Therapy for the the comorbid diagnoses?

Hi.

After a lot of problems with our therapist I had a session today where I laid out the facts and what I can and can't accept from her in relations to the DID. We have 3 or 6 months left with her, depending on when we move. Anyway - we/I talked to her about the comorbid diagnoses we have (ocd, anorexia nervosa and recurrent depression) and whether it was an option to work on those instead of the DID both because of the time restraint and honestly, because she's not at all equipped to deal with it. The ocd, an and depression have been things we've worked on a lot by ourselves over the years and we've come a long, long way. I was wondering though, most of these things have roots in trauma. Has it worked for any of you to work on the comorbid diagnoses without focusing on the dissociative and trauma processing part of it?

I'd be interested to hear both what you've experienced and what you might think about this.

It's our only therapy route for now. Hopefully we'll be able to focus on that in therapy and the DID by ourselves for now and in 6 months be stronger and be able to focus more on the DID. It's not the same but we work very well on our DID on our own at least, and while it won't be a focus of therapy, it will still have its place, naturally

Thanks
- Emma

we/I talked to her about the comorbid diagnoses we have (ocd, anorexia nervosa and recurrent depression) and whether it was an option to work on those instead of the DID both because of the time restraint and honestly, because she's not at all equipped to deal with it.

Don't hit me, but I have very bad news! I agree with your T. You need to work on the DID, not comorbid disorders. Sorry. Once you fix the DID the rest should be fixed too.

Hi lifelongthing.

We would be jumping through the walls if we'd only talk about comorbid diagnoses in therapy! It wouldn't work - not at all for us! We have talked about them in short, wondered why we have certain symptoms (example excruciating menstrual cramps!) but only by communicating with our parts, have we figured out the reasons behind these symptoms.

tylas wrote:Don't hit me, but I have very bad news! I agree with your T. You need to work on the DID, not comorbid disorders. Sorry. Once you fix the DID the rest should be fixed too.

I agree with Tylas here. Once you fix the DID, the rest will be fixed too!

Jo has a seperate person for her's. A psychiatrist for Bipolar and a therapist for the DID, not that I'm entirely sure I know what DID is. I'm just here. But I do know that's how she manages it, course Bipolar mostly needs medication. Or so I assume. - Theresa

I disagree. I say it depends on the person, on the circumstances surrounding the issue, and how it's worked on in therapy.

Cassandra and the others didn't have any DID-related therapy, but they still had major benefits from therapy that ended up helping them with our DID. The only things that were focused and worked on in therapy were PTSD, depression, grief processing, with slight focus here and there on anxiety and mood swings (we have rapid cycling bipolar disorder). Even though the therapy never touched on DID and was not meant to be DID-related in any way, the positive results from working on the individual issues would carry over and influence our DID/system. What we'd do is we would have the alters that had the most trouble with these issues, and then they would work on them in therapy and their progress would help them, and when alters are helped, that helps the system as a whole. For example, L.C. attended a lot of the therapy sessions, and she worked on her PTSD and depression in those sessions. If it was Kat, she'd work on managing her anger and managing the mood swings. If it was Cassie (she acted "through" Cassandra, though, she wasn't out herself), she'd work on grief processing and PTSD in those sessions. And the more each of the ones that went to therapy made progress, the better the system functioned, and we would make progress as a whole.

So yeah, I'd say it definitely depends. It is possible to have non-DID-related therapy be beneficial, but it all depends on how you go about working on it, the person themselves, and their system.


~The Hawk

I have to clear something up: it's not us that don't want to work on the DID - it's the T. As I wrote, she's not equipped to deal with it at all and working on DID with her is not an option (she has been very disrespectful to our parts and refuses to acknowledge that DID is not just "kinda like borderline" etc. She goes between being very nice and sweet about it, to not wanting to talk to the littles or anything like that. We have given her many chances (we've been with her more or less a year now) and we want to work on the DID and the traumas - but she isn't up for learning anything more ("The ISSTD isn't relevant to me", as she says). The options are to work on the comorbid diagnoses, or not have therapy for the 3-6 months it'll take us to get a new one (when we move).

So my question is more, how do I do this and is this viable, or is it better to quit therapy all-together? I wish to stay with her and work on the other issues - but I wondered what the success rate for you all had been for that.

(I will read and answer your post soon Hawk, I'm in a bit of a hurry right now..)
Thank you for answering, I really appreciate it

but they still had major benefits from therapy that ended up helping them with our DID.

