EDUCATIONAL
DOMAINS AND
ANDRAGOGICAL
APPROACHES
IN TEACHING
PSYCHOTHERAPISTS
ABOUTMPD
Richard P. Kluft, M.D.
Richard P. KIuft, M.D., is the Director of the Dissociative
Disorders Program at the Institute of Pennsylvania Hospital
and Clinical Professor of Psychiatry at Temple University
School of Medicine, both in Philadelphia, Pennsylvania.
For reprintswrite Richard P. KIuft, M.D., Director, Dissociative
Disorders Program, The Institute of Pennsylvania Hospital,
111 North 49th Street, Philadelphia, Pennsylvania 19139.
An earlier version of this paper was presented at the Sixth
International Conference on Multiple Personality/Disso-
ciative States, October 13, 1989.
ABSTRACT
Didactic efforts in educatingstudents and colleagues about multiple
personality disorder (MPD) often begin with rather traditionalattempts
to convey a body ofdidactic knowledge, and assume that they prepare
the student learner to begin his orher clinical work. Infact, although
such approaches are traditional and reasonably effective, they are
perforce limited. Educators divide the goals ofeducation into three
domains: cognitive, attitudinal, and instrumental. Also, adult
learners tend to absorb material best when it is oriented toward
problem-solvingrather than the communication ofinformation and
abstract concepts. Therefore, teaching professional students and
graduate therapists ideally should address the several domains and
include a large portion of material presented with the several
principles of adult learning born in mind. This presentation will
begin with a review of approaches used to educate therapists about
MPD, and then focus on techniques to bring about learning with
regard to the condition and its treatment within an andragogical
frame ofreference.
INTRODUCTION
Multiple personality disorder (MPD) is a relatively new
arrival among the mainstream concerns ofthe mental health
professions. As a consequence, the vast majority of the
individuals within those disciplines who encounter MPD
patients have received little or no systematic instruction in
their diagnosis and treatment prior to that event. Unceremo-
niously, they arrive at a moment in time at which such skills
become painfully necessary, and their absence, previously a
matter of indifference, becomes intensely disconcerting.
The resulting circumstances may prove anxiety-provoking,
demoralizing, and overwhelming. The therapist may feel de-
skilled.
Suddenly the ongoing flow ofa career thatwas otherwise
188
progressing in a more or less satisfactory manner is disturbed
with the intrusion of unwanted turbulence. New areas of
competence must be established. There are novel materials
to be mastered and unfamiliar skills to be acquired. There is
consolation, soothing, and balm to be applied to narcissistic
wounds, to feelings that are rubbed raw, and to emotions that
seem to be unleashed in the therapistbyworkwith MPD. These
(1) occur in response to the patient's plight and materials;
(2) are triggered in connection with the therapist's own
unique dynamics and concerns; (3) are stimulated in reac-
tion to the unpleasant professional ambiance that often
surrounds such treatments (Dell, 1988); and (4) emerge in
connectionwith the sheerdifficulty ofconducting the therapy.
Not only must the therapist stretch to assimilate the
novel, the novel must reach some accommodation with the
person and the professional that the therapist is, and the
person and the professional that the therapist is striving to
become. Failing this, workwith MPD has the potential to exert
a deleterious impact upon the trajectory of the therapist's
private life, personhood, and career aspirations. An integra-
tion must be sought that will not compromise the therapist's
basic values, talents, ideals, and goals.
It is hoped that the encounter between the therapist and
MPD will result in the therapist's gaining new areas of com-
petence in a relatively smooth and atraumatic manner, and
encourage the therapist toward continued growth by self-
directed educational efforts and by participation in ongoing
collaborative learning ventures. This hope is not always
realized.
EDUCATION ABOUT MPD
Available Formats
Although I have not accumulated systematic data with
regard to the observations that follow, they represent a
perspective drawn from twenty years of work with MPD
patients, and seventeen years of consultation to others.
