Q. What about young alters who want to go through re-parenting in therapy before they agree to age or integrate? - Angela
A: I am not a fan of outsiders reparenting alters. Too many counseling clients have become overly enmeshed or dependent upon counselors and other professionals who thought reparenting was a great idea. We have seen a few Dissociative Identity Disorder autobiographies that showcase this style, and failure, of treatment.
I believe insiders have the ability, the responsibility, and the skills to reparent younger alters. Most systems even have these older, wiser, calmer alters already created. They are there for a reason! Use them for that! I don't think we create these caretakers and protectors by accident.
I fear that depending on an outsider to reparent leaves alters too open for more hurt, abuse, abandonment, and even a slower recovery. Why? Because an outsider is never with you 24/7. An outsider will always lose patience with your needs sometimes because of their own needs and stressful life. An outsider will either start to resent your needs, or will become attached to the role of caretaker or special friend and may not want you to recover because they want to maintain that role. They may not even realize they are sabotaging your recovery, because they really usually do want to help you by giving you comfort and support. But it's a fine line between support and enabling.
So reparent from within. You have the resources. Plus reparenting inside helps the whole system learn how to take care of themselves, the body, and even how to nurture other relationships in their lives. That way both the reparent and the reparented grow from the process.
Sunday, August 21, 2011
Appropriate to share therapy notes?
Q. My therapist feels its not appropriate to share her notes and findings and theories on me with me, for fear it could inhibit progress. Is that right? - Rowan
A: Usually this is a real risk. Being a counselor, I know it's very hard sometimes to know how much to tell a client, and when. I also have to figure out if it's helpful to share that information, for the client, rather than just sharing clinical tidbits or jargon that makes sense to only me.
When working with someone who might have Dissociative Identity Disorder, this is a very complicated process. If the therapist tells too much, too soon, then people in the system may feel like the therapist "knows too much" (unsafe), "told my secrets" (untrustworthy), or worse "doesn't know what they are talking about!" (disconnected, not listening, not a good counselor, making up illnesses, pushing medications, etc.). The reactions from clients could be firing the therapist, refusing to seek outside help from referral sources (like medications), increased self-harm or suicidal thoughts, or severe loss of progress and trust in the counseling relationship.
Counselors should be able to tell you some basics, like what is my current diagnosis, are we making progress, are we a good fit, do we have an agreed upon set of boundaries or rules that both sides feel comfortable with, is medication an option or even recommended, are there other types of treatment or self-care things I can be doing to help my recovery?
I also don't like to share my notes because they are hard to read (handwriting), hard to understand (usually fragments or phrases that make sense to me), or are required but not therapeutically required (i.e., required by insurance companies for billing). I may also choose to leave out certain things from a chart because they are highly private and I don't think they are specific to the treatment, but I want to protect my client's confidentiality. For example, if I'm working with a client for anxiety that appears to be related mostly to a medical condition, I may opt to leave out the fact that my client discussed their homosexual lifestyle one session because it isn't directly related to our focus and therefore should remain private from anyone else who may read that chart. I want to be a counselor, not an informant.
A: Usually this is a real risk. Being a counselor, I know it's very hard sometimes to know how much to tell a client, and when. I also have to figure out if it's helpful to share that information, for the client, rather than just sharing clinical tidbits or jargon that makes sense to only me.
When working with someone who might have Dissociative Identity Disorder, this is a very complicated process. If the therapist tells too much, too soon, then people in the system may feel like the therapist "knows too much" (unsafe), "told my secrets" (untrustworthy), or worse "doesn't know what they are talking about!" (disconnected, not listening, not a good counselor, making up illnesses, pushing medications, etc.). The reactions from clients could be firing the therapist, refusing to seek outside help from referral sources (like medications), increased self-harm or suicidal thoughts, or severe loss of progress and trust in the counseling relationship.
Counselors should be able to tell you some basics, like what is my current diagnosis, are we making progress, are we a good fit, do we have an agreed upon set of boundaries or rules that both sides feel comfortable with, is medication an option or even recommended, are there other types of treatment or self-care things I can be doing to help my recovery?
