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Standard Training

Diagnosis and Treatment of Complex Trauma and Dissociative Disorders - The Standard Course Parts I & II

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Overall Course Objective: At the end of this experience, participants will have sufficient knowledge to be able to diagnose Dissociative Identity Disorder (DID) and Dissociative Disorder Not Otherwise Specified (DDNOS), and will have essential knowledge and skills needed to conduct individual psychotherapy to treat these illnesses.

The International Society for the Study of Trauma and Dissociation has successfully completed eight years of the ISSTD Professional Training Program and over 2500 participants have made use of this program.


Intended Participants: Participants must receive approval of the faculty member to attend. Licensed mental health professionals (psychiatrists, psychologists, clinical social workers, mental health counselors) who are personally treating a person with Dissociative Identity Disorder or Dissociative Disorder NOS.  Other health professionals, e.g., medical physicians and nurse practitioners, are encouraged to inquire about their interests with Professional Training Program Director,  Victor Welzant, Psy.D., to determine if their background might fit the seminar content. While we are not interested in a homogenized group, and like diversity, we also must attend to the need to provide an educational experience where people's basic backgrounds will allow for individual growth in the context of growth for the group as a whole.

Course Format: Part I and Part II are two separate courses. It is recommended that you take the courses in succession. Each Part is comprised of eight 2.5 hour sessions of literature discussion, lecture, and discussion of your cases. 
The current version of the course was revised in 2013 by Elizabeth Howell, Ph.D. and Shielagh Shusta-Hochberg, Ph.D.

Educational Materials: Participants are required to purchase assigned text books and will be provided carefully chosen selections from a variety of scientific journals and other textbooks for each section.  The syllabus for the course will be provided upon registration.

Disclaimer: This course provides an introduction to a variety of specific techniques that are applicable to stage-oriented treatment of complex trauma and dissociation. Nevertheless, this course is not adequate training in hypnosis or EMDR. If you plan to use these modalities, you should seek additional, specialized training, in those modalities.

Standard Course Part I - Session Topics and Objectives

Session 1: Beginning the Treatment: Putting the Essentials in Place


  1. Be able to begin the initial formal treatment with caveats and limitations clearly articulated. The clinician should be prepared to submit to the new patient any initial paperwork and should be able to begin formal charting and adequate progress note-taking.
  2. Be able to clearly delineate clinician availability between session appointments including setting up contingency plans if patients should experience emergencies between sessions and after hours when they may not immediately reach the treating clinician.
  3. Be able to explain that treatment for trauma, and especially for the dissociative disorders, needs to proceed carefully so as not to unduly overwhelm or destabilize patients, and help manage expectations by explaining that such treatment typically takes years rather than weeks or months, and that in some cases a definitive diagnosis may not be reached until later in the treatment.  
  4. Demonstrate familiarity with the ISSTD Guidelines for Treating Dissociative Identity Disorder in Adults, Third Edition, Summary Version (2011)
  5. Have an understanding of the phenomenological world and characteristics of people with complex trauma and dissociative disorders.

Session 2: Diagnostic Basics


  1. Be able to demonstrate knowledge of questions for an office mental status examination for complex trauma and dissociative disorders.
  2. Be able to understand the rationale for the comprehensive diagnostic workup. 
  3. Be able to use the DES (Dissociative Experiences Scale) to screen for pathological dissociation; and the SDQ (Somatoform Dissociation Questionnaire) for screening and assessment. 
  4. Be able to diagnose DID or DDNOS (ego state disorder), using the DDIS (Dissociative Disorders Interview Schedule), SCID-D (Structured Clinical Interview for DSM-IV Dissociative Disorders), the MID, or other diagnostic questions and instruments that screen for and/or assess  amnesia, depersonalization, derealization, identity confusion, identity alteration and somatoform dissociation. 
  5. Understand and be able to recognize common clinical presentations and co-morbid diagnoses of persons with ego state or alternate personalities typical of DDNOS or DID. 
  6. Be able to state five characteristics of a factitious or malingered presentation of DID.

