Part 2: Menagerie Aside, The Surreal Therapy Session Itself

Recently, I scheduled consultation interviews with two therapists, hoping one would be the “one.” Good news – I found her! Bad news, the other therapist has not a clue. You already know how that session started and ended – with the surreal therapy room and therapy menagerie. I promised to follow up about the consultation itself. This post is much less fun. It will piss you off.

Our adventure resumes already in progress

I left her house, fumbling with my keys, zoned and stunned as I carefully executed a K-turn without taking out any mailboxes. It was about 9 pm and I was exhausted. Somehow we pulled over at a mini-mart. Ostensibly to get coffee for the ride home. I joked with the kid behind the counter; smiled. Then got back into my car and sat there. Head spinning. Voices.

What the fck just happened?

The Three Questions

You know everything that happened up to the first word out of her mouth. Fur, dog-nose-in-crotch and cat-in-lap, marching Chinese soldiers, Indiana Jones.

“I like to start with the Three Questions.” She sat matter-of-factly in her chair, clipboard and pen in hand.

<Fck, a test?>

1) What in your life do you want to fix?

“Well,” I fumbled, “I am not sure. To feel whole. Engaged. To stop losing time. My husband says I say and do things I don’t remember. I ruined a fun evening with friends. I remember some of it, and I know I was behind the one who did it but I couldn’t not stop it. I feel radically different from one time to the next. I get triggered, and I have started to understand what triggers me by working with my first therapist.”

(Nod nod, write write.)

I didn’t barf out “PTSD/DID.” She didn’t ask anything during our phone scheduling and I didn’t offer. She also didn’t ask at the start of the session. She just launched into her Questions.

Now, I don’t like to tell people how to do their jobs. Instead, I often evaluate people based on how they treat me and interact with me. I wanted to see her thought process as I told her the symptoms.

She followed up a bit on the amnesia and “different parts” stuff…said the standard, “We all have different sides of us” thing. Which I am sure is a little “rejection” trigger for all of us, but I’m getting used to it. So, okay, do your little DX thing lady and move along. But she did seem to get the hint is was more than just “sides.”

“What have other people told you about this?”

“PTSD/DID”

“Well, I don’t like labels.”

<Then WTF did you ask me for? Is this your trick to get the answer to the quiz so you don’t have to think hard about diagnosing me 1n the first place? Strike 2. (The fur-lined brigade up the stairs and on my lap through the session was Strike 1.)>

…and, at no point did she ask WHY I might have been diagnosed with said “labels.” I was ready to offer why if she’d shown the interest.

2) How do you think we should accomplish this?

(laugh) Well, that’s a question I think you need to answer.

3) How will you be after you finish with the therapy?

(Integrated? Healthy? Happy? A grandmother?)

I offered some generic BS based on my responses for Question 1. Be more aware, conscious, don’t rip off hubby’s face, etc.

Now, these questions are not terrible, but perhaps unanswerable. Which, in and of itself, may actually answer them. But this early on, I was torked about the assertive body language and poised clipboard.

After I either passed or failed the Three Questions test, she went to the next phase of the interview. (Clearly, she was interviewing me and not the other way around.)

The event

Now, what follows is a technique that I think should be banned. Or used with awareness and caution.

At this point, she knows there is dissociation and trauma. She does not know the cause and has not asked. Has not given me body language that I should interrupt and offer. I understand that I am on the witness stand.

“What I like to do first is understand your background as the foundation for the work we will do together.”

<Huh? You may have accepted ME, but I’ll be damned if you assume I have accepted you, bitch. >

Sigh. “Ok.”

At this point I had stopped petting the cat.

Ever present clipboard in hand, she drew a circle and put my name in it.

“What is your husband’s name?” I told her and she put a circle next to mine.

“How old is he?

I told her.

“What does he do for a living?”

I told her.

“What is your mother’s name?”

<Oh Christ.>

Sigh. I told her.

“Still living?”

“Yes.”

“How old is she?”

I told her.

“What does/did she do for a living?” I told her.

Pen poised, “What religion?” I told her.

At this point, I was not feeling the love. I felt offended that she asked my mother’s name so casually. Kate nearly bolted for the door <with a resounding Fck This!>, but I stopped myself. I said, “Cami, people do things differently. Your last therapist had one method. The one you interviewed last week had another method. This is just a third one. You drove over an hour, you’re already here; just sit here with Kate keeping us on Yellow Alert and let it play out.”

