Treatment overview

Start with the week in front of you

The first few weeks of DID treatment are similar to treatment for other conditions - talk therapy. You bring in your concerns, such as lack of sleep, work being at risk, or self-harm. In my experience, I came in wanting to solve issues around disproportionate responses, difficulty maintaining relationships, among other issues. Something else that can come up over the course of DID treatment is that one identity state may want help while another wants to quit treatment.¹² This is an unfortunate push-and-pull many clients have to deal with.

From there, therapy may stay with everyday problems for a while. Grounding. Getting through a workday. Making nights a little less chaotic. Finding a way for identity states to pass along information. If life becomes unstable again, you may come back to the same work.³²⁴

From the outside, this can look almost too ordinary. You practice breathing or sensory grounding, write down what happened, and make a plan for the hours after a difficult appointment. What happens afterward matters more. Can you stay present? Can you make it to the next session with a little less chaos?⁵²

Parts work can affect the rest of the week

A parts-oriented session may begin with the few seconds before fear, shame, or an urge to self-harm takes over. In Healing the Fragmented Selves of Trauma Survivors, Janina Fisher combines ideas from IFS, sensorimotor psychotherapy, mindfulness, attachment theory, and structural dissociation. She treats these states as survival responses. Calling them resistance or an attempt to derail therapy would miss what they are trying to do.⁶

Fisher calls one part of this process “unblending.” You notice a part's fear, anger, or shame while keeping some awareness of the room and the present day. There is enough distance to listen without being completely overtaken by the feeling.⁶

Sometimes the problem doesn't show up until after the appointment. One identity state may leave feeling calmer while another is frightened or furious about what happened. If amnesia gets in the way, the therapist may not hear about that reaction until the next session. Twombly recommends watching for these delayed reactions and easing off when the person becomes overwhelmed.⁷

There is also the question of how hard the therapist pushes. ISSTD guidance warns against calling identity states forward before the person is ready or encouraging them to become more separate and elaborate.⁸ In a 2025 scoping review, Buys found 27 peer-reviewed IFS studies. Seventeen were case studies, and only one concerned DID.⁹ To read more, visit IFS and dissociative parts.

Trauma work may start with one small piece

Touching one memory can bring in far more material than anyone meant to reach that day. A therapist may narrow the target to one small part of what happened, pause when symptoms increase, or spend more time helping you reconnect with the present.¹⁰

Some clinicians use imagery here: a container for material that cannot be finished today, a meeting place for internal discussion, or an image of protection before a difficult situation. Van der Hart, Boon, and Steele describe those as phase-one clinical techniques and say timing and internal agreement matter. They also note that the techniques themselves had not been tested in empirical studies.¹¹

EMDR

“I'm trained in EMDR” leaves an important question unanswered: what changes when the client has DID? EMDR brings attention to traumatic material while using alternating eye movements, sounds, or taps. Early reports described serious problems when clinicians used standard EMDR with people whose DID had not yet been recognized. Traumatic material flooded in, dissociative barriers broke down, identity states emerged abruptly, and people destabilized quickly. That history is why ISSTD recommends screening for dissociation and changing the standard procedure for DID.¹²

“We'll go slowly” should mean something specific. The therapist may isolate one small piece of a memory so the work does not open into every associated memory. They may use shorter stimulation sets and stop often to check that you still know where and when you are. The session also needs enough time at the end for you to settle. Some clinicians use alternating sounds or taps because they may be easier to tolerate than eye movements.¹²

Personally, the EMDR I did was called the Early Trauma Protocol. Katie O'Shea developed it for early experiences that may not be available as clear verbal memories, and Sandra Paulsen later adapted the work for complex trauma and dissociation. Instead of beginning with one remembered scene, the protocol can move through early experience by developmental time frame, with containment and resourcing before trauma processing.¹³

I found very little outcome research on the protocol itself. In the one 2023 case report I found, an inpatient with dissociative PTSD received the protocol under O'Shea's supervision. The patient improved during a wider change in care involving the ward and staff. I could not find a controlled study of the protocol in DID.¹⁴

The identity state speaking in the room may agree to EMDR while another is strongly opposed. Before going ahead, the guidelines ask therapists to look at general stability, coping skills, internal cooperation, and whether the person can stay aware of the present while approaching the memory. Strong opposition is a reason to stop and prepare rather than press ahead.¹²

With those changes, EMDR may support containment, reduce symptoms, help identity states cooperate, or work through a carefully chosen trauma target. The guidelines place it inside the wider treatment plan.¹²

Before starting, ask what happens if you lose time, become flooded, or leave less steady than you arrived. The therapist should be able to explain how they notice dissociation, help you reconnect with the room, contain unfinished material, and respond if symptoms rise between appointments.¹²¹⁵

Hypnosis

Many people hear hypnosis and think of memory retrieval. In DID therapy, a clinician may use it for grounding, self-soothing, containing flashbacks, or helping identity states communicate.¹⁶

Kluft's 2012 overview spends time on something that sounds harmless: relaxation. For some trauma survivors, letting their guard down feels dangerous. “Safe place” imagery may calm one identity state and unsettle another. Kluft would discuss the imagery first and ask about concerns before using it.¹⁷

Searching for a memory with hypnosis raises a different problem. Scoboria and colleagues found that misleading questions reduced memory accuracy in a 2006 experiment. They did not reproduce an earlier finding that hypnosis itself reduced accuracy.¹⁸ ISSTD warns that hints, pressure, and leading questions can distort recall. Hypnosis may also leave someone more certain about a memory than the evidence warrants.¹⁹

Anyone using hypnosis here needs training in hypnosis and dissociation, informed consent, and a clear plan for stopping or changing course. Ask what the therapist wants hypnosis to do. Grounding, pain relief, and containment carry different risks from trying to fill a blank in someone's history.¹⁹¹⁷

