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Understanding and Treating Dissociative Identity Disorder
Building on the comprehensive theoretical model of dissociation elegantly developed in The Dissociative Mind, Elizabeth Howell makes another invaluable contribution to the clinical understanding of dissociative states with Understanding and Treating Dissociative Identity Disorder. Howell, working within the realm of relational psychoanalysis, explicates a multifaceted approach to the treatment of this fascinating yet often misunderstood condition, which involves the partitioning of the personality into part-selves that remain unaware of one another, usually the result of severely traumatic experiences.
Howell begins with an explication of dissociation theory and research that includes the dynamic unconscious, trauma theory, attachment, and neuroscience. She then discusses the identification and diagnosis of Dissociative Identity Disorder (DID) before moving on to outline a phase-oriented treatment plan, which includes facilitating a multileveled co-constructed therapeutic relationship, emphasizing the multiplicity of transferences, countertransferences, and kinds of potential enactments. She then expands the treatment possibilities to include dreamwork, before moving on to discuss the risks involved in the treatment of DID and how to mitigate them. All concepts and technical approaches are permeated with rich clinical examples.
Howell begins with an explication of dissociation theory and research that includes the dynamic unconscious, trauma theory, attachment, and neuroscience. She then discusses the identification and diagnosis of Dissociative Identity Disorder (DID) before moving on to outline a phase-oriented treatment plan, which includes facilitating a multileveled co-constructed therapeutic relationship, emphasizing the multiplicity of transferences, countertransferences, and kinds of potential enactments. She then expands the treatment possibilities to include dreamwork, before moving on to discuss the risks involved in the treatment of DID and how to mitigate them. All concepts and technical approaches are permeated with rich clinical examples.
330 pages, Paperback
First published April 7, 2011
33 people are currently reading
361 people want to read
About the author
Elizabeth F. Howell
8 books21 followersA psychoanalyst and traumatologist who specializes in the treatment of dissociative disorders, Elizabeth Howell, Ph.D., is Associate Editor of the Journal of Trauma and Dissociation and Co-Director of the Dissociative Disorders Psychotherapy Training Program of the International Society for the Study of Dissociation. Dr. Howell is a faculty member of the National Institute for the Psychotherapies Trauma Studies Program and an adjunct associate professor in the psychology department of New York University. She has written and lectured widely on various aspects of trauma and dissociation. The author of The Dissociative Mind (Analytic Press, 2005), she has been awarded the Print Media Award for her work.
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Displaying 1 - 3 of 3 reviews
June 26, 2025
Possibly the most important book on trauma I've read.
Touches on:
Janet: maladaptive behaviours were vital for survival at their time of development (trauma), but are actively harmful now (ptsd).
We consist of plural identities that in a healthy environment share information amongst one another, giving us the sense of a singular self, bodily/psychic autonomy. Trauma is the dissociation of these identities from one another.
All trauma involves dissociation (disconnections between identities, which lead to amnesia and emotional dysregulation), but not all dissociation is caused by trauma (dissociation can be a healthy psychic reaction to stress).
Children who have been traumatised have a strong attachment to their abusers because when children experience abuse they respond with attachment, the need for a site of security. The abuser, who is often also the carer, becomes a site of intense terror and need, and this relationship, of defenseless child and powerful persecutor, is reconstituted in the psyche of the child (bpd characterology).
The pathway to system resiliency/self-integration involves: 1) symptom reduction (of emotional dysregulation [depression, anxiety, rage], depersonalisation/derealisation, suicidality, helplessness), 2) internal reconnection (of identities and memories) and grieving (for what was lost due to trauma), 3) rebuilding of an (external) social base.
All psychic phenomena are embodied and relational: the therapist and patient form a third analytic, a site where they co-create the therapeutic environment. It is not the patient alone who projects and transfers their past relationships onto the present moment, the therapist also primes certain behaviours, and falls into certain roles the patient expects or switches into. Maladaptations are relationally generated and, therefore, must involve relational change.
Janet again: all identities are useful. They emerged at particular times to protect the self from a particular threats. Though some may appear self-destructive and helpless, and others appear malevolent and wrathful, they are all important (and vital) aspects of the patient, and through a compassionate understanding of their various roles in protecting the self, these identities move out of their hopeless or resentful states, find pride in their capacities to protect, and begin to heal, to respect other identities whom they once may have seen as pathetic or terrifying. This is not a blind acceptance of what some of these identities have done (they have certainly made extended periods of the patients' lives excruciating and disorienting), but rather an attempt to revision their roles, to accept what they were so that they may change (dialectical behaviour therapy: both acceptance and change are necessary for healing).
Touches on:
Janet: maladaptive behaviours were vital for survival at their time of development (trauma), but are actively harmful now (ptsd).
We consist of plural identities that in a healthy environment share information amongst one another, giving us the sense of a singular self, bodily/psychic autonomy. Trauma is the dissociation of these identities from one another.
All trauma involves dissociation (disconnections between identities, which lead to amnesia and emotional dysregulation), but not all dissociation is caused by trauma (dissociation can be a healthy psychic reaction to stress).
Children who have been traumatised have a strong attachment to their abusers because when children experience abuse they respond with attachment, the need for a site of security. The abuser, who is often also the carer, becomes a site of intense terror and need, and this relationship, of defenseless child and powerful persecutor, is reconstituted in the psyche of the child (bpd characterology).
The pathway to system resiliency/self-integration involves: 1) symptom reduction (of emotional dysregulation [depression, anxiety, rage], depersonalisation/derealisation, suicidality, helplessness), 2) internal reconnection (of identities and memories) and grieving (for what was lost due to trauma), 3) rebuilding of an (external) social base.
All psychic phenomena are embodied and relational: the therapist and patient form a third analytic, a site where they co-create the therapeutic environment. It is not the patient alone who projects and transfers their past relationships onto the present moment, the therapist also primes certain behaviours, and falls into certain roles the patient expects or switches into. Maladaptations are relationally generated and, therefore, must involve relational change.
Janet again: all identities are useful. They emerged at particular times to protect the self from a particular threats. Though some may appear self-destructive and helpless, and others appear malevolent and wrathful, they are all important (and vital) aspects of the patient, and through a compassionate understanding of their various roles in protecting the self, these identities move out of their hopeless or resentful states, find pride in their capacities to protect, and begin to heal, to respect other identities whom they once may have seen as pathetic or terrifying. This is not a blind acceptance of what some of these identities have done (they have certainly made extended periods of the patients' lives excruciating and disorienting), but rather an attempt to revision their roles, to accept what they were so that they may change (dialectical behaviour therapy: both acceptance and change are necessary for healing).
August 14, 2018
This book is INVALUABLE for treating DID. It’s straightforward, well-organized, and easily the best resource I’ve found on DID. I can’t understand why it’s out of print. Used copies are available but expensive. However, if you’ve just started working with DID patients and are in need of guidance, it’s well worth the money.
January 24, 2021
A must read for any trauma clinician.
Displaying 1 - 3 of 3 reviews