I’ve been continuing to add links to the List of All Articles page, and while doing so, I came across this article written in 2010.
It has 50 wonderful comments from the readers of this blog (wow! that’s excellent!), and I decided to bring this topic back up to view.
- What do you think?
- Do you agree or disagree with the comments presented?
- Do you have your own comment to add?
- What would the perfect treatment plan look like for you?
I look forward to hearing your good ideas. and if you like what you see, please be sure to show these ideas to your therapist.
Copyright © 2008-2014 Kathy Broady and Discussing Dissociation
Kallena Kucers says
Just found this post – what a potentially controversial question!
OK – so the main thing re “perfect treatment plan” is balancing the need for support in crisis with the need to learn to manage extreme feelings yourself. That’s a really tough one and will be different for everybody so, I won’t say exactly how many hours or whatever would be ideal (both contact hours + possibility of phone or text etc in crises, if agreed on), other than to say that usually most people can’t access enough. How many hours etc would also depend on what state the system is in – which would also vary depending on at what stage a person has been properly diagnosed as having DID – if stable, then needing less time but if in crisis then much more contact support.
This would also involve there being more than 1 therapist, so that there is someone known to cover for when your primary therapist goes on holidays. There would have to be a really close working relationship between both therapists so that any possibility of playing one off against the other just wouldn’t work. They also would have to be able to co-ordinate well to never take holidays etc at the same time. For those many who need meds it can be good if one of these is someone who can do prescribing of what is needed, if it is needed, as having the opportunity to develop enough trust in the person prescribing is also important.
The other thing that would exist in my “perfect treatment plan” is the guarantee that the therapist will be around as long as you need them and not leave, or retire, or move away or stop doing this job (or even get really sick or die!) or something like that. To have a therapist, who is probably the first person you’ve ever finally decided to trust ever in your whole life leave, even if they don’t want to, is more than tough.
If I could pick just how therapy would work it would be so great 😀 I’ve never even thought of that. I’m going to pretend money isn’t an issue for this.
Here’s my idealistic plan:
1) Weekly shorter appointments for only our main part. They would be about 30 minutes and would be focused on dealing with symptoms, managing day to day life, keeping safety and checking in about what’s going on for us. They would be with our main therapist. It would be mostly talking and sharing writing or drawing.
2) Every other week there would be a long appointment, two hours if possible. This would start with a check in about the safety of the system. Then there would be pre-planned work with a part or related parts working through trauma or dealing with current difficult issues within the system. These would also be with the main therapist. It could involve playing, drawing, talking, reading stories, etc. Every part would be allowed and encouraged to communicate during these appointments. The last 15 minutes would be for grounding only.
3) Once per month we would check in with a psychiatric medication provider to refill prescriptions and adjust medications that address symptoms. This would include checking on depression, anxiety, sleep, and pain symptoms. Less frequent and we stop trusting and end up not sharing.
4) Once per month we would see a bodywork person with experience and knowledge of working with trauma survivors for help with pain management and learning safe touch and healing. This would be clothed and include verbal communication to maintain safety.
This would round out to about two appointments per week. Less (like now) and it feels like we are scraping by before the next appointment comes around and cramming too much into a short time. Sometimes it almost seems like a few short appointments is more harmful than not. More than 2 per week, though, would be too intensive, I think. Wanting all that seems so selfish though. hmm.
Future: Someday I would like to see an art therapist. It’s possible I could benefit from OT someday too because we’ve got a secondary sensory integration thing.
I agree with your therapy ideas very much . With a cavate of acessable phone check ins for high emotional events.
I just wanted to say thank you very much for your blog and for updating your article list. I just found your blog a couple days ago and I’ve been (somewhat compulsively) reading through your article list and I’ve already learned so much. I have been feeling very much alone, and your insight gives me hope to push forward. Thank you.
I’ve nominated you for the Liebster Award. Thanks for your encouraging information and posts! http://lifeandptsd.wordpress.com/2014/03/25/liebster-awards/
Great question. Being someone in the field, as well as a survivor, I’d love to respond to this question =)
First, I think that the healthcare system in the United States really promotes short-term evidenced-based therapies, like CBT and DBT. While I personally don’t have anything against these modalities, my personal experience has been that people affected by trauma typically require long-term therapy. It sometimes takes years for a person affected by trauma to regain trust in other people. It also takes time for a person to develop congruence between what a person feels inside and what actually gets expressed in the therapy room, especially when the person has previously learned “Don’t express what you really feel.”
As a therapist, I love doing sessions outdoors (taking issues like confidentiality and potential environmental triggers into account.) I think the outdoors provide a wonderful learning tool for mindfulness and using the five senses to ground oneself. I personally prefer sessions in the late morning, as this is when I’m usually awake and most alert. I find that any of the artistic and creative therapies are fantastic for being in touch with feelings and using as a coping skill. I would allow anyone from my DID system to speak up. Any “alters” are a part of myself and who I am, therefore they all need/deserve treatment.