DID-oriented therapy that elicits alters

Domain XVI · Historical, discredited & harmful

What it is

This guide concerns a contested question, not a single named therapy. Lilienfeld (2007), in a provisional list of potentially harmful therapies that he called "a work in progress", included "dissociative identity disorder-oriented psychotherapy". The concern, as set out by the sociocognitive…

Format

• Safety and stabilisation. Goal: reduced self-harm and suicide risk, better management of dissociation and emotion, daily functioning. The ISSTD model's first phase is symptom stabilisation; the TOP DD programme aims to help lower self-harm and suicide risk and manage dissociation and emotions. Move…
• Format and length. Individual outpatient psychotherapy is the documented format; the TOP DD Network was a web-based psychoeducational adjunct to individual therapy. Beyond the averages above, session number and length follow the client's needs and the setting.

Who practises it, and how they are trained or regulated

• Late 1980s-1990s, treatment practices and litigation. Critics documented that alters per case rose during treatment, that most patients reportedly knew nothing of their multiplicity before treatment, that a small number of clinicians made most diagnoses, and that hypnosis was associated with more reported abuse and larger alter counts. Malpractice suits followed: a Chicago psychiatrist's patients, treated at…
• The psychotherapist's task here is not to choose a camp but to assess carefully, avoid suggestive elicitation of identities or memories, put safety and functioning first, and help clients and families harmed by suggestive practice. Change, in this guide's frame, comes from accurate non-leading assessment, a stable and transparent relationship, safety and emotion regulation, and paced work on trauma and identity that…

Evidence status, as the guide reports it

• 2007-2016, evidence contest. Lilienfeld (2007) listed DID-oriented psychotherapy as potentially harmful; Dalenberg et al. (2012) concluded there is "strong empirical support" that trauma causes dissociation and little support for the fantasy model; Brand et al. (2016) classed iatrogenesis and…

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?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• 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

• compliance masking distrust. Working when the client disagrees with you safely.
• delay because memories are uncertain. Working when risk is reported and the therapeutic relationship survives.
• psychoeducation becoming a new script the client performs. Working when the client applies ideas to their own life.
• retaliation; client harm continuing during delay. Working when practice changes or the concern is formally reviewed.
• risk rising after trauma-focused sessions; amnesia for self-harm. Working when the client uses the plan and risk falls.

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.