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Helping Future Therapists Treat DIDs

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Helping Future Therapists Treat DIDs

Postby Sotrsab » Wed Apr 25, 2012 1:25 am

Hi group,
I had a very interesting therapy session & I would like to ask for input on any/all questions. Can be very short answers since there are 5 questions posed, but I think that it would shed some light on DID generally speaking & show some interesting angles. Just to preface, my T is a Professor at a Christian University & is grooming me to speak this spring to his graduating (Clinical Psych) students on DID. These are the type of questions that I will be asked to address:

1) What would someone with DID want a T to know if treating them?
2) What works/does not work for you in therapy?
3) What is your career or your successes in life?
4) What resources do you find beneficial?
5) Have you had or do you have a serious medical condition? (This is based on the theory that DID’s live highly stressful lives (an understatement in my opinion :) ) & that extreme stress compromises the immune system.

Any positive/negative feedback concerning your own experiences even if unrelated to these questions will be helpful to those entering the field of Clinical Psychology.

So, anyone willing to give me insight? I want to prepare well (& well in advance) so I do a good job giving insight to our future T’s. Many thanks in advance…Sotrsab
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Re: Helping Future Therapists Treat DIDs

Postby yakusoku » Wed Apr 25, 2012 3:12 am

1) What would someone with DID want a T to know if treating them?
A. The importance of attachment dynamics and transference/counter-transference in the work. A lot of "content" is there and a therapist would do well to pay good attention to those areas. Also, that DID is for many a denial/invalidation based disorder. I know there is thought about the link between DID and disorganized attachment and in my case, that has manifested as having very anxious parts and very avoidant parts doing war inside as we tried to learn to trust T.
B. Denial of past abuses, denial of current realities that are intolerable, denial of self. Even the most functional often suffer under this. The lack of sense of objective reality can be crazy making (for the client and possibly for the T as well, who may have to hear different alters and/or the host disavow past events, present day actions and thoughts/emotions, which others claim with certainty). This is important for many reasons. Partially because these denials will sometimes be projected onto the therapist (s/he doesn't believe me!), as others have not believed in the past or abusers outright manipulated the truth in their favor; and essentially that integrating said parts together and the thoughts/emotions/experiences they hold requires negotiating through the invalidation/denial and into acceptance of one another.
C. That not all DID manifests with the classic/popular signs of obvious identity alterations with full amnesia. Even those with time loss may have it infrequently, for very short duration when heavily triggered, and it can be as insidious (and easily hidden by other parts). This was particular important for me as my therapist suspected DID a few weeks in, but asked a few vague questions about classic time loss scenarios (I had no idea what he was talking about and panicked and said, "No! Nothing like that!" without even thinking it through). We ended up sorting it out in the end and I wouldn't have been ready to confront that as a diagnosis until later anyway, so it worked out in my case, but someone else might have a missed diagnosis from assuming the classic presentation.

2) What works/does not work for you in therapy?
A. Short sessions do not work; long sessions do (two hours seems to be the minimum time that works for me to get out of the way and T to have decent amount of time to interact with and contain in the end). We just work very slow, I guess. :roll:
B. Sitting across from one another does not work; sitting next to one another, either on the couch or on the floor felt safer (once the relationship was well established). Being across from one another felt very adversarial, and having him take notes while talking made me feel like a zoo exhibit.
C. A strict environment and therapist inflexibility does not work. My T's willingness to adjust the room in ways that feels safe (TRIGGERS i.e. lots of light make one little have memories of being exposed and looked at) has been essential. His general willingness to consider changes to the way we work, like double-sessions, reading stories to littles, coloring together, etc. have made it safe for vulnerable ones to come out.
D. Consistency within the flexibility. My T is awful with scheduling and that has really taken a toll at times.
E. Safe touch (hugs, holding hands during prayer) negotiated between the T and ourself has been very positive and healing and is one of the only ways some of the littler ones have felt safe to talk.
F. As you mentioned a Christian University and my T works from a Christian Counseling perspective, being understanding of the religious ambivalence that is likely to be inherent with DID is important. Even though T will share his thoughts about God, his willingness to hear, accept and respond lovingly and without offense to those of us who are not on board with that stuff (and even to reframe certain concepts that were being twisted by a harmful religious upbringing) has made a huge difference.

3) What is your career or your successes in life?
A. Graduated with a BA from Stanford.
B. Have managed to have a stable relationship (together almost 14 years, married 9, basically my entire adulthood). Obviously, there are some unhealthy patterns there, but coming from a family where my mother had dozens of relationships in my life time, it seems like a big deal to me.
C. Currently, I'm a mom with a childcare business on the side. Before I was working in Admin, beneath my abilities, getting promotions and still eventually quitting, because I couldn't stay for anything longer than two years max without finding an excuse to sabotage. Fear of failure has kept me from trying for other things I might be capable of. It is a huge trigger for a lot of us, so we just don't risk and only try things we are sure to succeed in.

