Chapter 11. Basic Attitude for the Treatment of Dissociative Disorder (4)

Switching of identities itself is beyond our common imagination. A patient suddenly identifies herself as a different person, with different facial expression and demeanor as well as behavioral pattern. It is in these moments that clinicians feel deeply dismayed and confused. It might be fortunate if they have supervisors or advisers who give them a proper guidance, but they are often not in such a good luck. In that case clinicians might explain to the patients that they need to make a referral to more suitable clinicians, or flatly refuse to treat the patients, saying “We don’t treat dissociative patients.” This would be another experience of abandonment for most of the patients.
By writing this way, I might sound critical to these confused clinicians. However, this confusion can be a reflection of patients’ own, and therefore, quite understandable. Patients typically have a problem of not being able to figure out who they really are, as they have so many parts inside of themselves that they cannot handle on their own. They seek someone outside to pull themselves together. What is most important is that the clinicians survive that confusion and stays on task with the patients. This way the patients can be aware of a person in whose eyes they are at least a single person. In a sense, when patients’’ different identities are given a chance to express freely, their treatment process has already been started.

Different identities should be treated as different persons

One of the things that inexperienced clinicians fear the most is patients’ switching of identities in front of them. When he took charge of a DID patient for the first time, an anxious young clinician asked me as follows. “What if a child personality suddenly shows up?” To this I replied. “Do not worry. If it is obvious to the patient that you are not ready, the patient might avoid doing anything to trouble you.”