December 9, 2008
50 Treatment Issues for Dissociative Identity Disorder
Posted in DID Education, DID/MPD, Dissociative Identity Disorder, mental health, sexual abuse, therapy, Therapy and Counseling, Trauma tagged Add new tag, Addiction, Amnesia, Anxiety, Bipolar, Body Image, Body Memories, Childhood Sexual Abuse, Depression, DID / MPD, dissociate, Dissociation, dissociative, dissociative disorders, Dissociative Identity Disorder, Emotional Abuse, Emotional Crisis, Emotional Healing, Exploitation, Grief, Healing, Hurting, Integration, Isolation, multiple personality disorder, pain, Physical Abuse, Pornography, Prostitution, Relationship, Ritual Abuse, sadistic, Safety, Self Esteem, Self Injury, sexual abuse, Sexually Abused, Social Anxiety, Social Skill, split personality, splitting, Stabilization, Suicidal, Suicidal Behavior, System Work, Therapeutic Process, Trauma Bond, Trauma Survivor, trauma therapist, traumatic history, treatment, treatment for DID, Violence at 7:06 pm by Kathy Broady
“How long will it take for me to feel better?”
As a clinical therapist, I hear that question frequently. It’s a reasonable question. I certainly understand that when someone is deeply hurting and struggling in their life, they want to feel better as quickly as possible.
However, the clinical treatment for someone with DID / MPD is long term. Some research has said that the treatment can be completed within two or three years, but in my clinical experience, that is far from the truth.
Dissociative Identity Disorder is a result of long-term, chronic, severe, sadistic child abuse. As children, these survivors witnessed and experienced a myriad of heinous crimes. They typically describe repeated consuming abuse by multiple perpetrators, and then were otherwise emotionally neglected, starving for comfort, consolation, or attention. They were left alone, even while very young, to process and contain their pain by themselves. For these children, the splitting process became their way of coping with emotional intensity, conflicts, huge distress, and intense pain that were otherwise far too difficult to manage on their own. They blocked off their pain, locked it away from themselves, and left it there. Sitting, waiting, piling up for years.
When you understand how much pain and abuse has occurred in order to create the dissociative splits in the first place, it is no wonder that the healing process is also so very long. All areas of dissociative survivors’ lives are touched and profoundly changed or affected by the abuse. It simply takes a very long time to address everything properly.
Some of the treatment issues are:
- Stabilization of the person – both internally and externally
- Managing and eliminating self-injury and self-harm issues
- Examining and obtaining current-day external safety from abuse
- Internal system safety
- Developing effective internal communication
- Calming internal noise and chaos
- Working specifically with child parts
- Working specifically with adult parts
- Working specifically with teenage parts
- Learning about the other system parts
- Working with internal perpetrator introjects
- Creating emotional separation from external perpetrators
- Working with triggers
- Correcting cognitive distortions
- Addressing gender confusion, male vs. female issues
- Processing emotions
- Body image issues
- Reducing time loss, memory loss, amnesia
- Time confusion, time distortion
- Trauma processing – memory work
- Body memories and kinesthetic issues
- Understanding re-enactments and trauma bonds
- Healing sexual abuse issues
- Healing physical abuse issues
- Healing emotional abuse issues
- Healing ritualized abuse issues
- Healing exploitation, pornography, prostitution, sex slavery issues
- Managing family, marital, parenting issues
- Addressing addictions
- Managing eating disorders
- Household management issues – improving daily functioning
- Relationship issues and teaching social skills
- Understanding the effects of trauma on the brain
- Improving self-independence and self-reliance
- Improving self esteem issues
- Leaving disability and regaining employment
- Depression and medication management
- Bipolar disorder and medication management
- Anxiety / Panic and medication management
- Post-traumatic stress issues (PTSD)
- Reducing phobias
- Social anxiety and social isolation
- Safely eliminating suicidal ideation and suicidal behaviors
- Homicidal ideation and anger management
- Exploring spiritual confusion
- Philosophical issues
- Detachment and separation issues
- Treating sleep disorders
- Treating medical complications and physical harm resulting from the abuse
- Reaching integration, blended states, or effective system team work
That’s a tremendous amount of work. And most of these issues surface again and again and again, requiring in-depth attention on a regular basis for years of time.
Emotional healing on such a wide scale just does not happen fast. Forcing the issues or pretending to be “done” sooner than realistically possible is not helpful.
Simply put, years of severe injuries will require years of intense healing.
It takes as long as it takes.
__________
by:
Kathy Broady, LCSW
behindthecouch said,
December 10, 2008 at 10:32 am
An amazing if slightly overwhelming post – thank you.
