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Dr. Bob is Robert Hsiung, MD,
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Posted by Pfinstegg on August 12, 2004, at 3:17:02
In reply to And another thing..., posted by Ilene on August 11, 2004, at 18:21:14
This is true. Since I noticed my name, I thought I'd like to chime in. When you do have sufficient childhood abuse so that your cortisol levels are elevated, your brain is going to change- become abnormal- and you are going to be much more susceptible to depression and over-reactivity to stress. It's painful to realize that- that something bad enough was done to you when you were an innocent child looking for love and safety that your brain has literally been damaged. I feel so sad that this happened to me- as everyone does here in varying degrees depending on their own circumstances.
But still, there is a LOT we can do to get our brains back more towards normal. The AD's that we presently have are not all that great (probably we'll have much better ones in ten years which can really restore our brains), The AD's, some more than others, do normalize our neurotransmitter levels to an extent, and do help our brains regrow neurons damaged by cortisol and other chemical present in excess when we have overactive HPA axes. There are definitely studies showing that long term psychotherapy- particularly the kind where the relationship between client and therapist is given the most importance- does help our brains become more normal physiologically. I can't find them right now, but I'll try to soon. Now that functional MRIs and other new imaging studies are coming into use, they show how much a combination of therapy and medication can help- they aren't used routinely, as they are so expensive- and more of a research tool at present, but I think we're going to learn a lot from them in the next few years. My depression was so severe a year and a half ago (and all my cortisol tests so abnormal), that I sought out TMS. That treatment really normalized the cortisol findings for a few months at a time; now, I am enough better that I'm not doing it, but I would if I have a bad relapse. TMS is being studied very intensively right now, with the goal of getting it FDA-approved by 2005. Like everything else, it doesn't work for everyone, but I think it's going to be very valuable for lots of people. I never feel so well as I do in the three or four weeks following TMS. I just KNOW that my cortisol is normal, because I feel so calm and can handle stress so much better. And, even though my endocrinologist doesn't really want to test it, I pressure him into it- and it IS normal- temporarily.
I am trying to learn as much as I can about what is wrong in the brains of people with PTSD, and how to make it better. Sometimes, you just need everything- good therapy, medications, and perhaps something like TMS. I don't think we should underestimate the power of therapy to help make our brains more normal- it may be the most pwerful modality of all, though it's certainly not the quickest! I can't help thinking that there couldn't be a board like PB Psychology if we all didn't instinctively realize what power for healthy change therapy has in our lives. Everyone cares so much, and feels so badly, when there is a rupture in the connection to our therapists- and so relieved and happy when we are able to repair it. It seems to be our most essential topic here, doesn't it?
Posted by Aphrodite on August 12, 2004, at 11:55:42
In reply to Re: And another thing... » Ilene, posted by Pfinstegg on August 12, 2004, at 3:17:02
I would be interested in those studies if you have the time to look them up.
Forgive my ignorance; what is TMS?
Posted by Pfinstegg on August 12, 2004, at 12:15:03
In reply to Re: And another thing... » Pfinstegg, posted by Aphrodite on August 12, 2004, at 11:55:42
I'm working on finding them- there aren't too many (yet), but there are some, despite the big disagreements mentioned in the NY Times. They involve SPECT scans and functional MRI imaging, which are not used routinely .
TMS stands for Transcranial Magnetic Stimulation- it's kind of a new version of ECT, without the dangers of anesthesia and memory loss. It's not FDA-approved in the US yet, although it is approved in Canada and Europe, and I think, Australia. I found it to be really safe and very effective- not permanently, but for several months at a time.
Posted by Racer on August 12, 2004, at 12:29:09
In reply to Re: And another thing... » Ilene, posted by Pfinstegg on August 12, 2004, at 3:17:02
I'd be very interested in those studies, too -- and think for two seconds and you'll know why I would have experience with Cushing's Disease, so the whole HPA axis thing is high on my list of interests.
