November 21, 2010
I would like to make a follow-up comment from a comment made on the “What Would Your Perfect Treatment Plan Look Like?” blog.
Specifically, a portion of heartofindigo’s comment includes the following paragraph:
a final comment: I wish that T’s would do exactly what you are doing, and ask. I have heard of so many… can’t think of a way to put this delicately… asinine demands on the patient. like the therapist doesn’t trust the patient’s process or intent or something. like the therapist has “superior knowledge.” unless one has DID, I don’t see how one can assume that they can make the judgment about what is working or not. that has to come from the patient, and so there HAS to be a partnership.
plus that will empower us to reclaim our power, which is the root of the problem in the first place.
This is an extremely important point.
The dissociative survivor IS the expert for what helps them.
And from what I can see in reading through the comments in the previous blog, the normal 50-minute hour is far from helpful. For most dissociative trauma survivors, it’s not sufficient, it’s not enough, and in many ways, it’s not helpful. DID survivors simply need more time to make sufficient progress in therapy.
Should insurance panels be the final “experts” on how long sessions can be and on how many sessions a trauma survivor can have?
If DID clients are cash-paying for their therapy, can they make their own decisions about how much time they would like to have with their therapist?
Should therapists or counselors have the final say on how much time a dissociative client needs to work on their issues?
Should psychiatrists or doctors have the ultimate decision-making power to determine all treatment plans for dissociative trauma survivors?
Who gets to decide these things? Are clients allowed to have freedom of choice and the freedom to want or request something more or different than the norm? Do mental health professionals have the only vote about what is helpful?
In too many instances, treatment plans for dissociative survivors are designed by – and limited by — mental health professionals and insurance companies. And all too many DID survivors truly do not get their therapeutic needs met because the mental health professionals are setting “appropriate limits” to what they are willing to offer their clients. These limits are decided on based on the therapist opinion, and not on the clients’ needs.
In my personal opinion, a 50-minute session once per week is barely scraping the surface of what is needed to work with the dissociative population. Most DID survivors have a minimum of 5-10 insiders that could productively use the therapy session time at any given day, and the issues that these 5-10 insiders would be discussing would not be simple issues. Typically everyone in the DID system has complicated situations, painful issues, complex conflicts to discuss. Is this going to happen in 50 minutes? Not likely. Is everyone going to get a turn in 50 minutes? Absolutely not. In reality, it would be more likely that each and every insider could fill up a 50-minute session! To have to share such limited therapy time between so many inner people means that the pertinent and important issues just are not discussed in any great depth or detail. It takes a lot longer to make progress because so much just can’t be addressed.
Because of dissociative walls, the need to switch between inside parts, amnesia between many parts, time distortion, other dissociative complications, etc., it very often takes a DID survivor longer to dig into the issues of the day, and longer to get grounded and stabilized afterwards. Having the time to talk to a few of the insiders, to get their opinions about the topic, or to give them a chance to talk about their own issues does not happen quickly.
Part of what created and solidified dissociative identity disorder in the first place was having no where to discuss complicated, painful emotions, turmoil, and distress. For the therapy hour to remain a drop in the bucket in terms of meeting the needs, it leaves the dissociative survivor feeling like they will never get through the healing process. And in some ways, that is too close to being true.
But is it therapeutic exploitation to “allow” clients to have longer sessions and / or more than one 50-minute session per week?
When is too much? If a DID client needs more than normal, even for the dissociative population, should they be allowed to have more sessions than normal?
Should therapists be “required” to set an “appropriate limits and boundaries” by insisting on short sessions, even if DID survivors say and believe they need more time in therapy?
If clients say they need 2-hour or even 3-hour sessions, should they be allowed to have extended sessions? OR should therapists have the right and responsibility to limit these sessions to “normal limits” instead?
Whose opinion is correct?
In these situations, do therapists know best or do dissociative trauma survivors know best?
In case of a disagreement between the client and therapist, who should have the final say in length of sessions and frequency of sessions?
As heartofindigo stated, a big part of the healing process is about reclaiming personal power that was not allowed during the years of trauma.
Is freedom to decide length and frequency of sessions part of client empowerment? Or part of therapeutic responsibility?
