Treatment Obstacles for Dissociative Clients

Common obstacles include shame, denial, amnesia, unsafe environments, therapist inexperience, internal conflict, and crisis cycles. ^{1 2 3}

Main ideas

• Avoidance and denial may be protective, not defiance.
• Internal disagreement can slow therapy, especially when some parts fear disclosure or change.
• External instability, abuse, poverty, discrimination, and medical stress can make trauma work unsafe until support improves.

Questions for reflection

• Is the main obstacle internal, external, clinical, or practical?
• What would lower risk enough to keep going?
• Where is the treatment plan asking too much too soon?

Clinical note

Obstacles are information. They are not proof that someone is untreatable.

Footnotes

1. 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. 115-187. Full adult DID treatment guideline PDF. ↩

2. Bachrach, N. (2025). Recent evidence-based developments in the treatment of dissociative identity disorder. Frontiers in Psychiatry. Review article. Recent treatment evidence review. ↩

3. Van der Hart, O., et al. (2012). The use of imagery in phase 1 treatment of clients with complex dissociative disorders. European Journal of Psychotraumatology, 3. Phase 1 treatment article. Open access stabilization and imagery article. ↩