In this blog article, I’d like to hear your opinion.
Mostly, I’d like you to hear your opinion! Your opinion about YOUR perfect treatment plan is very important. Have you thought about what you might like or need?
If you think about it now, you might be able to express that better to your therapist or to the various mental health professionals in your area.
It’s very clear that the mental health professionals out in the world do not agree on treatment goals for Dissociative Identity Disorder (DID / MPD). For that matter, the mental health professionals of the world do not even agree that Dissociative Identity Disorder is a real and legitimate diagnosis, let alone agree on how to best work with trauma survivors with dissociative issues.
The disparity of perspectives and lack of education, training, and knowledge about dissociative disorders means that therapists take all kinds of different tactics in their approaches.
Obviously, some of these approaches are more effective than others.
After reading the hundreds of comments on the different articles on this blog, it is very clear that many dissociative survivors are not feeling completely satisfied with their healing process.
There are various limitations and obstacles in the way of having optimum treatment.
Many of you have written about some wonderful therapeutic experiences, but plenty of frustrations have also been included.
Please note: I am not asking about your therapist’s personal faults! Please don’t use this blog as a way to bash your therapist.
I’m actually asking the opposite.
Dream big for a minute.
If there were no limitations preventing you from having the perfect treatment plan for DID, what would that include?
In my opinion, those of you that have DID or live with someone with DID are the experts here.
You are much more knowledgeable about DID than the mental health professionals are and you know what genuinely works for you and what doesn’t.
So, in order to get an better understanding of what works best for the treatment of DID, I’d like to hear from a bunch of you.
You are the true experts here on what works.
You all know what you need to get through your healing. You know what helps and what doesn’t help at all (even if the mental health professionals insist on doing it that way).
Obviously what works best for one person may be a very different list of options than what works best for someone else, which is completely okay.
Everyone’s opinion is welcome and no one will be more right than anyone else.
Your comments would be appreciated, and your ideas as a collective group will be important.
The comments you write could send a message to the trauma therapists of the world and hopefully help them to hear what actually works, from your perspective.
If you could design your perfect treatment plan for DID, what would that look like?
- How many times per week or per month would you meet with your therapist?
- How long would your sessions be?
- What kinds of things would happen in your sessions?
- What artistic or creative therapies would you include?
- Would your sessions be inside of an office or anywhere else?
- What time of day would your sessions occur – morning, afternoon, evening, or night?
- Besides your therapist, who else would you want to have on your treatment team?
- Would you include any kind of group therapy in your treatment plan?
- What kinds of approaches would you want your therapist to use?
- Who from your DID system would be allowed to speak and present up front during your sessions?
Any other thoughts, comments, or ideas are welcome!
Post your comments below.
And of course, I wish you the best in your healing journey.
Warmly,
Kathy
Copyright © 2008-2018 Kathy Broady MSW and Discussing Dissociation
Why does it feel like we’ve answered this question before?
How many times per week or per month would you meet with your therapist?
– twice a week would be ideal, or ideally on demand when we are having our worst days
How long would your sessions be?
– probably 90 minutes, we often go over time by ten minutes or so currently so obviously an hour isn’t enough.
What kinds of things would happen in your sessions?
– probably the usual thing but we’d be interested in exploring other things as well. we have found ourselves, for example, having a need to get up and go hide in the corner of her office but never actually have. Maybe if we felt we were allowed to do so it might let some of our insiders feel more accepted. we have felt our littles retreat during session when they likely needed to be heard.
What artistic or creative therapies would you include?
– we would include things specifically for our littles, drawing for example. Mouse and Tee barely talk but they have made drawings of what happened to them
Would your sessions be inside of an office or anywhere else?
– we would prefer a modern office, not her current one, which is in an old house with too many doors and closets. we have had to ask her to open the closet door to make sure there aren’t any monsters hidden there. We have a dream of going to Walt Disney World with our therapist, we feel it would be very healing. Sometimes we want to sit on the floor so maybe if that was possible it could help.
What time of day would your sessions occur – morning, afternoon, evening, or night?
– we like the current time of six PM but in the dark months not so much. during the winter an afternoon session would be ideal. Also, during the days when we have strong pre-therapy anxiety a morning session would be best.
Besides your therapist, who else would you want to have on your treatment team?
– maybe our crisis counselor and J____ from the mental wellness centre. We feel very comfortable with them.
Would you include any kind of group therapy in your treatment plan?
– absolutely not. we’ve been in group therapy when in a psychiatric hospital for two years and it was a complete nightmare. We still have flashbacks about it. We DO participate in peer support group at the wellness centre but that is a very safe environment for us and it is specifically structured so it isn’t triggering.
What kinds of approaches would you want your therapist to use?
– we have heard of play therapy, would like to try that or anything else that could help our littles. We do EMDR too.
Who from your DID system would be allowed to speak and present up front during your sessions?
– everyone!
We’d like to add that we are very happy with our therapist. After decades of not receiving the proper help we so desperately needed, we finally have someone who understands trauma and, more importantly, BELIEVES us. We have suffered too much abuse from supposed professionals over the years. It is so nice to NOT have to try to explain ourselves yet again, something we find ourselves having to do nearly every time we call crisis. “We, what do you mean we?” it is so frustrating. At least the local CMHA crisis people know us and our disorder, particularly our crisis counselor, but nobody else does, not even our psychiatrist, but he does seem to have changed his mind somewhat about us recently. That’s probably because the last time we ended up at the hospital we had switched into Alia and it was pretty obvious that we weren’t Daria and the crisis nurse took a lot of notes while talking to us.
Because I am so bouncy right now – it is hard to know how to answer some of these….
I DO know that I wish the sessions were longer than the 50 minutes….preferably 1 1/2 to 2 hours – depending on what is happening……
I would like the option of meeting 2 x per week if needed……
I am fine with meeting in an office as long as no one else around anywhere can hear me…..
I REALLY wish there was a professional NEUTRAL person at work to help me process all that I get hit with during a work shift…I get bouncing between Inside and Outside triggers so much I can’t tell which is the “real” world I am dealing with…..Because there is so much confusion, I need a SAFE direction to bounce stuff off on so I can see if I am being “TOO sensitive” or if I am “seeing” things correctly…..But such a person does NOT exist in a workplace….what there is is connected to HR which then puts a target on you for dismissal….I spend so much of my session time with T trying to process triggers at work that I don’t have time to get to the “root stuff”…..but if I don’t get to process work stuff – I may find myself just walking off the job….NOT good….I don’t know how there ever COULD be such a person in a workplace…someone who understands my “diagnosis” and can help me get through a workday….a “life-coach” doesn’t quite cut it….it needs to be much deeper…….
I have often asked T about some type of Group Therapy…but no such group for people dealing with dissociation exists in my area…..a chance to VOICE what I deal with with someone other than T would be an interesting step…..probably a lot of upheaval….but I think a necessary one…….
I think that whoever feels the need and has the bravery to step forward should be allowed to….Right now it is only the very young or Rage who will speak up…..I can sense others “watching’ – but they are not brave enough yet……They should not feel afraid of “repercussions” if they do step up…….
MissyMing
06/07/20
No Retirement
We are losing another good therapist to retirement
Most of us like the cochair that we been working with
What makes a good therapist some of that doesn’t retire
Lori says everybody dying everybody retires and dies
Not everybody can be young forever like me or Jessie
She keeps telling me yes Belinda is still a good therapist even when she retires just like Karen was a good therapist and she retired
So Karen Retired the system and her made a quilt together. Belinda and Jessie are making a book together
So I guess a good therapist Thats getting ready to retire will do a special project
Something to remember all the hard work together
It won’t feel like alone.
We always use Karen quilt.
This is from a poll of everyone inside. so this is some of their comments
3 times a week in person for 1/2 the day
exsept for jadie who say all day all day all day
work hard hard hard but also have fun
go early
eat lunch together. pizza or chinese food or just about anything exsept mexican food
or make soup (that be asher)
go for walks
play games
play with pets
go to the zoo
go to the batting cages!!!
swim in the ocean
play in a river
go to the botanical gardens
do art therapy like paint or color
go horse back riding!!
all the hole time we talking but also take breaks for fun
These answer are based on the personal experiences. The Shell has had very good therapist.
