Posts From The Institute

When Treating Dissociative Identity Disorder, What Do You Do First?

One of the toughest challenges therapists face when they begin to work with clients who are DID is deciding where to begin. The first thing you want to do after you’ve assessed and diagnosed them is to carefully explain the concept of “parts” and the physiological mechanisms that create them. I say carefully because it might scare them to hear you talk about parts as a piece of their difficulty. I introduce the topic by saying, “We all have parts. I have parts. You have parts. The woman in the office next door has parts. Parts are a fact of all of our lives.” Then when I have normalized the concept of parts, I begin to explain how their parts work.

The purpose is to give clients insight into exactly what’s going on with their bodies, as well as their psyches. There is nothing more frustrating than having a dilemma and not understanding it. Obviously if clients can begin to understand what is going on, they begin to feel more comfortable with the process.

What I do is explain exactly what the parts are: that they are neural bundles that form and become distinct personalities that split off from the adult or “Going On With Normal Life” part.

I then tell them how severe trauma shuts down the Corpus Callosum so that the left brain and the right brain are not communicating. For example, just about every DID client has an Angry part. This is the part that unconsciously gets kicked off if something upsetting happens. These people will find themselves suddenly overly angry for what those around them might see as no good reason. The client will get as angry at the person standing in front of them as they were at the person that abused them in childhood. They cannot make the distinction between the two because the corpus callosum is not functioning and the left and right sides of the brain cannot communicate.

So you want your clients to understand the parts in their head and explain what those parts do to them. I use a chart that has the different characteristics of the parts and show clients which description on the chart matches up with the part they are experiencing when they are dissociating. You want to do that so they can understand what is happening to them—why they go unconscious, why the parts take over, and how the parts get triggered. These triggers are experiences or emotions that appear to be similar to what they experienced when they were being abused. When the emotion comes up, the parts come up. The parts are behaving in the present as though the abuse that happened years ago is occurring right now.

When you begin treatment by explaining the nature of the parts and the neurological basis for the problem they are experiencing, it begins to give the client a mechanism for understanding themselves and they can begin to feel at least a modicum of control.

Trauma Center of Virginia Director Speaks To EMDR Therapists

On Friday, February 2nd, Onnie Baldwin, Director of The Trauma Center of Virginia presented “An Overview of Using EMDR With Dissociative Identity Disorder” to members of the Central Virginia EMDR Regional Network. The event was hosted by Terry Becker-Fritz, a popular EMDRIA-certified trainer and supervisor. Among the 36 EMDR therapists in attendance were Amanda Trent, Crystal Horning, Allison O’Grady, Ginger Neff, Beth Adams, Robin Hornstra, Marion Brown and Betsy Cochrane, along with Chris Nufer, Associate Director of the Institute.

Ms. Baldwin, who is a Licensed Clinical Social Worker, shared her clinical experiences in treating Dissociative Identity Disorder, a mental health condition previously known as “Multiple Personality Disorder”.

DID, she explained, is the result of extreme abuse and neglect in infancy and early childhood causing an uncontrolled fragmentation of a child’s core personality. Use of a technique called Eye Movement Desensitization and Reprocessing (EMDR) has been effective in treating Dissociative Identity Disorder and other types of trauma, such as PTSD.

The Trauma Institute of Virginia, which Ms. Baldwin directs, promotes a collaborative community where therapists, researchers, educators, policy-makers, and community mental health advocates have a forum to advance the treatment of Dissociative Identity Disorder and other complex traumas.

The Institute is presenting a ten-part, web-based, training series on “Using EMDR To Treat Dissociative Identity Disorder and Complex Trauma.” For dates and curriculum, http://traumainstituteofvirginia.org/registration/

Professional groups interested in educating members in new trauma-based behavioral health therapy approaches are invited to contact the Institute regarding Ms. Baldwin’s availability for speaking engagements. Inquiries should be directed to info@traumainstituteofvirginia.org

Eight Books Every Therapist Should Read About Trauma

This year marks the inauguration of the Trauma Institute of Virginia’s education program. As part of this effort, we asked our director, Onnie Baldwin, LCSW, to share her list of the “must read” books for EMDR therapists who want to improve their understanding of complex trauma and dissociative disorders. These selections have also been chosen as suggested reading for the Institute’s upcoming training program – “Using EMDR To Treat DID and Complex Trauma” which is due to begin later this month.

