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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by judy1 on June 1, 2002, at 17:25:27
I know Marsha Linehan has written the definitive therapy for this disorder, but it must take a long time or I'm not benefitting from it. My dissociation has gotten worse (which it periodically does)- no triggers, just worse which means increased SI. Any thoughts would be appreciated. Take care, Judy
Posted by terra miller on June 1, 2002, at 20:23:37
In reply to Proper care for Dissociative Disorder, posted by judy1 on June 1, 2002, at 17:25:27
i'm laughing to myself that i have no idea who the author is that you mentioned. :-) anyway, since i don't know what she's written i don't know what therapy is it that isn't working for you, can you explain briefly? and if you are comfortable, are you talking about general tendencies toward dissociating like what might be included in BPD or PTSD, or more specific dxs like DDNOS, DID, etc. then i will write more.
terra
Posted by judy1 on June 1, 2002, at 21:00:33
In reply to Re: Proper care for Dissociative Disorder » judy1, posted by terra miller on June 1, 2002, at 20:23:37
Hi Terra,
She kind of wrote the book on BPD- but my official diagnosis is DD-NOS, which I guess is 1 step below DID. I also have PTSD and Bipolar and panic, etc. but it is the dissociation that is causing me the greatest grief. I've gotten to the point where I've run out of excuses for the injuries I cause myself, or the periods of time I can't account for... (traveling to places I don't remember, things like that). Again, I would love to hear anything you could add- Take care, Judy
Posted by judy1 on June 1, 2002, at 21:21:49
In reply to Re: Proper care for Dissociative Disorder » terra miller, posted by judy1 on June 1, 2002, at 21:00:33
http://faculty.washington.edu/linehan/
As I said, she's well known for her treatment of BPD, which I was dxed with in my 20's, but no longer am (I think anybody that SI gets labelled with BPD). My therapist and psychiatrist (who also practices therapy) do use her approach which is time consuming since there is a lot of analytical in addition to cognitive. I think we're talking years here. I have a great deal of difficulty trusting men, it has taken over a year with my male pdoc- but he keeps very strong boundaries. My therapist is a woman who is very patient, and I feel they both care about me which helps. I guess I'm tired of repeating the same destructive behavior, as my husband and probably my children are. I journal, work hard to stay grounded and do well in the day, it's the night that brings out the problems. Just venting- Judy
Posted by terra miller on June 2, 2002, at 11:09:26
In reply to Re: Proper care for Dissociative Disorder » terra miller, posted by judy1 on June 1, 2002, at 21:00:33
hi. your clarifying helped heaps in knowing what to talk about. now i have all kinds of thoughts which will come out randomly. :-)
you describe a lot of dissociative behavior that is practically speaking, panicking. so, for starters, i'm really sorry that you find yourself in those spots and the out of control feelings that they can create.
i very briefly skimmed the site that you provided and can offer my initial impression: i don't see how that particular approach to therapy would help someone who is dissociating.
rethinking false ways of thinking and other cognitive approaches is beneficial and necessary in therapy with people who dissociate. but my personal opinion is that i would think it would take so much time if that was the only approach being used. after a while, i would think someone who was dissociating would continue to do that (unconsciously) in order to make the therapist happy.
forgive me for any sweeping generalizations that i may be making. :-)
the fact that you are dissociating probably indicates stress on some level. that's how it developed in the first place... dissociating is a creative ability to deal with extreme stress/trauma. so my thoughts are, that if you are finding that you are dissociating MORE often, then there's something going on that needs to be addressed and the dissociating is probably not going to get any better unless you address it.
sometimes SI-ing is "just" a poor coping techniques which can be relearned with some hard work. some times, in someone with strong dissociative tendencies, it can be a form of a part of one's self trying to get the attention of you that there's a problem that's bugging you that you aren't addressing. sometimes if you can get alone and get really honest with yourself, you can find in your mind/heart what that issue is. lots of times if you address the issue, then the SI-ing slows down or may even elimate.
with losing time and stuff, that also is an indicator of stress. something is bugging you.