How many times per week or per month would you meet with your therapist?
Answer: 2x a week is great. Then once a month we meet with her co-chair I find this to be very adequate for our needs
How long would your sessions be?
Answer: I’m find that one hour is not enough to get the needs meet. We always go over. I also think she should be able to bill for family therapy . More often then not she will have contact with at lest two in one session .
What kinds of things would happen in your sessions?
Answer: a lot of talk therapy , and also is geared to who is present at the time. Or what kind of work the system feels like doing that day. Mostly we take charge of our time. We get to control ourselves we are not in the grips of another Authority figure telling us what to do. sometime we go out for walks, we play, talk about the traumatic events that have happened. We make contacts we discuss how to change things. We have never been told what we have to do or should do. It’s always been “what would you think would happen if you tried this or that.
What artistic or creative therapies would you include?
Answer: I think I would want art therapy
with music We did this in the hospital once. It felt good just expressing anger through scribbling. when words don’t know how to come out.
Would your sessions be inside of an office or anywhere else?
Answer: it should be adapted to the needs at the time or the topic that is being worked on. If your working with person that has issue around food. Then take them to a place to help that. Many years ago we did trips to the grocery store The exposure therapy was hard but effective . If a client doesn’t know how to play or have fun teaching show them . Exposure therapy should be a big part Exposure to emotions so we can see that they were OK and we will not continue to be punished for them
What time of day would your sessions occur – morning, afternoon, evening, or night?
Answer: the last one of the day. So if more time is need that can happen.
Besides your therapist, who else would you want to have on your treatment team?
Answer: a cochair that we see at lest once a month. So if for any reason our main therapist is un available she up to date: with who we are and what we are about . A connection has already been made so crisis can be diverted . On call person that is knowledgeable with D.I.D Spouse or a close friend.
Would you include any kind of group therapy in your treatment plan?
Answer: yes!!!!! When you can connect with other that are similar . You get to create other supports avenues
What kinds of approaches would you want your therapist to use?
Answer: it would be based on whom is in front of her. Age appropriate , mental capacity, To be tough or gentle when needed.
Who from your DID system would be allowed to speak and present up front during your sessions?
Answer: all
I’m impressed, I have to admit. Rarely do I come across a blog that’s both educative and interesting, and without a doubt, you have hit the nail on the head. The problem is something which too few men and women are speaking intelligently about. Now i’m very happy that I came across this during my search for something concerning this topic.
* “Never about me without me”
My biggest issue with mental health here in NZ is that I’m assumed to be “out of my mind” and therefore my own opinions and experiences and knowledge about my own wellness are taken to be invalid. It’s a dictatorship, and that is primarily what needs to change. I can’t get any help from the public system because they primarily focus on medications, medications that our body reacts very badly to, but they won’t believe us when we tell them about this reaction (a reaction that would likely kill us)… they believe utterly that they’re the only one with valid information about our situation. That only adds to our times of unwellness, we’re unwell /because/ someone’s ego was more important than our needs.. why would anyone think such attitudes would help?
Beyond body autonomy and being treated like a sentient adult…
We’ve had this fantasy about a treatment system for a while where each patient has a team. Each of the members of that team serve a particular function. They start off by everyone getting to know everyone and making sure everyone’s comfortable with everyone (nothing worse than a treatment professional you don’t feel like you can trust or are safe with). And a treatment plan is built for each System from scratch based on their specific needs and difficulties.
There would be therapy for every member of a System, to meet the needs and difficulties of each member of the system, instead of only focusing on the needs and difficulties of the entire system.
There would be dynamic needs-based respite care, not just for crisis times, but also have it available for specific treatment phases, like, we need to help our Littles to process their trauma, but we can’t do that as an out patient without seriously impacting our normal functioning (if a kid pushes into In Front and knocks out the adult, a completely mute five year old, for example, can’t cook dinner or socialise with friends or do most of the normal day to day adult functions).
There could be specialists on the team for the specific needs of the system or individual members of the System.
Like… we need proper socialisation but we also need to learn how to manage the attachment and trust issues, if we had a paid “friend” on the team who could help us manage and heal the attachment issues, help us see what a “normal, healthy” friendship looks like, but day to day like maybe they’re also a flatmate or something, then we could learn what we need to learn to understand and healthily participate in relationships. Like a set of friendship “trainer wheels” for say six months to a year, to help us learn what we need to have functional, healthy relationships on our own.
Maybe we could have a sort advocate available to be on the team too, because I don’t know about anyone else, but we find that we often can’t fight for our own rights and needs with other organisations that have authority over our life when we’re not well (it’s almost impossible when ARE well). Like an advocate who could do the phone calls that we can’t, they could talk to the doctor, or social welfare, or specialists… they could help communicate in the contexts where we can’t, and help put down our boundaries with such groups as well, and in the process (where possible), show us how to do that ourselves.
But have multiple roles that can be played, a “paid friend” and “advocate” are just the roles that come into mind with regards to our specific needs, others will have their own different needs, and I’d love to see each team constructed based on the specific needs of each System, instead of this clone treatment plan crap that’s currently in popular circulation.
A truly System-oriented treatment. Constructed for the System and the members of that system and what they need, but also, that they choose. None of that unilateral stripping of rights and dignity and privacy that is the old mental health model.
Hi,
First of all, thank you ‘just us’ and ‘nobody’ for posting on this blog. I am always amazed how the universe (God if you are so inclined) speaks to me through your postings friends. I know that I have read a lot on this website (I think all?) but much of it does not stick. So, when one of you points me back to a blog that I have not visited in a while, I am always thankful for the light that you shine on a corner of the website that has gone dim.
Then you find inspiration and wisdom in other’s postings that I am not familiar with or cannot remember. I was inspired to read Winter’s Keeper’s postings as well ‘just us’. I think that the bottom line was — there are good therapists and not so good therapists – and, sometimes it is all about where we are in our work and our willingness to embrace the ‘teachable moment’. What I especially liked about Winter’s Keeper’s postings was these key (in my mind) points:
• “… treatment doesn’t have to be perfect to achieve it’s goal.”
• “I am grateful to every last treatment professional that I encountered on the way for what they taught me.”
• “The one thing I did not do, and the therapist I ended up with did not do, was give up. In the end that was probably the single most important thing.”
To tell you the truth ‘just us’ and ‘nobody’, I have found reading the responses to this blog too difficult. Maybe because a big part of me would say that my ideal treatment would be to go and live with my T 24/7 and have continual access to her, fun with her, creative time with her, total access to her during all of my rough times during the week, etc. But, that is clearly not possible, sensible, realistic or healthful to me not to mention her.
I see my T once a week for an hour session. I find that, regardless of how difficult it is to wait (my little ones count the big sleeps until our next session) I do important work in between as I marinade in what I learned in my session. Often, I feel that it is a very good thing that I have the time to process what I have learned before launching into more with her … because, more is always what happens with her.
I would say that my T is more traditional in approach but she is open to ideas. So, I am thinking that maybe you could suggest some stuff to your Ts ‘just us’ and ‘nobody’ or bring some stuff to the office. I have a stuffed dog in my purse at all times but my T bought one for her office to have for my little ones. She even let them name the dog. She (the stuffed dog) is always there for us. My T encourages us not to be shy or embarrassed by holding the stuffed dog (she holds it sometimes herself). She also has a picture of her horse that the little ones can ask to see. I brought in lego for my one boy alters who likes to build when he talks. She keeps it on the table beside the chair that I sit in. There are also rocks to hold (another boy alter’s thing) although I also carry one with me in my purse. She encourages me to bring in pictures the little ones have coloured to talk about them and journals (although that does not work for me).
What I am saying here is maybe you can initiate some of these ideas/activities with your T. Maybe they will be receptive … maybe not. In the end, it will just be a bonus if they do get on board with your suggestions.
ME+WE
04/17/2018
It has been so nice and yet so sad to read all these posts. There are so many people here seemed to find real help and still so many lost. I cant blame it all on therapists like some feel it is but I can see where the therapist fear can and do stop them from doing some stuff that may help for so many persons.