“And your mother, she has how many brothers and sisters?”
“How many were boys, how many were girls?”
“What is the birth order?
“What is your material grandmother’s name? Living/age? Occupation? Faith?”
“What is your material grandfather’s name? Living/age? Occupation? Faith?”

We repeated this dance for both of my parents, all four grandparents, my children with their ages, geographic locations, marriages, children, occupations, etc.

Circles upon circles interconnected with weaving lines and arrows.

My life, my foundation, on a yellow page of notebook paper.

<Strike 3. You’re out.>

Some rambling other stuff

The rest of the session is somewhat a blur. I know at one point I intellectually told her what happened to me – molested as a child, raped as a teen at knifepoint. Hmmm, she considered. I felt like I had to vomit out my past in order to get this session marginally back on track to where it should have been going in the first place. IMHO.

She told me she would run some tests about dissociation, etc. Hmm. We’ve already established my familial and historical foundation and now we need my mental health profile foundation.

<Strike 4. It juuuuust keeps getting better and better.>

I told her I had taken the Dissociation/Steinberg (SCID-D) test – I thought the test was very informative and matched me pretty well. Actually, it was a major milestone of concrete evidence to help us in overcoming the denial thing. Good stuff.

“No, other tests,” she said. But she didn’t offer names quid pro quo.

<Probably has to look up the right ones. But didn’t she say she took a bunch of graduate classes?>

Oh yes, forgot about that. I managed to get some of MY interview questions in there. About needing someone who can handle the engineer bringing in researched articles, debating treatment ideas logically, who will not feel threatened. She told me to bring in the articles and she would read them. And she then informed me that she had taken many graduate courses.

<Heh heh.  “Many graduate courses.” We have a BS, two MS’s and a PhD. And we’re pretty darn cute. Top that.>

Conversation paused at that point, and this rather large woman shifted cumbrously to re-cross her legs the other way.

Ahhh, now we’ve got her number. <Smile of small prey in sight.> For the first time, this woman is intimidated by us. Her education or credentials must have been questioned in the past, and this is a trigger for her. With my exploring questions about facts, researching and sharing control of my therapy, her analytical demeanor and need to have the upper (and apparently secret) hand in knowledge is microscopically cracked.

<Morpheus, she is not The One.>

She asked about medications. I told her I am on Lamictal daily, with the occasional Xanax when the stress and anxiety get really bad and I prefer not to punch things and jump off bridges.

BUT…I hit a hot button. She launched into how addictive Xanax is and how I should go back and tell my meds doc to consider a different drug that I wrote down with her pen. Hint Hint. I got to hear about her work at an impatient facility for drug addition…how Xanax is the worse drug to become addicted to.

<WTF? Is this woman actually IN the room, or am I being interviewed by a one-way holographic recording?>

She is more concerned about a drug I take, hmmm, once every couple weeks, rather than the dissociation, amnesia and rising memories that I deal with every day?

<Do I look or act like I am drug-seeking? Have you asked ANY OTHER questions that cause you to actually THINK that? Strike 5. (5?)>

She is a LCSW – Licensed Clinical Social Worker. Somewhat far removed from being able to prescribe. Else, I think I’d have had at least one new ‘script on the way out the door. So escorted.

Why did you stay through that ridiculous preposterousness?

Sitting back in the parking lot of the mini-mart with a coffee and an entire bag of cashews. (Hmmm, who in here likes cashews, Emily? Comfort food.)

What is wrong? I asked myself. You are freaked. You feel violated. I was uncomfortable and the wall was up, Kate keeping things safe on yellow alert.

“Cami, you were triggered. We got triggered as soon as she asked Mom’s name. We were going to bolt and you didn’t let us. Why not?”

I thought about it, and realized I had had a very real reason. Still to this day I believe in my reason.

Early this summer when I contemplated leaving my first therapist, my best friend cautioned me. In therapy himself for years, he gives great sounding-board advice. He asked me quite bluntly, “Cami, do you want to leave your therapist because she isn’t right for you anymore, or because you didn’t like something she said about you?”

Hmmph. He is right. I am stubborn and if someone says something I don’t agree with, sometimes I just abandon them. That is one of my issues. That I have trouble facing when I am wrong.

After she asked my Mom’s name and I told her, my best friend’s words came back to me. Are you going to end this therapy interview because you are too stubborn to find that her methods might be worthwhile, or because you are genuinely uncomfortable?

And that is why I stayed. I wanted to evaluate the whole session – her whole introductory methods. I didn’t want to stereotype about the whole “tell me about your mother” thing. I consciously made the decision to stay, to learn, knowing full well 20 minutes in to the session that I would not be returning.

