Therapist consultation for dissociative identity disorder

Back when I was considering changing therapists, I wrote about Changing therapists – what to consider. This week, I took my own advice. Here’s what a leader in the field of dissociative identity disorder had to say to me.

My goals for the consultation

In the interests of my own anonymity (names for parts of me I DO to refer in this blog ARE are real), I will only refer to this person as a leader in this field for more than 20 years (yes – amazing!). She is in a leadership position in one of the state chapters of the International Society for the Study of Trauma and Dissociation.

I asked for a consultation to discuss three things:

1. Should I be seen by therapist with experience/training in the area of DID?

2. I have my own ideas about qualities I want in a therapist and the therapeutic relationship – are they reasonable?

3. Can you recommend someone who is in my health care plan who would be appropriate for me?

I immediately felt comfortable with this woman, and by the end of the session, wanted to work with her. We may be able to work with my insurance plan, but that is a side issue for me to explore.

First, I told her the basics of my “story”. She asked questions about my diagnosis and my previous therapy – how much had I accomplished? I summarized that I had been able to tell my story, I had identified many parts of my system (she asked if I had a map, yes), I had been able to identify triggers and also parts of me I was not aware of – this nasty rageful self inside me. I came to learn how I had hurt people, and how very sensitive I was to the slightest hint of rejection, disappointment, or attempts to control me.

Now I was looking how to address the amnesia, time loss, and rage. The switching. She said that I had made a great deal of progress in my therapy so far, and that it seemed I was very motivated and interested in the whole thing. Yes, I said, when I am part of me who is not still in denial. <heh heh>

I talked about what I wanted, and she asked what had caused me to leave my previous therapist. I was careful not to bash her, and praised her more than once during the session. I explained that she had done a great job with the things she was well trained in doing – PTSD, trauma. But when we got to the more complicated issues of DID, I felt that she wasn’t really engaging me, but seemed to be avoiding or not understanding these issues. She had said some things to me very early on that raised a red flag that she really didn’t know what was going on with different selves.

I also relayed the final couple sessions – her assertion that I challenged her credentials and that she was very upset at the emailed questions I asked. Her being “professionally and personally offended.” Her assertion that I picked fights to justify my anger, and her repeated statements that I had to “own” the problem (“your anger is the problem”) before we could work on it. I told this therapist that I realized what happened in the end – we each triggered one another. I did not mean to imply I felt she was incompetent, and she probably did not mean to try and force this anger thing down my throat. But we got to an impasse when I wouldn’t accept her assertion without exploring why she felt this, and she said we couldn’t work on it until I acknowledged it. Sigh.

The consultation therapist seemed to be somewhat appalled at what my last therapist had done. She told me that you NEVER try and force a trauma patient to accept something they don’t believe or don’t see. Even if it ends up to be true. That is mimicking the basis of the trauma in the first place. There are better, less abusive ways to address problems with the patient’s perception and beliefs.

She also stated that anger is a GOOD thing, not a problem! That sometimes we don’t use the anger appropriately, but she said finally finding and accessing the anger is a major step in therapy to stop internalizing the anger and to fight back. And since I found it and was trying to cope with it, I had achieved a major milestone.

So, looks like I did the right thing. I knew in my gut that I had to leave, but it’s nice to understand intellectually why my gut made that decision. It gives me peace with the decision.

Recommendations for a therapist for ME

We talked for a while about the type of person I am (engineer, black and white, strong willed, smart – and obviously these are just the qualities of a few of us in there, but the ones who have been contributing the most to this blog) and what I wanted from a relationship (active participation in therapy direction, ability to bring new ideas into therapy, someone who feels comfortable bantering and joking, someone who understands dissociation, someone who would not feel threatened my me asking about training and credentials.)

After we chatted, She agreed that I should look for someone who has some specialized knowledge, who is not defensive and is willing to learn. Openness is important, probing allowed, and mutual respect. Someone who will be “with” you mentally. She also agreed that finding a therapist with whom you “click” but has little experience with DID may be better than a disconnect with someone well trained. As long as the therapist is willing to learn. She also mentioned that she runs regular free sessions for therapists who want to learn more. Wow – amazing – I thanked for doing that!

And, perhaps, the clincher. I told her that I wanted someone who could joke around. I relayed that I told a DID joke to my meds doc and he just laughed and laughed. She knew him and said he was great. Then I told the joke to my old therapist, and she kinda chuckled, but I felt awkward after like I shouldn’t have done it.

So I decided to tell the consultation therapist the joke…

How many alters does it take to change a light bulb?

Four. One to change the light bulb, one to watch, one to deny that the light bulb was changed, and one to repress the memory.

She loved it!

After I left the session, I texted my best friend and told him how well the session had gone. He had only one thing to ask in response.

Did she laugh at the joke?

<smile>

Finding a new therapist

Here comes the crappy part. Trying to find a therapist with experience with dissociation who is in my medical plan. She told me “there is a dearth of qualified therapists in this area.” I simply cannot afford $195 for 45 minutes once or twice a week She identified two people on the list of about 300 that I had in my plan. I also found one more who is a member of ISSTD, but she didn’t know him. So, I will schedule some sessions with these 2 or 3 and check them out.

