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Dissociative Identity Disorder Treatment in a Vacuum?

September 19, 2011 Holly Gray

After a recent experience with state-dependent memory recall got me questioning the heavy focus on internal communication in Dissociative Identity Disorder treatment, I decided to ask readers of my personal blog how they learn about their systems. 63% of responders cited feedback from external others along with internal communication as the primary ways they gain insight into their DID systems. Only 9% cited internal communication alone. [See poll.] And yet in the six years since my diagnosis, I’ve never heard anyone who treats or has DID recommend engaging in the outside world as a path to self-discovery. In fact, I’ve heard the opposite: no one will understand Dissociative Identity Disorder but us; talk to yourself and to us, and no one else.

time-loveDissociative Identity Disorder Treatment Is Too Internally Focused

Navigating human problems requires, to some extent, engaging in the world, with other humans. Particularly when you consider that Dissociative Identity Disorder is a dynamic, complex web of processes designed to allow engagement with the outside world, not the inside one. We cannot hope to get to know ourselves, let alone solve problems, by focusing only on the inside. No one can, DID or not. But that's exactly what those of us with DID are encouraged to do ... we're supposed to journal, create art, and talk inside. Everything about Dissociative Identity Disorder treatment - except for those hours we spend on therapy couches - is internally focused. Does that seem right to you?

It doesn’t to me. I’m not capable of getting to know myself better, of understanding my experiences, motivations, and reactions more clearly, only by looking inside myself. I’m not convinced anyone is. And I think Dissociative Identity Disorder treatment forgets that.

Dissociative Identity Disorder Treatment Isn’t Effective in a Vacuum

In my six years of Dissociative Identity Disorder treatment, every clinician I’ve seen stringently cautioned me not to disclose my diagnosis to anyone except on a strict, need-to-know basis; and only after long consideration of whether or not they actually need to know. My peers with DID, by and large, mirrored that same directive. And while it wasn’t necessarily bad advice, it cast a veil of secrecy over not just the diagnosis, but any issues I had related to it. Those dire warnings to keep my diagnosis to myself, though well-intentioned, only served to increase my sense of abnormality and isolation. I felt weird and aberrant and like talking to anyone about my problems other than my therapist or others with DID was dangerous. And I couldn’t figure out why, if I was doing the right thing by only sharing with those select few who treat or have Dissociative Identity Disorder, the talking only rarely gave me any insight, or made me feel any better. But that’s sort of like expecting to learn anything when you only talk to people who agree with you. No one can grow in a vacuum.

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APA Reference
Gray, H. (2011, September 19). Dissociative Identity Disorder Treatment in a Vacuum?, HealthyPlace. Retrieved on 2019, October 17 from https://www.healthyplace.com/blogs/dissociativeliving/2011/09/dissociative-identity-disorder-treatment-in-a-vacuum



Author: Holly Gray

Brandi
says:
April, 2 2013 at 5:38 pm
Hi Holly,

Well, I've spent the past couple hours reading your blog and a few other things on this site and I must say, I've balls'ed it all up. I've told everyone one I know, I've reached out for helf from all my family and friends and written tons of confusing pain filled articles on my search for help.

I came to this website in search of help. Hoping for someone to tell me where I could find a therapist who would help me integrate. I have no desire to hide my disease, to keep the public uneducated so the next girl who has this has no idea what to do. Rock on. If you know of a therapist in Riverside, I'd be grateful for a name and number. Peace/Joy from all of us. :D
samruck2
says:
November, 15 2012 at 11:34 am
Hi Holly,

no one's probably watching this thread anymore, but as you know from my blog, my son and I both have personal relationships with ALL 7 girls in my wife's network and I believe that has helped them ALL to heal and move forward as the secrecy and shame of the abuse is removed. I act as a stabilizing anchor for the new girls who join us on the outside and it gives the others who have been outside longer a chance to get to know them and develop more communication.
jewel4america
says:
October, 7 2011 at 7:54 am
just one comment...
I am not ashamed of having DID... I did not cause this...
Others who choose to misunderstand or remain ignorant to what DID is.. it's on them.. not me..
DID means that I am a very strong, creative person who survived what many would not survive... it means the core of me wants me to survive.. to live... I do not consider DID mental illness... but rather that we are just a little smarter than most people.. we are survivors.. not victims.. and I know without DID, I would not have lived..
now.. trying to find a doc that is ''good enough'', ''knows enough'' to help me.. that's a problem..I'm NOT going to give up until I do.. I pray to God everyday and everynight about it..but I also do the research and ask the questions... God bless all like me.. I feel God gave us an extra layer of protection and that makes us just a little different, but I do not see myself as crazy or mentally ill... and I love me...
Mareeya
says:
September, 30 2011 at 7:24 am
"Perhaps part of why engaging with others helps us so much is because we do it less than our extroverted peers? It’s just a thought, not sure if there’s any merit to it."