Sitting in the parking lot, I realized why I stayed. Accepted it. But also recognized that it had triggered me. And I was proud that I’d kept that trigger under control. And that I left knowing *rationally* why I would not go back.

But emotionally, I felt laid out open on the table. I had let this woman inspect me, pull personal details out of me, invade me, without giving me the common courtesy of getting to know me at all.

All because I was giving her and her “learned” methods the benefit of the doubt.

(Small voice – “She raped me.”)

I drove home that night coming out of the numbness and feeling the anger rising. I was mad at her. And a bit at myself after realizing what I let her do. But also knowing why I did it.

<That fcking double-edged sword shit.>

Emily-Cami-Kate. Emily-Cami-Kate.

Postscript

I had my second session with the first (good) therapist the next morning. She knew I was interviewing another. She asked, and I told her how it went. And that I learned I could not work with a therapist as analytical and inspecting as Kate.

To her credit – she did not say anything negative about her “competitor’s” technique. Instead, she asked why I didn’t let just myself walk out when I was uncomfortable. I explained my reasoning. “But you didn’t’ tell that therapist you were uncomfortable.” “No,” I told her, “I wanted an unbiased assessment of how she interacts with someone.”

I was building evidence to justify without doubt that choosing therapist 1 was right, both emotionally and intellectually. I/Cami had gotten outside myself. And I had not realized I had also lost any direct communication with Emily or Kate.

Then she made a very astute observation. She said, “Then this is something we need to watch out for.”

?

“We need to make sure that if you are feeling uncomfortable about something, that you tell me. When you dissociate. I can often tell, but not always. I need to know, so we don’t go down a path that puts you in yellow alert and we lose our connection.”

That single assessment on her part made the whole negative experience worthwhile.

It taught me something important about myself. While a powerful part of me continues to be an information gatherer (my dear Kate), other parts less vocal must also be able to throw in the trump card to signal immediately that a boundary has been violated. And that no curious need to learn can every take precedence.

Cami and Emily

– ∞ –

See also:
Table of Contents for all blog posts|
A Surreal Therapy Consultation
Emily and Cami Share What you Suspected Anyway
Therapist consultation for dissociative identity disorder
Changing therapists – what to consider
Comment: Importance of Physical Environment in Therapy
Flame-Quenching “Move Along” Standard Disclaimer
Guest Book and Introductions

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9 Comments»

  davidrochester wrote @

This was a great post, especially the part about other selves needing to have permission to speak and get their needs met. For years and years and years, I let Ian run my life, I begged him to do it, because he was so good at it. In order to effectively do what I’d asked him to do, he had to “drown out” my other alters, which he could do most of the time. He knew he was doing this; I did not. He also thought it wasn’t a very good idea, but the only way he could communicate this to me was by failing to take over, which allowed the others to come out in ways that were life-ruining.

I never would have discovered all the others if I hadn’t “banished” Ian from my life because he was disrupting a relationship I thought I wanted to keep. As soon as he was out of the picture, I became a panicked, anxiety-ridden, terrified nutcase. It is still hard for me to view these reactions as positive, to take them as cues, to understand that when I have them, an alter is trying to get my attention in the only way he or she knows how, and I have to attend to those needs. Ian “gets” it more than I do, and often he will not intervene to get me out of the situation unless I listen first to what my others are trying to tell me.

Nowadays, before I go into any unfamiliar situation, I sit down and make an escape plan, and am very clear with everyone as to what level of discomfort will signal the need to leave, so that we don’t dissociate and become paralyzed, which is what has happened to us so many times in the past. If the plan is clear, it works very well for me … I take cues from the others about what is triggering or unacceptable, and then Ian comes in to get us out of the situation once the others have been appropriately heard. Sometimes, given his own way, Ian would stay if he were “out,” as his skills are completely different, and he might regard as a challenge something that the rest of us see as a threat. But I think the trick is learning to calibrate, and not living with just one part at a time.

My current therapist, who is also an LCSW, though she has training that allows her to be listed on the isst-d website, had a similar questionnaire, but it was prep paperwork that she sent to me before I saw her for the first time. It didn’t ask my parents’ names, but it did ask most of the questions you mention … what I considered basic background info. However, I was completely in control of how quickly I filled it out, and what I chose to say. She also told me that if I found any part of the paperwork to be triggering or upsetting, then I should leave it blank, and we could talk about it later when the time was right.

