Abuse by Professional "Experts"
Article is a Stub! In progress not completed by any means.
The way many professionals treat their DID clients gives the professional power and control over their so-called client. In most client-professional relationships, the client drives the narrative and within limits controls the professional.
But not so in most mental health scenarios. DID is no different.
Here's some common issues in DID treatment that are abusive in that they rob power, control, mental health and healing from the multiple system.
Content Warning: There's some very blatant CSA and therapy abuse issues on this page, the worst ones are towards the bottom. It may be very triggering for victims of therapy abuse or childhood sexual abuse (CSA) to read this page.
Devaluing Internal Relationships thus Fostering Therapist Dependency
Some professionals try to separate folks within the system, call them "just" parts of "you" and demean/belittle them by calling their self-image into question or outright refusing to acknowledge them (refusing to talk to alters, not allowing them to front in therapy, talking about the "real" you, etc.). Just like abusers will talk down about your friends, try to limit you talking to them, cut you off from external support — many therapists are dead set on cutting you off from or devaluing your internal supports.
If DID/OSDD are relational disorders, then shouldn't the "cure" be relational as well?
Healing shame, working on internal relationships & community, putting As Inside, So Outside (AISOAVV) to really good use — these are all relational cures for a dissociative disorder that is all about betrayal, shame, abandonment, insecure attachment, etc.
This is why it's so important to lean into the internal relationship aspects of stabilization. It's not about "healing the trauma" as much as it's about healing the broken relationships, and because of AISOAVV, we've internalized those broken relationships. No external people OWE us the experimental forum in which to heal ourselves; we have an internal milieu in which to do so thanks to the principle of AISOAVV. Whether we have awareness of an inner world or not, we have the internal relationships, the internal emotional landscape in which to play out the healing, trust-building, collaborations, community-development that we need in order for our system to achieve equilibrium.
Any therapy that devalues the internal relationships of the plural system ends up breaking the therapeutic relationship — it's inherently abusive and fosters a power & control scenario, a toxic dependency. The therapist breaks internal trust, and then the client must rely on the therapist as the sole relationship in which to play out all of the acts of relational healing.
The therapist’s role is a facilitator and mirror, maybe even a role-model, for these internal relationship healings. Instead, the abusive therapist throws a wrench into the internal works and redirects their patient to rely solely on them. They drink up the attention of the dependent patient, playing out whatever it is the therapist needs from the relationship, rather than maintaining the professional distance that is required for the patient to achieve healing.
We agree that DID is a disorder which was forged in dysfunctional relationships. But we absolutely disagree that it requires dysfunctional relationships with counter-transferrance and dependency on the therapist to heal them. When a therapist pits headmates against eachother, reinforces imbalance in the system by treating one headmate as more important than the rest, or one as more "real" than the others, or in any way detracts from the necessity of healing these internal relationships — it is outright, blatant, therapy abuse.
Protracted Treatment Periods
When therapy is 10+ years and often several sessions a week, who benefits? Obviously it's an easy payment stream for any therapist to keep multiple systems in therapy. I'm not saying the client doesn't need help for 10 years, but it sure does make it easy money for professionals when they don't have to hunt down new clients very often.
We should question why treatment is often done in a less-than-efficient manner. When you devalue a client's internal support system, treatment will take longer. There's less internal support and assistance, more crisis interventions are needed, etc. "Stability" alone is insufficient to begin trauma work.
Separate from External Supports
Someone, somewhen, had a bad experience putting folk with DID into a room for group therapy. Maybe several so-called DID experts had problems with group therapy for folk with DID at various times. Yeah, no shit. Pushing boundaries, airing triggering baggage — not such a great idea.
But they unnecessarily generalized this problem to mean that multiples should not congregate.
Along the lines of not allowing multiples to bask in the presence of one another, many professionals actively discourage "encouraging" the multiple system to be — well, to be a multiple system. They don't want to "encourage" the "alter" personalities to feel comfortable fronting. They don't want support groups or gatherings of DID folk to reinforce the idea that the alters are real.
But left to our own devices, we feel most comfortable in spaces where it's OK for our "alters" to front and take over, where we can discuss our experiences without people thinking we're crazy. It's a life-affirming experience JUST LIKE EVERY SINGLET HAS WHEN ALLOWED TO BE AUTHENTIC.
Instead, though, they discourage our authenticity and venues in which we can explore our authentic selves.
No better Trophy!
It's not a question of what's right for the multiple. In the culture of psychologists, it's all about the bragging rights for the therapist. How many multiples have you hunted down and "tamed"? Nothing less than integrating a multiple system will do as a trophy. No one brags about helping a system live as a group entity. The disappointment when a multiple refuses merging/integration is palpable. There goes the book/movie deal!
