The use of object relational thinking in the treatment of DID

Nel Draijer, PhD
Beginning with an overview of traumatic transference phenomena, an object-relational approach will be presented to make these difficulties productive for the patient. The treatment of patients with severe trauma related disorders, such as DID, Complex PTSD and borderline personality disorder (BPD) proper, is characterized by transference and counter transference phenomena that directly endanger the therapeutic relationship. The relationship itself is attacked, to protect against dangerously experienced dependency needs.

Severe trauma related disorders meet criteria for 'borderline personality organization' (Kernberg, 1984), characterized by predominantly intact reality testing, primitive defenses (splitting, projective identification), identity diffusion (inner shifting of identity or self-states between ‘good’ versus ‘bad’, victim versus perpetrator, ‘well cared for child’ versus ‘totally neglected child’, etc.). An object-relational approach is particularly helpful in analyzing and sustaining the severe transference and counter-transference forces active in the treatment of complex trauma related disorders.

Conclusion: Severe trauma related disorders, such as DID, Complex PTSD and BPD proper, are primarily relational disorders (instead of anxiety disorders) in which negative transference endangers the therapeutic relationship. TFP is extremely helpful in getting these treatments into calmer waters, even in the case of the so-called ‘impossible patients’.