Adult Treatment Planner
13: Dissociation
SNOMED Terms
- Alcohol dependence
- Dissociative disorder
- Gender identity disorder
- Identity disorder of childhood
- No diagnosis on Axis I
- Person with feared complaint, no diagnosis made
- Sleep-related dissociative disorder
Goals
- Integrate the various personalities.
- Reduce the frequency and duration of dissociative episodes.
- Resolve the emotional trauma that underlies the dissociative disturbance.
- Reduce the level of daily distress caused by dissociative disturbances.
- Regain full memory.
Behavioral Definitions
- The existence of two or more distinct personality states that recurrently take full control of one's
behavior.
- An episode of the sudden inability to remember important personal identification information that is
more
than just ordinary forgetfulness.
- Persistent or recurrent experiences of depersonalization; feeling as if detached from or outside of
one's
mental processes or body during which reality testing remains intact.
- Persistent or recurrent experiences of depersonalization; feeling as if one is automated or in a
dream.
- Depersonalization sufficiently severe and persistent as to cause marked distress in daily life.
Diagnoses
- Alcohol Dependence
- Dissociative Identity Disorder
- Dissociative Amnesia
- Depersonalization Disorder
- Dissociative Disorder NOS
- Diagnosis Deferred
- No Diagnosis
Objectives and Interventions
- Identify each personality and have each one tell its story.
- Actively build the level of trust with the client in individual sessions through consistent eye
contact, active listening, unconditional positive regard, and warm acceptance to help increase
his/her ability to identify and express feelings.
- Without undue encouragement or leading, probe and assess the existence of the various
personalities
that take control of the client.
- Complete a psychotropic medication evaluation with a physician.
- Arrange for an evaluation of the client for a psychotropic medication prescription.
- Take prescribed psychotropic medications responsibly at times ordered by the physician.
- Monitor and evaluate the client's psychotropic medication prescription for compliance,
effectiveness, and side effects.
- Identify the key issues that trigger a dissociative state.
- Explore the feelings and circumstances that trigger the client's dissociative state.
- Explore the client's sources of emotional pain or trauma, and feelings of fear, inadequacy,
rejection, or abuse.
- Assist the client in accepting a connection between his/her dissociating and avoidance of facing
emotional conflicts/issues.
- Decrease the number and duration of personality changes.
- Facilitate integration of the client's personality by supporting and encouraging him/her to stay
focused on reality rather than escaping through dissociation.
- Emphasize to the client the importance of a here-and-now focus on reality rather than a
preoccupation with the traumas of the past and dissociative phenomena associated with that
fixation.
Reinforce instances of here-and-now behavior.
- Practice relaxation and deep breathing as means of reducing anxiety.
- Train the client in relaxation and deep breathing techniques to be used for anxiety
management.
- Verbalize acceptance of brief episodes of dissociation as not being the basis for panic, but only as
passing
phenomena.
- Teach the client to be calm and matter-of-fact in the face of brief dissociative phenomena so as
to
not accelerate anxiety symptoms, but to stay focused on reality.
- Discuss the period preceding memory loss and the period after memory returns.
- Explore the client's sources of emotional pain or trauma, and feelings of fear, inadequacy,
rejection, or abuse.
- Arrange and facilitate a session with the client and significant others to assist him/her in
regaining lost personal information.
- Cooperate with a referral to a neurologist to rule out organic factors in amnestic episodes.
- Refer the client to a neurologist for evaluation of any organic cause for memory loss
experiences.
- Attend family therapy sessions that focus on the recall of personal history information.
- Arrange and facilitate a session with the client and significant others to assist him/her in
regaining lost personal information.
- Calmly reassure the client to be patient in seeking to regain lost memories.
- Utilize photos and other memorabilia to stimulate recall of personal history.
- Calmly reassure the client to be patient in seeking to regain lost memories.
- Utilize pictures and other memorabilia to gently trigger the client's memory recall.
Index