THERAPY THAT WORKS

by Sarah

In 1986 doctors diagnosed me with "stress" rather than epilepsy and recommended that I see a counselor. I was 14 years old and thought I was a normal teenager. What stress was so hard on me that it made me space out and fall down flights of stairs or forget everything for a classroom assignment?

That year, I began participating in a group for visually impaired teenagers facilitated by a rehabilitation counselor. I enjoyed seeing the other young people and talking about things no one else understood. Sometimes we rehearsed situations similar to those we encountered in daily life. But being in this group was different from being in the real world. We were free of the intimidation which came with confronting family or other authority figures with whom we experienced difficulties--difficulties which were often due to a lack of understanding of the needs of a visually impaired child and a lack of time and/or resources to learn. In the group, we felt confident in expressing our feelings and needs. Out in the real world, we did not have the skills to cope with feelings of inadequacy or intimidation which kept us from expressing ourselves.

Upon entering college, I began seeing another therapist. She was compassionate, and I became dependent on our contact despite my initial resistance to therapy and the accompanying feeling that something must be wrong with me. These weekly sessions probably helped to sustain me during that time of emotional distress, but they did little to enable me to cope with situations beyond the present. As fond as I was of my therapist, she still lacked an understanding of the effects of disability on my life and of how to impart lasting knowledge and/or skills which would enable me to cope or take control of my life on a long-term basis. ... And at the end of my freshman year, she left the university for another employment opportunity.

I was disappointed, to say the least. I resisted finding a new therapist. If I could not see Tana, I would not see anyone. I didn't want to begin again, retelling everything from the past to a new therapist. Only at the beginning of my third year, after I transferred to a new school, did I seek another therapist.

The transfer wasn't what caused the stress. I had lost my closest friend to suicide. I found myself dealing with horrible, intrusive visions of something happening to me--particularly visions involving being hit by a car. I sometimes saw them while sitting at my desk reading or writing papers. I saw myself beginning to cross the busy street near my dorm and being struck by a car which did not stop at the crosswalk. When I saw these visions, I could hear the noise, feel the impact... I found that the only way to escape them was to flee my room. ... But where was I to go? I began keeping company with anyone who would have me, even going out to eat with them when I wasn't hungry and sitting with them in the smoking section at the restaurant. I despised only alcohol more than cigarettes.

Eventually, I made an appointment at the university's psychology clinic and began seeing a graduate student for counseling. I remember little of this time. I know that I looked forward to the sessions, but the fall of 1992 is a time which I cannot remember with the exception of a few vague incidents. My journal entries tell me that it was a painful time, but I also know that the most telling entries have been destroyed from all places where they might have been kept.

My counselor graduated eventually. I do not know if this was in December of 1992 or May of 1993; and I do not know how long I saw her. I don't know much of what we talked about.

I went the next couple of years without therapy again, afraid of beginning only to have to stop as I had before. Sometime in 1995, I finally decided to try again. I liked my therapist, and our sessions were moderately helpful. However, after about a year the sessions were terminated very abruptly. "This is going to be your last session," she told me. She was leaving that weekend--moving to another state! I knew this was likely nothing personal, but I felt abandoned. I had been given the name of another therapist, but I was hesitant to go.

Perhaps I should have gone. The summer of 1996 turned out to be a turning point for me. I was spacing out often and experiencing dramatic, rapid mood swings. I had begun to experience memories of isolated instances of sexual abuse which had taken place during adolescence and early adulthood. I could not connect these with most of the spacing-out episodes, but I did recognize their impact on me as a newlywed. I sought out support and information online.

The resources I found were helpful in some ways. They were also frightening. I avoided reading things written by people who had multiple personality disorder--they were usually odd and graphic, and I couldn't relate to such severe abuse anyway. However, in the back of my mind anxiety grew. What was wrong with me? I knew that I had been burying my feelings for some time. Perhaps someday they would explode.

