How to Know if Your Therapist is Good at Working with Dissociation
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- Опубликовано: 25 апр 2024
- In this video from The CTAD Clinic, Dr Mike Lloyd (Clinic Director) discusses a questions raised frequently, that of how can a person approaching therapy know if the therapist is going to be good at working with their dissociation or not. Mike answers this questions from a personal opinion perspective, as well at from conversations had with patients and therapists in the field over the years. Mike offers examples of questions to ask, ways of measuring information available, and red flags that need to be understood.
This video is for anyone looking at therapy, but expecially relevant for those with conditions such as Other Specified Dissociative Disorder (OSDD) and Dissociative Identity Disorder (DID).
#therapy #therapists #dissociation
i started with a therapist who was not specifically dissociation trained, but trauma-trained, and they went back to school and classes when they started working with me specifically to learn and train about dissociation specifically - working with her was the best decision I've ever made. no-one else in my area who worked with dissociation would even try to work with me because I was "too complex" or "outside their scope" and oh my gosh the lady I ended up working with has saved my life many times over and im so grateful for her. give people who are willing to learn a chance - (again in my experience) it's so much better to have someone trying who doesn't know everything yet than to have no-one, or someone who isn't trying to learn. obviously if everyone could find someone knoweldable off the bat that'd be great - but I wouldn't be surprised if other's have my experience of looking and begging for help and being turned away.
That’s pretty much how I started, so it definitely works!
Yes… Honestly I can hardly find a therapist to stick with me. Of course it’s more complex than that but I scare some off or they don’t take insurance etc etc. I think I’ve found someone sort of by happenstance who is actually willing to stick with me. They’ve been doing a lot of research (hopefully training but I’m too shy to ask what exactly they’ve done esp because doubt etc) Anyways I think they’re willing to work with me… Like actually willing to work with me! And I hope if the need arises they’ll help me find someone else or they’ll be willing to be there as a sort of fallback if I do - because I’ve tried so many and experienced people scare me because they can be really mean.
Thank you for this Mike! Really helped see where I’m at in my “pilot license” too! 🙈
knowing our competencies is extremely important for therapists as it would break code of conduct otherwise! It’s great you’re doing a video like this as I think transparency is absolutely key with any kind of therapy between patient and practitioner 😊
I remember being on the other side and being completely lost (and unconfident!) in challenging or asking a therapist questions! I’m sure this will help so many!
Omg you were the one who introduced us to the CTAD clinic's youtube channel in the first place
I certainly hope so, the horror stories I hear show that competency is not being taken seriously everywhere. Thank you!
@@thectadclinic100% agree. Im the US, regulatory boards often dismiss complaints, even though working within competency is an ethical obligation stated in the guidelines. It's very disheartening.
I started asking new Ts if they can explain their understanding of structural dissociation. It is a nice way to not just check if they know the basics but to see how they explain things and with how much ease they explain them. Experienced T have done this a bunch of times and kind of fall into a rhythm while doing it. Fit can be tricky. Hearing how Ts think and how they explain things helps me a lot to get a sense for the personal fit too.
That’s a great way to approach this, thank you!
So, I'm having a tough week. I know that CTAD always helps me, there's something about his eyes that actually makes me feel seen even though it's just a video. This can be such a lonely disorder, I think these therapists are literally angels.
Thank you! It would be lovely having this as a testimonial on the website!
I was undiagnosed when I went back into therapy after years of going without. I am certain I was the first client that ever had a dissociative episode in front of my now, ex-therapist. LSS...he said he would do whatever it takes to work through everything, and I was ok with that. However, he was not able to handle the "angry parts" very well. He took what they said personally, and would treat them as if they were just rude people who didn't deserve to be understood. It's all too much to write here, but things got much worse and unethical.
He left me with no choice but to walk out after 5 yrs of working together. The fall-out from that whole experience has taken more than a year to work through with my current, very experienced therapist. The difference is like night and day. I was alerted by a friend that the ex-therapist has added dissociative disorders to his list of specialties. God help anyone who ends up in his office.
Thank you for this, I truly hope the right help is now available for you!
Thank you for another very helpful video. I want to comment that even realising that you have agency to ask these questions, that you’re allowed to, that you’re allowed to take some control (if lucky enough to have choice in therapist picking) in who works with you and how. This is something we are only JUST scratching the surface of in our own “journey” (ugh, hate that word). And it’s a HUGE thing that is taking a LOT of time to sit with. We have accepted what has been given us, and placed the ‘knowing’ automatically in professional hands since we first entered the mental health system here in Australia. This idea that we have some agency and say - wtf?!
So once again, really great video - and, I think some people like myself may take a lot longer to feel this is allowed. I’m glad this video is here to help encourage people that they have some power in their stories now even if they didn’t back then.
