February 11, 2009
As I’ve said over and over in this blog, internal communication – people within the DID system talking to each other – is absolutely central and crucial to the healing process. The inside parts need to hear each other, talk to each other, see each other, write to each other, etc. The more you all talk amongst yourselves, the better your healing journey will progress.
Addressing and finding problem issues as they surface via the internal landscape is another key element in the healing process. This involves an intense level of system interaction that can feel very real and be very powerful. Looking inside and finding the visual manifestations of the problem issues makes for a quick way to understand what is happening for you.
For example, if you have a strong urge to self-injure, and yet you don’t quite know where that is coming from or how to control the compulsions, look inside to your internal world and see who is demonstrating that pull towards self-harm.
Do you see someone inside that is holding a weapon? Do you see someone inside who is internally doing harm to her inside body or threatening to hurt someone else within the system?
When you can see who it is in your system that is containing the feelings, urges, and beliefs about doing self-harm and internally acting it out at that precise moment in time, you can address the problem more specifically. Problem-solve with those specific insiders about the their desires to self-injure, and find other ways to meet their specific needs.
Or, as a second example, if you are feeling an overwhelming sadness and you do not know why, look inside and see who it is in your inside world that is demonstrating and expressing that sadness and despair. If you feel like you need to cry (and yet those feelings really aren’t “yours” to claim), look around in your system and see who is crying. When you can visually see who is feeling so sad, you can then make some decisions about how to comfort the one that is crying.
Do you see a little girl crying in the corner? Is she hiding in a closet or under the bed? Do you know why she is crying? Do you know who she is? Look around till you find where she is, talk gently to her, give her a teddy bear or a blanket or a hug, and find out what the problem is. As you learn more about what is bothering her, reassure her that you will do something to help fix the problem, comfort her and address her needs the same as you would if you saw a real child crying.
Here’s another for instance. If you are having the kind of week where you find that you are really really having trouble eating, and you really don’t know what that is about but you know you feel like starving yourself, look inside for clues. Who do you see close to you that is in full agreement with actively starving themselves? Is your anorexic part pulled near the front? Is your anorexic part having a bigger struggle than usual during that week for some reason? What is going on with her? If you approach her, and speak to her, you might be able to understand what is bothering her so much at the current time. Once you start talking with her, you can probably find a solution to the issue that is more effective than self-starvation.
Any time you feel something prominent happening in your external everyday life and you can’t quite figure out what it’s about, look inside for clues. Literally, look. Go inside and look. What do you see? Chances are, someone within your inside world will be intensely feeling those very same things and will be visually showing that when you look in their general direction.
The intensity of internal feelings or desired behaviors will be rippling out to the front of the system from the insiders deeper within your system. They may or may not be literally presenting in the outside worlds, but the intensity of their issues can still strongly affect how you present-behave-feel in the outside world. In essence, their issues can overflow onto you, and you end up feeling what they are feeling, even when the issue actually belongs to them.
Become familiar enough with your internal worlds and friendly enough with your insiders to make checking in with them an easy process on a regular basis. Check with them frequently, repeatedly, in an ongoing kind of way. As you are familiar with the “norm”, you will more quickly recognize the changes that happen along the way.
Learn to identify problems by what you can see from your system, instead of staying stuck in the outside world being clueless as to why a certain emotion or behavior has suddenly become so prominent for you. If you can feel it, but you can’t claim it as “yours”, then it’s coming from someone within your system. Even if they can’t tell you what is happening, they can often show you. So — the more you look inside, and the more you can see of your internal people and see what they are doing, the better you can understand the source of any problems. An accurate assessment of the problem is necessary before you can accurately problem-solve.
Looking closely at your internal world will provide a wealth of information for you.
What is your internal world telling you today?
What are your insiders showing you?
By: Kathy Broady LCSW
January 26, 2009
Here is a quote from my article “Overcoming Instability Issues and Unsuccessful Memory Work,” posted on January 3, 2009.
“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.”
It has come to my attention that I need to expand on these statements.