Probably the most frequent vehicle of education is the
simple single lecture. It is brief, requires a minimum of
commitment from both the sponsor and the attendee, and
therefore is generally palatable. However, its abili ty to convey
more than an overview is questionable, and post-lecture
audience questions almost invariably indicate that many
have found the material difficult to absorb and hard to
reconcile with the bulk of what they know. Lectures rarely
can speak to the needs of particular individuals. Their main
impact may be to increase recognition ofor openness toward
the subject, and to stimulate an urge to learn more. For some
DISSOCL\TIOi\, Vol. III. :"10. 4: December 1990 '
- . - - - - -~- ----
attendees, who are already grappling with MPD, the most
important outcome may be the resolution of a particular
confusing issue or the garnering of a crucial clinical pearl.
Next to be considered are workshops, which are offered
at an increasing number ofprofessional conferences. Usual-
ly one, but occasionally two days in duration, they take the
student through a series of topics. Beginningworkshops may
differ in focus, but in general they orient the student to the
phenomena, etiology, diagnosis, and treatmentofMPD. The
student learner who comes eagerly wanting "everything"
from such and experience is likely to come away with a sense
of having been overloaded with more material than one can
absorb with comfort. For the most part, the workshop is an
excellent vehicle for conveying what can be learned and
what can be done in the abstract, but often leaves the student
learner uncertain as to what aspects of that which has been
conveyed have immediate applicability to his or her circum-
stances, and somewhat uncertain as to how to integrate the
new materials and skills into the ongoing flow of daily
practice. This is especially true for first-time attendees who
may have begun work with their first MPD patients in a
manner that they infer having heard "experts" speak is
suboptimal or undesirable.
An increasing number ofstudy groups are now available
across the United States and Canada; many of them are
affiliated with the International Society for the Study of
Multiple Personality & Dissociation (ISSMP&D). Whatastudy
group can provide depends upon its composition and ma-
turity. Most study groups, at their inception, consist of a
nucleus of a few interested individuals concerned about
their clinical work with MPD patients. Often they serve as a
support group and a forum for informal peer supervision.
The members struggle with basic issues together, and often
are quite egalitarian. Over time, however, study groups may
follow a number of different pathways. Some retain their
peer support and peer supervision focus, while others be-
come formalized or move on to advanced concerns. While
study groups are of exceptional value, and should be a part
ofone's ongoing education ifthey are available, itis impossible
to generalize about their place in the growth of a particular
therapist's expertise. Certainly they counteract the loneli-
ness one can feel in working with MPD, and are a valuable
starting point for networking.
Some examples may illustrate the diversity and the
process of change that study groups may undergo. Study
group A invariably discusses clinical issues in the caseloads of
the participants. Study group B has assigned readings and
presentations, and resembles a graduate course in psycholo-
gy. Study group C frequently invites speakers from outside of
their membership. Clearly each provides a different educa-
tional ambience. The Philadelphia Study Group began in
1982 with shared clinical problem-solving, including the
bringing in of patients for consultations and demonstra-
tions. It moved to a format of presentations on problems of
general concern, followed by discussion. It then moved back
toward general clinical problem-solving. As its members
grew in sophistication it became as well a nurturing envi-
ronment for ISSMP&D presentations and publications -
more than twenty current and former members have made
presentations and/or published in the field and/or taught
on national faculties. Currently the group is a mixture of
clinicians, the very experienced and the newly interested,
struggling to find its focus. In the same evening's discussion
group sophisticated discussions of the in tegration of highly
complex MPD patients alternate with earnest inquiries as to
whether one indeed should talk to the personalities.
Therefore, despite their unquestionable value, the study
groups of today constitute too diverse a range of organiza-
tions with too varied a range ofagendas to recommend them
as complete educational resources for any clinician.
Ongoing consultation or supervision is a format of
incomparable value. A well-matched supervisor and super-
visee/consultant and consul tee can cover an incredible
amount ofmaterial rapidly and in a custom-tailored manner.
