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During the past decade, there has been a growing recognition of posttraumatic psychopathology (Terr, 1991). The relationship between early severe psychological trauma and dissociative disorders has been firmly established (Spiegel, 1984, 1990). The identification of posttraumatic syndromes in general, and dissociative disorders in particular, has been on the rise (Kluft, 1984; Putnam et al., 1986). As a result, interest in the treatment of these conditions has been reawakened. To date, however, there have been very few analytically oriented case studies that review the treatment of individuals with the most severe dissociative disturbance, multiple personality disorder (Marmer, 1980a, b; Berman, 1981).
It is the purpose of this paper to describe the clinical presentation and inpatient treatment of a patient with multiple personality disorder in order to highlight the characteristic clinical features and the primary psychotherapeutic concerns. Particular attention will be paid to the complex dissociative mechanisms employed in response to early psychological trauma. In this regard, the posttraumatic origins and defensive functions of alternate personalities will be explored. Attention will be paid to transference themes that arise in the course of the psychotherapy with a patient with dissociated ego states, including consideration of transferences