Refusal to Treat
Sometimes a dissociative disorder or plurality comes with a side helping of other issues — physical and mental health issues that the plural needs assistance with from their health team. Sometimes, having a dissociative diagnosis biases professionals from treating their comorbid issues. So a physical health team may refuse to treat someone who is plural, or a mental health team may refuse to assist a plural in finding appropriate medication for other issues, or case management, social work, support environments or hospitals may give the client the run-around and shuffle them to other units or professionals, citing "difficult patient" and exerting "difficult patient bias" on people for plurality.
This is not the same as a therapist who says that they do not specialize in trauma or DID and helping the client find a new/appropriate therapist.
However, it does cover therapists who shame the plural in the process of refusing treatment. Those who say "you're not traumatized enough" or "DID doesn't exist" or any other stigmatizing messages while showing the client the door count.
A good therapist will help make sure to pass the DID client along in a gentle, timely, and supportive manner.
The flip side of outright refusal is not knowing what they're doing. According to Harvard University, 90% of therapists don't know how to treat clients with DID. Sometimes there's no other professional to go to. There are plenty therapy deserts out there. So a plural ends up at an office where the practitioner is clueless. They go on instinct, what they know from TV, movies, dramatized so-called biographical recounts — and they pull shit out of their ass. If the client has to train them, maybe they'll point the professional to the outdated 2011 ISST-D guidelines. They're outdated, it's like 80-pages of reading material, it's disorganized and non-procedural. In other words it does not say "Step 1: do this" — it goes in a lengthy, wordy, jargon-filled way about the business of explaining itself to the point that it renders the document impractical at best and unfortunately for foreigners, untranslatable and unusable. For an international organization to do this is unprofessional. So a friend says "I'm in Egypt, and there are no therapists for DID!" and we say "Look for a trauma therapist" but their therapist can't read or translate the guidelines in any practical way to shore up their inadequate knowledge on the topic. This frustrates both the therapist and the client.
Professionals may abuse clients by supplanting their internal belongingness (by reinforcing internal trust difficulties, encouraging them to turn their backs on each other, pushing them to drive wedges between headmates, or simply failure to encourage mending internal relationships), and redirect attachment & belongingness to the professional. Pros are specifically trained not to do this (transferrance/countertransferrence issues), but it's a power trip for the professional, even if taking a nurturing parenting stance towards the client. It can be due to outright abuse, but it can also be a professional with weak boundaries or a savior complex. This results in failure to thrive in therapy, disempowers the client, and leaves the client vulnerable to becoming shame triggered New at any real or perceived loss of the professional's support in their life, which can turn into a shame spiral and is very dangerous & destabilizing for the client.
Traumatized plurals are desperately in need of consistent attention, care and love. Once they come to trust a therapist, they can be intensely focused on them, and it is all too easy to let the boundary between therapist and plural slip into something risky, damaging, or outright destructive. Therapists that encourage conversation or meetings outside of paid therapy boundaries, touch the plural, shower the plural with parental doting or love are risking both the therapist and the plural. An alarming new "evidence-based" style is attachment therapy. Once a plural is attached, until they graduate to full independence, they need constant care and attention that can drain anyone's batteries. And in a mirror of wrongs done to them by parents that gave too little attention, a therapist who gives too much can undermine the plural's independence and self-determination as the plural falls over themselves to keep their new parental figure happy. Some therapists get off on this — it's heady and addicting to be the object of love. Some take advantage of it and will abuse patients on purpose. At minimum, it compromises the plural system's ability to judge what is right and wrong, and since traumatized plurals already have boundary issues, it can lead to many other inappropriate behaviors. For more see Re-parenting in the Missing Manual.
Thriller by Proxy
Generally specific to "DID specialists" there are those specialists who went into this specialty specifically to find horror stories (digging for awful trauma like they're into horror/thriller movies — adrenaline junkies by proxy, like those into "true crime" and medical trauma shows etc.) or to enjoy tales of childhood sexual abuse by proxy. More about the latter below.
NO interest in their wins and the good things they were doing, hobbies they took up, etc. — if the talk wasn't about the trauma and the bad stuff, they had zero interest. That's really messed up. There are therapists that push into trauma work too early, push for the worst trauma too early, want graphic retellings of trauma — it's REALLY bad to do that and push for that, it can completely destabilize the client.
On the other end, the longer the therapist keeps the DID client destabilized, the longer they get paid. Not a great combination for helping a client really move forward with their life. (see Protracted Treatment Periods, above)
Some who hang out the "DID specialist" shingle are looking to exploit the client directly, thus picking a population known to have poor boundaries, lack support, and have poor skills in reality testing. They may be into just having power and control over others, and enjoy playing mind games with and disempowering their client. Others may start a sexual relationship with their client for reasons of power and control, etc.
Other "DID specialists" may specifically be looking to slake their own sexual urges by trying to live vicariously through their victims' stories of childhood sexual abuse in an attempt to use the stories to satisfy their own pedophiliac urges. But like many such attempts, it backfires (this misdirection doesn't work), and they need to escalate. They may specifically seek out child alters to attempt to dampen their own urges and it becomes a twisted sick tragedy, leaving the plural more scarred than ever.