What are your thoughts about this dilemma?
Kathy Broady LCSW
Copyright © 2008-2010 Kathy Broady LCSW and Discussing Dissociation
November 21, 2009
There have been some interesting discussions and comments from various trauma survivors about how much their therapists have meant to them. These readers have shared some very tender moments with their therapists and have talked openly about the depths of their heart-warming connections and healing moments.
Clearly, these survivors have found their therapists to be important and significant people in their lives. The work and the effort of developing these therapeutic relationships have clearly been worth it to them.
Why is their therapist important?
On the flip-side, other commenters in this blog have written about horror stories they have had with former trauma therapists. It seems there is an endless supply of the “bad t” stories that get passed around and shared over and over. I can’t tell you how many of those stories I’ve heard. I’m sure each of you have already been told about at least a dozen bad therapists. In these stories, the clients are angry with their therapist, they accuse the therapist of causing all kinds of harm, and they speak of these therapeutic relationships as traumatic or disturbing or exploitive.
Who are these bad therapists?!
Is there any trauma therapist that has not been considered to be a “bad t” by someone or another? Honestly, most therapists get targeted sooner or later by someone. It happens frequently. (Please remember the blogs about love/hate relationships and protecting your therapeutic relationship.)
So if there are allegedly so many bad therapists, or perceived bad therapists, why do trauma survivors repeatedly risk having a therapist in the first place?
Why does a therapist matter to you?
Why bother with the hassle of developing and maintaining a therapeutic relationship?
Why does a therapist warrant your business, your time, your respect, or any caring connection from you?
What does a therapist do anyway?
There are a variety of reasons why dissociative trauma survivors might find therapists to be important. I’ve listed 50 benefits of having a therapist. This is not an exhaustive list. If you have an idea to add, please comment.
50 Benefits of Having a Therapist
1. To have someone encourage you to love and accept yourself to the point that you can truly live, without focusing on death and needing to die
2. To have someone in your life that will make it ok to not have to dissociate away from your real life
3. To have someone to bounce ideas on, to problem solve, to explore new behaviors
4. To have someone to talk to about deeply private and personal things
5. To have someone who can genuinely hear your pain, and sit with you when you are hurting
6. To have someone who can give you their undivided attention, their best listening ear, even if for a specified period of time
7. To have someone who gives you courage and hope to keep going, even in the darkest moments
8. To have someone who provides a gentle, safe environment for the healing of your deepest wounds and painful memories
9. To have someone who repeatedly offers positive emotional support and encouragement
10. To have someone who sincerely believes in you and your abilities, talents, and accomplishments
11. To have someone who truly sees you as a good person, a worthwhile person, a valuable person
12. To have someone who will address the variety of issues that underlies the mental health difficulties in your life.
13. To have someone who will build a relationship with you, willingly connecting with you, no matter how badly you feel about yourself
14. To have someone who will challenge your thinking and cognitive distortions
15. To have someone who will connect the dots of your dissociated life experiences
16. To have someone who will encourage you to be comfortable becoming your very own self
17. To have someone who will encourage you to build a life based on your strengths instead of the life your abusers may have designed for you