I also don't like to share my notes because they are hard to read (handwriting), hard to understand (usually fragments or phrases that make sense to me), or are required but not therapeutically required (i.e., required by insurance companies for billing). I may also choose to leave out certain things from a chart because they are highly private and I don't think they are specific to the treatment, but I want to protect my client's confidentiality. For example, if I'm working with a client for anxiety that appears to be related mostly to a medical condition, I may opt to leave out the fact that my client discussed their homosexual lifestyle one session because it isn't directly related to our focus and therefore should remain private from anyone else who may read that chart. I want to be a counselor, not an informant.
Tuesday, March 22, 2011
Is DID a lifelong diagnosis?
Q: Is the diagnosis of DID a lifelong diagnosis? - Anon
A: It depends on what your goal is in treatment (integration or healthy co-functioning). When many people ask this question what they are really wanting to know is if the trauma ever heals. Do the bad memories ever stop being so close to the surface?
"Time heals all wounds" can seem like a vicious lie when you are a survivor or have Dissociative Identity Disorder. One of the main problems with that saying is that time doesn't move normally when you have trauma in your life. It's hard to " just forget" or " move on" when parts of your brain are actually functioning as if they are still in the middle of the traumatic experiences. And research on PTSD and Trauma that looks at trauma processing and neurological functioning show this to be the case.
Recovery is slow and usually incremental. It may be hard to realize how far you've come in recovery. But those around you may see dramatic differences because they aren't living inside the chaos everyday. Add to that the issues that you face AFTER you get through therapy to process the trauma, learn to not rely on dissociation to cope, and then the time you may spend seeking integration. These can include recovering from addictions, learning coping and life skills, and learning to have health relationships and support network in your life. Recovery may be lifelong.
But yes, I have seen in myself and others that you can move from a place of chaos, abreactions and flashback, PTSD and frequent triggers to a healthy place. You can reach a point where you actually have a hard time retrieving some of the same memories that used to jump into your mind whenever they wanted. It's wonderful when you are able to control your memories instead of them controlling you.
Some people are afraid of losing memories. Don't be. When you move out of the "stuck in trauma overdrive" into a place where memories are stored naturally, then you do lose some of the details. But you don't lose the gist. You don't forget that you were hurt. You just forget the intense details that act as triggers such as specific smells or fabrics. And normal, healthy people do not have access to as many detailed memories as traumatic abuse survivors. Part of that is functional - the brain removes memories that are no longer needed to make room for new learning and new memories. Wouldn't you rather have that room for some newer, better, happier memories? Another part of it is consolidation - memories that are of similar events may be merged into more generic memories. For example, remembering abuse that occurred repeatedly but now no longer able to remember them each individually.
So Dissociative Identity Disorder will stay around as long as it is needed, or it can be improved and possibly ended through the hard work of recovery. Some people claim their alters just "went away" but all the times I've seen that they have actually suppressed their memories and alters and run the risk of it all coming apart again. They aren't done with recovery, they are in denial.
A: It depends on what your goal is in treatment (integration or healthy co-functioning). When many people ask this question what they are really wanting to know is if the trauma ever heals. Do the bad memories ever stop being so close to the surface?
"Time heals all wounds" can seem like a vicious lie when you are a survivor or have Dissociative Identity Disorder. One of the main problems with that saying is that time doesn't move normally when you have trauma in your life. It's hard to " just forget" or " move on" when parts of your brain are actually functioning as if they are still in the middle of the traumatic experiences. And research on PTSD and Trauma that looks at trauma processing and neurological functioning show this to be the case.
Recovery is slow and usually incremental. It may be hard to realize how far you've come in recovery. But those around you may see dramatic differences because they aren't living inside the chaos everyday. Add to that the issues that you face AFTER you get through therapy to process the trauma, learn to not rely on dissociation to cope, and then the time you may spend seeking integration. These can include recovering from addictions, learning coping and life skills, and learning to have health relationships and support network in your life. Recovery may be lifelong.
But yes, I have seen in myself and others that you can move from a place of chaos, abreactions and flashback, PTSD and frequent triggers to a healthy place. You can reach a point where you actually have a hard time retrieving some of the same memories that used to jump into your mind whenever they wanted. It's wonderful when you are able to control your memories instead of them controlling you.
