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Dr. Bob is Robert Hsiung, MD,
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Posted by Dinah on February 11, 2005, at 19:23:33
In reply to Re: p-doc and coming assessment » Dinah, posted by alexandra_k on February 11, 2005, at 19:19:08
By respectful, I meant that she might not ask for a demonstration. I can't think of anything less respectful than asking for a show of some sort.
I don't blame you, but if she's any good she'll know that a two hour assessment is no place for that level of trust.
I realize that some criteria mention the clinician seeing a switch between alters, but surely that isn't necessary in an assessment interview. I always thought it meant over time.
Posted by Pfinstegg on February 11, 2005, at 19:26:34
In reply to Re: p-doc and coming assessment » alexandra_k, posted by Pfinstegg on February 11, 2005, at 19:20:36
Oh, I didn't realize that she won't be working with you. Will she choose someone good for you?
Posted by alexandra_k on February 11, 2005, at 19:33:23
In reply to Re: p-doc and coming assessment » alexandra_k, posted by Pfinstegg on February 11, 2005, at 19:20:36
> This sounds promising. DID specialists are pretty rare!
Wellllllll. I have a nagging concern that by NZ standards anyone who has treated a single case is probably considered an *expert*. But then I am a cynic by nature...
> They usually prefer the least severe one they can get away with.
Typically yes. But more severe = the greater liklihood of obtaining funding...
>My experience has been that skilled DID therapists do NOT ask about different ego states- they work hard to establish safety and trust, and wait for you to be ready to share all of this with them. They also do not ever push for accounts of abuse. Safety and secure attachment are always the first goals of therapy, and just that part can take a long time.. Even if she has to ask some things directly in order to make a diagnosis, once you are working with her, I think you'll begin to feel much better, and will feel that she is respecting your own inner timetable(s).
She isn't going to treat me. It is a once off two hour assessment. She is supposed to write a reccomendation to community mental health as to whether they should pay for someone in private practice to treat me because there isn't anyone suitable in community mental health. She lives a couple of hours away. Too far away to treat me (though I might ask her if she wants to be an e-therapist) :-)
> Take care, and be sure to let us know how things unfold.
Thanks. I am sure I will...
Posted by alexandra_k on February 11, 2005, at 19:41:09
In reply to Re: p-doc and coming assessment » Pfinstegg, posted by Pfinstegg on February 11, 2005, at 19:26:34
> Oh, I didn't realize that she won't be working with you. Will she choose someone good for you?
She doesn't get to pick. She just writes a report for community mental health. Something like this:
For all these reasons.....
I give her this / these diagnosis...
And in light of that I would reccomend that you guys pay for someone to work with her x number of sessions per month / fortnight / week for round about x amount of time.Then we have to see if there is anyone in private practice in this region who will work with me.
That is a further issue. There might not be anyone.
My p-doc says he can think of a few people who might be interested. Ironically, a couple of them work part time for community mental health and part time in private practice. He said that on community mental health time there are enough potential clients for clinicians to 'pick' the 'easy' cases, or the cases they find most satisfying or whatever. They won't pick me up on community mental health time but he seemed fairly sure they would pick me up in private practice time.
That doesn't help me feel too good.
And he is typically full of b*llshit anyways, so who knows...But if I don't do the assessment I am stuck with charming but hopeless p-doc who says 'sure I don't mind working with you seeing as nobody else will' but forgets to turn off his cellphone and pager or forgets to turn up or whatever...
Posted by Pfinstegg on February 11, 2005, at 19:51:57
In reply to Re: p-doc and coming assessment » Pfinstegg, posted by alexandra_k on February 11, 2005, at 19:41:09
Gosh. So many hurdles to get over.
I think your idea of writing out what you would like to tell this consultant is a good one. You do want her to know enough to make the best recommendation, but it's awful to feel totally out of control of what's going to happen. I guess describing your main symptoms, and possibly referring to different ego states (without letting her necessarily see or interact with them) would be a good way to go. And don't forget to throw in a few subtle references to your intelligence and assets- in a modest way, of course...
Posted by alexandra_k on February 11, 2005, at 20:03:15
In reply to Re: p-doc and coming assessment » alexandra_k, posted by Pfinstegg on February 11, 2005, at 19:51:57
Thanks :-)
I experience them mostly as voices. So there is a lot to talk about there. I know quite a bit about them.
Do other people get them as voices???
