Self-Management of Dissociative Disorders:
A Psychoeducational Therapy Group for Individuals with DID and DDNOS
Focus Upon Stabilization
The standard of care for Dissociative Identity Disorder and Ego State Disorder/DDNOS requires that the foundation stage of treatment focus upon stabilization of psychosocial functioning (Internal Society for the Study of Dissociation, 2005).
Before further treatment can be effective, dissociative patients must be prepared with extensive knowledge regarding the nature and function of these difficult-to-understand conditions. Psychological tools needed to manage suicidal and self-mutilative impulses, amnesias and fugues, flashback panics, and "out of control" switching among states of consciousness must be provided.
Balancing Treatment Needs
While essential to a positive prognosis, teaching procedures for increasing individual awareness and understanding of the dissociative process is time consuming and demanding. In individual psychotherapy, demonstration and coaching for mastery of non-dissociative coping skills is often interrupted by the requirements of emerging crises.
Maintaining a balance among psychological skill development, resolution of traumatic associations, and crisis intervention is a significant challenge in psychotherapy of the dissociative disorders, accounting for frequent use of inpatient care, partial hospitalization, and intensive outpatient treatment.
Why a Group Approach?
Designed to support and supplement the work of individual psychotherapy, focus of the Self-Management group is upon:
- Increasing psychosocial stability
- Decreasing crisis inpatient admissions, and
- Accelerating the process of individual psychotherapy
Treatment Goals
Group is divided into three areas:
- Awareness and Understanding: Minimization, rationalization, and avoidance are common treatment-interfering responses of individuals with dissociative disorders. Skills taught in this module include discrimination of normal from pathological dissociative experience and awareness of how once-helpful dissociation can become counterproductive.
- Consciousness Skills: Dissociative clients often experience a sense of unrealitiy, behavior inconsistent with conscious intent, and amnesia to recent events. In this segment, skills for enhancing perception and memory across states of consciousness are taught.
- Affect Management: Individuals who have long used dissociative defenses to deal with current-day emotional distress and recall of past traumatic events, are ill prepared to deal with the intensity of emotion-laden stimuli. Skills for affect containment, modulation, and appropriate expression are presented and practiced in this module.
What This Group is Not
The Self-Management therapy group is not a substitute for individual therapy. Rather, it is a structured, skill-focused group designed to increase individual psychotherapy time- and cost-effectiveness.
The Self-Management group is not a forum for exploration of past traumatic experience or identity components. Consistent with the standard of care, clients are encouraged to limit the tasks of reviewing and resolving traumatic memories to the security of the individual therapeutic relationship.
Participating clients may be assured that all aspects of the self (alters,ego states) are welcomed to the group. At the same time, clients will be encouraged and assisted to participate within states of consciousness most suited to a learning environment.
Who May Participate
Participation in group is contingent upon simultaneous involvement in individual therapy. Referral from the client's primary mental health care provider or inpatient treatment program is required.
Group Facilitator
Sheralyn Cox, Ph.D. facilitates the Dissociative Disorders Self-Management group. Sherry has received advanced training in treatment of the dissociative disorders. She is a member of the International Society for the Study of Dissociation, the International Society for Traumatic Stress Studies and the American Society for Clinical Hypnosis and has done extensive teaching and consultation in this area.
Format
This time-limited group meets weekly for 90 minute sessions and repeats quarterly. Held in the Psychotherapy Associates offices, group meeting time will be negotiated among participants. Fees for group are $35 per session. This treatment protocol has been covered by most health insurance and other third party payment plans, including Medicare and the Nebraska Medical Assistance Program (Medicaid).
Intake Procedure
Referral, in writing or by telephone, should be directed to the attention of Sherry Cox at 402-475-5069, fax 402-475-2350, or e-mail scoxphd@alltel.net. Clients who have been referred are asked to contact the Psychotherapy Associates office to schedule an individual screening and assessment interview prior to acceptance into the group.