A. Your Normal Voice
To clarify, speaking “in your normal voice” does not mean to be devoid of all emotion. A dissociated, numb, detached voice is not your “normal voice”. A “normal voice” can and does have plenty of emotion — otherwise, we would all sound like robots.
Pick a safe topic (one not about trauma), but a topic about which you have passionate opinions. For example, what was your opinion about Bush vs. Obama? Did you have a strong preference for which man you wanted to have as the next President? How much emotion was in your voice when you expressed your opinions about the election?
Or, think of your favorite funny movie – one that really makes you laugh and leaves you feeling good for the rest of the day. When you talk about that comedy show, reliving the funny plots to your friend, do you have emotion in your voice?
In each of these situations, most people will have a relatively strong emotional connection to the topic, but they will be able to use their “normal voice” and incorporate a healthy amount of emotion in their speech.
Reaching up to (but not beyond) this level of emotional intensity is my recommendation for early stages of trauma work.
B. Emotional Intensity
I do not recommend that the first steps and stages of addressing memories and trauma be experienced in the extremes of emotional states. To go from blocked, dissociated, amnesiac non-awareness of traumatic material to full-fledged, full-voiced screams and cries is far too big of a jump. That’s a black vs. white approach, and neither extreme is going to be helpful for you.
Of course there are times when more extreme and intense emotion needs to be expressed – that is absolutely true. However, I do not think it is in any survivor’s best interest to start at that level of emotional intensity. Expression of that kind of emotional intensity happens way further down the line in treatment chronology. If you jump there too soon, there will be problems.
Why?? Because of the backlash. If you have no awareness of certain traumas for years of time, and then, within a short amount of time, you get flooded with a tidal wave of emotional information about that trauma, you can bet that there will be struggles with self-injury, self-mutilation, and physical pain as a backlash response to the sudden and excessive emotional pain of remembering.
The strength of your dissociative walls – the years of not knowing about certain traumatic information, emotion, and physical feelings – clearly and without question indicates that there is, and will be for an extended period of time, system conflict about that memory information surfacing.
While some parts will be very relieved at the chance to talk about their trauma, you will also have some insiders upset and angry that the memory surfaced in the first place. Some insiders could be so upset if memories surface or are talked about that they might threaten punishment or harm, or they might forego threats and simply act on their own beliefs and their own feelings. You will have some insiders re-living the physical pain, and others trying to deny the whole shebang. With all the opposing responses going on within your system, you won’t be able to sit with the emotional intensity for very long. An internal war will follow. That’s not very healing. That’s quite traumatizing.
It is much better and safer to approach emotional intensity in graduated steps — to build your tolerance and emotional endurance, and to make sure that there is no internal backlash. While some parts of you might want to scream and shout, there may very likely be someone else inside who will believe that kind of behavior should be punished.
If you don’t have sufficient system cooperation to be expressing such intense emotion, and to maintain your safety in the days following, then it is not safe for you to be pushing for that level of intensity.
C. The Here and Now
When doing trauma work, it is absolutely critical to have a solid connection to the present day, the here and now. All too many dissociated insiders actually think / feel / believe they are still living in the time frame that they are most connected to. Just because you – the adult host — know it is 2009, does NOT mean that your inside parts have that solid awareness. They are more familiar with other time zones. They may fully believe they are still there, in those times, living in those places, near those perpetrators, etc. They will be frightened of ongoing abuse, and will react accordingly.
Check that thoroughly. If for any reason, your insiders still think they are in that traumatic time frame, they will still be too afraid to address the issues in the most effective ways. They will still believe their perpetrators can hear them, or can see them, or will be showing up again at any moment. (Working with internal introjects of external perpetrators is a huge issue, but will be addressed in at a different time.)
As you show the current time frame to your insiders and prove to them that they are living in a new time frame (2009), and that they are living in your current house, that the perpetrators they fear are far far away, you are giving your memory-holding parts the ability to get grounded back to the current day once they begin memory work. This grounding to the current time frame is critical for them to know they are safe.
D. Current Safety
ALL parts must know they are safe enough to talk about their trauma, but this is especially true for child parts. They have to know that it is ok, and that the perpetrator isn’t going to show up and hurt them for talking. They also have to know that the other insiders will not punish them for talking about their memories.
