The name “Dissociative Disorders” is a common umbrella term in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to describe mental disorders featuring behavioral, perceptual, and identity problems as major defining characteristics. Today, Dissociative Identity Disorder (DID), and Dissociative Amnesia (DA) Depersonalization/De-realization Disorder (DPDRD), Other Specified Dissociative Disorders (OSDD) and Unspecified Dissociative Disorder (UDD) are the only mental disorders recognized under this category (Matuskey, 2017). Yet, their inclusion in the diagnostic manual remains a controversial matter. Part of this controversy stems from questions raised on the actual authenticity of Dissociative Disorders as a legitimate psychiatric illnesses.
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Moreover, Dissociative Disorders is thought to develop as a direct consequence of extreme and continuous childhood abuse or trauma. Proponents of its legitimacy theorize that dissociation is used by patients to cope with traumatic experiences by essentially repressing traumatic memories thoughts, and actions. The concept of the existence of repressed memories is particularly controversial since mental health experts doubt the validity of the presence of a causal relationship between repressed memories and childhood abuse. Instead, they hold the dissenting view that traumatic childhood experiences are rarely forgotten victims and the reemergence of so-called “repressed memories” is likely an erroneous finding by overzealous therapist and troubled clients. Furthermore, Dissociative Disorders are sometimes regarded as social constructs driven by sociocultural expectations and elements of modern society such as mass media.
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My Professional Beliefs about Dissociative Disorders
Although dissociation and dissociative disorders (DD) currently represent a divisive subject, I hold the professional belief that DDs are real; a fact further supported by published scientific literature. Currently, clinical data supports the theory that a direct correlation exists between dissociation and traumatic experiences (Bailey et al., 2019). The rationale behind my choice is further supported by incidences where individuals diagnosed with the condition are generally within a healthcare setting and are, generally, representatives of a control clinical population. Psychiatric patients with any sub-type of Dissociative Disorders typically record significant improvements after starting recommended treatment options (Myrick & Brand, 2016). I, therefore, believe that it is important to advocate for the spread of relevant information about disorders in under this group to the public to support early intervention and promote further research.
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Furthermore, dissociation is a mental state emerging after a traumatic experience; further supporting its position especially since is accompanied by a clear departure from normal pathology. Psychological detachment from a traumatic experience is common among victims of severe abuse since it mitigates the effects intrusive thoughts and memories (Staniloiu & Markowitsch, 2018). This is consistent with the idea that traumatized patients will often attempt to segregate their awareness from the reality of past traumatic experiences. Dissociative Disorders should, therefore, be recognized and accepted as a real psychiatric disorder since this will promote efforts geared towards identifying the most effective interventions for stabilizing patients with the condition. This will, thus, improve patient’s quality of life and minimize the possibility of self-harm or engaging in self-destructive behaviors.
Strategies for Maintaining a Therapeutic Relationship with client with Dissociative Disorders
A strong therapeutic alliance forms the foundation of clinical interventions and is fundamental when treating a patient with complex psychological conditions such as Dissociative Disorders. I would, therefore, strive to first develop a rapport with the patient during our initial meeting and help them feel welcomed, notwithstanding the unfamiliar environment. Furthermore, it is also imperative to remember that therapeutic relationships may take a long time to develop. This is normally the only guarantee that a strong, close, and trusting relationship can be forged, which is especially important for DD clients haunted by past traumas (Lynn et al., 2015). A .neutral environment will enhance the quality of therapy sessions by allowing the client to express deep-seated thoughts and emotions while feeling heard.
A therapist should also avoid judging clients. Instead, one should focus on treating them with compassion while avoiding offering advice on sensitive matters such as religion. A therapist should always take charge of each session to provide a sense of direction and focus on managing their emotions. An open patient-therapist discussion should also be conducted on the primary objectives of each therapy sessions to help the client to better understand what exactly they want from it and how to achieve set goals (Sanders, 2018). Therapists should always remember that their clients are vulnerable persons in need of high-quality care and attention which they are capable of providing. In the event they are unable to meet the client’s needs, they should make a conscious decision to discontinue the services and refer them to another therapist.
Ethical and Legal Considerations Related to Dissociative Disorders
Likewise, ethical and legal considerations should always be taken into account when treating patients to guarantee adherence to the highest standards of professional practice. First, clients presenting the symptoms of Dissociative Disorders have a right to know the preliminary diagnosis. Relaying this information during the first meeting is an important step in guiding treatment based on the most appropriate treatment option available. This treatment option should also be based on a client’s individual needs. Clients who confess to having frequent self-harm ideations should also be placed under suicide watch as failure to do so may have grave implications for a therapist and the respective healthcare provider.
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