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Therapy clarification

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Therapy clarification

Postby LKinney » Tue Nov 05, 2019 5:46 am

I saw our T today.

I asked her to clarify and got some info.

So, we were mistaken for one; she has a lot of experience with dissociation, but she clarified she's never treated anyone like us before. She has been consulting on our case with a retired psychologist. He said we either have "mild DID" (what does that mean?) or OSDD.

Okay.

My understanding is OSDD is from the DSM V, so even though he's retired his info has to be mostly up-to-date? She says he just retired and is up-to-date, but just clarifying here.

It sounds like he told our T that we had one personality and it split. That is different from what I have read DID is, and nothing I read on OSDD said one way or the other on that front.

Our T is very big on wanting to do EMDR. Dax is flat out against it as the science doesn't back it up much, but I said maybe...I'm just worried it will make LKinney even angrier with me than she already is, and right now she's nearly completely blocking my access to anyone else in our system, so I don't want to make her more upset with me! :shock:

Is EMDR what is used for DID/OSDD? Our T against said going for a family therapy model, which makes sense to me. But is there an actual treatment model? I'm unclear on this.

I get pretty confused with the difference between DID and OSDD. Does this information change anything in terms of trying to communicate with the others? Right now my main goals are keeping our outer world functioning (going to work, etc) and trying to open lines of communication with the others (including the others we know are in there but know nothing about).

Thoughts?

I don't think our system would tolerate trying to find someone new. We like our T and we seriously lucked out. It's been a massive struggle to make ourselves go and trying to find someone more specialized who we like might just mean we don't go at all, but read enough from many of you about the wrong kind of therapy, so interested in your insight.

Thanks.
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Re: Therapy clarification

Postby birdsong87 » Tue Nov 05, 2019 6:21 am

Giving that T the benefit of doubt I would guess he said that you as a system make one personality, but parts of it separated from each other, you could say split, and that would be consens in DID theory for the moment.

If EMDR is not backed up enough with science for you then nothing ever will be. science about trauma treatment is tricky business and influenced by a lot of factors. as trauma treatment it is one of the big acknowledged treatment options and the most gentle of them.

It is not proper treatment to jump into EMDR and processing right away.
treatment is supposed to happen in 3 phases
here is what the phases should look like from a DID text book your T should get.
https://www.psychforums.com/dissociative-identity/topic203580.html

EMDR needs to be used with caution and the T needs training for DID. It can lower the dissociative barriers in some people, which can lead to better communication. Some use it just for that, without trauma work. for others it gets terribly overwhelming and could cause a crisis. so your T better be sure what they are doing and not have blind faith in some tools they learned. it is tricky business and it is not for everyone.

you can find the treatment guidelines for DID here
https://www.isst-d.org/wp-content/uploads/2019/02/GUIDELINES_REVISED2011.pdf
Make sure you and your T know them. they explain structural dissociation and give an outline on how to treat it. in general the ISSTD website is a good place to find basic info.

this is the first thing I read about your T and it seems like they are looking for information and actively seeking help, which is a good sign. you could try for a certain number of sessions and then re-evaluate.
Dx: DID cPTSD
L (host 1); Asti (host 2); Annett (teen protector); Maya (child); Age (observer); Thamara (child); Danielle (aut. teen); Mike (caregiver) and others
our blog on resources: https://www.dis-sos.com
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Re: Therapy clarification

Postby TheGangsAllHere » Tue Nov 05, 2019 3:42 pm

OSDD is the newest term for dissociative symptoms that don't completely meet the criteria for DID. The cause and treatment is the same--there's no substantive difference. It's used if someone has fully elaborated alters (such as you do) but there's no significant amnesia for past or present events--for example if there's emotional amnesia but the actual events are remembered, and there's no day-to-day lost time. (That's technically called OSDD 1b.) There are other types of OSDD, but that's the most common.

I don't remember right now all the details of your description of your system. Do you have full recall of all the traumatic events of your childhood and no day-to-day lost time? (Technically, you only need amnesia in the past OR the present--so having only memory gaps in the past is enough to get the DID label, for what it's worth.

It sounds like the psychologist has a somewhat outdated view of how severe the symptoms have to look from the outside to "qualify" as DID. And of course, OSDD can be just as "severe" as DID. It's not a milder disorder, it just lacks amnesia.

birdsong87 wrote:Giving that T the benefit of doubt I would guess he said that you as a system make one personality, but parts of it separated from each other, you could say split, and that would be consens in DID theory for the moment.


