350 CHAPTER 8
When addressing the presence of alters in those with DID, the type of treatment
a clinician employs depends on which theory he or she accepts and thus guides treat-
ment. Proponents of the posttraumatic model advise clinicians to identify in detail (or
to “map”) each alter’s personality, recover memories of possible abuse, and then help
the patient to integrate the different alters (Chu et al., 2005). In contrast, proponents
of the sociocognitive model advise against mapping alters or trying to recover possi-
ble memories of abuse (Gee, Allen, & Powell, 2003). Instead, they recommend that
the therapist use learning principles to extinguish patients’ mention of alters: Alters
are to be ignored, and the therapist doesn’t discuss multiple identities. Alters are
interpreted as creations inspired by the patient’s desire for attention, and treatment
focuses on current problems rather than on past traumas (Fahy, Abas, & Brown,
1989; McHugh, 1993).
In addition, hypnosis has sometimes been used as part of treatment, particu-
larly by therapists who treat DID according to the posttraumatic model; in this
case, hypnosis might be used to help the patient learn about his or her different
alters and integrate them into a single, functional whole (Boyd, 1997; Kluft, 1999).
Using hypnosis is, by its very
nature, a social event: The thera-
pist helps the patient achieve a
hypnotic state through sugges-
tions and bears witness to what-
ever the patient shares about the
dissociated experience. However,
using hypnosis to treat DID is
controversial because the patient
will probably be more suggestible
when in a hypnotic trance, and
the therapist may inadvertently
make statements that the patient
interprets as suggestions to pro-
duce more DID symptoms. Fur-
ther, it is not clear that hypnosis can always help such patients, although there is
some evidence that it sometimes might be useful (Powell & Gee, 1999).
Treatment may also focus on reducing the traumatic stress that can induce
dissociative disorders. For instance, soldiers who experience dissociation during com-
bat may be removed from the battlefi eld, which can then reduce the dissociation.FEEDBACK LOOPS IN TREATMENT: Dissociative Disorders
When Breuer was treating Anna O., he relied on the “talking cure”—having her
talk about relevant material, at fi rst while in a hypnotic trance and later while not
in a trance. This use of hypnosis continues today, and is often part of a treatment
program for people with dissociative disorders (Butler et al., 1996), including dis-
sociative amnesia (such as Mrs. Y in Case 8.1), dissociative fugue (such as Joe in
Case 8.2), and DID (Putnam & Loewenstein, 1993). Hypnotic treatment for a dis-
sociative disorder usually involves helping the individual to become aware of and
integrate dissociated perceptions and memories, as well as to understand what may
have led to the dissociation. Let’s examine hypnotic treatment and how it leads to
feedback loops among neurological, psychological, and social factors.
In the 1980s, researchers began to investigate the neurological changes that occur
as a result of hypnosis and subsequently established that hypnosis alters brain events
(Crawford et al., 1993; Kosslyn et al., 2000; Sabourin et al., 1990–1991; Spiegel,
Bierre, & Rootenberg, 1989; Spiegel et al., 1985). The specifi c brain changes vary,
however, depending on the task being performed during the hypnotic trance. When
hypnotized, patients may be able to retrieve information that was previously dissoci-
ated; in turn, this may make them feel more like themselves and experience percep-
tions or memories in a more normal way (psychological factor).P SNP SNWhen using hypnosis to treat dissociative
symptoms, the therapist may make sug-
gestions such as “ You will feel yourself
becoming relaxed... you will notice your-
self going into a state of trance... you will
fi nd yourself about to remember whatever
was dissociated.” One goal is to help re-
integrate whatever has been dissociated,
such as specifi c memories.
Will & Deni McIntyre/Photo Researchers, Inc.