Catching a Wave: The Hypnosis-Sensitive Transference-Based Treatment of Dissociative Identity Disorder (DID)

In this article, I will describe the way in which I work with enactment-prone dissociative patients in the transference. This approach requires an appreciation of the phenomena of hypnosis and the auto-hypnotic aspects of some forms of dissociation. Essentially, I learn from the patient and my interactions with the patient how hypnotic phenomena and auto-hypnotic defenses manifest themselves in the therapeutic relationship in order both to understand them and ultimately to bring them under conscious control. Because of the fluidity and turbulence of these states, I use the analogy of catching a wave, in which timing and balance are essential, albeit elusive factors in effecting a successful treatment. The importance of having experience with many patients, attending conferences, seeking supervision, and undergoing one's own therapy will be also discussed as important prerequisites for the clinician endeavoring to utilize this type of approach. This preparation, this quest for such a "balance," is modeled after the so-called tripartite model of training employed in psychoanalytic training institutes. I will offer clinical material to illustrate this approach, which I have described as "psychoactive psychotherapy." In such treatments, the clinician may be taken by surprise and is likely to be thrown "off balance" from time to time. The mutually shared understanding of such moments is essential to regaining clinical balance in the therapeutic setting, and can lead to if not create important turning points in the treatment process.