However, the availability of consultation or supervision may
be problematic in terms of logistics or expense, and many
desirable consultants or supervisors do not have sufficient
time to undertake additional work. Group supervision/
consultation is, an increasingly popular alternative. Peer
supervision may be productive. My own style is to request
those in group consultation/supervision to meet between
their sessions with me in peer supervision, to help them
internalize critical thinking and to emphasize the autonomy
and ongoing mutual support system-building that I value.
One disadvantage of a complete emphasis on consultation
or supervision for learning is that there are no checks upon
the supervisor or consultant, nor is there assurance that
alternative points ofview will be offered to the supervisee or
consultee.
As the literature has expanded, an increasing number of
clinicians are learning about MPD from self-directed read-
ing. This is an economical and flexible format, but often
leaves the student learner at the risk ofacquiring knowledge
out ofcontext.ltis remarkable how frequently the individual
who has learned about MPD from reading alone arrives at
unrealistic and unfortunate conclusions. One egregious
example I frequently encounter concerns colleagues's inter-
pretation of two articles of my own (1984, 1986) on the
treatment ofMPD. In these studies a major objective was to
demonstrate that MPD patients could achieve stable integra-
tion. Naturally, the emphasis was on patients who achieved
integration; most of the statistics reported were descriptive
of this subgroup. For this cohort the average duration of
u"eatmentfrom diagnosis to integration was under two years.
Many therapists assumed, on the basis of these publications,
that itwas reasonable to expect to integrate the average MPD
patient in under two years. Unfortunately, a figure based
only on highly successful treatments is most atypical. In fact,
several of the MPD patients described as less than successful
in the 1984 article are still in treatment with me and remain
unintegrated! Many therapists have misread the thrust of
those articles and have been either demoralized by or skep-
tical ofthose results. The colleague who reads in isolation has
no way to correct his or her misperceptions.
A final format for learning is one that I will term extrap-
olation. Many individuals assume that the best way to under-
stand and treat MPD is to build an understanding of MPD
based on theories and approaches which are accepted within
189
-
DISSOCIATIOX. Yol. III. Xo. 4: December 1990
EDUCATIONAL DOMAINS &ANDRAGOGICAL APPROACHES I '
their primary area of expertise. At best these efforts are
fascinating; at worst they approach questionable practice.
For example, a number of individuals who are basically
skeptical about MPD continue to advance treatment strate-
gies that take the form, "if you don't reinforce it it will go
away." Periodically one oftheir patients comes my way after
failing in treatment with them, and does well, to which they
rejoin, "she went to someone who would gratifY her fanta-
sies." The basic datum of the failure of their preferred
paradigm and the success of an alternate is not registered,
and they continue to approach MPD patients with a set of
ideas and techniques that they find congenial.
Summary Re: Formats
When all is said and done, one has to ask of these
formats, What do they generate? Do those who employ them
emerge knowing the field? Can theyworkwith MPD? Can they
handle MPD?
I know many therapists who are excellent individuals,
have attended study groups for years, have read every major
article, and have attended all manner of workshops, yet still
are unable to access alters. They simply do not know how.
Many therapists who have attended every International
Conference still struggle when they must deal with hostile
alters. They have not mastered how to contend with these
phenomena. They are receiving teaching without acquiring
the relevant learning. This is worthy of reflection.
Certainly there are some therapists who are not cut out
for this sort of work, but this side-steps a much larger issue.
It remains an unpleasant possibility that those individuals
involved in training others about MPD are better clinicians
and researchers than teachers. I recall that when I began to
teach in the early 1970s I was, I thought, a very good teacher.
If my students did not "get it," the fault had to be theirs. Any
professional educator would cringe at these words, but I was
not a trained educator. Over a period of time, however, and
despite generally good ratings as a teacher, the negative
feedback I received gradually made an impression. I began
to study education. One of the first discoveries I made is that
what must be learned and what must be taught do not
constitute a whole- they consist of a series of educational
objectives that can be understood as constituting a series of
domains.