Thank you, and yes, I agree. Being able to ask such direct questions can be incredibly difficult, certainly during a therapy process.
This has deeply revealed some disturbing things to me that I should have been more wary of, but apparently, I'd been dissociated from said wariness, so I did nothing. I've been seeing my therapist (specialist in trauma & PTSD, as well as somatic experience [and of course depression, OCD, etc... the basics, I'd call them]) for almost 5 years now, with 3 of those years being him attempting to help me with the knowledge that I have dissociative parts. It's not that I haven't made any breakthroughs with him, because I have, but I am the only client of his - and that he has ever had - with alters (or at least that he knows of; it IS a covert disorder). The only reason he has any training in dissociative disorders now (after over 30 years of studying trauma) is because he hit a wall with me and it was painfully obvious to me that he didn't know what he was doing anymore. He wasn't saying or doing anything about it, so I had to literally beg him to consult a specialist. Me wanting outside help overtly ticked him off (very out of character for his calm self...), which was confusing as hell to me because... shouldn't he have known to do that in the first place, upon knowing he now had a client with issues that he knew were way outside of his specialties...? Someone please correct me if I am wrong; it felt as if I was some kind of experiment more than I was a client he wanted to understand and help. Per my begging, he consulted two specialists but only went to one training course with few hours. I truly do not think he would have consulted anyone if I hadn't begged him. Not even asked -- BEGGED. I thought I had made so much progress; but I haven't. My boyfriend has noticed this as well and has brought it up many times over the years, but I always had an excuse because a part of me was protective over our therapist's reputation (or something...?). It has been a loop, even with me doing my part of healing (homework) outside of therapy. Not ups and downs like normal healing, but a loop. I almost feel duped. I am realizing just now that an overly-trusting part of me with an almost cult-like loyalty ("the therapist can do no wrong, and how dare you if you speak badly about them!") had taken over for quite some time now, and other previously naive alters put their rose-colored glasses on again. A vigilant protector part had lost his trust after we had disclosed that we had been through Freemasonic abuse as a very young child. He was WAY too quick to defend that group of people, to the point of rudely interrupting my very normal rage toward my abusers during this disclosure, which resulted in a massive amount of distrust in my child parts that led to most of them going back into their silence out of fear and shame. I have gotten to multiple points during the last few months where I told him that I think I'd like to see a specialist, and he persuaded me that it would be such a difficult process that, essentially, I shouldn't bother even trying, and it would be a silly move on my part. I really, really want to give him the benefit of the doubt because he has only been at this for 3-ish years now, although with very little training, and that perhaps I'm paranoid... but this video broke through some dissociation enough for me to start looking at the bigger picture of this. I don't want to make a rash decision that could lead me to not having a therapist at all, and that fear has been layered upon as a result of what he told me about me wanting to find a specialist. This may sound defeatist, but this is such a lonely feeling of what seems to be betrayal. I am VERY protective of my child alters, and they have near-zero trust for him now. Because they know the most about what happened to us and the people who perpetrated the abuse, this tells me what I am dealing with is not in our best interest as a whole. I feel like a veil has been torn, and I think I may need to find a new therapist. If anyone has any thoughts on this, please let me know. This is a disorienting/disturbing but necessary realization.
Pardon the novel; thank you for this eye-opener, CTAD. I needed to hear this. 💛
It makes sense. Work with a bunch of different clients with different situations and issues and challenges. Get that experience.
That way, if you move into DID work, basically the only difference, beyond the dissociation, is that now a group of your clients share a single physical body. But they will all still have their own unique situations and issues and challenges.
That’s a great way of describing it!
In the states, we are seeing more people finish training and "hang out a shingle". Particularly holistic providers and CMHTs. This puts people with DID at risk, because it takes an experienced and skilled provider to do this work safely. Would you go to a surgeon because they have your diagnosis but aren't board certified? Don't think that training doesn't matter. But don't think training alone is enough. You want someone who has experience in enough areas that matter. I'd be particularly happy with someone that has treated kids and someone who has treated people with addictions, then came to trauma treatment. They have a nice big skill set!
One of the best questions to ask the therapist is "what is reparative when you are working with dissociation"?
A good follow-up is" what can I expect to feel as I experienced these changes."?
A third question (and I would leave it for 3rd) is "what are the risks of working on my dissociation"?
Thank you for all of the very helpful and informative videos. God bless you.