That actually makes quite a bit of sense to me, Holly. We notice the contrast more, you know?
Poser
says:
September, 28 2011 at 3:12 am
Holly
Another hit parade on the blog. You seem to touch a nerve (in a productive way) when you write...the return blogs delve deep into subjects not often touched by the outside world.

There is so much to say here. Disclosure for me has been a dismal failure. At work it brings jokes and fear of firing. At home mental illness is a subject of taboo. The only safe place is therapy and inside. Yet, therapy is also frustrating because those without DID simply cannot understand the repercussions and what it is like to live with DID. Damn the professionals, they only have what they have studied...not experienced.
Those of us with DID have such a wide variety of experiences that we can only go on what our own personal world allows as far as disclosure. I am happy that you, Holly, have a great support system and find disclosure a safe theraputic place. My experiences have been the opposite, resulting in ANY disclosure to family being thrown back at me as an explanation for simple normal issues.
Holly I enjoy your posts and get a great deal of information out of them as well as the replies. It all makes me think...deep and long. I wish I had the ability to disclose to others. Sometimes we discuss how to tell our one outside friend about the family inside. In the meantime things go on as they always have. We live in the outside world...do the best we can with what we have...and read and learn. I've said before that having DID is like being gay fifty years ago...one day it will be looked at not as different and a plague, but a way of life that is accepted and just a bit different.

In reply to by Anonymous (not verified)

Holly Gray
says:
September, 29 2011 at 1:48 pm
Hi Poser,

"I am happy that you, Holly, have a great support system and find disclosure a safe theraputic place. My experiences have been the opposite, resulting in ANY disclosure to family being thrown back at me as an explanation for simple normal issues."

Here's the thing: I experience the support, yes. But I also experience what you describe, what so many people with DID describe ... the ridicule, the repulsion, the blame, the jokes, etc. I am not, and have never been immune to that crap. I believe I am very lucky to have certain people in my life that support me. But I also get the same BS as everyone else. And I've learned that if people reject me because of my diagnosis, there will be others who won't. And only because I allow them. I didn't used to. I kept my diagnosis a secret. Some people knew, but I didn't talk about it with them. And if I did, I immediately regretted it, retreated inside myself, and isolated myself from them until the exposure wore off. Or forever. Frankly, what changed is not that suddenly an influx of incredibly understanding people showed up at my door offering to support me. No, what changed is that I decided other people's attitudes didn't reflect who I am, and made up my mind not to let intolerance and nastiness keep me in hiding. And then I discovered something amazing ... most people take their cues from us. So do I still get the same treatment from people that you do? Absolutely. But now I also get something else - love, acceptance, understanding, support. It's not either/or. It's both. And then I get to choose what I value the most. What's more important to me? Hiding who I am to avoid hearing cruel, unsympathetic things? Or not hiding and hearing those cruel, unsympathetic things along with the love, acceptance, understanding, and support? I choose the latter. It's not all about luck for me. It's also about the choices I make.

Which isn't to say I think telling everyone you have DID is *the right way*. But I do think that we can disclose, get support and understanding, without ever telling anyone we have DID. Disclosure isn't just an announcement of a diagnosis. And it's not the equivalent of tearing back the curtain and revealing all. I'm public about my diagnosis but I don't reveal *most* things about my life or my feelings or my experiences. Disclosure, to me, is revealing something that makes you feel vulnerable to someone or someones that you believe are worth the risk. And doing so in good faith. It doesn't have to be, "I have DID."

