This was originally posted on our Forums in response to a thread on finding therapists. The author was anonymous, but given their experience, it felt like capturing it in the KB would be worthwhile.
Here is my take on this question. To start, I am a therapist who specializes in working with DID and without medications. I have been working in mental health for over 35 years and have been working with CPTSD and DID specifically for the last 15 years.
There are several points I’d like to make, but first of all, I’d like to address this and maybe some DID folks can relate to this.
Many DID folks of course are highly functioning, contrary to Hollywood portrayals, which we know are mostly nonsense. Unfortunately, when most DID systems finally come to realize they need help it’s because they feel absolutely unsafe and unable to trust anyone. In the beginning, they often look 1st for any way possible to do it themselves. Which is a big mistake but an understandable one since the function of the system was to keep replicating evolved parts to manage emotions and events.
So it’s best not to be a do it yourselfer in this regard. One needs a guide to walk the path out of the Divine Comedy. This is not like going to HOME DEPOT, you need outside help to heal attachment trauma. You also need someone to help you become conscious of what you are unconscious of. I mean I get it, the abuse that takes place to create Dissociative Identity Disorder in someone is usually the most horrific kinds of trauma. So it’s really hard to trust. Also I mostly work with many DID people who have become disillusioned by therapists who say they can help you but really have no training in assessing or working with DID. In reality, therapists and counselors do not get any training whatsoever in either DID assessment or treatment in graduate school or PhD programs. That is the real truth. All training in working with trauma and DID is separate and expensive training you must do on your own outside of college. I was fortunate that the therapist who trained me also had recovered from DID.
As I’ve written before, DID is the white whale of therapy, so all therapists want to have the experience of working with it. Everybody wants to see what switching really looks like because they have seen movies and think switching is florid and dramatic as actors like to make it seem; but the truth is, more than half of all mental health professionals actually don’t believe in the scientific evidence that demonstrates DID is a real phenomenon! I know many of you already know this. Sadly they don’t believe it’s real. If you just read through all the DID posts on Quora, you’ll find lots of psychiatrists and 1st year psychology students who post on quora questioning whether or not it’s actually real. It is bizarre and tragic that DID is actually stigmatized by mental health professionals themselves. Especially when it is included in the DSM 5 because of years of cross-cultural scientific evidence. However, there are still many good and sincere people out there who do want to help. Here is some important stuff to know related to the question ask when seeking help:
1. Most DID clients are misdiagnosed with Bipolar disorder and Borderline disorder. This makes sense when you understand the DID diagnosis very well because parts don’t want to reveal themselves. But the parts inside do want to protect the internal family system from continuing to get abused. So usually one part stays up all night in bed watching with the eyes open for the attacker to come into the room. A protector part. So when you report that you often go without sleep and work a lot and do a lot and there is some psychotic symptoms you will get this diagnosis. Usually one or two of the parts have a really hard time managing and processing emotions; so that combined with Attachment trauma create a Borderline Personality Disorder DX for another part or 2.
2. You can get help through working with a therapist who has training in somatic psychology. You can understand this more by reading what this is on my website, we have a good section explaining this. Seattle Trauma Counseling: A Place to Begin Healing ; Look at the section entitled What are the differences between normal talk therapy and Somatic therapy?
3. There are 2 essential forms of therapy that are necessary to recover from the trauma your system has experienced.
Somatic psychology and Ego State therapy (also called Internal family systems or parts therapy). Somatic psychology works with the body instead of talking and generally speaking some somatic schools teach how to work with DID. There are various methods within somatic psychology and some work better than others. So EMDR and Brainspotting are both examples of somatic methods that treat trauma and can help DID, however it’s still best if you screen the therapist and see if they have some training in working with DID. You should also assure them you are not dangerous to work with and that you just need help. The Barebones or one method that almost always includes an understanding of how to work with parts is called Ego state therapy or Internal Family Systems. Anyone with this training can handle working with DID and when I train clinicians I require them to get some training in this as a foundation. Some other good methods that can help people with DID is Sensorimotor psychotherapy, Trauma release exercises (TRE). This one overall is a necessity, I feel, to learn as it helps parts to discharge past trauma held in the body. The beauty of this method is you really don’t have to talk at all for it to work. EMDR in my opinion is still a form of exposure therapy and can be hard on a system if they have worked 1st to develop safety.
4. Safety. The famous developmental psychology researcher Pierre Janet told us that there are 3 important phases to trauma work:
1) Creating safety and stabilization within
2) Resolving trauma memories.
3) Integrating new learning with the consciousness.
With DID a healthier system will start to develop more compassionate co-consciousness.
I would say that any therapist you work with should start at the beginning just trying to helping you to to feel some sense of safeness in your body. Safeness is the foundation of trauma work with DID. Trying to help parts to feel safe and help each other is the most important phase of treatment.
5. Finally, and this is the big one, When you interview your therapist, you should know that anyone worth their salt as a therapist isn’t going to try to get rid of or ignore your parts. They are simply going to try to help parts become an internal family system. They are going to try to help you find the way to accept and help one another. No ones going to try to take away from you what you have created to protect you from danger. Its going to be OK, but you’ve got to try to hang in there with a therapist for at least 6 months and give it a try. A therapist with training in working with DID should be interested in meeting and getting to know your parts without fear. It is a necessity because often each part needs its own therapy to release whatever it is holding. As each part is in a way, a set of compartmentalized emotions. I really hope this is of help to some people and I also want to say that there are good therapists out there who care about DID people and want to work with them and help them.