Here is our Director’s list of the eight books every therapist should read on the sources and treatment of DID and other trauma-related behavioral problems.

  1. Intensive Psychotherapy For Persistent Dissociative Processes:The Fear of Feeling Real, Richard A. Chefetz. W.W. Norton & Company, New York, NY 2015 ISBN 978-0-393-70752-6
  2. The Developing Mind – How Relationships And The Brain Interact To Shape Who We Are, Daniel J. Siegel. The Guilford Press, New York, NY 1999 ISBN 978-1-57230-740-7
  3. A Secure Base – Clinical Applications of Attachment Theory, John Bowlby, Routeldge, New York, NY 1988, ISBN 978-0-415-35527-8
  4. Healing The Divided Self – Clinical and Ericksonian Hypnotherapy for Post-traumatic and Dissociative Conditions, Maggie Phillips, Ph.D. & Claire Frederick, Ph.D., W.W. Norton & Company, New York, NY 1995, ISBN 0-393-70184-0
  5. In An Unspoken Voice – How the Body Releases Trauma and Restores Goodness, Peter A. Levine, Ph.D., North Atlantic Books, Berkeley, CA. 2010, ISBN 978-1-55643-8
  6. Traumatic Stress – The Effects of Overwhelming Experience on Mind, Body, and Society, Bessel A. van der Kolk, Alexander C. McFarlane, and Lars Weisaeth, Editors. The Guilford Press, New York, NY 1996, ISBN 1-57230-088-4
  7. Trauma and Recovery – The aftermath of violence from domestic abuse to political terror, Judith Lewis Herman, M.D., Basic Books, New York, NY 1992, ISBN 0-465-08766-3 (paper)
  8. Sensorimotor Psychotherapy – Interventions for Trauma and Attachment, Pat Ogden with Janina Fisher, W.W. Norton & Company, New York, NY 2015, ISBN: 978-0-393-70613-0

Registration for “Using EMDR To Treat DID and Complex Trauma” is now open. Learn more here.

What Is Dissociative Identity Disorder? (And Where Can You Learn To Treat It?)

Dissociative Identity Disorder (DID) is a mental condition that is caused by severe early childhood trauma. The trauma can be caused by emotional, sexual, or physical abuse but the most powerful trauma is caused by neglect.

DID begins as the brain is forming in childhood; usually before the age of eleven or twelve. What causes the damage is that a child who is not emotionally capable of handling the reality that the person who is their one source of love is either denying them care, physically abusing them, sexually abusing them, or emotionally abusing them. In an attempt to deal with this, the child’s brain creates separate neural bundles to store the painful memories away from their consciousness. These bundles form in order to allow the child to interact with the parent when the abuse is going on. These bundles of neurons contain the memories of what the abuse was. So she holds these memories off in separate places in her brain. The purpose in that is that the child could not thrive or even continue to live if she remembered exactly what happened to her.

These bundles may contain a number of emotions. One could be anger or “fight.” One could be sadness. One could be the need to attach or comply. Or one could be fear or “flight.”

These bundles develop as a defense to protect the child from the trauma as it is happening. And when the trauma stops, these bundles of neurons shut down.

The child who was born into this world and existed before the abuse or neglect began we call in treatment, the “going on with normal life” part. After the abuse stops, this is the part that comes back into being and continues to function in everyday life. This “going on with normal life” part generally doesn’t remember any of the abuse that happened. These protective bundles continue to form as the abuse or neglect continues. This is why someone with DID. might have anywhere from one to a hundred of these bundles or “parts.”

When these parts take over a person’s body, the “going on with normal life” part will go to sleep and the person will behave in ways that make them appear to have multiple personalities that enter and exit the body at will without leaving the person any memory of their existence. This process of walling the memories off in parts is the essence of DID.

The Trauma Institute of Virginia was founded to promote a collaborative community where researchers, educators, mental health advocates, policy makers, administrators and therapists have a forum to advance the treatment of Dissociative Identity Disorder and other trauma-related syndromes.

How Trauma Therapists Know The Signs
That Point To Dissociative Identity Disorder

One of the key insights therapists who train with us at The Trauma Institute of Virginia learn is how to look for signs that might indicate that a client has Dissociative Identity Disorder.