As for DID being a way of life, I can't agree. This is not a way of life for me ... just today my son called me to ask where I was. I was supposed to be picking him up from school. But I'd mixed my days up, yet again, and thought his father was picking him up. I think every parent does stuff like that now and then. But it's constant for me. If it's not in regard to my son, it's an appointment, or a date with my partner or a friend, or a work assignment, or anything. Every day. That's no way to live.
Eliza
says:
September, 27 2011 at 8:48 pm
I'm glad to have something to offer, Holly! Hope you are doing okay.
Michael Lang
says:
September, 22 2011 at 2:51 pm
Hi All,

Great discussion! And so many ideas and helps for when we struggle ...

I just want to hark back for a sec to the issue of speaking to and relating to our therapists. I am a therapist ... and am very aware that we therapists are also people, with problems, egos, traumas and our own needs ... even though we are supposedly the "expert". I very much appreciate Holly's push to ask the questions, easy, difficult and all in-between, about your own treatment ... to take initiative and ownership. I also very much appreciate Castorgirl's extremely apt comment that not all are feeling secure enough or confident enough to ask. And after all, aren't most with DID *constantly* questioning themselves? What just happened? Did I say that really? Am I to blame for this? Is this my fault? Do I really have any right to ask anything or have an opinion?

It is really difficult territory. Still, I firmly believe that this work is for YOU, my client, and not for me. Yes, I do get things from the work, even little nuggets that help me with my self-worth ... after all, I'm human and am doing work that I love. However, I am very much against the expert-patient idea/model that we see, sometimes. And I believe that ISSTD and so much current literature out there is against it, as well. When we suffer betrayal at the hands of the powerful, trauma and unthinkable abuse, how are we going to handle being in a relationship with someone who insists on being an "authority" over us? Would that pose just a bit of a problem? Maybe an awfully big problem? Perhaps.

It's really my responsibility as a therapist to make that problem be as small a part of the picture as possible when working with people with relational traumas, in situations in which collaboration, in some form and on some level, is very, very important for healing. So I say, when you have the wherewithal to muster that courage, please do question your therapist. Ask why. Ask where this is going, and how. It can be a risk for you ... but also an opportunity for growth. Your therapist may become nervous! Your therapist may also learn something and grow, too (though he or she may not admit to it!). And in the process of it all, boy of boy, will you be doing some important and relevant work related to connecting with people in the world around you, and I believe that might just be where Holly started this thread off.

Very Best to All of You ... thanks for the great conversation!
Michael

In reply to by Anonymous (not verified)

Holly Gray
says:
September, 27 2011 at 12:09 pm
Hi Michael,

" ... I am very much against the expert-patient idea/model that we see, sometimes. And I believe that ISSTD and so much current literature out there is against it, as well. When we suffer betrayal at the hands of the powerful, trauma and unthinkable abuse, how are we going to handle being in a relationship with someone who insists on being an “authority” over us? Would that pose just a bit of a problem? Maybe an awfully big problem? Perhaps."

Agreed. I do get the impression that a lot of DID clients need to experience safe authority before they can invoke their own authority. And that seems totally reasonable to me. I feel like I went through something like that briefly with the therapist who diagnosed me initially. But I'm not comfortable leaving my treatment solely in the hands of my treatment team. So I eschew the expert/patient idea too. Besides which, there are plenty of consumer experts who know far more about their own disorder than most therapists. I can't imagine them going, 'Oh hmm, what you're saying is actually ill-informed but because you're the therapist I'm going to just ignore my own hard-won insight.' I certainly wouldn't.
Veronica
says:
September, 21 2011 at 11:14 am
I think that I am incredibly lucky that my therapist has a dissociative disorder herself. And is wicked smart. We do try to learn what inside structure is like, for clarification mostly; but everything is really geared towards me functioning better in the outside world. Obviously, if one wants to function better in the outside world, one needs to go there. Scary!

But by engaging with the outside world, we can see where the problems lie. The triggers, fears, stess, unwanted behaviors, etc., and only then we can, if able, work to see why those things would be a factor on the inside.

One thing my therapist always says, that I love and think makes so much sense, is regarding internal communication and why it is often so difficult. She says, "You can't bullshit the inside." Meaning that though we may think we are gung ho about just up and learning everything we can and being in fullfilling communication, and getting all our sh** together today, the inside knows that we are really scared to death and so don't really want that at all. So, the sharing will ONLY come when we, through interacting with the world, gain insight, grow, and put some of those fears to rest. Only then can we really make any progress inside.

