May 24, 2010
In response to some questions asked about my previous blog article about Mother’s Day, I’ve decided to follow up with an additional post on the topic of transference. Transference isn’t necessarily an exciting topic, but it is fundamentally important to understanding the dissociative therapy treatment process. Hopefully, this article will help to clarify more about the importance of these issues.
What is transference?
How do you recognize it?
How do “mother issues” become a common transference issue for female therapists? (And likewise, how do father issues become common transference issues for male therapists?)
Is transference healthy?
Is it important?
Yes, transference issues are a common part of the healing work done with every trauma therapist / dissociative client. The frequency of transference issues makes them very important topics to talk about and to understand. Transference issues surface all the time in the DID therapy process — in a variety of ways — often in simple and unexpected ways. It would probably be fair to say that some kind of mother transference can potentially show up every week in therapy.
Addressing transference issues appropriately are fundamental to healing, so if it seems I write about them a lot in this blog, it’s because they are important. Transference issues are when feelings about an important person in the past become “transferred” onto another person in the present. It can be as simple as a little reminder, or in the case of some dissociate trauma survivors, it can go as far as the client literally seeing someone else’s face put on to the other person in a flashback type fashion.
Transference happens when something connected to Person A significantly reminds clients of Person B, or to their relationship with Person B, to the point that Person A can be viewed as the same as Person B. Person A is not Person B, but clients deeply tangled in their transference issues may not be able to tell the difference. In essence, it becomes a type of relationship psychodrama where clients address their complicated, complex feelings about Person B by acting them out with Person A. At some point, clients need to recognize Person A is Person A, and that Person A is not Person B. Only Person B is Person B.
In the therapy process with survivors with dissociative identity disorder, the therapeutic goal of working with transference is to allow clients address emotionally painful material with Person A while having that safe distance from Person B (the alleged “bad guy” or traumatic figure). However, therapeutic progress will occur only as clients see that Person A is simply the “reminder” of their feelings and memories regarding Person B. By exploring the issues about Person B with Person A, clients can achieve deep healing on their genuine trauma and simultaneously successfully separate Person A from staying in that “bad guy” place.
If clients do not transfer the feelings back to Person B, but keep them stuck on Person A, they have prevented healing from occurring. Person A is only a temporary “substitute”. The real issues belong with Person B. Staying focused on Person A prevents and distracts the real healing from happening.
Understanding complex details of the actual relationship between clients and their mothers is important to recognizing specific instances of transference, but some common examples of how mother transference issues can be seen in regular DID therapy session situations are:
- The therapist cancels a session (or two or three) and the client fears the therapist will never come back, or that the therapist hates her, or that the therapist is abandoning her. (re: mother abandonment)
- The therapist doesn’t call or email a response quickly enough and the client feels like the therapist is ignoring her, or refusing to speak to her, or hates her, or is mad at her. (re: mother neglect)
- The therapist wears a green shirt that reminds the client of a traumatic situation when the mother was wearing a green shirt, and the client becomes fearful that the therapist will abuse her the same as the mother did. (re: mother trauma)
- The therapist hands a male co-worker a file containing conference information and reference materials but the client becomes convinced that the female therapist (mommy) is telling the male therapist (daddy) all kinds of bad information about her so that the client will end up getting in trouble and abused. (re: mother betrayal)
- The therapist shows genuine kindness, acceptance, and compassion with the client and the child parts. The child parts attach to the therapist and wish with their whole heart that the therapist could be the mommy they never had. The client clings excessively to the therapist and pretends the therapist is her mother. (re: mother fantasies)
Survivors struggle with transference issues all the time, and there are many survivors that find it “safer” to blame a therapist instead of really looking at their family dynamics / actual trauma issues. While it may feel safer or easier to displace the issue onto a therapist, those same survivors can spend a lot of time not actually addressing their real issues because they are obsessing about the wrong person. It can create a lot of wasted therapy, wasted time, wasted resources, ill feelings, etc.
However, it is important realize that some people really will not (or cannot? Or chose not to?) face their real issues, so they transfer and project their issues onto someone else instead for an extended period of time. There can be a number of motivating factors, and addressing why someone wants to (needs to) focus on the wrong target is a critically important part of the healing process too. Why are they stuck at this point? What else is going on for them? What are they avoiding? What secondary needs are they meeting by obsessing on the wrong person? What’s the rest of the story? There has to be more going on somewhere.
