My Approach to DID Treatment

My approach to working with individuals living with Dissociative Identity Disorder (DID) begins with a person-centered foundation.

I believe clients are the experts on their own experiences. Therapy should be guided by each person's unique goals, needs, values, strengths, and pace. Creating a safe, supportive, and nonjudgmental environment is one of my highest priorities because meaningful healing often begins when people feel genuinely seen, heard, and accepted.

I also strive to provide evidence-informed care.

DID remains an area where research is continuing to develop. I believe clinicians have a responsibility to stay informed about current treatment approaches and emerging research while also being honest about the limitations of the available evidence.

That means I do not assume that one treatment model will be right for every person.

Instead, treatment should be collaborative. The question is not simply:

“What does the treatment manual say?”

It is also:

“What does this particular person need?”

Finally, I approach DID from a neurodiversity-affirming and anti-ableist perspective.

In my experience, many of the challenges faced by people with DID arise not only from dissociative symptoms themselves but also from misunderstanding, stigma, discrimination, and societal responses to difference.

Therapy should therefore involve more than reducing symptoms.

It can also support greater self-understanding, self-acceptance, connection, autonomy, and the ability to navigate a world that is not always accommodating of diverse ways of experiencing oneself and the world.

My goal is to help clients build greater safety, connection, resilience, and the freedom to create a meaningful life on their own terms.

One framework that often fits well within this approach is phase-oriented treatment.

What Is Phase-Oriented Treatment?

If you have recently been diagnosed with DID, you may have heard your therapist mention something called phase-oriented therapy or phase-oriented treatment.

It is one of the most widely recognized approaches to DID treatment and is reflected in treatment guidelines from the International Society for the Study of Trauma and Dissociation (ISSTD).

The basic idea is fairly simple:

Healing does not have to begin by immediately talking about the worst things that ever happened to you.

Instead, therapy generally begins by helping someone develop safety, stability, coping skills, and greater ability to manage dissociation. Trauma processing is approached gradually when the person has enough support and stability to tolerate the work.

Traditionally, phase-oriented treatment is described in three broad phases:

Phase One: Safety and Stabilization

Phase Two: Trauma Processing

Phase Three: Integration and Rehabilitation

That sounds wonderfully orderly.

Human beings, however, are rarely that orderly.

The phases are better understood as areas of focus than as three boxes that must be checked off in sequence.

Why Does DID Treatment Often Begin With Stabilization?

DID is commonly understood in relation to overwhelming experiences that exceeded a person's ability to cope with or integrate what was happening at the time.

For many people with DID, current difficulties may include dissociation, memory disruption, emotional overwhelm, anxiety, difficulty feeling safe, relationship challenges, or urges toward unsafe behavior.

If someone is struggling to remain grounded in the present, immediately asking them to spend large amounts of time immersed in traumatic memories may not be helpful.

That is why treatment often begins with a different question:

“What do you need in order to feel safe enough to eventually approach what happened?”

Stabilization is not what we do while waiting for the “real therapy” to begin.

Stabilization is therapy.

Phase One: Building Safety and Stability

The first phase focuses on developing enough safety and stability for treatment to proceed without unnecessarily overwhelming the person.

This may include:

• learning about trauma and dissociation

• developing grounding and coping skills

• improving emotional regulation

• reducing self-harm or other unsafe behaviors

• strengthening the therapeutic relationship

• understanding triggers

• increasing communication and cooperation among parts

These are also the central goals identified in the group treatment material for Phase One.

Many people spend a significant amount of time in this phase.

That is completely normal.

Healing is not a race.

It can sometimes be frustrating. A person may understandably think:

“I know what happened. Why aren't we talking about it?”

Or:

“Why are we still practicing grounding? I want to get better.”

But imagine learning to swim.

You probably would not begin by dropping someone into the deepest part of the ocean and saying:

“Great. Now swim.”

You would first learn how to breathe.

How to float.

How to recognize exhaustion.

How to move through the water.

And how to get yourself back to safety.

Trauma therapy can require a similar foundation.

The goal is not to avoid the past forever.