As for the therapy remolding our brains, was it you who brought this up when I slipped back to very old problems that I thought I'd overcome entirely almost 20 years ago through therapy? Whoever it was said, basically, that the traumatic events in my childhood (which, again, included being hit by a car and spending months in hospital/body cast/physical therapy -- I never think of that as a trauma, because I didn't have the experience to find it traumatic at the time, but my body may have experienced it differently...) created neural pathways that became a sort of superhighway system for a long time. Through therapy, we created a sort of frontage road system, if you will: we rerouted all that neural traffic onto new pathways. The old pathways were still there, but they weren't used, the pavement cracked, weeds grew, etc. With the recent traumatic events, the new highways were overwhelmed -- in this case, because they didn't work when faced with the kind of tanks they were faced with -- so the traffic got rerouted onto those old Superhighways again. That doesn't mean that the old therapy didn't work -- it did, as shown by the fact that that system hadn't been used at all in so long. It does mean that those neural pathways, once created, will always be there -- they cannot be destroyed. Therapy allows one to build new highways to reroute the traffic, which allows those old, damaged Superhighways to gather weeds.
Sorry for the amateurish analogy, but it's the best way I had to explain it. As for me, while it would be very nice to be able to wipe out all the long term effects of the trauma and just be happy and healthy and wealthy and wise - well, it would be nice to have long thick shiny hair, too, and 20/20 vision, and maybe a straighter nose, you know? While we're at it, maybe I'd like to be shorter, too -- and I want a pony and some ice cream.
Honestly, despite it all, giving up all those traumas of my childhood (and adulthood, for that matter) would also mean giving up some of my most valued experiences, as well. There's no doubt the car accident was not pleasant, but the nurses were very nice to me, my Grandma sat by my bed and read to me, once I was out of traction and had my cast they let me ride in a go-cart -- just like Curious George! -- and I have a lovely surgical scar that goes from my belly button to my sternum that I wouldn't give up for the world! (<< Although the plastic surgeon I consulted about something else thought I was nuts for saying that, it's still true.) I guess it's just that I wouldn't be me without all of it, you know?
(Aphrodite: TMS is trans-cranial magnetic stimulation. It's the use of magnets, similar to those used for MRI (I think) to stimulate certain areas of the brain -- prefrontal cortex, maybe? -- that has shown a lot of promise. I think, Phinstegg will correct me if I'm wrong, that it was being experimentally used for stroke recovery when they discovered that it also seemed to improve mood, as well.)
Phin, tell me the lastest on TMS? Did you have bilateral, or unilateral? I've read some about it, and that seemed to be the biggest question? (There's a study at Stanford, but I haven't had enough on the ball to apply for it. Maybe I should sit on a cattle prod until I do it...)
Posted by Ilene on August 12, 2004, at 13:01:14
In reply to Re: And another thing...(quick note to Aphrodite) » Pfinstegg, posted by Racer on August 12, 2004, at 12:29:09
> Phin, tell me the lastest on TMS? Did you have bilateral, or unilateral? I've read some about it, and that seemed to be the biggest question? (There's a study at Stanford, but I haven't had enough on the ball to apply for it. Maybe I should sit on a cattle prod until I do it...)
Do you have info on this study? Please email me at
iafuerst-at-morcopy-dot-com
Posted by Pfinstegg on August 12, 2004, at 14:50:11
In reply to OT question for Racer » Racer, posted by Ilene on August 12, 2004, at 13:01:14
There are two psychiatrists, recommended to me by the Dept. of Psychiatry at Emory University, who are very experienced, and who give it "off-label". They are Dr. Mark Hutto, of North Atlanta Psychiatric Associates, and Dr. Steven Best, just west of Chicago. I believe Dr. Best may give it bilaterally, but I went to Dr. Hutto, who gives it only unilaterally, to the left frontal hemisphere. There are various studies, some of which involve being willing to have ECT, and which involve varying placement of frequencies of stimulation. I didn't want ECT, and anyway, would not have qualified for any of them because I'm left-handed.
Currently, Neuronetics Corporation is conducting a 16-center study, hoping to push towards FDA approval in 2005 or 6. They have a web site which you can look at; Dr. Hutto has one too, and can be contacted by e-mail if you are interested. Only about 2/3rds of the people who take it benefit, but you never know whether you'll be one of them. If you are, it's a wonderful treatment for depression.
