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Edited notes from an email posted by Richard Kluft on the ‘Dissociative Disorders Email Discussion Forum’ recently.  Richard Kluft is a well-known author, clinician, teacher, researcher etc, in the field of dissociative disorders.

Reproduced with permission.

Every day each patient confronts me (and my patient him or herself) with unique challenges, and forces us to reinvent our therapeutic work together. To me, the work is not unlike sailing. When you sail, you usually just can't point the boat where you want to go and get there. Instead, aware of the changes in the wind and the current, and unable to sail directly to many degrees of the compass, you do your best to plot a course, or at least determine a strategy about how to tack back and forth, knowing that its very essence is its malleability, and that no voyage will ever work out without a constant attention to the changeability of the enterprise.

In a given day I may see a dozen DID patients, and in each case my approach to each patient, and each patient's personality system's responses to my efforts may be different. This has always made it difficult for me to offer general advice about what to do, or, even to describe what I do.

I would urge list members to give thought (as Connie Wilbur used to say:) "in depth and at length" to advice that is offered. Some ideas may be great, but not fit with the rest of a given therapist's approaches, or the overall tenor of a particular treatment, or be workable with a particular patient.

When we are dealing with a patient's pain and suffering, we want to eliminate or at least minimize its capacity to be hurtful in the present; i.e., (and here I think I may be paraphrasing Janet) we want to transform a symptom into a memory, something that can be recalled and discussed, but which does not intrude itself into daily life in some dysphoric and dysfunctional manner. Patients' individual styles and beliefs may play powerful roles in what is needed. For some patients, a focus on the cognitive distortions and consequences of the trauma may suffice; for others, nothing less than an earthshaking emotional outpouring drains the past experience of its hurt.

When patients are being traumatized, and their minds are managing to contain and protect themselves from as much pain as possible, they do not all arrive at the same strategies, or dissociate things in the same manner as others may. What they do is not universally the same. Moreover, many will restructure their dissociative defences over time.