Treatment in 3 phases

" Whatever the diagnosis, psychotherapy aims to help each patient to maintain and improve their functioning while changing the ways of being that persist but are not adapted ". Treat traumatic dissociation (Steele, Boon and Van Der Hart, 2017)

 

The appropriate treatment to treat a dissociative disorder consists of:

Phase 1: Being in the here and now, learning to discuss and understand each other

• Encourage the patient to create and have enough security in their daily life and their surrounding environment.

• Increase communication both internal (between parties) and external (especially with the therapist).

Phase 2: Trauma

• Learn to cope with trauma,

• Integrate traumatic memories.

Phase 3: Modify the automatisms, the hope and the future

• Adapt your relationship to others to internal changes

• Adapt your relationship to yourself to internal changes

• Reflecting on a new beginning, a life with new, more appropriate bases

• Autonomy

• Thinking about integration: total or partial

 

Each of these 3 phases is nested, overlaps, has no fixed duration or pre-established order (except at the start a more or less long time of stabilization and reassurance with phase 1) ... The patient can do phase 1, then a little phase 2, then go back to phase 1 and go to phase 3 and return to phase 1 ...

 

The important thing is to make sure at the start of therapy that the patient has enough security in their daily life by starting phase 1 and that they learn to develop this feeling of inner security by having a job where they feel good. , sufficient income, decent housing and physical security in close relationships ... Being a minimum of security is the key word to be able to start this long and painful work to meet yourself. As long as there is not this "minimum" of security, the patient must not approach traumatic memories and his therapist must help him to contain them.

 

Thereafter, the therapist must adapt to the needs of the patient . It is not up to the therapist to choose when to go to phase 2 or phase 3 or return to phase 1 of stabilization. The patient and their traumatic parties know what is good for them and how quickly they must and can move forward. Remember that dissociative identity disorder is an incredible and very complex means of survival put in place by the patient! We did not wait for you to appear in our life to survive and get out of it ... So trust us, do not be too directive or rigid! The therapist if he perceives too many signs of upheaval can advise his patient to take time to improve his safety in his daily life if this is not the case.

 

For therapists, see the section on this site "some tips for professionals" and read the book "Treating the dissociation of traumatic origin" by Steele, Boon and Van Der Hart which discusses in detail the different phases of therapy.

 

My therapy from a personal point of view :

At the start, I was looking for a psychotherapist to help me manage my couple difficulties, manage my ex-husband and his harassment, manage my conflicts at work and find someone who could reassure me about the state of my daughters, their security and their balance.

 

I had a diffuse feeling that I had periods of depression, moments when I was losing all my means and I started to realize that I had experienced domestic violence and rape with my ex-husband and to say to myself that this perhaps the past was the key to my behavior with the companions that I was able to have thereafter. I had a diffuse feeling that I had a lot of inconsistencies, a lot of strange behaviors that I couldn't explain, things that I did like a robot, moments when I was losing skills, time without knowing how or why ... I did not understand myself and I devalued myself a lot. I had the impression of having "bad luck" and of attracting only twisted people, of being a "magnet" to problem situations both at work and in my intimate and friendly relationships. I was looking for how to get out of these situations where I relived violence in a loop.

 

I had seen Anne-Laure Buffet's conferences on domestic violence and I recognized myself in what she said about it, which allowed me to understand a lot of my actions. At first, all my attention was focused on my ex-husband and what I had experienced with him, and the repercussions it could have had on my life as a woman.

 

I spent at least 3 years "flying over and running away" from my dissociative symptoms. I agreed to fly only over the "surface" of the problem and therefore I did not find any real improvement in my daily life or real lasting solutions to my anxieties and my problems.

 

I saw my current psychologist and a psychiatrist at the time. My psychologist tried in the form of a dialogue to get in touch with my dissociative parts and to help me become aware of my switches but no formal "diagnosis" was made.

 

What changed everything for me was when my psychiatrist diagnosed PTSD (Post Traumatic Stress Syndrome) and DID and that health insurance officially recognized my ALD (long-term sickness allowance) on my vital card duration). This official recognition has changed everything! All my life I had not been heard, recognized, believed, what I had experienced was denied. With this recognition, officially, society finally saw in me a victim, my suffering was visible, it was no longer perceived only by me and society extended a hand to me.

