Chapter 12. Various Therapeutic Techniques (5)

When an identity with vehement emotional expression often emerges, it is likely that the patient is currently exposed to some traumatic stress, such as bullying or power harassment at school or workplace, still living together with past abuser, and so on. The clinicians should see to it that any potentially stressful or traumatic factors should be removed or reduced in the patient’s life. If there is mood disorder or substance abuse as a co-morbid condition, that should be taken care of by the use of proper medications or necessary treatment setting.
If these measures are not effective enough and violent identities still continue to appear and its deleterious effects are serious enough, an acute and temporary hospitalization might be sought. In these cases, those who are in charge of the patient’s hospital care should be mindful about the nature of dissociative disorder including its traumatic origin, so this hospital care should not be another chance of re-traumatization for the patient.
In these situations, however, clinicians as well as family members might be able to still avoid psychiatric hospitalization by timely use of PRN medication. As far as my own experience goes, I often use olanzapine orally disintegrative tablet (Zydis) to tide over that acute violent period. If we try to avoid unnecessary hospitalization, it is worth relying on these measures.
Facilitate communication among different identities
Needless to say that facilitating communication among different identities is crucial in DID treatment. The condition of DID is like different people sharing the same body, or riding a same vehicle (see “microbus model” in the previous chapter). Usually these people do not quite know each other’s situation. Therefore, clinicians’ assistance in promoting their communication of information can be quite meaningful.
Let us further apply this situation to the metaphor of microbus. Even if different drivers are behind the wheel each time, the bus might still look the same from the outside. People assume that the bus is always headed for the same destination. Therefore it is inconvenient if a driver is not aware of what the previous driver had in his mind, where he loaded or unloaded, where he intended to go, etc.