Medication and groups

Medication may help with depression, anxiety, sleep problems, or another condition alongside DID. Psychotherapy remains the main treatment for DID. Identity states may report different effects or side effects, so the prescriber needs to follow what changes rather than relying on one early response.²⁰

Groups can offer skills, education, and contact with other people who understand some of what you are dealing with. A general trauma group can become overwhelming quickly if the facilitators are unprepared for severe dissociation. ISSTD guidance keeps individual therapy at the center of DID treatment.²¹

Research on DID treatment has not caught up with the number of questions people have about it. Much of the literature comes from clinical guidance and naturalistic studies. Bachrach and Huntjens describe several newer approaches as promising and call for better comparative studies.²²

A session can feel productive and still leave the rest of the week worse. Pay attention to sleep, crises, distress, internal communication, and whether getting through the day becomes easier or harder. Twombly recommends easing off when coping gets worse.⁷ Better is not the same as finished looks at what improvement meant after six years of treatment.

Footnotes22

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. 132-134. Treatment goals, coordinated functioning, and integration. ↩

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. 136-141. Safety assessment, stabilization, symptom management, and pacing. ↩ ↩² ↩³

3. 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. ↩

4. 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. p. 139. Developing communication, co-consciousness, and cooperation among identity states. ↩

5. 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. 151, 157. Grounding and present-orientation during distress or altered states. ↩

6. Fisher, J. (2017). Healing the fragmented selves of trauma survivors: Overcoming internal self-alienation. Routledge. Introduction; chapters 2-5 and 8-10; appendices A and C. Fisher's clinical model blends parts work informed by IFS with structural dissociation, sensorimotor psychotherapy, mindfulness, and attachment-focused treatment. It emphasizes unblending, dual awareness, and a more compassionate relationship with trauma-related states. ↩ ↩²

7. Twombly, J. H. (2021, November 6). Trauma and dissociation informed IFS [Podcast interview transcript]. IFS Talks. pp. 2-4 and 6-8. Clinical commentary on adapting IFS for complex dissociation, including risks of overwhelm, destabilization, premature work with hidden identity states, insufficient coping skills, and poorly paced trauma work. ↩ ↩²

8. 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. 133 and 140-141. Guidance against eliciting identity states before the person is ready or encouraging identity states to become more elaborated and autonomous than they already are. ↩

9. Buys, M. E. (2025). Exploring the evidence for Internal Family Systems therapy: A scoping review of current research, gaps, and future directions. Clinical Psychologist, 29(3), 241-260. pp. 241-260; Results and discussion. Scoping review of 27 peer-reviewed IFS studies, most of them case studies, with DID represented at the case-study level rather than in a controlled trial. ↩

10. 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. 141-144. Readiness, titration, and returning to stabilization when needed. ↩

11. Van der Hart, O., Boon, S., & Steele, K. (2012). The use of imagery in phase 1 treatment of clients with complex dissociative disorders. European Journal of Psychotraumatology, 3, 8458. Guided imagery, pitfalls, and discussion. Clinical examples of imagery for protection, containment, and internal meetings, together with cautions about timing, agreement, and the lack of direct empirical tests. ↩

12. 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. 158-160. DID-specific cautions and modifications for EMDR. ↩ ↩² ↩³ ↩⁴ ↩⁵

13. O'Shea, K., & Paulsen, S. L. (2009). When there are no words: EMDR for early trauma and neglect held in implicit memory [Workshop handout]. pp. 4, 16-19. Early Trauma Protocol preparation, work by developmental time frame, and a slower, more detailed pace for people with dissociative disorders or serious attachment injuries. ↩

14. Winkler, O., Burback, L., Greenshaw, A. J., & Jin, J. (2023). Shifting to trauma-informed care in inpatient psychiatry: A case study of an individual with dissociative PTSD undergoing EMDR therapy. Case Reports in Psychiatry, 2023, 8161010. Treatment course and discussion. Single inpatient case using the manualized Early Trauma Protocol under Katie O'Shea's guidance alongside broader trauma-informed changes in care. ↩

15. 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. 163-164. Collaborative informed consent and discussion of treatment risks and alternatives. ↩

16. 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. 156-157. Clinical uses of hypnosis and self-hypnosis for grounding, self-soothing, symptom control, containment, and internal communication. ↩

17. Kluft, R. P. (2012). Hypnosis in the treatment of dissociative identity disorder and allied states: An overview and case study. South African Journal of Psychology, 42(2), 146-155. pp. 146-148 and 152-154. Clinical discussion of hypnosis for stabilization and carefully paced trauma work, including risks associated with relaxation, imagery, suggestive memory inquiry, and overwhelming exposure. ↩ ↩²

18. Scoboria, A., Mazzoni, G., & Kirsch, I. (2006). Effects of misleading questions and hypnotic memory suggestion on memory reports: A signal-detection analysis. International Journal of Clinical and Experimental Hypnosis, 54(3), 340-359. Abstract and results. In 194 undergraduates, misleading questions reduced memory accuracy; the study did not replicate an earlier finding that hypnosis itself reduced accuracy. ↩

19. 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. 157-158. Leading questions, memory distortion, unwarranted confidence in recalled material, clinician training, and informed consent. ↩ ↩²

20. 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. 151-153. Medication as treatment for associated symptoms rather than DID itself. ↩

21. 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. 148-150. Potential uses and limitations of group treatment. ↩

22. Bachrach, N., & Huntjens, R. J. C. (2025). Recent evidence-based developments in the treatment of dissociative identity disorder. Frontiers in Psychiatry, 16, 1650164. Treatment evidence and conclusion. Critical review of evidence quality and emerging treatment approaches. ↩