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perla75 April 3rd, 2009 01:09 PM

I know a lot has been said here about DID. I have read many of the posts and learned quite a bit. Also, I understand that comments cannot be made regarding specific cases. So I will try to be general about my question.

If a person is diagnosed with DID, and also currently experiencing a significant trauma, is it better to delay treatment until the trauma passes? I ask this because even the preparatory work (foundation building, trust building) is causing a worsening of anxiety for me at this point. My therapist is highly qualified for this type of work, she's recieved extensive training in dealing with DID and also in using EMDR. But I find I cannot tolerate the sessions at this point. But here's the problem: my anxiety gets so bad at times that I have no interest in life. I feel that I need help, but the help is making it worse.

What is the best course in this type of situation?

Sandra Paulsen April 4th, 2009 08:35 AM

Re: DID and EMDR
I'll say a couple general things that may or may not apply to you.

Oddly, a present trauma can sometimes really help mobilize DID treatment. I know that sounds twisted, but here's the rationale. First off, DID results from a lifetime/longtime of having to disown unbearable truths and pain. Throwing things over the wall, as it were, or stuffing things in a closet. Much of the self system is organized around keeping secrets from the self and the world, or not feeling things. Not being present in the body, in the life.

A current trauma occurs and it either 1) causes the closet door to fly open and everything falls out, so stuff simply has to be dealt with finally or, 2) causes enough pressure and pain in the self system that a greater portion of the system is suffering and therefore ready to allow some changes.

Present traumas typically cause deep reverberations because there may be common themes between the present situation and the unworked past -- themes like loss, or shame, or betrayal.

Now having said all this, it still doesn't work to dive in and do deep uncovering work right away. It is still necessary to make sure people have the ego strength and inner resources to do the work. And it is still necessary for all parts of self to understand they are in the body, they need to be oriented to current place, time, and the life they are actually living. Loyalty to others, including perpetrators, above self, is a real problem that has to be addressed or the treatment gets stymied.

Resources are anything life enhancing. Resources activate the ventral vagal nervous system. Cole slaw can be a resource. Friends. A horse. A kitten. A pleasant color. A talent. A bubble bath. a walk in the woods. or even the thought of a walk in the woods. all these are strengthening.

For people who are willing and so inclined, strengthening spiritual resources is the strength resourcing method - it trumps everything else. for those who aren't, fine, another list will help. Grounding. Music that taps into the soul.

That's why I have oodles of links to indigenous song and dance videos on my website. Because Native American and Native Hawaiian music and dance are one path to activating the ventral vagal nervous system at a high level, for some people.

Once people are resourced, whether spiritually, through nature, or through a more mundane method, they are further down the road to healing. Then they can stomach untangling the inner conflicts, and then they can face the necessary work of facing trauma. Even there, there are means to make that work more tolerable.

enough said,--Sandra

perla75 April 4th, 2009 04:47 PM

Re: DID and EMDR
Thank you so much for your answer. It will be very helpful in my decision about whether to continue therapy or not.

Sandra Paulsen April 4th, 2009 09:07 PM

Re: DID and EMDR
I forgot an important part. When people choose to avoid the work, typically they reenact the unspoken story because it exerts pressure on their emotions, thoughts, body sensations and behavior for their whole life. Their relationships are effected, as are their health, sleep, work, and overall happiness. Then as they approach the sunset of their life, they grieve to have never been fully present in their life, because the "I" was dissociated. They may feel empty or as if they are not quite real.

So its a devils choice, and not for wimps, but for those who grab the brass ring of treatment and face what has been avoided and disowned, it is possible to heal and be more fully present.

perla75 April 4th, 2009 11:02 PM

Re: DID and EMDR
You're right, it certainly is not for wimps. I'm not sure I'm not one of those right now. I might have to start medication if I'm to go forward with it, or I may not be able to function. But I very much want to heal. I'm so very tired of feeling out of control and at the mercy of my fight or flight response. My body can't take much more, I feel like it's killing me.

