Last month, I wrote a post addressing some concerns of people with Dissociative Identity Disorder (DID) who are trying to find a therapist to work with.
As promised, these are my answers to some of the questions that folks with DID are often curious about when interviewing a potential therapist.
Didn't find the answer to your question? Feel free to contact me with your specific question, to learn more, or to set up your free consultation.
- How long have you been working with DID?
I started working clinically with DID and other dissociative disorders in May 2015, before I graduated and while completing my master’s level internship. I have been independently researching trauma and dissociative disorder treatments since 2000, and have spent several years with people who have Dissociative Identity Disorder. Since graduation, I have continued to work with people struggling with trauma-related issues including: dissociative disorders (including DID), post-traumatic stress disorder (PTSD), complex post-traumatic stress disorder (C-PTSD), anxiety, and depression. I have gained clinical experience in both supervised private practice, inpatient programs, partial hospitalization and intensive outpatient programs, and my own private practice.
- Where did you get your DID experience or training?
- How have you continued your education or training?
I have continued to study and/or obtain Continuing Education Units (CEU’s) in the Structural Dissociation Model, Ego State Therapy, Attachment Theory, neurobiology of trauma and PTSD/C-PTSD, Eye Movement Desensitization and Reprocessing (EMDR), and various treatment models for dissociative disorders and PTSD/C-PTSD. I am also a member of the International Society for the Study of Trauma and Dissociation (ISSTD). To find out more about ISSTD, visit their website at http://www.isst-d.org/. ISSTD provides access to some of the most up-to-date research in the field. I regularly consult with experts in dissociation.
- How well do you understand PTS/PTSD/C-PTSD?
I have a firm understanding of PTSD versus Complex PTSD, as well as PTS.
PTS: Post-Traumatic Stress
Post-traumatic stress occurs when a person has witnessed or experienced a traumatic event, and exhibits symptoms of PTSD, but does not meet the diagnostic criteria for PTSD. The symptoms are the same, but they do not last as long (they may diminish or lessen after a few days, and typically do not last longer than a month or so). If the symptoms do interfere with your day-to-day functioning, they don’t interfere for an extended period of time.
Symptoms of PTS include:
-Feeling anxious or uneasy
-Shakiness
-Increased heart rate
-Feeling distracted
-Sweatiness
-Nightmares about the experience
PTSD: Post-Traumatic Stress Disorder
PTSD is caused by experiencing or witnessing one or more traumatic events, or learning that a loved one has experienced a trauma. First responders and other professionals who hear details about traumatic experiences can also develop PTSD. These events include, but are not limited to a car accident, rape, assault, or combat. Symptoms of PTSD last for more than a month, are ongoing and severe, and significantly interfere with functioning in one or more areas of your life (occupational, social, etc.).
Symptoms of PTSD include:
-Nightmares
-Flashbacks
-Intrusive Thoughts
-Hyper-vigilance
-Exaggerated startle responses
-Isolation
-Decreased interest in activities
-Negative mood
-Difficulties with feeling positive
-Difficulty concentrating
-Difficulty sleeping
-Engagement in risky behaviors
-Inability to recall key aspect of the trauma
- Amplified blame of self or others for causing the trauma
-Avoidance of trauma-related thoughts, feelings, or reminders
-Emotional distress or physical reactivity after exposure to reminders of trauma
-Derealization (feeling that things are not real, distorted, or distant)
-Depersonalization (feeling detached from oneself)
C-PTSD: Complex Post-Traumatic Stress Disorder
C-PTSD is not an official diagnosis, but a well-known type of PTSD caused by interpersonal or social, ongoing traumatic experiences. These can include experiencing childhood abuse, physical abuse, sexual abuse, emotional abuse, exposure to gaslighting, domestic violence, a history of being bullied, torture, and/or ritual abuse. C-PTSD develops when a person experiences multiple, chronic, inescapable traumas.
Symptoms of C-PTSD include symptoms of PTSD, in addition to:
-Emotional dysregulation
-Inhibited or explosive anger
-Chronic sadness
-Suicidal thoughts
-Feel easily overwhelmed
-Helplessness
-Worthlessness
-Guilt and/or shame
-Fragmented sense of self
-Intimacy issues
-Trust issues
- How do you feel about or view DID?
I feel like I could write an entire, separate blog post on this topic. In a nutshell, I view dissociation as a protective factor that ensured survival, and an ingenious way to cope, and a creative means to manage in completely overwhelming circumstances. I understand where the “disorder” part of DID comes into play, as well, because for many folks it starts to get in the way of functioning or one’s ability to experience joy in their lives.
- Do you work with all of the parts of a DID system?
Absolutely, yes! Any and all parts of any and all systems are welcome, and encouraged to participate in the counseling process. To me, stating that I only work with the “host,” or the "ANP," or any other particular part of a system would be like saying to a “singleton” that I am only willing to work with one aspect of their personality. It doesn’t make sense for “singletons” in counseling to not work on themselves as a whole, and it doesn’t make sense for someone with DID either, in my opinion.
- Do you consult with other professionals when needed?
Absolutely, yes! I network with local professionals, attend additional trainings, and consult with other professionals who specialize in dissociative disorders on a regular basis.
- How frequently are sessions scheduled, and how long do they last?
This depends completely on the client’s individual needs. Typically, one 50-minute session per week.
- What is your fee, and do you accept my insurance?
My current fee can be found here. I am considered an out of network provider, and I am happy to provide receipts for reimbursement for the client to file for out-of-network reimbursement. I always encourage clients with insurance to check with their insurance provider to determine if they can be reimbursed for out-of-network therapy with me.
- What is your policy regarding emails? Phone calls? Crises?
Email is not a secure form of communication. There is no way to 100% ensure that emails, which are stored on servers, will not be read by third parties. I have a conversation with potential clients regarding email, privacy, and confidentiality. Clients are then free to decide if they want to email personal information. I will generally respond with non-clinical information to let them know I received the email, encourage them to bring their emailed concerns to the next session to discuss, or if necessary, I will follow up with a phone call.
Occasional phone calls between sessions are fine within the function of needing some encouragement or help with grounding. If the return phone call goes beyond a certain time frame, I charge additional fees.
I am always sure to explain that I do not work in an environment conducive to responding to crises, as it sometimes may take me 24 hours to respond. I develop a crisis plan with clients, listing emergency numbers, contacts, and suggestions for coping. If repeated crises are occurring several times per week, and the client is frequently unable to regulate or keep themselves safe, I might suggest a higher level of care until they are able to stabilize.
- How do you feel about integration as a counseling goal?
A goal of full integration (or fusion of parts) is completely up to the client, and completely respected as a decision that only the client can make. Integration of information, including access to one's own adaptive neural networks is helpful in resolving trauma. I do not push clients toward integration as a goal, as most of my experience involved DID goals of cooperative functioning. Again, I’ve known many unintegrated folks with DID who are extraordinarily high functioning, and living happy, balanced, and productive lives. I have known others who wish to fully integrate, and I respect each client’s decision.
Kristen Henshaw, a Licensed Professional Counselor in Austin, TX specializes in trauma recovery, dissociative disorders, and supporting those who have experienced chronic invalidation, manipulation, or gaslighting in relationships. She offers an affirming environment and welcomes diversity. Contact her to schedule your free 30-minute consultation.