Some people are afraid of losing memories. Don't be. When you move out of the "stuck in trauma overdrive" into a place where memories are stored naturally, then you do lose some of the details. But you don't lose the gist. You don't forget that you were hurt. You just forget the intense details that act as triggers such as specific smells or fabrics. And normal, healthy people do not have access to as many detailed memories as traumatic abuse survivors. Part of that is functional - the brain removes memories that are no longer needed to make room for new learning and new memories. Wouldn't you rather have that room for some newer, better, happier memories? Another part of it is consolidation - memories that are of similar events may be merged into more generic memories. For example, remembering abuse that occurred repeatedly but now no longer able to remember them each individually.
So Dissociative Identity Disorder will stay around as long as it is needed, or it can be improved and possibly ended through the hard work of recovery. Some people claim their alters just "went away" but all the times I've seen that they have actually suppressed their memories and alters and run the risk of it all coming apart again. They aren't done with recovery, they are in denial.
Saturday, March 19, 2011
Suicidal? Get help from the professionals!
Two social networking type sites that I frequent have had serious suicidal gestures from users this past week or two. And these aren't support type sites. I have mixed feelings about this.
On one hand I am grateful they said something that raised eyebrows and got other users to inquire deep enough to get to the root issue - suicidal thoughts with intent. On the other hand it frustrates me that people reach out in these secretive ways in places they know their comments could easily be overlooked as just stress or a bad day. After all, these sites aren't run by or moderated or otherwise staffed with professionals.
Maybe I'm also a bit jaded after having been around so many people who claim or even threaten suicide as a form of emotional distress or sometimes manipulation. Most of the time these folks have no intent, no plan, and are just acting up to reach out. But each false "wolf call" makes us all more jaded and unresponsive. And that makes us ready to lash out, belittle, ignore, or punish the next person who may be much more lethal and serious.
I've been in that suicidal place. I know how hard it is to reach out and also the fear of reaching out. And it's a battle you don't have the energy for when you're suicidal. But please, reach out to people who can help. Or be honest and tell your friends that you're suicidal and need them to help you find the pros. A hotline, 911, a hospital emergency room, anything but a covert remark on a social networking site that can easily be missed, misunderstood or seen too late. Your life is worth more than kinda-sorta asking for maybe-if-it-is-not-a-bother help.
On one hand I am grateful they said something that raised eyebrows and got other users to inquire deep enough to get to the root issue - suicidal thoughts with intent. On the other hand it frustrates me that people reach out in these secretive ways in places they know their comments could easily be overlooked as just stress or a bad day. After all, these sites aren't run by or moderated or otherwise staffed with professionals.
Maybe I'm also a bit jaded after having been around so many people who claim or even threaten suicide as a form of emotional distress or sometimes manipulation. Most of the time these folks have no intent, no plan, and are just acting up to reach out. But each false "wolf call" makes us all more jaded and unresponsive. And that makes us ready to lash out, belittle, ignore, or punish the next person who may be much more lethal and serious.
I've been in that suicidal place. I know how hard it is to reach out and also the fear of reaching out. And it's a battle you don't have the energy for when you're suicidal. But please, reach out to people who can help. Or be honest and tell your friends that you're suicidal and need them to help you find the pros. A hotline, 911, a hospital emergency room, anything but a covert remark on a social networking site that can easily be missed, misunderstood or seen too late. Your life is worth more than kinda-sorta asking for maybe-if-it-is-not-a-bother help.
That's not my name!
On Second Life I heard a song called "That's not my name " by the Ting Tings. It was an instant hit inside. Not only do we have a name that is difficult for many people to pronounce because it's unusual, but then you add in the Dissociative Identity Disorder. How often do you have someone inside who wants to argue that they aren't the body's name? How often do they want to have that argument when it's an outside person you'd never in a million years admit to being MPD to?!
Anyway, if you haven't heard it, or just want to see a really cool and cute video of the song, check out this SL of it:
http://chaffro.blogspot.com/2008/11/fuzznutz-music-video.html
Anyway, if you haven't heard it, or just want to see a really cool and cute video of the song, check out this SL of it:
http://chaffro.blogspot.com/2008/11/fuzznutz-music-video.html
Friday, March 18, 2011
Still alive!
