ABSTRACT
I discuss foundational principles for understanding the process of psychotherapy for dissociative identity disorder (DID). I review the importance for DID psychotherapists to be educated in discrete behavioral states theory, psychodynamic psychotherapy, hypnosis, attachment theory, betrayal trauma theory, affect theory – especially about shame – coercive control, and social and cultural factors that affect DID patients. Discussing the mind inevitably involves metaphors; metaphors influence how we conceptualize and communicate about DID. I discuss ways of understanding and talking about self-states and how to conceptualize DID self-states developing in a DID child, who is beset with unpredictable but inevitable betrayal, threat, and danger from attachment figures. I describe the individual with DID at the levels of self-states, self-state systems, and the whole human being. I review studies of the psychological profile of DID that indicate a unique, disorder-specific psychological structure with both posttraumatic and dissociative liabilities and substantial resilience that illuminates and reinforces the utility of the evidence-based, tri-phasic trauma treatment model. Developmental dissociative processes appear to preserve important psychological capacities, consistent with the understanding that DID patients can be successfully treated with a supportive-expressive, trauma-dissociation focused treatment.
