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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 60. This is the beginning of the thread.
Posted by alexandra_k on February 11, 2005, at 15:30:29
We shared a joke to start with
(he can be fairly charming)
I almost forgave him that he didn't email me
(like he said he would)
I was careful
'You were going to email me about that?' in a questioning kind of way.
'Been off sick for a couple of days'.
It was Friday. He was supposed to email me Monday.Message received
He does not want to work with me
There is a hurt like that
(a broken promise)
Every time I go.
(i hope he is not like that with his son)
He says he will work with me
But his behaviour tells me otherwise.It is going to be a diagnoistic assessment.
I am not happy about where this could be going.
I am concerned the notion is that I need to be diagnosed with DID to be reccomended treatment.
I know there are tests... But to diagnose it doesn't the clinician have to meet them?
No no no.
That is not going to happen.
No no no.
Firstly I do not bare my soul to just anyone
(and trust takes time)
Secondly I don't know what is there.
But I don't want to go that way.
No no no.
I want them to go away
Not encourage them.
I am not a freak
Posted by alexandra_k on February 11, 2005, at 16:34:24
In reply to p-doc and coming assessment, posted by alexandra_k on February 11, 2005, at 15:30:29
> I am not a freak
Not that anyone with the disorder is a freak.
But people have been treated like freaks
And the more of a 'rarity' you are considered to be the more likely that is to happen.
But not to me
Not to meSorry I think I should just shut up now :-(
Posted by Pfinstegg on February 11, 2005, at 16:51:28
In reply to p-doc and coming assessment, posted by alexandra_k on February 11, 2005, at 15:30:29
There are several "dissociative scales" that can be used to help in diagnosis, but I think mainly the therapist and patient gradually arrive together at the realization that it exists. As someone who's got a disorder on the dissociative scale, I do want to encourage you not to think of yourself negatively because of that. I'm so glad, now, that I got properly diagnosed and am now getting treatment that is really helping. No-one in my life (except my husband and my analyst) knows that I have this. I have a doctorate, teach in a medical school, have been married for 30 years, and raised one son who is about to get his doctorate in physics, and is getting married to a great girl next fall. Everyone around me is OK, even thriving, but I was not. The right treatment has been a godsend for me; I feel so lucky to have found it, after several misadventures in therapy. None of the previous therapists ever dreamed that I dissociated, and I didn't know it either.
There are several very high-functioning, wonderful people posting here who have the same thing - Daisy, Aphrodite, Poet have all shared their experiences here, and have been a wonderful support to everyone else- certainly to me.
It sounds like perhaps you got scared with this pdoc- fear is a big feature of these disorders,and can really sabotage our efforts to obtain the right help. Feeling that the people we are turning to for help dislike or even hate us is another thing that happens a lot. When that happens to me, I really feel like running, or just "turning off" inside! I hope you won't turn your back on what might turn out to be a good start on getting the right kind of therapy.
Will you let us know how things go? I know you're young (26?), and want very much to go to grad school in something- perhaps here in the US. It would be so great not to have to carry the terrible burdens of abuse with you your whole life, and it would give you so much more energy to use in fulfilling your own dreams. Let us know what happens with this pdoc, OK?
Posted by alexandra_k on February 11, 2005, at 17:37:22
In reply to Re: p-doc and coming assessment » alexandra_k, posted by Pfinstegg on February 11, 2005, at 16:51:28
> There are several "dissociative scales" that can be used to help in diagnosis, but I think mainly the therapist and patient gradually arrive together at the realization that it exists.
I am sure that would be the case if you were paying to see someone. But here treatment decisions need to be justified according to a diagnosis. Thats why I am nervous. I am afraid it might come down to 'do this or you won't get treatment'. If they do need to meet them before a diagnosis can be made... I don't see whats wrong with DDNOS but that might not be enough to justify treatment.. I don't know. Would it be helpful to try to write down my concerns and give them to her? To try and talk about it? Or should I just see how it goes? But that isn't going to happen. If anybody tries to force that I shall just leave. Perhaps end up with nothing. Maybe that is the point. This is really getting to me. My p-doc doesn't even want to talk about it because he is 'afraid it will upset' me. No sh*t. Well, I'll just deal with this on my own then, shall I??? He is hopeless. Well intentioned and charming enough, but absolutely bloody hopeless nevertheless.
Yeah. I need to keep this / the possibility of this really quiet. Really really quiet...
Thanks for what you wrote. I don't know how I feel about all this. I don't want this to be happening to me. I JUST WANT TO SEE SOMEONE WHO WANTS TO WORK WITH ME AND CAN HELP ME. What if they are making me worse because that is the only way for me to have a chance of getting anything? But then I do think the only reason why everyone has gotten so burned out with me was because they didn't know what to do with me.
I don't know.
Sorry
Long and Rambly
and Very Confused.
