In-patient treatment for trauma based disorders

I hate that word, “Disorders.” But the name is less relevant than the fact that at least part of the medical profession acknowledges it.

I have been researching specialized treatment for abreactive work. In-patient programs for trauma. Let’s talk about some of these facilities and what the offer.

Why?!? Are you getting ready to “snap”?

Inpatient is a scary thought for me, but something I must consider, as I am reaching the point where the rage and anger, hidden behind a nearly impenetrable wall, is finally forcing its way out.

I feel I need a safe environment to do this work. Not only mentally, but physically safe. For me and for my caregivers.

This idea scares me. To everyone “out there” I am successful, funny, together, etc etc etc.

“Why would she be admitted as an in-patient to a mental institution? Did she suddenly ‘snap’?”

My dear, the ‘snap’ happened so long ago. We’ve just been cruising up on the ‘break.”

What multiples REALLY look like

My friend sent me a good site – a blog I must disclose, that reprints an article by Sara Lambert called, On Being a Proper Multiple. I’d like to quote a chunk here, illustrating the difference between how a multiple appears on the outside, compared to what a multiple feels on the inside. (The publication year is not listed; her use of the term MPD rather than DID suggests it is 1990’s.) The emphasis is mine.

“While the dramatic, bizarre symptoms of the overt multiple were almost impossible to miss, psychiatrists did not yet have the understanding or skills to recognize the more typical picture of multiplicity: one of obsessive secrecy, masked symptoms, terror of exposure, and intense post-traumatic stress.

The increase in numbers of MPD diagnoses over the years seems to support the opinion that the only thing rare about MPD is the ostentatious variety of the condition.

“Many multiples are in fact highly concerned with controlling themselves and their circumstances. Many label themselves “perfectionist control freaks” and always keep a tight rein on their behavior. Even before they know they are multiple, they invest huge amounts of energy in acting and appearing singleton.

My consistent experience as a researcher and supporter to many multiples is that the typical picture of modern MPD is one of subtlety, secretiveness, and intense post-traumatic stress which complicate and mask the multiplicity.”

So, what you see is NOT what you get.

What does therapy for DID really involve?

From what I read, the idea of in-patient is also somewhat “normal” – that wonderful word I cling to.

Psychotherapy is often arduous and emotionally painful. The person may experience many emotional crises from the actions of the personalities and from the despair that may occur when traumatic memories are recalled during therapy.

Several periods of psychiatric hospitalization may be necessary to help the person through difficult times and to come to grips with particularly painful memories.

Generally, two or more psychotherapy sessions a week for at least 3 to 6 years are necessary. Hypnosis may be helpful. [Merck]

Facilities offering In-patient work for trauma, dissociation and DID

I found several. I am sure this is not comprehensive. It is my research only and not an endorsement of anything.

1. The New Orleans Institute within the River Oaks Hospital. The discussion of Trauma Based Disorders mentions “common presenting problems” and their “treatment philosophy” that feel appropriate for the anxiety and anguish that initial stabilization and memory work brings about.

After forming a trusting, safe relationship with the primary therapist, the individual addresses core trauma issues. As they begin to feel the trauma, reassociating the cognition and the affect, information reprocessing techniques are utilized to restructure their sense of self in relation to “what was done to them.”

The adult’s capacity to reason and the victim’s capacity to feel are slowly integrated, resulting in diminution of destructive behavior and enhanced capacity to relearn a constructive sense of self”

2) The Timberlawn Trauma Program for Psychological Trauma and Extensive Comorbidity (director – Colin A Ross). The treatment philosophy focuses on “acute stabilization, improved functioning and self management” and specifically states that it does not focus on the retrieval of repressed memories.

It assumes co- morbidities (multiple symptoms/diagnoses). It uses cognitive-behavioral, experiential, and didactic therapies to focus on recovery based on the ego state theory to address “core attachment issues”:

[In] ego state theory … the human personality … is composed of different elements or modules that jointly shape individual thought and behavior. In normal human development, experiences are assimilated and integrated as the building blocks of personality.

Severe, chronic, unresolved trauma and attachment conflicts interrupt this process. … [T]he mind develops an unhealthy fragmentation of thought, feeling, memory and perception. This fragmentation is manifested as personality disorders and extensive comorbidity.

While this sounds good, I can’t get a clear idea of the actual therapeutic setting. The average length of treatment is 2 weeks. Same program offered in different locations, such as Forrest View Hospital and Del Amo Behavioral Health System.

