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
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