Attachment as a Second Language: Treating Active Dissociative Identity Disorder

Evidence is accumulating (Brand, Classen, McNary, & Zaveri, 2009, Brand, Loewenstein, & Spiegel, 2014; Brand et al., 2013; Brand et al., 2012; Dorahy et al., 2014) to show that by and large, Dissociative Identity Disorder (DID) is well amenable to psychotherapeutic intervention along the lines of the International Society for the Study of Trauma and Dissociation (ISSTD) Guidelines for treatment of DID in adults (ISSTD, 2011), based on the Three Phase Approach (Van der Hart, Nijenhuis, & Steele, 2006). In this paper, however, I would like to draw our attention to those cases where improvement is not reached, despite high-quality, dedicated therapeutic efforts. I refer particularly to patients with Active DID (Sachs, 2013c, 2017): patients who remain persistently victimized and apparently unable to establish even the most basic safety needed for the therapeutic process (“phase one” of the threephase approach). I suggest that the therapeutic problem in these cases may lie in mis-attunement (Stern, 1998) between the therapist’s and the patient’s attachment language; and that this mis-attunement is due to a uniquely disordered attachment-pattern which characterises people with Active DID. I thus propose that, in these cases, phase one needs to be substantially modified and focus on therapeutic attunement rather than on safety. “Attachment as a second language” is proposed for treating people with persistent (“Active”) DID, while considering the clinical, theoretical and practical aspects of this therapeutic approach.