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Dissociative Identity Disorder: Ethically Unsplitting the Split Personality
Dissociative Identity Disorder continuing education social worker CEUs

CEU Answer Booklet
Psychologist CEs, Counselor CEUs, Social Worker CEUs, MFT CEUs

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Audio Transcript Questions The answer to Question 1 is found in Track 1 of the Course Content. The Answer to Question 2 is found in Track 2 of the Course Content… and so on. Select correct answer from below. Place letter on the blank line before the corresponding question. Do not add any spaces.
Important Note! Numbers below are links to that Section. If you close your browser (i.e. Explorer, Firefox, Chrome, etc..) your answers will not be retained. So write them down for future work sessions.

Questions:
1. What are three ways of meeting the alter personalities of a client with dissociative identity disorder?
2. What are four lines of questioning you can use to obtain a personality history?
3. What are three steps you can use to write a behavioral contract with your DID client?
4. What are three techniques for promoting internal communication with a DID client?
5. How can your client achieve cooperation between alter personalities?
6. Control over the switching process is achieved gradually and has been described as the result of several factors.  What are three of the processes?
7. What are two techniques which can be effective in minimizing transference reactions in dissociative identity disorder clients?
8. What is a useful assumption regarding remarks and applicable interventions in a therapy setting with a DID client?
9. What are two techniques to help DID clients with partial memory assembly? 
10. What are two techniques regarding the internal self-helper of the DID client?
11. What is one of the most common forms that an internal persecutor takes?
12. What are four steps to overcoming resistance?
13. What are three steps to mapping the personality system of a dissociative identity disorder client?
14. What are four techniques for achieving therapeutic resolutions when treating dissociative identity disorder?

Answers:
A.  Two techniques for memory assembly are the affect bridge and the memory bridge.
B.  Two techniques which can be effective in minimizing transference reactions are accurately remembering which personality said what, when, or where and being real with the client. 
C.  Four steps to overcoming resistance are recognizing resistance, clarifying the nature of the resistance, identifying the therapeutic context, and making a statement to the client regarding the ‘cost’ of resistance.
D.  Three ways of meeting the alter personalities are the alter personalities "come out" voluntarily,  indirect inquiry, and direct inquiry.
E. Three processes are the host’s acceptance of the diagnosis, the host’s willingness to meet the other alters, improved communication within the system that allows for smoother and more appropriate switching,   increasing internal trust, and  improved communication also fills in the gaps in time, and alleviates fears about what may have happened.
F. Four techniques for achieving therapeutic resolution are fusion and integration, assessing fusion stability, therapeutic interventions for fusion failures, and post-fusion treatment.
G. A useful assumption regarding remarks and applicable interventions in a therapy setting with a DID client is that each personality is continuously listening and aware of what is going on.
H. Three steps you can use to write a behavioral contract with your DID client are specificity as to what is required from each personality, determining the consequences for contract violations, and length and termination of contracts. 
I.  Three steps to mapping the personality system are choosing a form of map, identifying useful information, and using maps as final integration tools. 
J.  Your client can achieve cooperation between alter personalities through internal decision making skills.
K.  Three techniques for promoting internal communication are therapist as a go-between, the bulletin board, and internal conversations. 
L.  Two techniques regarding the internal self-helper of the DID client are finding your client’s internal self-helper and working with your client’s internal self-helper.
M.  Four basic lines of questioning that can be used to obtain a personality history are naming each personality, determining physical aspects of the alter, determining perceived function, and chaining.
N.  Internal persecutors often take the form of critical and condemning voices usually heard by the host personality.

Course Content Manual Questions The Answer to Question 15 is found in Section 15 of the Course Content… and so on. Select correct answer from below. Place letter on the blank line before the corresponding question.
Important Note! Numbers below are links to that Section. If you close your browser (i.e. Explorer, Firefox, Chrome, etc..) your answers will not be retained. So write them down for future work sessions.

Questions:
15. What is the DSM description of Dissociative Identity Disorder?
16. What are five stances regarding the treatment of DID?
17. Why does Middleton caution against focusing on memory recovery and memory extraction in therapy for a client with DID?
18. What is one technique suggested by Middleton for helping clients with DID identify the therapist as distinct and real?
19. According to Phelps, how does the behavior analytic perspective address amnesia and differential remembering in clients with DID?
20. What is a behavioral therapy for DID clients recommended by Phelps?
21. What are the four core processes in the Suppression-of-Affect phase of tactical-integration therapy?
22. What are the three core concepts in the Dilution of Affect phase of tactical integration therapy?
23. According to Kluft, what is it important to consider regarding informed consent while working with a client with DID?
24. What are six techniques that can be useful in treating a client with DID?
25. What are the five areas of assessment in the SCID-D-R for dissociative symptoms?

Answers
A.  Six techniques are: 1. Hypnosis; 2. EMDR; 3. Psychopharmacology; 4. Group therapy; 5. Family therapy; 6. Creative Arts & Functional therapies.
B.  Four core processes are: 1. dealing with the personalities; 2. stabilizing the personalities; 3. mapping the personalities; and 4. talking with personalities.
C.  DID is the most extreme form of dissociation. It is characterised by two or more separate identities or personality states that recurrently take control of the individual's behaviour, accompanied by a loss of memory of significant personal information that is too all-embracing to be explained by normal absent-mindedness.
D.  Five stances are: 1. Strategic integrationalism; 2. Tactical integrationalism; 3. Personality-oriented psychotherapy; 4. Adaptionalism; 5. Minimization
E.  In DID, the person is unwilling or unable to remember or report some experiences until that person is in a different situation or the reinforcement contingencies change.
F.  Although informed consent from one alter can be applied to the patient as a whole, it is best to discuss issues concerning informed consent in an atmosphere that specifically encourages all alters to listen in to the discussion, especially those who see themselves as protectors of the patient.
G.  Middleton suggests using humor in therapy for DID clients.
H.  Five areas of assessment are: 1. amnesia; 2. depersonalization; 3. derealization; 4. identity confusion; 5. identity alteration.
I.  Three core concepts are: 1. use of fractioned abreaction rather than full abreactions; 2. working within "like-clusters" of personalities; 3. blending of personalities.
J.  Phelps recommends the client role-playing and rehearsing several social interactions and experiencing some situations expected to produce "normal" emotional behaviors.
K.  Using memory extraction techniques on someone whose selfhood is not growing stronger can only unnecessarily traumatize them, trigger malignant abreactions and/or invoke previously used defenses to redissociate that which would otherwise remain too overwhelming.


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