Formulating dissociative identity disorder in clinical practice: a Q-study

Abstract

Dissociative Identity Disorder (DID) is a complex and often poorly understood dissociative disorder, characterised by disruption of identity with the presence of two or more distinct personality states (APA, 2013). Several theoretical models have been proposed to provide a framework within which to understand this client group. However little i known about the conceptualisation of this presentation by therapists working clinically with this population. The current study aimed to explore the subjective options of therapists regarding the conceptualisation of DID in clinical practice. Q-methodology was used in order to operationalise and analyse these subjective beliefs. A Q set of 54 statements was created from previously reported interview data (Stokoe, 2014) with clinicians who had significant experience in working with clients with DID. The Q set was then administered to 18 therapist participants, who were asked to Q sort the statements in relation to how essential the items were conceptualising or ‘formulating’ DID. Factor analysis identified three factors, suggesting the presence of three differing perspectives regarding the ‘essential’ features of the formulation of DID. Factor A focused on “Trauma, attachment and the internal system”, whilst Factor B, “The conscious experience of DID” prioritised the everyday experience of DID and Factor C emphasised the “Helpful aspects of DID Compartmentalising emotions to enable functioning”. There was consensus across all three factors regarding the ‘least essential’ items to include in their formulations. However, the identification of three statistically distinct factors indicates the existence of differing viewpoints amongst the therapist participants.

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