Controversy Surrounding Dissociative Disorders And Ethics

Controversy Surrounding Dissociative Disorders and Ethical Considerations

The field of mental health has long grappled with the complexities surrounding dissociative disorders, which include dissociative identity disorder (DID), dissociative amnesia, and depersonalization-derealization disorder. These conditions are characterized by disruptions in consciousness, identity, memory, and perception, often linked to traumatic experiences. The controversy within the field primarily revolves around the legitimacy, diagnosis, and etiology of dissociative disorders, especially DID. Critics question whether these disorders are genuine mental health conditions or artifacts of suggestibility, therapy influence, or media portrayal. This skepticism stems from historical cases, varying diagnostic criteria, and the variable presentation of symptoms (Loewenstein & Putnam, 2015). Furthermore, some practitioners argue that the rise in DID diagnoses may be driven by therapist suggestion or cultural factors, leading to concerns about overdiagnosis or false memories. Conversely, proponents emphasize the clinical evidence and alignment with trauma models, asserting that dissociative disorders are valid responses to severe trauma, particularly in childhood (Brand, Loewenstein, & Spiegel, 2013).

My Professional Beliefs About Dissociative Disorders

In my professional opinion, dissociative disorders represent genuine psychiatric conditions rooted in complex trauma histories. I believe that dissociation functions as a defense mechanism, allowing individuals to compartmentalize distressing memories or experiences that are otherwise overwhelming. The literature supports this perspective, emphasizing the strong association between trauma and dissociation (Spiegel & Loewenstein, 2014). I consider the diagnosis of dissociative disorders to be valid when supported by careful clinical assessment, consistent symptom presentation, and historical evidence of trauma. It is crucial to approach these disorders with sensitivity, understanding that they can significantly impair functioning and require tailored therapeutic interventions. I support the use of trauma-informed therapy, such as dialectical behavior therapy, Eye Movement Desensitization and Reprocessing (EMDR), and specialized dissociation treatments (Dorahy et al., 2014). Recognizing the legitimacy of dissociative disorders guides ethical practice, promotes empathetic engagement, and facilitates effective treatment planning.

Strategies for Maintaining Therapeutic Relationships

Maintaining a strong therapeutic alliance when working with clients presenting dissociative symptoms requires several tailored strategies. First, establishing safety and trust is paramount, as clients may have profound fears of losing control or re-experiencing trauma (Brand et al., 2013). Clinicians should employ a trauma-informed approach, emphasizing confidentiality, consistency, and validation of the client’s experiences. Psychoeducation about dissociation can help clients understand their symptoms, reducing shame and fostering cooperation (Dorahy et al., 2014). Additionally, clinicians should work at a pace comfortable for the client, avoiding retraumatization by respecting boundaries and readiness. Incorporating grounding techniques and mindfulness exercises can help clients stay connected to the present moment during sessions. Consistent monitoring of dissociative episodes, combined with collaborative safety planning, enhances the therapeutic relationship and mitigates risks of dissociative episodes (Loewenstein & Putnam, 2015). Building a foundation of empathy and reassurance is essential in fostering client engagement and progress.

Ethical and Legal Considerations in Dissociative Disorders

Working ethically with clients who have dissociative disorders involves careful attention to several considerations. Informed consent is critical, especially given the sensitivity of trauma histories and the potential for re-experiencing distress during therapy (American Psychological Association [APA], 2017). Clinicians must ensure that clients understand the nature of dissociation, the goals of treatment, and the boundaries of confidentiality. Legal considerations include safeguarding client safety, particularly when dissociation leads to self-harm or dissociative episodes that impair judgment. When clients display legal issues related to dissociative symptoms, such as memory gaps or false accusations, clinicians must balance confidentiality with the duty to protect (Loewenstein & Putnam, 2015). It is also paramount to document carefully, noting symptom presentation and therapeutic interventions to avoid misunderstandings or legal challenges. Ethical practice requires clinicians to be culturally competent, recognizing that cultural beliefs influence symptom expression and treatment engagement. Maintaining professional boundaries, ongoing supervision, and adherence to evidence-based practices further support ethical integrity (Dorahy et al., 2014). Overall, being aware of these considerations helps safeguard both the client and the clinician, ensuring responsible and compassionate care.

References

• American Psychological Association. (2017). Ethical Principles of Psychologists and Code of Conduct. APA.
• Brand, B. L., Loewenstein, R. J., & Spiegel, D. (2013). Working with Dissociative Identity Disorder and Trauma. Journal of Trauma & Dissociation, 14(2), 132-146.
• Dorahy, M. J., van der Hart, O., & Middleton, W. (2014). Dissociative Disorders and Trauma: New Perspectives and Treatment Approaches. Psychiatry, Psychology and Law, 21(2), 202-214.
• Loewenstein, R. J., & Putnam, F. W. (2015). A Review and Update on Dissociative Disorders. Current Psychiatry Reports, 17(6), 63.
• Spiegel, D., & Loewenstein, R. J. (2014). Dissociation and Trauma: Toward an Etiological Model. Psychological Trauma: Theory, Research, Practice, and Policy, 6(4), 347-356.