Just as the prevalence of incest and child sexual abuse was a well-kept secret until recently, the phenomenon of multiple personality disorder (MPD) – recently re-labelled dissociative identity disorder [DID] – has been minimized. In her practice as a psychologist, Margo Rivera has found this to be no coincidence.

Confirming that the root of most severe dissociative conditions lies in severe trauma, most commonly child abuse, Rivera first discusses the general historical and social contexts of dissociation and proceeds through clinical theory, case vignettes, and recorded personal experience to provide practical guidance to assessment and treatment. Rivera covers such topics as 'therapeutic frame,' 'transference and countertransference,' and how to understand and make use of these concepts. She discusses the controversies around 'False Memory Syndrome' and ritual abuse, issues which currently divide professionals treating trauma survivors.

Rivera makes a unique contribution to the treatment of lesbian and gay abuse survivors. She theorizes that all sexuality is a social construct, subject to change over an individual's lifetime, a reality that is nowhere more clear than in those with MPD who may experience themselves as alternately heterosexual female, homosexual male, lesbian, and heterosexual male.

Insightful and provocative, this important therapeutic guide will be of interest to professionals who treat trauma survivors as well as to their clients.

Margo Rivera is an assistant professor of Psychiatry at Queen's University and co-director of the Personality Disorders Service at Kingston Psychiatric Hospital.

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