I am one that think like those that dont think they can ever have relief because my need is to much for any therapist. I have also had many therapists over the years between office therapy and inpatient/partial hospitalization. I have occasionally made progress with finding new coping skills and working on the emotional control rules, but the relief was never lasting long and never really helped me inside, just helped me control what the rest of the world could see.
My current therapy is most normal I think with two meetings per week except I do stay for 90 minute meetings instead of the 60 min. We do traditional talk with what I guess are special things for trying to find new ways of thinking about things, dealing with things that happen and emotions that come up but it just seems like we do the same things over and over again with each new thing that happpens. I don’t know about everybody else because I didnt see anybody mention it here, but one thing I notice that causes me real trouble is that my therapist seems to think that when I say something about a problem or something that worry me or an issue and she responds or we talk about it a little while, it is fixed and over for me or at least it should be. She has even gotten a little upset at me a few times because I repeat something we already talked about that day or earlier and says I shouldn’t be thinking about it or having a problem with it anymore because we already talked about it. Since I know it upsets her, I try to pretend that things are all better after we talk about something once and just hide it after that. I think this is pretty traditional nowadays, but she did give me her email address so I could email her if I needed help at home, but I don’t do that because I know that if I start to do it then she will get upset later and tell me I am doing to much. Other then that, my sessions are pretty much how I have always heard other peoples are until I read this here. I sure wish my therapist would read this and believe the stuff people said might help and we could try it because I just don’t think anything is helping the way it is now. I dont know if stuff like yous said here would really help me either but it makes me cry and want it super bad. I cant say exactly what would be good or help me cause I dont know for sures but I will try to see what I think would be better the now is.
Go 4 time week but I really want to say 5 but I know that would be way no chance but the days alone are so bad and least the days I get to work with my therapist are easier to not hurt myself before the day is over to get away from all the pain. Some days I sits in my window and watch people outside all day and it all hurts so bad.
We would still do an hour half and again I want to say two hour but same thing before that I know that way to much to ask. Maybe more the anything else here even, I agree with the people say that one hour isn’t enough to talk to my therapist cause it so hard to talk and I dont think she really understands just how hard it is even though she said she does. I am glad she lets me do the hour half now because it is still hard but I bet it be impossible if she only did one hour.
I dont know what we would do that would really help. I would love to do some of the things people talked about like painting things, doing sand or playdo or all that kinds of stuff with my therapist but I wouldnt do it if she just said here it is and you can do it. If she did stuff with me I want to do it but I feel silly wanting to do it all ready so I think it would feel silly to do it but if she did to then I want to. I didn’t read much people talking like they want to play big games like board games or card games or even games like Wii or Xbox, but I would so love to even do these kind of things. I know that doesn’t sound very much like therapy maybe but just even being able to have normal kind of fun in life every once in a while would be great. I am so isolated in life and there is nobody that I have ever been able to do things that other people think are normal like that. I watch people do it on tv and want a chance to do those kind of things so bad and even cry because I just want to play a game with someone and that seems so crazy but I want it so bad. Sometimes I wonder why therapists are so strict on what they will do with people because maybe some of us are going to live and die and never got to do some of these kind things because if there is nobody in the world that want to be around with us and our therapist believe it is wrong to do these kind of things because it isnt what is write, then we will just never get to even do those kind of things that could be happy for a minute.
I like the late meeting because it is closer to night time and that is the hardest time and sometimes I can pretend that I just left my therapist and she is still there and talking to me when it gets worse.
I dont think groups of people would be good at all.
The people that can talk to the therapist will be anybody she wants to talk to. I dont understand a lot still and I can feel some that she talks about and I only know one person else but I dont know the other people she said she talk to sometimes so I dont know who would talk to her. She said it ok that I dont know them yet but she knows there names and she said she can talk to them when she wants to and sometimes they want to talk to her and that is ok I guess.
See I really dont know what would be good and really help but I sure wish something would cause it is so sad to be alone all the time and nobody that can help me and I dont really want to die like this and be alone for my whole life.
Hi Kathy!
What a great set of questions! Okay, my insight may be a bit different due to not only therapy but also going to school to be a therapist (yep, I’m in grad school).
* How many times per week or per month would you meet with your therapist?
2x/per week and 1x/month. Depending on what I was needing, possibly more. Currently seeing 3 therapists, getting ready to add 4. These two I see each week: One helps me work through life in general on current stuff that is impacted by past trauma, one helps with grief and past trauma. The third one I see 1x/month for art. The 4th one I will see 1x/month for EMDR.
*How long would your sessions be?
1.5 – 2hrs per session. 1hr sessions just aren’t enough time especially when it takes forever to open up. And yes, I will probably be the therapist who does standard 90min sessions with my clients instead of the typical 50-min session.
*What kinds of things would happen in your sessions?
I’m not exactly sure what is meant by “kinds of things”. I’m guessing what methods would be used in therapy. In that case, whatever is going on would probably dictate what type of methods need to be used: this could be a game, just shooting the breeze, doing some art, working on a collage together, etc.
*What artistic or creative therapies would you include?
Definitely art therapy. Play therapy would probably be helpful. Have used sandtray but that is challenging. Have not tried psychodrama or music so not sure how those would work.
*Would your sessions be inside of an office or anywhere else?
Both inside and outside the office. I have even done sessions via video chat (like with Skype) because I was not able to leave the house for whatever reason but needed a session.
*What time of day would your sessions occur – morning, afternoon, evening, or night?
I like morning time best but right now due to my class schedule, I schedule in the afternoons before I go to school because of the distance I have to drive to school. My therapists are in the same city where I attend school.
*Besides your therapist, who else would you want to have on your treatment team?
My psychiatrist and regular physician. Hey, my thought is it’s a team effort–takes a “village” to help with treating someone with DID because like having an internal city inside.
*Would you include any kind of group therapy in your treatment plan?
Most definitely! I have heard that people with DID do not need to attend a group. I say pish-posh! Of course a person needs to be stable, meaning not rapidly switching like a rolladex. I have done group as part of my course requirement (yes, there was an entire class on group therapy). I’ve also done group in the hospital and in treatment. I did quite well with it.
*What kinds of approaches would you want your therapist to use?
Definitely NOT use CBT or DBT. These seem to have a backfire effect. I think the approach would depend on the client. I’m still trying to figure out what works for me. So far, basic old talk therapy has been the best approach, and being allowed to process the trauma as it comes up.
*Who from your DID system would be allowed to speak and present up front during your sessions?
Whoever needs to talk. I still do not have control over the switching–meaning I can’t just flip a switch and have certain alters come forward. I still don’t know who comes out front or when it happens. I have no idea if that is even capable. I do KNOW what causes switching and what triggers cause it. I only know I’ve switched by what my therapist tells me and by how I’m feeling. Depending on what is going on in my body (the after-effects), I can tell who has been out as well.
I don’t know if I know what would be very helpful because I have been in therapy with the same person for over 10 years and am struggling almost as bad now as I was when we started.
My therapy has always been 2 days a week except my therapist was absent a lot for family issues over the years. We always meet in his office in the morning for 55 minutes. We mostly talk and have completed a couple of workbooks about DBT and how to control my emotions. We don’t do anything of the neat stuff people talked about here and I don’t think he would ever do that. I might do a group if I ever felt any better and nobody ever talks but me and he says that it isn’t good to let the voices talk because that will make them worse if he pretends they are real.
I don’t know what will help me but I do agree with what a lot of people said about there not being enough time in appointments because in the beginning I tried to make myself talk better but I would start to cry and he would sit silently in his chair until I got control of myself or the time ran out and I just had to go home crying and like somebody else said I had to fix things on my own by using bad coping skills. I just stopped talking much because it made it so hard to go home that bad and he wouldn’t help me except making me do the work books and they didn’t help. I have thought about changing therapists for a long time but it might just get worse. Reading what other people said their therapist does to help them makes me want to change more.
If I had a new therapist that like me then I think some of the things people have said here might help me. If it were somebody that I felt safe with I think having more days like maybe 3 or 4 because I want to get better and longer time might help me be ok to talk again also. I would like to try some of the creative things people said. I don’t know about methods because we only did the DBT books and I don’t know what is out there. I wouldn’t care when I went either. I really don’t know about who would talk because I still don’t understand what happens for real. Maybe I should try someone different and see if there is someone that would do the things people said here.