you probably should be asking yourself if you feel like you can share stuff with your therapist/how much you trust her. does she work with dissociative disorders, or more borderline specific? someone who has experiece with DD should understand about triggering behavior. the other option is that your therapist knows exactly what is going on with you and is working at your pace -sometimes you wonder :-)
i'm in the middle of my second read-thru of a book that i highly recommend. it is written specifically for dissociative identity disorder, but even without that dx, i think you would find it very helpful. it helps to think in terms of, some people are DID but there therapist hasn't given them that dx. because the client hasn't gotten to a comfortable point to where the therapist is made privy to there being another well defined part in there. (not to say that you are or aren't DID.) the therapy approach is basically the same whether you have defined parts of self or lost memory, which helps destygmatize the DID dx for some.
this book is somewhat academic, but not too much (if you read at this site you should be able to handle it fine) The Dissociative Identity Disorder Sourcebook- Deborah Bray Haddock, pub. Contemporary Books 2001 McGraw-Hill. i like her approach. i especially like her approach to BPD. (especially the part where she basically says that clients usually get the BPD dx well before the therapist knows what's really going on. which is exactly what happened to me. i went from PTSD, to PTSD and BPD, to DID/PTSD. "i" clearly do not SI, so my therapist and i would get really argumentative about the BPD dx because it didn't fit me in my eyes. about a year later, my dx. shifted to where my therapist framed it as "part of me is BPD" but that "i" certainly was not. that's when we began to understood the road ahead of us.)
oh, my. i had no idea how long this post was. so sorry. as far as therapy, i would think a more psychodynamic approach would be beneficial. there are times when i benefit from direct rethinking sessions. but the norm is the classic- how are you feeling today thing. the idea is that if you have something to share or reveal, you have to do that so that you can heal. i find much of my healing is all about talking. once i share something i have recalled, often i do not need to process it further; my brain assimilates the previously dissociated material and i begin to cope better. but until i talk about it, the material remains dissociated. and if there are parts of you involved that have become defined enough to develop opinions (like in DID) then if you don't allow those parts time to talk about what they need to talk about, then they'll do what they can to get your attention (and you start losing time, and finding SI-ing, and stuff like that.)
i think to heal from dissociating you have to do the opposite and talk about things, so that what was hidden is no longer hidden and is now associated- you can recall it now.
sorry so long.
~terra
Posted by judy1 on June 2, 2002, at 18:38:06
In reply to Re: Proper care for Dissociative Disorder » judy1, posted by terra miller on June 2, 2002, at 11:09:26
with your post Terra, before I respond. There is a great deal for me to think about in it, a great deal that struck chords and made me uncomfortable. Which then begs the response, why? My therapist has written a book on DID, and if she feels that it may be applicable to me I think, like you wrote it is something that I would not respond well to. When you write about yourself, are you concious of discrete personalities? I guess I think that everyone has an inner child, etc. (and I certainly fall in that category), but as far as naming different personalities of myself, I cannot do that- is that something you are able to do or did I misunderstand. Please don't apologize for the length of your post, I'm grateful that you took the time to give me things to ponder and perhaps feel brave enough to confront. Take care, Judy
Posted by terra miller on June 2, 2002, at 22:54:00
In reply to I wanted to spend some time » terra miller, posted by judy1 on June 2, 2002, at 18:38:06
hi. (another long and winded reply....) :-)
honestly, most of the time i do not at all believe i dissociate and totally do not believe the DID is real. every once in a while i go through a season of telling my therapist to "prove it." then usually some crisis will come up and i will have no time to argue my point. aaargh.
i think what has really helped me in understanding DID is realizing that it's not about what people think is typical: different changes in expression in relating to the world that carry different names (Sam, Sammy, Samantha, Big Sam); people think Cameron West, or Sybil. i'm not completely certain that i fit into that description or not. i think i "might" have parts with names, but i am certain that i have parts without and that those parts of me run my life at times.
