What We Know and What We Need to Learn About the Treatment of Dissociative Disorders

Journal of Trauma & Dissociation

Bethany L. Brand PhDa*

Volume 13, Issue 4, 2012. pages 387-396.

Available online: 31 May 2012

Abstract

In this editorial, I briefly review research design issues and the current treatment research for dissociative disorders (DD), discuss the limitations and challenges of conducting treatment studies for patients with DD, and conclude by describing what I see as the first wave and second wave in the field of dissociation.

Insurers and federally funded programs are increasingly requiring that treatment be empirically supported in order for treatment to be reimbursed. For example, psychoanalysis will no longer be reimbursed in The Netherlands because of what is perceived as a lack of empirical support.

Other countries have also established standards about the treatments that have sufficient empirical support to merit government payment. I believe it is only a matter of time before it is common for patients with DD to be required to seek out empirically supported treatment if they want treatment to be reimbursed.

We need to financially support treatment studies in order to develop a more solid empirical basis for the treatment of DD.

~~~~~~~~~~~~~

Finally.

Insurance companies are placing more requirements on empirically established therapies (those based on clinical observation only) used to treat dissociative identity disorder/multiple personalities. Insurers want evidence that the psychotherapy is effective probably because payment for services seems endless for this psychiatric diagnosis.

This article, unfortunately, seems to be more of a warning signal than a call for mental health providers to be responsible and provide mental health consumers with psychotherapy that has a record of working.

Since the American Psychiatric Association evidently has no intention of making such requirements of psychotherapy or those who practice it for a living, the policing of this powerful and influential Industry is left to the courts – usually when a patient and/or their families sue the provider – and/or to the Insurance Industry.

If the Insurance industry keeps losing money by providing coverage for therapies with no proven effectiveness yet requires years and years and sometimes decades of treatment, we can expect to see coverage limited or discontinued and a shift to proven effective treatment to increase.

Below are some links to aid in your understanding of the difference between scientific evidence & methods and that of empirical research and evidence based only on clinical-observation.

In short, empirical evidence means observation only. Scientific evidence must be observable And measurable using strictly established methods that evaluate a theory. It takes ideas therapists have – like the link between childhood sexual abuse and multiple personalities – to the next step beyond simple observation or empirical evidence.

Mental health care consumers using only empirical evidence (observation) – like that made by a psychotherapist during sessions to evaluate and prove the effectiveness of their therapy –  are buying therapy based on someone’s opinion, not science.

JB

What is empirical evidence?

  • Scientifically-based research from fields such as psychology, sociology, economics, and neuroscience, and especially from research in educational settings
  • Empirical data on performance used to compare, evaluate, and monitor progress

United States Department of Education

http://www2.ed.gov/nclb/methods/whatworks/eb/edlite-slide005.html

Empirical research is a way of gaining knowledge by means of direct and indirect observation or experience.

Empirical evidence (the record of one’s direct observations or experiences) can be analyzed quantitatively or qualitatively. Through quantifying the evidence or making sense of it in qualitative form, a researcher can answer empirical questions, which should be clearly defined and answerable with the evidence collected (usually called data).

Research design varies by field and by the question being investigated. Many researchers combine qualitative and quantitative forms of analysis to better answer questions which cannot be studied in laboratory settings, particularly in the social sciences and in education.

In some fields, quantitative research may begin with a research question (e.g., “Does listening to vocal music during the learning of a word list have an effect on later memory for these words?”) which is tested through experimentation in a lab. Usually, a researcher has a certain theory regarding the topic under investigation.

Based on this theory some statements, or hypotheses, will be proposed (e.g., “Listening to vocal music has a negative effect on learning a word list.”). From these hypotheses predictions about specific events are derived (e.g., “People who study a word list while listening to vocal music will remember fewer words on a later memory test than people who study a word list in silence.”). These predictions can then be tested with a suitable experiment.

Depending on the outcomes of the experiment, the theory on which the hypotheses and predictions were based will be supported or not.

http://en.wikipedia.org/wiki/Empirical_research Retrieved 06/01/12.

Scientific Method – definition Wikipedia Retrieved 06/01/12.

To be termed scientific, a method of inquiry must be based on empirical and measurable evidence subject to specific principles of reasoning.[2] The Oxford English Dictionary says that scientific method is: “a method or procedure that has characterized natural science since the 17th century, consisting in systematic observation, measurement, and experiment, and the formulation, testing, and modification of hypotheses.

http://en.wikipedia.org/wiki/Scientific_method

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20 Comments

  1. Jessica

     /  06/06/2012

    actually shes using mroe resoruces then my school does usually, most of our books though at least arent that old.

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  2. Altus

     /  06/04/2012

    Whoops, I posted a sample of Brand’s work under “Bridging the Gap Between Clinical Research & Clinical Practice”…(topics are starting to merge for me.) Anyway it has a link so it’s awaiting moderation. Interesting how far of the mark Brand’s own work is when it comes to a well-constructed study. First she teaches Herman, a theorist, who is outdated by two decades, then she puts together a poorly constructed study (the shortcomings are highlighted in the paper) and calls it “research.” Don’t the students of Townson who pay up to $64,000 for their education deserve better? Hmm, the $64,000 question.

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    • Yes, students deserve better and so do those they will diagnose and treat in the future. That’s what bothers me the most.

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