Boundary Issues in Treating Dissociative Identity Disorder & multiple selves

Psychotherapists who treat people they believe have multiple personalities face a number of ethical and boundary issues during sessions, between sessions, or when a patient is hospitalized.

Some mental health providers encourage patients to email or call them between sessions while others discourage the practice sometimes as a means to help the client become self-sufficient or perhaps they do not want their personal lives interrupted. There is a vast area of gray in the middle that is fluid depending on client need or therapist schedules, commitment, or vacations.

People who believe they have multiple personalities, alter parts, other selves, and the like, may or may not have been formally diagnosed with Dissociative Identity Disorder, or DID.  In the age of the Internet, many people are self-diagnosing and using social networks to obtain information about multiple personalities and to solicit or receive support.

Trauma of a sexual nature is often pointed to as the cause of DID so the practitioner faces many ethical and boundary issues simply deciding whether or not to offer non-sexual touch as a means of comfort or support.

The article below by Drs. Kenneth S. Pope and Patricia Keith-Spiegel, addresses many aspects of boundary issues and the ethical ramifications that follow. I hope you find it insightful.

A Practical Approach to Boundaries in Psychotherapy:
Making Decisions, Bypassing Blunders, and Mending Fences

Abstract: Nonsexual boundary crossings can enrich psychotherapy, serve the treatment plan, and strengthen the therapist-client working relationship.  They can also undermine the therapy, disrupt the therapist-patient alliance, and cause harm to clients.  Building on Gutheil and Gabbard’s (1993) conceptualization of boundary crossings and boundary violations, this article discusses and illustrates grounding boundary decisions in a sound approach to ethics. We provide 9 useful steps in deciding whether to cross a boundary, describe common cognitive errors in boundary decision-making, and offer 9 helpful steps to take when a boundary crossing  has negative effects.

Full article, retrieved 01-05-14.

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