Sorry we vanished there for awhile. I hate when that happens!
We have been dealing with some chronic illness and major job stress stuff for the past year. I am really shocked at how bad this past year has been. But we have survived. Yay.
I have felt very dissociated at times, and very empty at others. I think this crisis has caused more dissociation, less co-awareness, and few people wanting to be out. Most of us don't like pain, so when the body is stuck in chronic pain it's hard to get any volunteers. I can't blame them, I'd leave too.
But I am trying to keep the house running and the job stuff going. It's taking all the energy I have to keep my head above water. So it's hard to help mom and hubby through their own struggles now too. I feel bad about that. But I keep hoping that it will improve. For all of us.
So I have felt the need to write again so maybe that means people are willing to talk inside and outside again. See you soon!
We have been dealing with some chronic illness and major job stress stuff for the past year. I am really shocked at how bad this past year has been. But we have survived. Yay.
I have felt very dissociated at times, and very empty at others. I think this crisis has caused more dissociation, less co-awareness, and few people wanting to be out. Most of us don't like pain, so when the body is stuck in chronic pain it's hard to get any volunteers. I can't blame them, I'd leave too.
But I am trying to keep the house running and the job stuff going. It's taking all the energy I have to keep my head above water. So it's hard to help mom and hubby through their own struggles now too. I feel bad about that. But I keep hoping that it will improve. For all of us.
So I have felt the need to write again so maybe that means people are willing to talk inside and outside again. See you soon!
Friday, May 09, 2008
Treatment guidelines?
Q: How is Dissociative Identity Disorder treated? What about children who have DID? - Peter
A: The International Society for the Study of Trauma and Dissociation have created treatment guidelines for Adults and Children with Dissociative Identity Disorder. These documents which cover diagnosis, assessment, and treatment information can be attained here.
Additional books that may be useful include:
Dissociative Identity Disorder: Diagnosis, Clinical Features, and Treatment of Multiple Personality by Colin A. Ross
Not Trauma Alone: Therapy for Child Abuse Survivors in Family and Social Context by Steven Gold
Rebuilding Shattered Lives: The Responsible Treatment of Complex Post-Traumatic and Dissociative Disorders by James A. Chu
A: The International Society for the Study of Trauma and Dissociation have created treatment guidelines for Adults and Children with Dissociative Identity Disorder. These documents which cover diagnosis, assessment, and treatment information can be attained here.
Additional books that may be useful include:
Dissociative Identity Disorder: Diagnosis, Clinical Features, and Treatment of Multiple Personality by Colin A. Ross
Not Trauma Alone: Therapy for Child Abuse Survivors in Family and Social Context by Steven Gold
Rebuilding Shattered Lives: The Responsible Treatment of Complex Post-Traumatic and Dissociative Disorders by James A. Chu
Monday, May 05, 2008
Diagnosis from MMPI?
Q: Can you diagnose Dissociative Identity Disorder from an MMPI? - Anna
A: Dissociative Identity Disorder can not be diagnosed from an MMPI.
The MMPI was originally designed to measure the following symptoms/disorders:
1 Hs - Hypochondriasis
2 D - Depression
3 Hy - Hysteria
4 Pd - Psychopathic Deviate
5 Mf - Masculinity–Femininity
6 Pa - Paranoia
7 Pt - Psychasthenia
8 Sc - Schizophrenia
9 Ma - Hypomania
0 Si - Social Introversion
Over the years, people have found that they can measure other symptoms/functioning using the same questions, and have created other scales (measuring protocols). They are too numerous to list here, but you can see them all here. Post-Traumatic Stress Disorder is one of these additional scales, so it may be diagnosed from the MMPI.
A: Dissociative Identity Disorder can not be diagnosed from an MMPI.
The MMPI was originally designed to measure the following symptoms/disorders:
1 Hs - Hypochondriasis
2 D - Depression
3 Hy - Hysteria
4 Pd - Psychopathic Deviate
5 Mf - Masculinity–Femininity
6 Pa - Paranoia
7 Pt - Psychasthenia
8 Sc - Schizophrenia
9 Ma - Hypomania
0 Si - Social Introversion
Over the years, people have found that they can measure other symptoms/functioning using the same questions, and have created other scales (measuring protocols). They are too numerous to list here, but you can see them all here. Post-Traumatic Stress Disorder is one of these additional scales, so it may be diagnosed from the MMPI.
