Mental Health related to Trauma

Myths which prevent people seeking trauma therapy

An excellent blog about the myths preventing some people from seeking therapy.

http://www.goodtherapy.org/blog/treatment-of-trauma-in-therapy-part-i-five-common-myths-0513145

Considerations for survivors of extreme trauma and ritual abuse

Timescales for healing
The treatment guidelines for Complex PTSD by the ISTSS give a longer healing than the article above – between 18 months and 2 years is suggested, but this will depend on the degree of trauma and your current situation in life. If you are one of the many survivors who is still living with domestic violence or experience a bereavement during treatment, for example, then it may take longer.

Myth No. 2: No therapist can handle all of my trauma and emotions. It is just too much.

Firstly, in common with the Complex PTSD treatment guidelines, the Dissociative Identity Disorder treatment guidelines describe the first stage in treatment as focusing on Safety and Stability – learning more ways to cope with difficult emotions and trauma symptoms before trauma is discussed directly. Ways to contain existing trauma memories for a time may be needed. Therapists should also be comfortable working with clients who have additional diagnoses, self-injure and have previously had multiple suicide attempts. These are all common in survivors of severe and prolonged trauma.

Secondly, it is true that many therapists cannot manage the severity of trauma that many people with Dissociative Identity Disorder, Other Specified Dissociative Disorder (DDNOS) or extreme abuse have experienced. It can be particularly difficult because both disorders are caused with very early repeated trauma, typically at pre-school age or younger. Consequences can be either the vicarious traumatization of the therapist, or denial and minimization because he/she can’t face the reality of it. Things that help include:
1. Looking for a therapist who has worked with similar disorders or trauma before, rather than someone mostly familiar with simple PTSD. E.g. try Find a Therapist on http://isst-d.org or Trauma / Dissociation professional organizations, and ask for recommendations if none are close by/or available for very long term work.

  1. A therapist who has a supervisor with experience in the same field can help your therapist by spotting very early signs of difficulty and suggesting ways to handle this without while continuing therapy, this won’t you involve directly. An old publication by Kluft (1989) provides a way for therapists to handle this if it happens and includes indicators of when continuing therapy could be harmful (generally avoidable if earlier action is taken).
    The rehabilitation of therapists overwhelmed by their work with MPD patients.
  2. Therapists working with such complex clients need to be available for long term work, and willing to spend additional time on professional development. Therapists considering working with ritual abuse survivors can find valuable guidance in Dr Alison Miller’s book, Healing the Unimaginable (2012). Chapter 7 by survivor Stella Katz describes her ‘job’ in the cult, containing graphic descriptions of her role in torturing children, and explaining why she did this before she left the cult and ultimately healed. The ISST-D ritual abuse special interest group (for professionals) may be helpful.

Therapists who are suitable may be very difficult find, but some exist.

Myth No. 5: The therapist will judge me if I tell him or her what happened.

A trauma therapist’s role is to help guide and support someone who has experienced trauma, not to criticize or blame.
The DSM-5 diagnostic criteria for PTSD (criteria D) include distorted thinking surrounding the trauma resulting in self-blame, persistent shame, guilt, horror and/or anger, and negative beliefs about yourself,  example ‘I am bad’. A therapist will be able to work through these with you, along with the additional symptoms of Complex PTSD and Dissociation.

All victims have been forced to perpetrate against others, usually since early childhood. All perpetrators are victims of severe abuse. Keeping this in mind is critical in treating survivors. Black-white or evil-good frameworks feed into survivors’ fears that they are irredeemably evil.
Dr Ellen P. Lacter, clinical psychologist

If you experienced ritual abuse then it is extremely likely that you were forced or tricked into doing things which horrify you and carry immense shame. You may have been forced to harm or kill others (forced perpetration) or have been forced to make impossible ‘choices’ such as choosing between having another child harmed or being harmed (double binds). These are common ways that abusive groups use to damage children and vulnerable adults – it is one way that abusers use to keep survivors silent, they often blame you or pretend ‘choice’ when you were not free choose to do normal childhood things or to leave. This is so awful and unbearable that it commonly creates different alter identities to do what abusers demand, an identity lacking empathy may be needed. Feeling intense guilt and shame now shows that you regret what happened, a sign that you are not truly ‘bad’.
Therapy should be able to help you understand why you acted as did, the effect of previous trauma on your mind, and help you reinterpret the trauma with an adult perspective.

Lastly, the no particular type of therapy is recommended above others for complex Dissociative Disorders, a good alliance between therapist and client leads to the most effective therapy. According to Kluft Dissociative Identity Disorder will not spontaneously resolve without treatment (a small number of cases of PTSD without a dissociative disorder do resolve treatment).

More information about ritual abuse

Working with Difficult and Destructive Alters

Trauma And Dissociation project:

Dissociative Identity Disorder -Working with difficult and destructive alters

Originally posted on Discussing Dissociation:

I’m going to take a slight detour in the internal communication series and write a little about working with difficult alters.  It is crucial to work with these internal parts, no matter how challenging and hopeless things seem in the beginning.  Your therapy and healing will never be resolved unless you approach the issues connected with these difficult insiders.

And for that matter, the whole process of building a connection with these difficult, complicated insiders is based on building good communication skills with them, so in that sense, this post is still part of the internal communication series.  System work, in whatever way it happens, is a critical part of internal communication and the overall healing journey for everyone with Dissociative Identity Disorder (DID/MPD).