Session 3: Initial Steps: Pacing and Phase-Oriented Treatment


  1. Understand the stage or phase-oriented model of working with trauma and its application to work with dissociative disorders, reiterating the need to slow down patients who are urgently rushing toward recovery without sufficient preparation, risking dangerous decompensation.
  2. Be able to be on the alert for landmines of dissociated traumatic material that may explode without warning.
  3. Be able to deal with the sudden emergence of traumatic material when it does occur.

Session 4:  Boundaries
[The Course Directors assume participants are very familiar with the concept of interpersonal boundaries. This topic is stressed here because: Often having been subject to severe boundary violations in their early lives, many dissociative patients are vulnerable to repetitions of the violations of their personal boundaries, and sometimes they may be prone to violate other’s boundaries; they may lack adequate understanding of how therapeutic boundaries are designed to protect them.]


  1. Understand the rationale for the maintenance of appropriate therapeutic boundaries in the treatment of DID and DDNOS.
  2.  Be prepared to respond appropriately to requests for touching, holding, or sexual activity.
  3. Understand the use or abuse of personal disclosure.
  4. Understand the influence of dissociation on the function of the clinician.

Session 5: Transference and Countertransference


  1. Understand the significance of the treatment frame and how this affects both transference and countertransference experience.
  2. Understand the common transference reactions and associated transference-countertransference matrices in the treatment of persons with dissociative disorders.
  3. Understand the range of countertransference responses to dissociative processes.
  4. Understand traumatic transference.
  5. Be able to discuss Davies and Frawley‘s (1994) eight transference-countertransference positions as well as Karpman's drama triangle* in the evaluation of transference and countertransference. *Karpman’s triangle describes the universal positions of victim, perpetrator and rescuer; note similarity to Davies and Frawley (1994).

Session 6: Organization of the Personality


  1. Be able to describe the usual kinds of alter personalities and relationships among them.
  2. Be able to facilitate negotiation with and between alter personality states. 
  3. Understand the meaning of the terminology, Emotional Part of the Personality and the Apparently Normal Part of the Personality
  4. Understand the genesis and meaning of somatoform dissociation.

Session 7: Treatment Techniques and Theoretical Approaches


  1. Understand and know how to avoid common clinical pitfalls of work with dissociative disordered patients.
  2. Know techniques to pace the emergence of traumatic material in the therapy of DID or DDNOS patients.
  3. Understand the place of abreaction of trauma in the treatment of DID or DDNOS patients.
  4. Be able to use "talking through" and other techniques to encourage co-consciousness of alter personality states. 

Session 8: Clinical Approaches to Working with Persecutory Alters


  1. Be able to state two techniques for working with persecutory alter ego states.
  2. Be able to discuss the creation of persecutory alters.
  3. Be able to understand the importance of persecutory alters and their role in survival.  

Standard Course Part II - Session Topics and Objectives

Session 1: Diagnostic Issues, Part II: Complex Trauma and Dissociative Disorders: Differential Diagnosis and Comorbidity: Depersonalization Disorder, Schizophrenia, Eating Disorders, Borderline Personality Disorders, Narcissism, OCD and other Anxiety Disorders, Depression


  1. Be able to describe three differentiating criteria for DID and schizophrenia.
  2. Be able to describe how DID can be misdiagnosed as OCD and ways of handling this if applicable to your client.
  3. Be able to describe “chronic relational trauma disorder. ”What are some ways that BPD may be understood to be on the dissociative spectrum and ways that it may be seen as a separate disorder?
  4. Be able to cite some quantitative data regarding the prevalence of dissociative disorders.
  5. Be able to describe somatoform disorder. How does it compare and contrast to what Nijenhuis calls “psychoform disorder?” 

Session 2: Stabilization, Affect Management, and Containment


  1. Be able to list three useful grounding techniques.
  2. What are some medications that may help people with dissociative disorders? When might these be appropriate and when not?
  3. Be able to give three examples of vicarious trauma. 

