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
Emily First Girl: ...........Camigwen ............Multiplicity 
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.