right now for me things are still very much in protective mode. to me that feels like i am still extremely clueless, even though i have spent the last 3 years talking to my therapist nonstop, twice a week. he knows me better than i do, which is somewhat annoying. :-)
so, anyway, what i notice most is switching. for example, today i had a traumatic conversation with my spouse (with whom i am separated) and i just kept switching throughout the whole conversation. what that felt like to me was like waking up from a dream, but doing it every 30 seconds. (this isn't typical; typical switching for me happens throughout the day, not every 30 sec.) but i think it happened that way because the nature of dissociating is to split up the memory so that you either don't recall any of it, or you only recall part of it. so in my case, i was switching every 30 secs so theoretically i have this traumatic conversation now stored in my brain in 20 different compartments. (theoretically)
some ways that this manifests, which can really throw you, is for example when growing up- let's say you had a mom who was a jerk. but you want to love your mom like every kid does. you can't stand the discrepency. so you shove the reality of how she acts like a jerk and what you remember is only how she was nice and loving. you carry that with you and you might insist how loving she is/was. then you get to be 35 and you start remembering that she wasn't "just" loving and you have to rethink your world. i think that's when people sometimes get the BPD dx- when they notice black and white thinking. but it's not a bad thing; it's that in order to deal with some stress, one might just have had to split the emotions up in order to handle what then was intolerable. black and white thinking isn't always bad.
notice that i handle all this all fine academically :-) now if you had seen me at 12:30 today, that would have been another story. :-)
the first month of therapy, my therapist suggested that i might think about getting out some crayons and paper. i thought he was a nut case for suggesting that. he talked a little about inner child stuff, and i thought he was a nut about that, too. now i laugh at myself about that still.
i think everybody has that childlikeness inside of them, i agree. what is experientially different to me is i don't think for people who aren't DID that they have to deal with the opinions in your head, or arguments, or demands... or sometimes feeling driven to eat a donut, or whatever. sometimes it feels like overwhelming urges to behave in a way that's not consistent with who you know yourself to be. but if i have time that i can't account for, then i don't have any idea what i was doing and i know that there are parts of me that i have yet to know and understand; but until i am able to master my memories and make them my own and function within knowing all of them, i expect i will continue to either lose time or be aware of being multiple because i have parts of me that carry on everyday life. (sometimes i know how to cook and sometimes i stand in the kitchen and want to burst into tears because i have no idea what to do...)
i still am not at the place (i probably never will) where i feel comfortable freely sharing my dx. usually i just say PTSD, which is true and that's all people need to know. in your case, it felt appropriate and i hope it's helpful... and i hope not too overwhelming. just because this is my story does not mean it is your own. but if it starts to make you wonder, just take it slow and listen to what your heart is telling you. if there's stuff you need to know about and you are open to learning it, it's probably going to reveal itself to you as you are ready to hear it. just go slow at your own pace. :-)
terra.
Posted by terra miller on June 2, 2002, at 23:37:16
In reply to Sorry, about Dr. Linehan.., posted by judy1 on June 1, 2002, at 21:21:49
i was thinking about you and what you said and wanted to say that i hope they get better. i'm not sure if you're feeling panic, or losing track of time or not sleeping or what. but i understand that nights can be tough and i have spent my share not sleeping, or sleeping sitting up in a chair because i couldn't bear to lie down, or sometimes just telling myself over and over and over, "Lift you arm, pick up the xanax pill right there. You can do it. Just do it and things will look better."... sometimes I get so paralyzed that I can't even move to get to the xanax, which I now have learned to just keep right next to me because if it's across the room I'll never get to it. In case any of that helps you know that you aren't alone in some way, wanted to say I was thinking about what you said.
