Intended Participants: Participants must be 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 Dr. Chefetz 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.

Meeting Frequency: Once monthly for 9 months.

Course Format: This course is designed for 2.5 hour sessions of combined literature discussion/lecture and discussion of cases presented by students. Actual session format is at the discretion of ISSTD faculty.

This course syllabus and bibliography are the property of the International Society for the Study of Dissociation (ISSTD). Please do not copy or distribute without permission from the ISSTD. The ISSTD may be contacted at info@isst-d.org

Educational Objectives:

Overall 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.

Session-Specific Objectives: Participants will:

Session 1: Diagnosis

1. Be able to diagnose DID or DDNOS (ego state disorder), using the SCID-D (Structured Clinical Interview for DSM-IV Dissociative Disorders) or other diagnostic questions about amnesia, fugue, depersonalization, derealization, identity confusion and identity alteration.
2. Be able to use the DES (Dissociative Experiences Scale) to screen for pathological dissociation.
3. Understand and be able to recognize common clinical presentations and co-morbid diagnoses of persons with ego states or alternate personalities typical in DDNOS and DID.

Session 2: Initial Steps, Treatment Frame, and Treatment Principles.

1. Understand the three stage model of working with trauma and its application to work with dissociative disorders.
2. Understand the importance and practice the maintenance of appropriate therapeutic boundaries in the treatment of DID/DDNOS.
3. Be able to distinguish tactical integrational and strategic integrational approaches to the treatment of DID and DDNOS.

Session 3: Transference and Countertransference in Trauma

1. Understand the common transference reactions of abused persons with dissociative disorders.
2. Understand countertransference reactions to working with dissociative disorders, including personal countertransference to patients currently in treatment.
3. Be able to define projective identification, recognize it in dissociative disorder transferences and countertransferences, and formulate therapeutic responses to it.

Session 4: Resistances in Treatment; Recognizing Factitious Presentations.

1. Be able to state five characteristics of a factitious or malingered presentation of DID.
2. Be able to state two techniques for working with malevolent alter ego states.

Session 5: Treatment Techniques I: Communicating and Contracting with Alter Egos

1. Understand how to use autohypnotic techniques (Dissociative Table Technique) to effect inter-ego/personality communication as part of psychotherapy.
2. Be able to negotiate behavioral contracts between alter personality states.
3. Be able to use "talking through" and other techniques to encourage co-consciousness of alter personality states.

Session 6: Treatment Techniques II: Treatment Pitfalls & Pacing, Managing Abreactions.

1. Understand and know how to avoid common clinical pitfalls of work with dissociative disorder patients.
2. Know techniques to pace the emergence of traumatic material in the therapy of DID or DDNOS patients, including fractionated abreaction and hypnotic distancing techniques.
3. Understand the place of abreaction of trauma in the treatment of DID or DDNOS patients.

Session 7: Working with Traumatic and Recovered Memories.

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 techniques to minimize successful lawsuits related to working with recovered memories of abuse.
4. 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.

Session 8: Treatment Modalities -- Medications and Hypnosis.

1. Understand autohypnotic imagery in DID and DDNOS and be able to utilize it therapeutically for internal communication and pacing the emergence of traumatic material.
2. Be able to state the usefulness of antidepressant, antipsychotic and anti-anxiety medications in the treatment of DID and DDNOS.
3. Understand the implications of autohypnotic distortions of reality for assessing medication side effects in DID patients.

Session 9: Integration and Treatment.Terminations.

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 fusions.
3. Be able to state the common dynamics leading to premature termination of treatment in DID.

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