EDUCATIONAL DOMAINS
Although several authorities have divided the domains
of learning somewhat differently (Bloom, 1956; Gagne,
1972; Tolman [in Hilgard & Bower, 1966]), a simple con-
densation would maintain that learning has cognitive, af-
fective or attitudinal, and insu-umental or psychomotor
domains.
Following primarily the model of Bloom (1952), the
cognitive domain has to do with the recall and recognition of
knowledge and the development of intellectual abilities and
skills. The affective/attitudinal domain pertains to changes
in interests, attitudes, and values, and the development of
appreciation and adequate adjustment. The instrumental or
psychomotor domain involves skill mastery and a "how to do
190
it" perspective.
The importance of this discourse to our topic is that
work with MPD involves learning in all of these domains; and
learning involves change, the act or process by which behav-
ioral change, knowledge, skills, and attitudes are acquired
(Boyd, Apps, & Associates, 1980). Most ofour focus has been
on education, which emphasizes the agent of change. Not
only has the MPD field neglected these domains in its
teaching- it also neglects them in its evaluation process. I
have reviewed my evaluations from several dozen workshops
that I have taught. I have been criticized many times because
student X could not read my slides or felt that I spoke too
rapidly- however, I have never been criticized because
student X left one of my workshops unchanged by the
experience.
HOW DO ADULTS LEARN?
It becomes crucial to reflect for a moment upon what
sort ofperson becomes a student learner with regard to MPD.
Absint the presence ofsome child prodigy in our midst, and
the occasional interested undergraduate or relatively young
graduate student, the modal consumer ofinformation about
MPD is an adultlearner. To summarize a wealth ofinformation
eloquently reviewed and synthesized by Knowles (1984), the
adult learner is a very different individual from the youngster
in school. For the latter, the principles ofpedagogy apply; for
the adult learner, whom Knowles referred to as a "neglected
species," the ideas of andragogy are far more relevant.
Many theories of pedagogy are essentially behavioral,
and regard the student as the recipient ofskillfully contrived
stimuli. This so-called mechanistic view regards the learner
as essentially passive, reactive, and empty. In contrast, and
more relevant to adult learning, is an organismic view, which
focuses on the learner as a developing organism whose
essence is activity. Theories that stem from the mechanistic
model are educator-centered in the main, and largely be-
havioral. Theories that stem from the organismic model are
often of the artistic/humanistic variety, and focus upon the
motivation and self-actualization of the student learner.
Eduard C. Lindeman (1926) was the pioneer in exploring
how adults learn. He found that adults are unlikely to be
stimulated either by abstractions, uncompromising re-
quirements, or authoritarian models. For adults to be stim-
ulated, the route ofeducation is that ofsituations rather than
of subjects. The highest resource is tlle adult learner's
experience. Adult learning "represents a process by which
the adult learns to become aware of and to evaluate his
experience. To do this he cannot begin bystudying'subjects'
in tlle hope that some day this information will be useful. On
the contrary, he begins by giving attention to the situations
in which he finds himself, to tbe problems that present
obstacles to his self-fulfillment. Facts and information from
the differentiated spheres ofknowledge are used, not for the
purpose of accumulation, but because of need in solving
problems" (Lindeman, 1926, p. 160).
The educator moves from authority and oracle to facil-
itator. "None but the humble become good teachers of
adults" (Lindeman, 1926, p. 160). Summarizing Lindeman's
DISSOCIATION, Vol. III, No.4: December 1990
work, Knowles observed: "1. Adults are motivated to learn as
they experience needs and interests that learning will satisfy;
therefore, these are the appropriate starting points for or-
ganizing adult learning activities. 2. Adults' learning is life-
centered; therefore, the appropriate units for organizing
adult learning are life situations. 3. Experience is the richest
resource for adults' learning; therefore, the core methodology
of adult education is the analysis of experience. 4. Adults
have a deep need to be self-directing; therefore, the role of
the teacher is to engage in a process of mutual inquiry with
them rather than to transmit his or her knowledge to them
and evaluate their conformity to it. 5. Individual differences
among people increase with age; therefore, adult education
must make optimal provision for differences in style, time,
place, and pace oflearning" (1984, p. 31).
