What kind of treatment do CDS UK offer?

CDS UK typically offer long-term intensive psychotherapy to people with dissociative disorders, based on the International Society for the Study of Trauma and Dissociation’s guidelines (ISSTD, 2011). This is in the absence of any UK NICE guidelines for dissociative disorders. The ISSTD approach consists of three phases of work, although these are not necessarily worked through in a linear way.
No two therapy journeys are the same. All CDS UK psychotherapists are specialists in working with complex trauma and dissociative disorders. Because of the diversity typically held within each dissociative system, we work flexibly in response to each person’s particular needs and presentation. This may include the integration of a variety of modalities, such as art or music therapy, play therapy, a body-based approach, or other trauma-specific approaches. These would be used in collaboration with the patient and as part of an overarching trauma and dissociation informed therapeutic approach based on the ISSTD model.
CDS UK also offer a team approach, meaning that often more than one clinician is allocated to each patient.
We can also offer less intensive psychotherapy when indicated, as well as aftercare packages for patients who have completed treatment but would still benefit from a level of specialist support.

What is the ISSTD 3-phased psychotherapeutic approach?

The three phases of the International Society for the Study of Trauma and Dissociation’s (ISSTD) approach are: 
Phase 1: Stabilisation and Safety
This phase includes establishing safe and trusting relationship with the main therapist and other members of the patient’s therapy team. It will also include some psychoeducation and helping the person to explore their feelings about their dissociative disorder. 
It will focus on learning to manage trauma symptoms and risk management, with the aim of maximising safety, emotional stability and resilience. This often includes gaining an understanding of the person’s dissociative internal personality structure, engaging directly with different identities where possible and encouraging them to communicate more with each other.
Phase 2: Working through traumatic memories
This phase focuses on helping the person understand what has happened to them in their life (including working with the different identities of the person) and its subsequent impact on their mental health, emotional experience, expression and relationships. The aim is that through this phase of the work the trauma can be worked through in such a way that symptoms such as flashbacks, amnesia, episodes of dissociative fugue and risk behaviours are reduced. For some patients, a shared narrative (understanding of their history) is possible. It is crucial that trauma processing work is undertaken in a collaborative way, rather than being imposed prematurely.  
Phase 3: Reconnection
This phase is about living a more integrated life, coming to terms with what has happened and engaging with the external world as far as possible. The focus is on agency, improved quality of life and living safely and cohesively. 
CDS UK do not seek to impose a final outcome on patients in relation to the concept of identity integration. Often, some integration of identities happens organically as the therapy progresses, as amnesia reduces, and dissociated identities no longer need to remain segregated in order to prevent psychic crisis or collapse. Some people with DID are keen to proactively work towards integration of the personality. 
However, for many people with DID, the concept of ‘multigration’ is a more realistic and preferred therapeutic goal, meaning that identities become aware of each other and learn to function in a more harmonious and collaborative way, with reduced amnesia. 
Mourning the many losses inherent to a highly traumatic past is a key component of all three stages but tends to feature strongly in this phase of the work. 

FAQs about treatment

What does a typical psychotherapy package look like?
This varies depending on patient need, but typically CDS UK will offer:
  • One double session (100 minutes) of intensive specialist dissociation and trauma- informed psychotherapy per week. This is to allow enough time for different identities to work during the session if needed, whilst ensuring that the patient is safe and stable enough to leave.
  • Provision for additional support therapy for 2 hours per week to provide additional contact and support to the patient (e.g., during the main psychotherapist’s holiday break times or crises). This is usually provided remotely via email, telephone or online. This need will be assessed within the first 3 months of treatment beginning,


  • Provision of 4-5 hours of specialist support work per week. This is typically face to face contact, to encourage the patient to engage more fully with the community and develop their independence, where this is needed.
  • Access to a reasonable level of out-of-hours and emergency support, which can be provided via e mail, telephone or text message if required. Emergencies will be managed in partnership with appropriate local services.
  • Access to the CDS UK’s support and administration team, including an allocated case manager who is a senior clinician experienced in working with complex dissociation.
Where does therapy take place?

We are a national service and work with people from all over the country. We have a network of psychotherapists working in various locations across the UK and as far as possible, we offer treatment close to a patient’s home. We also see patients at our main office in North London. We can be flexible and offer remote modalities at times when face to face contact is not possible.

What therapeutic outcomes can be expected?
These vary and will be discussed between therapist and patient but typically include:
  • A more stable sense of wellbeing and more resilient and robust mental health. 
  • An ability to experience and manage feelings and to express these in a constructive way in relationships. 
  • An ability to develop and maintain more secure and nurturing relationships with others (including good communication and collaboration between identities). 
  • An ability to function well in day-to-day life and engage in activities that are satisfying and supportive of the person’s mental health.
  • Effective management and significant reduction or elimination of risk behaviours 
  • Reduced reliance on crisis services.
How do you monitor therapy outcomes?

We use a variety of validated outcome measures to monitor the therapeutic process, in conjunction with patient experience questionnaires and regular detailed therapist reports for the patient’s local NHS funding organisation. CDS UK are currently actively supporting research into therapeutic treatment approaches and outcomes.

Doesn’t long-term therapy create dependency on the therapist?
Research suggests that DID stems from a history of severe and protracted developmental trauma, in conjunction with a disorganised attachment, i.e., the absence of a safe adult to offer support and comfort. It is therefore logical that the development of a secure enough patient-therapist relationship is a fundamental part of the healing and recovery process. 
It is quite usual for patients to feel a strong connection to their therapist/s as the work progresses and arguably, the therapy could not progress meaningfully without the development of a good-enough therapeutic attachment.
However, a fundamental aim of psychotherapy for people with DID – as with other patient groups – is to promote agency, independence and the capacity to form new and safe attachments with others. We find that a consistent and long-term therapy relationship is a crucial part of the work and can act as a bridge in facilitating new, secure relationships, over time.  
What is the CDS team approach?
Each patient at CDS UK will have a main therapist allocated to them. When appropriate they may also have an allocated support therapist or specialist support worker. In addition, they will have a case manager who is responsible for overseeing the more practical aspects of the work, such as making contact with other involved professionals as and when needed.
This is an aspect of our service that is greatly valued by most patients, through offering an agreed level of support between main therapy sessions and during therapy breaks. All members of the therapy team liaise regularly in order to offer a well-coordinated and joined up therapeutic approach and all work is overseen by the CDS UK core clinical management team.
What about medication?

There is currently no evidence that medication alone is effective in the treatment of dissociative disorders. However, some people may find certain medications helpful, for example to help manage chronic problems such as depression, anxiety or insomnia. As the presence of a severe dissociative disorder can significantly affect the way people respond to medication, CDS UK can offer psychiatric consultation when needed with our specialist Consultant Psychiatrist.

What happens at the end of therapy?

At CDS UK we aim to prepare our patients for the end of therapy as far as possible. This will include discussion of any ongoing needs and liaison with local mental health or social care services where needed. We are able to offer consultation and training to local teams where understanding of dissociative disorders is lacking. We can offer less intensive aftercare packages for patients who need a lower level of ongoing specialist support.