Abstract
In this presentation, Dr. Loewenstein will review the basic issues in transference and countertransference in DID treatment. He will review that the core transference is fundamentally traumatic, with its most basic variant the anticipation that therapists will inevitably exploit the DID patient in some way for their own narcissistic gratification. This belief exists despite therapists’ apparent concern, helpfulness, probity, and (often) specific statements to the contrary. Dr. Loewenstein will discuss basic variants of traumatic transference in DID treatment. Transference issues in DID treatment will be framed in terms of the development of DID as an early childhood-onset, posttraumatic, dissociative developmental disorder, where dissociative self-states develop in response to typically unpredictable malevolent maltreatment by caregivers. In addition, Dr. Loewenstein will discuss the impact of these transferences on therapists, including posttraumatic and dissociative countertransference responses. Then he will discuss negative therapeutic reaction (NTR) in DID treatment, particularly in response to posttraumatic shame dynamics. Classically, NTR occurs in psychotherapy when interventions that logically should lead to positive change in the patient, repeatedly lead to symptomatic worsening. In DID treatment, NTR is specifically based in posttraumatic relational dynamics involving humiliation. This overview leads to discussion of an extreme traumatic transference response in DID treatment: mind control transference (MCT). Here, DID patients experience that therapists’ overt helpfulness and concern is really in the interest of gaining access to the patient’s mind to malevolently invade, control, and even enslave the patient. MCT occurs to some extent in all DID therapy. However, it dominates therapy in patients with histories of organized abuse; extreme, invasive psychological abuse by attachment figures; abuse by mental health practitioners, including mental health practitioner parents, and combinations of these. In the MCT, the setting of therapy and virtually all interactions with the therapist may activate posttraumatic reminders and cues. Contrary to typical trauma therapist expectations, MCT patients are terrified by the possibility of being “known”, “seen”, or “understood”. In many cases, words used by therapists are themselves literally experienced as a source of danger. Therapy with these DID patients is inevitably prolonged by the complexity of the MCT and its activation in the therapeutic setting itself. Dr. Loewenstein will discuss countertransference responses that may result in even experienced therapists feeling baffled, deskilled, confused, and even angry when previously helpful interventions result in apparent stalemate and seemingly endless NTR. At the same time, understanding MCT dynamics can help therapists make sense of some seemingly intractably “stuck” DID patients. Dr. Loewenstein will describe clinical case material to illustrate what he has found helpful for both MCT transference and countertransference, and the vital importance of therapeutic patience. 

Potential to Distress: Yes

Timed Outline

Day One
15 Minutes - Introduction
30 Minutes - Traumatic Transference in DID treatment
30 Minutes - Posttraumatic and Dissociative Aspects of Countertransference in DID treatment
30 Minutes - Break
60 Minutes - Developmental aspects of DID and its relationship to attachment, humiliation, unpredictably malevolent sadism, and the Negative Therapeutic Reaction in DID treatment 
45 Minutes - Introduction to the concept of Mind Control Transference

Day Two
30 Minutes - Introduction and Recap of Day One
60 Minutes - Mind control transference in the therapeutic encounter Part 1
30 Minutes - Break
45 Minutes - Mind control transference in the therapeutic encounter Part 2
45 Minutes  - Ask Anything” Questions to the Presenter