Understanding and Treating Dissociative Identity Disorder: A Relational Approach, 1st Edition (Paperback) book cover

Understanding and Treating Dissociative Identity Disorder

A Relational Approach, 1st Edition

By Elizabeth F. Howell


330 pages

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pub: 2011-04-21
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Building on the comprehensive theoretical model of dissociation elegantly developed in The Dissociative Mind, Elizabeth Howell makes another invaluable contribution to the clinical understanding of dissociative states with Understanding and Treating Dissociative Identity Disorder. Howell, working within the realm of relational psychoanalysis, explicates a multifaceted approach to the treatment of this fascinating yet often misunderstood condition, which involves the partitioning of the personality into part-selves that remain unaware of one another, usually the result of severely traumatic experiences.

Howell begins with an explication of dissociation theory and research that includes the dynamic unconscious, trauma theory, attachment, and neuroscience. She then discusses the identification and diagnosis of Dissociative Identity Disorder (DID) before moving on to outline a phase-oriented treatment plan, which includes facilitating a multileveled co-constructed therapeutic relationship, emphasizing the multiplicity of transferences, countertransferences, and kinds of potential enactments. She then expands the treatment possibilities to include dreamwork, before moving on to discuss the risks involved in the treatment of DID and how to mitigate them. All concepts and technical approaches are permeated with rich clinical examples.


"Elizabeth Howell, in Understanding and Treating Dissociative Identity Disorder: A Relational Approach, has once again shown that successful psychotherapy hinges on working with dissociation in the context of a human relationship. In her new book, she extends the central thesis of her earlier volume, The Dissociative Mind, to brilliantly portray how, even with individuals who seem to defy the time-honored rules of psychotherapeutic engagement, the deepest healing and the deepest growth are intertwined in the ever-shifting interactive relationship with the multiple aspects of self haunting the patient's inner world. Synthesizing within her own perspective the valuable contributions of other clinicians and researchers in the area of trauma and dissociation, she demonstrates how the complex relational environment defining the "disorder" labeled DID is not a strange form of illness but a debilitating form of anticipatory self-protection – the automatic reliance on a dissociative self-state structure designed to preempt the return of traumatic affect and interpersonal betrayal. Howell's inspiring range of scholarship and clinical perceptiveness is so deeply embedded in her wisdom, that I strongly anticipate this book being an invaluable resource for all mental health practitioners of all orientations." - Philip M. Bromberg, author of The Shadow of the Tsunami (2011), Awakening the Dreamer (2006), and Standing in the Spaces (1998)

"Elizabeth Howell has officiated at the wedding of traumatology and relational psychoanalysis by serving us with a thoughtful and nuanced melding of theoretical knowledge and clinical wisdom borne out of many years of hard work. Especially valuable are detailed case descriptions and discussion, which bracket the book and punctuate the text even in the section on relevant neurobiology. This is an accessible 'must read' volume for clinicians interested in better understanding their patients who are struggling with the aftermath of chronic complex trauma and dissociation." - Richard A. Chefetz, International Society for the Study of Trauma and Dissociation, USA

"A must for any psychologist looking for deeper study of this serious and life changing disorder and how it affects their patients." - The Midwest Book Review

"Howell's voice is personal, and at times passionate…Howell is familiar with relevant current research literatrue and summarizes it thoroughly, but this is not what makes her book original. Rather, it is her collection of clinical "pearls." She frequently includes short segments from verbatim transcipts of psychotherapy sessions and these are very valuable as illustrations of therapeutic technique…for those seeking a glimpse into the office of a master clinician who knows how to work with dissociative patients." - Judith L. Herman, MD, Psychoanalytic Psychology

"An impressively comprehensive yet nuanced guide for the understanding and treatment of patients with dissociative identity disorder (DID). The first half of the book is an excellent summary of relevant theory, while the second half focuses cogently on several clinical topics. We recommend Howell's latest book as a reliable guide for both novice and experienced analysts." - Miriam Korn, Journal of the American Psychoanalytic Association

Table of Contents

Introduction. Part I: Understanding Dissociative Identity Disorder. The Lives and Psychotherapy of Three People with DID. The Dynamic Unconscious and the Dissociative Structure of the Mind. "The 'We' of Me:" Personality Organization in DID. DID is a Trauma Disorder. Dissociated Self-states, Trauma, and Disorganized Attachment. Some Neurobiological Correlates of the Structure and Psychodynamics of Dissociated Self-states. Dissociated Self-states: Creation and Contexualization. Part II: Treating Dissociative Identity Disorder. Assessment and Diagnosis of DID. Phase-oriented Treatment. Facilitating Co-consciousness and Co-participation in the Treatment. Working with Persecutory Alters and Identification with the Aggressor. The Therapeutic Relationship: Multiple Dimensions of Co-construction. Dreams in DID. Suicidality. Comorbidity and Seeming Comorbidity: Problematic Outcomes of Severe and Rigid Dissociative Structuring of the Mind.

About the Author

A psychoanalyst and traumatologist who specializes in the treatment of dissociative disorders, Elizabeth Howell, Ph.D., is Associate Editor of the Journal of Trauma and Dissociation and Co-Director of the Dissociative Disorders Psychotherapy Training Program of the International Society for the Study of Dissociation. Dr. Howell is a faculty member of the National Institute for the Psychotherapies Trauma Studies Program and an adjunct associate professor in the psychology department of New York University. She has written and lectured widely on various aspects of trauma and dissociation. The author of The Dissociative Mind (Analytic Press, 2005), she has been awarded the Print Media Award for her work.

About the Series

Relational Perspectives Book Series

The Relational Perspectives Book Series (RPBS) publishes books that grow out of or contribute to the relational tradition in contemporary psychoanalysis. The term relational psychoanalysis was first used by Greenberg and Mitchell (1983) to bridge the traditions of interpersonal relations, as developed within interpersonal psychoanalysis and object relations, as developed within contemporary British theory. But, under the seminal work of the late Stephen Mitchell, the term relational psychoanalysis grew and began to accrue to itself many other influences and developments. Various tributaries—interpersonal psychoanalysis, object relations theory, self psychology, empirical infancy research, and elements of contemporary Freudian and Kleinian thought—flow into this tradition, which understands relational configurations between self and others, both real and fantasied, as the primary subject of psychoanalytic investigation.  

We refer to the relational tradition, rather than to a relational school, to highlight that we are identifying a trend, a tendency within contemporary psychoanalysis, not a more formally organized or coherent school or system of beliefs. Our use of the term relational signifies a dimension of theory and practice that has become salient across the wide spectrum of contemporary psychoanalysis. Now under the editorial supervision of Lewis Aron and Adrienne Harris with the assistance of Associate Editors Steven Kuchuck and Eyal Rozmarin, the Relational Perspectives Book Series originated in 1990 under the editorial eye of the late Stephen A. Mitchell. Mitchell was the most prolific and influential of the originators of the relational tradition. He was committed to dialogue among psychoanalysts and he abhorred the authoritarianism that dictated adherence to a rigid set of beliefs or technical restrictions. He championed open discussion, comparative and integrative approaches, and he promoted new voices across the generations.  

Included in the Relational Perspectives Book Series are authors and works that come from within the relational tradition, extend and develop the tradition, as well as works that critique relational approaches or compare and contrast it with alternative points of view. The series includes our most distinguished senior psychoanalysts along with younger contributors who bring fresh vision.

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Subject Categories

BISAC Subject Codes/Headings:
PSYCHOLOGY / Movements / Psychoanalysis
PSYCHOLOGY / Mental Health