18. To have someone who will encourage you to try new things and to stretch your horizons
19. To have someone who will expect you to honestly work on your issues instead of blaming others
20. To have someone who will foster your leadership skills, job skill development, educational opportunities, etc.
21. To have someone who will genuinely accept you, warts and all
22. To have someone who will have the courage and ability to tell you “no”
23. To have someone who will hear your heart and the depths of your soul
24. To have someone who will help to remove the jagged edges from your life
25. To have someone who will help you build a tolerance and acceptance of others
26. To have someone who will help you create personal safety, both inside and out
27. To have someone who will help you find and connect with your very best self
28. To have someone who will help you to build the ability to tolerate and sit with intense emotions in yourself and in others
29. To have someone who will help you to contain the extremes of your behavior and feelings
30. To have someone who will help you to emotionally grow, develop, mature
31. To have someone who will help you to move past the blocks, walls, and black holes
32. To have someone who will help you transform self destruction into self acceptance
33. To have someone who will hold you accountable and responsible for troublesome areas
34. To have someone who will hold your secrets with you
35. To have someone who will listen to you, and understand your point of view
36. To have someone who will look for the positive in each and every one of your insiders
37. To have someone who will make it safe enough for you to express your true feelings
38. To have someone who will offer encouragement and support, even when its tough
39. To have someone who will offer guidance as needed
40. To have someone who will offer opportunities to explore trust, acceptance, compassion, kindness, gentleness, patience
41. To have someone who will push you to move forward, instead of sitting complacently
42. To have someone who will recognize family dynamics and their impact on you
43. To have someone who will remember what your insiders say, especially when it is too difficult for you to retain it
44. To have someone who will set appropriate limits and boundaries
45. To have someone who will sit with you while you face your deepest fear, shame, guilt, horror
46. To have someone who will sort out conflict and disagreement
47. To have someone who will stay with you, even when you expose your worst self
48. To have someone who will talk to your inner parts, even the ones you are afraid to speak to or unable to speak to
49. To have someone who will teach and model new behaviors, and healthy emotions
50. To have someone who will team up with you in your healing journey
True therapy is so much more than a sequence of techniques to address trauma, or emotional containment, or cognitive distortions, or dissociative separation, or destructive behaviors.
Therapy happens with real people, between real people. Therapy is a healing process. It touches many levels of life. The emotional depth of true healing is founded in the solidity of the therapeutic relationship.
Unfortunately, your trauma and abuse happened at the hands of violent, hateful, destructive people.
Fortunately, your healing will happen within a caring, accepting, compassionate relationship.
Kathy Broady LCSW
February 16, 2009
I am not sure who wrote the following list of “Do’s and Don’ts for Singleton Friends of Multiples”. This list was e-mailed to me years ago by a person with Dissociative Identity Disorder, saying this list was comprised by an anonymous group of multiples. I have had it posted on AbuseConsultants, in the survivor poetry section of that website.
I am sure that there could be many other suggestions added to the list, but for today, I will post it in exactly the same format as I received it.
For anyone wanting to offer friendship and support to a person with Dissociative Identity Disorder, a group of multiples have suggested the following helpful guidelines:
Do’s and Don’ts for Singleton Friends of Multiples
- Do NOT ever touch us from behind.
- Do NOT ever touch our throat.
- Do NOT ever touch the back of our head.
- DO speak to our inner children like children.
- Do NOT ask “Who’s here now?” If we wanted you to know we would tell you.
- Do NOT tell an alter that you don’t know to “go get” the host…there could be several of the same name…different age groups.
- Do NOT expect consistency of feeling, thought, or action on any subject.
- Do NOT tell anyone to go inside because you do not like their views.
- DO set healthy boundaries.
- If you are uncomfortable with something said or done, say so, and do NOT avoid us in the future without an explanation.
- Be HONEST.
- Be understanding that we have many crisis situations in our lives of healing from our abuse, i.e.: flashbacks, panic attacks, body memories.
- Laugh, make jokes with us, really, it’s OK!
- Do NOT assume anything if you honestly want to know about our “disorder” please ask, we’ll tell you the truth.
- Do NOT treat us like “the freak you happen to know” around your singleton friends.
- Do NOT use our difficulties as a subject of conversation with your singleton friends.
- Sometimes we are paralyzed with depression, and cannot call you, clean our house, or get out of bed. Don’t take it personally.
- We will fight being hospitalized….. even though we actually show that we need it at the time. Hospitals are extremely frightening for us.
- DO be supportive of our healthy behaviors no matter how small the accomplishment may seem to you.
- DO be encouraging.
- When we ask to talk to you, we aren’t asking you to come up with answers to our problems. We don’t expect you to FIX it. Sometimes we just need someone to LISTEN… that is the greatest gift of all!!
- DON’T tell us that the abuse happened a long time ago and for us to “just get over it!” That is a HUGE insult!!
For those of you that are multiple, what other suggestions would you add to this list?
Do you agree or disagree with the suggestions as listed?
What have you needed your husband or wife to do – or not do — specific to your needs as a trauma survivor?
Your thoughts, comments, and suggestions are welcome.