For me, if I did not have the help of the outside world, or had no one to depend upon for feeback, I'd be totally clueless. I walk around in a fog most of the time. And I can journal or "ask" until the cows come home and not get squat. I recently had a very traumatic situation develop with another person. And when I was talking to someone about it she asked me what triggered the whole process. To save my life I can't answer that, I totally have no idea at all. I know I was present, I know something happened and have all of the feelings, but I have nothing but a blank space where that info should be. If I ask internally, it is now almost like, "Hey, why're you asking here? You know whom you should be asking."

I'd like to add though, that by working with my therapist, and learning about myself through interacting with the world, I have actually made tremendous progress in the area of internal communication. I do get help and insight that way from time to time. But that only started long after I began getting to know myself based upon my interaction with the world.

So, that's my story, and I'm sticking to it :)

In reply to by Anonymous (not verified)

Holly Gray
says:
September, 27 2011 at 3:18 pm
Hi Veronica,

"But by engaging with the outside world, we can see where the problems lie. The triggers, fears, stess, unwanted behaviors, etc. ..."

I totally agree. Interaction outside of ourselves helps to illuminate the issues inside of ourselves. That's been my experience anyway.

And this is such a great point:

"Obviously, if one wants to function better in the outside world, one needs to go there."

Thanks for your input!
lenore
says:
September, 21 2011 at 8:22 am
"Those dire warnings to keep my diagnosis to myself, though well-intentioned, only served to increase my sense of abnormality and isolation."

This is what I feel. I'm suppose to be developing friendships. But I can't let anyone close, they might find out. The only one I talk to is my T. I'm closest to her & yet I'm not close to her at all & never will be.
I hate that I'm alone.

In reply to by Anonymous (not verified)

Holly Gray
says:
September, 27 2011 at 3:20 pm
Hi lenore,

It's lonely, yeah? I feel like it's a pretty mixed message, too. Don't isolate, engage! But better not even hint at anything related to your diagnosis! It's ridiculous.
Paul
says:
September, 21 2011 at 5:23 am
Holly, Sorry if you found my comments upsetting. I wasn't disagreeing with you on what you said about disclosure in this post. I was only trying to say that there were other ways to disclose and feel like you are not isolating. And also to say the truth that disclosure is a universal problem. Not that I had answers, but I was just bringing up my thoughts...

About the other stuff. I misinterpreted what you were saying. I thought you said that the therapists and patients don't put any stock in external interactions.

Paul
Mareeya
says:
September, 21 2011 at 5:14 am
Fantastic post, Holly!!

This sentence really resonates with me:
"And yet in the six years since my diagnosis, I’ve never heard anyone who treats or has DID recommend engaging in the outside world as a path to self-discovery." ...... emphasis on "as a path to self-discovery".

While I have the greatest respect for my therapist, as well as all of the very informative materials that I have read on Dissociative Identity Disorder, I would have to agree with you that I am not aware of patients with DID being 'encouraged' to engage in the outside world as a 'path to self-discovery'. In my own experience with therapy, I've been told to ask inside, journal, create art, and then ask inside some more. But I've never been told to engage in the outside world with the purpose discovering myself, or parts of myself. This has left me feeling as though there is something missing in the advice I've been given, because for me, asking inside just doesn't cut it.

I will say that I have been encouraged to find trustworthy people in my external world as a source of support, but not as a means to learn more about myself.

While all of my introspective activities have been helpful to a degree, I believe I've learned the most about myself through external encounters. (As much as I hate them being the introvert that I am.)

Now... while I've learned a great deal through my external encounters, I also need to add that these learning experiences were often painful. I learned about myself through mistakes I've made while trying to navigate the external world. These were very important lessons which taught me so much more about my system than introspection alone could have taught me. So, as painful as it has been, it has been important.... even crucial to my own self discovery.

So Holly.... your poll as well as this post has given me much to ponder with how I have personally learned about my system. Thank you so much for taking the time to share your personal thoughts.

In reply to by Anonymous (not verified)

Holly Gray
says:
September, 27 2011 at 3:24 pm
Hi Mareeya,

This really resonates for me, as I'm rather introverted myself (as in, I need copious amounts of solitude to function at my best - *not* that I'm shy, as many people believe introversion is).