Sandra Paulsen April 6th, 2009 10:58 AM

Re: DID and EMDR
Again this may not apply a bit to you. but folks who are truly DID have a capacity that less dissociative folks don't have - and that is the capacity to allow the necessary work to occur behind an amnesia barrier for some of the sessions. This can make the therapy much more comfortable. The therapist has to know how tho. Therapists can make clients much worse if they push for remembering trauma instead of doing the things that would be stabilizing - like containment, tucking in, resourcing, de-conflicting. Here's the step...

The client comes to therapy with a part that does life in front, driving, walking in the door. then that part goes off "on a cruise in the mind's eye" is what I say, and the therapist works behind the wall, defusing conflicts and more. Then near the end the parts tuck in (because they have been shown by the therapist that it is in their interest to do so), and the part comes back from the cruise when called back, just in time to write the check for a session they barely attended! The disturbance is thus contained behind a wall.

The front part attends session when life has to be discussed, and also for resourcing purposes, grounding, anything that activates the ventral vagal nervous system.

Medication helps sometimes as well. Sometimes not.

perla75 April 6th, 2009 05:02 PM

Re: DID and EMDR
Might that be why I tend to feel like I can't focus on what my therapist wants me to do, but later at home, I do all kinds of processing? It seems like we're getting nowhere in therapy, but then at home I start to go through all kinds of memories and thoughts, and even dreams. The day after therapy is tough. But I feel better later.

Sandra Paulsen April 7th, 2009 12:09 AM

Re: DID and EMDR
If ANY client has stuck EMDR, EMDR should be set aside until a sufficiency of the client's self is on board with the therapy, the healing and the EMDR. Else it is like pushing the accelerator to the floor while having the emergency brake on. Truly a recipe for suffering, hard on the engine.

It's the client's responsibility to tell the therapist what is and isn't happening, and its the therapists job to not use a procedure if that procedure is not appropriate for where the client is in therapy.

I don't know about you, and I don't know about your therapist, but lots of EMDR therapists mistakenly use EMDR on a DID client before the time is right, causing great upset, and removing dissociative barriers without putting something else in place.

I have not a clue if that applies in your case, but I'm taking the opportunity (AGAIN) to harp on this, as it is the single most common problem - big problem - in EMDR practices.

sixfeetunder November 16th, 2009 10:23 PM

Re: DID and EMDR
What if EMDR has worked in the past but the front person seems scared to proceed as life seems to be going well but most of the alters are ready to proceed with EMDR? I am trying to do what my therapist wants me to do but I feel I am failing. But then when I get home and settled a whole stream of thoughts and emotions come out. Especially therapist attachment?

Sandra Paulsen November 17th, 2009 11:33 AM

Re: DID and EMDR
I know you realize I can't comment on YOU in particular. And one person's system can be quite different from the next person's, but in general, speaking about MOST people, if any part is reluctant then EMDR should not be done until and unless that part's concerns have been addressed. It is there for a reason. Therapist attachment is a big one. Mistrust can be for a couple different reasons: 1) the therapist isn't trustworthy, OR 2) trust is a big issue for the client, always has been, and that is being reenacted in the present relationship. In my office, it is the latter that applies (that is, people don't know that I am trustworthy and they are fearful because of their own history). In general then, clients can ask themselves (if they are on speaking terms with themselves) -- could this be part of a memory? mistrust might be leaking up through the floorboards?

A final point. Usually that protection is from a different part of self - a protector part. When front parts have concerns it is often (not always) about loss of control. So then, to test that, clients can ask themselves....could control be part of a memory? are control issues leaking up through the floorboards?

If I had a bumper sticker, it would say, "could your concern be part of a memory?" Now most DID people can't answer these questions well on their own. That's what therapists are for, to facilitate that discussion. But therapists can't facilitate a discussion of a concern they don't know about.

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