Guidelines for Treating Dissociative Identity Disorder in Adults, Third Revision: A Tour de Force for the Dissociation Field
Reading the guidelines for anything in the mental health field is rarely a pleasure. Although the reader will usually come away from reading this kind of material informed as to norms for practice in the particular area of focus, most guidelines are as dry as they are informative. As a consequence, guidelines are often written, placed in texts, and generally not often referred to.
This will not be true for the International Society for the Study of Trauma and Dissociation's latest iteration of the Guidelines for Treating Dissociative Identity Disorder in Adults. This document, the product of intensive work by some of the finest minds, most innovative researchers, and most dedicated clinicians in the fields of trauma and dissociation, is a comprehensive introductory monograph on the treatment of dissociative identity disorder (DID) and its close cousin, dissociative identity disorder not otherwise specified. The quality of the writing is superb, making it hard to believe that it was written by a committee. The document takes the reader through the history of dissociative disorders treatment and carefully and thoughtfully addresses both the commonplace elements of working with clients living with dissociation as well as some of the more radioactive and controversial issues in the field.
Although the entire document is excellent, several sections seem particularly noteworthy. The discussion of whether DID is a real or clinician-created iatrogenic phenomenon is one that I particularly appreciated and one that I believe psychotherapists and clinicians working within forensic contexts will find to be particularly helpful both in allaying their own concerns about possible iatrogenesis and also in refuting challenges from doubting colleagues who are poorly informed about dissociation. The authors do a nice job of not demonizing or getting into an intellectual struggle with that particular hypothesis about DID; rather, they carefully explore and challenge it in light of the empirical knowledge base and scientific scholarship about dissociative phenomena. A similarly thoughtful and scholarly job was done with the entire false issue of so-called false memory.
Another especially helpful component of these guidelines is their international focus. Critics of the dissociation field and those who have questioned the reality of the dissociative disorders have frequently asserted that DID is a phenomenon unique to the United States. The authors of these guidelines hail not only from the United States but also from Canada, Israel, The Netherlands, New Zealand, Sweden, and Turkey. Research on DID from elsewhere in the world is also cited, including studies from Argentina, Norway, Switzerland, Northern Ireland, Great Britain, France, Germany, Italy, Spain, Oman, Iran, India, Australia, the Philippines, Uganda, China, and Japan. This document thus puts soundly to rest the myth that DID occurs only in the United States and only because a handful of clinicians are creating it through suggestion. Rather, these many studies from both developing countries and the industrialized world make it clear that DID and other dissociative phenomena are very real, diversely human results of coping in the context of intolerable trauma.
In addition to putting forth these truly outstanding sections, the guidelines do a masterful job of instructing clinicians on how to most effectively work with dissociative clients. Without being prescriptive, and with the utmost respect for the range of theoretical orientations brought to the work of treating dissociation, the authors have found those factors that are common to best practices in work with clients with DID. The clear and unequivocal boundaries set here for dubious practices such as regressive “reparenting,” and the emphasis on the core necessity for clear, compassionate, firm boundaries and consistency, ought to be read by all practicing psychotherapists, not simply those who work with dissociation.
The field of dissociation treatment can be very proud of these guidelines. They exemplify the best in the science and practice of psychotherapy. Wise, integrative, and scholarly, they do more than offer guidance for the reader. They also serve as a source of validation and support for the many clinicians who are already working this way with dissociative clients. Our field—both clients and clinicians—owes thanks to the authors of these guidelines for their dedication, clarity, and wisdom.