Do you need a ‘DID expert’ therapist?

This is an assumption I come across a lot. People with dissociation or multiplicity are supposed to need extensive, painful therapy, by an expert in the condition, to stand any chance at a decent life. Hogwash!

First, the caveats: can therapists be awesome? Oh you bet your last cup of coffee they can! Can experts who have trained highly in their field, who are passionate and informed, be a huge damn relief to talk to and learn from? Hell yes. I’ve already written a little about what the point of therapy is and how to recognise good therapy.

Having said that, I tend to beat the drum of ‘you don’t need a shrink to have a life’ quite a lot for a person who sees shrinks. Why? Isn’t this ridiculously hypocritical of me? Do I just not want to share my shrinks? Well, it goes like this. I used to see shrinks because I was scared and overwhelmed and had no idea what the hell was going on in my head/relationships/life. It was SCARY. Super scary. I was terrified of everything about the process and used to sit frozen on my allocated seat, hanging on every word uttered by the shrink who was almost godlike in status and had the power to uplift or doom me with a word. I discovered over time that the idea that psychiatry is a science, that diagnosis is an accurate and sensitive tool, and that shrinks are infallible and highly knowledgeable about the complexities of life and how people work on the inside is pretty laughable. I collected diagnoses like some people collect shoes. Pick your shrink’s speciality, pick your diagnosis. I’ve seen a lot of shrinks over the years. Some have been great, some have been average, some have been horrible. Most have been at least a somewhat mixed experience – partly helpful and partly not. Horrible shrinks have been as much, if not more of a threat to my mental health than other horrible people in my life.

Going off to see shrinks meant I had ventured into a world that was selling me a bunch of ideas about myself and my life such as: I was sick. That someone else’s ideas about me (after a 45 minute conversation) were more accurate than my own. That all shrinks should be trusted, immediately, and any reluctance or failure on my part to engage in that proved that I had problems. That massive power imbalances in relationships are helpful for people with trauma/abuse backgrounds. That having a good shrink is the most important thing you need in order to have a decent life after crap has happened (not friends, or housing, or access to a really, really good library, shrinks). That I needed ‘expert therapeutic help’ to be able to function. That I needed someone in my life who could take control away from me and put me into hospital. That multiplicity meant I was broken, damaged, or in some way inferior to other people. That someone else can heal my pain. That my history and pain is about my choices and my reactions rather than a broader social context. That my suffering is caused by a random breakdown in my brain.

I haven’t found any of these ideas to be at all helpful. I see shrinks now, because I value having a safe place to talk about really tough or very personal things. I love to team up on thorny issues, to pick their brains about information I don’t have, and to explore difficult territory without shame. I do the same things with some of my closer friends.

I don’t give shrinks any power over me. If I disagree with them, I argue. If I’m not happy with their approach, I leave and find someone else. If they’re ignorant, narcissistic, or in some other way a person I really don’t like the idea of spending an hour with, I don’t hang around and let them start playing with my brain. I run the show. I choose who, when, and how to engage. My shrinks don’t cure me. They join me in my process, or they get out of the way. I employ them to help me achieve my goals. They are equals on an exploration, they are not a surgeon with a patient waiting numbed beneath the knife. Am I discounting their skills in describing them this way? No! It takes a lot of skill to be an explorer. Any old hack can cut into a vulnerable person, and every other bugger is convinced they can run anyone else’s life better than they can. But exploring? Now THAT takes skill. You have to be able to not know answers, to explore new territory, to listen – really listen, to be equally vulnerable and human, to be able to be present in the face of pain, to construct theories and ways of understanding the world, and be willing to turn them inside out when they don’t work. Good shrinks are highly skilled, wonderful people, and I love working with them. I’m aware of the context of the relationship – that is, the ideas embedded in psychology/psychiatry/counselling etc that I disagree with, and I make efforts to prevent them from taking up residence in my brain.

