Cape Cod Institute
 
Behavior OnLine Forums  
The gathering place for Mental Health and
Applied Behavior Science Professionals.
 
Become a charter member of Behavior OnLine.

Go Back   Behavior OnLine Forums > BOL Forums > EMDR

Notices

Reply
 
Thread Tools Display Modes
  #1  
Unread May 12th, 2006, 01:25 PM
aikanae aikanae is offline
Member
 
Join Date: Jul 2004
Posts: 3
Default risks of dissociation

i am chronically dissociated, i think sometimes it's referred to as complex DID.

i have not found someone that has a lot of experience with DID, though most say they understand dissociation. i am attracted to emdr because of it's training with ego states - my understanding is that is the closest to what i experience.

what happens when chronic dissociation isn't recognized or understood?
Reply With Quote
  #2  
Unread May 12th, 2006, 11:45 PM
Sandra Paulsen Sandra Paulsen is offline
Forum Leader
 
Join Date: Jul 2004
Location: Bainbridge Island WA
Posts: 207
Default Re: risks of dissociation

Your question is an important one.

EMDR training per se does not include training in ego state therapy. Many EMDR therapists also get training in ego state therapy because it is a hand-in-glove fit, but it's not required.

Its important for anyone with complex DID to first and foremost work with someone trained in that condition, using ego state therapy or other methods as put forward by the issd (see www.issd.org). I like ego state therapy best.

EMDR should NOT be used early in the treatment of DID. The treatment of DID requires a phased approach with a careful emphasis on stabilization, containment, ego strengthening, resourcing, grounding and such, before trauma work is conducted with EMDR or any other method.

Once the DID client is stabilized and resourced, and the self-system is on board with the therapy and the trauma work, EMDR is often appropriate and profoundly life changing.

Finding the right therapist is easy in some areas than other areas. ISSD has a list of its members, but that doesn't require particular credentialing. Someone who is both a member of ISSD and EMDR trained Part I and II and advanced specialty training in the ego state methods with EMDR would be a good choice possibly.

Last edited by Sandra Paulsen; May 12th, 2006 at 11:58 PM.
Reply With Quote
  #3  
Unread May 13th, 2006, 09:00 PM
aikanae aikanae is offline
Member
 
Join Date: Jul 2004
Posts: 3
Unhappy Re: risks of dissociation

I understand your answers need to be very general and not specific to my situation. I will try to keep my questions focused on emdr related topics.

How does a therapist know when someone with DID has been resourced and stabilized properly? Is it trial and error or are there other specific goals / signs to look for?

Is there a problem if all parts can't be known?

I may end up directing my own therapy. That's why I want to know.

The therapist I did have I thought was experienced. It now seems his vast 'experience' comes from screening out those who aren't so easy.

I have contacted the ISSD trainer for this area and no one is available or accepting insurance (self pay @ 100/hour). Emdr therapists claiming they treat dissociation out number ISSD therapists, a thousand to one.

It seems there's a high demand for such a "rare disorder".

If ISSD experience is so critical, then why are so many without it - claiming they can treat DID? The vast majority of those are clearly basing it on edmr skills. It really is 1,000:1 in this area.
Reply With Quote
  #4  
Unread May 13th, 2006, 10:36 PM
Sandra Paulsen Sandra Paulsen is offline
Forum Leader
 
Join Date: Jul 2004
Location: Bainbridge Island WA
Posts: 207
Default Re: risks of dissociation

I'll try to respond to each question below.

<Q:How does a therapist know when someone with DID has been resourced and stabilized properly? Is it trial and error or are there other specific goals / signs to look for?>

When a DID client can easily access a range of thoughts, behaviors, memories, images, words, etc that evoke feelings of comfort, calm, spirituality, confidence, strength, or other good feelings. When the client can sometimes do that for herself, not just with the aid of the therapist. When the client can tolerate good feelings without punishing self. When the client can tolerate pain without unraveling. When a sufficiency of the self system is on board with the therapy. When a goodly percentage of the client remembers, or remembers with a little prodding, that the disturbance is in the past, its not happening now (assuming its not), that it is 2006, and the person is now in Timbuktu (or whereever), not Cincinnati where the perp was, or that the perp is dead (if true), that the client is now an adult and will never again be a helpless child without an adult to help (because the client is now an adult, and all parts of the self are in the same body). Now, it doesn't have to be 100% of the self knowing all these things, just some critical mass of the self system.