In closing

I was so afraid of leaving my first therapist. I tried to make it work, and I practically begged for her help in getting me over that trust hump. I knew I would be walking away from many months of good work and would have to start over, and I tried to ask her questions that would help me decide.

All in all, I am glad for the small explosion that we had in the end. It forced me to really pay attention to all the little things that had been bothering me for months. After I met with the consultation therapist, it became much more solidified in my mind that I had made the right decision. My initial work with my first therapist was very good and I learned a lot, but it is time to move on. I will continue to get better, I know.

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9 Comments»

  annenco wrote @

I love your blogs, what I’ve read so far. We’re going to be looking for a new therapist as soon as we get resettled in a new spot. It’s kind of scary but really appreciate people like you who share what they have learned and share what others might want to think about for themselves.
I love that joke, one of my favorites. Have you seen the long version? The long version has one that IS the light bulb and doesn’t understand why it needs to change hehe!
I’m glad this person was so helpful and you felt validated in your decision. Best of Luck as you journey on.

  emilylonelygirl wrote @

annenco

Good luck with the new therapist – I hope some of what I wrote here helps you. Just be wary of the problem I had hitting my old therapist with a detailed list of questions all at one time! Even though many people (including 2 others who deal with mental health) felt the questions were totally appropriate, be careful with the delivery.

I am glad that my blog is useful – that was my goal – to share what I am learning about myself and my journey to others in the same boat.

Yeah – here is the long version…

How many alters does it take to change a light bulb?

As many as will: one to change the bulb, one to change it back, three to argue over whether they want it light or dark, one to throw the light bulb against the wall to hear it crash, one to clean up the mess, four to go shopping for new bulbs and come home with stockings, licorice, Disney movies, popcorn and masking tape, one who insists it “IS” the light bulb and doesn’t understand why everyone always wants it to change and can’t it just be itself???? etc….

Thanks for writing!

  davidrochester wrote @

This is such phenomenal advice, Emily.

I found my therapist through the ISST-D site, and she was a match made in Heaven for me, and vice versa … but she would not be a good match for someone who was highly, highly vulnerable or needed a complete sense of very nurturing safety, because she is too edgy and has too pervasive a sense of humor … both of which qualities make her ideal for me; she’s deeply empathetic, and understands DID in such depth and detail that it amazes me, but she also has a no-nonsense straightforwardness that appeals deeply to my own take-no-prisoners pragmatism.

The thing I respect most about her is that she is fully aware of not being a good match for everyone who comes into her office. She has a trusted colleague who is very good at creating a “nest” for clients who are deeply, deeply afraid of the therapeutic experience, and to whom she refers people who need that, because, as she says, “I can’t always turn my personality down enough for people who are very vulnerable, and I would never want to frighten or hurt someone despite my best intentions.”

She has also frankly stated that she won’t work with certain types of narcissists and borderline personalities because she just can’t “feel” them, and it wouldn’t be right for her to work with them.

All of this increased my confidence in her enormously, and has also proven to be an excellent model for me in overcoming my own boundary issues with people … my therapist models good boundaries, and the fact that it’s OK to have preferences, and to self-protect without judging.

Interviewing a therapist is a key component to success in therapy, IMO. It’s like dating. You get a wish list, and ya gotta stick to it, even if it takes several tries before a “click” happens.

  emilylonelygirl wrote @

I WANT TO WORK WITH YOUR THERAPIST!!!

You and I are similar in our outlook and need to be involved in our therapy, need to challenge and exchange sarcasm with the therapist, etc. TAKE CHARGE! CHALLENGE ME! And the fact that she REALIZES her limitations…the world would be a MUCH BETTER place if all people (way beyond just therapists) were that way. Some idiots are so wrapped up in their own self-importance that they damage others along the way. And often they are clueless what they have done/are doing.

– Kate, the Goddess of Wonder and Brilliance

(…and one wonders why there were “mutual respect issues” with this therapist. Sigh. – Emily)

  davidrochester wrote @

Yeah, I agree — she’s really amazing. Several of my blog readers feel they’ve benefited more from reading about my therapy with her than they have from years of their own therapy. šŸ™‚

Come to Oregon … it’s a great place to live. You’d like it!

  Jackie wrote @

Oregon – doesn’t it snow there? Not a place I’d find myself(s) unless there was major shift is lattitude and longitude of the US.

  emilylonelygirl wrote @

David – Interesting, sometimes I learn something about my OWN therapy from reading my diaries of what we talked about!

  Beth wrote @

Does anyone know of therapists familiar with D.I.D> in Eugene, Oregon who accept OHP medicare insurance?

  Emily’s Camigwen wrote @

Beth – sorry for very late reply. I am not familiar with all programs, but maybe someone is. Please use the search engines and call your insurance for recommendations. Sorry I could not be more help.


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