MIAMI UNIVERSITY The Graduate School Certificate for Approving the Dissertation We hereby approve the Dissertation of Carol Lee Bentall Humphreys Candidate for the Degree: Doctor of Philosophy _______________________ Chair William B. Stiles, Ph.D. ____________________________ Reader Roger M. Knudson, Ph.D. _____________________________ Reader Larry M. Leitner, Ph.D. _____________________________ Graduate School Representative Paul V. Anderson, Ph.D. ABSTRACT FROM FRAGMENTATION TO NEGOTIATION: ASSIMILATION OF ALTERS IN A CASE OF DISSOCIATIVE IDENTITY DISORDER By Carol Lee Bentall Humphreys This case study examined the psychological changes shown by Kristen, a female client diagnosed with Dissociative Identity Disorder, across four years of psychotherapy. A team of eight (six coinvestigators, myself as the primary investigator and former therapist, as well as my dissertation advisor) tracked Kristen and her alters’ shift in experience from internal fragmentation at therapy intake to dramatically increased communication among her alters at termination. This change process included the gradual reduction of Kristen’s internal amnesic barriers as she actively engaged in therapy. Her experience of “pulling one brick out at a time” was examined using the assimilation model, a theory of psychological change. We analyzed therapy notes, psychological reports, audio-tapes, video-tapes, transcribed therapy sessions, client-produced emails, drawings, and letters to further an understanding as to how change occurs in therapy for those who experience fragmentation. This was a theory-building study, informing the assimilation model as well as evaluating its account of Kristen’s extreme experiences of internal multiplicity. FROM FRAGMENTATION TO NEGOTIATION: ASSIMILATION OF ALTERS IN A CASE OF DISSOCIATIVE IDENTITY DISORDER A DISSERTATION Submitted to the Faculty of Miami University in partial fulfillment of the requirements for the degree of Doctor of Philosophy Department of Psychology by Carol Lee Bentall Humphreys Miami University Oxford, Ohio 2009 Dissertation Chair: William B. Stiles, Ph.D. © Carol Lee Bentall Humphreys 2009 Table of Contents List of Tables ............................................................................................................................... viii Dedication ...................................................................................................................................... ix Acknowledgements ......................................................................................................................... x Introduction ..................................................................................................................................... 1 Current Study .............................................................................................................................. 1 Dissociation ................................................................................................................................ 2 Dissociative Identity Disorder .................................................................................................... 4 The Assimilation Model ............................................................................................................. 6 Assimilation and DID ................................................................................................................. 8 Assimilation of Problematic Experiences Sequence .................................................................. 9 Case Study Methodology .......................................................................................................... 10 The Client ................................................................................................................................. 12 Kristen’s Worlds and the Alters ................................................................................................ 14 Why I Chose This Case ............................................................................................................ 17 Design ...................................................................................................................................... 17 Method .......................................................................................................................................... 18 Participants ................................................................................................................................ 18 Measures ................................................................................................................................... 21 Procedure .................................................................................................................................. 21 The Rounds of Analyses ........................................................................................................... 23 Results ........................................................................................................................................... 25 Elaborated Concepts ................................................................................................................. 25 Organization of Results ............................................................................................................ 26 Data Packet # 1: Historical Documents .................................................................................... 27 Why I Chose This Data Packet. ........................................................................................ 27 What We Learned ............................................................................................................. 28 Clinical Observations ........................................................................................................ 28 Assimilation Constructs .................................................................................................... 31 Data Packet # 2: Beginning Therapy Sessions ......................................................................... 36 Why I Chose This Data Packet ......................................................................................... 36 What We Learned ............................................................................................................. 36 Clinical Observations ........................................................................................................ 37 Assimilation Constructs .................................................................................................... 45 Data Packet #3: Early Sand Tray Work .................................................................................... 47 Why I Chose This Data Packet ......................................................................................... 47 What We Learned ............................................................................................................. 48 Clinical Observations ........................................................................................................ 48 Assimilation Constructs .................................................................................................... 51 iii Data Packet #4: Home Visit ...................................................................................................... 53 Why I Chose This Data Packet ......................................................................................... 53 What We Learned ............................................................................................................. 53 Clinical Observations ........................................................................................................ 54 Assimilation Constructs .................................................................................................... 60 Data Packet #5: Client Notes to Therapist and Self .................................................................. 63 Why I Chose This Data Packet ......................................................................................... 64 What We Learned ............................................................................................................. 64 Clinical Observations ........................................................................................................ 65 Assimilation Constructs .................................................................................................... 67 Data Packet #6: Semester Summary and Emails ...................................................................... 69 Why I Chose This Data Packet ......................................................................................... 69 What We Learned ............................................................................................................. 69 Clinical Observations ........................................................................................................ 70 Assimilation Constructs .................................................................................................... 78 Data Packet #7: Therapy Summary, MMPI-A Reports ............................................................ 80 Why I Chose This Data Packet ......................................................................................... 80 What We Learned ............................................................................................................. 81 Clinical Observations .......................................................................................................