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08-06-2007, 05:13 AM
The aim of treatment and self-help is to bring about increased connection between feelings, thoughts, perceptions and memories, and to foster a sense of empowerment. This should create a greater sense of wholeness and internal order, and less disruption in work, social and home life.

<span style='font-size:21pt;line-height:100%'>Talking treatments</span>
Effective treatment for the dissociative disorders may combine several methods, but always includes talking treatments. (See Understanding talking treatments.) It is important that this helps people to approach underlying causes as well as the effects of the dissociative problems. It’s helpful if the therapist is familiar with dissociation and trauma work, but it’s the quality of the therapist–client relationship that is most important to recovery. The therapist should be accepting of the client’s experience; willing to learn how to work with dissociation and trauma; able to tolerate high levels of frustration and bear extreme pain; and be prepared to work with the client long term, often for several years.

Getting talking treatment through the NHS may depend on where you live. Usually, only short-term therapy is available, which may do more harm than good for the dissociative client. You may be able to get low-cost or free psychotherapy through voluntary organisations. Therapists in the private sector are another option. Some offer fees on a sliding scale. (See Useful organisations.)

<span style='font-size:21pt;line-height:100%'>Medication</span>
Medication may be helpful in treating symptoms of depression, anxiety, or insomnia, but there is no drug to treat the dissociation itself. Antipsychotic drugs are generally not helpful.

<span style='font-size:21pt;line-height:100%'>Care in the community</span>
Supportive and creative community mental health services can help people to cope with the everyday effects of dissociation and related problems that impact on daily life. The workers don’t necessarily have to be professionally qualified, but they do need to know about dissociation and how to respond to a person in a dissociative state.

<span style='font-size:21pt;line-height:100%'>Crisis intervention</span>
If a person is suicidal or otherwise unable to stay safely in the community, a GP or community mental health worker may make a referral for admission to hospital, or for intensive care from a home treatment team. (This is a community-based crisis-response service who can provide support in your own home as an alternative to hospital admission.) Alternatively, you may ask for help at a hospital accident and emergency department. Mainstream crisis intervention services are unlikely to understand or acknowledge the dissociative experience, but they may be the only option to help a person survive through the crisis. Before a crisis occurs, it’s a good idea to make a personal crisis plan with the help of a care co-ordinator, friend or other supporter. Think about things that help you avoid going into crisis, and what helps you survive if a crisis does occur.

<span style='font-size:21pt;line-height:100%'>Self-help</span>
Recovery usually requires active self-help. It’s common for therapists to set ‘homework’. This may include a variety of self-help techniques and exercises.

If you want to try self-help techniques on your own, remember that dissociation can complicate this. In DID, for instance, the identity who self-harms must be involved in any self-help activity for these behaviours.

Keeping a journal is one way to help improve connections and (in DID) awareness and co-operation between identities. It can include the writings or artwork from any aspect or identity of the dissociated self.

Imaging is a way to use your imagination to create internal scenes and environments, which help you stay safe and contain difficult feelings and thoughts. With practice, it can also be used to bring different identities to an internal conference table to make co-operative decisions.

Grounding techniques, which keep you connected to the present, can help you avoid flashbacks or intrusive thoughts, feelings or memories that you can’t yet cope with. The techniques include breathing slowly, walking barefoot, talking to someone, sniffing something with a strong smell, and many others.

Planning for child, adolescent and other identities to have control, at times and in places that are safe, is essential self-help for people who have DID. This is time for them to do things they like, to have experiences they were denied during an abusive childhood.

You may wish to develop coping strategies for everyday challenges. For instance, a person who loses time, due to dissociation, may decide to wear a watch with the day and date on it.

Many people have found that reading about the life and experiences of survivors with similar problems has helped them.

<span style='font-size:21pt;line-height:100%'>Support groups</span>
Sharing experiences with others who have the same problems can provide emotional release and practical assistance, provided that these support groups are well organised and maintain very clear boundaries (see Useful organisations).