So sorry for your experiences! I tried DBT, and my T and I agreed to stop formal DBT until all my parts can be in the present. Since mindfulness is such a big component of DBT, and I dissociate out of the present too often, I was not benefiting from a DBT program directly, though we still have used some components over time, like wise mind, distraction, opposite to emotion, maintaining relationships, etc. I hope you can feel supported in your therapy. 2/9/18
Hi Crasandra,
I think that you have pretty much answered your own problem here — look for a new therapist. Please excuse my response if it sounds too blunt or out of line. That is not my intention. I do not mean to interfere. Of course you have to find what is best for you.
Three things struck me as a red flag in what you have said here.
1) You do not feel that you have made any progress in the ten years that you have worked with this T — you feel worse.
2) Your T will not speak to your insiders — personally I feel that that is a HUGE mistake.
3) You have seen the potential for approaches to therapy that you feel would work for you but that you know your current T would not participate in.
This is not to say that your T has not helped you to this point but maybe he is not the person for the job from this point forward.
Take it slow and be gentle and patient with yourself. What you are healing cannot be done quickly.
ME+WE
02/09/2018
Hi Crasandra,
Welcome to Discussing Dissociation, and thank you for your comment. I hear such pain in what you wrote! I have to agree with the feedback you are getting from the other community members here — after 10 years, I would seriously hope that ALL of my clients were feeling better, and feeling progress, and knowing that their healing was helping their lives improve. It doesn’t mean that life has to be perfect in 10 years, but it’s important to know without a doubt that you are growing, and learning, and things are getting better in at least a few areas of life.
I hope you continue to read here and get more information about what you can do to help your healing journey. I’m sorry to hear it hurts so much, and I really do hope you can find some healthy comfort for your pain.
Warmly,
Kathy
If you could design your perfect treatment plan for DID, what would that look like?
◦How many times per week or per month would you meet with your therapist? 4 times per week making certain there is Monday and Friday so there are not many days without help to handle on our own right now because things are bad.
◦How long would your sessions be? 2 hours
◦What kinds of things would happen in your sessions? talking, physical activities to get anger out, hypnosis, NO emdr because that was horrible for everybody because we got so emotional and our therapist just leaves us setting there trying to handle it all and we just can’t do it.
◦What artistic or creative therapies would you include? none, nobody deserves to be doing fun things
◦Would your sessions be inside of an office or anywhere else? inside
◦What time of day would your sessions occur – morning, afternoon, evening, or night? We don’t care
◦Besides your therapist, who else would you want to have on your treatment team? nobody
◦Would you include any kind of group therapy in your treatment plan? No way
◦What kinds of approaches would you want your therapist to use? We will try anything except emdr again
◦Who from your DID system would be allowed to speak and present up front during your sessions? Whoever the therapist wants to talk to.
This was a nice question but we think the therapist is more important then all that stuff and the things therapists aren’t suppose to do make it the worst. They aren’t supposed to talk about them self, they aren’t supposed to push you to help you do things, they aren’t supposed to touch you, they aren’t supposed to give you no presents, they aren’t supposed to just talk the truth to you and instead they play games with everything we say and try to turn it all into questions and used against us so we just don’t say much anymore or ever asks questions because it’s all so fake. There already is nobody we can trust and talk to and our therapist says we can trust her but she never just talks real so how can we believe her? It’s so hard when there is nobody that can handle how crazy we are and wants to be around us and when our therapist is the only person that is ok with us being around but then has so many rules she has to follow or she says she will get in trouble it is so hard. Nobody can be real with us or give us something to help us feel better or hold us nicely or call us and ask if we are ok or anything and when we don’t have anybody else that can be nice to us either and what kind of people are we if we can’t even pay somebody to pretend to care it is awful to even be alive.
Awesome sauce, we LOVE this idea. We will create our perfect idea to help us get better the fastest.
◦How many times per week or per month would you meet with your therapist?
We would have different days for different things: 2 days for olders to talk, 1 day for older activities, 2 days for the littles to play and talk to ms T
We would still get to talk on the phone to ms T when we the bad things happen in our head and hurt us and we can still send her texts and emails whenever we need to like we do now.
◦How long would your sessions be?
2 hours
◦What kinds of things would happen in your sessions?
Talk days would be talking about stuff that has been happening and the stuff that happened in the past and doing whatever work ms T says we need to help fix things.
The older activities would have things like big people games like cards, board games, crafts, painting, etc…
The littles day would be playing with things like toys, sand, play dough, silly putty, dolls, stuffies, and when we are super sleepy, maybe we could even have a short nap with ms T in the room because it is so hard to sleep at night sometimes because we are so scared and it is better with ms T in the room and maybe we could sleep good.
◦What artistic or creative therapies would you include?
older people will do painting, make creative things that mean something, maybe do ceramics, or knit with ms T because she likes to do that and could teach us.
littles would like to color, and markers, and cut things, and glue and clay, and make pretend animals like painting on rocks and leaves and stuff
any other idea ms T has because she is very creative and smart
◦Would your sessions be inside of an office or anywhere else?
we would be in both because sometimes we need to be in the safe room but maybe sometimes we could go to parks or lake or go out to eat or for a walk
◦What time of day would your sessions occur – morning, afternoon, evening, or night?
we like to go in the afternoon because it not so early and not to late that it get dark before we get home
◦Besides your therapist, who else would you want to have on your treatment team?
ms T wants us to go to somebody that helps with things that hurt the body but that doesn’t sound to good to us. we are ok with our psychiatrist and if there was somebody that wanted to help us but there is nobody that wants to be around us to help but that is ok and ms T says that someday people will like us when we are not mean to them anymore
◦Would you include any kind of group therapy in your treatment plan?
yes we would like a group of big people for the older people to talk to and a group of little people for the littles to talk to
◦What kinds of approaches would you want your therapist to use?
whatever ms T says will help because she is very smart and we do not know what will be good to help like that. A long time ago it was easier and we just talked to ms T and then played games and stuff with her but then later she said we had to start doing some other stuff that we do not like so much now. A long time ago she said we needed to work on some bad stuff that happened and so we did things where we kind of went to sleep and ms T said she helped people talk about that bad stuff that happened. That was ok because it did not bother us to much and people inside started being nicer sometimes and then we did not do the sleeping thing as much and ms T said we had to start talking awake now and that was super hard because we had to talk about bad stuff and sometimes we have to talk about it again and again and again and again. That is so hard and sad and sometimes very scary but ms T also calls and talks to us on the phone at home when we are doing the bad work days to make sure we are ok and she said it would start to feel better after we did that lots of times and she was right that we do feel better when we think about some of the bad stuff now but she said we will have to talk about a lot of the different bad things that happened lots of times to make everything start to feel better but she said she will help us keep doing it and we will not be alone and she will keep talking to us on the phone when we do the hard days and if we feel real bad and she says it will get better and better if we keep doing the hard stuff so we do not know what stuff would help best but ms T does. But even with adding the talking about bad stuff ms T still plays with all of us in fun stuff sometimes so that helps the bad times not be so bad so if we do that in the our way to get better plan it will be good.
◦Who from your DID system would be allowed to speak and present up front during your sessions?
we would all get turns to talk to ms T and she could tell us when it is each of our turn so she could help everybody fix what is broken inside
I do two times in week and it very hard and not help me much. Go for years and it stay still bad. I think three or four times be better to help not have so much time to try to be ok without hurt me but she say we have use hospital again if we need that much help to be ok at home so I try hard.
I try to talk but so hard and I am scared to start talk sometimes and try anyway and then it be time to go and I started talk to late and now it hurt inside to much and have go home so sometime just not let talk come out because it not be enough time and I never going to tell sad cause if sad come out and have to go home with sad out it will be to bad and when sad come out she sit in her chair and make me feel all alone with sad and that make sad badder cause she not care that I so sad and I make sad stop so she not just keep look at me and not want to help make it better. I need longer time to talk cause to scared to start talk lot times.
I want to be ok to talk to her and her help it be ok. I will do the stuff she says will help it all get better. I want her talk to them inside and make them be nicer and not be so mean. Her will help with the bad dreams in sleep and days. Her will play games and let us play with playdo and let us play with her toys like them other kids get to and let us have a teddy bear to hold when we are there and a teddy bear to take home that she puts magic spray on to help it feel better at home and teddy help us not hurt self at home.