<Q:Is there a problem if all parts can't be known?>

Doesn't have to be 100% of the parts, again, just critical mass. Don't ask me to define critical mass. Except I'll say it sure has to include those powerful and sometimes cranky parts that are the fiercest protectors, the fiercest punishers. All parts are there for a reason, a good reason from their point of view, and all the big players must be honored and understood. Most challenging and key among these are those with loyalties to the perps, especially perp introjects (like holographic internal representations of external parties, often family members) who mistakenly think they ARE the externals. They need to get it, with prodding, that they are internal likenesses. They need to be at least partially on board with the notion that loyalty to the body they live in, the self, is now what's needed to optimally survive. This contrasts with growing up, in which loyalty to the perp may have been optimal for survival and for maintaining attachment, and miserable crumbs of love.

I'm saying "some" and "partially" because it can't be "all" or one would never get around to the EMDR, and the EMDR will take care of some of it. And now matter how well prepared, surprises will emerge in EMDR, and other parts will pop up with the EMDR associations. Still, one is far better having secured a "sufficiency" of the self system than to just dive in without securing anything internal or getting "informed consent" of the self system as best one can.

<Q. I may end up directing my own therapy. That's why I want to know.>

Gosh, I hope you don't have to do your own dental work too. Its better to have an external. Its hard to wax the floor of the room you are standing in.

<Q. The therapist I did have I thought was experienced. It now seems his vast 'experience' comes from screening out those who aren't so easy.>

I've done lots of consulting, and lots of therapists think they have worked with dissociative disorders just because they've observed some dissociation or had a few easy cases. The hard ones will bring lots of us to a more humble state however.

<Q. I have contacted the ISSD trainer for this area and no one is available or accepting insurance (self pay @ 100/hour). Emdr therapists claiming they treat dissociation out number ISSD therapists, a thousand to one. It seems there's a high demand for such a "rare disorder". If ISSD experience is so critical, then why are so many without it - claiming they can treat DID? The vast majority of those are clearly basing it on edmr skills. It really is 1,000:1 in this area.>

Yes, its not fair is it. That people are first victimized by perps and then have to pay for their own recovery. Therapists are typically so weary of insurance hassles (not getting paid or grueling and time consuming paperwork) that we back out of it. And if one is good enough to be good at treating DID, one doesn't have to take insurance. There are some though.

Not enough therapists realize they should join ISSD and get appropriate training in dissociative disorders, because historically it wasn't emphasized in schools. That's changing now.

I think you can ask prospective therapists on the phone about ISSD membership or alternative training, how many cases they have treated, do they work with a consultant on thorny cases, because ethically they should.

If an EMDR therapist has only had a brief ego state workshop, that's not enough training to treat DID with EMDR. Its a start though.

ISSD now has an online course that therapists can take, with a great faculty.

And to answer a question you posed in your initial query, if EMDR is done on a DID without groundwork being done and sufficiency of parts being on board, the EMDR will arrest and "loop" because the protector parts will put an end to it. And they can be quite testy about it, since they may experience the EMDR as not a memory but something happening now, and confuse the therapist with the perp. Not pretty. And in rare cases, premature EMDR can precipitate a crisis, if defensive parts get startled by EMDR associating the traumatic memory (without their permission, from their point of view). They may feel they have to resist change, keep the secrets, remain loyal to the perp, or kill the self. Far far better to have taken the time up front to bring them on board, educate, orient, appreciate and so far the key parts of self.

And DID isn't that rare.

Okay, enough said for now. Good questions though, Aikanae.
Reply With Quote
Reply

Thread Tools
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Forum Jump


All times are GMT -4. The time now is 07:31 PM.


Powered by vBulletin® Version 3.7.3
Copyright ©2000 - 2019, Jelsoft Enterprises Ltd.
Copyright © 1995-2004 Behavior OnLine, Inc. All rights reserved.