First: is it really a “standard of care”?

In their own words, no. On page 117, the Guidelines say:

“The recommendations in the Guidelines are not intended to be construed as or to serve as a standard of clinical care. The practice recommendations reflect the state of the art in this field at the present time. The Guidelines are not designed to include all proper methods of care or to exclude other acceptable treatment interventions.” (p. 117)

In plain words: the Guidelines describe what a group of experts recommended in 2011. By their own statement, they are not meant to be a required standard, and they are not the only acceptable way to treat DID.

The three phases

The Guidelines describe treatment in three phases (p. 135):

“1. Establishing safety, stabilization, and symptom reduction;
2. Confronting, working through, and integrating traumatic memories; and
3. Identity integration and rehabilitation.” (p. 135)

The idea of treating in phases is much older than the Guidelines:

“As early as the late 19th century, Pierre Janet advocated a phase-oriented treatment for dissociative disorders.” (p. 135)

They also say that not everyone moves through all three:

“…some patients may continue in Phase 1 treatment for long periods of time…” (p. 141)

In plain words: Phase 1 is about safety and handling symptoms. Phase 2 is working with trauma memories. Phase 3 is bringing things together and building life going forward. Some people stay in Phase 1 for a long time.

How long is treatment?

“As with treatment for other patients with complex posttraumatic disorders, treatment for DID patients is generally long term, usually requiring years, not weeks or months.” (p. 145)

In plain words: the Guidelines expect treatment to usually take years. Notice the words “generally” and “usually.” It is a general expectation, not a rule for every person.

How often?

“The minimum frequency of sessions for most DID patients is once a week, with many experts in the field recommending twice or even three times a week if resources permit this.” (p. 145)

“Although the 45- to 50-min session remains the norm for most therapists…” (p. 146)

In plain words: at least once a week for most people, and more often only “if resources permit.” A regular session is about 45 to 50 minutes.

Money and insurance

The Guidelines mention money only a few times:

“…lack of financial resources for treatment…” (p. 133), listed as one reason some people do not reach final fusion.

“…external factors such as insurance and other financial resources…” (p. 145)

“Given the current constraints of third-party payers, most hospitalizations are brief…” (p. 148)

In plain words: the Guidelines recognize that money and insurance affect treatment. They do not say what insurance must pay for. Insurance companies set their own rules, so if you are told “insurance requires this,” it is fair to ask to see that rule in writing.

Is full integration the only goal?

“Integration is a broad, longitudinal process referring to all work on dissociated mental processes throughout treatment.” (p. 133)

“A desirable treatment outcome is a workable form of integration or harmony among alternate identities.” (p. 133)

“…a considerable number of DID patients will not be able to achieve final fusion…” (p. 133)

“…a more realistic long-term outcome for some patients may be a cooperative arrangement…” (p. 134)

In plain words: the Guidelines say a good outcome can be full fusion, or it can be parts working together in harmony. They say outright that many people will not reach final fusion.