Disorder in the Therapist's View of the Self: Working with the Person with Dissociative Identity Disorder

IN THE TREATMENT OF A PERSON with dissociative identity disorder (DID), both patient and therapist are confronted with major challenges to their routine views of having a “self,” being an “I.” To become engaged in this work, the therapist might anticipate the potential alteration of the identity and meaning of nearly everything that could be perceived as part of being human. Little of what we take for granted about our routine experience of a day is untouched. The treatment of DID is an exploration of distortions in the experience of experiencing.

The diagnostic criteria for this disorder, whether drawn from the Diagnostic and Statistical Manual (American Psychiatric Association, 1994) or the Structured Clinical Interview for Dissociative Disorders (SCID-D) (Steinberg, 1993) shed little light on the paths that need to be illuminated for the therapeutic dyad to succeed in the work of healing. Many clinicians are wary of treating a person with this diagnosis. Reasons I have heard for turning down a referral often include lack of special knowledge, fear of being embroiled in a tumultuous therapy, and refusal to engage in a treatment that has had so much negative