I would like to do art stuff.
We will be in her room and go to the park and to the water.
I would do the things she says will help me feel better.
I have to go in the evening.
Don’t want to talk to lots of people.
I don’t like groups of people.
She can talk to anybody she wants to and it helps when she talks to them in there and helps them feel better and be nicer sometimes so I want everybody to talk to her and feel better and be nicer.
My therapist would definitely not be babysitting 🙂 I make sure she makes those kids work like crazy when they are with her and apparently they do. AFTER they do all their talking and work, then they could go do the fun stuff 🙂 My inside kids know that when they talk to her, they have to talk, work hard, he honest, talk about their feelings, and talk abput ANYTHING she tells them to.So she would definitely not be babysitter (although…hmmm.. maybe for $2000 a day she might be agreeable to that once in a while), she could make the, work hard, then have fun with them.
It just occurred to me that I dnt even know how many inside kids we have. I have lost count, and I try not to think about it too much.
I trust our therapist with my kids. If I actually had a way to leave them with her, I definitely would. Because I need a nap. 😉 Of course, so does she after she spends much time with them..
In my ideal plan…
1. 1st, I would need to be extremely wealthy, because I would need to pay our therapist about $2,000 a day, which she is totally worth that because…
2. i would drop the inside kids off with her, while I go take a 😴 nap and maybe have a massage so i can get a break from them
3. since so many of them have food issues. they could eat lumch with her. we could see how many days in a row she could eat pizza.
4. they want to go horse back riding, feed ducks, talk, ice skate, go bowling, read books, play games,, go for walks, play with our dog, play school (they love homework)…[all the while talking her ear off]
5. i would go pick them up about five hours later in time to get them home for dinner, pay her the $2,000 and some pumpkin bread as a reward for making it through another day with them.
6. repeat daily.
7. once every 2 weeks or so i get a turn to sit and talk and find out whats been going on so i know how to help them.
Now I just have to figure out how to become a zillionaire. 🤔
Caden, how honestly spot on is this funny idea. It does put things in a perspective though, doesn’t it. We are very much like a crazy family in here but as the parent now (even though there are a couple of other adults with me, I am the one becoming responsible for the care and well-being of everybody. (my therapist does still work with them in therapy, and is still teaching me how to help them better myself, and still helps me with many things regarded to taking care of them), but I am slowly becoming more independent in this area and would LOVE LOVE LOVE to have times away from everybody and all that extra work.
As an internal family, sometimes it is really nice but other times, I would LOVE a babysitter and be able to run away screaming. Bwahaa. Sending the kids to therapy to have some of their needs met and work on their issues or having a sitter that understood and specialized in this area, would be so helpful.
Even writing that now still sounds so crazy even though I have seen how much accepting this part of my life has greatly changed things that I had never even known were related (before I might not have realized there was a family hiding in myself, but I was also self-injuring on a daily basis and hospitalized regularly to protect myself). Now I acknowledge my internal crazy family and have to deal with things that most of the world has no idea how to even accept as fact, but my self harm greatly minimized to almost nothing and I am happier then any time I have been in my entire life, so something has changed for the better with the changes inside me. (I can NOT imagine where my life would be today if I had remained with either my well-meaning and kind therapist that I had at first that had no understanding of DID or the second therapist who believed that the inside family had to be ignored or a person would never improve). Of course, if my T would hire herself out as a DID sitter, I would even be happier to have the breaks from the adult parent work I have to do all the time now. It can be exhausting to be mommy to a family of 14 ranging from 2 yrs to 34 yrs. Bwaaaahhaaaa. But I sure wouldn’t trade it for my life 10 years ago when I knew nothing but dysfunction, failure, self harm, and just tried to survive from moment to moment. The other very interesting thing I am seeing that my therapist told me would likely happen over time, is that the family does appear to be growing and some don’t even come around much anymore. If my therapist is right, the family will continue to grow up and go away when and if they want and feel safe enough and ok enough to no longer need to be here. Thank you so much to my therapist and I don’t think it would be fair to ask her to ‘babysit’ everybody still here while I was out at the spa. Bwaahaa. She has already spent so much time holding my hand and practically carrying me through so much of this process along with parenting the children HERSELF for the last 7 years; which taught me how to not only acknowledge them, then accept them, and then parent them (when I wanted to beat those inside people up, my therapist was hugging them and me) and somehow all her treatment of all of us transferred to an internal lesson of how I should be treating them and me. It took many years, but her methods worked and not only did I internally learn how to parent them, my desires have moved from wanting to beat them up all the time and kill them or at least make them vanish, to wanting to give them hugs myself now. So, I guess after all these years, it has now transferred to time for me to suck it up and keep parenting them myself and accept the reality that I may never get a bath alone again or at least until they grow up and move away from home. Bwaaaaahaaaaaa
I love this Caden. Made me smile. Really like your sense of humor too. 🙂
Oh, Caden, I love your creativity! Also thrilled you have a T worth it all! 1/24/18
If you could design your perfect treatment plan for DID, what would that look like?
How many times per week or per month would you meet with your therapist? 2 times per week
How long would your sessions be? 60-90 minutes
What kinds of things would happen in your sessions? talk therapy, meditation, EDMR (if appropriate), problem solving, identifying parts “system work”, trauma work, social skills training
What artistic or creative therapies would you include? art therapy, art collage, peace flags, journaling ideas homework,
Would your sessions be inside of an office or anywhere else? quiet room, picnic table outside, doing exposure therapy in a car to drive on the interstate
What time of day would your sessions occur – morning, afternoon, evening, or night? late morning (not a morning person)
Besides your therapist, who else would you want to have on your treatment team? medication management MD, artist, other therapists for vacation times, crises plan in place
Would you include any kind of group therapy in your treatment plan? yes
What kinds of approaches would you want your therapist to use? eclectic works best for me; CBT, DBT, talk therapy
Who from your DID system would be allowed to speak and present up front during your sessions? all parts would want to speak and need to speak
I go to a trauma T 4 days/wk and my original T from before she referred me for Dissociation’ 1 day/week. In ideal, I wouldn’t go 2 days (weekend) in a row without therapy. 70-90 minutes would be ideal vs current 60 min.
I’d do more art in ideal.
I’d have DID group (I’m trying to start one with my T!). I need DID people to feel sane. This forum helps. I’d like face to face.
Ideal would include eventually my perpetrators! I presume they were abused and could apologize for hurting me.
In ideal, I’d trust more. Neuroscience seems to point against memory work until parts can get out of trauma time and into present. That’s hard to accept when intrusive memories predominate. I want to trust the science.
In ideal, I’d practice grounding hourly in my life.
In ideal, my explainer would always be up front in session and others would speak through him or another adult.
Thanks for letting me compare reality to ideal.
How many Times per week or per month would you meet with your therapist? 1 to 2 times per week in the beginning during the getting to know each other phase. 3 or 4 during the more intense treatment phases and then begin to tapper back off in the latter phases as reliance on therapist decreases and self-sufficiency increases
how long would your sessions be? 1-2 hours based on need with therapist suggestions regarding trauma work sessions length
what kinds of things would happen in your sessions? Talking, trust and relationship building, tasks related to safety in and out of sessions, creative and sensory activities, work with various parts in ways best suited to their needs, specific methods to work on trauma when the person is ready, after core work is done address new understanding of social interactions, self and self-esteem as independence increases
what artistic or creative therapies would you include? Various art and sensory activities along with play therapies based on specific interests and needs of different parts.
would your sessions be inside of an office or anywhere else? Most sessions within the safe environment of an office with exceptions for situations or outings that address personal needs regarding safety, health, or that are part of the therapeutic work for ptsd treatment
what time of day would your sessions occur – morning, afternoon, evening, or night? This is variable based on current need
besides your therapist, who else would you want to have on your treatment team? Psychiatrist or treating doctor for medication when needed
would you include any kind of group therapy in your treatment plan? Maybe toward the end of treatment as the treatment direction begins to focus on improved social interactions and adaptability
what kind of approaches would you want your therapist use? Not being tied to a specific approach as it appears this disorder has many varying needs in order to progress toward a healthy mental state. Helpful approaches might include talking, skill building, trauma work, hypnosis, approaches that are geared toward working with children when young parts are being worked with, and no specific approach at all if the therapist is insightful enough to ‘see’ what helps and make adjustments to continue progress and help bring healing and growth
Who from your DID system would be allowed to speak and present upfront during your sessions? Any parts should be free and encouraged to participate or it is unlikely that any true healing can occur if individual issues are not brought forth and dealt with
My most helpful plan for therapy
Number of sessions:
We are doing 3-5 now depending on what we are doing. For the first 5 years, we did 3 sessions per week and that was good most of the time. For the last 2 years we have added working on real hard stuff and when we are doing that we meet 5 days a week (M,W,F for talking and calmer stuff to help things be better for me outside of sessions) (T,Th for hypnosis and work on the hard stuff that happened a long time ago). After we get some of that stuff better, we stop with the hard stuff for about a month and only do 3 days during that time.