Insiders may first appear in your therapy process being difficult – obstinate, obnoxious, aggressive, scary – and they may maintain destructive behaviors for a long time…

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“You can’t patch a wounded soul with a Band-Aid.” ― Michael Connelly

Trauma And Dissociation project:

You can’t patch a wounded soul with a band aid
New book looks at combats vets after conflict

Originally posted on Jadetheobscure :

Invisible illness

Thank You for Your Service ― David Finkel

ThankYouForYourService_300dpi

David Finkel, author of the New York Times bestselling book The Good Soldiers- a journalistic account of the lives of the men from the 2-16 infantry battalion on the front lines of Baghdad, emerges once again with a gripping addition to his work – Thank You for Your Service. This new book takes a look into the lives of soldiers who serve in Iraq, this time with a glimpse into what happens when they return home.

In Thank You for Your Service, Finkel meets with men from 2-16 to look at the way the war has affected their lives outside the battlefield. First person accounts of adjusting to life outside Iraq throw light on a new war fought by many soldiers, this time with themselves.

The wars of the 21st century have been well covered by journalists, reporters and…

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Using visualization for stabilization and safety in Dissociative Identity Disorder and OSDD

stabillity, safety and symptom reduction in treating DID

Phase 1 of Treatment

Phase 1 of treating both Complex Dissociative Disorders and Complex Posttraumatic Stress Disorder is establishing safety, stabilization and symptom reduction.

Guided Imagery

If you have ever looked at a holiday brochure and imagined yourself lying on the beach, in the sunshine or perhaps swimming in the warm water, or you have looked at a car and imagined what it might feel like to drive, then you have used guided imagery, often called visualization.

Dr Onno van der Hart, a psychologist and researcher specializes in the field of Trauma and Dissociative Disorders, and has written an interesting paper on the use of guided imagery for reducing PTSD symptoms and improving daily life functioning, most of which applies to Complex PTSD as well as Dissociative Identity Disorder and Other Specified Dissociative Disorder (formerly DDNOS).

This approach is also referred to in the Guidelines for Treating Dissociative Identity Disorder in Adults (p156-158) as an auto-hypnotic technique which has been well-proven in Phase 1 of treatment. It does not involve trance-like states or investigating amnesia/gaps in memory, but instead serves as a method of self-soothing, calming and containing distress. Because this is an auto-hypnotic technique it can be used outside therapy sessions, and whilst maintaining awareness of the present and current surroundings. Anxiety can also respond well to the use of guided imagery to aid relaxation.
Van der Hart suggests the following examples of guided imagery:

  • Imaginary protective gear (especially useful for emotionally younger ones)
  • Inner safe places
  • Containment of traumatic memories
  • The imaginary meeting place (for dissociative parts/alters within DID)
  • Inner community building (for dissociative parts/alters within DID)
  • The inner source of wisdom

I would highly recommend reading the full article, this section starts at around the third page, under the heading ‘Guided imagery during phase 1 treatment. The book Coping with Trauma-Related Dissociation also includes helpful exercises including creating an inner safe place.

van der Hart, O. (2012). The use of imagery in phase 1 treatment of clients with complex dissociative disorders. European journal of psychotraumatology, 3. (full article)

Related links

Guidelines for Treating Dissociative Identity Disorder in Adults Journal of Trauma & Dissociation, 12:115-187, 2011 (Institute of Trauma and Dissociation – large file)

Treatment of Dissociative Identity Disorder (dissociative-identity-disorder.net, our wiki)

Treatment of Dissociative Disorders Study Results (July 2014, traumaanddissociation.wordpress.com)

Forging a Deeper Understanding of Flashbacks Part I  (Paul F. Dell, understandingdissociation.wordpress.com)

Structural dissociation: Division of the personality (traumaanddissociation.wordpress.com)

Phase I: Overcoming the phobia of dissociative parts (traumaanddissociation.wordpress.com)

Flashback Worksheets for Trauma Survivors (ritualabuse.wordpress.com)

Attachment-based therapy (crazyinthecoconut.co.uk)

Dissociative Identity Disorder and Amnesia

didisreal http://traumaanddissociation.wordpress.com:

Amnesia within Dissociative Identity Disorder explained

Originally posted on Dr. Kathleen Young: Treating Trauma in Tucson:

Dissociative AmnesiaI am continuing the conversation about dissociative identity disorder (DID) and characteristics that make up the diagnosis. I want to address amnesia,  what it looks like in DID, and the function it serves. Of course,  not everyone with amnesia has dissociative identity disorder. Remember, the first two criteria, different self states and amnesia, must exist together for a DID diagnosis to be made.

According to the DSM-5, there are three primary ways amnesia present in people with dissociative identity disorder:

1) gaps in remote memory of personal life events (e.g., periods of childhood or adolescence; some important life events, such as the death of a grandparent, getting married, giving birth); 2) lapses in dependable memory (e.g., of what happened today, of well-learned skills such as how to do their job, use a computer, read, drive); and 3) discovery of evidence of their everyday actions and tasks that they do…

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Learning More About Myself

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didisreal http://traumaanddissociation.wordpress.com:

Reflection in therapy: the quest for perfection and the inner critic

Originally posted on DIDdispatches Blog:

image

This week I’m trying to work through some issues about myself, it’s odd to think I actually put myself through difficulties by being over critical or judgemental of myself. But apparently I do self judge and it’s not good, I am also inpatient which I didn’t realise fully either until it was spelt out to me the other day.

I have known I’m self critical for some time, I mean I constantly put myself down and yet I had never realised how much I judge myself. In therapy the other day I realised that actually I am repeating behaviours from my past and judging myself. I think part of this is the fact despite thinking I now accept my Dissociative Identity Disorder, in my heart I still don’t, well not fully.

I have always wanted to be normal whatever normal is and I have always striven to just be good…

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