November 21, 2010
Freedom of Choice and Client Empowerment or Therapeutic Exploitation?
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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:
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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.
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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?
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By:
Kathy Broady LCSW
http://www.AbuseConsultants.com
Copyright © 2008-2010 Kathy Broady LCSW and Discussing Dissociation
January 1, 2010
What are you going to do?
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~~ 2010 ~~ Happy New Year ~~ 2010 ~~
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Hey Everyone –
I’ve been busy with the holidays, but wanted to come write a quick note to say hello and most of all, to wish everyone a the very best for 2010.
What are you going to do this year?
How are you going to make your life better?
Sometimes it’s hard to remember that you really can make decisions that change your life, or at least affect your life. We ALL really can make 2010 a year that takes our lives closer to being the kind of life we want.
What changes do you want in your life this year?
What things do you want to stay the same?
Think about it. At this point in time, no one can affect your life more than you can. You can make a bigger difference in your life than anyone else.
So…… What are you going to do for yourself this year?
???!
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HAPPY NEW YEAR, everyone. May 2010 be your best year ever!
Warmly,
Kathy
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By:
Kathy Broady LCSW
December 5, 2009
Multiplicity – Keaton Style
Multiplicity, the 1996 movie with Michael Keaton, is not specifically about Dissociative Identity Disorder – it is technically about being cloned — but it is a funny, light-hearted comedy that absolutely pertains to DID / MPD.
Have you watched this show?
Keaton’s character has a lot in common with DID. As you watch the movie, you can see the following similarities happen in this sequence:
- Putting his fax machine (electronic equipment) on the blitz easily
- Creating split, after split, after split, with each different self assigned to work in different areas of his life
- Feeling that life is overwhelming and he can’t get it all done
- Participation in scientific experiment (ok, so this is supposed to be a fun post, so I won’t delve into that)
- Having an unusual, complicated sense of time, especially once he has more than one self
- Fighting between the parts over “who’s me” – “I’m the main one – No, I am!” The different selves squabble over who is the leader of the body-life, e
- As the different parts have different experiences, they contain different memories and different feelings. While they all started from the same place, they develop unique lives.
- The different parts argue with each other – take opposite opinions, have different goals, different priorities. They each make significant decisions that effect the whole of the body-life.
- At first, the idea of having split lives works really well. It helps to get more things accomplished effectively.
- Experiencing “memory loss” – the parts are not aware of what the other parts are doing, and they have to suddenly cover for the activities of the other parts
- Gradually realizing they need to coordinate and talk about whose doing what to keep things running smoothly
- People out in the world can notice the difference between the different parts, despite their best efforts to not let this be seen
- Sometimes its hard to tell the difference between the parts – sometimes the differences are more than obvious
- Once the original person starts splitting, the easier it is to split again, and again, and again. Eventually, the parts begin to split as well.
- “Not me” – it was one of the others – passing responsibility and blame to someone else in the system
- Bickering and fighting occurs between the parts — they even get jealous of each other
- As there is more and more unawareness of what the others are saying or doing, the reality of being multiple affects his life more significantly
- As the different ones experience new activities for the very first time, the newness of the event is an exciting unexpected experience for each of them.
- The “host” of the system realizes that he has handed his life out to so many others, and at some point, he misses his life, and wants to get back involved. While being away so much has its perks, he realizes he is missing out by not being involved.
- Consequences start happening when the parts do not know what the other parts know, when one part can’t cover for another, and the information gaps start becoming more and more obvious.
- There are hurt feelings between the parts when they think outside people like one of the other parts better than them
- When they finally work together on a project, they can accomplish a lot, really quickly
- When insecurities arise between the parts, they have to remember “You are me, I am you” – they have to remember they are really the same person, even though they experience life as different people
That’s pretty good for Hollywood!
How many of these events can you relate to?
Have these kinds of complications happened in your life as a multiple?
Have you experienced these feelings in your life as a multiple?
This movie is a nice change from the usual dark, unflattering versions of multiplicity portrayed in the media. It’s not a perfect display of life as a dissociative survivor, but it shows a lot of humor about the difficulties in developing system cooperation and internal system communication.
If only real life as a multiple was this fun…!
For some light-hearted entertainment that you might relate to as a multiple (or as someone who lives with a multiple), I recommend watching this show.
Enjoy!
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By:
Kathy Broady LCSW
