January 3, 2009
I have a question about stability. I accept that I need to be reliable, motivated, responsible and willing to delve into things I generally don’t want to delve into. As for stability – I can see how a stable client is easier to work with for a therapist. However, what if the beginning stages of therapy have resurfaced old issues or retraumatised the client to the extent that they are now “unstable”? How would this fit with your schema? And what should the therapist’s (and client’s) roles be in re-stabilising?
Typically trauma survivors, particularly those with Dissociative Identity Disorder and PTSD enter therapy because their life is already full of emotional complications, symptoms of depression, anxiety, self-injury, internal chaos, flashbacks, confusion, memory loss, time distortion, time loss, body numbing, nightmares, voices, etc. As a whole, people do not enter therapy because their life is already stable. They go to therapy because they have some awareness that they are starting to fall apart. There is something wrong, something very uncomfortable, and something very unmanageable about their life. They may not be able to define it, but they can feel it and see it in the way their life is unraveling.
And yes, Kerro, you are right. There are various stages of therapy that can be quite de-stabilizing, yet maintaining stabilization is a fundamental building block of therapy. Sometimes the path seems like two steps forward, one step back. And, yes, there are times when it feels more like one step forward, two steps back. It is a very fine balance. To do the healing work required for trauma survivors to gain overall life stability, these survivors have to address painful difficult issues that are potentially de-stabilizing.
So, not doing the work leaves people de-stabilized.
But doing the work also can cause people to be de-stabilized.
Some days, it feels like the line between the two is nonexistent.
Take it slowly, one step at a time. Look ahead, increase your self-awareness, try to maintain the stability that you have, and try to predict the areas of your stability are the shakiest and and prepare for them ahead of time. This is important.
What is stability?
Stability consists of a lot of different elements all at once. Some examples of stability are when survivors:
- Can manage intense emotions without using serious self-injury to cope.
- Can be challenged with something emotionally difficult without making it ”the end of the world” or some other dramatic crisis.
- Are willing to move forward by learning about new areas of life and using new coping skills, instead of self-destructing from the same old place and/or blaming others for their lack of progress.
- Do not consider suicide as a realistic problem-solving solution to difficult situations.
- Can manage feeling depressed, and even suicidal, but knowing they wouldn’t actually do anything lethal or harmful.
- Take their medication as prescribed, regularly and consistently.
- Eat regularly, without starving themselves or without bingeing repeatedly.
- Get a regular, sufficient amount of sleep, rest, and personal down time.
- Have a steady source of monthly income that meets their basic needs.
- Can incorporate painful trauma memory work into their lives without self-destructing or attacking others.
- Work cooperatively with their internal system without attacking each other from within.
- Maintain a safe and consistent distance from and/or can establish boundaries with people that repeatedly abuse them.
- Can keep their regular job/employment, even while working on therapy issues.
- Can use their dissociative skills to their advantage, instead of to their detriment.
Sometimes therapy is like walking through a minefield. If you know you have to get through the minefield to survive, but there is the potential that you will set off one of the mines on your way through, you would tread very carefully. You would check everything you do, in smaller and more detailed increments. You would listen and watch for clues every single step of the way.
In the therapy process, once you start feeling a little too de-stabilized in a particular direction, back off and stop pushing that issue at the moment. Give it a break for an hour, a day, a week, a month — depending on the circumstance. Get to know yourself and what you can handle. Learn your own red flags for when you are starting to fall apart and getting too overwhelmed. Give yourself the space and the time to do your work. There’s no need to rush headlong into things that particularly de-stabilize you.
Remember, when healing from trauma, there are usually many, many different areas of healing. Remember the list of 50 different treatment issues for DID/MPD? If you are finding one area too difficult to deal with right now, simply put that issue on hold, and work on a different area. They ALL have to be done. They ALL have to be addressed. You can decide when something is genuinely too difficult, or too tangled, or too emotional, or too destabilizing for right now.
As a general rule of thumb, put internal communication work and system work as the first steps to focus on. If you cannot even speak to your insiders, you certainly will not be able to tolerate their intense emotional trauma memories.
In years gone by, the mental health profession used to promote abreactive memory work as valid and necessary. I absolutely, unequivocally disagree with that. Abreactions are often hypnotically induced, and they are basically inducing a flashback — putting the person back in time and directly into the intensity of the trauma. Most survivors find they do not even recall abreactive work, so as far as I am concerned, it is an absolute waste of time, and just leaves the person feeling more traumatized than healed.
If you cannot speak, in your normal voice, discussing your trauma memories from the safety of the here-and-now while still connected in the present, then don’t even try to address your memories. It is too soon.
In my opinion, memory work is NOT the core of the healing from dissociative disorders. I believe that developing the internal communication, internal cooperation between parts, and system teamwork is a much more important element, as well as being crucial to a person’s stability. Decreasing the dissociation and separation between the inside people has many facets to it. The trauma is only one area of separation between insiders. Build strong connections with each other first and then, much further down the road, address the memory / trauma issues, and you will likely find that the memory work is much less de-stabilizing than it once was.
Memory work has its role, and yes, survivors do have to process their trauma. Please know that you are not getting a “free pass” on not addressing that. BUT, it is not the first goal of treatment, and it is certainly not the main focus of the therapy.
In your outside life, when you first walk up to someone new, as you are first meeting them, do you say, “Hi. You don’t know who I am. I don’t know who you are. But I want to know your most painful memories. Tell me all your deepest, darkest secrets RIGHT NOW.”
Hello??? Of course you don’t approach people like that. SO, don’t approach your insiders that way either. Get to know them as people first. Find out who they are, what they are like. Build a relationship, a connection, and a rapport with them first.
In fact, building connections in your internal system, building that teamwork approach, improving communication, and etc. is the main and most effective stabilizing factor that I know. Once you truly can connect with your insiders, and you care for them and have relationships with them, you can hear their trauma through an entirely different perspective. You will have compassion for your inner people, and that will help you to heal. Jerking their memories out of them before you even have a relationship with them isn’t good for anyone.
Focus first on relationship building with your parts. Get to know them. Talk to them. Learn their names. Overcome your fears of who they are. Appreciate their strengths. Develop friendships with them. I guarantee that your overall stability will greatly improve as you are more connected with your internal system on a genuinely friendly, caring basis.
Kathy Broady LCSW