And then one day it happened. I was settling down for a nap on a September afternoon, and I saw her--a little girl about 12 years old. And I recognized her. I had seen her in 1992 after my friend's death. I had seen her type on the computer at night while I longed for sleep, pouring out thoughts and feelings to anyone who would listen--thoughts and feelings which I refused to express. I had seen her in those visions. I had seen her when I balked at the edge of that street crossing. And I had heard her scream. I never acknowledged her except to try to write what I was seeing in a story. I never acknowledged that she represented an aspect of myself. But she was there and had a name and a face and a voice.M.o<

My mind spun. What did this mean? I feared the answer--and I knew the answer. Tasha was not the only one I had seen. I had ignored others, too--Faith, Cara, Chelle, Beth... I made a list of the ones I knew I had ignored. There were 11. What else could this mean? I had multiple personalities. I couldn't deny it now.

I knew that I should go back to therapy. But how, I wondered, would a therapist respond to someone coming in and announcing that she had discovered she had multiple personalities? No, I couldn't go. I would find a way to help myself. I would start a new kind of journal. I would write from whatever perspective I needed to. I would "play along with this crazy game". If I got all the feelings out, then maybe the faces and voices and names would go away.

They didn't. I have no doubt that my acceptance, however partial it was, kept me from losing touch with life completely. But I needed help. I sought another therapist in February, 1997. My marriage was in trouble, and my illness was cited as the primary cause.

As usual, the therapist was kind. For the most part I liked her. But she could not understand why I was dissociating. I had only memories of occasional instances of mild sexual abuse. I was not physically abused. I had grown up in a home with Christian parents who may have been busy but who certainly made sure I was cared for.

I did not understand any better than she did. But her expressions of doubt caused me to experience periods of intense denial. When she began to question me about why I was still creating personalities, saying that this was not common in adulthood, I became very agitated and felt threatened. My homework assignment for the week was to identify those personalities which I had created within the last year and why.

I returned home and plopped on the bed, sobbing at the top of my lungs like a little girl--and I saw a little girl lying on the bed sobbing at the top of her lungs. Why not? Adults didn't do that. And not only was I an adult, but I was supposed to be strong and not let other people's words hurt me. The truth was that I was never strong. I stored my strength in faces and voices and names, just as I stored my weakness. I was nobody except whoever I was expected to be.

I did not return to therapy with that therapist. I was ashamed of myself and my illness. I returned to ignoring the faces and voices and names, and I pretended nothing was wrong.

I tried a couple of other therapists but did not stay in therapy because my living situation became unstable. My family was planning a cross-country move, and I decided to join them. A fresh start might be good for me, and perhaps I would try therapy again after getting settled.

The move went well, and by September, 1998, I was feeling moderately comfortable in my new surroundings. I had also somehow achieved a natural integration. I was not in denial, but I saw no faces, heard no voices, thought of no names. That is, until January, 1999.

In January, 1999, my peaceful existance was shattered. Circumstances at home were not predictable or calm, and I began to hear almost constant screaming in my head. I saw faces which were unfamiliar--terrified faces of little girls. I allowed myself the luxury of returning to existence as a head full of faces, voices, and names. I also decided it was time to return to therapy.

I chose a clinic which employed a number of therapists and called to ask if any of them specialized in trauma or dissociation. I was given an appointment, and I decided to send Meg to the first session. Meg had no problem quizzing people and making sure they were respectful and trustworthy. Depending on how her quizzing went, perhaps Cara or I would join her. Cara was my trusted executive personality. She knew all there was to know, and she managed what I knew.

I have been seeing this therapist for over two years now. While doing some research during a self-help phase of my journey, I had come across information about a type of therapy called dialectical behavior therapy. After reading the description, I knew that I wanted to try this. The problem was that it was a group therapy, and I knew of no groups in my area.

I brought it up to my therapist, but initially nothing was done about it. She told me that she had used it in an in-patient setting, but she had never tried it outside a hospital. Finally, in November, 1999, she started a group for people who she thought might benefit from DBT. We met for 90 minutes once a week to discuss skills and strategies for coping with and taking control of our lives. DBT group is like a class in many ways. There are specific topics to cover and homework to do. In addition to the 90-minute group session, each of us also meets with a therapist individually to discuss specific areas of our lives. Often we refer to what we have learned from the group in these individual sessions.