Posted by Aphrodite on August 12, 2004, at 15:03:22
In reply to TMS, posted by Pfinstegg on August 12, 2004, at 14:50:11
Posted by Aphrodite on August 13, 2004, at 6:59:51
In reply to TMS, posted by Pfinstegg on August 12, 2004, at 14:50:11
Pfin,
I am curious what your feelings are about medication (ADs) as it relates to your previous discussion of therapy trying to integrate the differing parts of yourself. I am not on medication, but yesterday after 10 months of difficult therapy, he gently suggested it. I rebelled at first -- like he was trying to silence some of the more troublesome parts of me -- but now I think I'll consider it. I do not know if you are on meds or not, but I fear that it may make the therapeutic job of working on the ego states more difficult. You do not have to answer, of course, if you prefer not to. Or, you could email me at babbleaphrodite at yahoo dot com, or not at all. I understand either way.
Anyone else have any thoughts on meds and how they affected the work of ego states? It frightens me.
Posted by DaisyM on August 13, 2004, at 10:38:02
In reply to question about meds and ego state work » Pfinstegg, posted by Aphrodite on August 13, 2004, at 6:59:51
One of the huge issues I have is not sleeping. The dreams are terrible and they wake me up and I stay up the rest of the night to avoid more of them. A few months ago, my therapist became very concerned about this because it was contributing very heavily to the suicidal ideation...I was too tired to cope. He talked about medication and suggested I talk to my MD or he would refer to a doc. Sounded fine to me.
I left his office and an hour later freaked out. It was very much like what you said. The parts of me that have been so contained, so silenced where having a fit that we were trying to silence them again. Because she is mostly out at night. It was one of the worst episodes I've had...I literally lost the next morning, couldn't move off my bed. So if this is the discussion just prior to last night, I can see why you had a crisis.
That said, after much more discussion, I do have something to help me sleep now. I don't take it every night but there are times when I've taken it early and put myself to sleep. It helps. I've heard so many differing opinions on the idea of medications. The idea is not to mask your feelings and pain but to make things manageable between sessions so that you can live your life.
My son's therapist stressed that medication was a tool to bring the anxiety down enough to learn how to deal with it, if possible, without medication. But until the anxiety came down in the first place, nothing was getting past it. And that is exactly how it worked...he went on, stabilized and worked hard to learn other things. Now we've weaned him off. He is struggling again so he might go back on. But it isn't a life sentence just because he started taking them. But if he needs them lifelong, that is OK too.
I totally understand your hesitation. I share it. Sleeping aides were a huge first step for me. And they've help me tolerate going into even darker places. I think you should keep talking about it. Since you are already invested in therapy, I doubt whether they would shut down your progress.
Posted by Shadowplayers721 on August 13, 2004, at 12:12:12
In reply to Re: question about meds and ego state work, posted by DaisyM on August 13, 2004, at 10:38:02
Some of mine aren't touched by meds at all. When I was in the hospital, they gave me the shot to calm me down. A little girl came out and started talking about another one. She was wide awake and alert. Meds didn't affect her in the least. You couldn't knock her out with anything. Others initially will fight against them and have some weird reaction, then they will give up and all them to do their action. Meds are tricky with me.
Take klonopin. Sometimes, it knocks me out. Other times it does NOTHING. Then, others, it just calms me a bit. Now, this is the same dosage 0.5 mg It just depends.
Posted by Pfinstegg on August 13, 2004, at 12:51:53
In reply to question about meds and ego state work » Pfinstegg, posted by Aphrodite on August 13, 2004, at 6:59:51
Hi.. I'll answer anything! (or at least offer my 2 cents). You asked a wonderful question, and there isn't a simple answer. Generally speaking, I think therapists (my analyst is among them) who do work trying to integrate separated ego systems prefer to use little or no medication. However, during the most difficult times, many will suggest them. Mine wanted me to see a pdoc a year ago at a time when the good effects of TMS were wearing off, and the therapy was becoming extremely painful. I went on Lexapro between 10 and 20 mg. It made everything much more bearable, but it did have a dulling, anhedonic effect on me, and what I was able to express in therapy. So we decided to gradually wean off of the Lexapro. Because I had taken various SSRIs and atypicals for eight years previously, I was very susceptible to their dopamine-lowering, anhedonic effects. Instead, I'm presently taking Wellbutrin 75 mg. of the old-fashioned regular release. This is a very low dose (300 xr being an average dose), but it is enough to help me have what feels like more normal dopamine levels, and to tolerate the stress and pain of therapy. I also have trouble sleeping, and take klonopin 0.5 about every other night.
So, to sum up, we are trying to keep everything at very low doses, but we're not at the ideal of no medicaton at the moment. I do find that, the less medication, the stronger and more spontaneous my feelings are in therapy.
