Almost 20 years ago I worked with my first client with dissociative identity disorder (DID), what was then called multiple personality disorder (MPD). I stumbled upon the realization that she was DID six months after I started working with her.
During our first session, Mary (not her real name) was so anxious that she appeared afraid of her own shadow. I thought I was dealing with perhaps the most anxious person I'd ever met, but I had no clue that anything else was going on. The next week she appeared calmer and I thought that maybe my caring presence had an impact or she wasn't usually as anxious as she first appeared. For six months we worked on issues in her life that were hard for her to cope with. I thought she was getting progressively better. At the time it never occurred to me that the improvement might be too good to be true. I just took it at face value and was patting myself on the back for a job well done.
Then one day, Mary came for her appointment looking as anxious as she had been at our first session. I was perplexed, to say the least. And to top it off, she looked uncertain and very hesitant and fearful--as if she didn't really know me. Mary seemed uncertain which way to turn to get from the waiting room to my office. It also seemed like she was trying very hard to act as if nothing was wrong.
I didn't know what to do. I was very hesitant to question her about this. It would have been easier to just dismiss my observations. I figured the safest thing to do was to listen and observe.
Mary mentioned that she hadn't wanted to come and her family had insisted. I was puzzled. I'd thought we had a pretty good therapeutic relationship. She had been coming every week for six months without cancellations. Why all of a sudden was she so hesitant? I asked why she had been reluctant to come. She said something like she knew she needed help but it was hard to trust anyone after all the betrayals she'd experienced.
What made it hard to trust me now? She said I'd been nice enough. It was nothing personal. I asked her to say more about our time together and she said she vaguely remembered meeting me but was too scared to come back. It seemed clear that if I hadn't asked, she was not about to volunteer this information. She was talking about our first session as if it was the prior week.
That was the start of a 20 year odyssey to learn how to treat DID clients.