Saturday, May 03, 2008
Do all memories need to be recovered?
Q: Do all our memories need to be recovered and processed to heal? - Tom
A: No, not at all. If that was the case, you'd probably spend a VERY long time in counseling and miss out on a lot of the life you could be living NOW! You have to remember enough to know what happened, why you have parts, and what needs to be done to feel safe again. Most Multiples have gone through repeated abuse events, sometimes with more than one abuser. Each abuser has to be addressed in counseling, but many of the types of abuse events were repeated. As you deal with a few memories related to one abuser and one type of abuse event, you'll also be dealing indirectly with the other similar events (and usually the same alters). Some memories stand out as major turning points, major traumas, or other life-changing events which tend to require a lot of processing in therapy so not all memories are created equal!
A: No, not at all. If that was the case, you'd probably spend a VERY long time in counseling and miss out on a lot of the life you could be living NOW! You have to remember enough to know what happened, why you have parts, and what needs to be done to feel safe again. Most Multiples have gone through repeated abuse events, sometimes with more than one abuser. Each abuser has to be addressed in counseling, but many of the types of abuse events were repeated. As you deal with a few memories related to one abuser and one type of abuse event, you'll also be dealing indirectly with the other similar events (and usually the same alters). Some memories stand out as major turning points, major traumas, or other life-changing events which tend to require a lot of processing in therapy so not all memories are created equal!
Are my memories true?
Q: How do I know if my memories are true? - Jane
A: That is a question survivors ask themselves and their counselors over and over again. Unfortunately, there isn't an easy answer. No one can be totally sure of the accuracy of all of their memories unless they have been followed by video cameras their entire lives! So save yourself the torture and accept that your memories, and the memories that your alters have, are true... but they may not be accurate.
What that means is they are true to the personality that has them, but they may contain inaccuracies such as:
1. Symbolic material that helps convey emotions, memories, fears, and other information,
2. Combination of more than one similar event into an amalgam that appears to be one memory,
3. Deception or misinformation purposely added by the perpetrators of abuse to further scare, manipulate, discredit and silence the victim,
4. Merging of real events with internal imagery used to dissociate (for example, being abused by the child imaging they were really somewhere else taking a hot air balloon could create a memory of being abused while in a hot air balloon,
5. Blocking of information or denial which removes some of the events, emotions, or sensations involved in the original event.
The key is using therapy, internal dialogue, journaling, and other methods to help distill the truth of the memory, the emotional content of the memory, and how the information needs to be handled in order to help heal from the damage. Therapy should not be seen as an arena to gather memory evidence to use in court against your perpetrators, but rather a place to let every part of yourself be heard, validated, and thanked for helping you get through difficult times and confusing emotions.
A: That is a question survivors ask themselves and their counselors over and over again. Unfortunately, there isn't an easy answer. No one can be totally sure of the accuracy of all of their memories unless they have been followed by video cameras their entire lives! So save yourself the torture and accept that your memories, and the memories that your alters have, are true... but they may not be accurate.
What that means is they are true to the personality that has them, but they may contain inaccuracies such as:
1. Symbolic material that helps convey emotions, memories, fears, and other information,
2. Combination of more than one similar event into an amalgam that appears to be one memory,
3. Deception or misinformation purposely added by the perpetrators of abuse to further scare, manipulate, discredit and silence the victim,
4. Merging of real events with internal imagery used to dissociate (for example, being abused by the child imaging they were really somewhere else taking a hot air balloon could create a memory of being abused while in a hot air balloon,
5. Blocking of information or denial which removes some of the events, emotions, or sensations involved in the original event.
The key is using therapy, internal dialogue, journaling, and other methods to help distill the truth of the memory, the emotional content of the memory, and how the information needs to be handled in order to help heal from the damage. Therapy should not be seen as an arena to gather memory evidence to use in court against your perpetrators, but rather a place to let every part of yourself be heard, validated, and thanked for helping you get through difficult times and confusing emotions.
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