Posted by Dinah on August 13, 2004, at 13:28:46
In reply to question about meds and ego state work » Pfinstegg, posted by Aphrodite on August 13, 2004, at 6:59:51
Some medications have more effects on it than others. You can always try, and if they are shutting you off from parts of yourself, back off.
I find that the very low dose combo of klonopin and depakote I'm on keeps me on even enough keel that I'm not careening from crisis to crisis, without affecting my ability to reach different parts of myself. When I'm extremely agitated, I take the occasional Risperdal - which does tend to cut me off; but on those occasions I feel so darned bad that I don't mind being cut off.
Posted by Aphrodite on August 13, 2004, at 17:56:09
In reply to Re: question about meds and ego state work, posted by DaisyM on August 13, 2004, at 10:38:02
You're so right, Daisy, that part of the session in which he suggested a pdoc and meds set me into crisis mode. I also couldn't tolerate the thought of he and another person talking about me. Also, since he sends a summary when he refers someone to the pdoc he works with, I am afraid she would have a preconceived notion of who I am.
So, he suggested I find a pdoc on my own and have control over the situation. I was already thinking that I should start small and just get something to help me fall asleep and stay asleep and see if I can then tolerate everything else. Thanks for the insight, as always.
Posted by Aphrodite on August 13, 2004, at 17:59:53
In reply to Re: question about meds and ego state work » Aphrodite, posted by Pfinstegg on August 13, 2004, at 12:51:53
> I do find that, the less medication, the stronger and more spontaneous my feelings are in therapy.
>
>That's what I would have guessed. I'm afraid that if meds suppressed my sorrow they would also suppress any joy that might be found. I think that if I can tough it out, I'd rather be in the thick of it all, feeling everything, so that the differing parts could integrate fully.
Of course, I may just be saying this because I feel a little rebellious toward his suggestion:) Those tantruming little inner children can be difficult!!!
Posted by Aphrodite on August 13, 2004, at 18:03:50
In reply to Re: question about meds and ego state work, posted by Aphrodite on August 13, 2004, at 17:59:53
Posted by Pfinstegg on August 14, 2004, at 10:05:38
In reply to Above for Pfinstegg ^^^^ (nm), posted by Aphrodite on August 13, 2004, at 18:03:50
As you can see, we compromised (he wanting meds temporarily, me not wanting them). I had to stop and remember that he's been doing this work for 30 years, and probably knows when to suggest them. Since I've been able to get by on very low doses, I don't think it's making a lot of difference one way or another. The Wellbutrin, if anything, makes one's feelings stronger, and the Klonopin for bed-time only.The SSRIs- well, they all vary some, but the Lexapro seemed to take away all my dreams, sexual desires and strong feelings in general, so, for me, it was a poor choice for in-depth work. I am noticing that, off of it, my other ego states are a lot closer to the surface, and easier to get out into the open. I also make lots more sudden, unexpected slips of the tongue - comments which only the *other parts* would make. As an example:
My T. brought up something I had mentioned a number of times- a vivid mental picture of my father having been castrated, with blood all over his legs. He asked, "When did you start to have that thought?"
Without knowing I was going to speak, a voice in me quickly said " after". I was so shocked to hear myself say that, as I don't remember what he actually did to me. It helped us a lot to start chipping away at these unconscious memories- I am remembering a bit more almost every time I'm there. I don't think this would have happened if I'd been highly medicated, but the low levels seem to be helping me in my own life, while not interfering with therapy
Posted by Aphrodite on August 14, 2004, at 14:49:05
In reply to Re: Above for Pfinstegg ^^^^(caution - may trigger » Aphrodite, posted by Pfinstegg on August 14, 2004, at 10:05:38
Thank you for all of this helpful information. I will keep this in mind if I should end up consulting a pdoc.
Sounds like you are doing such hard work. I hope there is much healing on the other side of it.
Posted by daisym on August 14, 2004, at 17:07:23
In reply to Re: Above for Pfinstegg ^^^^(caution - may trigger » Aphrodite, posted by Pfinstegg on August 14, 2004, at 10:05:38
Have you tried free flow writing giving your therapist a voice from your head and seeing if your inner child will answer? It is very compelling, especially if you do some deep breathing before you start writing.We started by me walking my therapist through my childhood homes. I was the tour guide, based on my age at the time. (this was all on paper -- I did it without him being with me.) As we walked the halls and put our heads into rooms, I would tell him about things that went on, or who had that room, whatever. He had me write about how I felt about each room, during the day and at night. And then he had me think about questions he might ask if I described something.
