Structural-dissociation-informed therapy

Domain III · Humanistic, existential & experiential · Onno van der Hart, Ellert Nijenhuis, Kathy Steele · 1993 · Netherlands

What it is

This is not a single manualised therapy. It is a theory, the theory of structural dissociation of the personality (TSDP), plus the phase-oriented treatment model its authors derive from it, drawing on Pierre Janet's psychology of action. The attribution to Onno van der Hart (Netherlands), Ellert…

Format

• Format. Individual outpatient psychotherapy, built on the therapeutic relationship. Some patients need supportive care, case management or quick access to hospital instead of insight-oriented outpatient work. Phase 2 can use extended sessions, but only to titrate material more slowly, never to…
• Duration. No fixed session count is given. Treatment of complex dissociative disorders runs for years. In one published case, three years of Phase 1 work on phobic avoidance came before any synthesis, and integration was completed at five years. The authors cite Kluft's suggestion that integration…

Who practises it, and how they are trained or regulated

• Goals: safety; less self-destructive behaviour; better daily functioning; a stronger ANP (more reflective and regulated, with more energy); tolerance of inner experience; growing empathy and cooperation among parts. Traumatic memory content is not shared yet.
• Main work: relationship; psychoeducation; regulation and grounding skills; daily structure and energy management; containment and safe-place imagery; inner communication and a meeting place; early attention to aggressive and perpetrator-imitating parts.
• the client can mentalise and regulate arousal and tolerate inner experience;

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Overload. Keep the steps small.
• Delayed reactions in the next 24–72 hours.
• Ambiguous signals. Treat any doubt as a 'no'.
• Rebound avoidance after a step that went well.
• Shame that presents as hostility or withdrawal.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.