Frankly, interacting with shrinks takes a lot of skills, and this is often not acknowledged! You need to be able to tolerate the power imbalance. You need to be able to assess them for safety. You need to able to walk away from the bad ones. You need enough assertive skills to be able to give them feedback about their approach. You need enough articulation to be able to communicate with them. You need a whole stack of courage, a whole huge stack of it, to actually make therapy useful by being willing to get into some tough stuff. You need the ability to be able to keep seeing the shrink as a human being – either when you feel dependant on them, or pissed off with them, or really excited about them (or in love with them), it really helps the whole process if you can not turn them into angels or demons in your brain. (in some therapies, I grant you, that is the process) Basically, you do a lot of work! In fact, there’s a tenant of therapy I love which is ‘Never work harder than your patient’. The person who does the work, has the power. As imbalanced as the relationship is, it is still a relationship. Some of us are better at eliciting useful responses from our shrinks than others. This is also a skill. You also need to be able to grieve everything your shrink is not and cannot be for you, that they can’t be your parent or partner or lover or take away what you’ve come through. Sometimes this grief is so intense it overshadows every other aspect of the relationship.

Therapy is not useful for everyone, and not useful at every point in life. Even the very best therapy. Nor are support groups, or books, or meditation, or almost any approach to pain except keeping on breathing. Therapists are human. Even the best ones make mistakes, have areas they don’t know much about, or use frameworks and ideas that get in the way instead of helping. I’ve learned a lot from the good shrinks I’ve seen over the years and I really appreciate that. But no shrink has had all the answers or all the skills. I’m glad I’ve seen a few, as frightening and stressful as it was to lose or walk away from a good one. It’s been liberating to discover that I can find new good shrinks and get something useful from their different approach, and that I can cope without a shrink and look after myself.

I’m often contacted by people who are frightened they can’t navigate DID without a shrink. A good shrink will help this a lot, yes, but no shrink is way, way better than a bad one. If bad ones are your only options, get the hell out of there! It’s messy, but frankly, so is therapy. If you think trying to make sense of DID on the back of your book reading, some rudimentary peer support online, and a lot of slowly learning about yourself is really hard, then spare a thought for all the people dealing with involuntary hospitalisations, parts who hate the shrink and go berserk whenever an appointment comes around, and littles who bond to them as if they’re parents and are heartbroken when they can’t come over and hug them after a nightmare… it’s not all roses! Having another person involved with your system can be tremendously supportive, but it’s also a whole additional person with their blindspots and history and reactions and crazy ideas to deal with.

I’m often asked what kind of therapy is best for DID… and I can’t answer that question because there is no therapy for DID. There are a bunch of therapies for people. Some of them help shrinks to be better, more courageous, more patient and inspired shrinks. Some of them have frameworks and approaches that are more useful for more people. Often the type of therapy is way less important than your relationship with the shrink. Some of the most useful therapy I’ve had was counselling through a sexual health clinic, which has nothing to do with DID and yet – conversations about shame, development, desire, abuse, power, and love – everything to do with DID!

Experts are also often not all they’re cracked to be. Being an expert in something sometimes means it’s hard to see everyone as new and different. You get used to seeing the same patterns and using the same frameworks. You have blind spots, which over time you become less and less aware of. What was once a guide, over time hardens into dogma. As an expert therapist, you speak with authority, so less people turn up in your office and contradict you, so you don’t get exposed to new ideas. People get used to your ideas and approach and don’t feel like spending money to sit in a room with you and be told their approach is wrong. The expert position can be an ego boost, and a pretty comfortable chair to sit in. Dismantling it from time to time can take a fair bit of energy and courage. Great experts do this! They are proud of their work and passion and history with the topic, but they wear the label of expert pretty lightly, and they keep in mind that none of it outweighs the expertise in their own life of the person sitting in front of them!

One of the psychologists I saw for a year had no expertise in DID. I spent about the first 6 sessions having to reassure her that this wasn’t a problem. As I said to her – you don’t need to be an expert in multiplicity – I am! Sometimes there’s advantages to learning with a shrink, because you find and fit frameworks to your experience, instead of the other way around. Good shrinks that don’t know anything about multiplicity but are willing to engage it anyway are worth 100 experts who don’t click with you, listen to you, or understand your unique quirks.