3) The Retreat at Sheppard Pratt. Oh boy. Ya gotta wonder when fluff comes before fact. Straight away, the “comfortable and elegantly appointed setting in a specially renovated space …[with] a private suite, inclusive of a bath, with the highest quality amenities” is presented, with pictures, BEFORE any information about the treatment itself.

The website focuses primarily on dual diagnosis (the bad shit along with some sort of drug or alcohol abuse) in a 12-step setting. <we don’t need no fcking 12 steps. Well, perhaps one step for EACH of us, but we don’t need “intensive treatment experience in a psychotherapeutic milieu, unencumbered by the payment policies of third parties” for a 12-step program. heh heh heh. Marketing at its greatest.>

Minimum stay is 20 days. Okay. Can be extended 1 to 3 months. Oh, but here’s the best. They take no insurance AND 20 days of payment is required up front. Daily fee: $1,750. $35,000 to walk in the door. As my best friend loves to say, “Jesus H Christ on a popsicle stick. ” This one is obviously the “retreat of the stars.”

Hey, I heard the other day that Britney Spears has DID. It surely is not for me to say, but the above link is this most “respectable” I could find. On the other hand, Herschel Walker has written a book about his experience with DID. Now that DID is becoming more “Oprah”, I am sure we’ll see a lot more of it, which can be both a good and a bad thing.

4) Dissociative Disorders and Trauma Program at McLean Hospital. This one sounds positive – the description of a typical individual they focus on describes us – individuals with –

[D]epression, post-traumatic disorders, dissociative disorders and personality disorders. Patients may suffer from intrusive thoughts and feelings related to traumatic events, emotional numbing and social isolation, memory difficulties, altered perceptions and personality fragmentation.

Many trauma survivors also experience intense difficulties with trust and relationships, shame and negative self-images, and self-destructive or suicidal impulses that further complicate treatment.

When I read descriptions like this – concrete and accurate, my confidence level in the program skyrockets. Yeah, it could all be marketing, but isn’t that the first step in making the call?

Whoever wrote these paragraphs had an absolute CLUE! Thank you.

The treatment program does involve acknowledging the traumatic history, which I feel (for me) is critical:

Given the highly chaotic and disrupted early environments of many trauma survivors, the program emphasizes the need for patients to develop solid relational skills and control of symptoms prior to embarking on the exploration and emotional release of traumatic experiences.

Patients are encouraged to acknowledge and deal with traumatic history, while maintaining control, safety and functioning. Patients receive help in gaining control over their own experiences, so that they can proceed in treatment without being retraumatized by the intense feelings and experiences that invariably arise throughout treatment.

Length of stay is 3 – 7 days – for “brief acute management of psychiatric illnesses” … so that patients can continue on an outpatient basis. A less intense partial inpatient program is the Women’s Treatment Program.

5) Two Rivers Psychiatric Hospital Trauma Treatment Program. This program says that it is different from others. Here is the very first line – another clear and concise statement that they have a clue:

We specialize in the treatment of self-injury and focus on stabilization of emotions and behaviors which are out of control.

They also acknowledge that processing and understanding the memories is important.

We attempt to integrate and resolve past memories of abuse so the individual feels greater freedom in the present to control emotions, solve problems and relate to others.

We help the individual contextualize memories so they become part of a bigger picture.

6) Trauma Center at Justice Resource Institute. Not sure about the inpatient with this one, but some of the treatment methods seem like they are designed to get right at the trauma rather than dancing around the edges with 12-step and feel-good group therapy BS.

  • Eye Movement Desensitization and Reprocessing (EMDR)
  • Sensorimotor Psychotherapy
  • Accelerated Experiential Dynamic Psychotherapy (AEDP)

I have no idea if these work, but will do more research.

7) Women’s Institute for Incorporation Therapy within the Hollywood Pavilion. I like this statement – basically, let’s get through the crap quickly and then get you back to your regular therapist to follow up.

WIIT reduces and stabilizes the internal crisis and conflict that go on inside the trauma survivor. They can help you get through stuff that would take a long time in outpatient therapy. Then you can return to your therapist calmer and much better able to take advantage of their help.

This place feels comfortable, and they will work with you on finances. The inpatient portion of the program is approximately 2 weeks.

[Update] I tripped across a list of Treatment Centers for MPD/DID.  I am not sure how updated the list is, and I did not check out any new ones on this list.

References

The Merck Manuals: Online Medical Library. (2003). Dissociative Identity Disorder, accessed from http://www.merck.com/mmhe/sec07/ch106/ch106d.html

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12 Comments»

  beautiful dreamer wrote @

I’ve always thought that as long as I manage to avoid inpatient treatment, there is nothing too awfully wrong with me.

