Problems that arise treating a DID patient without the skills to do so

Sometimes I am so damn stupid.

I keep falling into the same trap and I am amazed that I haven’t figured it out, but continue to let myself be an idiot. I assume that everyone is an expert. That everyone, in their chosen field, knows more than the average bear.

Kinda like that old riddle:

“What do you call a med student who graduates with a D average?”

“Dr.”

Just to be clear – I am not slamming doctors here – it’s just the most illustrative joke I could think of. I have a few idiots doctors but also some great ones, like my meds doc. But I digress.

What happens when you continue to see what you want

After talking with my meds doc about my blowup with my last therapist, he said that she probably went on the defensive when she read my email asking about training and her experience with people like me. And that when she got angry and accused *me* of being the one who picked the fight with *her*, I should have realized that she was likely uncomfortable with the direction my therapy was going. She didn’t have the training, and my asking the same questions over and over, and asking about techniques I’d read elsewhere, were enough to make her feel attacked and offended.

I should have realized it when she said she wasn’t going to research the area, that she is very busy with her other work. That’s a fair statement from her. But being the idiot that I am, I didn’t put 2 and 2 together. Or even 1 and 1. And I’m the one with four degrees? I was blind and only saw what I wanted – I desperately wanted her to have the experience, because then I’d have to start over with another therapist. That scared me.

I wish I had seen it before it happened. I *assumed* that she had the training. After all, she didn’t say that she didn’t, but she *wouldn’t* say that she did. I *assumed* that I was just not seeing it, or wasn’t experiencing it right. I *assumed* that the problem was me. I had lost trust and I needed to somehow work to get it back – that it was my problem to deal with.

Losing trust when selves are ignored or disrespected

It is so hard to define trust. It’s one of those nebulous things – you can’t describe it, but you know it when you see it.

I started to lose the trust in October – 7 months ago. Four months after I started therapy with her. In October she assured me I didn’t have multiple personalities, as if to relieve me. I felt put aside and blurted out 5 minutes before the end of the session, “But then why do they have names?” Silence. And then the session was over.

Shortly after, she asked if I was able to integrate Sam – the violent rageful part of me with whom I have very little contact. And this was a month before I was actually diagnosed with DID by the meds doc. Sam is probably the furthest away from me. I remember reacting very strongly – Integrate Sam? I don’t even FEEL her, how could I integrate her? There are many more selves in here sharing my life who I will obviously integrate first.

Did she think you just made the decision to integrate and it just *happened*? I don’t know – I didn’t explore her intentions at the time. Looking back, she seemed to be scrambling about what to do. I ignored the red flag.

The engineer kept researching online, but the erosion of my faith was in my gut. That part of me who can sense an untruth immediately. Some people say, trust your gut. Most of my gut is in a little girl who had to become VERY AWARE of her surroundings and evaluate danger. After the engineer gathers ALL POSSIBLE RELEVANT INFORMATION, other parts of me make the decision. Gives us time to think; digest.

My trust was further eroded when my therapist left me blowing in the breeze when I was about ready to jump off the cliff. I asked why we weren’t doing anything – not working on this. Not talking about the rage alternating with sanity, the memory problems between those parts of me. “Stabilization” she told me. She said she would just “be here” with me in the room. The engineer’s standing there going WTF? Give me some TOOLS to deal with this! I’ve got R A G E! I’ve punched out the inside of my car, cut, broken things. Tried desperately not to do something desperate.

What should happen in stabilization when alters are involved?

And another thing about “stabilization” … she told me that because it was in such a precarious state, that delving into traumatic memories (the next step in the process) was not a good idea, as it could make me worse. Yes, I know. But there is more than just dragging out traumatic memories – there is working with the system to see who is aware of what is happening, and who she could have used as an ally in the process. Perhaps that part of me that keeps saying, “don’t punch glass.”

She didn’t engage the ISH – the Inner Self Helper. I never knew what this entity was until I started researching alters, and it appears I may have one of these suckers. Dunno, but sure would like to explore it with someone knowledgeable in the field. An ISH is an ageless part who has always been here; sexless and charged with knowing most everything, preventing suicide, and becoming an ally with the therapist to pass information and get things done. Working with the Inner Self Helper is an old reference, and some of it not completely relevant (some mystical shit I don’t believe in), but much of the description makes sense to me based on what I have experienced inside.