One sign that a client is not just a trauma client, but DID, is that they have lapses in memory. I asked one of my clients if she had lapses in memory and she said “No more than anyone else. I was with my partner in the kitchen and I needed to go to the bedroom to get something. I didn’t return to the kitchen for an hour. My partner asked what I had been doing for the last hour and I had no idea.” Then my client added casually, “But I think most people do that.” Later my client and her partner found an angry note from the client to her partner that my client had no memory of writing. DID clients frequently lose track of time and think it’s normal. It would be obvious to anyone who has taken our training courses in D.I.D. what had happened was that a part had taken over the body for that period of time. If people tell you they’ve done things that they don’t remember doing, that’s a sign.

Another sign to watch for is an abrupt change of facial expression, tone of voice or body posture. Some therapists who work with D.I.D. clients say that as one part takes over for another, they detect a flicker of the eyes. But I’ve found that’s not necessarily true. Often clients will go from part to part very smoothly. So if you are looking for eyes to flutter or close to tell you a switch has occurred, you may miss it.
Instead what you might experience is that while you are sitting there talking to someone all of a sudden the expression on their face changes so drastically that it’s apparent it doesn’t look the same person. The voice can change. The client can suddenly become stern or submissive. In some cases, if the “freeze” part takes over, they can suddenly stop talking completely. So, you watch closely for a variety of physical and emotional attributes that might indicate someone has switched. By reading their body language, one can tell with some clients exactly which part is inhabiting their body simply by how they are holding their body.

Another sign to look for is if the person dresses completely out of character. This happens sometimes when the child part dresses the body. The client may come in wearing an outlandish costume and not have come to consciousness until after the client left the house. If you ask about the outfit, you might get a very confused answer. It might also lead you to help the client know of their other parts.
A trained therapist learns to watch carefully for all of these things and more. Does all this mean that someone might just walk into your office for the first time and you know by the end of that session that they are DID? No. The point is that there are certain signs you look for.

I believe Dissociative Identity Disorder is the most creative defense mechanism a person can develop to protect themselves from memories of abuse or neglect. And it requires an equally creative therapist who has the training to see through those defenses and read the signs that point to D.I.D.

 

The 90 Second Rule

When you are working with clients who have anger issues, you may want to consider teaching him or her “The 90-Second Rule.” Our emotions come into our body and are interpreted in the brain. We think we feel them in the brain, but the emotions are actually feelings in the body. When an intense emotion such as anger comes into the body, it will be funneled straight to the adrenal glands. Then adrenaline is sent to the brain through vagus nerve. It goes to the amygdala which is the switching station in the lympic system. The amygdala interprets the message as anger. This message is sent to the hypothalamus (the hypothalamus is the emotional regulator) which then floods the brain with cortisol. When the brain is flooded with the anger message we received from the body, we experience the anger. This is the course of anger that allows us to say sometimes, “I’m so angry I could burst.” No matter what the cause of that anger, the process between the adrenalin gland, the spinal cord, the amygdala and the hypothalamus and then the constant anger surging through the body, will only last 90 seconds unless you continue to feed the anger.

So what does that mean? The amazing thing is that if you stop this chemical process, the anger will stop. The key is, don’t feed the anger. An example would be when one is driving and somebody cuts him or her off. Our driver had the right of way but almost hit the other car. Just barely missing it. The other driver drove on probably not even knowing that he almost hit the person in our example. But for the next half an hour our driver is saying to him/herself, “That stupid so and so, I wish he were here so I could give him a piece of my mind.” As long as the driver keeps this message going, it keeps the anger going. It feeds the emotion. The cortisol keeps flooding the brain and repeatedly triggering more anger and stress. The other guy is down the road oblivious to what almost happened. Our driver is ruining his/her day over something the other driver probably didn’t know anything about.

Get your clients to learn a new behavior which is to say to him/herself, “That was a stupid thing he did and it pissed me off but there’s nothing I can do about it now.” Then the person in our example isn’t feeding the anger and in 90 seconds it will naturally dissipate. In time the client will learn to catch themselves before they feed the anger beyond its original 90 second life.

The 90-Second Rule is a very interesting piece of neurology that is important to the work that we do treating DID. Almost all people with DID have angry “parts”. With this understanding, you can teach the angry parts to wait ninety seconds and they will generally stabilize. If you don’t feed the anger, then the chemical reaction that’s been kicked off in the brain will simply peter out and you will no longer be experiencing angry. I teach this technique to clients with angry parts and it is extremely effective in stabilizing them. Of course, most of the time, we are all inclined feed the chemical reaction over and over again. But the thing to remember is — you don’t have to.