So, by all means, go hunting for a therapist if you want one. 🙂 Look for someone who has heard of the word dissociation, and who can spell it… But don’t panic if you’re among the masses of people who can’t find this, or can’t afford it. You have lived with this a long time! You have a massive store of wisdom within you, and clearly, a will to survive. And if you’ve found someone good but totally out of their depth – great. Go exploring together. Don’t believe everything you read, try stuff out, be open to new ways of thinking about things, and go make a life. If you’ve fallen on your feet and have a great shrink who is helpful and knowledgeable about DID, awesome! I hope it’s brilliantly helpful, try not to be too surprised if things don’t go exactly as you think they will, and don’t be too scared if you lose them or things change at some point. Get the most out of it while you can. 🙂

For more information see articles listed on Multiplicity Links, scroll through posts in the category of Multiplicity, or explore my Network The Dissociative Initiative.

11 thoughts on “Do you need a ‘DID expert’ therapist?

  1. The willing, interested, engaged, but dissociation ignorant therapist of today may be one of those rare gems of future years, who has both knowledgeof dissociation and is just plain a good therapist. When I first started to work with my therapist over twenty years ago, she only knew enough about dissociation to know that she needed to get supervision when she saw me repeatedly retreat into a very traumatized child part. She says that working with me changed the course of her practice and she has focused most of her continuing education on topics that are relevant to Trauma, dissociation, attachment therapy, Internal Family Systems, and supportive modalities for such work. She has made the choice to not become a “trauma expert”, though, and she continues to have a mixed practice, because she thinks that she works better as a therapist and is a healthier person by doing so. She limits herself to doing Attachment Therapy with a very small number of clients, because she invests herself so heavily in the relationships with those clients. I have moved away and come back to town 4 times over the years, worked with other therapists, focused on issues other than the trauma while working with her, and thought that I was coming back to focus on non trauma issues this time (ha!). Her comment was that she likes to think of herself as doing the mental health equivilant of the GP in the medical model.

    My second most favorite therapist was someone who was a specialist in dissociation, and who also focused therapy through the shared relationship. I worked with someone on a dissociative disorders unit who knew a lot about dissociation, but who wanted to be the expert and be in charge. I hated working with her. Someone else on the same unit was less autocratic, but still wasn’t going to invest in a relationship with me, because I was only going to be there for a few weeks. I worked with him and developed some useful skills, but I think that the various group therapy/ psychoeducation classes probably had a greater long term benefit.

    Looking at the others that I have worked with, there is a clear pattern… If the therapist/ psychiatrist/ whomever was real with me and particularly if they invested in an attachment oriented therapeutic relationship, then they were people that I could work with. If they held up their expert status as a shield to keep their distance, then I might be intimidated, but I had no real respect for them and there was no therapeutic relationship.

    Sorry to rattle on so much!

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    • Fantastic, thanks for sharing your experiences. 🙂 I’m similar in that my primary need is a sense the therapist is a real person willing to connect with me. That’s just invaluable.

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  2. There is such a lot of confusion around the different titles and qualifications that mental health ”doctors” have, that I always like to be specific with the correct title. Just one of my nit picky things 🙂 Each title that a professional is known by gives information about their original knowledge base eg psychiatrist- medical doctor with further qualification/medical model/drug therapy etc. I find it helpful to have that background info. Of course it does not equate to one type of professional being more helpful than another, nor does it give an indication about their expertise in being empathetic, respectful or helpful.

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  3. I think this is a really good article and you have hit the nail on the head with regard to the question of whether or not a person with DID needs a therapist who is an expert in the area of DID. However, I would like to make what I think is an important point, there is a big difference between a therapist and a ‘shrink.’ It is unusal for a shrink to provide any kind of therapy. Either way I think I agree that the key to good therapy for people with DID is not always whether or not the therapist is an expert on DID.

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