I am one of those very controlled multiples who seems to pretty much have it all together. Oh, I have my obvious “quirks” but they just add a bit of color to my personality.

Thanks for this good, well written post.

  emilylonelygirl wrote @

Beautiful Dreamer

Hmmm. Interesting thought. Doesn’t quite resonate in me, perhaps because I am sometimes not well integrated…well, not normally anyways. At times when I thought in-patient was needed, part of me saw the need, part of me clearly NEEDED it, and other parts of me weren’t really much bothered by it. So, overall, was I “okay”? I don’t know the answer to that question, for me anyway.

Don’t mean to disagree with your assessment of yourself – just my mental meanderings of how that applies to me.

Thanks
Em

[…] the opposite. We’ve written elsewhere about what multiples really look like: “obsessive secrecy, masked symptoms, terror of exposure … they invest huge amounts of […]

  Batesie2012 wrote @

I just wanted to make a slight correction to your information about Sheppard Pratt. The Retreat is a separate program that is not specifically related to trauma. There is a specialized Trauma and Dissociative Disorders unit (B4). I have been there. They DO accept insurance, and the cost is not as high. The program is really good and is headed by Richard Lowenstein, a well known name in the field. I got a lot of help there on more than one occasion. I hope that helps to clarify somewhat and doesn’t offend.

Me

  emilylonelygirl wrote @

Hi Batesie2012

Thanks for the clarification – I have not been to any of these, but for some I have talked to people. Don’t worry about offending by offering real experiences and information – this stuff is helpful to folks you read it.

And welcome – please share here. If you have experiences that you think would be helpful, let me know.

Emily/Cami

  Val J. wrote @

McLean Hospital’s Women’s Treatment Program was a life saver for me. I admitted myself for a month long stay due to my PTSD. Their program was of significant therapeutic help in my progress towards ending PTSD.

  Emily’s Camigwen wrote @

That’s great – it sounded like a good program, and it is really good to get feedback from someone who benefited from it. Thanks for sharing and good luck with your healing.

  Anonymous wrote @

Hi there,

Forgive the anonymity, but I’m not feeling particularly forthcoming about identifying information since I wanted to speak frank and openly about some of my own (and some acquaintances) experiences with some of the programs you’ve mentioned both here and in your other posting on the subject.

  Emily’s Camigwen wrote @

Anonymity is fine, and completely understood. Your first hand experiences are welcome.
Cami

  another anonymous poster wrote @

Don’t think my first attempt posted; if it did and you’re screening, feel free to delete this and reply to me directly, though I have no problem with you mentioning it yourself elsewhere. I really am anal about my privacy, but I feel like I have a lot of insight when it comes to this, and I remember how hard it was (and is) to find anyone willing to speak about a DDU or trauma unit any time since the big shutdowns in the 90s (funny, gives me the same feeling as all those unspoken childhood threats used to; and you sure touched on that well as well (see: admit; hope for sympathy; become evil incarnate (or a more proper noun for it, snickers))

[post note moved to top of comment: As I’ve been writing this I realise I’ve gotten more and more candid about certain things that could cause some bad juju, and frankly I think you’re quite intelligent to know that that in itself can lead to a bad experience with any of these places if you go in acting fully armed. (nb: I’m not asking you to “keep the secret” by any means; but the internet lives on, and you have managed to stay in touch with more people than I did since I stopped going anywhere near sites having anything to do with my … lives.]

Anyway, forgive my anonoymity, but I still actually have traumatic memories (some much worse than my original traumas) about the places I went to (and some acquaintances went to), as well as a few good ones, and would like to impart what I know without feeling what I cannot describe as much other than as a blanket of ominous paranoia for some reason.

Having gone through the list above, the list you mentioned in your other posting, and the ex-post-facto list you included in your addendum, I can tell you more than just a fair (or often very unfair) shake about at least half of the programs you mentioned primarily via first- but also via second-party knowledge. I’d be more than glad to describe the inevitable ups and downs, but I’d truly be overjoyed to provide you with warnings in a few cases (and I’m not even talking about the FMSF era, here — that that addendum you posted mostly dates from that time period).

If you want specifics, feel free to comment here with a way to send along a valid email (I’d just include my own in my comment field but my current email access as of a couple of months ago is too spotty to check daily).

I’ve agreed with much, if not most of what you’ve said, and I feel we have a striking amount in common. One thing I’ve noticed (noticed: see ‘understated way of stating “I may have been overly rageful about”) is that most of the inpatient AND outpatient programs *refuse* to do processing work. I went into one pretty well stabilized and after about 2 months I was barely able to leave, NOT because of the “work” done but because the staff actually fervently PREVENTING me from doing the work.