For example:
Me: When I was 9, I slept with my baby sister.
Him: You shared a room?
me: No. I had my own room.
Him: But you slept with your sister. Why?
me: I was afraid of the dark.
him: A nightlight wasn't enough?
me: No.
him: was she afraid of the dark?
me: No. I protected her.
him: from the dark
me: No. from what happens in the dark....and so on. I have done this now with almost all of the houses we lived in. I can't get through one age range but that tells us there is something there I'm not ready to deal with. We have an agreement that I will show him these writings, or at least tell him about them when I use this technique because he doesn't want me to "sit" on new memories and allow them to become new secrets I have to keep.
My gate keeper is so strong there are rarely slips of the tongue. But, if my therapist talks directly to my younger self, she will now talk about what happened with him. I must say, it was easier to have the adult just tell in broad strokes what happened. Because her recollections are loaded with the emotions. And that makes my brain freeze and words are hard to find.
I wish it wasn't this hard. For any of us.
Posted by Pfinstegg on August 14, 2004, at 19:04:53
In reply to Re: Above for Pfinstegg ^^^^(caution - may trigger, posted by daisym on August 14, 2004, at 17:07:23
I wonder if our therapists trained together! He asked me to bring drawings of the room arrangements in the house I lived in as a child, and kept them in front of him for weeks while he asked the same sort of questions. We started with the girl taking him on a room-by-room tour of the house, and telling him where each piece of furniture was, where the beds were, how she felt at various times of the day in the rooms, all very detailed and at a slow pace. Once we had done that, the girl seemed to decide that he was a safe guide, and she could start to talk to him more directly about her thoughts and feelings. It was such a new, startling experience to realize that, while *I* really trust my analyst and want to hurry up and get my problems solved, *she* has to proceed very cautiously-she has difficulty knowing whether he can be trusted or whether he is another abusive male. My analyst does some amazing things (like yours)- one time, it popped into my mind to talk about wading in brooks when I was a girl (I grew up on a farm). He said, "maybe you would like to come and see the brook outside my balcony." I said. "OK". He went over and drew the sliding door back, saying, "you can see it best if you come out on the balcony". We both stood on the balcony; there was a brook running through a little park with clear water and a tiny waterfall.
the girl: "it's beautiful- do you wade in it?"
T: "no, but I cross over those stones when I walk over to pick up my car after it's been serviced." (he points)
girl: "you do? It's nice to have everything you need nearby." (she looks at him, not afraid). "I'm going to lie down again."
T: "OK.
girl: "that's your brook"
T: "you might like to go and walk there sometime"
girl: "I'm going to. You have everything here-sunlight, fresh air, goldfinches (there's a birdfeeder on the balcony) and a brook- and you have yourself- that's the most important."
T: "mm"
girl: "and I have you, too."
T: "yes, you do- I'm your doctor"
girl: "that's so good- mostly, I've had to be my own doctor."
T: " yes, but now you have me- I'm going to be here as long as you need me."
girl; "I'm so happy!"
Reading what I've just written, I know it sounds a little silly, but in fact, it really WAS the girl speaking to him, and he was speaking directly to her. It sounds like such a simple exchange, but in fact it was moving and powerful- and very helpful in getting the girl to feel safe enough to speak to him more fully- she felt much safer because he recognized that she liked to wade in brooks- and just followed his own instincts! Invariably, when he does follow them, like that- really taking chances- he's so on target! Things like this happen only occasionally, but are so meaningful and helpful when they do. When I tell him that, he says they are "co-created" interactions- he never knows when they'll happen either, but he does also put a high value on them.
What you said is so true- it is SO much harder to bring the actual child into the therapy relationship to tell her story; she is so much more enraged, fearful and disgusted than the adult, who, as you say, kind of knows in general but avoids the most painful feelings. I think the little exchange I printed out is an example of the girl having a really new experience with her analyst- one that's safe and fun. Do you have those?