Take care,
Terra
Posted by judy1 on June 3, 2002, at 0:17:12
In reply to the land of denial » judy1, posted by terra miller on June 2, 2002, at 22:54:00
First I'm so sorry you had such a traumatic time with your ex, I hope you're feeling better now. I do 'trigger' fairly easily, because of some recent medical problems I had to see a new neurologist recently (and I brought a letter with me from my therapist explaining I had PTSD and difficulty with being examined). All he did was bring a female nurse in the room and still had me lay on my stomach and I just 'left'- you probably understand what I mean. Later that night I cut myself pretty badly to the point of several stitches. So perhaps denial is an appropriate term, and when you wrote in your last post that my therapist is going at my pace, I can believe that too. Thank you for explaining about names, I don't think that way either. But I do keep things from my therapist and shrink, if I say I have voices boom I'm on an anti-psychotic but in a sense I think I've always had them- it's just sometimes it's very frightening as is the loss of time. Do you forget a lot of things- like where you left something? When you feel like you are switching, I assume the 'essential' you doesn't remember anything like you said, but does some part of you remember? Are you able to communicate to the other parts of yourself? If you don't want to answer any of this, please don't- I appreciate everything you've already written. Take care, Judy
Posted by judy1 on June 3, 2002, at 0:24:47
In reply to nights » judy1, posted by terra miller on June 2, 2002, at 23:37:16
Nights are the worst for me especially if my husband is out of town. Many times I have gone into my children's rooms and slept on the floor, other times I've taken a LOT of extra meds to knock myself out which I realize is a dangerous game. My therp would like to see me twice a week also, but I can barely manage one- I get too worked up. And I know I'm doing it to myself, nobody is pushing, but I do get flashbacks (do you?) and I flip out. This helps me to write things out (thank you), maybe I'll try to communicate more- I realize she and my shrink can't read my mind. Have a good night, Judy
Posted by terra miller on June 3, 2002, at 11:13:22
In reply to Re: nights » terra miller, posted by judy1 on June 3, 2002, at 0:24:47
Hi.
> Nights are the worst for me especially if my husband is out of town. Many times I have gone into my children's rooms and slept on the floor
This was definitely me early on. I always felt safer with my kids. If not then I would literally hide under a pile of stuffed animals. There was a stage when I could not sleep in our bedroom at all, and that's when I literally slept sitting straight up on the couch. I had another stage when I could not sleep because I was in such emotional pain unless I was embedded in my bear... which is 4-5 feet big (when you've got a big body, you have to own big stuffies <grin>)
>other times I've taken a LOT of extra meds to knock myself out which I realize is a dangerous game.I still do this. I actually think it is appropriate "IF" you know what dose is appropriate for you and you have your pdoc's approval. I actually get in trouble for not using my meds enough and suffering. But there are times for taking sleeping meds and times for taking panic meds. (It took me 3 years to get to this point of acceptance, by the way <s>)
I also am prescribed meds that you can't overdose on very well. To be honest, it was a depressing day when I read the information and realized how difficult it actually was to end my life by taking too many of my pills. I hated having that way out taken from me, but honestly I think that's the point when I truly became the safest with myself.
>My therp would like to see me twice a week also, but I can barely manage one- I get too worked up.
I used to get so worked up that I didn't think I could make it. We only stayed at once a week for the first month or two and then switched to twice a week because I couldn't make it between sessions. I do have a very strong trust alliance with my therapist, who is a man believe it or not.
>And I know I'm doing it to myself, nobody is pushing, but I do get flashbacks (do you?) and I flip out.
I actually embrace flashbacks now. I hate them every time, but I now view them as ways to get to the stuff that I know nothing about. I figure if I'm not triggered by something, then I will not likely get out what I need to know... it often takes a trigger to pull something up to where I can know it.
more in other post
terra
Posted by terra miller on June 3, 2002, at 14:51:42
In reply to Re: the land of denial » terra miller, posted by judy1 on June 3, 2002, at 0:17:12
> First I'm so sorry you had such a traumatic time with your ex, I hope you're feeling better now.
Thanks. I am doing better and feeling more organized in my thoughts today.
>I do 'trigger' fairly easily, because of some recent medical problems I had to see a new neurologist recently (and I brought a letter with me from my therapist explaining I had PTSD and difficulty with being examined). All he did was bring a female nurse in the room and still had me lay on my stomach and I just 'left'- you probably understand what I mean. Later that night I cut myself pretty badly to the point of several stitches.