Thing is, almost every in-patient unit will (and does) do that now. A lot of this is due to backlash, a lot is due to the FMSF and questionable iatrogenic issues leading to mass litigation (and yes, a lot of those are very intertwined). MPD/DID was “oh so hip”. I also remember fighting tooth and nail because I *knew* my problems.

Inpatient programs teach “skills” now — not that skills are anything to scoff at, but in my experience most people with knowledge of the skills already (either via reading or a half-way decent outpatient therapist) basically wind up hitting against wall after wall.

I’m thinking of at least 3 specific units in your list for the above, tho it fits pretty much every one I know of in all of your lists… Save for a scant few (and note, still, I shall not name names).

And by the way ‘fakers’ are everywhere — especially on DID/trauma units. Sometimes it becomes debilitatingly challenging getting help at all because they’re the ones who give the best performances. And of course if you try to express your needs, you are often seen as a trouble patient.

Funny thing is, in almost every place either I or any of the people I’ve known has come across at least one has walked away better for the experience… and almost always it’s been because the’ve been very very lucky when it came to which therapist/psychiatrist
they got dealt on entry (you cannot request a specific gender if you have issues with certain genders (for myself, it was women; and of course, they somehow wound up throwing me with three of them and refused to change me out for the one doc who could challenge me); if you have issues with religion, you cannot request “please, no people are are fervently religious” (but if you refuse to talk to them you are considered a trouble patient, instead of simply expressing your trauma). You are also expected to let them believe they know who you are and where you are better than you know yourself.

I crashed and burned after my next to last attempt. And I mean that fiercely. I wound up trying again about a year and a half later elsewhere and noticed a whole different set of issues. And a whole new set of ‘fakers’.

I fear even submitting this entry because I know just how bitter it seems, but it’s not even really about me — I’ve noticed this in other in-patient clients too: The smarter you are and the more insight you have, the more you think you know what you need, the more trouble you tend to be given. Some of it is because you don’t fit the stereotype. Some of it is because shame does indeed do a great job of making you clam up expressly when they want you to open up but you can’t because they won’t listen or respect you…

Some of it, I strongly suspect, is also just the result of a complicated financial life situation I was going through at the time that REQUIRED certain steps to be taken on their part which they considered “unacceptable” (thankfully I had a social worker who risked her JOB to help me with that)

Which isn’t to say there aren’t good things about places like Sheppard-Pratt (real coffee if you get the first pot; snacks whenever you want/need em within reason; if you get lucky (and I was definitely in need of it) a single room (if I recall most of them were single then — it was a few years ago now); the aides from Towson were more ‘real’ than any aides I’d met elsewhere (but the’d get scolded for being friends with the ‘patients’). Loewenstein is brilliant if you are smarter than the average bear plus are extraordinarily lucky enough to get him. I was not. And he was the only person that managed to even get a slight chink in the wall of shame. I never talked. I went inpatient TO talk.

WIIT is something… strange. I’d say it probably fits a certain type of person very well. There’s no, to almost no, individual therapy at ALL in WIIT though. It’s very cognitive, not cognitive-behavioral. You have to truly push to get what you need. They had a couple of truly wonderful nurses, and a few staff members that probably cared, but they also had a hard time dealing with complicated situations imho. I had nowhere near as much luck as a roommate had there. Their methods of dealing with trauma are actually probably insanely good if you have discrete sets of traumas. It still felt like a very weird version of a classroom setting most of the time. Also, if you have dietary restrictions or are just a picky eater, good luck. I mean, really. And if you’ve got ADHD or take any antianxiolytics, don’t even consider it. They’ll neither prescribe nor support it. Also since they’re sidearmed with a nursing home it can get a bit… uh, odd. Plus I’ve seen them totally f*ck up meds on people. Myself included. If you’re not on meds though, and your traumas are discrete, you could come away with some good insights. I’d say less is true about their outpatient program, though they do try to do decent aftercare.

The short: McLeans is VERY brief. Consider primarily for stabilization if it’s nearby.

