Trauma Therapy after DBT and Medication

[borderlandman]

The treatment of trauma that results in PTSD, Complex PTSD (DESNOS), and DID has evolved in Europe, Israel, Australia and Canada to recognize structural dissociation of personality requiring psychotherapy beyond the initial stabilization engendered by DBT, CBT, etc.

This additional psychotherapy includes the management and elimination of dissociated personality parts.

I am a survivor of delayed myelination, insecure attachment (family wide), childhood sexual abuse at ages 4 and 13, threats to life 3 times, and 40 years of emotionally abusive relationships (2 marriages and 3 non-marriages). I have gone through one full round of DBT and am repeating it, I meditate daily, exercise regularly, eat in a healthy way, regulate my sleep, engage in activities I enjoy, and take the one medication that has been effective with depression. In general, I can regulate my emotions better than I ever have in my life. My "diagnosis" falls into the Complex PTSD or DESNOS category.

Nevertheless, I can often internally "see" some of these dissociated parts with distinct faces and expressions and still occasionally hear distinctly different internal voices. The relationship and sexual trauma dreams continue. These are disturbing and even though I often am a lucid dreamer, I have been unable to influence the parts represented in the dreams. I can analyze what is occurring in the "moment" in the dream, which seems much like dissociation. My daily life is still influenced by dissociative parts under various emotional circumstances.

Is there any substantive information regarding DBT and trauma management?

Are there any self-help techniques that can integrate the personality?

Are there therapists out here who do not minimize or fail to validate the traumatic effects of 62 years of perceived emotional/verbal abuse?

 

[Dragonfly]

Are there therapists out here who do not minmimize or fail to validate the traumatic effects of 62 years of perceived emotional/verbal abuse?

Borderlandman, welcome to Psychlinks. You show a lot of courage and insight - and clearly have tried to do as much as you can to minimize your current difficulties. Your last question (above) had me puzzling for a moment - I can not remember anyone on Psychlinks (therapists or not) who would minimize or otherwise fail to acknowledge the effects of trauma. My guess / hope is that if you come here often enough, you will soon see the kind of nurturing, supportive environment that is fostered here. It just is, that's all. (although, that in and of itself can be kinda hard for some because it is different than expectations or previous experiences).

Are you working with a specific therapist who can more closely align therapy with your current needs?

 

[forgetmenot]

Who ever those therapist were that minimized you experiances you illness i am sorry you had to deal with them. I am also sure though there are great therapist who do get it who totally understand the trauma and the depth of destruction I hope you find that therapist who can help you integrate the personas if not teach you how to live with each part hugs to you.
i finally found one who understands i do hope you can too

 

[borderlandman]

The therapeutic situation is as follows. I was in individual therapy for about 8 weeks, after which I entered DBT skills (2 hours per week) and DBT coaching (1 1/2 hours per week. After finally getting across to my therapist that I really did suffer from a traumatic past, my therapist, skills teacher and coach accepted only the sexual abuse aspect of the trauma. I asked my psychiatrist for a referral to someone who deals with trauma and/or dissociation. There are several such people, psychiatrists and therapists, in the same organization I utilize for my mental health needs. My psychiatrist referred me to a particular therapist to try out. He also admitted that no one in the area or within 250 miles provides the therapy I was seeking with a phase based approach to integrating emotional parts of my personality. The first phase is DBT or CBT or similar. After consulation among the professionals, they decided that I simply continue DBT since DBT skills would allow the integratation of the problematical emotional parts by "filtering down" to these parts in time. The peer reviewed professional literature I have read on structural dissociation of personality clearly points out that one's symptoms/suffering require a three phase approach to integrate these emotional parts. No one close to my location offers the later two phases of therapy. (See Structural Dissociation of Personality; The Haunted Self by Van der Hart, Nijenhuis, and Steele). The 400 peer reveiwed journal articles I have read surrounding delayed myelination, insecure attachment,development in the early years of life, emotional regulation problems and abuse and trauma fit nicely together. They also recognize the pernicious effects of emotional abuse, even in the absence of physical/sexual abuse and their role in the development of Complex PTSD. These later abuses are downplayed by the DBT oriented therapists in my area and they are so stuck to the benefits of DBT, which are considerable, that they do not recognize the links between structural dissociation of personality and psychoformand somatoform disssociative experiences. I resolved many aspects my sexual abuse on my own 42 years ago through self-help CBT. I did not integrate my emotional parts that held those memoories, and they persisted while acquiring unrelated triggers through classical conditioning. My relationship problems, emotional dysregulation, and victim parts persisted leaving me vulnerable to repeated emotional abuse. This fact is why I have felt "blown off" by these people. (Not by people on this forum.)