Obviously, one of the role of therapists is to help someone build the skills / ability to look at their real issues, and to weed out or steer away from the incorrect focus on distractions / displacements. For a therapist to encourage a client to stay focused on a surrogate target would be a disservice to the client. That would be like medically treating someone for a broken pinky finger when in reality, they had bone cancer. The diagnosis of the problem has to be correct, or it is not proper treatment. This is true in understanding the complexity of transference issues. Accurately recognizing what is being transferred from where to where is critical in resolving the issues.
If someone wants to address their healing, it typically is much more effective for the clients to genuinely address their mother (or father) issues directly instead taking it out on a therapist (or a co-worker, or a neighbor, or a friend, or a spouse, etc etc.). No one will find healing on Situation A if they are obsessed about Situation Q.
It is fair to say that female therapists are frequently put into that “mother role”, far more than the average person would be, especially with traumatized clients. This is even more true for DID survivors with child parts. (Most child parts have bunches of unresolved mother issues, and understandably so.) Yes, working on mother transference issues is a natural part of the therapeutic process, but it is only the starting place, not the ending place.
There is a very fine balance of working with the transference, and not getting caught in them, or stuck in them.
If your therapist is not your mother, but she reminds you of your mother, what can you do to sort out your deep painful feelings?
If your therapist is not your mother, but you wish she were your mother, what can you do to meet those unmet needs?
Do your feelings for your mother effect how you view your therapist?
Have you discussed these feelings openly with your therapist?
The very best remedy to keep from getting caught in a negative transference dilemma involves a lot of detailed, honest communication between you and your therapist. Talk about this. Talk LOTS about this. Sort out who is who and what is what. Don’t be afraid to approach this topic with your therapist, as it is fundamentally one of the most important areas of your healing work.
Good luck – and keep working at this. It’s important!
Kathy Broady, LCSW
Copyright © 2008-2010 Kathy Broady LCSW and Discussing Dissociation
March 8, 2010
This set of picture-postcards demonstrates a passage through time for a trauma survivor with dissociative identity disorder (DID / MPD).
These pictures show different phases of the dissociative healing process, and illustrate how healing occurs. Notice that they move from a more shattered, painful, chaotic place to a calmer, structured, organized place. Where there is originally nothing but a fragmented sense of self, there later becomes a clear sense of personal identity.
The first picture-postcard has a mixture of colored pieces of all different shapes and sizes. Some pieces are more jagged, some are rounded. The mosaic nature of this design would automatically lead to many of the same questions as asked about the DID “Self Portrait” picture. For example, I would ask what the different colors represented, what the different shapes represented, if there was communication (or not) between the different pieces, if the black stitching between the colored blocks had a specific meaning, etc.
For this top picture, there are two specific shapes that I would ask more questions about. There is a definite triangle that points upward and spreads out down towards the bottom of the picture. Triangles can have a variety of meanings, and I would like to hear what this DID artist had in mind. The triangle also has layers to it. Does this have anything to do with the internal system layering?
For example, in the triangle shape that I see, the top two layers are yellow, followed by a green / blue layer, followed by a black layer, followed by a red layer. The placement of these colors could be purely metaphorical or accidental, but I could see this layering as representing important system functions and emotions.
A purely hypothetical system description could include the following ideas. The yellow layers are the happy front parts – the façade layers, the denial parts, the “I’m fine, nothing is wrong here” type of system parts. The blues and the greens could be parts of the system that know a lot of information, do a lot of the everyday work / functioning jobs of the system, etc. These parts know plenty of the historical trauma information but have to keep helping everyone manage life. They can feel some emotions, but work hard to not get overwhelmed or overloaded with emotions. The black layer could be a layer of depression, sadness, grief, anger, or amnesia, dissociated information, deeper internal controls, etc. The red layer could be more intense amounts of pain, anger, fury, trauma information, details about the abuse, etc.
The second shape that could have particular relevance is the large black shape with the blue tip. These pieces have an obvious phallic appearance to them. I would ask the artist if they intended this to be the case (chances are, they hadn’t even noticed that!), and then I would ask them questions pertaining to sexual abuse issues. If this symbol does specifically represent sexual abuse, it is clear how the abuse has been such a huge part of their lives. Just like this black piece is, in some ways, the foundational piece of the whole picture, it might feel like the sexual abuse has been the defining issue in this person’s life.