Session 3: Disorganized Attachment and Dissociative Disorders


  1. Be able to describe disorganized attachment and its implications for the formation and reinforcement of dissociative disorders.
  2. Be able to articulate how trauma is often, in itself, not enough to bring about severely dissociated identity states. 

Session 4:  Fragmentation and Memory Disturbance


  1. Know the clinical factors that are associated with the production of distorted memories and the interview techniques that minimize this risk.
  2. Be able to maintain appropriate therapeutic neutrality regarding the historical veracity of recovered memories.
  3. Be able to state the impact of trauma and emotional arousal on encoding, storage and retrieval of memories, and the clinical implications for processing recovered memories of trauma. 
  4. Be able to address what are the levels of hypocrisy that Ferenczi describes in the creation and maintenance of split-off states?
  5. Be able to describe what Ferenczi means by “confusion of tongues.”

Session 5: Understanding the System of Personality Organization, Part. 2: Subjective and Objective: Etiology, Mapping, and Neurobiology


  1. Be able to describe the usefulness of, as well as some caveats about, mapping.
  2. De able to use and describe Fraser’s “dissociative table technique.”
  3. Be able to describe the results and the meaning of the results of Reinders, et al.’s study, ie, what does this show about the neurological differences between real and simulated DID? 

Session 6: Transference and Countertransference, Part 2: Enactment, Projective Identification, and Dissociative Attunement


  1. Understand the dissociative basis of enactment, projective identification and dissociative attunement.
  2. Be able give examples from your clinical experience of each of these.
  3. Be able to describe the clinical processes of each of these.  

Session 7: Treatment Techniques and Therapeutic Approaches, Part  2: Hypnosis, EMDR, Somatic Approaches


  1. Understand the differences and similarities between hypnosis and dissociation as well as the rationale for the use of hypnosis for affect regulation, ego strengthening, and communication between alter personalities. 
  2. Understand auto-hypnotic imagery in DID and DDNOS and be able to utilize it therapeutically for internal communication and pacing the emergence of traumatic material.
  3. Be able to describe the usefulness as well as the caveats for using EMDR with highly dissociative patients.

Session 8: Working with DID: Integration and “Where do We Go from Here in the Mental Health Field?”


  1. Recognize clinical signs that indicate readiness for alter personality/ego state integrations in DID and DDNOS.
  2. Be able to describe at least two hypnotic images for use in assisting with ego state or personality integration or resolution.
  3. Be able to state the common dynamics leading to premature termination of treatment in DID.
  4. Be able to describe aspects of the concept of integration.
  5. Be able to describe “tactical integration.”
  6. What should clinicians know about evidence-based treatment and DID?

Modules to Meet Your Training Needs: Chronic complex trauma, child and adolescent trauma and dissociation, basic and advanced training in adult dissociative disorders are available in face-to-face and online formats.

Intro, Standard, Advanced, Child & Adolescent Courses Available Online. Online/Distance Learning modules utilize the same curriculum as the in-person courses. Continuing Education credit is available for these online/ distance learning courses. Information Regarding Online/Distance Learning

See important information below regarding registration.


Continuing Education Credits

Continuing Education Sponsor:
CE Learning Systems is a co-sponsor of this event. To earn continuing education credits, participants must purchase credits separately. Participants will need to complete an evaluation and a post-test (online courses only). CE credits are available in the U.S. and Canada.

ASWB - CE Learning Systems, (Provider #1020), is approved as a provider for social work continuing education by the Association of State Social Work Boards (ASWB) www.aswb.org, through the Approved Continuing Education ACE program.  ASWB Approval Period: 02/23/2013 - 02/23/2016.  Social workers should contact their regulatory board to determine course approval. Social workers participating in this course will receive continuing education clock hours.