Kathy Broady said,
December 10, 2008 at 2:25 pm
Thank you, behindthecouch, for coming to this blog and reading thru’ the articles. I have been a trauma therapist, specializing in Dissociative Disorders for 20+ years, so this list of 50 Treatment Issues comes directly from my years of experience of sitting beside trauma survivors on “my couch”. I’ve listened to them, heard their pain, and remembered what was important — so these ideas haven’t come from me, they come from survivors themselves. I thoroughly believe that healing is possible, that good trumps evil, that there is hope, and that we as a society have to take a stand against the abusers of the world. I really hope that this blog can be helpful for many.
Thank you again for your very kind words. I appreciate that!
Kathy
davidrochester said,
December 10, 2008 at 3:54 pm
Yes, that’s a comprehensive and accurate list. My therapist was surprisingly honest about the length, difficulty, and destabilizing dangers of therapy when I first consulted with her … probably because, unlike most of her clients, I presented with the problem I actually had, having been aware since age 10 that I had at least two separate functional identities (though I was unaware of the other 6 — so far — who have started to speak up since I learned better listening skills from my therapist). I’m expecting 5-7 years in therapy, though I’ve seen more improvement in 16 months than I would have thought possible.
But yeah. It’s a heck of a lot to deal with.
Kathy Broady said,
December 10, 2008 at 4:26 pm
Hi David,
Yes, it is a lot to deal with, but it sounds like you have got a real good foundation started already and a good therapist on your side — that’s great news. I’m not surprised at all that you have found more insiders once you learned more about listening to them. You’re still in your early years of healing, so … as you dig further into your “stuff”, you’ll probably find a few more – welcome them kindly when you find them. They are each heroes in their own way.
Thanks again for stopping by, and keep up the good work!!!
Kathy
healingone said,
January 10, 2009 at 12:18 am
‘whelmed Kathy . ..just whelmed . . . . . when I think I okay most of the time and then I no am some of the time and I see lists like this, it makes me feel like I no am as healed as I know I am . .. if I am feeeeeeling . . finally….. after no knowing for a whole lifetime that I was so so numb or so racey or ragey so easy and now I am feeeling so so many feelings, then why do i gotta worry ’bout a long long list of things like this? If so many layers and layers of coverings over me no are there no more and I am me and I like me mostly always less i dare say something like I like me which then means the noise wants to start up from otherwheres, then why why why do healing have to be talked ’bout with lists that make it seem so hard? Maybe I was too tired and too me to read that stuff, but Kathy . . . I no like long lists. I just no do. When the stupid nuns hadded us make lists and lists and lists of words of words and of the same sentence so many many times, so all you did was no do the sentence at all, all the way through, you did some words over and over ‘gain afore going on to the next set of words in the sentence . . anyways . . I like things simple. And I no mean easy . . I mean simple to understand . . .And I know I am healing and i know it coz of I been feeling and feeling and feeling and hurting and crying and learning all ’bout how hurt I really am and that means I been learning how special and good I really am and how much I ‘served to be loved and cared ’bout . . . then why why why do things have to be long lists that seem so hard when . . . when that just makes it all seem so hard. And there no way what I been doing for almost four years of crying and grieving and coming to love me even though it hurted lots and lots and lots and is no the least bit easy, is near as hard seeming as what that list feels like w hen I look at it. Crying and grieving and righteous angering is simple easy to understand. All that stuff is big words hard. Anyways . . I have been jumping round some and then I acided to start from the ‘ginning . . . I like your blog lots Kathy. I do do do, but long long lists of hard word stuff is oooghy to me. but I do like all the stuff ’bout getting to know me. I mean talking inside and stuff. So we working on that some and I have always talked lots and lots to whoever is the hosty one and so now we working on her talking to me back and helping me some. So . . . this blog seems lots grownuppy to me , but there just no way I no am gonna be here reading coz I just am ’round all the time now and I the biggest writer of all of everybody in here so . ..do you think maybe you could do some blogs for littles . . coz ,maybe lots of us need to hear things our way? Something like that Kathy, please??? little me . . . . .you know
multipixie9 said,
January 19, 2009 at 7:51 am
i sympathize with “healingone” in the dismay over that long list of things that must be healed/helped or changed in us to live in health. it is the first time i’ve been somewhere that what it takes to heal was not minimized. it is a place where i know we are not judged for being many. you are the first one who put it accurately that there was so much sustained evil, pain and horror. you are the first one who said it upfront that there were many who abused us for a long time and i don’t remember even one hug or piece of comfort except for candy and books – nothing human. my husband blames me and thinks i choose to stay in dysfunction and pain rather than be healed and i have gone to counseling and done so many things for change and growth and freedom. i’ve been looking for help since i was 18 and suicidal and God helped me survive, but i just want to be ok. i only want to be ok. i’m not asking for the moon, just a piece of green cheese.
leslie for the pixies
multipixie9 said,
January 19, 2009 at 8:06 am
if we can’t just be healed like a miracle, then i wish we could be accepted and cared for. in this world it seems like what we want is asking too much.
i don’t think it is possible to be pain free or totally healed but surely it could be better than it is now. i’m 55 and i have few memories free from pain or the past.
sometimes i just wish someone would stand up in front of everyone i know and say, “It really is not her fault and she’s trying so hard to do what most of you take for granted. just be kind and don’t judge her and she will keep working to improve.”
leah for the pixies
Kathy Broady said,
January 19, 2009 at 2:29 pm
Hi Leslie,
Thanks for your comment. As painful as it can be, I think saying the truth is the best way. DID therapy is very hard work – and it’s not quick. And anyone that tries to say otherwise is either not very informed, or they are skimming over the deeper layers of work.
