Study review: Better is not the same as finished

Recovery is quieter than people expect

Myself included, a common question that gets raised around recovery is wondering "when does it get better?" A look into studies and testimonies from clinicians paints a different story.

People often assume linear is recovery when it isn't. Source

In this study, I wanted to take a look at what improvement looks like. Here we have a six-year follow-up study from the perspective of 61 therapists and their clients.¹

Six years is a long time to ask someone to keep showing up for treatment. The question underneath a study like this is not whether a graph moves in the right direction. It is whether a life that has been ruled by crises, fear, and disruption can begin to make room for ordinary things again: a workday, a friendship, a quieter evening, a period without needing emergency care.

Researchers often publish treatment studies after a few months. Six years is different. People move, therapists retire, care changes, and life does not pause while research is being done. By the end of this follow-up, 61 therapists were still able to report on their patients, down from 295 at the start of the larger study.¹ That loss of people is a limitation. It also shows how difficult it is to study recovery over years instead of weeks.

At the six-year mark, the remaining therapists filled out a short web survey about safety, stress, quality of life, victimization, and everyday functioning. Researchers compared those answers with information collected at earlier points in the study.¹

Each therapist had carried on with the outpatient work already underway. Over six years, the focus could shift from sleep and getting through a workday to internal cooperation or staying present in a difficult conversation. Life kept changing around treatment too. The paper gives us a view of that whole stretch of care.¹

What got easier

At the six-year follow-up, therapists reported better overall functioning, fewer psychiatric hospitalizations, fewer stressors, and less recent sexual revictimization. Family stress and conflict among identity states also fell in the analyses.¹

What stands out is how ordinary the improvements are. People were spending less time in crisis, being hospitalized less often, and reporting fewer stressors. Those changes may not sound dramatic, but they create more room for everyday life.

Better is not the same as finished

Many people in the study still had serious trouble with work and close relationships. Self-harm and suicide attempts did not change significantly in this follow-up group; rates were already low at the earlier point used for comparison.¹

Better is not the same as finished. Someone may stop needing hospital admissions long before they stop struggling to trust people, keep a job, or feel settled in their own life. This study is interesting because it leaves room for both parts of that truth.

Why early therapy can look ordinary

This helps explain why so much early treatment can seem unrelated to trauma at first. A person may be working on sleep, grounding, getting through the day, reducing unsafe coping, or building communication before discussing trauma memories in detail. Clinical guidance describes that work as part of a phased approach to DID treatment.²

Some starting points for the kind of work that may happen in this phase:

• Dialectical behavior therapy (DBT) for skills around distress, emotion regulation, and relationships.
• Acceptance and commitment therapy (ACT) for values, psychological flexibility, and making room for difficult inner experiences.
• Grounding techniques for returning attention to the present when a person feels overwhelmed or pulled into a flashback.
• The Stanley-Brown Safety Planning Intervention for building a concrete safety plan with a clinician when suicidal thoughts or self-harm are part of the picture.

Lily Bailey's version

Lily Bailey was writing about OCD, not DID. Her account of getting better without reaching a final, permanent finish line puts the same idea in a few words.

“I’m not totally recovered though. Sometimes I have terrible days.”³

Lily Bailey

Recovery From Mental Illness Isn't Always Linear · Psychology Today, 2018

Footnotes3

Footnotes

1. Myrick, A. C., Webermann, A. R., Loewenstein, R. J., Lanius, R., Putnam, F. W., & Brand, B. L. (2017). Six-year follow-up of the treatment of patients with dissociative disorders study. European Journal of Psychotraumatology, 8(1), 1344080. Results, limitations, and conclusions. Naturalistic symptom and functioning outcomes over six years. ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶

2. International Society for the Study of Trauma and Dissociation. (2011). Guidelines for treating dissociative identity disorder in adults, third revision. Journal of Trauma & Dissociation, 12(2), 115-187. pp. 135-136. Consensus model for sequenced treatment. ↩

3. Bailey, L. (2018, April 3). Recovery from mental illness isn't always linear. Closing reflection on partial recovery. First-person OCD reflection on improvement, relapse, and living with recovery that remains incomplete. ↩