 

I wanted to understand and verify for myself, I asked to check and "pass" the PTSD tests myself in the presence of my psychiatrist. Fill in the boxes, see black on white writing all the "traumas" that I had experienced helped me move forward. Seeing that I cumulated things like having seen my father being beaten up, that he had taken a stab, that he had threatened to commit suicide, the numerous deaths staking my course, the deplorable living conditions of my childhood, having lived in a country in civil war, the daily violence suffered by the type of welcome of the sect, my contact with extreme poverty, hunger, human suffering ... See that to each of the questions to which I had to answer , I could answer "yes" with a specific fact ...

I realized that my childhood had not been so beautiful and perfect and ideal as I kept repeating to myself and to others ...

Then I started to search to understand for myself, books, interviews, conferences ... I read the books "the haunted self" by Steele, Boon and Van Der Hart and "The black book of sexual violence "by Doctor Muriel Salmona. It worked. Everything stuck with me. In the same way that Anne-Laure Buffet's lectures had echoed, these books spoke of me!

 

At the beginning, I thought that everything would go very quickly. I had read and understood what DID was, it would be a breeze, it was enough to share the memories. I wanted my therapists to force these parts to let go all of a sudden so that I got rid of them and they disappear. They just had to tell my shrinks and I would be rid of it, my life would be perfect, I would have no more problems or difficulties. What they had experienced, I didn't care enough. I just wanted to get on with my life and be quiet. They weren't really part of me.

 

My therapists insisted on helping me find safety in the here and now, that I take steps to find a decent apartment (mine was unhealthy), focus on how to protect myself at work and put good distances, don't no longer suffer harassment or violence ... that I meet a social worker ...

I was angry, frustrated.

It was not what I expected from them, I wanted them to "heal me with a magic wand" so that I could finally be happy and liberated, without suffering, without feeling, without making efforts...

Nothing was happening as I wanted, I was annoyed that they always come back to these points, I did not see the interest. All I wanted was for them to get rid of those "parts". Everything was their fault (to the parties), the failure of my life was their fault. I wanted them to go!

 

I was very afraid of finding myself in "security", I think that my phobic parts of inner experience and my dissociative parts knew that if I were, they could no longer "prevent" anything. I had already understood in a way that when I was safe, when I was well, my dissociation diminished and flashes of traumatic memories invaded me. I was terrified!

 

My "imitating aggressor" and "angry" parties struggled a lot with my psychologist and were very much opposed to therapy and my "little parties" used my psychiatrist to express all their emotional lack. It was as if I replayed scenes and interior battles, my psychologist seemed cold and directive to me, she represented a threat, my psychiatrist was the mom of which I had always dreamed, sweet and benevolent. My psychiatrist took a lot of ancestry over some of my parts, I replayed with her a form of grip and idealization as I had experienced with my attackers. My psychiatrist, who was just starting to train in psychotrauma, dialogued almost exclusively with my "little parts" or my "moms parts". I felt resistance from him when other parties tried to come and talk to him (including my "suicidal parties" and my "angry parties"). She often told me that violence was prohibited (against oneself or others) and gave me techniques to stop its expression in my daily life (a hand in "Stop" ...) as soon as I tried to express it or in talk. I had the feeling that she was afraid of me, of being a potentially dangerous monster when I had never felt or believed that of me (I have NEVER been violent towards anyone and my violence to me has always been "sub-control". I have always had "control" parts that blocked some of my parts so that I was always able to manage my life to a minimum and protected me from self-destructive tendencies) . My diagnosis of DID then seemed to me a threat. At the start, this diagnosis had been a real relief, an immense inner healing and had given me back my self-esteem, my confidence in myself and in society and the human being. Now he was dangerous, I was dangerous and society was going to find me dangerous. I felt like I was becoming a threat and someone to be afraid of and my struggle and my inner phobia increased.

 

At the same time, little by little, with the help of my psychologist, my inner cohesion and inner dialogue progressed.

 

It is as if I have two parallel lives, as if I were two different patients.

The one who dialogued better and better with my psychologist, who had more and more confidence and who made concrete progress in therapy. My parties agreed to come and express themselves and show themselves to it, my parties opposed to therapy and imitating the aggressor began to be accepted and perceived internally as ultimately non-aggressive and with good reason to do so. I began to deepen my functioning, to seek to understand the "triggers", to be attentive to my feelings and to the parts which are expressed and to seek to reassure and understand them. The sharing of traumatic memories was done slowly and I managed to manage them.