I was partly venting in my post, but I have felt I needed validation regarding my understanding of my status in competition with my therpists views. I have partially accepted their point of view on an emotional level, however, on a rational level I have difficulties with their views since they do not involve good reasons to believe as does the structural dissociation of personality view does. I want to go for the gold to acquire the best possible adaptive personality to everything that challenges me. Having a very limited income, I cannot just pick up and move to a city with therapists qualified to offer what I want. I have a list of these therapists in the United States. They do exist.


I would be happy to answer questions if anyone has them.

Thanks for your post!

 

[Dragonfly]

,,,I cannot just pick up and move to a city with therapists qualified to offer what I want. I have a list of these therapists in the United States. They do exist.

Borderlandman - where do you live? If it is a small town, please also let me know where the nearest largest town / city is. If you are not comfortable posting this info in public, then just PM (personal message) me .... Really. Please understand that I can not promise anything, but I am willing to look into a few things and try to help find someone who might be a better fit for you. There has to be a way to get you the help that you seek and that you deserve.

 

[borderlandman]

I live in southwestern Colorado (Durango). My list of qualified therapists come from the International Society for the Study of Trauma and Dissociation. This does not mean that there are not other qualified therapists to handle this problem.

The closest ISSTD member therapists (2) are in Colorado Springs. Other in Colorado are in the Denver metropolitan area and in Fort Collins. There are none in New Mexico; some in Salt Lake City and some in both Phoenix and Tucson.

My list of member therapists locate all of them in metropolitan areas or in close by communities.

Since part of my problem is attachment related, I need a therapist who can move in and out of the attachment mode with me to deal with my emotional parts. These emotional parts (EPs) have at least a rudimentary sense of self and individual memories, behaviors and triggers that enable them to intrude on my normally operating personality. The ISSTD has a recommended set of guidelines for treating PTSD, Complex PTSD and DID. If you go to their website, you can view these guidelines and get a feel for what they have found to be necessary beyond DBT and medication.

isst-d is the link with org following. Then go to treatment guidelines.

I do appreciate your help very much.

 

[Dragonfly]

Borderlandman,

Here are some web sites / people you might want to contact:
Grief Counseling Durango CO. Grief Counselor, Grief & Loss, Trauma Therapist Durango CO.
Durango EMDR Therapist - EMDR Therapist Durango, La Plata County, Colorado (CO) - EMDR Counseling Durango

Please understand that in no way is this meant as an endorsement of any particular individual or treatment modality. I offer these resources simply as a place to continue your search. Here's a couple of other thoughts - I wonder if what you are looking for is so specific (by the time you add location, experience, openings, gender preferences etc), that such a person might not currently exist. That, as with all relationships, the therapeutic relationship is often a matter of "the best fit ...." or "the best approximation to the ideal." Again, in all of our relationships, we decide what is the most important and non-negotiable, what would be nice to have, and what doesn't matter. As I am sure you know by now, it will likely take more than a phone conversation with a potential therapist to decide if the fit approximates what you are looking for / need. Finally, if a therapist is not the one for you, I would encourage you to ask for additional resources. The people that you call will be in your area - and therefore have a better idea of who might be best for you. All the best. Please keep us posted on how it is going.