The study and the treatment of the dissociative disorders has generated a plethora of newer theories and approaches, none of which have demonstrated effectiveness superior to the models they are put forward to replace. I will argue that while conceptually-driven patterns of intervention have certain strengths, the fact that no model advanced to date actually addresses the full range of dissociative phenomena guarantees that each will fall short of providing optimal guidance to the clinician. Instead, I will describe how the intense study of selected clinical phenomena and clinical research suggest insights that in turn facilitate the development of new treatment interventions.
Critical incidents related to the defensive use of aggressive sexualisation, sexual re-enactments, dedicated preoccupation with self-destruction, prolonged silences and associated stalemates in treatment, and moments of decompensation during trauma work will be explored to demonstrate how many techniques are useful for the treatment of DID and related states are the natural outcome of working up from clinical observations rather than down from theoretical models. Dissociative phenomena are always trying to teach us how to help dissociative patients, but sometimes we must engage in quite a struggle to clear our own minds and appreciate those lessons.