And the other only focused on his need for attention and to have emotional and compassionate signs at each session with my psychiatrist. I emerged from these sessions frustrated and angry with her and with myself. My self-destructive tendencies increased outside the sessions and while until now, I had always managed to channel or prevent them, I began to scarify myself to get his attention (I had never done it), to drink more ... as soon as I told her about it, she worried and condemned. She wanted to send me to see an addictologist, offered to hospitalize me (I was hospitalized for a few weeks by her) ... I felt like I was going crazy and a drug addict in addition to being dangerous. I couldn't explain to her and convince her that I had parts "controls" and "analyzes" which until now had always known how to protect me. For example, all these "overflows" NEVER occurred when I had my daughters at home. I always knew how to preserve them and hide my ups and downs from them. When they were with me, only my "mom parts" were present and my therapy was then put on hold or I made sure that another trusted person took over and brought them what they needed for my place (my sister or my mother, a friend ...).

 

I could not improve this link with my psychiatrist, I tried via emails to express to him what I felt, why I reacted thus, I explained to him what I needed, I explained my victories with my psychologist and why and how it worked in order to create the same dynamic with it ... in vain. In session with her I was a little girl in need of affection who cries a lot or a mom who talks about her daughters as soon as I walked through the door of her office. I was unable to do anything else despite all my efforts, analyzes and awareness. I was sinking little by little and I was exhausting myself from maintaining this link at all costs.

 

And at the same time I stubbornly refused to break this link and to base my therapy solely on my psychologist. I had the deep-rooted fear that if I depended solely on one person, they could take hold of me and harm me. I thought it would destroy our "healthy" and "balanced" bond. In addition, the "recognized" status of my psychiatrist was important to me. I believed that the support of a psychiatrist had more weight in French society and in the eyes of judges and health professionals than that of a psychologist. I wanted to be recognized "officially" (a psychiatrist had in my eyes a medical training, a diploma of "weight") and I was afraid of not being believed and taken seriously if my follow-up and my diagnosis were not made only by a psychologist (I didn't know that this diploma was regulated and I thought that anyone after 3 weeks of training could claim it). And finally, I told myself that if I had a "team" around me, several professionals who all say the same thing about me, it would give weight and that the veracity of my statements would not be questioned if I testified .

 

I ended up stopping my follow-up by the psychiatrist after she told me "all the little girls dream of becoming pregnant with their rapist". It was the electroshock, the phrase too many.

 

Now I am at peace. I found a good balance with my psychologist.

I integrated and accepted that my parts are part of me, I gradually accept that my shame, my anger, my despair ... are legitimate feelings being part of me. I talk a lot inside and I no longer try to force or speed things up. My parts of me cooperate more and more and understand each other better and better. I am slowly modifying my automatisms and I am much more forgiving towards myself. My traumatic amnesia and my amnesic barriers between parties are still present but I still remain more and more aware of what is happening inside me. My daily life has improved enormously. I suffer much less physically, I am less exhausted permanently. I start to look at my life with hope and to think about another job, other dreams ... I accept more the sharing of traumatic memories although fears and blockages remain. I know that one day my games and I will be one!

 

Please note :

This text describes how I was able to experience things at one time, since then I have understood things…

What was played out between my psychiatrist and me was also very much due to the fact that I replayed scenes from my past. I would like to tell her that she stops blaming herself and feeling guilty. I do not blame him.

At the time, I was very much looking to "train" and inform her. Many of my parts had this goal: to train people, to explain them to save, so that they could save other people like me. So that people like my brother do not commit suicide, so that members of a family do not have to live this immense and irreparable loss as I experienced it.

I was able to be obstinate and push her to her limits, forgetting that behind the psychiatrist, there was a woman. Starting when we are just starting out in the discovery of dissociation by a complex DID like mine is far from obvious… My "observer" and "analysis" parts constantly observed him during the sessions and the least of his gestures or words were dissected and analyzed. It must have been very stressful and oppressive for her ... I wanted to repair with her all my broken emotional and relational ties in my story, I wanted to express to her and make all the anger and rage that I had felt face come over her to the professionals I had met in my life (due to his official status as a psychiatrist). She "paid" for everyone else, for indifference and ignorance of society.

I learned that she is training in the management of dissociation and I find it great!

 

And taking a step back, I realize what it has brought me! First to finally know what I had (my diagnosis) and who I was. Thanks to her I finally understood myself, my whole life took on meaning. And she taught me to listen and take into account my "small parts", thanks to this, I was able to quickly set up a collaboration between my "mother parts" and my "small parts". It is, I believe, the very first collaboration that took place in me. I started to pay attention and to become aware of the cries that I heard constantly inside me that I obstinately refused to listen to. With my psychologist, it would have taken longer for me to understand that parts of me were suffering and needed to be comforted ...

 

In my journey, I experienced a lot of betrayal and abandonment but I also met beautiful people who helped me. This psychiatrist is one of them.