I am so sorry that happened to you! Yes, I know what you mean by "left." Sometimes one of the biggest (I know it is for me.) causes of bringing on SI is feeling ignored and taken advantage of and feeling out of control and being frustrated by that... and it all builds up and that's when you end up to the point of where you landed. Once all that frustration builds up inside, it takes heaps of concentration not to SI and to try to cope in other ways. (If I'm feeling so frustrated that I want to beat on my body, I hop on my exercise machine until I am exhausted and watch a video where good triumphs over some large evil... for me that's watching intense stuff like Schindler's List or The Matrix or Apollo 13.)
>I do keep things from my therapist and shrink, if I say I have voices boom I'm on an anti-psychotic but in a sense I think I've always had them-That for me was the biggest obstacle to getting help and telling somebody. Inside there's that strong feeling that if you tell anyone, they will label you psychotic or schizophrenic. I was afraid of that, too, and that I would be put on an anti-psychotic. I got to the point where I could trust my therapist, and he told me over and over that I wasn't psychotic and how my symptoms were way different than schizophrenia. But it was hard to tell him. And it took months for him to gently convince me that he didn't think I was crazy.
>it's just sometimes it's very frightening as is the loss of time. Do you forget a lot of things- like where you left something?Yes! It drives me insane!
>When you feel like you are switching, I assume the 'essential' you doesn't remember anything like you said, but does some part of you remember?
I am assuming there's always memory of what I do in this brain somewhere. Sometimes I remain present ("they" call it co-consciousness.) and am aware of both my thoughts and another part's thoughts. But usually what I feel is a switch coming on, then I switch, then I switch back (a process that I don't feel happen because I'm not out), then I am present... if this happens over minutes, then I might not notice. If this happens over hours, then I notice that I can't account for what I was doing. But lots of times I don't even notice that I've even lost time until somebody asks me a question and I for the life of me have either no idea what they are talking about or what the answer is to their question. Almost every session anymore my therapist will ask me how my weekend went (don't know. don't remember anything.) or refer to our last session together (don't know. don't remember anything.) Most times I can guess so that I am not found out. With other people I guess, hoping they'll keep talking so I can catch on to what they are talking about. In therapy, I've stopped guessing. I say, "I don't know" a lot. But it took a long time before I let down my defenses enough to let my therapist know how very little I remember instead of trying to hide it by guessing.
>Are you able to communicate to the other parts of yourself?I don't know. Sometimes I think yes. Most of the time it feels like a big joke; that there is no way that this is real. When I am frustrated is when it feels the most real... like when I'm getting dressed and somebody is dead set on a certain outfit and I just want to get dressed, you know? And I find that I cannot move because somebody is pitching a fit. That's when I communicate... usually in the form of, "Will you just leave me alone and let me get dressed! I don't want to wear that shirt"... pause... still can't think clearly...."Ok, we'll wear the stupid shirt then. Are you happy now?!"... all of a sudden can think and move again..... it's not like that all the time. Mostly I do a lot of listening and very little talking.
Terra
Posted by judy1 on June 3, 2002, at 18:37:02
In reply to Re: the land of denial » judy1, posted by terra miller on June 3, 2002, at 14:51:42
I just wanted to let you know I received Deborah Haddock's book today (the one you recommended). I'll let you know what I think when I read it. I also wanted to thank you for your honesty, I think you're very brave and sound very much together. I'm sure that it has been a lot of work on your part, and I hope someday I get to the point where I'm able to cope in a healthier fashion. Take care, Judy
Posted by terra miller on June 3, 2002, at 22:44:43
In reply to Hi Terra, posted by judy1 on June 3, 2002, at 18:37:02
I so hope you find the book helpful. Please remember to put it down if it becomes too much for you to read or you get too triggered. Treat yourself with gentleness and care and I just bet some of that SI will settle (at least I hope so.) Let me know how you are doing if you feel comfortable with that.