4) What resources do you find beneficial?
A. Forums like this.
B. Between session contact via text, phone.
C. Technical articles that explain dissociation.

5) Have you had or do you have a serious medical condition?
Nope, never. I have had several somatic complaints, but I hate doctors and would never get them checked out. I just wrote them off as some weird physiological thing. Turns out most were body memories or other psychological issues.


In general, from what I've heard from other peoples' experiences, treating a DID client can be a very demanding job. My T muses that he is surprised what an "easy" difficult client I am. It can be emotionally demanding, triggering if the T has their own issues, cause vicarious trauma, cause burn out if T's do not watch their own needs/resources. It's probably good for a T to be doing their own work and have supervision as various boundary issues are likely to come up. I know that's a good idea in general for Ts.
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Re: Helping Future T's (religious trigger?)

Postby HopeIsHere » Wed Apr 25, 2012 8:26 am

Relatively new to this and responding for my 15-yr-old son...our experience this past couple weeks.
) What would someone with DID want a T to know if treating them?
To be clear about what to expect when first discovering the DID (help set up rules right away or boundaries...don't diagnose and say 'see you next week'. The stabilization stage should have some get-through-the first month cliff notes. :)

2) What works/does not work for you in therapy? Explaining your educational / expertise doesn't really matter. The security comes from knowing you can be trusted. Always calm voice. Always remember who you're speaking with. You may have legit arguments against some irrational concept that an alter expressed...but as a T - it is your job to think about the timing. Also...reassurance that talk of 'integration' does not mean oblivion...seems to be a great fear among his alters right now. Also..we have not 'mapped' yet....I think making it tangible/organized may help cope with the news that one is not 'alone'. My son felt very out of control and scared until he started conferencing and we talked about everyone having a place when they are not 'out'. (like a house) It helped!

3) What is your career or your successes in life? 15- Freshman in HS. Wrote a 700 pg book, 500 pg book, working on 3rd. Not published yet - but enjoy it.

4) What resources do you find beneficial? Parental support. Understanding. Patience. Confidence. Calm tones. T that knows that the session may need to run over to get somewhere rather than cut things off because 'times up'. This board!!!! Haven't found any other resources...

5) Have you had or do you have a serious medical condition? Diagnosed Aspergers. Since we have just got this DID diagnosis and don't know yet exactly when or what caused the splitting....I am curious as to if part of a trauma might be something you would not think of (like over-stimulation of lights, sounds, etc... or the semi-photographic memory where a traumatic scene on a movie (in passing) may have really affected him. I know one nightmare he had for months was based on a POSTER for a movie he saw in a store. We don't watch horror movies so it took me forever to piece it together!

On a religious note (trigger?) I am a Christian and as all this started (violent! nightmares and aggressive he-might-kill-you-if-I-let-him-out alters...i wondered about demon activity. Oppression... but once I met this one...he was really misunderstood. he was not a monster...i believe he is capable of killing...but only defensively. I think what helped me to move past that knee-jerk reaction of 'what if this is just spiritual warfare' was seeing that this alter was not about playing games, tormenting me, or my son...he was there to protect - from me too if needed. Knowing that distinction...alters may rightfully be angry, hurt, lash out, be protective, maybe rude...doesn't mean it's 'a demon' was something I had to figure out. Even 'professing' Christians can be shy, confused, embarrassed to ask...perhaps volunteer it.

***Thank you for doing this...I would have been totally lost without this board this past couple weeks and knowing someone is trying to help others be better T's with it is great****
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Re: Helping Future Therapists Treat DIDs

Postby TinyPieces » Wed Apr 25, 2012 10:14 am

Oh! This is a wonderful wonderful thread. Im glad to see it up.


1) What would someone with DID want a T to know if treating them?
-Well I havent been in T for this for ages, but long enough to know that there needs to be inbetween session contact
- Longer sessions. I have very short sessions and it causes incredible chaos..It feels like a race, and sometimes I dissociate and lose the whole session.
-It would also help if T told me what we did so Im not walking around wondering what happened in session, because I forget.
2) What works/does not work for you in therapy?
-doesnt work to have someone ignore insiders. Its basically ignoring the people who know more than I do about what happened.
-Listen to alters.
- I have many littles and they are scared and maybe if someone made it feel safe, like kids are not unwanted or kicked out....they might be able to feel trust and it can help us feel safe to go through what the trauma is.
-T should know that there might be protectors constantly trying to mess up T...or deny or minimize....should know how to handle this.
3) What is your career or your successes in life?
-Im functional? lol...
4) What resources do you find beneficial?
-in between contact
-this forum is helpful
-blogging
5) Have you had or do you have a serious medical condition? (This is based on the theory that DID’s live highly stressful lives (an understatement in my opinion ) & that extreme stress compromises the immune system.

