Background
Rose is a 14 year old, African American female living in the Mott Haven division of the South Bronx with her mother and two siblings. Her mother is a single parent. Rose was very normal throughout her childhood. However, things started to change after she enrolled for her secondary education. She started exhibiting different personalities. At times she was cool and collected, whereas at other times she exhibited strange bodily sensations and tone of voice. This condition is commonly known as dissociative identity disorder (DID). Individuals suffering from this disorder patients who exhibit two or more personalities.
Her mother attributes Rose’s condition to post traumatic stress that followed her parent’s dramatic and appalling separation, coupled with an abusive childhood. Rose’s father was a very violent man and a drug addict. He used to frequently assault her wife and children. In addition, he was a fairly irresponsible. Nevertheless, he had a special bond with her daughter. The divorce adversely affected Rose. As Rose’s condition began to deteriorate, her mother decided to take her to a nearby psychiatric center that specializes in treating mental disorders. At the same time, Rose’s mother called the school counselor to tell him that she had taken Rose to the nearby psychiatric center to get further assistance.
The school counselor requested for an exchange of information between the psychiatric center and the school through her mother. The school’ counselor offered to provide the Centre with copies of Rose’s educational reports and behavior charts. In addition, he volunteered to answer any question asked by the medical team about Rose’s condition and her progress at school. The counselor explained that the exchange of information was very vital for both parties (school and hospital), as well as the patient. The exchange will ensure that the center gets all the information it requires, whereas the school will use the information to re-evaluate the patient’s condition. On the other hand, the exchange will ensure that Rose gets all the necessary help she requires.
Intervention Process
Conducting an Assessment and Determining Areas of Intervention
The center diagnosed Rose with dissociative identity disorder (DID). As a critical component of the re-evaluation process under the International Society for the Study of Disassociation (ISSD) and American Psychiatric Association guideline, the diagnostic team, the school counselor, selected team from the school and Rose’s mother should get together and re-examine all the available information on Rose, including her past medical records. With parental consent, the school team will be allowed to invite any individual from school with vital information as regards Rose’s condition.
During the meeting, the diagnostic team and the physician will sum up the information provided and answer any question regarding particular attributes of dissociative identity disorder exhibited by Rose and recommend a treatment plan. The team will also discuss the impact of the condition on the patient’s educational performance. This information will be very important for the school team, especially in deigning suitable program for Rose.
Three categories of measures can be used to assess dissociative identity disorder symptoms. These are comprehensive physician-administered structured interview, comprehensive self-analysis instruments, and succinct self-analysis monitoring instruments. There are other measures, but they are mainly used for research purpose. Comprehensive self-analysis instruments and succinct self-analysis monitoring instruments are mainly used on adult patients.
However, since the patience is relatively young, comprehensive physician administered structured interviews will be used. The comprehensive physician-administered structured interviews will help to identify specific symptoms of disassociation and selection of suitable interventions (International Society for the Study of Disassociation, 2011, p. 128). The additional information will be collected and the medical team will meet again with other parties to elaborate on the findings and interventions. After considering all the evaluation data, the diagnostic team, the school team and the physician will consider if the patient is eligible for treatment and the need for special schooling and other related services. Consequently, an evaluation précis is drawn, which will serve as the basis for crafting an intervention plan.
American Psychiatric Association (APA) stipulates the diagnostic procedure that must be followed during the DID prognosis. For instance, it stipulates that prognosis should be carried out among patients who exhibit two or more personalities. According to APA, personality is defined as an entity that demonstrates an exceptional pattern of thought and discernment and relational style that entails both the environment and self. Besides, personalities must demonstrate a pattern of manipulating the behavior of an individual (American Psychiatric Association, 2004, p. 7). Dissociative identity disorder is also characterized by episodes of amnesia or abnormal and extensive loss of memory relating to personal information, fugue, identity alteration, confusion of identity, and depersonalization among others. Therefore, DID diagnosis should be able to differentiate the real symptoms from the imaginations (Foote et al., 2008, p. 30).
Developing and Implementing the Plan
The treatment of dissociative identity disorder will be guided by the learning theory and behavioral therapy principle. Learning theory will be vital in comprehending post traumatic responses, such as panic, resentment and shame in reaction to external factors that cultivates dissociation. Exploring and incorporating the two approaches will help Rose to transform disturbing memories. The learning process will aid in overcoming phobic reactions. Moreover, behavior modification techniques will help in suppressing dissociation, for example, ignoring or attempting to turn off the expression of alternative identity (International Society for the Study of Disassociation, 2011, p. 147).