I see a lot of pain in this picture. The artist does not give the sense of happiness, of calmness peace of mind. The jagged pointy edges remind me of cutting, and I would be asking a lot of questions about self-injury.
There has been clear movement from the first picture to the second. Notice how the like colors are starting to get grouped closer together, creating a more cohesive look. There is much more green in this picture, and while the real meaning of that depends on how the artist interprets the colors, to me, it represents a lot of growth. I see a lot of progress being made in this picture. The trauma survivor has clearly been working on their healing issues, and they have been doing a lot of dissociative system work. Things are starting to come together for them.
In phase two, to me, the person is still feeling broken and dissociated, but she is not nearly as overwhelmed with the pain as before. The blue can seen as representing the teamwork efforts being accomplished by the internal system. There are still some missing chunks of time (as seen in the gaps of the blue), but the dissociative person is truly building good internal communication and has built solid connections between the internal parts. This dissociative person is starting to find herself, and she is building a sense of self-esteem, self-worth, and self-identity. As a system, they are definitely doing good work!
There are still several big jagged sharp points, possibly indicating a lot of pain, upset, questions, intense feelings, etc. The phallic shaped pieces in this picture are more obvious, which could be interpreted to mean that the DID artist is clearly addressing their sexual abuse issues. This survivor is aware of the sexual abuse issues, and the healing their sexual abuse trauma is the center of their healing work. While the trauma is still prominent, it is not overwhelming them as much as it used to. They aren’t finished with their healing, but they are making excellent progress. There is less black, and more brown, which feels to me like this person is becoming aware of more and more of the information related to their trauma. They “aren’t in the dark” as much as they used to be and life is feeling much more hopeful.
Even with all the progress, I would still ask this survivor about their suicidal feelings. The sharp points are very painful, and while the survivor may not be using self-injury behaviors as much, they may still have intense moments of suicidal ideation. It appears they are building good coping skills, and not in as high risk of following through with these suicidal thoughts, but the feelings are still there from time to time.
This third picture represents the final stages of healing from dissociative identity disorder and sexual abuse. It is hopeful, and shows how everything is coming together for this person. Notice the strength of the center of the picture. All of the colors connect with the other colors and the ability to share information is accomplished easily. Time loss, time distortion, memory gaps are not likely to be a problematic issue anymore.
The C appears to represents the host of the system, or the main “front” person, the leader of the system, or who the person wants to be as a whole. Notice how the front is a whole self, and is clearly and firmly planted in front of any of the others. This C person is now confident as the leader of her system, and presents well out in the external world.
The internal system behind the C is cooperative, quiet, calm, organized, peaceful, etc. The ability to work together, and provide information to the front C self, seems abundantly clear.
I would ask this survivor if the colors still represent the same things as they did in the earlier pictures. The meanings may or may not have changed at this point.
What I see is that the survivor is more aware of all the things she feels. C doesn’t dissociate like she used to anymore. For example, if the red still represents her pain or anger, C is aware of having those feelings, and she can acknowledge their existence, sitting with them, without letting them overtake her, or without having to dissociate them away. C has built the ability to connect with her intense feelings, and this is an incredible accomplishment. C might have times of dark depression or sadness, for example, but again, these moments do not overtake her ability to live her life as she wants it to be.
Notice that there is no obvious phallic shaped symbol in this picture-postcard. The trauma issues are resolved in a much more quiet way, and while C knows about her past, the idea of being a sexual abuse survivor doesn’t have to be the center of her life anymore. She has been able to resolve many of her trauma issues, and lay these to rest, moving on with her life.
The front of the C is facing the yellow and greens, indicating growth, progress, healing, movement, happiness, and enjoying life. C is moving forward into better times! The darkness and pain are more behind her (the black, red and brown are towards the back of the C). While life is probably never going to be perfect for this person, she is hopeful, and she is doing well.
The Moral of the Story
Will C create a fourth picture-postcard?
We’ll have to ask her!
The point of these wonderful hand-made picture postcards is obvious. The healing process for dissociative identity disorders works. It helps. Trauma survivors lives can become better. Healing does happen. It takes a lot of work, and a lot of time, but you really can feel better, and have an improved quality of life.