APA - ISSTD's Continuing Education Co-sponsor, CE Learning Systems, is approved by American Psychological Association to sponsor continuing education for psychologists. CE Learning Systems maintains responsibility for this program and its content.

Prior to 2010 Continuing Education (CE) credits were provided by the Institute for Continuing Education.

Course Fees
This fee includes copyright fees and course materials. You will receive course materials when registration is complete. All fees are in U.S. Dollars. CE credits are available for purchase through our CE co-sponsor, CE Learning System, Inc. Students will receive an email directly from the CE co-sponsor with information on the cost of credits and the process to obtain them.

Registration Requirements and Registration
Receiving Approval to Register: ISSTD is interested in the success of this program. To ensure the highest standards in our profession, we require each potential participant to call and speak with the instructor in your area (if two instructors, speak with at least one, if registering for the online program, contact ISSTD Staff

If your instructor agrees with your participation in this program, they will tell you to register. If you register without prior consent of an instructor, we cannot guarantee your instructors approval and your registration fee may be refunded to you, minus an administrative fee of $45 for handling of improperly submitted registration materials. Applicants must be licensed clinicians, or if you are a graduate student, a letter from your Department Chairperson giving permission for your participation in this program must be sent to your faculty person.

Course sites which have two faculty listed will have one course co-taught by both faculty. To begin the registration process, use the information on the Faculty Page to contact the faculty member in your area for permission to register. Calendar of Programs with Instructors Contact Information


Registration is limited to 12 persons per site and varies per hybrid/online course. Participants must be licensed professionals, and students must also receive the approval of the local faculty to attend. Clinicians in training may attend with the written recommendation of the chairperson of their training program/department. Familiarity with treating a person with a major dissociative disorder is preferred in the Advanced and Master's level courses. Progression from Intro I to Intro II, through Standard I and Standard II is highly recommended prior to attempting the upper level courses. It is recommended that participants have contextual experience of dissociative processes to be able to take in more advanced course material in a meaningful way.

Remember, if you register without the prior approval of a faculty member, your registration may be refunded to you less a $45 administrative fee. When you click to register you are indicating that you have read the preceding paragraphs about the details of this program, and the rules surrounding the processing of registration fees.

Members please remember to log in to receive your member discount. Contact Program Manager by email at info@isst-d.org or call 703-610-9037 if you need your username and password or any additional registration assistance.

If you have a problem or a concern about registration, please contact the ISSTD Professional Training Administrative Director, Victor Welzant, Psy.D.

Cancellation Policy
If you withdraw from any course less than 15 days prior to its local starting date, there is a $45 non-refundable charge. If you are sent course materials, prior to your notification of withdrawal from the course, regardless of the date of your notice, your refund will also be less the copyright fees. Registration is limited to 12 participants per location for in person courses and varies for hybrid/online courses. Once the course starts no new students can be accepted more than one week after the course begins. The course fee is not refundable if you withdraw from the course after two weeks prior to its start, unless an acceptable replacement for your registration is found, in a timely fashion, prior to the start of the course. Refund of fees, and acceptance at that time, is the decision of the course Directors. All materials used for this course are subject to copyright laws and are not for duplication or distribution by course participants. Fees must be submitted with registration, and must be submitted in US dollars.

Thank You
ISSTD is thankful to the original course directors, Richard Chefetz, MD; A. Steven Frankel, PhD, JD; Donald Fridley, PhD; Elizabeth Howell, PhD; Annita Jones, PsyD; and Eli Somer, PhD as well as the many distinguished faculty members who have contributed and continue to give their energy and talents tirelessly to make this training program successful.

© 2017 ISSTD  This course syllabus and bibliography are the copyrighted property of the International Society for the Study of Trauma and Dissociation (ISSTD).  Use of this material is prohibited without written permission from the ISSTD.



professional training:

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Child & Adolescent - Online
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Intro Part I - Hybrid NYC
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Intro Part I - Hybrid Northern Kentucky
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Intro Part I - Tucson
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Standard Part 1 - Montreal
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