Before starting any memory work with young parts be sure to address the following issues with them:
- Are they still connected to now – 2009? Show this, prove this, in any way that they can.
- Can they still see the room that you are physically in?
- Can they see that you live in this house now?
- Can they see that the house looks different? Can they see how the yard, garage, grounds, barns, etc look different from when the places where you grew up?
- When they are talking about the scary things that you remember, can they come back to being right there, in the current-day place where you are – the place that is far, far away from where those mean people live?
- Can they see your therapist’s office? Do they see the couch there? The pictures / decorations that are there? Do they know that your therapist’s office is also a very very very long way away from where those bad people are?
Reassure all child parts that you can and will keep them safe, both inside and out. If you cannot promise that you will be able to keep them safe from mean insiders and outside perpetrators, then address those issues first, before attempting to make the hurting parts talk about trauma.
Everyone needs solid reassurance about safety BEFORE talking about their trauma.
Kathy Broady LCSW
January 17, 2009
This blog is a continuation of the initial article posted on December 31, 2008, “25 Ways to Avoid Self-Injury and Prevent Self-Harm.”
If you are feeling pressured to get past the “heat of the moment” and you need some ideas of how to do this safely, try using a handful of the following ideas. These ideas will not help solve your self-injury issue on a long-term basis, but they could help you to get through the actual moments when you are feeling at the highest risk. Safe distractions that also provide some element of emotional expression are a good balance.
- Find a brick wall (or any kind of strong wall with no windows), and kick a soccer ball against the wall. Consciously put the anger you are feeling into the ball as you kick it. The cracking sound of the ball smacking the wall can be satisfying as well. The louder the better!
- Use handfuls of ice, ice packs, or cool cloths to soothe and calm yourself. Some people may find warm cloths or heated warm towels more comforting. Changing a physical sensation in your body and concentrating on that may help to calm your frayed nerves.
- Put your anger into something useful — be more assertive with utility companies that aren’t doing their job, or tackle other external household issue that need a more aggressive approach. I’m not necessarily promoting being rude to someone who doesn’t deserve it, but you might be able to constructively resolve an existing problem with your added energy and intensity.
- Color or draw. Small, repetitive movements are soothing and calming, and you might learn something from your picture. The others inside might tell what they are upset about through the drawing that is made.
- Dance out your feelings. Use strong energetic body movements to release the adrenaline and to wear yourself out. Pick music that fits your mood. Sing along if you can – the voice release is good too.
- Write a long letter to your abuser(s). At this point, write these letters with plans to NOT send them. The point is not to set up a confrontation. Let your focus be on expressing your feelings about what they did to you. Write the things that you might never have the courage to actually say to them in real life. When you are finished, you can read the letters out loud repeatedly. Use intensity in your voice. Let yourself say the words with emotional honesty and genuine expression.
- Get obsessed with some safe activity — for example, do in-depth research on a particular subject on the internet, pull every weed from your yard, wash every dish in your cupboards, pace 10,000 steps, etc.
- Count those annoying little doodads on the ceiling, and when you lose count - which you will – start over.
- Do puzzles (the harder the better). There are lots of free online jigsaw puzzle sites if you do not have any actual puzzles in your home.
- Practice relaxation, yoga, and deep breathing exercises. Take long, slow, deep breaths. Inhale deeply and slowly, hold for a few counts, then release your breath slowly. Do this until you can feel yourself calm down.
- Play video games, and take your aggression out on beating the game, or smashing and bashing the other “enemy” characters in the games. Time away “in another world” can help release the pressure you are feeling right now in your world.
- Clean out your fridge or freezer, scrub it, making it clean and organized. This same idea can be applied to closets, or drawers, or bookshelves, etc. Getting involved with a complicated household task will give you another focus, a place to put your energy, and a positive sense of accomplishment when you are finished.
- Alphabetize your books, CD’s, Videos, DVDs, etc.