ISH’s are thought to arise when the intellectual side separates from the emotional side. There are a ton of references to how splits can often occur, but perhaps in another post. There is a lot I don’t understand.

!!! The therapist can shortcut costly clinical time … making internal contact with the ISH to receive information or guidance and to report that response to the therapist. [Damgaard]

I wish during that horrible couple of months that we could have worked more on the different parts of me. Try to find out what was going on inside. Finding the parts who would talk, and who would not. But sadly, my therapist only said, “Whoever comes here is welcome.” She never asked about anyone specifically. So a lot of us with things to say were ignored, so we shut up and went away. Fck it.

When one alter is suicidal and the others are not

After the terrible time was over, I asked how close she had come to contacting my family or having me committed. She said, not at all. <Hmmm. Ding ding ding. Wrong answer!> I asked why not? (Unspoken plea – why didn’t you take me seriously?) She said, “Because you are still concerned about responsibilities in the future – things at work for example.”

Wow, and therein lies a MAJOR difference dealing with suicide and treatment of multiples versus singles.

Let me be obvious. It is completely within the normal scope of DID for one self to be radically suicidal, and the rest do not want to die.

I believe I spoke on this earlier in Dear Ms. DID: Does Altercide, suicide of an alter, kill the entire system? Did I not take weeks of research to her about inpatient work where I could feel safe? Crying out for help is not always obvious? By the way – she does have this blog address. But I doubt she reads this, otherwise I doubt we’d’ve had that blowup the way it happened.

I was actually somewhat disappointed that she was not clued in at all. That one part of me who DOES feel the responsibility to get my work tasks done, and who DOES want to live, will keep doing the day-to-day items that she feels necessary to be done. So we are not COMPLETELY screwed <fcked> when/if we come back to reality. But when the other rageful person takes over, all bets are off. There is no concern for responsibilities.

When I reached that state, in the rage, I was somewhat co-conscious – I could feel the rage 100% but then also a voice in the back of my head telling me not to punch glass. Not to turn the wheel. One part of me saved the other from killing us.

Because my therapist did not have the experience in DID, she did not even consider this could be the case. I wish I could tell her this – do not make that assumption. I was scared what part of me could do. You should have been, too.

Her method to help me

She said that she did try to help – again she offered my coping mechanisms. Go to the park and take pictures. Listen to music, etc. I pushed back – I need something for that RAGE when I KNOW I should NOT pick up the camera because I will THROW IT. She countered, clearly frustrated, “I am not withholding anything from you.” I didn’t SAY that – I pleaded – you are the expert – please help me! I don’t know this stuff, I am reading but right now, floundering! Help me!

Idiot, she wasn’t the expert. You ignore all the signs and when you desperately needed the specialization, it wasn’t there.

Why I am so stupid

So, back on track here. My therapist would not tell me about people she had treated. She did not give me answers to questions about her training. She only wanted me to understand that she had treated many people for many years, and that that and my track record with her should be enough.

I was stupid enough to keep hammering for the information I wanted.

I was stupid enough to not realize that she didn’t have the information to give me.

Wasn’t it Einstein who said,
The definition of insanity is doing the same thing over and over again and expecting different results.

And kinda like that old adage – If all you have is a hammer, everything looks like a nail.

In her defense, she has a *very nice hammer*. It is excellent for trauma, for understanding triggers, for dream analysis, etc. And for a lot of months, I looked like a very good nail.

But as we got to some very tough issues with severe dissociation, I started looking more and more like a screw. (Ok, go ahead and laugh here – this chick’s got a screw loose, ha ha.)

So we had our blowup in the end. I triggered her and she triggered me. I WISH I had understood her hesitation and discomfort before it lead to her feeling defensive and lashing out. I WISH that I had seen that she didn’t have the answers I was demanding. Now I know why she accused me of trying to prove I was smarter than her – I WANTED her to me smarter than me! Show me that!

With lack of any information, I assumed she was experienced in the field of severe dissociation.

My bad.

So what is your lesson learned?

I am a perfectionist – something apparently common with those abused. If I am perfect and try really hard, no one will see that anything is wrong. No one will have reason to find fault with me and hurt me. Don’t yell at me, don’t be mad at me. I will be perfect.