The goal is to make approaching it safer and more sustainable.

Safety Can Mean Different Things to Different Parts

For someone with DID, stabilization may also involve recognizing that different parts can have very different understandings of what safety means.

One part may desperately want to talk about the trauma.

Another may believe talking about it is dangerous.

One part may trust the therapist.

Another may have learned that trusting anyone leads to harm.

One part may want change.

Another may believe the existing system of coping is the only reason everyone survived.

These differences do not necessarily mean someone is “resistant.”

They may tell us something important about what different parts learned they needed to do in order to survive.

Rather than fighting those responses, therapy can become curious about them.

What is this part afraid will happen?

What is it trying to protect?

What would help it feel safer?

That curiosity can be an important part of Phase One.

Phase Two: Processing Trauma

Once sufficient stability has developed, therapy may begin to focus more directly on traumatic experiences.

This phase may involve:

• processing traumatic memories

• understanding how past experiences continue to affect the present

• reducing shame and self-blame

• reducing trauma-related symptoms

• increasing cooperation among parts

• developing a more coherent understanding of one's life story

Your group material similarly describes Phase Two as focusing on traumatic experiences, their present-day effects, symptom reduction, and greater cooperation among parts.

But trauma processing does not simply mean telling the story.

Remembering something and therapeutically processing it are not necessarily the same thing.

The purpose is not to see how much distress someone can endure in one session.

And it is not to force memories or information from one part to another.

For people with DID, memories and emotional experiences may be distributed in complicated ways across the system. Different parts may hold different emotions, beliefs, perspectives, or information connected with an event.

Treatment therefore needs to proceed carefully and collaboratively.

More distress does not automatically mean more healing.

The goal is to help traumatic experiences become less overwhelming and less able to dominate the present.

Going Back to Stabilization Is Not Going Backward

A common misconception is that someone has to completely “finish” Phase One before entering Phase Two.

That is not how healing usually works.

A person may begin trauma processing and then experience:

a death,

a relationship breakup,

housing instability,

work stress,

increased dissociation,

a medical crisis,

or renewed conflict among parts.

At that point, the most appropriate work may once again be stabilization.

That does not mean therapy failed.

You did not lose all of your progress.

Therapy is not a video game where returning to an earlier level deletes your save file.

The skills developed in Phase One are tools you are meant to return to whenever you need them.

Safety is not something you graduate from.

Healing is often less like climbing a staircase and more like following a winding path.

Sometimes you move quickly.

Sometimes you stop.

Sometimes you revisit something you learned months or years earlier.

All of those can be normal parts of recovery.

Phase Three: Building the Life You Want

The third phase shifts increasingly toward life beyond immediate trauma survival.

The original group material describes this phase as involving stronger relationships, improved daily functioning, a more connected sense of self, and the development of a meaningful future.

I particularly like that final goal:

building a meaningful future.

Because the point of trauma therapy is not to become exceptionally skilled at talking about trauma.

The point is to live.

That may include:

strengthening relationships,

developing greater confidence,

pursuing education or career goals,

exploring interests,

building community,

developing independence,

creating a more positive relationship with oneself,

and building a life that is not organized entirely around what happened in the past.

Someone who has spent years or decades using enormous amounts of psychological energy simply to survive may eventually find themselves facing a new question.

Not:

“How do I get through this?”

But:

“What do I actually want my life to be?”

That can be an enormous shift.

Does Integration Mean Everyone Has to Become One Identity?

The word integration can cause understandable confusion in discussions of DID treatment.

Integration can be used broadly to describe increasing communication, cooperation, awareness, continuity, and connection among parts.

It can also be used more specifically when discussing fusion among identity states.

Those are not necessarily the same thing.

Treatment should not begin with a predetermined belief that every person's recovery must look identical.

For some people, treatment goals may include greater fusion.

For others, the emphasis may be on improved communication, cooperation, shared awareness, stability, and functioning.

The broader goal is not:

“How do we make your internal experience look the way someone else thinks it should?”

It is:

“How do we help you live more safely, freely, and effectively?”