Kathy Broady LCSW
January 1, 2009
Happy New Year !!
I’ve been thinking for hours now about what kind of profound post I would make at the beginning of this new year. My words are still trickling in slowly….
So, while I’m thinking, I’ve decided to ask you all what you are thinking….
What are your goals for 2009?
And, seriously, if you could rule the world this year, what would you do? What changes would you make, and how would you bring those about? How would you address the world economy? How would you approach world peace? What would you do about famine, wars and diseases?
Wouldn’t it be nice to be able to fix such big problems with just the snap of your fingers.?!
Ok, ok, so all that is just a little too unrealistic.
It doesn’t hurt to dream, but let’s talk about the worlds you can control – you own life, your own system, your own internal worlds.
At this stage in your life, you do have a lot of input into what happens in your life. You aren’t a helpless, child without resources or power. You are grown. You are much older, and while you might be stuck and struggling at certain points, you truly do have considerably more freedom, more power, more options, more control than you had in your early years of life. You can’t change the past, but you can make it so the past does not cripple your present so much. You can make this year, these days, even right now, better for yourself.
I’m just sure you can.
It’s not necessarily easy and it might take a whole lot of hard work, but you do have the ability to make things better for yourself.
So let me ask again.
- What are your personal goals for 2009?
- What are your hopes? your dreams?
- What could realistically happen for you this year if you really worked for it?
- What areas of your life do you want to heal?
- What do you want to happen within your own system?
- How are you going to help your internal parts this year?
- Who do you want to meet from within?
- Who do you want to establish a friendly, working relationship with from within your system?
- Who do you want to connect with in the external world? Even if that means mending some fences, and working through conflict issues?
- With whom do you want to create stronger boundaries, so you aren’t as vulnerable or as abused by them?
- What topics are going to be the focus of your therapy?
- What areas of your life are you willing to leave on hold for now?
We are each in charge of our own lives. Some say that to a very large degree we actually create our own lives. I understand that some things happen outside of our immediate control. However, we can decide to work around and grow past those obstacles, no matter how big they are. As much as we have to work with the cards that we have been dealt, we also can make decisions in the current day to make our lives more how we want them to be.
What do you want for yourself this year? How hard are you willing to work – learn – research – stretch – push yourself to get that?
If getting something new and better in your life means letting go of something familiar but “crappy”, are you willing to do that? Are you willing to prevent or refuse to allow victimized thinking that keeps you stuck in places you don’t like? Are you able to find your own way, your own strengths, your own power, your own ability to think?
Do you believe in yourself and your self worth enough to get something better?
It’s a New Year.
What’s going to be new about your year this year?
Kathy Broady LCSW
December 23, 2008
Hello to all my Readers,
I hope this day finds you doing well.
The first part of this article certainly caused a little stir, and maybe raised a few eyebrows along the way. Please know, my intention in posting these blogs is not to offend anyone. If you have any questions or concerns about anything I’ve posted, please comment and let me know what you’re thinking! And here’s a big Thank You! to the folks who did comment to the “Part 1″ post. I appreciate that.
Let me try framing the context of this article. In previous blog posts, we’ve been discussing questions to ask a new therapist. This article is, in some ways, a follow-up to that idea, because these are the kinds of things a therapist is going to be thinking about / assessing in new clients as they arrive at their door. These are also the strengths that you want to emphasize when you are meeting a new therapist.
If you approach your therapy keeping these qualities in mind, you will honestly find that more therapists will stay interested in working with you for the long haul. That is not to say you have to be perfect. Who is???! It means, work on these things. Be mindful of them. Developing these strengths will make you a better person overall, and that is very much the goal of therapy.
These qualities, in my opinion, have nothing to do with mental illness. I have worked with some very disturbed people with huge issues, and yet, they possessed these qualities, and they made huge progess in their healing. I’ve also seen some folks who appeared to be rather high-functioning, and yet, they did not, or could not grasp some of these basic ideas.
I agree with the brave soul who commented that these qualities are an important part of everyday life. The more that survivors strive to incorporate these strengths into their approach to everything, the better. Your self esteem will improve, your self-dignity will be solid, and people around you will appreciate you more.