I remember when she had me take some other standardized psychological tests … she was very careful about how she did it, and offered me the option of filling the paperwork out in her waiting room so I could have some privacy but still have her easily at hand if the questions triggered or upset me. I didn’t appreciate this at the time (I was more like, “WTF??”) but I appreciate it now.

  camigwen wrote @

Great experiences and advice – you said,

Nowadays, before I go into any unfamiliar situation, I sit down and make an escape plan, and am very clear with everyone as to what level of discomfort will signal the need to leave…I take cues from the others about what is triggering or unacceptable, and then Ian comes in to get us out of the situation once the others have been appropriately heard.

I must absolutely take this to heart. I have tried to make escape plans but it was always *me* trying to detect anything triggering, and then telling myself, “Okay, I can deal with this, I can deal with that.” But never looking inside…didn’t know HOW to look inside.

Now I can see I have to listen carefully to hear Emily and temper that with any yelling Kate is doing. But like Ian, something she just says Fck, deal with it yourself. Hmmm. Sink or swim? I have SO much to ask (of myselves)!

Excellent – an escape plan with input from everyone. Listen, assess. Then Kate or another gets us the fck out with as little fuss as possible. I am writing this down in my little book of notes.

Sometimes *I* feel left out in the cold, and wonder now if those inside are letting me flounder until I get a clue. I did look over Emily’s shoulder in a diary entry a few weeks ago that when I came, she felt (and still feels a little) that I am somewhat ineffective but well-intentioned.

How’s that for rocking your self-worth? (laugh!)

But I really treasure that, because it is insight into how I am accepted! Stuff I never had!

Cami

  Secret Shadows wrote @

That was awesome!!!! I am so freaking exhausted, though, that I cannot say all the things I would like to say, but it really was awesome to read. I enjoyed reading both posts about you finding a new therapist. There was humor, understanding, insight, and…well,,,it was just awesome.

You have selected a good therapist it seems. One who really wants to understand. One that sees what needs to be seen and cares for your feelings. That’s great!

  davidrochester wrote @

Sometimes *I* feel left out in the cold, and wonder now if those inside are letting me flounder until I get a clue.

I’d say yes, absolutely, my dear.

What I found, when it hit me like a ton of bricks that my paradoxical reactions to perfectly “safe” situations were actually triggers, was that my alters weren’t willing to trust me to protect them. And why should they? I’d failed to do it for thirty-five years. So I had to earn that, and I had to do it very carefully.

I remember very clearly one of the first breakthroughs I had with this … my youngest alter, who is now permanently cared for by Ian (who is incredibly insightful about children, and would make a great dad) was terrified of my clients, and would cause me massive anxiety during even the simplest interaction. When I “found” this alter, before I’d found a permanent safe space for him, I asked him what he needed in order to soothe him while I was dealing with my clients. He said he wanted a cat. My immediate reaction was one of impatience — how could I possibly accommodate that, during my work day? I thought about it, and realized I have a stuffed cheetah toy that looks a lot like one of my cats (that’s why I bought it; it’s hilarious to watch her play with it). I asked the small alter whether he’d accept that, because we couldn’t keep a living cat in my car. He seemed OK with that. So I started carrying this toy around in my car, and before I had to go see a client, I’d, uh, kind of cuddle the toy (or the small alter would) and that would provide enough comfort to reduce my physical anxiety symptoms enough to let me do my job.

After I’d done this for a couple of days, I was seized with a feeling of enormous irritation. I didn’t understand why my small alter wouldn’t believe me that my clients wouldn’t physically harm us (that was what he was afraid of, for reasons I still don’t understand). Why wouldn’t he trust me? Why wouldn’t he just believe me?

Ian stepped in and said: “Why should he believe you, when you have ignored him all this time, and you can’t provide even a very small level of attention with an open heart? Why should he trust you? Would you trust someone who behaved like that to you?”

And of course, he was right.

All of this is to say that for me, learning to better manage the triggers and anxieties of my alters has been a process of learning humility, and of taking very small steps. It was a huge victory for me when my smallest alter trusted me enough to stop being triggered by my everyday life, and to stay in a safe space. It took a couple of months to work that out with him, and a great deal of paying attention to the very specific way it felt when he was triggered, as opposed to the others being triggered. And I had to plan “escapes” for the simplest things … for the smallest everyday events. No matter where I go, I have to reassure everyone that I know where the exit is, that there is a clear path out, that I will protect all of us in situations that are too much to handle … or that I will at least keep that as an option, in the case of situations where it is beneficial to the self as a whole to stay engaged ( as is the case with my new job; every day I renew my pledge to leave if I need to, and ask permission to try for one more day, because as a whole, it’s positive for us to be there).

