Schema Therapy for DID and Complex Dissociative Disorder: Moving from 50 to 6

This presentation introduces the Schema Therapy (ST) approach to the treatment of dissociative identity disorder (DID) developed by Ida Shaw and Joan Farrell.

This innovative approach explores the consolidation of numerous dissociative parts into a smaller number of modes, using the principles and techniques of schema therapy.

A challenge in working with DID is the complexity of presentations of twenty to a hundred “parts” or “personalities”. Central to the initial ST approach is the recognition that individuals with DID often present with a bewildering array of dissociative parts, each carrying distinct memories, emotions, and coping strategies. This approach acknowledges that individuals with DID may present with various dissociative parts, each associated with unique memories, emotions, and coping mechanisms. The client comes to understand that a trauma they experienced led to the development of a set of modes specific to that event that operate outside of conscious memory. When numerous severe traumas are experienced multiple sets of modes develop. These modes operate semi-independently Schema therapy, with its emphasis on unmet childhood needs and deeply ingrained patterns, offers a framework for understanding how these parts—once adaptive but now disruptive—can be compassionately redefined as schema modes. Through therapeutic alliance, experiential techniques, and skills building, clients gradually learn to recognize, validate, and ultimately integrate the many voices within into a limited number of schema modes. Using ST, each set of modes is identified and addressed during treatment. The goal is to organize these “parts” into the four types of mode, viz., child, coping, critic and Healthy. This reduces internal chaos and fosters a sense of continuity. As modes heal, they are triggered less leading to stabilization. This allows awareness, management, and healing to progress as they would for a patient without DID. As clients grow more adept at accessing their Healthy Adult mode, the therapy empowers them to meet their needs in balanced ways, paving the way for deeper healing and lasting transformation.

This model of ST for DID originated and was pilot tested in an inpatient ST program for borderline personality disorder developed by the presenters to which patients with DID were also referred. It has also been tested in an experimental case series for 2 years of weekly sessions with positive results which will be presented. This is a significant decrease in treatment compared to the typical 10 + years of psychodynamic psychotherapy.