November 21, 2010
Posted in DID Education, DID/MPD, Dissociative Identity Disorder, mental health, Online Therapy, therapy, Therapy and Counseling, trauma therapist tagged AbuseConsultants.com, Boundaries, Choosing, Counselor, Decision Making, DID / MPD, DID Survivors, DID Treatment Goals, Dissociative Identity Disorder, Empowerment, Exploitation, Freedom, Freedom of Choice, Freedom to Choose, Freedom to think, Kathy Broady, Length of Sessions, Limit, Mental Health Professionals, Psychiatrist, Psychotherapist, Therapeutic Exploitation, Therapeutic Limits, Therapist, Therapy for Dissociative Disorders, trauma therapist, Trauma Therapy, Treatment Goals for DID, What works? at 4:31 am by Kathy Broady
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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
http://www.SurvivorForum.com
Copyright © 2008-2010 Kathy Broady LCSW and Discussing Dissociation
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August 30, 2009
Posted in Borderline Personality Disorder, DID Education, DID/MPD, Dissociative Identity Disorder, Self Injury, therapy, Therapy and Counseling, Therapy Homework Ideas, Transference Issues, trauma therapist tagged AbuseConsultants, AbuseConsultants.com, Bad apples, Boundaries, BPD, BPD Behaviors, DDNOS, Destructive Behavior, Destructive Gossip, Destructive Survivors, DID Community, DID Therapists, DID/MPD, Displacement, Dissociative Community, Dissociative Identity Disorder, Dissociative Population, Fakers, False Accusations, False Allegations, Gossip, Haters, Honesty, Ignore gossip, Kathy Broady, Liars, Losing Therapeutic Resources, Loss of Therapist, Love-Hate, Lying for attention, Lying to get attention, Lying to therapists, Mental Health Professionals, Not following bad examples, Projection, Protecting your therapeutic resouces, Protecting your therapist, Protection, PTSD, Sabotage, Self Destructive Behavior, Therapeutic Resources, Think for yourself, Transference Issues, Trauma Survivors, trauma therapist, Trauma Therapy at 2:44 pm by Kathy Broady
There are thousands of clinical therapists in the world.
However, of all the therapists in the world, only a few work with trauma and PTSD.
Of all the trauma therapists, only a few work with the areas of sexual abuse and severe trauma.
Of those therapists, only a few work with dissociative disorders, DID/MPD and DDNOS.
Of the DID therapists, only a very few work with issues relating to organized perpetrator groups.
And in that small subset of therapists, only a few work with more than two or three dissociative survivors at any one time.
And it is the rare therapist among that already vanishingly small number who stay in the field for more than a few years… or long enough to gain the experience they would need in order to be most helpful to the population of clients they serve,
So of all the thousands and thousands of therapists in the world, there are relatively very few who will have the kind of knowledge and experience that you are looking for when you need a specialist in the areas of trauma and dissociation.
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Why do so many therapists refuse to work in this area when there is so much need?
And why do so many therapists leave the field after committing years of dedication to dissociative survivors?
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It’s time to be honest.
First – please remember, I am one of the rare few who has stayed loyal and passionately dedicated to the fields of trauma and dissociation for more than 20 years. It is hard to find trauma therapists with that much commitment to the dissociative population. I am on your side – I will prove that over and over – but I am going to be honest.
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DID’ers are a very difficult population of people for a therapist to work with !!!!
Now don’t get me wrong. Some of you are absolutely wonderful – without question, the most incredible heroes and the very most courageous people I have ever met. Those of you in this category are absolute diamonds, and I really cannot say enough positive things about you. You all are truly inspirational, and I am honored to work beside you.
Unfortunately, those who are genuinely dedicated to their therapy and who work hard to achieve their deepest healing are all too often undermined by the few survivors who are willing to do anything but work on their healing.
Oh, these survivors will SAY they are working in therapy…. They will CLAIM they are dedicated to their healing…. They go through the motions, and they spout all the right words. To a point. And then they don’t anymore.
Because in reality, this small number of survivors is more interested in hurting other people than they are in healing their own pain. They are more interested in destroying others than they are in helping themselves. They are willing to lie about anything or anyone just to get attention drawn to themselves. They are very destructive and they are very sick.
And these destructive survivors could be costing you a lot more than you realize.
Ouch.
I am sure as a population, this is not pleasant to hear. Please know that I am not saying this to all of you.
Those of you that are genuinely dedicated to your healing know exactly what I am talking about – I’m sure – because you have most likely already witnessed your healing resources being used up, beat up, and exhausted by fellow survivors whose intentions were far from honorable. The survivors that do this are sabotaging those of you that are truly trying to heal, because the therapeutic field gets completely burnt out by “them” and ends up not having the time or energy or interest to work with you. Many good therapists simply will not be willing to risk working with other survivors after they have had some bad experiences with these destructive survivors.
So… the survivors that are undermining your therapists are doing harm to themselves, to the therapists, and to you. They are attacking, abusing, and destroying your therapeutic resources, leaving you with less. These “bad apples” are giving the whole dissociative population a bad name, and frankly, this kind of behavior should not be tolerated by any of us.
