state the common dynamics leading to premature termination of treatment in DID.