Take the point from C – if she can do it, you can too!
Kathy Broady LCSW
Copyright © 2008-2010 Kathy Broady LCSW and Discussing Dissociation
February 15, 2010
The healing process for survivors of abuse and neglect is very difficult. While it is a rewarding journey, it is a painfully difficult process.
Trauma survivors with dissociative identity disorder typically have lots of child parts in their systems. Sometimes these child parts may seem to outnumber the adults!
Working with the kids is an important part of the healing process. Inside kids often know a lot about your internal system, family dynamics, and trauma memories.
But these inside kids, while very much connected to the rest of your adult self, also have real kid needs. They need to be cared for, kept safe (inside and out), allowed to have healthy daily provisions, given support, comfort, and compassion. These are the parts of you that were frozen in time when your needs were not properly meet during your actual childhood. They are the parts of you that just could not go on any further in life, and had to stay stuck where they were, back in that time. They are often the parts that lived through the horrors that you are remembering.
If you ask me, child parts are little heroes. If you think that working on your trauma issues is hard as an adult — with a therapist and all the current-day resources available to you — imagine how hard it was to be a little child living that trauma, completely on your own, with no help at all. Your little kids have had a rough go of it. It really is important for you to do what you can to soothe their wounds and heal their hurts.
One thing that helps child parts to move forward and to not stay stuck is to meet some of their unmet needs. Between years of abuse and neglect, and many incidents of trauma, your child parts will have oodles of experiences of not having their needs met appropriately. The sooner you and your system can treat your child parts in healthy ways, the sooner they will heal. Having corrective emotional experiences will allow your child parts to experience the positive things that were missing in their development.
If your child parts are not in a place where they can emotionally flourish, it will be important for you to help them reach a place where they can experience creative happy living.
Reading good children’s stories with your child parts are as helpful for your inner kids as they are for outside children.
The book, “I Knew You Could” by Craig Dorfman is a wonderful children’s story about encouragement, support, positive self-belief, and healthy determination. The story is about a little train that goes through different areas of life, questioning his train-abilities and wondering if he can make it through the various stops in life.
I am not a professional storyteller by any means, but through the years of working with DID / MPD clients, I have been asked by many a child part to read a story. It seemed to me that maybe other child parts out there in the world would also enjoy having a positive, encouraging story read to them.
Please use this story as a way to encourage yourself and comfort your inner kids. Your healing journey is difficult — filled with lots of stops and bumps along the way — but you have already survived the worst of it. You can heal from here, and create a much better life for yourself and your insiders.
When you hear “I Knew You Could”, what are your favorite lines in the story?
Which phrases fit your life right now?
What does this story mean to you?
And whatever difficult things are happening in your life… keep working at it!
You can do it.
I know you can!
Kathy Broady LCSW
February 10, 2010
Lots of trauma survivors with dissociative identity disorder are just starting their healing process. Other dissociative survivors are not new to their healing process, but they might realize that they haven’t yet covered all the basics.
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”.
For individuals building the foundation for their work with your dissociative system, here are some of the first things to do.
DID 101 involves:
1. Get to know your system. Build the courage to find and meet your insiders. Remember, they were formed and created to help you – even if it doesn’t feel like it, you are (or can be) on the same team. Who are your inside parts? What jobs do they have? What kinds of things are they able to do? It’s really ok for you to build positive relationships and actual friendships with your insiders. If this feels scary for you, explore those feelings. What makes it hard for you to get to know your insiders? What fears or resentments do you have? Understanding your resistance to these ideas is important.
2. Become more comfortable with your diagnosis. If you don’t understand what dissociative identity disorder (DID /MPD) is, be sure to speak more with your therapist or psychiatrist about what it means to be dissociative. There are lots of books, websites, blogs, articles, conferences, etc that can help to educate you about the basics about DID. Understanding DID will help take out some of the mystery and confusion for you.
3. Build a support system and capable treatment team. It is very helpful if you can surround yourself with a few other people that understand trauma dynamics, preferably at least one or two other people, besides your therapist and doctor that understand that you are working on healing from trauma. These support people don’t have to be experts in DID – if they are just willing to spend some time with you when you need a safe distraction from your healing work, that will be helpful. Please don’t lean on lay-support people for the heavy issues. Leave the complicated treatment issues for your therapist to work with – your support friends are not therapists, so be very careful about not pushing them too far or demanding too much of them.
