Dealing with Alters: A Pragmatic Clinical Perspective

Temple University School of Medicine, Philadelphia, PA, USA.
Psychiatric Clinics of North America (Impact Factor: 2.13). 04/2006; 29(1):281-304, xii. DOI: 10.1016/j.psc.2005.10.010
Source: PubMed


The treatment of DID is facilitated by therapists' being prepared to work directly with alters. Interventions that access and involve the alters in the treatment are vital components of the successful treatment of DID and should be a part of the therapeutic armamentarium of those who treat this patient population.

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    • "Careful phenomenological assessment of patients with DID as compared with psychotic patients shows many salient differences between the psychotic experience of Schneiderian passive influence and that of dissociative patients (Loewenstein, 1991b). Moreover, because DID voices reflect dissociated aspects of self, attending to these voices can provide insight and enable these patients and their therapists to gain a fuller, developmentally based perspective on the issues of the patient as a whole (Kluft, 2006). "
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    ABSTRACT: Patients with dissociative identity disorder (DID) are often diagnosed with borderline personality disorder (BPD) and misdiagnosed with psychotic illnesses. This study is designed to determine whether the Rorschach protocols of 67 patients with DID differ from those of 40 patients with BPD and 43 patients with psychotic disorder (PSD) in variables reflecting capacity for working alliance, complexity of experience, and ability to reason despite traumatic flooding. As theoretically and clinically predicted, the DID group could be distinguished from the PSD sample by the DID group's significantly higher level of traumatic associations alongside their more logical reasoning (e.g., Trauma Content Index [TCI], WSUM6). In comparison to the BPD group who, by definition, were also likely to dissociate and struggle with other trauma based symptoms, the DID sample showed greater social interest (Sum H), self-reflective capacity (FD; Form Dimension), ability to perceive more accurately and think more logically (X-, WSUM6). The authors discuss the treatment applications of these findings and make suggestions for further research.
    Full-text · Article · Sep 2009 · Psychological Trauma Theory Research Practice and Policy

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    ABSTRACT: RESUMEN: En los últimos años cada vez más estudios empíricos de paises muy diferentes están mostrando una prevalencia importante de los trastornos disociativos y en particular del Trastorno de Identidad Disociativo (antes personalidad múltiple). Pese al encendido debate en torno a este diagnóstico, los datos son claros y consistentes. Más allá de la discusión sobre estos estudios en el presente artículo nos centraremos en el tratamiento de estos cuadros. La importancia de identificar adecuadamente estos trastornos es que el esquema de tratamiento tiene especificidades respecto a otros abordajes y que la efectividad de estos tratamientos es mucho mayor que la de aquellos que se centran en otros síntomas disociativos del paciente, ignorando la fragmentación. Abstract In recent years many empirical studies of very different countries are showing a significant prevalence of dissociative disorders in particular Disociative Identity Disorder (formerly multiple personality). Despite the intense debate around this diagnosis, studies results are clear and consistent. Beyond the discussion of these studies, in this article we will focus on the treatment of these disorders. The importance of properly identifying dissociative disorders is that treatment regimen has specificities over other approaches and that the effectiveness of these treatments is greater than that of those who are focused on other dissociative symptoms of the patient, ignoring fragmentation.
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