- Hammer nails into a piece of lumber or old tree stumps until you are exhausted. Watch your fingers – the idea is to NOT do any self-injury! The physical movement will be helpful, the noise will be satisfying, and if you speak about your anger and upset while you are banging away, you will be expressing your feelings at the same time.
- Wash your vehicle, your outside windows, your driveway, your floors, etc. The physical movement helps, and the accomplished feeling of being clean afterwards can help lift your mood.
- Go sit in the waiting room of a hospital, and read a book or magazines, and sip on coffee. You do not have to talk to doctors or any of the hospital staff – people will assume you are there waiting for someone who has an appointment. Just being in a calm, safe place can help.
- Take the time to groom your pets and give them treats. Try teaching your dog a new trick.
- Do something for yourself that makes you feel pretty, such as brushing your hair, doing your nails, getting your hair cut, coloring your hair, wearing perfume, etc. When you feel lousy, try doing the OPPOSITE of that by doing something that helps you feel pretty.
- Make something creative. You might have to pre-plan this, or have some options available just around the house. Finish a paint-by-number picture, work on needlepoint or sewing projects, try beading, learn how to make your own jewelry, etc. Getting creative will help distract you and put you in a better frame of mind.
- Do a collage. It is amazing what comes out in pictures, and you might not have realized what was going on in the background. The collage might explain it to you.
- Do acronym writing exercises. These might help you uncover why you are feeling so terrible while expressing some of the pain. Expression often eases the pain.
- Hold a frozen orange. Feel the coldness. Look closely at the frost on it. Hold the frozen orange where you wish to SI. Scratch the orange, smell the aroma. Look at bright orange color. Count the little dots in the orange peel. As you feel better, allow yourself to eat the orange and throw the peelings away.
- Throw water balloons at a fence, a wall, or a tree and watch them explode. As you throw each water balloon, make a comment about something you are upset about. Use your body and your voice to express your feelings.
- Build a model car or airplane or create something that takes a lot of detailed mental focus.
- Go to the library or book stores where it’s fairly quiet, but people are around. Make a list of 100 books you would like to read at some point in time. Or pick five books from each aisle that you would be willing to read. You can browse for hours, and no one would think anything of it. The same kind of book browsing could happen at online book sites as well.
Stay busy – do things over and over from these lists until you feel safe enough to manage your self-injury impulses. Sometimes just getting past the peak time will be enough to keep you safe.
The more you work on emotional expression in an ongoing way without allowing it to build up to a critical numbing point, the better. One of the biggest keys to resolving self-injury issues is to increase your emotional endurance. The more you can sit with your feelings, the less you will have to hurt yourself to numb them away.
Kathy Broady LCSW
January 10, 2009
I’m going to take a slight detour in the internal communication series and write a little about working with difficult alters. It is crucial to work with these internal parts, no matter how challenging and hopeless things seem in the beginning. Your therapy and healing will never be resolved unless you approach the issues connected with these difficult insiders.
And for that matter, the whole process of building a connection with these difficult, complicated insiders is based on building good communication skills with them, so in that sense, this post is still part of the internal communication series. System work, in whatever way it happens, is a critical part of internal communication and the overall healing journey for everyone with Dissociative Identity Disorder (DID/MPD).
Insiders may first appear in your therapy process being difficult – obstinate, obnoxious, aggressive, scary – and they may maintain destructive behaviors for a long time, but regardless of where they start, any alter within your system can become a helper or a protector. If you as the person truly want to achieve healing, then the healing of your difficult insiders can and will happen as well. No matter how difficult they initially present, they can become productive, helpful, positive members of your system.
Remember, even as a multiple, you are still one whole person. If any of your insiders are left to behave obnoxiously, or if they maintain their destructive negative goals, their behaviors and feelings will affect you and the outside people that interact with you. You cannot block off your “problem parts” and pretend they don’t exist and still expect to achieve positive healing. ALL of your insiders have to have the chance to heal, including the people you are afraid of or the ones about whom you don’t immediately find anything likable.
Some difficult alters are destructive by their own choice and design. They do what they do because they purposefully want to be negative and interrupting. Other difficult situations are complicated simply because the issues at hand are very complex and emotionally challenging. Those internal parts may not want to be as much “trouble” as they are, but until their issues are more resolved, they may not know what else to do.
