Reading Room
The Spectrum of Dissociative
Disorders:
An Overview of Diagnosis and Treatment
by Joan A. Turkus, M.D.
page 3
Treatment
The heart of the treatment of dissociative
disorders is long-term psychodynamic/cognitive psychotherapy facilitated by
hypnotherapy. It is not uncommon for survivors to need three to five years of
intensive therapy work. Setting the frame for the trauma work is the most
important part of therapy. One cannot do trauma work without some
destabilization, so the therapy starts with assessment and stabilization
before any abreactive work (revisiting the trauma).
A careful assessment should cover the basic issues of history (what happened
to you?), sense of self (how do you think/feel about yourself?), symptoms
(e.g., depression, anxiety, hypervigilance, rage, flashbacks, intrusive
memories, inner voices, amnesias, numbing, nightmares, recurrent dreams),
safety (of self, to and from others), relationship difficulties, substance
abuse, eating disorders, family history (family of origin and current), social
support system, and medical status.
After gathering important information, the therapist and client should
jointly develop a plan for stabilization (Turkus, 1991). Treatment modalities
should be carefully considered. These include individual psychotherapy, group
therapy, expressive therapies (art, poetry, movement, psychodrama, music),
family therapy (current family), psychoeducation, and pharmacotherapy. Hospital
treatment may be necessary in some cases for a comprehensive assessment and
stabilization. The Empowerment Model (Turkus, Cohen, Courtois, 1991) for
the treatment of survivors of childhood abuse--which can be adapted to
outpatient treatment--uses ego-enhancing, progressive treatment to encourage
the highest level of function ("how to keep your life together while doing
the work"). The use of sequenced treatment using the above modalities for
safe expression and processing of painful material within the structure of a
therapeutic community of connectedness with healthy boundaries is particularly
effective. Group experiences are critical to all survivors if they are to
overcome the secrecy, shame, and isolation of survivorship.
Stabilization may include contracts to ensure physical and emotional safety
and discussion before any disclosure or confrontation related to the abuse, and
to prevent any precipitous stop in therapy. Physician consultants should be
selected for medical needs or psychopharmacologic treatment. Antidepressant and
antianxiety medications can be helpful adjunctive treatment for survivors, but
they should be viewed as adjunctive to the psychotherapy, not as an
alternative to it.
Developing a cognitive framework is also an essential part of stabilization.
This involves sorting out how an abused child thinks and feels, undoing
damaging self-concepts, and learning about what is "normal".
Stabilization is a time to learn how to ask for help and build support
networks. The stabilization stage may take a year or longer--as much time as is
necessary for the patient to move safely into the next phase of treatment.
continued | back to
top | back to reading room
about me | support | thoughts on suicide |
|