"DBT is really about developing skills so you can do trauma therapy," my therapist told me. It was about developing skills for dealing with emotions and communicating effectively. Why hadn't anyone given me this before? One therapist had even refused to do memory work with me when I was experiencing intrusive memories and flashbacks. "You can't cope with the present," she told me. "What makes you think you can cope with memory work?" Yet she was not helping me to learn skills for coping with the present or memories.

Other therapeutic techniques were also part of my treatment program. My therapist and I often discussed possible ways to tackle specific issues, and she was also comfortable in admitting when she didn't know how to address an issue I brought in. This didn't bother me. In fact, it helped me to trust her more because I knew that she was being honest with me.

Another aspect of therapy which worked in my favor this time was my treatment plan. I never knew what was in the treatment plans my other therapists wrote. I knew there was such a thing, but the thought of asking what was in my plan never occurred to me. My last therapist sought my participation in developing this plan, and we outlined specific major issues to address and what order in which to address them. This outline came out of one of my homework sessions in which I analyzed the thought processes I had in response to a certain upsetting event.

I stopped running from therapy and actually looked forward to it instead of thinking of reasons to avoid it. I feel that my hesitancy was based on fear of not making progress or of premature termination. After two and a half years of therapy, I began applying for jobs regularly--something I had previously feared so much because of previous instances of discrimination based on my visual impairment that I would wait for months between applications. I noticed a change in the quality of my depression: I was still unhappy but no longer felt that I was defective or hopeless. "I just have to wait," I told my therapist, "because some things are out of my control. I cannot make someone hire me."

A second factor in the success of my therapy was the shift from "treating" the way I understood myself (in parts) to treating the way I related to other people and thought about my experiences. I learned to identify the events that influenced my feelings, and I learned to recognize ways I could control the events and tolerate what I could not control. The focus was no longer on my "defective" ways of thinking but on what enabled me to communicate and cope with my experiences. After all, my understanding of myself was never what troubled me except when it served to show me that I was not coping well with my experiences.

I am also a firm believer in DBT. DBT is most commonly used for treatment of borderline personality disorder. However, my therapist used it with people who have trauma histories and other disorders--in fact, none of us in the group was diagnosed with BPD. I was somewhat alarmed to learn that some of the elements of DBT are based on principles from religious movements which conflict with my own Christian beliefs. However, as I allowed myself to try it, I found that these concepts are actually very common-sense concepts and can be modified according to Biblical teachings.

Resources

If you would like more information about DBT either for your practice or, if you are a client, to share with your therapist, I recommend the following sites and resources.

B.F. Skinner Meets Buddha in DBT
In this article, Sally Hansell discusses the history of DBT and studies showing its effectiveness as a treatment for borderline personality disorder.

Emotion Regulation and Memory: The Cognitive Costs of Keeping One's Cool
Jane M. Richards and James J. Gross examine methods of emotion regulation and their consequences.

Description of DBT
This is a bit from one of Marsha Linehan's books describing DBT and the importance of a validating environment. This description focuses on DBT as a treatment for borderline personality disorder.

DBT in New Mexico
This description of DBT has a broader focus and identifies some other situations which DBT can be used to address successfully.

The Difference Between DBT and "Regular Therapy"
This is one therapist's view of the value of DBT vs. other types of therapy. He admittedly has not used it himself, but the page provides some good explanations of the requirements of DBT and why it is effective for people who have borderline personality disorder.

Skills Training Manual for Treating Borderline Personality Disorder ($27.95)
This is the DBT handbook. The first half consists of therapist scripts, which my therapist says are very helpful--in fact, she uses them regularly for our group. The other half is made up of reproducible handouts for use by the clients in the group.

Cognitive-Behavioral Treatment of Borderline Personality Disorder ($46.95)
This book was published in 1995 and discusses DBT in more detail within the contaxt of borderline personality disorder.

Other Therapy Resources

Therapy: Questions Answered
This page provides some good tips for narrowing the search for a therapist based on the type of therapy and other factors.

What to Look for in a Therapist Here are a few qualities to look for in a therapist.