Treatment overview

Start with the week in front of you

The first weeks of DID treatment may have little to do with describing trauma. Sleep may be falling apart. Work may be at risk. Self-harm may be getting harder to interrupt. One identity state may want help while another wants the appointments to stop.¹²

Treatment begins with what is making life difficult now. Someone may spend weeks practicing grounding, getting through a workday, making nights less chaotic, or finding a way for identity states to share information. If life becomes unstable later, therapy may return to the same work.³²⁴

Breathing or sensory grounding, journaling, and plans for difficult moments can look ordinary from the outside. A useful exercise should leave the person more able to stay present and get through the time between sessions.⁵²

Parts work has consequences after the session

A parts-oriented session may begin with what happens just before fear, shame, or an urge to self-harm takes over. Janina Fisher combines ideas from IFS with sensorimotor psychotherapy, mindfulness, attachment work, and structural dissociation. In Healing the Fragmented Selves of Trauma Survivors, she approaches these states as survival responses rather than resistance or an attempt to derail therapy.⁶

Fisher calls one part of this work “unblending.” The person notices a part's fear, anger, or shame while keeping some awareness of the room and the present day. From there, they can listen to what the state is communicating without being completely overtaken by it.⁶

DID changes what a therapist has to watch for. A session that feels calming to one identity state may leave another frightened or angry afterward. Amnesia and internal disagreement can hide that reaction until the person is home. Twombly recommends watching what happens between appointments and slowing down when coping gets worse.⁷

ISSTD guidance also warns therapists against calling identity states forward before the person is ready or encouraging them to become more separate than they already are.⁸ DID appeared in only one of the 27 peer-reviewed IFS studies found by a 2025 scoping review; 17 of the 27 were case studies.⁹ If you're interested in learning more about IFS, check out IFS and dissociative parts.

Trauma work happens in pieces

Trauma work is usually planned in pieces rather than treated as one long disclosure. A therapist may narrow the target, pause when symptoms increase, or spend more time reconnecting the person with the present.¹⁰

EMDR

Saying “I use EMDR” tells you little about the pace or procedure. The standard version can move too quickly for someone with severe dissociation. The ISSTD recommends checking safety, internal cooperation, and readiness, then modifying the procedure when needed.¹¹

Hypnosis

Many people hear hypnosis and think of memory retrieval. In DID therapy, it may instead be used to practice grounding and self-soothing, contain flashbacks, or help identity states communicate.¹²

Kluft's 2012 overview pauses over something that sounds harmless: relaxation. For some trauma survivors, letting their guard down feels dangerous. “Safe place” imagery may calm one identity state and unsettle another. Kluft would discuss the imagery first and ask about concerns before using it.¹³

Using hypnosis to search for a memory raises a separate problem. Scoboria and colleagues found that misleading questions reduced memory accuracy in a 2006 experiment. They did not reproduce an earlier finding that hypnosis itself reduced accuracy.¹⁴ The ISSTD warns that hints, pressure, and leading questions can distort recall; hypnosis may also leave someone more certain about a memory than the evidence warrants.¹⁵

Anyone using hypnosis here needs training in hypnosis and dissociation, informed consent, and a clear plan for stopping or changing course. Ask what the therapist wants hypnosis to do. Grounding, pain relief, and containment are very different from trying to fill a blank in someone's history.¹⁵¹³

Medication and groups

Medication may target depression, anxiety, sleep problems, or another condition alongside DID. DID itself is treated through psychotherapy. Responses can vary across identity states, so a prescriber still needs to follow changes carefully.¹⁶

Groups can offer skills, education, and contact with other people. A general trauma group can become overwhelming if its facilitators are not prepared for severe dissociation. ISSTD guidance keeps individual therapy at the center of DID treatment.¹⁷

Much of the evidence for DID treatment comes from clinical guidance and naturalistic studies. Controlled studies remain small, and no method has emerged as the best choice for everyone.¹⁸

Between appointments, note what changed: sleep, crises, distress, communication, or the ability to get through the day. Twombly recommends slowing down when coping gets worse.⁷ Better is not the same as finished follows one treatment study over six years.

Footnotes

1. 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. 132-134. Treatment goals, coordinated functioning, and integration. ↩

2. 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. 136-141. Safety assessment, stabilization, symptom management, and pacing. ↩ ↩² ↩³

3. 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. ↩

4. 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. p. 139. Developing communication, co-consciousness, and cooperation among identity states. ↩

5. 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. 151, 157. Grounding and present-orientation during distress or altered states. ↩

6. Fisher, J. (2017). Healing the fragmented selves of trauma survivors: Overcoming internal self-alienation. Routledge. Introduction; chapters 2-5 and 8-10; appendices A and C. Fisher's clinical model blends parts work informed by IFS with structural dissociation, sensorimotor psychotherapy, mindfulness, and attachment-focused treatment. It emphasizes unblending, dual awareness, and a more compassionate relationship with trauma-related states. ↩ ↩²

7. Twombly, J. H. (2021, November 6). Trauma and dissociation informed IFS [Podcast interview transcript]. IFS Talks. pp. 2-4 and 6-8. Clinical commentary on adapting IFS for complex dissociation, including risks of overwhelm, destabilization, premature work with hidden identity states, insufficient coping skills, and poorly paced trauma work. ↩ ↩²

8. 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. 133 and 140-141. Guidance against eliciting identity states before the person is ready or encouraging identity states to become more elaborated and autonomous than they already are. ↩

9. Buys, M. E. (2025). Exploring the evidence for Internal Family Systems therapy: A scoping review of current research, gaps, and future directions. Clinical Psychologist, 29(3), 241-260. pp. 241-260; Results and discussion. Scoping review of 27 peer-reviewed IFS studies, most of them case studies, with DID represented at the case-study level rather than in a controlled trial. ↩

10. 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. 141-144. Readiness, titration, and returning to stabilization when needed. ↩

11. 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. 158-160. DID-specific cautions and modifications for EMDR. ↩

12. 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. 156-157. Clinical uses of hypnosis and self-hypnosis for grounding, self-soothing, symptom control, containment, and internal communication. ↩

13. Kluft, R. P. (2012). Hypnosis in the treatment of dissociative identity disorder and allied states: An overview and case study. South African Journal of Psychology, 42(2), 146-155. pp. 146-148 and 152-154. Clinical discussion of hypnosis for stabilization and carefully paced trauma work, including risks associated with relaxation, imagery, suggestive memory inquiry, and overwhelming exposure. ↩ ↩²

14. Scoboria, A., Mazzoni, G., & Kirsch, I. (2006). Effects of misleading questions and hypnotic memory suggestion on memory reports: A signal-detection analysis. International Journal of Clinical and Experimental Hypnosis, 54(3), 340-359. Abstract and results. In 194 undergraduates, misleading questions reduced memory accuracy; the study did not replicate an earlier finding that hypnosis itself reduced accuracy. ↩

15. 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. 157-158. Leading questions, memory distortion, unwarranted confidence in recalled material, clinician training, and informed consent. ↩ ↩²

16. 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. 151-153. Medication as treatment for associated symptoms rather than DID itself. ↩

17. 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. 148-150. Potential uses and limitations of group treatment. ↩

18. Bachrach, N., & Huntjens, R. J. C. (2025). Recent evidence-based developments in the treatment of dissociative identity disorder. Frontiers in Psychiatry, 16, 1650164. Treatment evidence and conclusion. Critical review of evidence quality and emerging treatment approaches. ↩