Posted by Pfinstegg on August 14, 2004, at 19:20:43
In reply to Re: Above for Pfinstegg ^^^^(caution - may trigger » Pfinstegg, posted by Aphrodite on August 14, 2004, at 14:49:05
At the moment, this seems like a general three way post with you and Daisy, which I appreciate very much having, but I wanted to thank you, especially, for your kind wishes. The therapy I'm having now is MUCH harder than my previous attempt at it, but I actually feel fortunate and privileged to have found a therapist like this, and I do feel very hopeful and confident about the future- if I can just make it through the present!
You know I wish you the very same.
Posted by Aphrodite on August 14, 2004, at 20:01:12
In reply to for Aphrodite, posted by Pfinstegg on August 14, 2004, at 19:20:43
Thank you so much for sharing your poignant conversation with your therapist. I truly made me cry . . . and cry . . . and cry. (I grew up on farms, too.) Your therapist sounds so gentle and caring. I am inspired by the fact that you could actually talk as the girl. The only way I do so is the interfacing me saying, "She would like to say . . ." or "I think the little girl is feeling . . ." I never let them fully out for fear of losing control.
I'm trying to be patient with myself on these matters. It seems like an uphill climb, but the other option just doesn't seem worth living. Thanks for sharing.
Posted by Dinah on August 14, 2004, at 20:33:32
In reply to Re: childhood rooms » daisym, posted by Pfinstegg on August 14, 2004, at 19:04:53
That *does* sound like a moving and powerful exchange. I thank you for sharing it.
I don't think my therapist could be that spontaneous, though maybe I'm not giving him enough credit. And he talks to whoever shows up for therapy, but the difference in how he talks is slight if present at all.
Posted by Pfinstegg on August 14, 2004, at 20:40:09
In reply to Re: for Aphrodite » Pfinstegg, posted by Aphrodite on August 14, 2004, at 20:01:12
Oh, I'm glad it was OK to write that, and that it really meant something to you. I was afraid it sounded kind of silly, though it was very meaningful to me. It's only just recently that I can let go enough so that she speaks. Before that, I always said just what you say- "she might say.." or " I guess she thinks.." My analyst helps tremendously with this, by always being a bit ahead of me in speaking directly to the girl. He takes care to use simple language, and a gentle. comforting voice, and he knows all the good things about the girl's life- like the brooks and farm animals, frogs and salamanders, spring flowers and the ancient horse who used to lie down if anyone got on his back, and brings those up to help her get started. I could see him doing that for months, but still was not ready to let my guard down enough to allow the girl to really speak. She was dreading what would happen after she had talked about the good things- how bad were the bad things going to be? Now, she and I know that when she's ready, it won't be unbearable- we can go back and forth, from *her* to *me*, both my T and I knowing which one is speaking, and that each part is real. As it happens, we do run the gamut of fear, pain and sorrow, but there is also joy and delight. I really know, now, that doing this kind of therapy can lift those terrible burdens which abuse inflicts on us- I can feel it happening, bit by bit, but it's QUITE SLOW.
I mentioned a couple of interactions which meant a lot to me- one terrifying, and one fun and happy. I would love it if others would do the same!
Posted by Dinah on August 14, 2004, at 20:49:29
In reply to Re: for Aphrodite, posted by Pfinstegg on August 14, 2004, at 20:40:09
>
> I mentioned a couple of interactions which meant a lot to me- one terrifying, and one fun and happy. I would love it if others would do the same!I really wish I could. At the moment, I can't really think of anything profound - positive or negative. Although I might have mentioned things as they happened. Nothing stands out though. I'm closing my eyes and trying to remember. Lots of impressions... But nothing like what you described. Therapy with any part of me is probably mundane and plodding, with lots of repetition.
I remember how it felt, the first time. And a few times I totally surprised myself. But nothing truly profound.
Posted by Pfinstegg on August 14, 2004, at 20:58:57
In reply to Re: childhood rooms » Pfinstegg, posted by Dinah on August 14, 2004, at 20:33:32
Honestly, Dinah, I fought like a cornered animal when my analyst first gently suggested that I had a dissociated childhood self. I was completely terrified of what the implications of that might be- would I fall into a heap of incoherent pieces? But it's becoming an amazing journey, though a hard one.
I've always assumed there's just *one* Dinah to show up, but that, at first, she didn't really want to show up at all. Now, she does want to, and she's developed a powerful bond with her T. For her, there was just *one* Dinah, who needed to make a healthy, strong connection- and she did it. Does this seem about right? (I'm getting all mixed up between pronouns, which I also do with my analyst-sorry!)
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