"While all of my introspective activities have been helpful to a degree, I believe I’ve learned the most about myself through external encounters. (As much as I hate them being the introvert that I am.)"

I wonder if that plays a role in how helpful engaging externally is or isn't. You and I are used to our own company, our own thoughts, perspectives, ideas. Perhaps part of why engaging with others helps us so much is because we do it less than our extroverted peers? It's just a thought, not sure if there's any merit to it.
Eliza
says:
September, 20 2011 at 8:50 pm
"again, I was rewarded when I displayed my ability to re-frame the crap out of things, put them away, and choose happiness once again"

Too funny, Holly. I asked for CBT two years ago because I was seduced by its well-evidenced efficacy, but it only took one hour of it for me to furrow my brows at the therapist and wonder how CBT was different from my current masterful practice of "re-framing the crap out of things" ... and it only took three sessions before the therapist sent me up another tier to see a psychotherapist. I was terrified by and uncomfortable with this new expectation of sharing feelings.

It is still nearly impossible for me to stop re-framing the crap out of my experiences, even with a psychotherapist virtually begging me to be authentic. I don't doubt: there is a happy medium, and it will be a struggle to get there, involving uncomfortable swings towards another extreme.

Take care,
Eliza

In reply to by Anonymous (not verified)

Holly Gray
says:
September, 27 2011 at 3:25 pm
Hi Eliza,

"I don’t doubt: there is a happy medium, and it will be a struggle to get there, involving uncomfortable swings towards another extreme."

That's really motivating for me to read, especially right now, today. Thank you.
Deanna
says:
September, 20 2011 at 6:24 am
One of my goals in returning to therapy was to be able to disclose to my teenage children and my brother about my DID. This was prompted by a conversation with my daughter upon finding out I had Fibromyalgia. She said "Mom, why didn't you TELL me about this?" She was hurt and had a tinge of betrayal. I hadn't NOT told...but I hadn't shared much with her either. I realized then that they need to know this about me for THEIR sake. But then it get's tricky. I'm 2 years into therapy (this last round) and what I didn't factor in is that sharing the diagnosis also involves sharing some of the details of how I got this way (abuse). My therapist pointed out that I need to be able to help THEM cope with their emotions about some of the things that happened to ME. I'm getting closer...but I'm don't feel strong enough (consistently) yet. I don't anticipate my healing to revolve around this disclosure but it will lift this veil of secrecy I have at home with them and that will feel good.

I have found this community (The DID Bloggers) to be my best source of "friendship" and support. External communication with someone who doesn't really "get" it has been frustrating for me. My therapist clearly encourages internal communication thru dialogue, journaling, and art.
Faycin A Croud
says:
September, 20 2011 at 6:15 am
I have bipolar disorder and I tend not to share my diagnosis with people I haven't gotten to know unless I am trying to make a point. Life is hard enough without the additional judgment of the ignorant masses. Although that is why I do sometimes use my diagnosis to make a point!
Alistair McHarg
says:
September, 20 2011 at 2:07 am
Holly: Another great post. As you know, D.I.D. is not my issue - I'm bipolar & have/had a substance abuse issue. But I do see similarities - in both cases there is fear-driven flight into the "other". -- Isolation is always the enemy, as we lose ourselves in ourselves it becomes increasingly easy to believe nonsense. By bouncing our ideas off others, and listening to their responses, we move towards being grounded in reality. By diving inwards you discover the raw materials of recovery, but your measure of health is really how well your interact with the society of others.
Akid
says:
September, 20 2011 at 12:37 am
Hello Holly and friends,

I still consider myself new to therapy; further, I am only recently diagnosed DID -- a very strange thing to say/type about myself; I am still struggling with the possibility that such a diagnosis is applicable. Nevertheless....

I say "new to therapy" because in my 25+ years of psychiatric treatment and hospitalizations for anorexia, depression, panic attacks, et al., I never pursued out-patient therapy for more than brief interludes. These early stints on a couch were so readily abandoned, I believe, because I did not find the voice or vocabulary to adequately describe my 'internal distress': each attempt to broach such with a therapist or psychiatrist yielded quizzical looks, skeptical responses, or worse, an overt disregard without acknowledgement of what I said whatsoever. All of this "treatment" caused me greater shame over what I came to believe was my apparent inablility to better control my "emotions/internal experiences." I came to believe that I truly was aberrant, unable to be understood by anyone, and exceptionally alien -- though I could fake being a real person pretty convincingly. Through these therapy experiences, I believe, I became even more efficient at completely shutting-down any internal communication I might have otherwise had. In fact, doing so successfully was a requirement for me to gain credibility or respect with any therapist.