This is good, it has really helped. In the beginning we tried 2 days but it was way to hard for me and I had to use to many hurtful coping skills at home to get through the days between sessions. Now there are a lot of sessions, but I don’t use those bad things very much anymore and I can already tell that my desperate need and panic outside of the session times are starting to decrease.
How long for sessions:
I agree with everybody else that 1 hour isn’t enough. One time my therapist had to go somewhere and we had to leave while one of the kids were there and we have no idea how we made it home ok. Right now we do 90 minutes on the 3 days and it is better but there are still times that I am having a hard time and it is time to go. I thing the 2 hours on the 3 days would really help me be able to talk about stuff and I think more alters would talk if they weren’t so scared of running and out time and what would happen if they had to go outside. In the beginning we tried to do the one hour and I kept pretending everything was ok because it was so hard for me to talk and I knew if I tried and got emotional that I would just have to go home with all of that and then I had to use bad things to help me calm down. When I told my T I had been doing that for about a year, he increased our time to the 90 minutes and started helping me calm before leaving the office. That has helped so much and I haven’t had to use hurting stuff when I get home now, but sometimes I am still scared to let go of control sometimes because I am scared to run out of time and still be in that sad spot with to much pain and no help at home. On the days that we work on the hard stuff and do hypnosis or keep talking about the hard stuff, we do 2 or 3 hours and he just decides depending on how that session is going. This has all worked out pretty good but I still think the 2 hours instead of shorter would help the work better.
What things would happen:
We do a lot of talking and he talks to the others and we work on the hard stuff and do hypnosis now. This stuff if good but I think some other stuff would be better to. I read what other people get to do and I really want to get to play with my therapist to. I know the little ones would love it to. My T doesn’t have toys or games or soft stuff or places. If my T and I could play games or card or do craft stuff like other people mentioned, I think that would really help me relax and even be able to work on some stuff better. I know I would love it but I do wonder if I could do it unless me T made it like a therapy requirement for that day because it would be embarrassing to play with toys and do stuff like that but I really want to. I wish we could do that kind of stuff and I know the little ones already want to play with play dough and sand after I read all this. Also, His office isn’t very comfortable and in the beginning when we did hypnosis, I had to set up on the tiny couch and it isn’t very comfortable so it is really hard to be relaxed sometimes and that caused a lot of trouble for me in the beginning of hypnosis and my T almost stopped trying because he thought I couldn’t me hypnotized. I told him about not being able to relax during the hypnosis and now we switch chairs and I get to set in his big recliner chair. I think if things were more relaxed and friendly with stuffed and soft things around that I could hold and hug, that I would be able to talk better. Sometimes our T will put his hand on our shoulder when we are sad and when we are working on hard stuff he will hold our hand and he gives us a hug when we leave each day and says we did good. It helps us feel so much better because things feel so much safer when T is close. His big chair is way across the room and the space in between us is so scary and sometimes all I can focus on is what is in that big space even though I feel safe with my T, he doesn’t understand all the stuff that could hurt us before he could get over there and help. My T doesn’t know it because I don’t want to make him move is big chair so sometimes I just have to be quiet and set there. So when he comes and sets by us it is easier to talk because there isn’t so much of that scary space there and T makes everything feel safer. I wish he could also add just hold us a tiny bit because all inside feels better when we gets that hug, it’s like for just that second that nothing is going to hurt us and we get to take a real breath. The first time he gave us our good bye hug it was so different then anything ever else because it was real touch that didn’t hurt me and was ok and good. I felt like it was the first time I had ever taken a real breath and I realized every time how I am never really alive in this world. Now it is like I get to be alive and safe for about 3 seconds a few days a week which is something I never feel outside of those few seconds but it gives me hope that it could be possible to feel that on my own in the future if I just keep working on the hard stuff. So adding a little friendly hold sometimes would be so nice to have a chance to breath and feel safe for maybe 30 seconds even. Those are things that I think would really help us do better and feel safer to talk about things.
Art or creative stuff:
We don’t do that now but I think it would be great. We would love to be able to make stuff with our hands and maybe paint and get creative. I really think that would help all of us in here.
Session in office or other place:
In the office for most days but sometimes go to a place with lots of space and real quiet with nature stuff like trees or water or stuff that feels good around.
Who else would be there:
Nobody cause I don’t do good with people
What kind approaches:
We do good with the talking and hypnosis but sometimes it is super hard for me to do the emotion stuff and sometimes I am to scared and hold it in real hard. We worked for years on all the breathing and meditation and stuff and T even bought me a workbook that we used but none of it really helps me much yet. My T says that the things we learned will help me after we work on some of the hard stuff so I haven’t given up on those, they just don’t help much right now. When the emotions start and I stop them, I know my T can tell and so he backs off because he doesn’t want to makes things worse, but I wish he would actually help me get it to come out instead. I think that he thinks I don’t want it to come out but I do, I am just scared of how much it hurts and what will happen if T just stays in his chair and wants me to deal with it alone. He has said he will help me deal with everything until I don’t need his help anymore and can use the tools we learned but I always think that someday he will just set there to see if I can do it alone this time and then I will never be able to trust him again and I will hide everything away again, so I try to stop them so this can never happen. I wish T realized that his being there and helping me was enough to help me be safe with them even if I don’t like them and help me push them out because things are better after that happens. So, not being so careful with everything and helping push me when I can’t do it by myself. We would also like the play therapy stuff peoples talking about to.
Who talks:
Everybody will get to talk whenever they have something to say, but right now some don’t ever come out except to talk to T during the hypnosis. I wish they would talk without it more and that T would make them come out to talk to him more because they don’t cause as much trouble inside after T talks to them. Sometimes T tells them to do things and to be nicer and some will listen to him and things get easier inside for a while and most never listen to me, but some of them don’t listen to him at all anyway either. We tried stuff to help me help them and to get them to listen to me but I hate them still and they hate me to. T says that right now there is still so much hurt in them that has to be worked on in the hard days and that after we do that and they don’t hurt so much either that we will start working on me helping them and them talking to and listening to me and that we will someday all be a family and I will take care of them then. For now, T says it is ok for it to be his job to help them feel better until we all feel better and I can do it for them. I am so glad that my T does talk to them and accepts them for themselves because if my T was like that other person who said they aren’t real then I know they would have gone and never talked to him again. It is only because he accepts them and even encourages them to come talk to him and be themselves no matter how old or how they feel that some of them do talk to him and listen to him. I still think that if T would play like other people said that some of the others might feel safe enough to come talk also. That would sure be nice.
Kathy, I want to thank you so much for this site and the helpful material you provide. I found your site a while back after my current therapist directed me here to watch your Piglet bedtime story video after loosing my husband and his security at night. I have read your blog since then but I have not commented before, but I am very interested in this article as I have had 3 very different therapists and treatment plans and have seen first hand how differently each affected me and my progress. I have now been in therapy a total of 16 years with 2 very unsuccessful treatment models and one that has changed my life. I would like to show those below and how the only one to really help me is very different then what most therapy is supposed to look like today. I agree with what you have said in many areas of your blog related to how therapy for DID has to put aside some of the therapeutic stereotypes and help clients where they need it, even if it seems contradictory to many believed therapeutic methods. There are people being helped by therapists that are willing to put legalism aside and reach out to their patients in a healthy manner, but there are also many people still being hurt and/or unhelped by well-meaning therapists that are stuck so tightly in the rules taught them so many years ago in school and the concern that reaching as far as many DIDers need, will cause them to become forever dependent; so instead, they withhold what is needed in the name of safety but ultimately continue the abusive cycle of refusal to meet the true needs of the person and children. I hope maybe my comparative treatment plans can help you show how out-of-the-box thinking is what some DIDers need to heal.
