Integrating the Multidimensional Inventory of Dissociation into Clinical Practice


Since the development of EMDR in the early 1990s, a large body of research has shown that it is efficacious for PTSD. Clinicians and researchers have found positive treatment effects beyond PTSD for more complicated conditions. Unfortunately, clinicians soon discovered that EMDR seemed to move complex trauma patients into dysregulated states rather than towards the expected, adaptive resolution of targeted traumatic memories.

Stories of uncontrolled abreactions, the unplanned emergence of self-states, and subsequent destabilization leading to major setbacks or harm prompted some clinicians to dismiss EMDR as a viable treatment option for persons with dissociative features. Although some advanced EMDR trainings and publications address these complexities, ‘basic’ EMDR therapy trainings historically have not. Therapists new to EMDR gain a powerful tool, yet they are frequently caught unprepared to recognize dissociative features, conceptualize treatment in terms of dissociation, or modify treatment when dissociative symptoms pose a treatment challenge.

The Multidimensional Inventory of Dissociation (MID) has thus become a valuable assessment tool for trauma-focused clinicians--and EMDR practitioners in particular--both to determine the presence of pathological dissociation and to develop more fine-grained interventions for preparation and successful trauma accessing/reprocessing. The MID is a 218-item, self-administered instrument with 168 dissociation items and 50 validity items developed by Paul F. Dell, PhD (2006, 2011). The MID reliably differentiates and offers a diagnostic impression for Post-Traumatic Stress Disorder, Otherwise Specified Dissociative Disorder, Dissociative Identity Disorder, Somatization Disorder and Borderline Personality Disorder.

Participants will be introduced to the MID in this ‘walk through’, during which they will learn to administer and score the MID; navigate the MID Analysis to enter data, interpret results, and conduct a follow-up interview; and begin to understand how the information offered up by the MID Report may influence treatment. Those who are new to the study of dissociation will also learn about later-treatment phase Indicators to go back and assess for pathological dissociation, as well as, in a concrete way, to connect MID impressions with what clinicians may see (or have already seen) in client sessions.

Case examples will be discussed, with particular attention paid to how certain clusters of dissociative symptoms could influence clinician’s decisions regarding the use of specific kinds of preparation and trauma accessing methods. Implications for stabilization and potential markers for readiness for trauma accessing in an EMDR therapy frame will be offered.

MID documents are available without charge to mental health professionals and researchers at

This session was originally presented as a live conference session in March 2019.

Target Audience


Learning Objectives

At the conclusion of this session participants will be able to:

  • Describe and identify key indicators to assess further for pathological dissociation early in treatment (before trauma accessing), and when concerns arise throughout treatment
  • Complete administration, scoring, and navigation of the MID Analysis to input client responses, view and interpret results of the MID Report, and perform a clinical interview to clarify results of the assessment and direction of treatment
  • Describe several unique applications of the MID Report, based on case examples, and how the MID can be used to clarify diagnosis and guide treatment planning in both clinical and consultation roles.
Course summary
Available credit: 
  • 6.00 ISSTD Certificate Program
    This program is eligible for 6.00 credits in the ISSTD Certificate Program.
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Presenter: Michael Coy
Presenter Bio: D. Michael Coy, MA, LICSW, is a Seattle-based therapist whose treatment interests include pre-verbal and attachment trauma, addictions/compulsions, and complex trauma and the dissociative disorders. Michael began collaborating with co-presenter Jennifer Madere and Multidimensional Inventory of Dissociation developer Paul F. Dell, PhD, in 2016 to overhaul the MID Analysis and MID Manual. Michael is an EMDRIA Approved Consultant, has intermediate training in clinical hypnosis through ASCH, and is Level I trained in Sensorimotor Psychotherapy. He served on EMDRIA’s Standards & Training committee from 2014 to 2017. Michael wears a number of hats with ISSTD, including Treasurer, Webmaster, and Co-Chair of the EMDR Therapy Training Task Group, which is in the midst of developing ISSTD’s own, home-grown EMDR basic training.

Presenter: Jennifer Madere
Presenter Bio: Jennifer Madere, MA, LPC-Supervisor, EMDRIA Approved Consultant practices in Cedar Park, Texas. Having worked with child and adult survivors of trauma on their journey of healing since 2003, she sought basic training in EMDR Therapy in 2010. Jennifer uses EMDR therapy and psychodynamic approaches in treatment of anxiety, complex trauma, and dissociative disorders, and has basic training in clinical hypnosis through ASCH. She began presenting the MID to EMDR clinicians in 2014, and collaborated with co-presenter D. Michael Coy and Multidimensional Inventory of Dissociation developer Paul F. Dell, PhD, to make the MID more accessible to clinicians. Jennifer serves on the EMDR Therapy Training Task Group, which is in the midst of developing ISSTD’s own, home-grown EMDR basic training.

Available Credit

  • 6.00 ISSTD Certificate Program
    This program is eligible for 6.00 credits in the ISSTD Certificate Program.


ISSTD Member cost:
Your Price:
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"Your Price" above reflects your final price based on your membership status and career level. 

  • ISSTD defines a student as those enrolled in a program of study leading to a degree or certification in the mental health field and who have an interest in trauma and dissociation. 
  • ISSTD defines an emerging professional as mental health professionals who have completed an advanced degree and are in the first three years of their career (or first three years after graduation for researchers).
  • If you do not fall into one of the above categories please register as Professional/Retired. 

These prices are for Tier I countries. For a list of countries by Tier click here. If you are located in a country that falls into Tier II-VI please contact ISSTD at to receive the appropriate discount code.