The teaching style that facilitates adult learning best
involves warmth, indirectness, cognitive organization, and
enthusiasm (Gage, 1972).
How does one design an andragogical climate and
format? Knowles (1984, p. 116) has offered some compari-
sons between pedagogy and andragogy that are valuable and
instructive. While pedagogy assumes the dependency of the
student and creates a climate that is authority-oriented,
formal, and competitive, andragogy assumes the increasing
self-directedness of the student and creates an atmosphere
that is characterized by mutuality, respect, collaborativeness,
and informality.
While pedagogy assumes that the student's experience is
of little worth, and planning must come from the teacher,
andragogy assumes that the learner is a rich resource for his
orher learning, and effects a mechanism for mutual planning.
Pedagogy assumes readiness for learning is a matter of
biological development and social pressure, so that learning
needs are to be diagnosed by the teacher. Conversely, an-
dragogyassumes that readiness stems from the developmental
tasks ofsocial roles, and that learning needs mustbe diagnosed
mutually.
What is learned in pedagogyis for postponed application;
objectives are formulated by the teacher. Andragogyisfocused
upon immediacy ofapplication, and the objectives are to be
formulated by mutual negotiation.
Learning in pedagogy is subject-centered, so that the
course is designed into content units determined by the logic
of the subject matter. In contrast, andragogy is problem-
centered, and designed into problem units that are sequences
in terms of the adult learner's readiness.
Naturally, the activities of pedagogy emphasize trans-
mittal techniques, or how to get the knowledge into the
student. Conversely, andragogy emphasizes experiential
techniques that focus on inquiry.
The evaluation ofpedagogy is, ofcourse, the province of
the teacher alone. In andragogy, evaluation occurs by the
mutual re-diagnosis of educational needs and the mutual
measurement of the program.
What follows from the above is the candid realization
that the majority ofeducational endeavors that are mounted
or self-eonstructed with regard to MPD do not create an at-
mosphere that is consistent with the needs of the adult
learner. The early histories ofmany of the study groups have
involved periods in which these conditions were met, but
many of those groups changed as they come to contain
members whose needs were so diverse that the needs of all
participants were unlikely to be fulfilled on an ongoing basis.
My study of the literature of adult learning inclines me
toward increasing respect for the conceptoflearning contracts
in andragogy. A classic reference in the field is Knowles'
Using Learning Contracts (1986). In essence, a learning con-
tract is "an alternative way of structuring a learning experi-
ence: It replaces a content plan with a process plan. Instead
of specifying how a body of content will be transmitted
(content plan), it specifies how a body of content will be
acquired by the learner (process plan)" (Knowles, 1986, pp.
39-40). The contract may be between the student and him-
self or herself, with a group, or with a mentor, etc. Knowles
notes that it involves a series of steps.
Step 1 is the diagnosis of your learning needs. A learning
need is the gap between where the student is and where the
student wants to be with respect to a particular set of com-
petencies. What does the student need to acquire? The
learner, after reviewing his or her own thoughts, can get help
from other resources to complete this process.
Step 2 is specifyingyour learning objectives. What are you to
learn? Here the educational domains are a good guide,
because they will help you toward the next step.
Step 3 is specifyinglearningresources and strategies. The adult
learner is ill-served by simply acceptingwhat is offered. Itmay
have little relevance to his or her own needs.
Step 4 is specifying evidence of accomplishment. What will
demonstrate the presence of the competency in question?
Step 5 is specifyinghow the evidence will be validated. By what
criteria will the evidence noted above bejudged? How and by
whom will those criteria be applied?
Step 6 is reviewing your contract with consultants for the
purpose of assuring that you have assembled a con tract that
relates to your needs in an optimal manner.
Step 7 is carrying out your contract. You need not hesitate
to revise it in midstream.