First therapist: 2 years with very nice therapist with typical theraputic practices. My diagnosis depression, anxiety, PTSD. Did not make much progress but had a good bond. She retired
Second therapist: 6 years with a ‘traditional’ therapist that focused on Cognitive Behavioral Therapy and Dialectical Behavioral Therapy. During our consultation, he asked me questions that led him to suspect that I had DID. He explained many aspects of DID to me and that the best treatment methods were focused on the ‘host’ individual with minimal attention to alters because that could intensify their presence. We worked together in that direction another 2 years with no progress or real connection with him and he decided I needed somebody that specialized in Dissociative Disorders because my self injury was increasing to critical levels on a regular basis.
Current therapist: I accepted the referral to another agency and was set up with a therapist that was experienced in working with Dissociative Disorders. I had never met or even read about a therapist with ideas and rules quite like this one. She said we needed to stop pretending the alters were not there and struggling with severe problems and that if I were going to feel better, it was going to take a lot of time and work on both our parts. She opened herself up to me in ways I didn’t think were allowed. She provided me her phone and email information and practically required me to contact her when I was under stress for now(she said I would eventually not need it, but until I and my alters could accept her help, we would never heal). When I questioned her about what my other two therapist would have considered boundary violations, she simply said “If my past and present clients are healing, I don’t care what other professionals think of our methods.” Many, many other surprised came from my current therapy including the fact that I am now 9 months free from any form of self-injury and have not been hospitalized for almost 2 years.
I will provide a few more details of the differences in therapy styles an treatment methods in my answers below. It might have taken 16 years of therapy in total (with the helpful part being very different then what many therapists would think would be helpful, but I am now on my way to becoming an independent person that is starting to accept herself as an ok human being.
Ok, on to answers (I will answer first with my current successful therapy program and then note the prior unsuccessful ones and final comments on what I would change if I thought it would improve or speed success: although I am very happy with the current progress)
• How many times per week or per month would you meet with your therapist?
Current/successful- The very beginning we met 3 time per week for 2 hours each. After we started getting into more emotional work and more work with alters, she increased to 4 times per week with at 90 minutes and one at 3 hours for trauma work. We have made such progress that we have decreased over the last year back to 3 times per week again.
First therapy- 2 times per week for 60 minutes
Second therapy-1 time per week at 50 minutes and a second time every other week at 90 minutes for trauma work.
My thoughts: Although my first therapist was a very compassionate and caring woman, she was very rule/boundary focused and had told me that 2 times per week might be to much time and we would have to watch it. The second therapist was insistent that he knew the best treatment methods because he had done all the research and that anything more would ultimately cause to much attachment and undermine the therapy in the end. These experiences caused me to be almost phobic of the high level of therapy recommend by my current therapist and it took a very long time before I could accept the increased level of therapy. Now I can see behind me and know that without this level of care through my treatment, there is no way I would have been able to handle all that I had to do and go through with either the number of sessions nor the allotted time typically given in a traditional therapy environment.
• How long would your sessions be?
Current/successful – better description above, but it continues to change as my needs have changed. I initially disagreed with the need for a higher level of contact based on the strict boundaries I was told previously were vitally important or I would regress and become dependent on a therapist to do everything for me, but with much explaining and gentle insisting on my therapists part, I gave it a try and although it was very hard work during the time, it has paid off and we are now beginning the direction of decreasing time instead of me needing more.
First therapy- 60 minutes
Second therapy- 50 minutes and 90 minutes for trauma work (I was often sent from the office in bad emotional shape because there wasn’t time. I mentioned to the therapist that leaving in an upset state was having a bad effect on my at home and he mentioned therapeutic boundaries and that I had to learn to self-sooth and directed me to more of the DBT skills we had worked on.
My thoughts: same as in the number of days questioned
• What kinds of things would happen in your sessions?
Current/successful therapy- She uses a very eclectic type of therapy. We focus a lot on ‘talk therapy’ with the addition of creative aspects like art activities, games, reading, etc. (painting, clay work, drawing, coloring, walks, etc… When she has worked with the younger parts, she has played games, cards, toys, stuffed animals, Xbox, etc.. depending on their ages and needs… She even took a couple to a park before and for ice cream and once to a movie). In the very beginning, she used drawing/painting/colleges/etc to help myself and each alter build what she called ‘safe homes’ and slowly over time, as we were each ready, she helped move every bodies homes into a village were could live together and support each other. She also utilizes hypnosis which is what allowed me to access my trauma memories and allow her to slowly help alters work on issues until it was safe enough for my to be able to learn about the traumas myself and work on them also. We also incorporated what she called prolonged exposure therapy which was extremely emotional and difficult work and something that was necessary with each new trauma that had to be tolerated by me, but after the hard work was over, I am now able to think about and discuss these situations with only mild discomfort from knowing that was my life (no PTSD responses to any of that anymore). It was not an enjoyable experience and my therapist has to be the strongest woman on the planet to set beside me and hold my hand and even hug me sometimes to comfort me through some of this work, but I wouldn’t change it for anything now.
First therapy- talk therapy with a cognitive behavioral focus
Second therapy – talk therapy with cognitive behavioral and dialectical behavioral focus. We used a couple of workbooks in both areas. He used body focused methods and memory work was done through methods involving trying to watch movie screens in my head, pretending to be behind screens, and running through the scenes backwards and forwards. This was all extremely difficult and highly emotional work with no release until I would get home and use my own coping methods.
My thoughts: I guess I put my thoughts up there already but I will say that for me, both the current prolonged exposure and the various methods the second therapist tried were both very difficult for me to do because they both dealt with addressing trauma. That being said, the exposure work was tolerable because of the guidance and help of the therapist and has brought lasting results where the other methods under the second therapeutic method only brought intensified pain and a need to self-sooth afterwards.
• What artistic or creative therapies would you include?
Current/successful therapy: very much creative and artistic work integrative with all aspects throughout the therapy so far.
First therapy- no
Second therapy- no
My thoughts: As I mentioned earlier, initially I tried to decline the artistic and creative ‘out of the box’ ideas as they did not fit the traditional role in my head plus, I had fought for all of my life these desires in my head to do things like play with toys and watch kiddie movies. These were something I tried to ignore and not accept through my life as big girls do not act that way. After my current therapist helped me understand that I would never be ok with myself until I could accept myself for who I was, I slowly began to allow myself to participate with her (when I didn’t play with something in the beginning she did alone, even painting a picture while talking to me because I wouldn’t paint with her. After similar creative activities went on with her alone for a while, I decided to join her and after a while, my feelings towards these thoughts in my mind calmed down. Of course, the younger parts were all about it and I know these activities were part of what helped some of the other parts accept and trust her much quicker.
• Would your sessions be inside of an office or anywhere else?
Current/successful- most sessions were in office unless we went for a walk or an occasional outing for myself or a young alter.
First therapy-all in office
Second therapy-all in office
My thoughts: Obviously, I have found success with the current method, but I would have enjoyed more sessions outside (as long as we weren’t focused on highly emotional things at the times) The distraction of a quite area outside can really help calm me and I seemed better able to open up and talk to her.
• What time of day would your sessions occur – morning, afternoon, evening, or night?
Current/successful- afternoon
First therapy- mornings
Second therapy-afternoons
My thoughts: I do not have a real preference
• Besides your therapist, who else would you want to have on your treatment team?