I transfer that to other people – I expect THEM to be perfect, too. I know I have gotten annoyed and even angry with people who slack on the job. Who just don’t show the interest but who want the credit. Not the bozos who are too stupid to do anything more, but those smart ones who try to beat the system while stabbing you in the back.

I expected my therapist to be perfect and to have the roadmap for my therapy at least loosely defined in her mind. To be able to respond to my questions about what I was experiencing.

And perhaps even worse, I expected her to tell me if we were reaching unfamiliar ground. If she felt a little out of her area. I expected her to be honest about her experience. I needed some reassurance that what she was doing was right for me, or if it was something she just couldn’t provide.

Take home message

Trust your gut. Or in our case, trust the part of you who still has unanswered questions and can’t seem to get the answers. Trust the part of you who just feels that something isn’t right – be it as simple as closing down because you know the therapist’s office is not soundproof. As much as the emotional ones will plea with you to work it out, getting and maintaining trust therapy is not a democratic decision – any dissention in the ranks is a trump card that must be seriously considered.

Know yourself – you are the best source of knowledge about yourself.

PS

Again, not an overall slam on my old therapist. The only slam I have is that she would not be clear about her experience with other clients like me, and did not convey her growing discomfort in treating me.

References

Damgaard JA (2004). THE INNER SELF HELPER: TRANSCENDENT LIFE WITHIN LIFE?, Investigations Volume I, Number 3/4, accessed from http://66.201.42.16/viewitem.php3?id=161&catid=27&kbid=ionsikc

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8 Comments»

  VANILLA wrote @

Hi Emily et al,

I thought I would just send a quick email of appreciation for your blog, it is an amazing resource for those of us who are “all mixed up” (vanilla flavoured) as my daughter would say. We were catipulted into the world of dissociation (DID) when we adopted our children. There is not much written about childhood dissociation that is positve and practicle, your blog is both, as it explains things how they really are.
Child 1 has to some degree become a little more integrated but I think that this is more because inners have stopped being at war with one another and are more team orientated than ever before. We have tried to show that dissociation can be a gift…it is a way of surviving the unsurvivable and if used in a time of peace means then you are literally ten times what us mere mortals can be-they like that idea!
Child 2 is far more of an ancient soul and has a peace and wisdom that is at times frightening. But the war has not yet begun, about 99.9% mental energy is spent forgetting. This is the child we are worried for, they have no anger (well that certainly isnt true its just so well walled up you wouldnt know it existed-we have seen only tiny, tiny glimpses of it years ago )…by and large the inners coexist in a state of fragile peace and confusion with one another but their world is gosimer. All our children receive attachment based therapy which has helped enormously. You are absolutely right a therapist who has an understanding and experience of DID is worth their weight in gold. Or at the very least one who is prepared to walk with you in your world and feel strong enough to you to be able to handle what you feel.
You caste your words far and wide which is an amazing act of trust; here they have been recognised and will be used to help us understand the world you and our children live in.
Thank You

  emilylonelygirl wrote @

Vanilla

You have such kind words for me – it honors me to know that my words are helpful to others, and are more than just part of my therapy of learning and writing.

Thank you also for your work with your children. I can’t imagine what it is like to be a child and understand that what you feel is recognized and treated as a gift, and that your parents are actively helping. That is just wonderful! I had no idea what was happening, but just kept living in my world as if it was just like everyone else’s.

In a way, I identify more with Child 2 – I had walled nearly completely for so long and escaped to my inner world of writing, art, and music. Small bits of rage I didn’t even recall most of the time. That gossamer world could be a lifesaver of inner strength.

Thank you for writing and sharing your experiences

Em et al.

  kprsjohn wrote @

In our experience we have run into a lot of Ts who have no idea as to how to treat DID, even those self claimed experts. Treating DID requires knowledge and common sense and the ability to see beyond what is textbook as every multiple is similar yet different.

We really like your site,

keepers

  emilylonelygirl wrote @

Deer keepers

Thanks for your comments. Seems many of us have the same experiences with some therapists. I am hoping I know now to identify a good one the next time around!

My best
Em

  parris wrote @

Dear Em,

I MUST feel that my therapist is more knowledgable of DID than I – at least clinically speaking. And thankfully, she is. (It took years of dealing with professional idiots, ha! before we found her, though.)