take care,
~terra
Posted by judy1 on June 4, 2002, at 18:27:34
In reply to Judy » judy1, posted by terra miller on June 3, 2002, at 22:44:43
I have an appointment with my therapist tomorrow and I wrote out a couple of questions that I want to ask her. One was an 'inner child' question, because honestly I felt that was a safe way to ask about how I'm functioning if I don't remember functioning and everybody has an 'inner child' so maybe I'm not communicating very well with mine. The other question is how can I SI and not be aware of it until after. I realize these are pointing to DID type questions and I'm shaking and haven't even asked yet. So maybe I'm not ready to ask? Just reading that book and identifying a little too much so I'm taking a break. It didn't trigger me, just feel a little afraid. Thanks if you get to this before tomorrow- Judy
Posted by terra miller on June 5, 2002, at 0:14:40
In reply to Terra?, posted by judy1 on June 4, 2002, at 18:27:34
Hi. I hope your appointment goes well. It sounds like you are working hard right now- good for you. Let me tell you something: I remember when my therapist sat down with me (something he rarely does; usually sits across from me) with a bunch of written material that i had given him (that's how i stay sane... i write everything out and give it to my therapist.) anyway, he slowly went through it showing me some of what i had written (i never remember) and the different styles of penmanship and emotional tones. all that is to say, it was as if "he" had determined that the time was right to tell me what he was suspecting. and i was totally nervous and relieved all at the same time. i felt like i finally could trust somebody and that i had chosen to trust the "right" somebody. he was kind, gentle and patient which put at ease all my fears that i would be perceived as psychotic, etc. "he" knew better.
more than being told you have a certain dx, you need to know if your therapist knows how to help you get better. for example- if you theoretically have a part of you that SI in order to cope but you have no awareness at all of that- what would your therapist's approach be to help that part heal? (it's always safer to ask questions "theoetically.") there's the approach of providing better coping skills/educating. but there's also the approach of seeing if there's stuff that needs processed/feelings/maybe stuffed memories. you have to get to that stuff to get better, IMO. but your therapist may be waiting until the SI is under control before going down that road... but that would be another excellent question to ask her; if she is doing that.
let me know what you are comfortable sharing about your appointment.
terra
Posted by judy1 on June 5, 2002, at 16:59:25
In reply to Re: Terra? » judy1, posted by terra miller on June 5, 2002, at 0:14:40
and I'm exhausted. After I had written some questions to ask her about inner child stuff, I had the worst headache and laid down. When I woke up there was more stuff written in print saying I shouldn't tell her anything (and I had SIed). I felt completely freaked and well, nuts. I landed up giving her the paper (I was really afraid to) and she couldn't have been kinder- very similar to how you described your doc. She told me to get 'Waking the Tiger' by Steven Levine and I ordered it. She also said if I start to have a headache again to go and spend time with my animals and children to stay grounded and since I was so upset , she said to wait on the journal until I see her Tuesday. So that's what happened, thanks for all your help. Take care, Judy
Posted by terra miller on June 5, 2002, at 19:53:37
In reply to saw therapist » terra miller, posted by judy1 on June 5, 2002, at 16:59:25
hey, i'm here if ever you need or want to talk. and it's up to you- that is, you always get to choose and the choice never ever needs to be pushed on you- who you choose to trust. i just thought i'd say that. sometimes we need to hear it.
your therapist gave you really good advice. petting animals but especially being with your own kids does help you stay grounded. the more of your senses you can involve the better. and there's something about the responsibility of raising your own kids that helps a whole bunch.
if you're feeling the strong urge to nurture yourself, you can try tossing a stuffed animal in your bed and sleeping with it. there's something about that that i haven't figured out yet, but my theory is that while i get to sleep, the child gets to cuddle.
i think you were very brave to give your writings to your therapist. i bet that was scary to do. with time, i hope she becomes more and more trustworthy so that you become partners in your healing. in my own therapy, there are lots of times when my therapist partners with me to know what it is that i need and what is wrong inside and what to discuss and what to wait to discuss. nobody knows better than you. i though maybe it would help to hear that.
terra
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