I don’t expect every trauma survivor to have a solid grasp on these qualities, but I do hope every trauma survivor strives to.
Intermingle these strengths into your life everywhere that you can. You’ll be glad you did!
And here is part 2 of the article, “10 Qualities Therapists Recognize in Good Clients”:
6. Honesty and Trustworthiness
- Are you willing to be honest with yourself?
- Are you willing to lie to your therapist, or hide information, or lie by omission?
- Do you gossip and tell lies behind people’s backs?
- Do you gossip about your therapist?
- Do you lie to your inside parts? Does anyone in your system try to trick or deceive the others in your system?
Therapeutic relationships are built on honesty and trust. Your therapist will need to know you possess these qualities as well.
- Will you treat your friends and family members with kindness and respect even if they have done things you do not like?
- Will you loyally protect your internal system from predators and perpetrators, putting the safety of your inside parts as a priority?
- Are you loyal to your therapeutic process and will you keep clear boundaries around the therapeutic process?
- Will you respect your therapist’s trust in you to the same degree that you expect your therapist to respect your trust in them?
- If you and your therapist experience a conflict, where do you look to resolve that? Do you expect to resolve the conflict within the context of therapy, or will you spread the conflict outside the therapeutic relationship and draw others into it?
Your therapist and support team can be your greatest allies in your healing journey. However, a deep level of mutual respect is expected and needed in order to progress in therapy. It is crucial that you thoroughly differentiate the “good guys” from the “bad guys”. Therapists understand the concepts of transference and projection, and they will work with you in those tender moments, but there will be limits to that. I can promise you, your helpers do not want to be thrown under the bus any more than anyone else.
- Are you determined to do the same things over and over again?
- Are you open to trying new options?
- Can you think outside of the box instead of being boxed in?
- Do you help to problem-solve the various dilemmas that surface?
- Will you work on ways to reach even the most difficult of insiders? Even if this involves several failed attempts before you successfully connect with these parts?
We’ve all heard the saying, “the definition of insanity is doing the same things over and over again, expecting to get different results.” A huge part of the healing process is learning new things and doing different things.
9. Gratitude and Appreciation
- Do you appreciate what people do for you?
- Do you recognize when someone is doing something for you?
- Do you thank them for helping you?
- In relationships, do you overlook smaller imperfections in appreciation of bigger strengths?
- Do you thank others in your dissociative internal system for the ways they have helped you to survive through the years? Do you recognize their strengths and talents in the current day?
Gratitude and appreciation are key elements of any healthy relationship. Don’t take the goodness of others for granted. Be thankful for what you receive from others.
- Are you a safe person?
- Do you use threats of violence, or threats of harm to others, or threats of emotional blackmail, or threats of any kind to destroy or control other people or to get your own way?
- Do you threaten self-harm or suicide as a way to manipulate others or to get your own way?
- Are you willing to hurt yourself or someone else in order to get your way, including others in your internal system?
- How far is “too far” to go to get what you want or prove you are “right”? Do you think there is such a thing as “too far”?
Therapists will model safe behavior. If you are acting in ways that are unsafe for yourself or manipulative of those around you, your therapist will set boundaries with you — just as you should set boundaries with someone who is unsafe in your direction.
If you follow these guidelines, you will have a much better relationship with your therapist and others around you. If you are looking for a new therapist, remember that the more you can genuinely offer in the areas listed above, the more those therapists will view you as a client with potential — and the more positive potential you demonstrate in these areas of your life, the greater interest more therapists will have in working with you. It goes to your advantage, your healing, your self-respect, and the amount of respect others will feel toward you to learn these things.
All people, including trauma survivors with Dissociative Identity Disorder (DID/MPD), can claim these strengths as their own. Work hard to be a “good person” in your therapy, and you’ll be amazed at how much difference this can make in your relationship with your therapist and with your system. Remember:
Maintain your stability the best you can.
Be dependable in what you do, and do what you say you will do.
Maintain your motivation and your willingness to work hard.
Be courageous, even when it is scary.
Stay clear and upfront about your personal responsibilities.
Be honest and trustworthy at all times.