That confuses me, Asti. I thought that current theory was clear that structural dissociation is a failure of the personality to come together as a single identity. The trauma interrupts normal development, and a single identity doesn't form. So there's no "split" because it never came together in the first place. Yes, together the parts are the pieces of what was meant to be one personality/identity, but that didn't happen.

The analogy I just thought of is if you wanted to make a cookie that was a jigsaw puzzle, you would make pieces of cookie dough that would fit together and bake into one cookie, but then if they didn't get put together before they started baking--they were separate on the cookie sheet--each one would grow and change shape, and it would be hard to see how they were meant to fit together at the start.

My T has never mentioned EMDR. But I've only been seeing him for 2 1/2 years, and it's been mostly phase 1 stuff, because of all the trauma caused by my therapy in the past. We're just starting to touch on past events in a more specific way.
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Re: Therapy clarification

Postby LKinney » Tue Nov 05, 2019 4:13 pm

Thank you both.

Our T is female.

Dax is against EMDR because of her research, in particular: https://www.scientificamerican.com/article/emdr-taking-a-closer-look/

We do think our T is a little too hung up on EMDR, that is our only complaint, but we really like her otherwise. I am not entirely against trying it, but I don't want to do it right now to avoid further enraging LKinney at this stage.

Our T said their consult said we had one personality and it fractured. From what I read here, that is not current with the view of DID.

We have basically ZERO memory of our childhood, just a few random things, but they are not something we clearly remember, they are like stories someone told us. We have no emotional attachment to or impact from them. We forget things pretty quickly, or get disconnected emotionally quickly. For example: we are DEEPLY impacted by the loss of our cats. It's been almost four years for one and just a little over one for the other (wow, even writing that for me is causing an emotional reaction; it's for sure not just LKinney). Both were very traumatic losses. We are somewhat more able to talk about the first one now because we do not feel the emotional trauma from the event in the same way. We also have difficultly remembering the details now. Even the more recent loss, the details of the trauma (it was a complete horror show of an experience) are fading.

We just assumed all people's memories were poor and faded like this, but we are starting to think that's wrong? We don't retain much in general, not good or bad. We have, on numerous occasions, especially in regards to our childhood, had people tell us things that happened and we truly have no memory. We might recall we HATE someone, but we could not tell you WHY. One our time high school friends even placed a tape recording of something we clearly did, but hearing it and ourselves was so disturbing to us because even hearing it we had NO memory at all. And this was not something traumatizing, just hanging out with friends.

So do you think this person is not up to date?

Thank you very much for the links. I will read and pass on to my T. She is actively researching, which is also why we wanted to ask here, to give her more info if you have it. We do not thinking switching at this time would be good for any of us and could result in us not seeing anyone at all, and I don't think that is right for us, especially with how hard it was for us to do this in the first place.

Thank you.
Xena - current front/main poster
"LKinney"- not actual name/original front for our whole lives
Anger based: Black Tiger, Grizzly, Andrea, Piper, Quinn
Traumatized: Laura, Vanessa, Dawn, Jessica, LKinney
Others: Nemo, Omega, Gabby, XT, Muse, Dax, Monica, Amelia, River, Punky
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Re: Therapy clarification

Postby TheGangsAllHere » Tue Nov 05, 2019 4:22 pm

Possibly not up to date with the latest in diagnosis and treatment, but it does sound like she is a good fit for you. Perhaps she would consider taking an online course with the ISSTD? They have a very good online training program:

https://www.isst-d.org/training-and-con ... criptions/

It sounds like that would be a better idea than consulting with that retired psychologist.
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Re: Therapy clarification

Postby birdsong87 » Tue Nov 05, 2019 4:57 pm

trying to rephrase it,
what I said was not the consens on how DID develops. it is how DID therapists are encouraged to see the person in front of them. and they are encouraged to think of them as parts of one personality.
The example given in literature is that of a company with many departments that are separated.
I notice that calling it a split might work in my language but not in english :oops: . the english literature insists that it is a separation, not a division. like separate departments, not divided houses.
again, it is not meant to reflect how DID developed. it only shows the therapeutic point of view that results in the different approaches to help.
it is meant to put away with the old concept of 'multiple personalities' that has been rejected in favor of dissociated identity. Ts who treat DID systems like different personalities all living in one body are not following the current guidelines. (not judging that, for some systems this is what they want, just saying that it is not the standard)

