November 10, 2009
Posted in Child Alters, Depression, DID Education, Dissociative Identity Disorder, emotional pain, Internal Communication, Self Injury, therapy, Therapy and Counseling, Trauma, trauma therapist tagged AbuseConsultants, AbuseConsultants.com, Anger, Depression, DID / MPD, DID Survivors, dissociative disorders, Dissociative Identity Disorder, emotional pain, Ending Therapy, Grief, heartbreak, Internal Chaos, Internal Fighting, Kathy Broady, Lashing out, Losing a therapist, Loss, Loss of a therapist, Love-hate relationships, pain, Quitting therapy, Saying goodbye, Self Harm, Self Injury, SI, Termination, Termination of therapy, therapy, Therapy Process, Trauma Survivors, trauma therapist, Trauma Therapy at 7:11 pm by Kathy Broady
Several people that have been reading Discussing Dissociation have made posts and comments about how enormously painful and difficult it is to lose a therapist.
There are several different ways to “lose a therapist” but for the purposes of this particular blog entry, I’d like to focus on situations where there was sudden loss.
In my years of experience, I have seen a variety of circumstances that have led to clients suddenly losing their therapist. When this happened during a long-term therapeutic relationship, the sudden loss is enormously difficult for dissociative trauma survivors.
DID survivors typically trust so few people, and there are usually very few people who are allowed to know the internal system in the way that the therapist gets to meet and know the insiders. It often takes months of regular, frequent sessions for DID survivors to start feeling the teensiest bits of trust with their therapist in the first place. It may also take years of time before some of the more vulnerable insiders experience any feelings of trust at all.
When you find a good therapist that you connect with, it’s usually pretty important to keep that therapist.
But what if something happens and you suddenly lose your therapist?
What if you lose your therapist due to
- An automobile wreck
- An assault of some kind
- An illness of some version
- An unexpected pregnancy issue
- A family member of the therapist is ill
- An unexpected “personal leave” of any kind
- An unexpected “medical leave” of any kind
- The family of your therapist has required a move to another location
In these situations, it is very difficult, but the adult parts of the survivor can often understand the need for their therapist to have stepped out of the office, even for an extended period of time. The loss is still there – and most of the internal system will likely still have enormous grief and struggles and emotional pain. The child parts and traumatized parts might blame themselves, but there will probably be someone in the system that can intellectually grasp that the sudden absence was related to an external issue, and not their fault.
But what about if you lose a therapist to one of these reasons:
- Your therapist terminates with you, even if that is not your preference
- Your therapist quits their job for any number of reasons
- Your therapist takes a new job and can’t take you with them
- Your spouse demands that you stop seeing your therapist
- Another person tells you that your therapist is “bad for you”
- Your therapist gets fired and can no longer work with you
- Your therapist decides they are no longer working with DID
What about situations where it is less externally based and more connected to you?
What does it do to the survivor to lose a therapist?
In my experience, when a DID survivor loses their therapist, especially when there is very little time for a termination or goodbye process, there is a huge emotional fall-out from the sudden loss. The therapeutic relationship is far too important to have a sudden ending, and the emotional overflow will be huge.
The DID survivor tends to:
- Act out their pain, anger, and fear in various forms of self-injury
- Be unable to move forward in other areas of healing
- Begin to either devalue or overly-pedestal the therapist (the love-hate response)
- Blame themselves or other insiders for the loss
- Cry, cry, and cry
- Experience internal system chaos, increased internal fighting, decreased internal cooperation
- Experience their internal landscapes and internal structures collapsing and the internal world may go dark, or feel unsafe and unfriendly
- Express an ongoing ambivalence towards the therapist
- Feel suicidal
- Go into a long, deep, dark, devastating depression
- Go into hiding – some of the internal parts may refuse to come back out
- Go numb – become more detached or dissociated
- Have a sudden regression in overall skills, abilities, and social interactions
- Have lots of dreams or nightmares about the therapist
- Hibernate within their own home, refusing to go out or interact with other people
- Lash out with inappropriate or excessive anger at innocent people
- Last out with inappropriate or excessive anger at the therapist
- Leave therapy, refusing to trust another therapist
- Lose hold of the positive gains they made with that therapist
- Pretend that the therapist never existed anyway
- Re-create history by remembering only the good events, making the therapist too perfect
- Re-create history by twisting events into something negative, taking comfort by believing the therapist was “a bad guy anyway”
- Refuse to truly leave the therapist alone (following from afar, maintaining contact, calling their phone, sending emails, etc)
- Spend a lot more time sitting, staring, spacing out, etc.
- Stay focused on the therapist, and their feelings about the therapist as their primary issue for an extended period of time
The termination process is as critical to the long-term health and well-being of the client as any other stage of therapy, if not more so. In fact, a very positive therapeutic relationship can become completely tainted and twisted if the termination process is not handled properly.
Cold-turkey terminations are dangerous.
I cannot stress that enough – sudden terminations are not good.!!
They are not helpful.
They are harmful and emotionally devastating for the clients, and they set up the therapists for future problems.
If your treasured therapist has to leave for any reason, take the time to have as many termination sessions as possible. The process of saying goodbye is complicated, but it is crucial to leave your therapist from a positive point of view. Otherwise, you will experience an ongoing emotional fall-out that will extend much further into the future than you would expect.
Kathy Broady LCSW