Phase 1 of Treatment
If you have ever looked at a holiday brochure and imagined yourself lying on the beach, in the sunshine or perhaps swimming in the warm water, or you have looked at a car and imagined what it might feel like to drive, then you have used guided imagery, often called visualization.
Dr Onno van der Hart, a psychologist and researcher specializes in the field of Trauma and Dissociative Disorders, and has written an interesting paper on the use of guided imagery for reducing PTSD symptoms and improving daily life functioning, most of which applies to Complex PTSD as well as Dissociative Identity Disorder and Other Specified Dissociative Disorder (formerly DDNOS).
This approach is also referred to in the Guidelines for Treating Dissociative Identity Disorder in Adults (p156-158) as an auto-hypnotic technique which has been well-proven in Phase 1 of treatment. It does not involve trance-like states or investigating amnesia/gaps in memory, but instead serves as a method of self-soothing, calming and containing distress. Because this is an auto-hypnotic technique it can be used outside therapy sessions, and whilst maintaining awareness of the present and current surroundings. Anxiety can also respond well to the use of guided imagery to aid relaxation.
Van der Hart suggests the following examples of guided imagery:
- Imaginary protective gear (especially useful for emotionally younger ones)
- Inner safe places
- Containment of traumatic memories
- The imaginary meeting place (for dissociative parts/alters within DID)
- Inner community building (for dissociative parts/alters within DID)
- The inner source of wisdom
I would highly recommend reading the full article, this section starts at around the third page, under the heading ‘Guided imagery during phase 1 treatment. The book Coping with Trauma-Related Dissociation also includes helpful exercises including creating an inner safe place.
Guidelines for Treating Dissociative Identity Disorder in Adults Journal of Trauma & Dissociation, 12:115-187, 2011 (Institute of Trauma and Dissociation – large file)
Treatment of Dissociative Identity Disorder (dissociative-identity-disorder.net, our wiki)
Treatment of Dissociative Disorders Study Results (July 2014, traumaanddissociation.wordpress.com)
Forging a Deeper Understanding of Flashbacks Part I (Paul F. Dell, understandingdissociation.wordpress.com)
Structural dissociation: Division of the personality (traumaanddissociation.wordpress.com)
Phase I: Overcoming the phobia of dissociative parts (traumaanddissociation.wordpress.com)
Flashback Worksheets for Trauma Survivors (ritualabuse.wordpress.com)
Attachment-based therapy (crazyinthecoconut.co.uk)
Amnesia within Dissociative Identity Disorder explained
Originally posted on Dr. Kathleen Young: Treating Trauma in Tucson:
I am continuing the conversation about dissociative identity disorder (DID) and characteristics that make up the diagnosis. I want to address amnesia, what it looks like in DID, and the function it serves. Of course, not everyone with amnesia has dissociative identity disorder. Remember, the first two criteria, different self states and amnesia, must exist together for a DID diagnosis to be made.
According to the DSM-5, there are three primary ways amnesia present in people with dissociative identity disorder:
1) gaps in remote memory of personal life events (e.g., periods of childhood or adolescence; some important life events, such as the death of a grandparent, getting married, giving birth); 2) lapses in dependable memory (e.g., of what happened today, of well-learned skills such as how to do their job, use a computer, read, drive); and 3) discovery of evidence of their everyday actions and tasks that they do…
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Reflection in therapy: the quest for perfection and the inner critic
Originally posted on DIDdispatches Blog:
This week I’m trying to work through some issues about myself, it’s odd to think I actually put myself through difficulties by being over critical or judgemental of myself. But apparently I do self judge and it’s not good, I am also inpatient which I didn’t realise fully either until it was spelt out to me the other day.
I have known I’m self critical for some time, I mean I constantly put myself down and yet I had never realised how much I judge myself. In therapy the other day I realised that actually I am repeating behaviours from my past and judging myself. I think part of this is the fact despite thinking I now accept my Dissociative Identity Disorder, in my heart I still don’t, well not fully.
I have always wanted to be normal whatever normal is and I have always striven to just be good…
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There are times when fighting is impossible and would result in serious injury or death, and flight is impossible too. This possum isn’t choosing to freeze, it is an automatic response.
A survival mechanism, activated in the face of inescapable threat.
- The fight flight or freeze mechanism is why we dissociate, becoming more hyper-vigilant, trying to control, avoiding at all costs!! (ptsdawayout.com)
- Chronic pain – caused by trauma? (traumaanddissociation.wordpress.com)
- Trauma (dissociative-identity-disorder.net)
- PTSD (dissociative-identity-disorder.net)
- What does the Amydala do? (hypnoticthoughts.com)
- Structural Dissociation of the Personality (traumaanddissociation.wordpress.com)
- A light-hearted explanation of the traumatized mind (dissociative-identity-disorder.org)
This is a great article about the messages from a childhood of abuse – self-blame, denial, amnesia and trying to
act “normal” figure out what “normal” actually is.
All mixed in with a bit of humor…
An alternative way of communicating -Dissociative Identity Disorder
- Download our Android app mobile access to Trauma and Dissociative Disorder information
Find out more about Dissociative Identity Disorder (dissociative-identity-disorder.org)
- Ways to communicate with Alters (dissociative-identity-disorder.net)
- Alters (dissociative-identity-disorder.net)
- Overcoming the phobia of dissociative parts
Originally posted on DIDdispatches Blog:
I want this blog to be honest and open about my life with Dissociative Identity Disorder and yet there are times when it is hard to be so upfront, to write about the things we are doing. Mainly I fear being judged which I know is ridiculous and yet it is one of my biggest fears.
If I’m honest those fears are in a way making it difficult to write, because I do wonder what other people will think about me and in turn my alters, the other parts of me. All my childhood and into my adult years I was judged by one of my main abusers, she’d continually put me down and be critical. Scathing comments about my failings were a daily occurrence, it was as if everything was my fault and I was utterly useless at anything.
Now I know that those comments were wrong and…
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