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
July 31, 2010
One of the diagnostic criteria for dissociative identity disorder is experiencing amnesia or lost time. While losing time may seem like an obvious hole in your every day life, it really might not be as obvious as it seems it could be.
For dissociative trauma survivors, the sliding of time is a normal everyday way of life. It just is how it is, and time feels very different for DID survivors than it does for other people. Dissociative survivors may or may not pay attention to the minutes that are gone, or the hours that have slid quietly by. They are very used to the ebb and flow, and unless there is reason to pay specific attention to the idea of lost time, they may not really be genuinely aware of how much time they lose.
Every dissociative survivor I have met has recognized specific periods of lost time in his or her life. Sometimes, multiples think they do not lose much time, but with a few detailed questions, it can soon enough be shown that there are very clear gaps in memory and awareness of regular life events. There will be everyday type things that they know they should know, but they don’t.
Some multiples will notice big chunks of time that seem to be gone. It will be 2 pm, and then suddenly, it’s 9 pm, and the survivor has no awareness of what happened during those seven hours. Those hours are considered lost time because they feel completely lost and unaccounted for. The host parts don’t remember what happened. If they look around, they might get some clues about what may have happened, but for the most part, it feels like time completely jumped seven hours ahead. Time feels lost to them because there is basically no information and no awareness about what happened.
Other times, DID survivors will feel like they are mostly aware of everything that happens through their day, but their ability to remember what happened yesterday, or even to remember what happened this morning, or an hour ago is extremely limited. This is a different kind of lost time in that the recall is so nonexistent that it becomes the same as lost time since the survivor has next to no idea what happened.
In both of these situations, time is being quantified from the perspective of the front host personality. Time loss can include other parts of the system as well, but the questions about lost time are typically addressed towards the host. This is an important distinction to remember.
Because you see, even though time feels lost to the front host personality, in all reality, time is not lost at all.
Yes, you read that right. Time is actually not lost. Time has not actually gone away. The DID survivor’s day is not shorter than everyone else’s day. Time has not disappeared in the way that it feels.
While we use the term “lost time” all the time, that is actually not what happens. In fact, no one with DID actually loses any time at all.
So where does the time go?
Actually, what happens is that the dissociative trauma survivors have switched to another part.
Yep, they’ve just switched.
Switching. Shifting from one part or another. “Transitioning” as US of Tara called it.
That’s all that happened. You’ve switched!
The hours of time can be completely accounted for if you know who was out and what they were doing. Time itself isn’t missing. What is missing is having the awareness or knowledge about who in your system was out doing what.
So when the host or front personalities are completely unaware of life events, and there is no knowledge of what has happened, they have simply switched to someone else in their system who is out and doing all kinds of things. The body is likely up and active, and any number of things could be happening. Someone inside the system will know exactly what happened between 2 pm and 9 pm!
For there to be “lost time”, this switch occurs with parts that are so dissociated and separated from the host personalities that the host personalities are not aware of what happened.
Actually, this kind of time loss / lack of awareness can happen between any part of the system with any other part of the system. Many of the insiders may not be at all aware of what the host personalities are doing either. Part of the reason for time distortion, triggers, and flashbacks is connected to the insiders not being aware of the outside life in the current day, place, or time.
Sometimes the lost time between these parts are just from not paying attention. For example, one set of parts can simply be daydreaming or drifting off, and simply not concentrating enough to be aware. Maybe they were choosing to have an internal nap or be otherwise internally occupied. However, if they actually tried to be aware of what was happening in the outside world, they may fully well have known exactly what happened during that lost time. Or with a little effort, they may have been able to get close enough to the front of the body to be aware enough to see, or hear, or know.
Other times, the dissociative walls / amnesiac walls are much thicker and less penetrable. In these situations, one set of parts does not want the others inside to know what is happening, and the blocks put between them are strong and absolute. Parts from within the internal system are specifically dividing themselves away from everyone else so everyone inside is not aware. If you have parts that are specifically hiding their activities from the rest of everyone else, this is an important issue to address in your therapy.
In my opinion, integration is not necessary for successful stable functioning. But, eliminating time loss and/or periods of unknown switching is important for exactly those reasons. It is ok that everyone within has their chance to do what they need to do, but it is also important to build the communication around what is happening. You all share the same life. Being more aware of what happens in that life is important.
So the next time you want to know what happened during that chunk of time that you don’t remember, ask inside. Ask who knows about it. Ask who was out, or who saw what happened. There will be someone inside that knows exactly what was happening during that chunk of “missing time”. You might need to work on increasing your internal communication with those parts, but once you know the others in your system, that time loss will decrease.
Even if the time loss is happens, but if you know who is out, that can help with knowing what happened. The more you know your whole system of insiders, the less unaccounted for time you will have.
Once again I’ll say, internal communication is the central core of treatment for dissociative identity disorder.
If you want to know what is going on, talk to each other!!!
Kathy Broady LCSW
Copyright © 2008-2010 Kathy Broady LCSW and Discussing Dissociation
January 1, 2010
~~ 2010 ~~ Happy New Year ~~ 2010 ~~
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?
HAPPY NEW YEAR, everyone. May 2010 be your best year ever!
Kathy Broady LCSW
December 5, 2009
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.
Kathy Broady LCSW