It sounds like you have had plenty of difficult times in your life… I can hear that it’s been painfully rough for you.
Hopefully some of the ideas presented in this blog will give you some guidance along the way for your healing journey… maybe by reading here, you’ll find some areas of work that will help you further down your path. I certainly hope so.
And I believe there is lots and lots of green cheese out there — and yes, there’s plenty enough for you to have some too.
The first key is to get to know your system, and to do things to comfort, support, and help each other. Maybe some outside people will join in as helpers for you too, but at this stage in your life, don’t wait for them. As you all help yourselves, you will begin to feel better. I’m sure of it.
Thanks for posting — your comments are a positive contribution here.
Kathy
multipixie9 said,
January 19, 2009 at 2:48 pm
Thanks Kathy, your remarks are very kind. I have seen things in your website that I’ve not encountered before. Talking to my insiders and interacting with them has been really tough, it is chaotic inside. However, your recommendation about the lists of 100 is something i am going to use. I’ve needed some constructive suggestions beyond “buy your littles some toys and coloring books”. I don’t mean to be rude, I just need a lot more than that to establish better relationships.
My counselor is my top hero in this world. 14 years ago she recognized mpd/did as my true dx after many dx were given and after so many people blew me off when I did not heal according to their therapeutic or spiritual agenda. I know it is pretty much up to me as the host to start making some things happen for my insiders – but it’s been a long road and i am so tired. I hope someone inside may have some strength to share so that I can turn the tide for all of us toward finding our own ways to live and love even if few people will participate in this with me. A little beats none at all! I am tired and while I am NOT suicidal, I have no love for/zest for life. Thanks for listening.
leslie speaking as host
muffledones said,
May 2, 2009 at 10:02 pm
So are these in rough order that you would approach them?
Thx
M
Kathy Broady said,
May 3, 2009 at 3:44 pm
Hi Muffledones,
It would be impossible to actually put these treatment issues into a specific, sequential order, mostly because many of them have to happen over and over again. For example, developing internal communication occurs all the way through the healing process. Sometimes creating safety (internal and external) can require years of work, but addressing it in steps at a time is important. Memory work happens repeatedly, but I do encourage the emphasis to be on internal communication and system work prior to addressing huge emotional memories.
Think of the goal of having all these treatment issues being addressed in your healing process on a recurring basis. If any of these areas are left out, have a closer look to see if you need to include it as well.
It’s just complicated!!!
Kathy
10 DID Therapy 101 Tips « Discussing Dissociation said,
February 10, 2010 at 3:41 pm
[...] DID therapy can feel huge, daunting, difficult, and overwhelming. There is so much to do and so many areas of work. For a broader overview of the many areas of DID healing, please refer to the article, “50 Treatment Issues for Dissociative Identity Disorder”. [...]
Lucifa said,
February 12, 2010 at 1:27 pm
Transference
countertransference
dependency
violence in the room
http://multiplexanimi.wordpress.com/
muffledones said,
November 4, 2010 at 4:36 pm
You have ‘processing emotions’, how bout adding learning bout them attall? Or if you know bout them, then overcoming phobia of them?
Also, attachment issues to be dealt with.
and Acceptance, learning to just have acceptance that there’s parts, whether or not you beleive it at any given point of time.
Coping With Crisis: Blog Carnival April 09 Edition « Multiple Voices said,
December 15, 2010 at 2:15 am
[...] 50 Treatment Issues for Dissociative Identity Disorder « Discussing Dissociation posted at Discussing Dissociation, saying, "Thank you for including my blog article that relates to the recovery issues for those that were severely abused in childhood." The reader might find the list of 'Issues' a bit overwhelming, but be assured, often working on one issue might cover another issue at the same time. [...]
Faith Burton said,
February 15, 2012 at 4:33 pm
I spent three years in therapy with a kinesiologist and she informed me of my MPD condition. I need to know how do I go about finding a competent psychologist/psychiatrist or whatever to finish the process of integration. And, if others don’t want to integrate, can they be forced to. I function moderately well, but it makes finding work difficult. I am out of work due to two car accidents and some do not want to get well. They like the attention and feel they deserve the pain they are suffering. Others, like me, want to go back to work because boredom is not a way of life that is acceptable. Gaining weight is not acceptable. Being helpless is not acceptable. Living day in and day out with the man someone married, but not worthy (he’s just like dad in many ways) is driving us crazy. Work would give us escape time. Any suggestions?