I await Ms Steele's response with interest. In the meantime, I'd add that not only would a highly dissociative DID client have to switch between alters to do the IN work, but in many cases a punitive perpetrator introject would not allow such an intervention to go smoothly. There are blocking beliefs that stand in the way, most notably, the introject believing that they actually are the external perp, that the perp's motives are paramount and that the child self should not be nurtured or receive comfort. Pushing ahead with a nurturing intervention prematurely without adequate 1) training in working with DID clients and 2) use of appropriate ego state interventions to defuse an angry introject could result in destabilizing results. At a minimum, workshop attendees should be cautioned about these possibilities. Certainly, IN should not be touted as appropriate treatment for DID clients if administered by therapists not trained in treating dissociative disorders.

Finally, there are no controlled studies regarding ANY treatment for DID, including ego state therapy, due to the difficulty of research with this fragile and complex population. There are, however, treatment guidelines offered at www.issd.org, which are based on the collective clinical experience of the body of leading dissociation experts.

As always, I urge EMDR practitioners to study dissociative clients and join ISSD. Why? Because EMDR in any form is an associative intervention. What does it associate? That which has been dissociated. We need to understand dissociative disorders before we can claim to treat dissociative clients with EMDR in any of its variants. Excellent online training is available now through ISSD.

Respectfully submitted,
Sandra Paulsen PhD