Who do I define as a difficult alters? Some examples are:
- Those that purposefully sabotage or terminate your therapy and your healing process.
- Those that are self-destructive, violent to the body, or harmful to the body in any variety of ways.
- Those that sabotage other people within the system, including hurting or negatively manipulating others, blinding them, locking them up, abusing them, etc.
- Those that are willing to hurt outside helpers – any of the people that are legitimately trying to promote healing. Any version of hurting the helpers – verbally, physically, emotionally, monetarily, violently, etc. – counts as being difficult and destructive to your treatment and to your system overall.
- Those that cannot contain the new learning and tend to repeat the same negative behaviors over and over.
- Whoever the system members themselves define as “difficult” or “challenging” because those parts hold issues or feelings that are particularly hard for them to work with.
- Those that have trouble connecting to the current day, time, place.
- Those that act out their trauma instead of talking about their trauma.
- Those that stay locked in trauma memories and do not see or interact with the current day, time, place, etc.
- Those that adamantly insist on staying hidden, separated, and amnesiac from the others inside.
The quick answer to address these complicated insiders is to speak to them. Talk to them. Get to know them. Try to understand them. Listen to their perspective on life. Even these insiders can be and should be approached in your therapy sessions. I can promise you, if you avoid talking to these insiders, they will continue to act out their issues. Ignoring them frequently means they will just act out more to get your attention.
It is essential to approach these insiders knowing they have had their job for a reason. You might not like the reason, or understand their reason, but the point is, they are doing what they do because they believe it is helping to achieve a goal that they want. Try to understand what it is that they are doing. Why are they acting out like that? What do they believe? What do they value? From their framework, does their behavior make sense?
Really listen closely to understand why they are doing what they are doing. Work hard to hear and listen to their perspective. You might be pleasantly surprised to hear that their goals are not as “bad” as you might have originally thought they were. The main difference is that you might not agree with the visible behaviors.
Once you have an understanding of why they are doing what they are doing, you can work with them to problem solve and find new ways – more positive and helpful ways – to get what they want. You can begin negotiations on what helpful and positive goals will be.
And the whole process starts by talking to them. Communicate with them. Let them talk to your therapist. Let them get involved in the healing process. Remember, if they aren’t helping the healing process, they’ll continue to hurt it.
Kathy Broady LCSW
Copyright © 2008-2010 Kathy Broady LCSW and Discussing Dissociation
December 23, 2008
Hello to all my Readers,
I hope this day finds you doing well.
The first part of this article certainly caused a little stir, and maybe raised a few eyebrows along the way. Please know, my intention in posting these blogs is not to offend anyone. If you have any questions or concerns about anything I’ve posted, please comment and let me know what you’re thinking! And here’s a big Thank You! to the folks who did comment to the “Part 1″ post. I appreciate that.
Let me try framing the context of this article. In previous blog posts, we’ve been discussing questions to ask a new therapist. This article is, in some ways, a follow-up to that idea, because these are the kinds of things a therapist is going to be thinking about / assessing in new clients as they arrive at their door. These are also the strengths that you want to emphasize when you are meeting a new therapist.
If you approach your therapy keeping these qualities in mind, you will honestly find that more therapists will stay interested in working with you for the long haul. That is not to say you have to be perfect. Who is???! It means, work on these things. Be mindful of them. Developing these strengths will make you a better person overall, and that is very much the goal of therapy.
These qualities, in my opinion, have nothing to do with mental illness. I have worked with some very disturbed people with huge issues, and yet, they possessed these qualities, and they made huge progess in their healing. I’ve also seen some folks who appeared to be rather high-functioning, and yet, they did not, or could not grasp some of these basic ideas.
I agree with the brave soul who commented that these qualities are an important part of everyday life. The more that survivors strive to incorporate these strengths into their approach to everything, the better. Your self esteem will improve, your self-dignity will be solid, and people around you will appreciate you more.
I don’t expect every trauma survivor to have a solid grasp on these qualities, but I do hope every trauma survivor strives to.