Posted by Dinah on February 11, 2005, at 20:09:06
In reply to Re: p-doc and coming assessment » Pfinstegg, posted by alexandra_k on February 11, 2005, at 20:03:15
Alexandra, I can answer that in Babblemail if you want an answer from someone neither fish nor fowl nor good red herring.
Posted by Pfinstegg on February 11, 2005, at 20:09:27
In reply to Re: p-doc and coming assessment » Pfinstegg, posted by alexandra_k on February 11, 2005, at 20:03:15
Yes. It's very common, according to my T; people can get misdiagnosed with schizophrenia unless they are assessed by someone experienced. I think the voices are considered only about midway on the spectrum, with separate personalities on the outer end of it, and subtle ego state differences on the inner end.
Posted by alexandra_k on February 11, 2005, at 20:14:58
In reply to Re: p-doc and coming assessment » alexandra_k, posted by Pfinstegg on February 11, 2005, at 20:09:27
Hmm. I miss time and find they have done stuff too. Sometimes the *voices* tell me what they have been up to. Sometimes they inform me of their plans and then I miss time and find I have done stuff...
I don't feel like I have to act on what they tell me to do... But there is a sense in which they can make me miss time and just do what it is that they wanted me (the body, whatever) to do...
Posted by Pfinstegg on February 11, 2005, at 20:31:38
In reply to Re: p-doc and coming assessment » Pfinstegg, posted by alexandra_k on February 11, 2005, at 20:14:58
The same thing used to happen to me, too. But after two years of treatment, I'm not losing time any more. Most commonly now, I get taken over by an inner emotional state which is extremely fearful; we are working on understanding the childhood origin of this, and also I am trying to be more aware of these different states simultaneously, so that I don't just get completely taken over by one state. I feel I'm learning much better ways to handle all these powerful emotions and feeling states, now, and my anxiety and depression is much less than it was two years ago. My therapist is wonderful, and very important to me; now that the worst is over, I find the therapy itself to be a beautiful and fascinating experience- and you know i wish the same for you!!
Posted by alexandra_k on February 11, 2005, at 20:36:19
In reply to Re: p-doc and coming assessment » alexandra_k, posted by Pfinstegg on February 11, 2005, at 20:31:38
Thank you. I just want the missing time to stop. And the arguing in my head. It is really loud / hard / painful sometimes. I think sometimes that I just want them to go away. But then I am a little afraid of that too. I think I found them because I was so very lonely as a kid. Didn't have anyone else to talk to. But they really can be horrible sometimes...
Thanks.
Posted by Pfinstegg on February 11, 2005, at 20:46:25
In reply to Re: p-doc and coming assessment » Pfinstegg, posted by alexandra_k on February 11, 2005, at 20:36:19
All these things can happen. But it will be slow- a number of years to really heal from it. Hopefully, you can get a good start in NZ, and then if you come to the States, you'll be able to find someone really good to continue with while you are getting your doctorate.
I was just thinking- it would be nice to lose that BPD label- it's considered kind of out-of-date in ego state/dissociation circles...(no-one needs so many diagnoses, but maybe the health system requires them to get piled on)
Posted by alexandra_k on February 11, 2005, at 20:49:28
In reply to Re: p-doc and coming assessment » alexandra_k, posted by Pfinstegg on February 11, 2005, at 20:46:25
> All these things can happen. But it will be slow- a number of years to really heal from it. Hopefully, you can get a good start in NZ, and then if you come to the States, you'll be able to find someone really good to continue with while you are getting your doctorate.
Yeah, I guess that is what I am hoping. If all goes well (touch wood) I could be in the US in September. That isn't really all that much more time here...
> I was just thinking- it would be nice to lose that BPD label- it's considered kind of out-of-date in ego state/dissociation circles...(no-one needs so many diagnoses, but maybe the health system requires them to get piled on)Yeah, I would like to lose that one. Hopefully that will happen :-)
It was just a requirement for DBT...
Posted by Pfinstegg on February 11, 2005, at 21:02:35
In reply to Re: p-doc and coming assessment » Pfinstegg, posted by alexandra_k on February 11, 2005, at 20:49:28
That's exciting! I hope it happens the way you want. When you do get here, you could go to an Analytic Institute and have a very low-cost analysis with a candidate in training. You will know even more about yourself, then, and can request that your student analyst have a supervisor and training analyst who is thoroughly skilled and familiar with dissociative disorders. By the time you get your doctorate (seven years?), you should be far along on the road to recovery, or perhaps completely healed- nice to think about...