Twenty years later and every possible anti-depressant known prescribed and tried, I am a master at Cognitive Restructuring. How else do you think I could get myself to shut up and not see/feel the things inside and be so distressed? It was called it therapy.

Now, I am now being told to "listen" and "talk" to "myself," that I have created this problem for myself because I so adeptly (and disrespectfully) ignore my feelings. It is very true that I have treated myself disrespectfully throughout my life. But never was it so applauded as when I did it in the name of "therapy."

I say all of that to say this: I no longer have any "internal communication." Every homework assignment I am given is for the purpose of encouraging such discourses amongst myself. Is it any wonder that I resent such assignments?

In reply to by Anonymous (not verified)

Holly Gray
says:
September, 20 2011 at 12:03 pm
Hi Akid,

"It is very true that I have treated myself disrespectfully throughout my life. But never was it so applauded as when I did it in the name of “therapy.” "

YES! Funny how that works, isn't it? Man, I just relate to that on so many levels. I remember when I was growing up my mother would tell me, "Happiness is a choice, Holly. You choose to be happy." And though there's certainly some truth to that, and though her intentions were nothing but good, those comments introduced me to the concept of cognitive restructuring. And when I did it well, throughout the years, I was rewarded with appreciation, kindness, respect. In therapy, I tried to give voice to all those things I had to silence in order to "choose happiness" but again, I was rewarded when I displayed my ability to re-frame the crap out of things, put them away, and choose happiness once again. Then finally, someone realized what was going on and all the directives changed. For me, it was a monumental relief. But that doesn't mean I don't feel some resentment for the fact that my diagnosis plays such a large role in how my feelings are received.

"Every homework assignment I am given is for the purpose of encouraging such discourses amongst myself. Is it any wonder that I resent such assignments?"

No. It's not at all. I find myself hoping that you feel free and safe to share those feelings of resentment and their origins with your therapists.
Paul
says:
September, 20 2011 at 12:31 am
Holly, I am going to have to disagree with you on this one. And that I think maybe your conclusions are a bit biased. I haven't read anywhere or had any personal experience that has suggested that all the answers (or even the majority) are found only through introspection. Psychodynamic therapy, which is most of therapy, is based on dynamics, internal and external, with yourself and others. I would like to know what the results would be if you polled therapists. I bet even fewer would say "internal communication alone."

If there is a bias towards introspection and looking inward, I would say it comes more from the patient/client and not the treater/therapist. You have talked many times about typical pathological symptoms and you know they generally are based around fear of the external world. If someone is trying to come to grips with literally being psychologically fragmented, continuously suicidal, having constant panic attacks, etc. then why isn't learning some internal coping skills a good step? It's simply a step. It's not saying that's the be all and end all.

About disclosure: You yourself said that being careful about disclosing DID "wasn’t necessarily bad advice". In a perfect world, there would be no stigma and we could be free to share all of who we are. But this is not a perfect world. And DID is not cancer. It never will be. I'm not saying that's right. It just is a fact. But there are ways to be public with others and still make healing progress through interactions with others. In fact, you can do this in a whole host of ways, and disclosing "I have DID" is only one path of many. "Full disclosure" is so incredibly over-rated and usually misses the point. DID does not define who we are. We have the most power (and ultimately gain most healing and gain most security) by choosing wisely to share aspects of ourselves with some and other aspects of ourselves with others. This is good advice for those withDID or not DID. This is even good advice for people without ANY mental illness. Everyone deals with issues of disclosure, across the whole gamut. Some people don't want others to know they are depressed. Some don't want others to know they were brought up poor. Even medical issues, that don't have much stigma, are often not disclosed. Ask any Crohn's patient how willing they are to disclose that diagnosis.

Paul

In reply to by Anonymous (not verified)

Holly Gray
says:
September, 20 2011 at 11:46 am
Paul, I don't know what article you read but it certainly wasn't the one I wrote ...

