First of all, what are the dissociative disorders?? The DSM-5, which is still used widely in the United States. includes: dissociative identity disorder (DID), otherwise specified dissociative disorder (OSDD), depersonalization/derealization disorder, dissociative amnesia, and not otherwise specified dissociative disorder. ICD-11, which is more commonly used around the world, includes these as well as partial DID, dissociative neurological symptom disorder, trance disorder, possession trance disorder, and secondary dissociative syndrome. Dissociation can also be a symptom across other disorders similarly to how anxiety and depression can be symptoms as well as various disorders.

Personally, diagnosis does not matter to me very much. Insurance companies care more about this and I do not utilize insurance. I care most about symptoms and your goals. However, sometimes it can be helpful to have an idea of what we are working with in order to guide treatment, so it may be useful to explore possible diagnoses in some cases. Sometimes a barrier to progress in counseling can be related to a separate set of symptoms that may be out of my scope of practice that I have to seek guidance, consultation, or possibly a referral. When it comes to dissociation or a dissociative disorder, sometimes clients who come to see me really want to “know” or “have an answer” about what they have been experiencing. This is also a situation where we will explore a diagnosis together. I have experience in utilizing the Dissociative Disorder Interview Schedule (DDIS), as well as other screeners that are deemed appropriate to rule in or out certain mental health disorders.

There are many approaches to treating dissociative disorders and dissociation. Because of the strong connection between dissociation and childhood trauma, the school of thought that I work from most is the trauma model and follows the similar phases that are mentioned in my other post on trauma therapy, but looks a little bit different just by nature of working with dissociation. There are two phases: safety and stabilization & traumatic memory processing. My approach is to be flexible between these phases. We will jump back and forth between these two phases throughout our time together and that is very typical. The first goal would be to focus on learning how to manage and engage with the dissociation- particularly when there are dissociative parts present, such as in DID, OSDD, and partial DID. We must learn to work together with all parts of ourselves and in order to do that, it is my job to earn trust and “buy in” from all parts of your system. That takes time and I am willing and able to be patient. Because of that required time, I do not rush the trauma processing phase because not all parts will be ready and able to remember those things yet. That’s perfectly okay. Each part of you decides when or if something is discussed and you always are able to set boundaries with me to say “I don’t want to talk about that.” (I learned from Ross on FRIENDS, I can pivot!) It is an ongoing goal of mine to work to maintain as much safety we can for all parts of you throughout all of our sessions, which often means we have start/stop/start again/stop again approach. It makes sense that it can be hard to learn about things that have happened to parts of us that do not feel as if they happened to you, so we have to be willing to let progress look more like a lightening bolt than a straight line upwards. Any moment of progress counts- anything is something and it matters. All parts of the self/system share a body and the more cooperation and communication that we can build, the better it feels and the less distress we experience. My goal is never going to be to force anything on you. Many clients come to me with questions or concerns about “fusion” or “integration.” I am only concerned about that if YOU want that. Many of my clients do not actually want either of these options. so that is not what we try to do. Most of my clients have be satisfy preferred the experience of having a stronger relationship internally with all parts which includes communication, collaboration, respect, and support.

I hope that this gives you an idea of what to expect when seeing me for dissociative disorders!