4. Once you have recognized at least one or two other parts, work on building communication with these parts. Internal communication is one of the very most important factors in DID therapy, and the sooner you can interact cooperatively with your other parts, the better your healing progress will happen. Approximately twenty of the articles in the Discussing Dissociation blog reference tips for building internal communication. This link groups these articles together. Learning how to talk to your other parts is the most important factor in your healing.
5. Connecting with your internal landscape. What can you see inside? Can you see the other insiders? Do you have an internal safe place? Internal visualization work is an important skill as it builds a way to connect with your insiders. Even if you can’t see the others inside, there will likely be someone else who can. Maybe ask if that insider will draw a map of your system for you? The sooner you can see inside, the better. And of course, if you see insiders that are not in positive, healthy, clean living conditions, you and other helpers in your system will need to do something to help them.
6. Working on limiting or preventing self-destructive impulses and self-injurious behaviors. Learning how to address self-harm urges is particularly important for your stabilization and progression in therapy. You have already been hurt enough – adding more hurt may feel like it helps you to cope in the short-term, but using behaviors such as cutting or burning is not any more helpful than using a shot of whiskey or a hit of cocaine. Explore better ways to cope with your intense feelings, develop more grounding skills, build positive containment strategies, and methods to reconnect with the here-and-now. A grouping of articles about preventing self-injury can be found here.
7. Live in a safe place both inside and out. If you live in a violent environment, address this issue as quickly as you are able. If you are continuing to be abused or sexually assaulted in any way, your dissociative walls will stay strong, and your system will have greater trouble trusting you and your treatment team. Of course, when anyone is fearful of abusive repercussions, it is much harder to disclose the real issues. Dangerous environments can include everything from domestic violence, abusive parents, organized perpetrators, to internal system perpetrators and angry introjects. Building more and more current-day safety is vitally important for your overall healing process. If you aren’t safe, make this a priority in your therapy process. Building an internal safe place is also critically important. However, please remember that in order to build an internal safe place, you have to have a genuine belief that safety can happen, at least part of the time. Making an internal safe place for your insiders is much more difficult when you are still concerned about external safety.
8. Start building options for positive self-comfort, self-soothing activities. The therapy process can be so very painful and emotionally difficult. Having a variety of options to do that are comfortable, safe, gentle, soothing, and stabilizing is important. What can you do when you want to have a break from the hard work of therapy? What can you do when you need some quiet space to think – or to not think? When you are hurting, what can you do that will help you to feel better? Soothing your pain in ways that help your healing (vs. using self-destructive options) is an important skill to develop.
9. Create healthy options for expression of feeling and emotion – use art, music, journaling, collage, blogging, forum posting, sculpting, painting, poetry, play therapy, sand tray therapy, scrapbooking, etc. DID therapy involves processing a lot of flashbacks, violent images, intense feelings, overwhelming thoughts, body memories, body pain, etc. Building a repertoire of artistic avenues to describe your feelings and experiences will be very helpful. You might not always have words that you can use so it is important to find non-verbal ways to safely express what you feel.
10. Create your own personal space. In this space, let it be ok for your insiders to come out, to be themselves, to be out in the body, and to exist. Out in the world, and when you are around other people, most of your daily life will be about keeping your insiders tucked in and acting socially inappropriate. But somewhere in your private time, your insiders will need time to surface, to know that it is ok for them to come out. Having the freedom to switch without reprimand is important as each of your insiders will need to do some personalized healing work of their own.
Not 11. Please note: I am specifically not including memory work or skills to do memory work in my top then list of DID 101 skills. The reason for this is that if you are just beginning DID therapy, it can be very destabilizing to focus on heavy-duty memory work. Yes, of course, doing trauma work is an important part of your overall healing process, but in the beginning of this journey, you need to build these basic skills before you begin to put a lot of energy into memory work. It is much safer and more stabilizing to have these foundational therapy skills in place before focusing on the trauma content of DID therapy.
DID therapy is intense, long-term, exhausting, and difficult. But your healing is worth it. As you truly address the painful conflicts, unmet needs, and internal confusion caused by your years of trauma, abuse, and neglect, you will feel better within your own self.
I wish you the very best in your healing journey –
Kathy Broady LCSW