Current/successful- Psychiatrist
First therapist-none (I had a medical doctor for meds)
Second therapy-added a Psychiatrist
My thoughts: The Psychiatrist was a helpful addition. I think it would be great to have supportive family as part of the team if desired. My husband was my rock while he was alive. He was what allowed me to work through some of the hardest elements of my current therapy because he helped provide stability and safety for me at home. I have continued to work since his passing, but it has been a much more difficult journey and I have had to turn to a lot more reliance on my therapist (My fear in the evenings became so intense that for 6 months, my therapist called me every evening to talk for 5 minutes to help me calm in order to get through the night (there had been a few hospital visits prior to this). She then said she was gong to stop calling but asked me to continue to reach out to her for the same call every night. After a few months of that, I was able to tell her that I was ready to start backing that time off and the choice for calls, texts and emails has always remained but over the last year my need has decreased to only a few times a month). My point was, that family is an integral part of the team and should be made part if it is therapeutic to do so.
• Would you include any kind of group therapy in your treatment plan?
Current/successful- no
First therapy-no
Second therapy-no
My thoughts- for some people and possible for myself later, group therapy might be ok. For me, I can’t imagine that time will come, but anything is possible. Sharing experiences of myself with a group of people is really not for me.
• What kinds of approaches would you want your therapist to use?
I am not going to specifically do this one as I think I covered it enough above and I know this comment is beyond long already.
• Who from your DID system would be allowed to speak and present up front during your sessions?
Current/successful- All parts of the system are necessary and speak when they want to now or when my therapist feels she needs to speak to one particularly. She has designed specific sessions over the time for different parts and has welcomed any at any time. In the beginning, I was very closed off and unaware of many things, but now I am able to just let things happen as they do in the therapy sessions. Because of her work with my alters, I have finally started accepting them myself (even the children that I hated and wouldn’t have anything to do with for the first 8 years (thank goodness my therapist was a mother and took that role for them until I was able to accept them myself. I learned from the way she interacted with my young alters, how to treat them myself when I was ready to accept them and help them. Today, she still works with them in the office, but she doesn’t intervene with phone call or email work, she doesn’t have to meet their emotional needs or ‘correct’ their behaviors. I am now able to provide for what they need and she is able to continue to work on areas of need within the sessions.
First therapy-none
Second therapy- This is a hard one because I had a couple of alters that tried to talk in therapy but he would pretend they weren’t there and kept referring back to me and refused to address them as themselves. He would frequently remind them and me that we are one person and needed to accept that in order to heal and function as one person.
My thoughts: I am now very happy with where things are regarding the parts of my system. If they need something, they come forward and if something needs to be dealt with, they are willing to come when the therapist asks them to. It hasn’t always worked smoothly, but over time and many sessions, it works well now.
My final thoughts on the perfect treatment plan: I know this turned out to be a very long comment, but after reading the comments of so many others and seeing how much I agreed with what was said by a lot of people and knowing how far ‘off the mark’ some therapy is in this area, I really felt the need to share my experiences with the different treatment plans.
There are many disorders out there that require treatment that would be unethical to deliver in a different situation and I feel DID is one of those. Sadly, there have been cases where things have gone wrong with individuals, and/or people have taken advantage of the looser boundaries of therapists, and therapists that have abused boundaries which have all led to a pretty strict definition of what is right or wrong in regards to therapy. We all know you would not conduct a therapy with someone that has chronic severe schizophrenia the same as you would someone who has Anorexia. Why would we believe that the needs of the DID population have to be the same as other populations in therapy or else they are being over-demanding and have become to attached to or reliant on the therapist. I understand the idea behind dropping a rope to a person in a well so they can pull themselves out, but if that person broke both arms and legs when they fell in the well, do we just leave them there to die since they can no longer pull themselves up? I see my life with DID very much like this metaphor. In the beginning, the only thing I understood was that I had fallen in a well and there was a bunch of crying going on in my head over it. My first therapist came and drop a rope and really tried to encourage and support me to get the strength to pull myself up. I felt supported, but still couldn’t get to the top any better because I simply was not able to. The second therapist came and dropped another rope and he kept yelling all the steps and rules to how I needed to hold the rope and where to put my feet to climb out. Again, I just sat in the bottom because no matter how great the plan might have been, I was still incapable of pulling myself up. The third therapist came and dropped the rope. When I didn’t climb out, she looked at me with a flashlight and saw the broken bones. She rented a machine that lowered her down to me and she helped me harness in. She pulled me back up to the surface where she began to very painfully reset my broken bones. In the beginning, I was not a little dependent. I was completely depended on her and I think I even fought her on the way up. Once we were at the top, I had come to trust her enough that I was willing to endure the pain of her resetting my bones. Still, I was present, following her directions and guidance, and even allowing the pain; but I was not doing much on my own. It was only AFTER she had come to me where I was and had done so much of the work for me that my bones mended enough that I was able to begin to work with her while I learned how to use arms and legs that had previously been shattered. My work was hard enough once I was able to begin working on myself, but I would never have made it to that point if my therapist had not allowed the necessary dependence on her and gave me all that she did. I worry about how many DIDers are laying on the bottom of a well with broken bones, yelling for help while very well meaning therapists and others are at the top of the well trying to encourage them to grab the rope and pull themselves up. Nobody realizing that the DIDer has so many broken bones that it is physically impossible for them to pull themselves up no matter how much their hearts may want them to.
Wow, thanks for sharing. I don’t know any therapists that would allow me to do treatment this way, or insurance that would pay for that type of treatment. I live in a rural area, so options are very limited, but we are trying to work on stuff.
I know, right DK. That’s why I decided to share my past and current experiences because I hoped that it might show how traditional thoughts were not what helped me at least. Because of my first two therapies, I almost refused the help of my third because it was so different then what I was told before. It took a great deal of convincing from my current therapist to get me to trust and allow the things that happened. Sadly, I don’t think there are to many therapists that are going to be willing to go as far as mine has to help me and so there are going to be so many people that could be helped that aren’t. Of course, I know that not all people would be helped by the same methods that my therapist uses but I also know that it was what I needed and I am not proof of how it helped and didn’t make things worse like the earlier therapists were sure it would. That’s not to say that I didn’t have some real desperate years in there where I wouldn’t have made it if my therapist wouldn’t have almost carried me, but because of all the help I was finally able to start carrying myself at some point and have now become more independent then at any other time in my entire life.
You are also correct that I know it doesn’t matter if all the therapists working with DID realized things that helped healing was different then most other issues, insurance is never ever going to pay for all of that kind of interventions. I am blessed to have the financial ability to cover the cost of my own therapy or I wouldn’t have been able to do it either. At several points I wondered if my current therapist was really saying I needed all these sessions so she could make the extra money. I look back now and feel really bad for thinking that way since I see how much progress I have made but I am sure that was part of my trust problem back then and I am just so glad I did not let it stop me from continuing.
I hope you are able to find somebody that can help you because the feeling of a real life on the other side of all the time and work is worth every bit of torment, utter dependence on another person, self doubt, and each moment of desire to give up on everything that is felt during the process. Hang in there because there are better times ahead if you can find somebody willing to help you get there.
How many times per week or per month would you meet with your therapist?
Twice ideally. My previous therapist met with me 3 times a week & my current only once. However I do have the support of a team so maybe that’s not necessary.
How long would your sessions be?
I have had 1hr and 2hr sessions and feel a combo of both work. Double sessions have enabled an important discussion to continue when deemed beneficial.
What kinds of things would happen in your sessions?
I’m really unsure on this question!
What artistic or creative therapies would you include?
Art therapy, movement therapy & music (drum) therapy. These have all done (& do) wonders for me.
Would your sessions be inside of an office or anywhere else?
Mixture. In office works but sometimes so does walking in a garden or a larger space.
What time of day would your sessions occur – morning, afternoon, evening, or night?
Mixture.
Besides your therapist, who else would you want to have on your treatment team?
My psychiatrist, my GP, a movement therapist, a music therapist, an art therapist, a 1:1 talking therapist, a play therapist and an out of hours crisis team.
Would you include any kind of group therapy in your treatment plan?
No. Absolutely not. Groups have in the past always further traumatised me.
What kinds of approaches would you want your therapist to use?
Mixture. I don’t yet know enough about approaches but definayely someone who has experience with DID & trauma
Who from your DID system would be allowed to speak and present up front during your sessions?
Strange question – I have no control over who presents. I am not an interactive DID system and so it’s not possible to say. Ideally if I had a choice which is I guess what you are asking – it’d be me, adult me.