Step 8 is the evaluation of your learning, getting some
assurance that you have, indeed, learned what you set out to
learn. The simplest way is to return to your consultants and
ask them for tl1eir assessment.
The student learner who undertakes to monitor his or
her education in such a manner becomes a more discrimi-
nating user of educational resources, better able to focus
upon acquiring the competencies that he or she actually
needs, and better able to focus his or her attention toward his
or her own needs in the process of general educational
endeavors and consultations.
What then of the lectures and workshops? How are we
best to understand their function? I submit that they are most
easily understood as somewhat pedagogic predidactic mobi-
lization experiences. They teach the vocabulary and the
culture of the field so that the process of adult learning has
a substrate upon which to build. For example, it is simply not
cost-effective to hire a consultant to teach one the basics
about MPD. One can acquire that knowledge more readily
from workshops, lectures, and reading. Apart from the need
to address urgent crises, the time to turn to a consultant is
191
DISSOClUIOX. Vol. III. ~o. 4: December 1990
EDUCATIONAL DOMAINS & ANDRAGOGICAL APPROACHES i
either after the diagnosis of one's learning needs and the
establishment objectives, or if one is stymied in his or her
efforts to achieve the aforementioned basics. At this point
what one will glean from the consultation or supervisory
experience will be infinitely richer.
STUDENT THERAPISTS VS. GRADUATE THERAPISTS
Within the community of psychotherapists, certain dif-
ferences exist between the needs of those who are still
officially students within their disciplines and those who
have graduated. In my experience a substantial percentage
ofstudent therapists remain cognitively geared to expect an
authoritative pedagogy model ofexplanation and instruction.
I have found that a more andragogic approach may leave
such students with either a sense of insecurity (the "truth"
has not been revealed/one has not been told what to do and
continues to have anxieties as one searches for guidelines
and rules) or the conviction that the teacher does not have
credible intellectual rigor. I have also found it most useful to
convey to such students an appreciation of the best that is
known, but to then attempt to facilitate their examination of
these materials in the light of their growing experience.
Often the anxieties that are engendered in the neophyte
who is not given a pedagogical mix sufficient to allay ap-
prehensions and establish a certain baseline of knowledge
are sufficiently intense to incapacitate the individual from
moving toward greater autonomy.
It is extremely helpful to avoid the infliction ofnarcissis-
tic injury with all student learners, but with the neophyte it
may not be immediately apparent just where the areas of
narcissistic vulnerability and the residues of adolescent
narcissistic concerns may impinge on the educational pro-
cess. In contrast, with the more experienced practitioner it
is easier to ascertain the narcissistic investments in various
ideas and practices, and to assess character issues with rela-
tive facility. I am particularly concerned with the provision of
a safe learning environment for neophytes, lest an over-
whelming experience with MPD blight their young careers or
dampen their enthusiasm for their chosen vocation.
One of the most difficult dilemmas that I have encoun-
tered, and admit that I have not resolved to my satisfaction,
is the thorny issue of teaching the student therapist how to
deal with MPD when that therapist still is lacking in general
knowledge about psychopathology and psychotherapy. Of-
ten I have found no alternative to proceeding in a very
didactic manner.
OBSERVATIONS ON TEAClllNG
One ofthe most important realizations to achieve in the
education of therapists with regard to MPD takes us back to
the domains. The cognitive domain's content can be mas-
tered from well-organized presentations and reading, and its
strategies from exercises in which challenges to thinking are
presented. The latter is sorely underemphasized in educa-
tion about MPD, and is one of the main reasons that so many
student learners can acquire considerable knowledge, but
make the same errors of thought over and over again. We
192
need to develop exercises that allow our student learners
more opportunities to test their critical thinking with regard
to the problems that they perceive as relevant.
In connection with affective and attitudinal domain,
modelling and vicarious reinforcement seem to be critical
methodologies. Should we not move toward educational
formats that include more demonstrations? Should we not
require more active participation from student learners, and
place them in exercises that offer them the opportunity to
"try on" what they need to acquire?
