Using visualization for stabilization and safety in Dissociative Identity Disorder and OSDD

Phase 1 of Treatment

Phase 1 of treating both Complex Dissociative Disorders and Complex Posttraumatic Stress Disorder is establishing safety, stabilization and symptom reduction.

Guided Imagery

If you have ever looked at a holiday brochure and imagined yourself lying on the beach, in the sunshine or perhaps swimming in the warm water, or you have looked at a car and imagined what it might feel like to drive, then you have used guided imagery, often called visualization.

Containment of Trauma Memories

Dr Onno van der Hart, a psychologist and researcher specializes in the field of Trauma and Dissociative Disorders, and has written an interesting paper on the use of guided imagery for reducing PTSD symptoms and improving daily life functioning, most of which applies to Complex PTSD as well as Dissociative Identity Disorder and Other Specified Dissociative Disorder (formerly DDNOS).

This approach is also referred to in the Guidelines for Treating Dissociative Identity Disorder in Adults (p156-158) as an auto-hypnotic technique which has been well-proven in Phase 1 of treatment. It does not involve trance-like states or investigating amnesia/gaps in memory, but instead serves as a method of self-soothing, calming and containing distress. Because this is an auto-hypnotic technique it can be used outside therapy sessions, and whilst maintaining awareness of the present and current surroundings. Anxiety can also respond well to the use of guided imagery to aid relaxation.
Van der Hart suggests the following examples of guided imagery:

  • Imaginary protective gear (especially useful for emotionally younger ones)
  • Inner safe places
  • Containment of traumatic memories
  • The imaginary meeting place (for dissociative parts/alters within DID)
  • Inner community building (for dissociative parts/alters within DID)
  • The inner source of wisdom

I would highly recommend reading the full article, this section starts at around the third page, under the heading ‘Guided imagery during phase 1 treatment. The book Coping with Trauma-Related Dissociation also includes helpful exercises including creating an inner safe place.

van der Hart, O. (2012). The use of imagery in phase 1 treatment of clients with complex dissociative disorders. European journal of psychotraumatology, 3. (full article)

Related links

Guidelines for Treating Dissociative Identity Disorder in Adults Journal of Trauma & Dissociation, 12:115-187, 2011 (Institute of Trauma and Dissociation – large file)

Dissociative Identity Disorder (traumadissociation.com)

Treatment of Dissociative Disorders Study Results (July 2014, traumadissociation.wordpress.com)

Forging a Deeper Understanding of Flashbacks Part I  (Paul F. Dell, understandingdissociation.wordpress.com)

Structural dissociation: Division of the personality (traumadissociation.wordpress.com)

Phase I: Overcoming the phobia of dissociative parts (traumadissociation.wordpress.com)

Flashback Worksheets for Trauma Survivors (ritualabuse.wordpress.com)

Attachment-based therapy (crazyinthecoconut.co.uk)

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5 thoughts on “Using visualization for stabilization and safety in Dissociative Identity Disorder and OSDD

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