Thank you for another amazing video Dr Lloyd. Ive had such a sad experience, got funding granted by the NHS at the end of 2019. Was given to one of the UK's 3 specialist centres and the UK's leading psychoanalyst made sure the therapist had the UK's leading DID psychologist as supervisor. Unfortunately though as I asked the questions you suggested when I started to worry, but the therapist was dishonest and hid the many problems from her supervisor. I became trapped with her and that made me v poorly. I don't blame the supervisor at all as I know health professionals are meant to be able to trust one another. Saying this though, that took my funding, my chance to get better and devastated does not cover it. I complained to therapists regulatory body the UKCP who wont investigate as it was funded by the NHS but NHS cant investigate as therapy was delivered privately. This worries me, anyone can say they are a therapist, they are unregulated and in some cases theres no way to even make a complaint or raise a concern, worrying me about other patients safety. It's a mine field. Thanks again for the video- its validating. Really hope the supervisor got a good idea of what went afterwards so this does not occur again - its important for the patient to be believed in this situation too and allowed a voice- it was so terrifying and isolating. Very best wishes to you and thanks again.
First and foremost I love your work. Here in the United states there is practically no dissociative specialist besides in very big cities. I live in a big city but there is only 6 therapist in the area and only 1 takes insurance. For those seeking treatment for dissociation but don’t have a therapist near by or cant afford a specialist what would you recommend? Myself I gave up treatment for my did since treatment was making my life worse since no trained individuals to treat me. But at the same time I don’t want to give up so I go to regular therapist and focus on fixing situations after we destroy it.(adultery, disappearing, constant losing jobs, etc)
I have encountered several therapists who seem to think that they know a lot about DID because they’ve been trained to treat dissociation symptoms like DPDR or they’ve been trained in IFS. I’m always wary of them though because I find it unsettling that they aren’t able to see that multiplicity is a unique situation. They aren’t offering to learn more about it or anything. They are just lumping my diagnosis in with IFS as though it’s exactly the same. Have you encountered this? Do you have any thoughts on it?
Thank you for delivering such a well informed video about what to look for in a therapist, it was very helpful.
Unfortunately many people with dissociative disorders are also autistic and a lot of therapeutic modalities which therapists are currently taught aren't helpful and can even be potentially harmful for people whose brains are neurologically wired differently. This also complicates things in the search for a suitable therapist, because professionals are either trained in treating autism or they are trained in treating dissociation. Given the high rate of traumatization in autistic people this is a real problem facing a lot of your subscribers.
Would you be able to make a video sharing your experience in this particular area, with the autistic community, because it would be very helpful. Thanks.
Great pointers to identifying a "good therapist" - my issue is knowing how to find ANY support via the NHS 😢
Very good video and well detailed. I do like that having someone who specializes and has put in over 20 yrs makes me as a patient, feel that they will help me. I want to go back to school online as well to learn more but will not be a therapist as dont feel that would be beneficial to me. However I love the schooling and book work. The other thing my therapist does is allow students into sessions to gain there credits viewing the therapy itself. It educates those in New training and I dont mind because it brings awarness.
Thank you Dr Mike and CTAD 👊💙
How do you think a therapist should react if the patient doesn't come 100% sober to a session? How should addiction and did be treated together, what are your experiences with it?
Any provider is trained to address addiction and trauma together...because they so often are! But being under the influence in therapy means you could be at least partially wasting your effort, time, and money. You aren't neurologically capable of getting a lot out of that session. When you need support and care so much.
Powerful and profound work as always, thank you.
Thanks again, Dr. Mike. You are as informative and helpful as ever. ♡♡♡
I had an excellent Dr helping me, he was putting everything into perspective. Unfortunately, his funding was cut to 4 sessions per patient. I have been moved onto another unit. Their first words were " we'll use our diagnosis." Fortnightly appointments were arranged, that was before Christmas 2023. Things
Just wanted to let you know your videos have been a comfort and wonderful to hear ac voice whon understand DID. Hank you.
As someone 𝒘𝒊𝒕𝒉 DID I have considered becoming a therapist myself.. I have vacillated on this idea however because my condition was not stable. That has progressed to a much more predictable state and am now really keen to pursue it once more. Have you encountered other therapists who have DID and are effective at the job? What’s your take on whether or not said therapist should self-disclose? Please consider doing a video on this. My name is Marie * thanks for all you do, it’s been a real help.
There are some programs in the US that does fill credit and that do classes for DID and Trauma. THE Colin Ross Institute covers some classes as does Bethany Brand, and Caroline Spring. Hope that helps some.
That’s a really good idea, I have certainly met people doing this, or planning to.
Be aware of how stressful being a trauma therapist is for people with NO trauma history at all. Providers burn out regularly, even when doing non-trauma work. You are hearing some of the most awful things people can do to each other, and hearing people routinely talk about self-harm and wanting to die, or threatening to end their lives. On YOUR WATCH. Before you worry about being clinically effective, think carefully about how years of witnessing your client's worst moments and hearing the worst stories possible will affect you. You are not helpful to anyone if you end up too fragile or dysregulated to support others.
@@Cathy-xi8cb this is a really good point, and one I don’t think is considered deeply enough.