With regard to the instrumental and psychomotor do-
main, practice is the essential component of learning. Yet
there is little in our educational packages to allow for that
sort of skill-building. Supervised role-playing might be a
valuable adjunct to current workshop formats. Clearly many
student learners leave the workshops of today cognitively
engorged, but not "knowing how to do it."
At this time, I am advising those who want to learn about
MPD to participate in workshops and study groups, but to
devise their own learning contracts and monitor themselves
quite carefully. I am suggesting that they obtain consultation
when there is a wish or need to do so, but I am increasingly
advising that they form a buddy system with another interest-
ed colleague so that they can discuss cases on a mutual "as
needed basis," learn together, and always have a partnerwith
whom they can role-play difficult situations and get feedback
about their acquisition of skills. I am also advising learners
who want to learn particular skills to contract with more
experienced hands to do so by either bringing their patients
along to the consultant or by spending a day with an experi-
enced person, observing them work. I have been impressed
with the incredible richness of these learning formats for
making "breakthroughs" in the learning process.
ILLUSTRATIONS
1. A Brief Contract
An experienced MPD therapist had spent years in the
field without encountering allegations of ritualistic abuse.
Upon first exposure to this material, the therapist felt de-
skilled. The learning needs proved to be largely in the
affective and attitudinal realm, and secondarily cognitive. In
the absence of a concise summary of this area to which the
therapist could be referred, an initial consultation, largely
didactic, was held. The needs in the affective and attitudinal
domain, which are best addressed by modelling, were attend-
ed to byfreewheeling discussions about the learner's and the
consultant's experiences. The learner calmed rapidly, felt
competent in clinical work with the patient in question, and
on follow-up demonstrated a clear capacity to continue the
patient's therapy.
2. An Intermediate Contract.
A skilled therapist sought consultation about the MPD
patients in the therapist's caseload. Mter some preliminary
discussion, the therapistwas encouraged to do an education-
al self-diagnosis. To the therapist's astonishment, what had
appeared to be a bewildering variety of problems could be
reduced to the therapist's lack of certain very specific skills
DISSOCIATION, Vol. III, No.4: December 1990
and a particular recurrent countertransference difficulty.
The therapist and the consultant agreed to discuss and
practice in role-play the skills in question. The therapist
rapidly mastered the necessary skills and carried them over
into his own practice. Simultaneously, the therapist returned
to his old therapist to explore the countertransference
problems in question. Mter three months of biweekly con-
sultations, the educational 0 bjectives seemedfirmly acquired.
On follow-up a year later, the therapist is more confident in
working with MPD and has produced some significant re-
search in the field.
3. A Sequential Rediagnosis Cantract
An individual with an intense involvement with the MPD
field is attempting to build further upon an already impres-
sive mastery. This individual has undertaken an ongoing
process of rediagnosing his/her unique educational needs,
and evolving novel approaches to acquire new competencies.
Ateachrediagnosticstep, this individual involves a consultant.
The consultant may or may not be involved in the acquisition
of the new competency, but always is presented relevant
clinical material thereafter to assist in determining whether
the competence has been acquired.
DISCUSSION
The previous sections have addressed major topics con-
cerning the importance of educational domains and andra-
gogical approaches in teaching psychotherapists about MPD.
I would like to build upon these themes to reflect on the
importance ofthese realizations for the MPD field in two areas,
chosen from among many possible examples.
Although a number of therapists have distinguished
themselves by their outstanding results in the treatment of
MPD patients, this has not been followed by the widespread
learning of their methods, techniques, and approaches.
Clearly, such therapists have something to teach, but it is
questionable how often they have the opportunity to do so.
The very nature of content-oriented traditional pedagogy
makes this unlikely. Likewise, the format of the workshop
does not allow for this, nor does traditional supervision. It is
only when the informed adult learner identifies the skills
across the several educational domains that constitute the
differential competency of the expert as deficits in terms of
his or her learning needs, that this type of competence can
be sought out and thereafter shared. The student learner
cannot immediately leap to a higher level of competence,
but unless he or she begins to identify the difference between
his or her best level of performance and that of the expert,
and strive to erase it, there is no way it will be taught. The
failure on the part of studen t learners to define their needs
in such a way delays the spread of expertise within the field.
