One Response

1. Lesley Says:
   April 16th, 2009 at 10:51 am

   I am always amazed at the lack of personal insight that clinicians have regarding their own contertransference issues. Just because one has never had a client with DID (or if they did, may have never considered it as a differential diagnosis in someone who has had severe trauma and/or chronic torture, which in my opinion is not best clinical practice) does not mean it doesn’t exist. I have never had a client with a diagnosis of Pica or Rett’s Disorder, does that mean it doesn’t exist? When these clinicians have such a strong negative reaction (anger at times) to the mention of DID, shouldn’t they consider what issues they have that are causing such an emotional reaction? From my experience, it is fear and lack of understanding/training. The research demonstrates that the average length of treatment before proper diagnosis is 15 years for this disorder. I think that as a profession, we should be looking at education and training to increase recognition and understanding of dissociative states when one is going to be working with trauma populations. Just as a competent practicioner would rule out underlying medical causes for depression, anyone working with chronic and complex trauma needs to understand and accept the ways it manifests and influences development. If someone ever does work with clients with DID, they will see the amazing resiliency of that client, and given the severe and chronic abuse and torture they endured, understand that the only way to survive is to develop these compartmentalized and disconnected ego states. We are only going to experience a greater number of people nationally and internationally that have had experienced chronic trauma and torture. We need to be more competent at treating this. As for malingering, this has the possiblity of occuring with all disorders (ie: “the voices told me to do it”; etc.). Of course, if there are secondary gains to any disorder, they need to be explored. Yes they are highly suggestible, because they are adept at depersonalizing and dissociating, hence the nature of the disorder and PTSD. Persons with DID usually do not want anyone to know about the alters that they are cognizant of, or about the conversations that go on in their heads. They fear people will think they are crazy and/or, as mentioned earlier by Kluft, that there whole defense system will be destroyed. As a field, I think we need to be more opened minded, more insightful, less fearful, and more concerned about the clients’ issues and experiences, than our own fears regarding this issue.

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