Posted by Pfinstegg on February 11, 2005, at 17:59:05
In reply to Re: p-doc and coming assessment » Pfinstegg, posted by alexandra_k on February 11, 2005, at 17:37:22
In terms of diagnosis, I think most everyone here in the US gets a diagnosis of PTSD (309.81) rather than DIDNOS. This covers all the sequelae of the abuse, and doesn't give anyone a diagnosis that might be detrimental to them in their work or personal life. How do you feel about this?
I think it might help them if you wrote something about the abuse, and the symptoms you feel comfortable revealing. If you don't want to talk about any dissociation, don't. To get a really good therapist, however, I think you will need to emphasize the central importance of the abuse. I think trauma is considered to be the only thing that can produce dissociative symptoms, but you don't have to mention those now- just try to get with someone who can help you with them without your feeling you have to reveal more than you are ready to now. PTSD is my diagnosis for insurance, and all other purposes. Would that be comfortable for you?
Posted by alexandra_k on February 11, 2005, at 18:32:28
In reply to Re: p-doc and coming assessment » alexandra_k, posted by Pfinstegg on February 11, 2005, at 17:59:05
My current diagnoses are Generalised Anxiety, Dysthymia, PTSD, and Borderline Personality.
I needed the last one to get one year of DBT. It was made in order for me to get that - well, I 'passed' the standardised tests that I had to do in a qualifying assessment. To tell you the honest truth I studied up on the criteria and bore that in mind. No outright lies, but a fair ammount of 'stretching'... I don't feel bad. I did what I had to do to get what I needed. It was my only available treatment option and it would only become an option if I 'passed' those standardised tests. I justified it by considering 'that was a pretty borderline thing to do anyways'. None of those diagnoses are sufficient to get the public health service to fund private treatment, though. CBT therapists can treat those conditions. There are CBT therapists in the public service who are working okay with other people with those conditions.
Thats why I am being sent to a dissociative disorder specialist. I am okay talking about the missing time. Talking about the voices. But not if she wants to 'meet' the voices. That is not okay.
But I don't know whether DDNOS will do it (in terms of obtaining funding) or whether it has to be DID. And if it has to be DID then I need to know whether she needs to meet them before she can make the diagnosis. The majority of clinicians over here do not consider it to be a legitimate diagnosis. So my bet is she would be very careful to make the diagnosis 'by the book' as opposed to our arriving at some general, unofficial 'agreement'. She will need to be able to justify making the diagnosis. Then the diagnosis will (hopefully) justify the public funding.
I would rather not have that diagnosis. But it seems to be a choice between treatment and no treatment (or 'treatment' where my real issues cannot be discussed).
I am not sure about abuse.
I am not convinced there *has* to be major abuse.
I am not at all convinced I suffered *major* abuse.But I was really really sensitive.
And from my perspective it was major - though another may have dealt with most of that and not had too much of a problem...
Posted by Dinah on February 11, 2005, at 18:56:21
In reply to Re: p-doc and coming assessment » Pfinstegg, posted by alexandra_k on February 11, 2005, at 18:32:28
I understand your concern.
I also understand your reluctance to produce on demand. I've always felt that clinicians can be terribly disrespectful to those with dissociative diagnoses. Especially since it is so doubted.
You're on the horns of a dilemma here. Is it possible to play it by ear and see what happens? If she's familiar with the diagnosis she might be more respectful than you fear.
Posted by Dinah on February 11, 2005, at 18:59:26
In reply to p-doc and coming assessment, posted by alexandra_k on February 11, 2005, at 15:30:29
I read "I am not a freak" as an indictment of disrespectful clinicians who see the disorder as a circus act rather than a judgement of those with the disorder.
Posted by alexandra_k on February 11, 2005, at 19:19:08
In reply to Re: p-doc and coming assessment » alexandra_k, posted by Dinah on February 11, 2005, at 18:56:21
>I read "I am not a freak" as an indictment of disrespectful clinicians who see the disorder as a circus act rather than a judgement of those with the disorder.
Thank you, Dinah. That is exactly right.
I guess I just want to know whether I am expected to do that or not *before* I go. If it is expected then I won't go do the assessment. It would save me a lot of distress.
I do see my p-doc once more before the assessment. I asked him this at our last meeting and he just said he had no idea what she was going to do. But I'll ask him for her contact details. I'd be happier giving him a brief email to foward on to her - but I wouldn't trust him to remember to pass it on. I'll figure a way to find this out.
> You're on the horns of a dilemma here. Is it possible to play it by ear and see what happens? If she's familiar with the diagnosis she might be more respectful than you fear.Yeah. But there is still no way that I am going to let her meet them. There would be nothing she could say or do in a two hour period (and I will never see her again after that) that could induce me to trust her *that* much.
No.
Posted by Pfinstegg on February 11, 2005, at 19:20:36
In reply to Re: p-doc and coming assessment » Pfinstegg, posted by alexandra_k on February 11, 2005, at 18:32:28
This sounds promising. DID specialists are pretty rare! Since she must be very experienced with the whole range of dissociative disorders, she should be able to help in deciding just what diagnosis will be needed. They usually prefer the least severe one they can get away with. 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).
Take care, and be sure to let us know how things unfold.
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
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