Reading Room
Aspects of the Treatment of
Multiple Personality Disorder
by Richard P. Kluft, M.D.
page 3
Certain therapist reactions are nearly universal. 10
Initial excitement, fascination, overinvestment, and interest in
documenting differences among alters yield to feelings of bewilderment,
exasperation, and a sense of being drained by the patient. Also normative is
concern over colleagues' skepticism and criticism. Some individuals find
themselves unable to move beyond these reactions. Most psychiatrists who
consulted the author felt overwhelmed by their first MPD cases.
10 They had not appreciated the variety of clinical skills
which would be required, and had not anticipated the vicissitudes of the
treatment. Most had little prior familiarity with MPD, dissociation, or
hypnosis, and had to acquire new knowledge and skills.
Many psychiatrists found these patients extraordinarily demanding. They
consumed substantial amounts of their professional time, intruded into their
personal and family lives, and led to difficulties with colleagues. Indeed it
was difficult for the psychiatrists to set reasonable and nonpunitive limits,
especially when the patients may not have had access to anyone else able to
relate to their problems, and the doctors knew the treatment process often
exacerbated their patients' distress. It was also difficult for dedicated
therapists to contend with patients whose alters frequently abdicated or
undercut the therapy, leaving the therapist to "carry" the treatment.
Some alters attempted to manipulate, control, and abuse the therapists,
creating considerable tension in sessions.
A Psychiatrist's empathic capacities may be sorely tested. It is difficult
to "suspend disbelief," discount one's tendency to think in monistic
concepts, and feel along with the separate personalities' experiences of
themselves. having achieved that, it is further challenging to remain in
empathic touch across abrupt dissociative defenses and sudden personality
switches. It is easy to become frustrated and confused, retreat to a cognitive
and less effectively-demanding stance, and undertake an intellectualized
therapy in which the psychiatrist plays detective. Also, empathizing with an
MPD patient's experience of traumatization is grueling. One is tempted to
withdraw, intellectualize, or defensively ruminate about whether or not the
events are "real." The therapist must monitor himself carefully. If
the patient senses his withdrawal, he may feel abandoned and betrayed. Yet if
he moves from the transient trial identification of empathy to the engulfing
experience of counteridentification, an optimal therapeutic stance is lost, and
the emotional drain can be ennervating.
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