Intermingle these strengths into your life everywhere that you can. You’ll be glad you did!
And here is part 2 of the article, “10 Qualities Therapists Recognize in Good Clients”:
6. Honesty and Trustworthiness
- Are you willing to be honest with yourself?
- Are you willing to lie to your therapist, or hide information, or lie by omission?
- Do you gossip and tell lies behind people’s backs?
- Do you gossip about your therapist?
- Do you lie to your inside parts? Does anyone in your system try to trick or deceive the others in your system?
Therapeutic relationships are built on honesty and trust. Your therapist will need to know you possess these qualities as well.
- Will you treat your friends and family members with kindness and respect even if they have done things you do not like?
- Will you loyally protect your internal system from predators and perpetrators, putting the safety of your inside parts as a priority?
- Are you loyal to your therapeutic process and will you keep clear boundaries around the therapeutic process?
- Will you respect your therapist’s trust in you to the same degree that you expect your therapist to respect your trust in them?
- If you and your therapist experience a conflict, where do you look to resolve that? Do you expect to resolve the conflict within the context of therapy, or will you spread the conflict outside the therapeutic relationship and draw others into it?
Your therapist and support team can be your greatest allies in your healing journey. However, a deep level of mutual respect is expected and needed in order to progress in therapy. It is crucial that you thoroughly differentiate the “good guys” from the “bad guys”. Therapists understand the concepts of transference and projection, and they will work with you in those tender moments, but there will be limits to that. I can promise you, your helpers do not want to be thrown under the bus any more than anyone else.
- Are you determined to do the same things over and over again?
- Are you open to trying new options?
- Can you think outside of the box instead of being boxed in?
- Do you help to problem-solve the various dilemmas that surface?
- Will you work on ways to reach even the most difficult of insiders? Even if this involves several failed attempts before you successfully connect with these parts?
We’ve all heard the saying, “the definition of insanity is doing the same things over and over again, expecting to get different results.” A huge part of the healing process is learning new things and doing different things.
9. Gratitude and Appreciation
- Do you appreciate what people do for you?
- Do you recognize when someone is doing something for you?
- Do you thank them for helping you?
- In relationships, do you overlook smaller imperfections in appreciation of bigger strengths?
- Do you thank others in your dissociative internal system for the ways they have helped you to survive through the years? Do you recognize their strengths and talents in the current day?
Gratitude and appreciation are key elements of any healthy relationship. Don’t take the goodness of others for granted. Be thankful for what you receive from others.
- Are you a safe person?
- Do you use threats of violence, or threats of harm to others, or threats of emotional blackmail, or threats of any kind to destroy or control other people or to get your own way?
- Do you threaten self-harm or suicide as a way to manipulate others or to get your own way?
- Are you willing to hurt yourself or someone else in order to get your way, including others in your internal system?
- How far is “too far” to go to get what you want or prove you are “right”? Do you think there is such a thing as “too far”?
Therapists will model safe behavior. If you are acting in ways that are unsafe for yourself or manipulative of those around you, your therapist will set boundaries with you — just as you should set boundaries with someone who is unsafe in your direction.
If you follow these guidelines, you will have a much better relationship with your therapist and others around you. If you are looking for a new therapist, remember that the more you can genuinely offer in the areas listed above, the more those therapists will view you as a client with potential — and the more positive potential you demonstrate in these areas of your life, the greater interest more therapists will have in working with you. It goes to your advantage, your healing, your self-respect, and the amount of respect others will feel toward you to learn these things.
All people, including trauma survivors with Dissociative Identity Disorder (DID/MPD), can claim these strengths as their own. Work hard to be a “good person” in your therapy, and you’ll be amazed at how much difference this can make in your relationship with your therapist and with your system. Remember:
Maintain your stability the best you can.
Be dependable in what you do, and do what you say you will do.
Maintain your motivation and your willingness to work hard.
Be courageous, even when it is scary.
Stay clear and upfront about your personal responsibilities.
Be honest and trustworthy at all times.
Stay loyal to your helpers.
Be creative in the hard times.