Posted by gardenergirl on February 12, 2005, at 8:35:14
In reply to Re: p-doc and coming assessment » alexandra_k, posted by Pfinstegg on February 11, 2005, at 21:02:35
Regarding hearing voices in DID or DDNOS, from what I've been taught, hearing voices inside the head is characteristic of the above. If voices are heard outside the head, that is more characteristic of a psychotic symptom. Also, being able to communicate in some way with the internal voices, as in a dialog...asking questions and getting a reponse is more characteristic of dissociative experiences. In auditory hallucinations in psychosis, the sounds or voices are experienced as if they are external, and they can be bizarre. They are usually not able to dialog with them.
Hope this helps,
gg
Posted by judy1 on February 12, 2005, at 14:17:07
In reply to Regarding voices, posted by gardenergirl on February 12, 2005, at 8:35:14
Having experienced both inner and outer voices, I would agree with what you wrote. The 'outer' voice has occured during manic (psychotic) episodes and ended when the episodes did. The 'inner' voices have been a part of my entire life- I have a DD-NOS diagnosis along with bipolar 1. Honestly, I feel I would be alone w/o the inner voices.
Posted by judy1 on February 12, 2005, at 14:29:22
In reply to Re: p-doc and coming assessment » Pfinstegg, posted by alexandra_k on February 11, 2005, at 20:49:28
It's been really helpful reading your dialogue with Pfinstegg, thank you for posting. I have several thoughts- I agree with losing the BPD label, it's often a detriment in getting a good therp for a dissociative disorder. I'm sorry there is such a scarcity of 'experts' in that field in NZ, I wish you all the best in finding someone to work with. My therp actually has DID, so I obviously lucked out. I found her by reading books on the subject and discovered her living in my area. After that I called her and we went from there. While I do not have DID, I do have DD-NOS and experience fugue states. I have seen her (more off then on) for about 3 years and in that time we have only worked on safety and trust. The best aspect of that (for me) has been a lessening of symptoms. Perhaps just knowing she is available to me and having her treat me like a 'normal' person has been the reason. I need to mention that my ex-pdoc does not believe in DID and she and I have had a few laughs about that.
When I decide to deal with my past (I used to say 'if') I know it will be with her and I understand it will take a great deal of time and work.
I wish you all the best- judy
Posted by Dinah on February 12, 2005, at 17:49:20
In reply to Re: p-doc and coming assessment » alexandra_k, posted by Pfinstegg on February 11, 2005, at 16:51:28
Pfinstegg, this is probably an incredibly rude question, and if so feel free to ignore it.
But I was wondering why you always leave me off the list?
Posted by Pfinstegg on February 12, 2005, at 23:04:56
In reply to Re: p-doc and coming assessment » Pfinstegg, posted by Dinah on February 12, 2005, at 17:49:20
Dinah, I had no idea I was leaving you off any lists, but I do see that I thanked three people about the "thanking therapist" thread, and then left the house for about eight hours. When I returned and checked in, I saw your lovely and very warm post in response- thank you so much for it! I actually always love talking to you here; but it is true that we haven't talked together directly lately. Sometimes, we are on the same threads, but seem to be focussed on another person. Then, it doesn't seem quite right to "highjack" it to talk directly to one another. I'm so sorry that I haven't been posting more directly to you, and would love to do so in the future. I can promise you there was no intentional avoidance- i think I get distracted because of my own difficult issues, and also because I sometimes try to focus on an issue that is currently very difficult for someone else. You have been so great- really the steadfast brains and heart of the board- and I would never want to cause you any hurt or distress. I must have, but I did not mean to. I hope you'll forgive me, and that we can continue having great discussions here.
Posted by Dinah on February 12, 2005, at 23:16:42
In reply to Re: for Dinah » Dinah, posted by Pfinstegg on February 12, 2005, at 23:04:56
Oh Pfinstegg, no. That wasn't what I was suggesting. Oh, it all seems so silly and petty now.
I just had noticed in the past that you never refer to me as one of the dissociative posters on the board, that's all. Not that you were ignoring me or anything. I'm reasonably insensitive about things like that. Especially with someone I've had a long relationship with, as I have with you.
No, it was more a question of identification. I always identify very strongly with Daisy's little Daisy particularly. Despite the lack of severe trauma in my childhood. I was just wondering if you saw major differences in how we present ourselves, other than the lack of childhood trauma. And perhaps the fact that I backpedal as much as I forward pedal.
It wasn't a personal question at all. Not personal in that way. It was more of an inquiry. But since it called for a personal opinion from you, I wondered if it wasn't rude to ask.
(And of course I always enjoy talking with you. And I'm always glad to hear I haven't offended someone.)