My best supervisees have pushed me to the limit to verbalize
and/or demonstrate what I know. It is essential to acknowl-
edge that a great deal of the accumulated wisdom of those of
acknowledged expertise is never shared, and it is essential to
appreciate that the expert cannot simply sit down and teach
such wisdom in a didactic manner. The expert may not even
realize what constitutes his or her expertise. This expertise
can, however, be shared in response to a planned and
inquisitive learning program.
Also, it is essential to realize that it is not impossible to
help a hospital or clinical staff come to grips with MPD.
Usually the individual who attempts to teach a staff about
MPD has his or her hands full. That individual usually is
highly invested in sharing what he or she knows about MPD,
and in indicating what he or she would like the staff to know
and to do. Implicitly a mechanistic and pedagogic focus is
maintained. Many difficulties may ensue. If, however, that
individual follows the principles ofandragogy, and helps the
staff to problem-solve and to learn onlywhat the staff)s ready
to learn, the process is much facilitated. In the training of
stafffor The Institute ofPennsylvania Hospital's Dissociative
Disorders Program an andragogical focus was maintained,
and is continued with weekly education built around prob-
lem-solving. The result has been the development ofa cadre
of nurses and psychiatric technicians who are competent in
many of the techniques that often are considered rather
advanced, and a sense ofmastery on the part of the staff, and
security on the part of the patients.
In closing, let me acknowledge that we have much to
learn from professional educators. Professional education in
its other sense, i.e., the teaching offered to students in the
professions, is often less effective than it is imagined to be,
and, as we model ourselves upon our own teachers, often we
perpetuate models of teaching which are mediocre orworse.
In many areas of endeavor, where data bases are well-
established, the ideas are well-known and familiar, and there
are many authorities to whom the learner can turn, one can
"getawaywith"notoffering the highest quality ofeducation-
the student has many resources with which to repair his or
her teachers's deficits and shortcomings. However, in a new
and controversial field where much still remains to be
established and often the best knowledge that is available is
thatwhich comes directlyfrom the so-called experts, students
are largely at the mercy of the skills of their teachers; and
those who teach must be prepared to conduct themselves
accordingly. •
REFERENCES
Bloom, B.S., eta!. (1956). Taxonomy ofeducationalobjectives. Handbooks
I-Ill. New York: McKay.
Boyd, RD., Apps,j.W., & Associates (1980). Redefining the discipline of
adult education. San Francisco: Jossey-Bass.
Dell, P.F. (1988). Professional skepticism about multiple personality.
Journal ofNel1Jous and Mental Disease, 176, 528-531.
Gage, N.L. (1972). Teacher effectiveness and teacher education. Palo Alto:
Pacific Books.
Gagne, R.M. (1972). Domains oflearning. Interchange, III, 1-8.
Hilgard, E.R, & Bower, G.H. (1966). Theories of learning. ew York:
Appleton- Century-Crofts.
Kluft, RP. (1984). Treatment of multiple personality disorder.
Psychiatric Clinics ofNorth America, 7, 9 - 29.
193
DISSOCIATIO:\, Vol. III, :'-10. 4: December 1990
Kluft, R.P. (1986). Personality unification in multiple personality
disorder: A follow-up study. In B.G. Braun (Ed.), Treatment ofmultiple
personality disorder (pp. 31-60). Washington, DC: American Psychiatric
Press.
Knowles, M.S. (1984). The adult learner: A neglected species. Third
edition. Houston: Gulf.
Knowles, M.S. (1986). Using learning contracts. San Francisco: Jossey-
Bass.
Lindeman, E.G (1926). The meaning of adult education. New York:
New Republic.
194
D1SS0CL-\TIOX, \'01.111, :\'0. 4: December 1990