Study review: Better is not the same as finished

Recovery is quieter than people expect

“When does it get better?” is a question I've asked too. I wanted to look at what clinicians were reporting after years of treatment.

A looping path that illustrates how progress can move forward, backward, and sideways.

Recovery often includes setbacks and changes in direction. Source

In this review, I wanted to take a look at what improvement looks like. Here we have a six-year follow-up based on 61 therapists' reports about their clients.¹

Six years is a long time to ask someone to keep showing up for treatment. It's also difficult to keep track of everyone over that time. At this follow-up, 61 therapists provided reports, down from 295 at the start of the larger study.¹ We hear much less about the people who were no longer participating.

At the six-year mark, the remaining therapists filled out a short web survey about safety, stress, quality of life, victimization, and everyday functioning. Researchers compared those answers with information collected at earlier points in the study.¹

The study followed ongoing outpatient treatment, with therapists continuing the work they were already doing with their clients.¹

What got easier

At the six-year follow-up, therapists reported better overall functioning, fewer psychiatric hospitalizations, fewer stressors, and less recent sexual revictimization. Family stress and conflict among identity states also fell in the analyses.¹

What stands out is how ordinary the improvements are. People were spending less time in crisis, being hospitalized less often, and reporting fewer stressors. Those changes may not sound dramatic, but they create more room for everyday life.

Better is not the same as finished

Many people in the study still had serious trouble with work and close relationships. Self-harm and suicide attempts did not change significantly in this follow-up group; rates were already low at the earlier point used for comparison.¹

Someone may stop needing hospital admissions and still struggle to trust people or keep a job. For a person in that position, those difficulties still need attention, even after a substantial improvement.

Why early therapy can look ordinary

A person may spend early treatment working on sleep, grounding, reducing unsafe coping, or building communication before discussing trauma memories in detail. Clinical guidance describes that work as part of a phased approach to DID treatment.²

Some starting points for the kind of work that may happen in this phase:

Dialectical behavior therapy (DBT) for skills around distress, emotion regulation, and relationships.
Acceptance and commitment therapy (ACT) for values, psychological flexibility, and making room for difficult inner experiences.
Grounding techniques for returning attention to the present when a person feels overwhelmed or pulled into a flashback.
The Stanley-Brown Safety Planning Intervention for building a concrete safety plan with a clinician when suicidal thoughts or self-harm are part of the picture.

Lily Bailey's version

Lily Bailey was writing about OCD, not DID. Her account of getting better without reaching a final, permanent finish line puts the same idea in a few words.

“I’m not totally recovered though. Sometimes I have terrible days.”³

Lily Bailey

Recovery From Mental Illness Isn't Always Linear · Psychology Today, 2018

Footnotes3

Myrick, A. C., Webermann, A. R., Loewenstein, R. J., Lanius, R., Putnam, F. W., & Brand, B. L. (2017). Six-year follow-up of the treatment of patients with dissociative disorders study. European Journal of Psychotraumatology, 8(1), 1344080. Results, limitations, and conclusions. Naturalistic symptom and functioning outcomes over six years. ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶
International Society for the Study of Trauma and Dissociation. (2011). Guidelines for treating dissociative identity disorder in adults, third revision. Journal of Trauma & Dissociation, 12(2), 115-187. pp. 135-136. Consensus model for sequenced treatment. ↩
Bailey, L. (2018, April 3). Recovery from mental illness isn't always linear. Closing reflection on partial recovery. First-person OCD reflection on improvement, relapse, and living with recovery that remains incomplete. ↩