Posted by Pfinstegg on February 12, 2005, at 23:47:10
In reply to Re: for Dinah » Pfinstegg, posted by Dinah on February 12, 2005, at 23:16:42
Oh, I see what you're talking about Dinah! For whatever reason, I thought you didn't have a dissociative disorder, so I wasn't including you because of that idea. I know you have mentioned having "emotional" and a "rational" selves, but that seemed more *normal*, and to be expected, than what Daisy, Alexandra and I were talking about. We seem to have different selves with completely different agendas, which sometimes seem to be at war with one another. Daisy has never said that she loses time, and can't account for it, but Alexandra and I have both had that happen; it is still happening to her, but I think I've gotten over it, having had such great therapy, which she hasn't been able to obtain yet. I am becoming convinced that people almost never dissociate unless they have been sexually abused as children. Being neglected, terrified or hit, have terrible consequences in later life, but I don't think those things cause true dissociation. I think they tend to diminish a person's sense of self-mastery and confidence- they often cause tremendous anxiety and depression, but I don't think they cause people to *break apart* the way sexual abuse apparently does. But assuming this is true, there are bound to be exceptions. The truth is, Dinah, the dissociation club is not exactly the one anyone wants to belong to!
Posted by alexandra_k on February 12, 2005, at 23:55:11
In reply to Re: for Dinah » Dinah, posted by Pfinstegg on February 12, 2005, at 23:47:10
I wasn't sexually abused.
Posted by Dinah on February 13, 2005, at 0:03:33
In reply to Re: for Dinah » Dinah, posted by Pfinstegg on February 12, 2005, at 23:47:10
> The truth is, Dinah, the dissociation club is not exactly the one anyone wants to belong to!
Goodness only knows I know that. That's why I'm always so indirect. At times I'm not indirect at all, to my thinking. And I usually end up thinking I'm scaring people. So I backpedal, because it doesn't feel safe to be honest.
> I know you have mentioned having "emotional" and a "rational" selves, but that seemed more *normal*, and to be expected, than what Daisy, Alexandra and I were talking about.
I think it's word choice perhaps, more than genuine difference.
> We seem to have different selves with completely different agendas, which sometimes seem to be at war with one another.
I think I can safely say that. I could safely say a lot more than that even. Well, not safely. That's the whole point. But I can honestly say that and more. I just generally prefer not to. :)
Posted by Pfinstegg on February 13, 2005, at 0:04:28
In reply to Re: for Dinah » Pfinstegg, posted by alexandra_k on February 12, 2005, at 23:55:11
Oh, OK. I thought it had happened to you in your early teens. I must have misread, or misunderstood, your posts from a month or two ago.
Posted by alexandra_k on February 13, 2005, at 0:10:51
In reply to Re: for Dinah » Dinah, posted by Pfinstegg on February 12, 2005, at 23:47:10
I believe dissociative disorders (just like mood disorders and other kinds of disorders) are on a continuum with normal functioning. Some people have *more* of a problem and others have *less* of a problem that is true. But there is no radical difference in kind between those with and those without. And there can be a fuzzy middle area where it can be genuinely indeterminate.
I appreciate most disagree with me - but I don't care.
I have reasons to believe all that - but I won't go there today.
One woman claimed her alternative identities developed when her father used to pretend he was abusing someone else.
Some people claim that people develop alternative identities later in life when they try to make sense of their experiences.
Some people claim that people develop alternative identities still later in life when their therapists suggest this way of making sense of their experiences.But what is the difference? It is a way of making sense of ones experiences. Some people may have more or less extreme experiences to make sense of but it is a way of making sense of them.
A difference in degree not in kind.
The trouble with taking sexual abuse to be a causative factor in *any* psychiatric / psychological diagnosis is that the clinician who buys into that will believe there must have been abuse. The client who buys into that will believe there must have been abuse.
Let the Freudian error not be repeated:
'I no longer accepted her declaration that nothing had occurred to her, but assured her that something *must* have occurred to her... Finally I declared that I knew very well that something *had* occurred to her and that she was concealing it from me; but that she would never be free of her pains so long as she concealed anything. By thus insisting I brought it about that from that time forward my pressure on her head never failed in its effect (Freud, 1953-74 in Webster, 2003 p.11)
After that performance is it any wonder people come up with stories of abuse?
When clinicians and clients both believe that it must have happened in order to justify their present distress????I think these may have been the cases Freud had (or at least should have had) in mind when he recanted that sexual abuse claims were true...
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