Have gratitude and appreciation for the good things and good people.
And be a safe person. Be safe for yourself, and be safe for others.
You can do it. I’m just sure of it.
Kathy Broady LCSW
December 13, 2008
I am writing this post in response to a question asked by BehindtheCouch.
BTC wrote, “do you think that a “trauma client” (ie one with PTSD or a dissociative disorder) should necessarily be treated by a specialised “trauma therapist” or, in your opinion, could any therapist who has the skills that you mention in your post do just as good a job with the client?”
This is a good question.
My first thought is yes, a client that has experienced a significant amount of abuse should (hopefully!) receive better therapeutic care from a trauma specialist. If you have the option to work with an experienced therapist who specializes in trauma disorders, snap up that opportunity as quickly as you can.
Trauma therapy is very much its own area of study, the same as with any other medical issue. In trauma work, the therapist must understand dynamics of traumatic relationships, trauma bonds, wide-ranging effects of trauma, layered complications of dissociative disorders, issues of external safety, self harm, system work, memory work, etc. There are dozens of issues specific to trauma disorders, with dissociative disorders being the most highly complex and requiring the greatest clinical skill. (Please see my article listing 50 Treatment Issues for Dissociative Identity Disorder.) The terms “trauma specialists” or “trauma therapists” imply these clinicians have invested significant chunks of time learning about trauma disorders. They should be more comfortable than the average therapist in terms of recognizing, understanding, and addressing the details of trauma work.
Please remember there are many areas of clinical expertise for mental health professionals. For example, I am licensed to provide clinical therapy for any area of my choosing, but in my 20+ years as a therapist, I have not worked with autistic children. However, I have worked with families with traumatized children who also have some very definite and particular needs. Sure, I could apply my basic, fundamental clinical skills with autistic children and their families, but once it became necessary to understand specifics related to autism, I would fail miserably. I would be scrambling for information, and fast! Even though I am a good trauma therapist, would these autistic children receive the same quality of clinical treatment with me as they would with a clinician that specialized with autism? I am quite sure they would not.
Who is a trauma therapist? For most clinicians, there are no regulatory boards that specify exact qualifications. Trauma therapists are self-proclaimed experts in the field, and clients are left hoping the professionals they are trusting are actually qualified to be specialists. Unfortunately, I have seen far too many problems caused by well-meaning professionals who simply did not know as much about trauma issues as they claimed. Their lack of understanding of trauma-related complexities, timing, processes, etc. caused significant harm, damage, and confusion.
On the other hand, finding a trauma specialist is difficult, and you simply might not have many therapists in your area that work with severe abuse issues. It is imperative that people suffering from Post Traumatic Stress Disorder (PTSD) or any of the Dissociative Disorders receive treatment in order to heal from their traumatic experiences. If your only option is to work with a “general practitioner” instead of a specialist, then that is what you do. Good basic therapy is certainly better than no therapy at all.
Select therapists who are open-minded to the effects of trauma, honest about their limitations, and willing to learn more. As long as their clinical skills include active listening, deep understanding, gentle compassion, effective communication, recognition of family dynamics, emotional tolerance, clear boundaries, etc., you will be able to progress in your healing.
However, it will be highly important to augment your treatment with additional information. Read books, search online, get regular and ongoing consultations with trauma specialists, join trauma / DID support groups, attend conferences, consider online or distance therapy with a trauma therapist as an adjunct (secondary) therapist, etc.
Don’t assume that general therapists will learn enough on their own to get you through the most difficult and complex places in your healing. You will have to take charge of your own work. Make sure to do extra homework!
Your greatest therapeutic gains will be with a therapist you trust. Therapy is about you. It is your looking at your life, your history, your feelings, your reactions, your truths, your beliefs. When you feel safe enough to be totally and completely honest with yourself, you will be able to look at your painful wounds and all the resulting affects of the trauma. You will be able to bring down those dissociative walls that you built for safety and separation from “all the hard stuff”.
Pick a therapist you can connect with, build a solid foundation, and keep going from there. You’ll feel better for it.
Kathy Broady, LCSW