Since DID emanate from a traumatic event, which can result in intense emotions, people suffering from dissociative identity disorder are likely to behave in a way that may cause harm to themselves and others. Therefore, the treatment should entail strategies of managing aggressive behaviors. In addition, behavioral or cognitive therapy should be administered to help the victims learn how to control their impulses.
Therapists must also understand that some patients are not willing to synchronize their personalities. If this happens, the therapists should not consider alters as problems to be alleviated, but as the creative reaction of a patient to trauma. One of the best strategy for treating dissociative identity disorder is to recognize relationships between alters and communicating with them directly. Therapists must also encourage the patients to listen to their personalities in order to facilitate essential conversation among the therapist, alters and the victim.
Like other interventions for psychological disorders, the treatment of DID will require the involvement of all the stakeholders, that is, the school counselor, school team, Rose’s mother and the physicians. While the ultimate aim of treating DID is to synchronize the functioning of the alter personalities, the existence of comorbid disorders, traumatic experience and issues regarding the safety of patients makes an all-inclusive treatment plan indispensable (International Society for the Study of Dissociation, 2004, p. 148).
The International Society for the Study of Dissociation (2004, p. 149) provided a framework to help physicians in treating DID. The framework includes: (a) stabilization of safety and minimization of symptoms (b) working straightforwardly and comprehensively with disturbing memories, and (c) identification of personality and restoration. Although these phases are administered during the treatment phases, they define the major therapeutic issues that emerge during the process. An intervention plan will be developed at the meeting involving the above mentioned stakeholders (International Society for the Study of Dissociation, 2004, p. 150).
In preparation for the meeting, the medical team will explore the evidence-based practices that have been used to tackle behavioral aspects of DID. Rose’s mother will help the medical team and the school team in setting goals for her child. The goals will encompass the behavioral aspects, in which Rose will be able to deal with the post traumatic stress and other behavioral challenges. Additionally, her mom and the medical team will work on ways of minimizing harmful behaviors. An extra goal will be set to provide Rose with access to education and other related services. This will enhance her degree of independence, support her psychosocial wellbeing, and improver her overall quality of life. In due course, the goals will be re-evaluated and amended accordingly with the help of all the stakeholders.
Based on the above mentioned goals and Rose’s need for exceptional support, the medical team together with other stakeholders settled on immediate therapy and behavioral services. The hospital assigned one of their specialists to help Karen and her mother with behavioral aspects at home. According to the International Society for the Study of Dissociation (2004, p. 120), a combinational of medication and behavioral therapy could achieve an optimal result among children and adolescents suffering from DID. The interventions will entail the alteration of circumstantial incidents that characteristically precede the occurrence of the anticipated behaviors. Modifications are also made to the surrounding so as to enhance the probability of success or minimize the probability of troubles occurring. This intervention framework is meant for the children and the adolescents.
In due course, Rose will also benefit from interventions that comprises of a mishmash of compound therapeutic procedures that are based on diverse approaches. In addition, the team will deliberate on whether the intervention techniques used at home could be applied at school. Last but not least, the medical team, Rose’s mother and the school team will deliberate on any additional techniques that could be used to help Rose recover very fast. The meeting will also discuss the traumatic memories to focus on, the intensity of interventions and the form of intervention to be applied.
Evaluation and follow-up services
The means of gathering data will be established in order to collect information on a regular basis. The information gathered will help to bring up to date interventions and report progress. The set goals will be reviewed and amended at the end of every year. Plans will be made together with Rose’s mother to share her daughter’s progress at home and any matter of concern. Last but not least, the medical team, the school counselor and the school team will organize regular meetings to share information regarding Rose’s condition or situation and deliberate on appropriate therapy. The meetings will also help to coordinate treatment among the stakeholders.
References
American Psychiatric Association. (2004). Practice guidelines for the treatment of Patients with acute stress disorder (ASD) and posttraumatic stress disorder (PTSD). American Journal of Psychiatry, 161, 1–57. Web.
Foote, B., Smolin, Y., Neft, D. I., & Lipschitz, D. (2008). Dissociative disorders and Suicidality in psychiatric outpatients. Journal of Nervous & Mental Disease, 196, 29–36. Web.
International Society for the Study of Dissociation. (2004). Guidelines for the evaluation and treatment of dissociative symptoms in children and adolescents. Journal of Trauma & Dissociation, 5(3), 119–150. Web.
International Society for the Study of Disassociation. (2011). Guidelines for Treating Dissociative Identity Disorder. Journal of Trauma and Dissociation, 12(2), 115-187. Web.