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
December 22, 2008
Most clients quickly think of the many qualities they want in their therapists. However, are those clients also thinking about whether or not they are presenting themselves as the type of client someone would want to work with? As an experienced psychotherapist, I am proposing that there are many criteria for clients to consider about themselves as well as about their prospective therapists.
Many of the following issues pertain specifically to trauma survivors and those with Dissociative Identity Disorder (DID/MPD).
Please consider the following concepts as important guidelines.
- Are you in a constant or repeated state of crisis?
- Are you looking for someone to rescue you immediately?
- Are you repeatedly in a suicidal or self-injurious panic?
- Do you make more than one emergency call every few months?
- Are you frequently in drunken states, or on the verge of over-dosing, or on the verge of self-injury or suicide?
Most therapists are not as interested in taking on heavily crisis-laden clients. The more stable you are, the more therapeutic options you will find.
- Do you show up for every appointment?
- Do you cancel at the last minute?
- Do you pay for your sessions up-front and without issue, irritation, or complication?
- Do you do you keep your word, and follow through with the things you say you will do?
- Do you regularly pass important information between the leaders of your internal system, and not hide behind dissociative amnesia as an excuse?
The same as employers, babysitters, and doctors, therapists want to be able to count on you. They don’t want scheduling nightmares, and they don’t want to have to beg or fight for their pay. Remember, there are a lot of other people involved in each weekly schedule, so keep your time spot precious to you. Show your therapist that your therapy work matters to you.
3. Motivation and Willingness
- Are you willing to do what it takes to get through your healing process?
- Are you open to new ideas?
- Are you resistant to change? Do you react with irritation, anger, frustration, or refusals when you are expected or encouraged to change?
- Do you complete your homework each week?
- Do you bring new issues of needed work to the table? Are you presenting topics that need to be addressed? Or are you waiting for someone else to point the trouble spots out to you?
Coming to therapy typically means you are looking for some type of change in your life. If you are happy with the way things are, or you do not see any areas that need work, or you do not see any changes that you are willing to make, why are you going to therapy in the first place?
- Change and healing require taking new steps – both little steps and big steps. Can you do that? Will you do that?
- Are you too scared or too anxious or too depressed to try anything new?
- Are you willing to venture into difficult, complicated, painful areas of therapy work?
- Are you willing to look at painful memories when it’s therapeutically needed or recommended?
- Are you willing to look at the reality of toxic, abusive, or dangerous relationships, even those with your loved ones or family members?
Therapists can help you address your fears, your problems, and your issues, but only if you are willing to allow that to happen.
5. Personal Responsibility
- Are you willing to look at what you are doing to contribute to the problems you are experiencing?
- Are you willing to face your part of the problem, rather than focusing exclusively on blaming others?
- Are you genuinely open to hearing feedback about your issues?
- Do you retain the things you have learned from session to session, month after month? Will you be able to apply what you learn over time, or will you continue to use dysfunctional responses over and over?
- Even if you are dissociative, are your adult parts in charge of and responsible for your child parts? Are you able to maintain an adult presence when necessary?
The more responsibility you take for your own healing, your feelings, your behavior, etc, the further you will go in your healing process.
(Please come back — the second half of this article will be posted tomorrow.)
Kathy Broady LCSW