The tempting: Of the places I talked to but didn’t go to (and wished to kick myself in the pants for, but I had to give up even trying; I’m coming to terms in my own ways, however… complicated… they may be… the one in Missouri struck me perhaps as the best possible option for in-patient PROCESSING (you know, the thing NOT A SINGLE ONE OF THE OTHER HOSPITALS WILL PERMIT ANYMORE (tho at SPratt it’s hit or miss if you get Loewenstein; he’ll actually very occasionally try to be a therapist, not just a disinterested MD shoving you off to a pushy overly ambitious cruel-hearted MSW (okay, now I’m showing my bitterness; but that two months+ DID leave me almost physically unable to leave on my own even tho I had no choice but to do so; they also ignored a bowel impaction; I have much bitterness about SPratt quite possibly because I waited years to get into that program and get guaranteed a male therapist only to have everything that triggered me throw in my face all at once — then have that trigger me thrice over by being punished for it; YMM(I HOPE)V).

A lot of the places that actually permitted for catharsis were shut down in leaps and bounds. A lot of the programs that exist now strike me more as a mix between DBT for borderline personality disorder + containment strategies (check out the Vermiglia (sp?) blue workbook and you’ll learn much of the same skills those inpatient programs tend to focus on.

The only real programs I have seen that help all that much (I’ve left a lot out here, including most my (mostly now estranged) friends) pretty much are cash-only these days, to add insult to injury — if you want (or, as you’re intelligent too, NEED holistic care, I think there’s more than one creek made o shit, and the scarcity of paddles is tragic. I suspect this is a socioeconomic issue as much as anything else, as well as a symptom of what’s most wrong with medical care in this country. I could name a handful of TERRIFIC programs that I couldn’t afford to go to in a MILLION years, which ironically are probably the only places with the infrastructure to treat people with highly above average IQs. Which isn’t even to say that the docs are stupid at the specialised places. I think most of the time they truly do have clear consciences. But that doesn’t mean they can understand. They’re only fed what they’re taught and observe — and as it’s been well discussed here (thank god!) the histrionics and the fakers tend to get more facetime, so in a weird way truth becomes a crippling condition all too often.

Another way of putting this is to say that when most people bake a loaf of bread, after about the 20th or the 200th loaf they don’t care as much about the intricacies of bread-making; they care that the product will sell and they’ll keep their job (and not get sued — or mocked professionally; good ENOUGH becomes the mantra).

Abreaction is now seen as a dangerous thing. Even when catharsis is, for some of us (I am guessing from what I’ve read so far of your journal) the HARDEST thing to put words to.

BTW if you’ve never read Baer’s books on Trauma (‘The Body Bears the Burden’ and ‘The Trauma Spectrum’) I highly recommend them.

The very thing that people like us (and I truly you aren’t insulted by the inclusive statement — I very very rarely use it at all but I feel it fits) is that the very things we tend to need the most and logically feel we should expect in programs made for people like us are also the programs that tend to — not always, but all too often — wind up being geared to a totally different type of person entirely.

I can give you the run down on a bunch of other places if you want by email — including some actual GOOD things about each of them. But like most things, I feel it’s more important to first do no harm, before mentioning how things might help. And as always one man’s poison can be another man’s salvation.

  Emily’s Camigwen wrote @

Anonymous

I am glad you got the courage to post and give some of your experiences. I have no first-hand experience with any of the programs – just my own research. From what you shared, I can see that my original therapist was probably right – I would not have gotten all that I was looking for. I guess I am not surprised that most facilities do no processing. That would require real work on the part of the staff. And I was looking to work on the trauma in a safe environment with skilled practitioners. Nope, I realize Not Gonna Happen.

I understand your bitterness – you understand what you need to a degree and you cannot find that offering and those that may be useful require cash up front. And that these programs may be great for some people in their stage of healing. I’d hate to end up in a place and see a bunch of fakers – not because they are faking, but because they are taking resources away from those of us who are really dealing with this, and because they (and their behaviors) can skew what the professionals really think this diagnosis is all about.

My best
Cami

  Heather wrote @

Like someone else already said, Sheppard Pratt Hospital in Baltimore, MD offers another program that is geared specifically to PTSD/Complex PTSD/Dissociative Disorders. Dr. Richard Loewenstein is the medical director of the Trauma Disorders Unit. The entire unit is geared to treatment of PTSD/DD and self-injury and has a knowledgeable staff. It offered multiple modalities of treatment including occupational therapy several times a week, art therapy twice a week plus individual consultations as needed, DBT, and individual therapy three times a week in addition to daily visits with a psychiatrist. I had a fabulous psychiatrist and therapist. They teach symptom management skills and provide a lot of psychoeducation. I don’t have any other inpatient experience to compare it to except the hospital where I was initially admitted before transferring to Sheppard’s program but it seemed to offer a lot more real “therapy” than other programs. This program does accept insurance, does not have a minimum stay requirement, and still has nice accomodations with private bedrooms and bathrooms.


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