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Now what?
If you all want mental health professionals to stay working in the fields of trauma and dissociation, it is important to make that work worth it to them, and not a “nightmare” for them.
I am not saying that you have to feed the egos of the therapists, or provide support for them, or do any freaky weird boundary violations. Therapists became therapists for intrinsic reasons of their own. We don’t need y’all to “make it worth it” to us by what you give to us.
Therapists want you to make their work worth it by allowing them to genuinely do their job. We want you to address your issues, work on your healing, stay focused on your system, be honest with your feelings, etc. If you will do your job of focusing completely on your own healing, we as therapists will be thrilled with that. Your genuine progress will be our reward.
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That being said, what can you do to protect the relationship you have with your therapist in particular? And how can you do your part to protect the resources available in the therapeutic community, so that therapists are more motivated to enter and remain in the field, and more survivors have the opportunity to work with truly skilled professionals?
How can you separate yourself from those survivors that are destructive?
How can you make sure you are helping the problem, and not creating the problem?
Here are some ideas of what NOT to do:
- Don’t lie to yourself and expect others to believe you.
- Don’t lie to your therapist. How can you heal if you are not honest in your sessions?
- Don’t lie about a therapist. Don’t believe lies about a therapist.
- Don’t gossip about a therapist. Don’t believe gossip about a therapist. Don’t spread unfounded false allegations. Don’t chase off or destroy therapeutic resources with false accusations.
- Don’t forget to examine your transference feelings, and recognize them as transference issues. Don’t forget how projection, transference, displacement, and amnesia can affect your thinking. Work openly and genuinely on these issues instead of blaming the therapist.
- Don’t attack a therapist because you are too afraid to address the real source of your anger.
- Don’t let therapists become the “bad guys” in your definition. Therapists are your helpers. They are there to help with your healing. Learn quickly how to define the helpers from the hurters, and address that confusion as often as necessary.
- Don’t assume that all “survivors” are automatically being honest with you (or themselves) when they are trashing a therapist. Remember, they may be in the “hate” cycle of the love-hate dynamic.
- Don’t assume that all “survivors” are working for the betterment of the survivor community. Some so-called survivors are truly moles from the dark sides of the world, and are here to cause trouble in any way they can.
- Don’t let your jealousies and insecurities consume you and destroy your focus. If you want your therapist all to yourself, hire them to work 40 hrs per week at their full hourly rates. If that is not an option, be mature enough to know your therapist is going to have other clients.
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Here are some ideas about what TO do:
- Be genuinely honest with your yourself. The more honest you are, the more healing you will accomplish.
- Be genuinely honest with your therapist. Your therapist can help best when they genuinely understand the issues.
- Remember that your healing is to be focused on you, your behavior, your feelings, your mistakes, your strengths, your weaknesses, etc. Your therapy is about you, so keep the topics focused on you, even when it is hard to look at yourself.
- Do your own internal system homework in between sessions. Your healing will progress as you put your own time and effort into it.
- Be kind, appreciative, thankful, and polite. This doesn’t mean to grovel or do penance. Just use normal social manners and social politeness.
- Remember that your therapist does not have to be your emotional (or physical) punching bag. If you are hitting too hard, redirect your anger towards your abusers, where it belongs.
- Give yourself adequate time to work through the complexities of your healing process. An experienced therapist will not rush you, and it is truly ok for you to take as much time to heal as you need.
- Separate yourself from other survivors that are troublemakers and instigators of negative drama. Just like school days, if you hang out with people causing harm, you’ll end up doing the same, or being tangled in their web. Their poor behavior will cost you. You can decide if that is worth it to you or not.
- Ignore the drama queens determined to cause trouble in front of you. If you refuse to buy into their antics, they will move on to other pastures. If you give drama precedence over your own healing, you will not be progressing in your own healing. Protect the entire dissociative community by supporting your therapeutic resources.
- Remember to think for yourself. All too often, survivors listen to any strong, authoritative voice that tells them what to do. If someone is telling you negative things about your therapist, set a boundary, stop, and re-evaluate all sides of your situation.
- Talk openly with your therapist about any concerns you have. Give yourself the chance to problem-solve any difficulties or conflicts that arise. Working through conflicts is an important part of your healing process, and it does not necessarily require a therapeutic rupture.
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If you can truly apply these guidelines, you will be honoring your own healing. You will also be showing respect to your individual therapist, protecting other ongoing therapeutic relationships, supporting the greater survivor community, and enhancing the larger therapeutic community.
Maybe most of you think that you are not actively involved in the destruction of the therapeutic resources, but if you support it, believe it, allow it to go on by your “friends”, etc, then you could be more involved than you realize. You can either help to maintain effective therapeutic resources, or you can allow their destruction.
It’s a conscious decision that each one of you has to make.
Everyone has to do their part in protecting the few therapeutic resources available for dissociative survivors. You can choose to support the destructive people, or you can choose to kick them to the curb, and get along with your own healing.
Remember, if you genuinely focus on yourself and your own healing, then you are doing all you need to do.
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By:
Kathy Broady LCSW
www.AbuseConsultants.com
www.SurvivorForum.com
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