Stay loyal to your helpers.
Be creative in the hard times.
Have gratitude and appreciation for the good things and good people.
And be a safe person. Be safe for yourself, and be safe for others.
You can do it. I’m just sure of it.
Kathy Broady LCSW
December 13, 2008
I am writing this post in response to a question asked by BehindtheCouch.
BTC wrote, “do you think that a “trauma client” (ie one with PTSD or a dissociative disorder) should necessarily be treated by a specialised “trauma therapist” or, in your opinion, could any therapist who has the skills that you mention in your post do just as good a job with the client?”
This is a good question.
My first thought is yes, a client that has experienced a significant amount of abuse should (hopefully!) receive better therapeutic care from a trauma specialist. If you have the option to work with an experienced therapist who specializes in trauma disorders, snap up that opportunity as quickly as you can.
Trauma therapy is very much its own area of study, the same as with any other medical issue. In trauma work, the therapist must understand dynamics of traumatic relationships, trauma bonds, wide-ranging effects of trauma, layered complications of dissociative disorders, issues of external safety, self harm, system work, memory work, etc. There are dozens of issues specific to trauma disorders, with dissociative disorders being the most highly complex and requiring the greatest clinical skill. (Please see my article listing 50 Treatment Issues for Dissociative Identity Disorder.) The terms “trauma specialists” or “trauma therapists” imply these clinicians have invested significant chunks of time learning about trauma disorders. They should be more comfortable than the average therapist in terms of recognizing, understanding, and addressing the details of trauma work.
Please remember there are many areas of clinical expertise for mental health professionals. For example, I am licensed to provide clinical therapy for any area of my choosing, but in my 20+ years as a therapist, I have not worked with autistic children. However, I have worked with families with traumatized children who also have some very definite and particular needs. Sure, I could apply my basic, fundamental clinical skills with autistic children and their families, but once it became necessary to understand specifics related to autism, I would fail miserably. I would be scrambling for information, and fast! Even though I am a good trauma therapist, would these autistic children receive the same quality of clinical treatment with me as they would with a clinician that specialized with autism? I am quite sure they would not.
Who is a trauma therapist? For most clinicians, there are no regulatory boards that specify exact qualifications. Trauma therapists are self-proclaimed experts in the field, and clients are left hoping the professionals they are trusting are actually qualified to be specialists. Unfortunately, I have seen far too many problems caused by well-meaning professionals who simply did not know as much about trauma issues as they claimed. Their lack of understanding of trauma-related complexities, timing, processes, etc. caused significant harm, damage, and confusion.
On the other hand, finding a trauma specialist is difficult, and you simply might not have many therapists in your area that work with severe abuse issues. It is imperative that people suffering from Post Traumatic Stress Disorder (PTSD) or any of the Dissociative Disorders receive treatment in order to heal from their traumatic experiences. If your only option is to work with a “general practitioner” instead of a specialist, then that is what you do. Good basic therapy is certainly better than no therapy at all.
Select therapists who are open-minded to the effects of trauma, honest about their limitations, and willing to learn more. As long as their clinical skills include active listening, deep understanding, gentle compassion, effective communication, recognition of family dynamics, emotional tolerance, clear boundaries, etc., you will be able to progress in your healing.
However, it will be highly important to augment your treatment with additional information. Read books, search online, get regular and ongoing consultations with trauma specialists, join trauma / DID support groups, attend conferences, consider online or distance therapy with a trauma therapist as an adjunct (secondary) therapist, etc.
Don’t assume that general therapists will learn enough on their own to get you through the most difficult and complex places in your healing. You will have to take charge of your own work. Make sure to do extra homework!
Your greatest therapeutic gains will be with a therapist you trust. Therapy is about you. It is your looking at your life, your history, your feelings, your reactions, your truths, your beliefs. When you feel safe enough to be totally and completely honest with yourself, you will be able to look at your painful wounds and all the resulting affects of the trauma. You will be able to bring down those dissociative walls that you built for safety and separation from “all the hard stuff”.
Pick a therapist you can connect with, build a solid foundation, and keep going from there. You’ll feel better for it.
Kathy Broady, LCSW