That is one reason individualized treatment matters so much.

What Are the Strengths of Phase-Oriented Treatment?

Phase-oriented treatment has several important strengths.

It:

prioritizes safety,

recognizes the complexity of severe trauma,

allows treatment to proceed gradually,

provides time to develop coping skills,

emphasizes stability,

and supports a collaborative therapeutic relationship.

These strengths are also highlighted in the original group treatment material.

For DID specifically, I think there is another important advantage.

It allows us to approach dissociation without immediately declaring war on it.

Dissociative responses developed—or attempted to develop—for protective reasons.

They may create tremendous difficulties now.

But therapy can hold two things as true at the same time:

“This is causing problems today.”

and

“There may be a reason your mind learned to do this.”

That opens the door to curiosity rather than shame.

A Note About the Research

It is important to be honest about the evidence base.

Phase-oriented treatment remains one of the most widely recognized approaches to DID treatment and is reflected in professional guidelines.

At the same time, the research literature on DID treatment is still developing.

Much of the evidence comes from clinical observation, expert consensus, naturalistic outcome studies, and longitudinal treatment research rather than the large body of randomized controlled trials available for some other mental health conditions.

Research does suggest that many individuals receiving treatment for dissociative disorders experience improvements in areas such as safety, functioning, dissociation, and quality of life, but important questions remain about which treatments work best, for whom, and under what circumstances.

That means clinicians need humility.

We need to remain informed.

We need to be willing to update our practices as research develops.

And we need to remember that no treatment model replaces the individual sitting in front of us.

Your original handout makes this point especially clearly: no single treatment approach has been established as the right fit for every person, and treatment should be individualized according to someone's experiences, strengths, needs, and goals.

Healing Does Not Have to Be Rushed

There can be enormous pressure in therapy to get somewhere.

Process the memory.

Stop dissociating.

Make the parts cooperate.

Move forward.

Get better.

But some of the most important changes in DID treatment can look very small from the outside.

Recognizing that you are beginning to dissociate.

Using a grounding strategy before you become completely overwhelmed.

A part communicating something it has never felt safe enough to communicate before.

Understanding why a trigger affects you.

Realizing that an emotion belongs to another time.

Setting a boundary.

Asking for help.

Being able to remain present a little longer.

Trusting someone a little more.

Those are not things that happen before healing.

Those things are healing.

Final Thoughts

Phase-oriented treatment begins with a deceptively simple idea:

Safety first.

Not because trauma does not matter.

Not because we are afraid to talk about difficult things.

And not because healing requires pretending the past did not happen.

Quite the opposite.

The past matters enough that it deserves to be approached in a way that does not unnecessarily overwhelm the person who survived it.

Phase One asks:

How can we create enough safety to do this work?

Phase Two asks:

How can we approach what happened without becoming consumed by it?

Phase Three asks:

Now that survival does not have to occupy quite so much of your life, what do you want to build?

There is no prize for moving through those phases quickly.

You can move forward.

You can pause.

You can return to stabilization.

You can need more support.

You can change your goals.

Your system can change.

Your understanding of healing can change.

The phases are not a test.

They are a framework.

And ultimately, the goal is not simply symptom reduction.

The goal is greater safety, self-understanding, connection, agency, and the freedom to create a meaningful life on your own terms.

Selected References

Brand, B. L., Classen, C. C., Lanius, R. A., Loewenstein, R. J., McNary, S. W., Pain, C., & Putnam, F. W. (2009). A naturalistic study of dissociative identity disorder and dissociative disorder not otherwise specified patients treated by community clinicians.

International Society for the Study of Trauma and Dissociation. (2011). Guidelines for treating dissociative identity disorder in adults, third revision.

Purcell, J. B., Brand, B., Browne, H. A., et al. (2024). Treatment of dissociative identity disorder: Leveraging neurobiology to optimize success.

Steele, K., van der Hart, O., & Nijenhuis, E. R. S. (2005). Phase-oriented treatment and structural dissociation.

van der Hart, O. (2012). Stabilization interventions in complex dissociative disorders.