My conclusions *are* biased ... this is a blog, not a scholarly journal, and while I sure try my best to look at things as objectively as possible, I then reserve the right to form an opinion and share it with others. Which is what I've done here.

"I would like to know what the results would be if you polled therapists. I bet even fewer would say 'internal communication alone.'"

I suspect you're right. But I never said, nor do I believe anyone is out there going around telling people with DID that the only way to get to know themselves better is via internal communication. I mean, I suppose it's possible, but I highly doubt anyone would actually say something so preposterous.

"If someone is trying to come to grips with literally being psychologically fragmented, continuously suicidal, having constant panic attacks, etc. then why isn’t learning some internal coping skills a good step?"

It is. And a vital one at that. I've never suggested otherwise.

As for disclosure, I'm not going to clarify my position yet again here. I've already done so twice in the comments now. I own that I must have worded that last paragraph badly, but I'm not going to own statements about disclosure that I've never even made.
castorgirl
says:
September, 19 2011 at 8:28 pm
I agree that you should keep questioning until you fully understand the reasoning behind a suggestions. But I question whether all of those within therapy have the confidence to do so. I know that at times during my healing, I've been unable to ask questions, mainly because of the inherent power imbalance that is present within the therapeutic dynamic - your treatment team is meant to be the "experts" after all. That is almost a separate issue from knowing whether what you are experiencing within the therapeutic environment is discomfort because what is being suggested doesn't work for you; there is a discomfort because of the changes that the techniques are causing - positive change can be uncomfortable, so can be resisted by the dissociative system; or whether the discomfort is for some other reason.

it's easy to doubt yourself while healing... so question, read, get second opinions, ask yourself some tough questions, and whatever is needed to help you navigate through healing. Sometimes the greatest lessons we learn come from the asking.

Reading your experiences within therapy, and the advice you've been given, it differs so much from my own... I wonder if it's a cultural/country issue, or a training one? I've never been had exclusive emphasis placed on internal communication, nor have I been warned not to disclose my mental health issues. Makes me wonder whether my experiences are the odd one out.
Michael Lang
says:
September, 19 2011 at 7:27 pm
Hi Holly!

I can only say "yikes!" when hearing about such untempered cautionary warnings you have experienced, and no doubt many others also do. What gives someone the right, or the wherewithal to think that they so fully understand someone's context and potentials for growth, that they would say, "listen, never, ever share with someone what your experience is, or your diagnosis"? I do realize how complicated relationships are, and people are, and therapy is ... but I think what you're talking about is certainly dangerous and disrespectful ... and given that the DID experience usually contains a background of whatever degree of betrayal and relational trauma, WHY would it ever be a good idea for a therapist to be that authoritarian without discussion?

Castorgirl, I followed you on Twitter! Neat stuff you have going on ... and enjoyed your comments. You're also a kiwi it looks like ... years ago I spent 8 1/2 months there in my travels, so your country has a special affinity for me. A beautiful physical country, for sure. I found a lot of neat people there, too.

Best to you both!
Michael
castorgirl
says:
September, 19 2011 at 6:48 pm
I agree Michael, that there is a middle ground somewhere. I've been encouraged to journal and other methods to increase my levels of internal communication; but this is in an attempt to ease the dissociative barriers that I currently experience. It's also just one of the skills that I'm encouraged to develop... a clinical psychologist that I saw suggested that I become a volunteer to increase my social skills, and trust of people. Interestingly enough, both the internal communciation and the volunteering were directly aimed at areas where I felt uncomfortable and were gaps in my coping mechanisms. This makes me wonder if we are hearing this advice as percieved gaps, and those who hear other advice are doing so because of other percieved gaps.

I will never disclose my mental health status to anyone that I don't trust. This means that I will never discuss it at work. I work in an environment where jokes are regularly made about the mental health of our clients, so to reveal too much in that situation is not safe. I could be a trail-blazer, but I'm not strong enough for that. I also need work to be an area of my life where I learn normal interactions with people. To learn about boundaries and safety... so about healing, but without everyone knowing my business :)

If anyone has questions about what the reasons behind why they are being asked to do anything within their healing - whether that be journal, internal communication, art, read a certain book... then I suggest that they ask their treatment team. The ISSTD has treatment guidelines which can also be checked.

