ABSTRACT
The diagnosis of DID or other severe dissociative disorders is often undetected by psychological and medical professionals, as the usual presenting problems at intake and assessment are depression, anxiety, addiction or other co-morbid diagnoses. In addition, these clients are savvy about therapeutic approaches and goals, interpersonally vigilant and live in the parts of the brain that scan for interpersonal threat. Their constant vigilance has them tuned into the therapist’s experience with, and level of attunement to, dissociative process. Consequently, these clients will hide their true state(s) when aware of the therapist’s lack of knowledge about the disorder. These clients can be exceptionally gifted at protecting the original self, slow to trust, making for a roller-coaster ride in the healing process. The therapists who work with severe dissociative disorders have a range of responses while working with this impact of trauma; there are those who: wish for these types of clients in hopes of experiencing the fascinating process that is inherent in witnessing this extraordinary human phenomenon; have been seeing these clients without even realizing that this is who they are treating; have experience in treating DID/DDNOS but fi nd themselves, at times, overwhelmed and frustrated during the therapeutic journey; and those who treat these post-traumatic reactions and develop over time an understanding that dissociation is not an unusual or peripheral phenomenon but integral to the human reaction to trauma.
