I have had both friends and clients who had dissociative identity disorder. I have also come across therapists who diagnosed virtually every client they saw as DID. I wish this book had been available back in those days. The authors have been working with trauma and dissociation for a very long time. One is a past president of the International Society for the Study of Trauma and Dissociation (Steele), another a co-founder and past president of the European Society for Trauma and Dissociation (Boon), and another a past president of the International Society for Traumatic Stress Studies (Van Der Hart).
This book comes from their work with many patients over the years, as well as experience with supervision of and consultation with other therapists. They guide us on to how to work collaboratively, for “a collaborative model likely provides the most effective paradigm for adult growth, change, and development.”
I appreciate this book on so many levels. The authors have put an incredible amount of thought into not only the content, but how to organize it in a highly useful way, and the content is very comprehensive. This is a useful book for any therapist, whether they work with people with dissociation or not. The authors include case studies throughout to help us learn how to diagnose and treat people, including how to communicate with the different identities. One thing that stands out in the case studies and in the authors’ experiences is how many years it can take for a person to be properly diagnosed. The diagnosis may not be particularly easy, since some of the identities may be phobic of each other, they may not trust the therapist, etc. It left me wondering how many people with dissociative disorders I may have missed over my years of work.
Trust and boundaries are discussed extensively. There will be transference and counter transference in any work, but perhaps particularly in work with folks with dissociation. The authors tell of cases where those issues were handled well, and some where they were not, and how the authors dealt with that. I really appreciate that openness. I also appreciated their discussion of the “good enough” therapist.
They address the process of dissociation. I have come across arguments over the years that dissociation does not exist, or that everyone is dissociative because we do not behave the same with every person or the same in every situation. The authors give a clear understanding of just what dissociation is and how it manifests, and that it is not the same in every individual.
The authors’ research of the literature is extensive, as is their ability to synthesize and present it in a cohesive and understandable way. They start at the very beginning with the concept of “realization” and the effect of trauma on a person physically, mentally, emotionally — really in every sense of being — with dissociation “perhaps the most profound type of non-realization.” Each dissociative part develops its own reality, and dissociation could be called “multiple reality disorder.” Therapy becomes almost a negotiation process among parts and their relationship with each other. The authors give very wise guidance on how to do that. They also gave examples of how a person can get better even without insight.
The book provides “core concepts,” or fundamental ideas that are snap-shots of the work’s principles or a summation of the ideas presented in those pages. These are bold and set apart in the text, as are the subheadings in the chapters and the case studies. The physical structure of the book makes it very user friendly. There is also a summary at the end of each chapter and questions to make you think called “Further Explorations.” The authors’ questions deepen your experience of the presented ideas and how you do the work.
There is an appendix with sources for screening and assessment instruments, prognosis/treatment/progress rating scales, and a sample safety plan. The authors spend a good deal of time discussing the collaborative therapeutic relationship at the beginning of the book, then progresses to triaging the best treatment place for the person, and moves on to how to assess, treat, and continue to build on the relationship while also taking care of yourself and the client. They even reminded me that it is important to make plans for what happens to my clients and their records should something happen to me.
This is an amazingly organized, thoroughly researched, comprehensive, practical learning resource. What shines through to me throughout is the authors passion for the work, and their compassion for the people they work with.
Treating Trauma-Related Dissociation: A Practical, Integrative Approach
W.W. Norton and Company, November 2016
Hardcover, 560 pages