Incredible this.. thank you so much for being transparent.
You are so welcome!
Thank you Dr Mike for this mini series of finding a therapist. Sounds like a terrifying experience to me. I don’t trust many people and have made some bad impulsive choices in my life. The fear of contacting and having a conversation with someone I don’t know. Shame there isn’t already I genuinely list of people that meet this criteria. Like a pet sitting site that you look at the list then meet one that sounded ok on the phone. If you don’t make a connection. Like that last little piece in your balance scale video. It all sounds an overwhelming thing to do = let’s not take the risk. 😟
We are like that with anyone looking after the cats and ducks, getting the fit right, asking the questions, feeling if it seems ok, it’s all there!
That’s why your clinic would be my first choice ❤
We *just* started working with a new therapist, using the treatment modality of somatic experiencing therapy, and she's been amazing! Took 4 years to find someone who specializes in trauma and CPTSD.
This video is great advice, which I can say from personal experience works very well!!
Thank you!
When I ask these questions. Should I ask specifically How many people you have treated with dissociation or Dissociative Identity Disorder, or does it not matter?
Oh, definitely ask that one!
hi there, idk where else to post this question to you, would it be possible to touch on how the study of Stoisism may affect and potentially be helpful for DID?
Could the extremely book smart but no hands on pilot, work with the hands on slightly less book smart pilot fly together....like say a psychiatrist psychologist possibly always learing off of each other being at opposite (book versus real life)?
Hi Mike, i don't expect you to see this. But do you (or anyone else reading!) have any tips on actually getting nhs care? I was stepped up to secondary care from my IAPT therapist with the suggestion that I was care cluster 5. After waiting 5 months I had a really basic triage assessment that didn't ask about any of my dissociation except to ask if i thought it could be my response to having childhood meltdowns. i was then stepped back down - I've now been waiting a further 4 months for *any* treatment at all, and don't have anyone in charge of my care. I feel like I'm supposed to be calling people to chase up but I don't even know where to start
Anyone. Help please?? Ahaha
8 months ago my therapist ended her post doc internship and I was transferred to a new therapist. The only therapy that's affordable for me is with graduate students at a university. Well, the new therapist pushed too far on the 3rd session, I had an extreme emotional flasbacn and things got much worse for me. This experience broke my trust and things just got worse until I stopped going and eventually was kicked out of the program, basically invalidating me and leaving me alone to deal with the damage. Now I'm scared to ever seek help again and I'm stuck with the damage. I don't know if I'll ever be ready to deal with my trauma again.
Very sorry to hear this. Sometimes students can be helpful under tight supervision, but grad students? Not sure about that, I would only consider with post-grad doctoral students. I hope you find help to be ok.
I'm going to assume that a modality of therapy that is unguided (like person centred therapy) may not especially be helpful for people with dissociation or am I wrong in that assumption?
FWIW my therapist is person-centered and has been the most helpful I've been to, by a long shot. She specializes in trauma.
Not at all, the modality is less important than the nature of the person using it. Flexibility is much more important. We do lots of what would be seen as a person-centred approach.
В России психотерапевты не пишут "работаю с диссоциацией". В лучшем случае терапевт работает с травмой. Я перечитала сотни анкет, но ни в одной не упоминалось о диссоциации. А на сессии тебе скажут что-нибудь вроде " У меня тоже такое бывало". А ты лишь самую макушку показал. И дальше рассказывать страшно, слишком схожа симптоматика с шизофренией. В ДРИ мало кто верит, А если верят, то только в самые яркие и очевидные случаи. Поэтому это расстройство как привидение, никто его не видит.
There is so much work to be done, globally, to get this right. Maybe some lectures in Russia would be possible?
I recently had some consults. A therapist avoided answering most my questions or was very vague, like not explaining her experience and training in dissociative disorders and what diagnoses she worked with. Just said she has experience. Then after asking how she manages countertransference to prevent enactments... She stated she has a good support system. I asked if that included consultation, if situation warranted it. She said firmly, with a tone, I can take care of myself. 😅 🚩🚩🚩🚩 Um, lady, I have a right to decide if you are safe enough by asking these questions. But whenever a therapist has this strong of countertransference in a consult or first session, it never gets better. In my experience, therapists will often show their red flags when I'm asking appropriate questions like this and these patterns will continue to repeat.
A positive experience I was thankful for was a therapist who said they worked with DID clients before. But when I asked clarifying questions (about conflicts between parts and how might he help the client in this situation), he admitted that he's realizing through my questioning he doesn't have the experience I'm looking for. I thanked him for his honesty.
I really liked your quantitative questions and will be adding them to my question set! Glad you shared those. Thanks!
Good advice - very thorough Dr Lloyd - Cheers, g (seans)