I’ve found that one of the least pleasant things about increased co-consciousness is that some of my alters don’t like me. That’s hard to take, but not too hard to understand; as an adult, I’ve neurotically repeated and sought out the same dysfunctional behaviors that caused this to happen in the first place. No wonder they don’t like me. I’m not too crazy about me sometimes, either.

  camigwen wrote @

Wow. You have been through what I am embarking on, and your personal examples resonate so strongly. Wow. I was shocked when I read what Emily said about me. And for you to have experienced the same. I realize that now…I know what Emily and Kate think of me. I have no idea about the others, even though I have had co-awareness (maybe that is a good term for pre-co-consciousness as I now understand it).

*Weight on heart* Realization – there is a lot of work left to do. On one hand, I better understand the milestones I need to work towards (good), but….wow.

My husband bought me a stuffed cat from Build-a-Bear several years ago. I sleep cuddled with him about half time time. He hears me tell the bear I love him. And my hubby is fine with that. Not sure why – maybe he senses I need comfort. Maybe because he gave me the bear and I love something that came from him. He also knows about me although we don’t talk about it much. But he sees differences.

I carry a shell in my pocketbook that another small alter bought. I carry that always – and it is all the acknowledgment she needs to know that I care about her. She is the youngest, but amazingly very emotionally strong. No trauma.

I guess some of this I have figured out without realizing it. Others I have to be slapped in the face with.

Thanks for helping some of me inside acknowledge the slapping!

  davidrochester wrote @

You’re very welcome. I think you’re on the brink of some of the most exciting, frustrating, enlightening work that DID folks get to do. I’ve been working on this for about eighteen months now, I guess … I started it the week after I began with my current therapist, and while it hasn’t been easy, things have happened that I would have considered impossible when I first saw her. When I started seeing Debbie, I was so debilitated by anxiety that I couldn’t have a cup of coffee with my best friend here in town, without throwing up beforehand, and suffering cold sweats and tremors for two or three hours leading up to meeting her. This is *my best friend*. So you can perhaps imagine what it was like for me to deal with strangers, and with my clients who are often emotionally reactionary.

I honestly thought I would be stuck like that forever.

Within four months of learning to listen to and negotiate with the alters who were trying to get my attention with these reactions, it was gone. Completely gone. I still have some mild anxiety with clients whom I don’t know, and with people who are having disproportionate emotional reactivity, but the extreme social anxiety has vanished, as though it never existed to begin with.

I am so glad, so very glad, that I never went on anxiety meds … if I had, I wouldn’t have been able to “hear” what my alters were telling me. I still occasionally take beta blockers to help control extreme physical reactions to stress or fear, but those do not affect my state of mind at all. One of the continuing negotiations has been explaining to the two alters who cause my anxiety that they need to learn to get my attention in another way, because we are all in the same body, and when they affect my body in such extreme ways, I can’t pay attention to what they really want or need, because my full attention is directed toward managing physical symptoms of stress. It took a while before they were able to hear me about this, but it’s so much better than it was.

If I’d listened to the other therapists and doctors I spoke to, I would be on several different prescriptions to control anxiety. I’m glad I listened to Ian instead, who told me to remain uncomfortable, because it would be useful, although it sure as hell didn’t feel useful.

All of this is to say … there is a vast wealth of information available to you when you pay attention to things that make no sense. They always do make sense, to someone. 🙂

  camigwen wrote @

Laugh!

there is a vast wealth of information available to you when you pay attention to things that make no sense. They always do make sense, to someone.

Excellent! And also sage advice.

  Tigerweave/Anna wrote @

That taking into account the quieter or not-fronting alters is something that really surprised me upon integration. I am realising the main fronter for my adulthood, Leonie, was really best at “damage control” and navigating a world rendered hopelessly confusing by the dissociation and lack of experience of it that the suppression of memories brought.

so the person I presumed I would be if I integrated – a sort of more integrated Leonie – just, er, wasn’t. I am so much more the quieter ones, the little ones, the others. Those feelings those personalities had are essentially my daily bread-and-butter experiences now.

Makes life a lot easier 🙂 Before integration it was a real mental gymnastics game to take them into account, and one I often failed at miserably, so was essentially living a life I wasn’t comfortable with, that wasn’t *mine* because I had trouble hearing the other alters and adjusting my behaviour accordingly.

[…] (That evil horribly-addicting substance I should admonish my meds doc for prescribing???) […]


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