I briefly looked at the article.
obviously it is not a scientific article. there are plenty of controlled experiments that show that EMDR works just as well as other exposure techniques. that is what the text says, it just pretends like this makes EMDR unnecessary. it totally misses the point that EMDR is more gentle than the other exposure techniques.
I personally know therapists who by now refuse to use the CBT version of exposure because it is too hard for their patients. and for them. it includes telling your trauma story in depths time after time, until you are desensitized to it. it takes 8-12 times of telling it in great detail with re-experiencing all the emotion in a controlled way.
current research indicates that this is not processing the trauma, it is just creating a new memory, that of facing it without freaking out, to cover the old. it is considered to have little reprocessing elements at all.
EMDR doesn't demand that you ever tell your story in depth. you could, but you don't have to. exposure is done in a focused way for only short intervalls. the relief comes a lot faster, it saves tons of time. working through a memory can often be done in 1-2 sessions. it is also considered to have less desensitizing elements and mainly work as reprocessing or memory that is stuck.

so yes, it is another exposure treatment. but among the exposure treatment it is actually the best yet. all other exposure treatments are not indicated for DID at all while EMDR is listed as a possibility if done with care.
there is the scientific question if the eye movement is even necessary or it the short intervalls of exposure would be enough. this is actually the most valid critique to the method right now. but it might not even matter with DID, as it is known that for some of us all kinds of bilateral stimulation help to connect the brain differently and therefore helps with inner communication. so even if the bilateral stimulation did nothing for other people, it might do something for those with major dissociation.

all that said, your T is still waaaaayyyy too fast if she wants to start on that now. she should focus on phase 1 work. it usually takes years. (I think it was the netherlands? where they have a very structured 8-10 year plan to treat DID? I read it somewhere, it had ~4 years of strict phase 1 work on it)
Dx: DID cPTSD
L (host 1); Asti (host 2); Annett (teen protector); Maya (child); Age (observer); Thamara (child); Danielle (aut. teen); Mike (caregiver) and others
our blog on resources: https://www.dis-sos.com
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Re: Therapy clarification

Postby TheGangsAllHere » Tue Nov 05, 2019 7:10 pm

Maybe it’s somewhat of a language thing. My T treats us as individuals who each have our own feelings, thoughts, beliefs, memories, and way of relating to the world. I don’t see why the word personality or identity wouldn’t apply to each of us. But he doesn’t lose track of the fact that we’re all part of a whole. I wouldn’t call it a whole personality, and my T never has. He calls us a community, or will often use the word you to mean us, plural (I wish English had a separate word for the plural you).

And he has called what he does “state of the art” therapy for DID. He gives ISSTD webinars, and probably helped write the guidelines.

I think the guidelines talk about not treating people as if there are truly separate people sharing a body. The reasons for the divisions have to do with trauma—it’s not like being an invisible kind of Siamese twins where many people just happen to share a brain. It’s that approach that I think they caution against, since it can cause more separation. But there’s no problem with considering each part as a personality or identity, as long as the whole person is kept in mind.

Other than the semantics, I think we agree about the concept, right?
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Re: Therapy clarification

Postby birdsong87 » Tue Nov 05, 2019 7:41 pm

I think we do.
there are discussions about what makes a personality/identity and there is quite a lot of disagreement that we have seen.
so even within the ISSTD there are slightly different schools of thought. We mainly go with Nijenhuis. He would argue that in DID we separate into action systems, so different parts are kind of specialized in certain areas but lack abilities in other areas. Other parts have these abilities. that is his main argument to say that parts are not full personalities, because they can't access all the action systems the system as a whole has.
for the big pictures these are semantics. the important thing to keep in mind is to connect parts to improve collaboration and not encourage parts to create their own lives independent from each other, as this would need dissociation to increase
Dx: DID cPTSD
L (host 1); Asti (host 2); Annett (teen protector); Maya (child); Age (observer); Thamara (child); Danielle (aut. teen); Mike (caregiver) and others
our blog on resources: https://www.dis-sos.com
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Re: Therapy clarification

Postby Floralie » Tue Nov 05, 2019 10:11 pm

I'm not native English speaker, so semantics don't have special meaning to me the way it has to someone who is. I think personality in healthy person is the same thing than system is for person with DID. So, it's in a way same thing. Still I use the words "own personalities" to describe parts, because we are like full people are. We still aren't full alone. But there's lot more info in DID system, than there is in one healthy personality, which is why they're kind of the same thing, but I think the word system can not be replaced with the word personality. It would mean parts only have separate identities, and that is not true, they have more. But you can not fit DID system in boxes that are made for people without it. We won't fit. We need our own words.
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Re: Therapy clarification

Postby ganjakites » Tue Nov 05, 2019 10:49 pm

Asking clarifying soon enough there will be enough to integrate whom ever does the reliving or whom has in their personality to keep exisiting
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