Dissociative Identity Disorder: Unsplitting the Split Personality

On the last track we discussed personality histories.  The four basic lines of questioning we examined to obtain a personality history are naming each personality, determining physical aspects of the alter, determining perceived function, and chaining.

On this track we will discuss behavioral contracts.  This track will focus on initial stabilization of the dissociative identity disorder client through the use of behavioral contracts to set limits on non productive behavior and to promote more adaptive behavior.  Therefore, the purpose of this track is to provide comprehensive methods and goals of initiating a behavioral contract. 

Putnam describes three steps for writing a contract.  These three steps are specificity as to what is required from each personality, determining the consequences for contract violations, and length and termination of contracts.  As you listen to this track, compare my behavioral contract methods with your own.  How are they similar?  How might they differ? 

Putnam's Three Steps for Writing a Behavioral Contract

#1  Specificity As to What is Required from Each Personality
First, let’s discuss specificity as to what is required from each personality.  The way I use contracts  is they may cover the entire system of personalities, or they may be limited to specific personalities.  I find it depends on specific client circumstances.  For example, Alan’s contract covered self-destructive behavior regarding his entire system of personalities.  However, Alan’s contract also covered the inappropriate emergence of his angry alter personalityVaughn at Alan’s job. 

When I made Alan’s contract, I spent some time discussing the contract with as many of his alters as I could get to participate in the process.  Do you agree that it can be helpful to invite each alter out one at a time to negotiate, comment on, or contribute to the contract’s format and provisions?  When Alan and I agreed that we had arrived at a satisfactory draft, I again invited any holdouts to come out or be bound to the contract.  

You may find it helpful to include in the contract that any personality who does not emerge and negotiate will be expected by yourself and the personality system to honor the contract.  Could you perhaps meet a new personality at this point? 

#2  Determining the Consequences for Contract Violations
One of the most difficult issues in negotiating contracts may be determining the consequences for contract violations.  Clearly, consequences should be aversive and not abusive.  I found tremendous help in asking Alan and parts of Alan’s personality system what they thought would be appropriate consequences. 

For example, when I asked Alan what he thought might be a good solution for Vaughn’s drinking binges, Alan stated, "Let that son of a bitch deal with his own hangovers!  And when he brings a strange woman home, let him wake up next to her!"  Also, you might find it helpful to specify length of time in the body.  So your contract might use limiting that time as a consequence. 

In addition, I try to avoid focusing too much on consequences.  By rewarding alters for honoring contractual obligations, Alan also benefited in that his alters had incentives for good behavior as well as consequences for undesirable behavior.  What reward system might benefit your client? 

#3  Length and Termination of Contracts
Third, in addition to specificity as to what is required from each personality and determining the consequences for contract violations, let’s discuss length and termination of contracts.  The duration of a contract will depend on the specific circumstances of that contract.  Some contracts may run the length of the treatment and be terminated at the end of therapy.  Others may cover only the length of a single session.  Would it perhaps benefit your DID client to renegotiate his or her behavioral contract after a specific length of time?

Common Problems with Contracts
Next, let’s examine some common problems with contracts.  When it comes time for you to make a contract with your DID client, do you foresee some problems?  Of course you do.  Some common problems might include the inadvertent reinforcement of pathological behavior, failure to enforce a contract due to mitigating circumstances, failure to determine whether certain child alters understand the contract, and the use of inappropriate consequences.  With Alan, his hostile alter Vaughn attempted to use contract negotiations as a way to monopolize therapy time.  Vaughn also repeatedly sought to place me in positions of either moral dilemmas or a double bind. 

Because contracts should focus on the type and duration of therapy, dangerous behavior, and therapeutic boundaries, I prefer to avoid involvement in personality prohibition.  For example, when Vaughn attempted to monopolize Alan’s therapy time, I simply let him burn himself out and later spoke to Alan about how he might control Vaughn during future sessions.  Otherwise, I find that it becomes easy to become involved in internal conflicts, which make it harder to foster internal communications.  What problems do you experience when negotiating behavioral contracts with your clients whether they are DID clients or not?

On this track we discussed behavioral contracts.  I described three steps to writing a contract.  These three steps are specificity as to what is required from each personality, determining the consequences for contract violations, and length and termination of contracts. 

On the next track we will discuss promoting internal communication.  Three techniques for promoting internal communication that we will discuss are therapist as a go-between, the bulletin board, and internal conversations. 
Reviewed 2023

Peer-Reviewed Journal Article References:
Afek, O. (2018). The split narcissist: The grandiose self versus the inferior self. Psychoanalytic Psychology, 35(2), 231–236.

Bell, M. C. (2018). Winter is coming to the experimental analysis of behavior. Behavior Analysis: Research and Practice, 18(2), 184–192.

Brand, B. L., Webermann, A. R., Snyder, B. L., & Kaliush, P. R. (2019). Detecting clinical and simulated dissociative identity disorder with the Test of Memory Malingering. Psychological Trauma: Theory, Research, Practice, and Policy, 11(5), 513–520. 

Bernecker, S. L. (2014). Helping clients help themselves: Managing ethical concerns when offering guided self-help interventions in psychotherapy practice. Professional Psychology: Research and Practice, 45(2), 111–119. 

Bonnie, R. J., & Monahan, J. (2005). From coercion to contract: Reframing the debate on mandated community treatment for people with mental disorders. Law and Human Behavior, 29(4), 485–503. 

Ducharme, E. L. (2017). Best practices in working with complex trauma and dissociative identity disorder. Practice Innovations, 2(3), 150–161. 

Yeomans, F. E., Delaney, J. C., & Levy, K. N. (2017). Behavioral activation in TFP: The role of the treatment contract in transference-focused psychotherapy. Psychotherapy, 54(3), 260–266.

Online Continuing Education QUESTION 3
What are three steps you can use to write a behavioral contract with your DID client? To select and enter your answer go to CEU Test.