Thanks for your answer Yeah, we've worked independently on some of our issues as well as had in-patient treatment for some of the comorbid diagnoses and it has helped us. The energy we put into the OCD and anorexia nervosa, which were both severe, can now be used for other things such as having more energy to deal with having a system and the PTSD part of it. There's also the issue of making each one of us feel like we are contributing and taking part in therapy (which we won't be allowed to with this T if we work on the DID, as she just wants part x, y and z there and not the rest) and making progress, which gives momentum and confidence in our ability to work through the harder things (DID and trauma related). I find this a good solution for us for now, and hopefully we'll have some more intense DID therapy in 3-6 months. I'm glad to hear it worked out well for you all

You can tell her that I say she is an idiot. It is T's like this that fill the mental hospitals with those with DID and work on the problems alters have instead of recognizing DID.

It took me about 3 months to find a new therapist as well after my first, who was wonderful, and who's focus was trauma and dissociative disorders, but had never treated anyone with DID. She was delighted to finally have a DID patient, but she was scared. She was trying to keep up with me in reading, but was overwhelmed. And the poor thing did not know what to do when I would have pseudoseizures at the slightest sound - even her voice! We both thought it was better for me to find someone with more expertise in DID, which she did try and help me do. I was lucky that someone had just moved to my area who's focus was DID and PTSD or I would have been out of luck. Those months were good for me. I kept reading and working on things myself.

"Coping with Trauma-Related Dissociation" (2 of the authors of this book wrote the haunted self, but this book is an easy to read workbook meant for patient use.)

http://www.amazon.com/dp/039370646X/?tag=bfftlbr-20

1. One option is that perhaps this T you have will accept this workbook and do it with you. Most likely she is out of her comfort zone, and rather than learning about DID, she chooses to ignore it. It is best to work with someone when doing the workbook, or the point often gets missed.

2. If you can work on integration and work with alters on your own during this time, perhaps she can work with the trauma issues. DID simply put has 2 problems and they can be worked on quite separately. Integration - see my thread on supportive integration. YOU do this by yourself. My T gives me direction, but I do hours and hours of work each week at home without him.

dissociative-identity/topic100124.html

3. PTSD - Trauma issues. This is the comorbid part that is helpful to work on, because besides integration, DID is much like PTSD, but of course with far more than one trauma to deal with. Your T sounds like she is willing to work on this.

You can't fix stupid and you don't need a stupid T (my word for those T's that refuse to educate themselves with current knowledge - it does not mean they are really stupid). You don't need to work on comorbid disorders that will resolve themselves once DID is fixed. You need to work on your DID - heck it already takes about 5 years of therapy to fix DID, who wants to spend time on comorbid disorders. My list would be long, Psychopath, sociopath, suicidality, autistic, borderline, OCD, depression, anxiety, somatoform disorders, eating disorder, PTSD, and so on and so on.

Research on this topic:
http://www.ncbi.nlm.nih.gov/pubmed/21278542

I cannot tell you what is best for you. Loosing your support is devastating, so I cannot suggest this either. Only you can weigh the issues and decide.

Have you read the ISSTD Treatment guidelines?
http://www.isst-d.org/jtd/GUIDELINES_REVISED2011.pdf

After reading this, maybe it is better to try to convince my therapist systemic therapy* may not be the best solution. There is a reason I want to go away, and it is not just to avoid problems. Yes, he has more experience with that kind of therapy, but that doesn't mean it is my biggest problem.

Would it help to work on phobias?

* As I understand it, therapy to improve relations in, for example, families, but I haven't read much about it yet.

Phase I of therapy does involve being able to function in every day life. At least with me - none of my comorbid disorders were ever worked on separate from my DID.

I scanned E. Howells last chapter that talks about this subject. I wonder if I can attach it here? It is a short chapter and I have to admit that I don't know much about comorbid disorders, because - as I have mentioned I don't deal with mine since they are a part of my DID.

Nope. It's not allowed. PM me if you want me to send you this.


Consider this: I am phobic of my head under water...

Well this is because as a child I was near drowned many times as a method to either control me, punish me or whatever, but the thing is that I thought I was going to die and thus some of the Alters in my system are phobic of water. Now will therapy with these alters fix that? Nope! No way. The only way to fix this is integration and trauma processing - treating the DID.

I sent a simple version of the above questions in this thread to Tom Cloyd since this deals with the types of therapists I have not had to deal with and thus do not feel good about giving much advise.