In my over-simplistic view, a good therapist is essentially like a good parent who, over time and observation, becomes aware of the child’s weaknesses and strengths, and knows how to protect her from harmful elements, from within, from without.

Therapists can’t be perfect, of course, but they have to know they hold certain power over clients. It’s their responsibility to not abuse that. If one has limited experience in DID, it would be nice to receive an honest answer.

As for your therapist denying your multiplicity, good grief! What an insult. Denying your reality is disrespectful and totally counter-productive. It’s as if you are being told, “I don’t understand your problems, they make me feel uncomfortable, therefore I will discount you.”

My med doc does this. It’s not an issue, she doesn’t hold my life in her hands, as my therapist sometimes does. But still.

But you have a more competent therapist now, right? (not that your old one is incompetent-incompetent, just ill-equipt in dealing with your situation.)

I’m glad that your ISH was accessible to you when a part was ready to jump. Our inner family has several helpers, and the primary one is self-termed Inner Family Mediator. His name is Karistides. When things get really down and dirty, he initiates dialogue amongst warring members, and records it in journals scattered around the house. It somehow defuses things.

I’ve read somewhere in your blog that you enjoy a good support network. This is priceless. However, my sense is that somewhere on your healing route, your system will need a real therapist who trusts you to know when you are in danger. And who will, without ego, listen, listen, listen until your plight is over.

Thanks for listening to my blather!

Parris

  emilylonelygirl wrote @

Hi Parris

Good stuff – thanks for adding your comments. Seems like we are all saying about the same thing – the need for knowledgeable clinicians – which is good!

I do want to clarify – I didn’t intend for my post to imply that my therapist denied my multiplicity. Her statement was before my official diagnosis, which she was clear she could not do. I believe she said what she said because I was very worried about what was wrong with me, and she was “assuring” me that I was not on the very severe end of the dissociation spectrum. But still, it felt like a hell of a slam to me.

However, your wonderful quote in the same paragraph, “I don’t understand your problems, they make me feel uncomfortable, therefore I will discount you,” IS something that happened at the end of my therapy. Sigh.

No, I do not have a competent therapist (in the field of DID) yet. I have a few names to check out but I am taking a break from the therapy. Something inside says to stop hammering at it for now, and to let myself stabilize on the new meds (about 7 good weeks and counting!) before I take up the hard work again.

Thanks for writing!
Em

  kermitmuppet wrote @

Hi there.

In my opinion you are totally right in asking what skills and experience the therapist has! I mean, surely thats normal? If he/she reacts badly to that maybe they should go see a counsellor themselves.
Trauma isnt something anyone who calls themselves a ‘counsellor’ can start tinkering with, they have to be very careful, very.
And offering coping methods? WTF! We are the coping experts! We have to be otherwise we would already be dead!
You want someone who knows where you are and can offer real skills to start integrating.
The problem is that you have more knowledge than any therapist you are likely to ever meet. You just need someone to guide you through it, and someone you can trust.
Im from the midlands in the u.k., and my therpaist has been brilliant. I would recommend him.
When i have pushed him to move faster hes backed off – and always been right. Hes also given me insights into how id be feeling in a weeks time, and he always right. Thats where the trust comes in, that he knows what im going through.
Only now after 18 months of therapy am i seeing that i have parts, and i even have internal conversation – usually when im asleep. As far as im aware theres 1 part that im rejecting. I probrably sound like a D.I.D. novice and i am.

End of the day , i dont want the tag, i just want to be whole again! The way i feel like i can relate to everyone is because i too was abused.

Sounds to me like you have everything in place apart from a decent therpaist to know how to start the ball rolling.
Your posts are very well written and i always learn something from them.

Keep strong, simon

  emilylonelygirl wrote @

Simon

Thanks for the encouraging post. You are not necessarily a “novice” in DID…I think in a way we ALL are. In learning about ourselves, piecing together fragments of memories, understanding how to interpret our dreams…all that takes time, during which we are making progress. So, I don’t think that “novice” is a good word because we all have to progress at our own (often slow) rate, and our healing processes are all different (but with similarities).

I agree we all have more personal knowledge than the therapists – but you are right that they need to guide us in what we are experiencing – to help us interpret and deal with the anxiety and embarrassment/shame/guilt that can come with this. And the rejecting/denial that is in parts of me as well.

Good luck with your travels,
Emily


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