Take care,
CG

In reply to by Anonymous (not verified)

Holly Gray
says:
September, 19 2011 at 7:38 pm
Hi CG,

I respect the choice not to disclose your diagnosis at work (or anywhere). Like I mentioned to Michael, when I talk about disclosure, I'm talking about a spectrum. And I brought up the repeated counsel not to disclose the diagnosis not because I disagree with it, but because, as I said, " ... it cast a veil of secrecy over not just the diagnosis, but any issues I had related to it." It isn't that I feel people should go around telling the whole world about their mental illnesses. It's just that I don't think it's terribly helpful to keep shushing each other up about it either.

"If anyone has questions about what the reasons behind why they are being asked to do anything within their healing - whether that be journal, internal communication, art, read a certain book… then I suggest that they ask their treatment team."

I'll second that with one addition to all those anyones who may have questions ... after asking why, consider whether the answers meet your satisfaction. There are a lot of people who will tell you both subtly and overtly that you are merely a patient, and to question common treatment practices or widely accepted beliefs is not your place because you're not a clinician. As if having a perspective and the audacity to express it isn't vital to increasing our understanding not just of DID, but of everything. You don't have to just acquiesce to whatever your therapist or the ISSTD or anyone else tells you is the right way to approach treatment. By all means, ask questions, read the guidelines. But don't forget that your standards are the ones that must be met, yours. You don't have to prove your credentials to have an opinion about your own treatment, or treatment in general for that matter. And you have the capacity to judge what's working for you and what's not.
Michael Lang
says:
September, 19 2011 at 6:21 pm
Hi Holly,
I want to say that this is a great debate, and that the best approach would be somewhere in the middle? I feel I understand why we might recommend a client not share their diagnosis unless one really knows and trusts who they are talking to; people can be ignorant and even mean with sensitive information, especially if it seems strange to them. It is a risky situation, just as it is when anyone shares something that might make them vulnerable with another person. On the other hand ... it is true that we do not exist in a vacuum, and social interaction absolutely does shape us and make us grow. I'd like to think there might be a happy, mindful medium. Perhaps such increasingly open communication might lead towards greater understanding of DID in society and culture? One can only hope.
Another thought: currently, I see two people in my practice who have DID. I admire both of them greatly ... I believe they are both extremely talented and interesting people, as you appear to be as well, Holly. :-) While it may make even less sense to hold ourselves back from exposure if we are that interesting and talented, I really believe the world does not always understand, try to understand or accept special talents or differences in people. Even looking at DID through a specialness "lens" like this, there might seem to be reason for discretion in sharing? Simple self protection?
Oh, and thanks for conducting the poll and the follow-up conversation ... really interesting!

In reply to by Anonymous (not verified)

Holly Gray
says:
September, 19 2011 at 7:02 pm
Hi Michael,

Thanks for weighing in on this. To be clear, I absolutely agree that discretion is important ... with everything, but certainly when it comes to a mental health diagnosis that's as misunderstood as Dissociative Identity Disorder. And not just because of our own boundaries but because of others' too. For instance, I'm totally "out" about DID but that doesn't mean it's always appropriate to discuss. No, my issue with the cautionary warnings around disclosure is that they're never tempered (I should say, in my experience) by any acknowledgment that sometimes, disclosure is helpful. As a result, there's a silencing effect not just around the diagnosis, but around everything related to DID. And that's just ... I don't know; it's like breathing recycled air, isn't it? It's unhealthy.

Which is also something I should have been clearer about ... when I talk about disclosure, I'm talking about a spectrum. I by no means want to suggest that all of us with DID should be publicly "out" about it. The fact is, I'm extremely fortunate to have the friends and family I do. And unfortunately, I know not everyone has the level of acceptance I do. It would be ignorant and reckless to tell people that just because my experience with disclosing my diagnosis has been overall beneficial, theirs will be too. But disclosure doesn't have to be that extreme. We can talk to friends about things that bother us, in ways they can relate to, by degrees, and without ever disclosing a diagnosis.

All of that said, I totally agree that somewhere in the middle is the best approach. Or even a main focus on internal communication, with the acknowledgment that external communication is important too. A happy, mindful medium ... yes! That's what I'd like to see.

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