-I am physically healthy for the most part.
Im very sad inside :( very sad.

BrOkUn KcrAyOnS
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Re: Helping Future Therapists Treat DIDs

Postby Ultraviolet » Sun Apr 29, 2012 10:30 pm

1) What would someone with DID want a T to know if treating them?

I wish I could have a therapist to understand all my diagnoses. I doubt it is possible.

2) What works/does not work for you in therapy?

It hasn't been working. I still hope to get help in therapy.

3) What is your career or your successes in life?

Not much. There have been some now and then, but the sacrifices were too great and the rewards not enough. Just surviving is a big feat like the other poster said. I can't believe I am here now, just scraping by.

4) What resources do you find beneficial?

Posts and blogs from people with the same conditions. I have an email friend that helps sometimes. It is not enough.

5) Have you had or do you have a serious medical condition? (This is based on the theory that DID’s live highly stressful lives (an understatement in my opinion ) & that extreme stress compromises the immune system.

Yes I have ME/CFS (with fibromyalgia), which experts now think is a neuroimmune illness related to cancers. I have Asperger's which is an autism spectrum disorder. The AD(H)D is too. I have anxiety and depression. Each of these and the dissociative disorder are causing me major problems.
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Re: Helping Future Therapists Treat DIDs

Postby SnakeskinSoul » Mon Apr 30, 2012 2:47 am

1) What would someone with DID want a T to know if treating them?

a. I would like a therapist to realize that DID is sometimes just a diagnosis, a starting point, and work from there to help a system get organized rather than try and "fix it". We were multiple before we were abused... DID is the result of abuse that happened to our entire system, rather than the cause of the system. I have trouble finding anyone, therapist or not, that accepts this.

b. I would also like the therapist to realize that integration is not the one and only route. We don't want to integrate! We just want to learn how to work together better!

c. I wish more therapist would engage, rather than sit there, nod and look at us expectantly. We like feedback, advice, thoughts, experiences, ANYTHING. If we wanted to sit and talk at someone, we could do that for free from our computer. But no, we want help, and to us... help is where you connect and have a discussion. Not let one person do all of the talking.

2) What works/does not work for you in therapy?

I think "c" above covers it. We need people to talk to us and have a discussion. Sitting there and saying "how do you feel about that?" doesn't work. It can help, but if I don't know how I feel or all of us feel different things... yeah, no.

3) What is your career or your successes in life?

We graduated from High School and are now writing. Almost done with one novel! :) The novels are all based on the lives and histories of our system members.

4) What resources do you find beneficial?

One-on-one chats, small group chats, activities and exercises (like questions and guided journelling things) that help direct our thoughts.

5) Have you had or do you have a serious medical condition?

We have fibromyalgia. I have PTSD. One of our system members is mute, another has severe depression and OCD.
All through history, the ways of truth and love have always won.
- Ghandi

Dx: PTSD, Fibro, GID || Multiple (not Dx'd) || Host: Snake (m/24) || Others: 100+; Steve (m/35), Jaenelle (f/20), Tom (m/25), Kanna (f/10-16), Namine (f/15), Bjorn (m/?), Sen (f/15)
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Re: Helping Future Therapists Treat DIDs

Postby moustik » Tue May 22, 2012 11:48 pm

What is vital for me is to be absolutely sure that my therapist will not leave me, i.e. that she is in for the entire recovery process. Abandonment is a core issue for me and I keep testing her commitment to the therapeutic relationship. She understand why I test her, she makes sure all part are reassured as to her long-term involvement.

Consistency is very crucial as well. Any sudden changes, even in the therapeutic room's decor, can trigger extreme anxiety.

Long sessions are better for me - 11/2 hour is the usual duration.

Touch is important - holding hands, hugging... But each alter has its own rules about it.

DID, like any other mental illnesses manifests itself in many different ways - I don't think there is one and only one method of treatment. It is important to me to know my T realizes that and can adjust the treatment if necessary over time.

I was very successful careerwise until a year ago - I totally collapse (went through a major depression). I am an Actuary, I had a high management position for a big insurance company. But the alter handling the career broke down, exhausted. It is unlikely that I will be able to work full time again.
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