My Plans for this Evening are…

One of the things we did at Sheppard Pratt’s Trauma Disorders Program, was every evening after dinner, we convened in our small group to go over our progress on our goals for the day.

In 2007/2008, everyone led off their share, by saying “Our goals for today were A, B, and C.  Today….(explain what we accomplished towards these goals).  My safety is….(explain any issues with safety), and my plans for this evening are….(explain what we are going to do to wind down, make sure parts are in their safe places, use coping skills, etc.).

During our last stay in 2018, it wasn’t as structured, but still had the same goal.  We reviewed what progress we made on our goals and chatted about what we were doing that evening.

It’s still a helpful technique, to wrap our mind around the day’s events. There have been days I’ve been surprised to find out I had gaps of time loss, and a little internal communication helped improve awareness.  It also helps parts feel heard and not ignored or avoided.

Here’s our basic outline for our night check-in.  I hope it helps give yous some ideas that are helpful!

Evening Check-In:

1. Read off goals for today and progress/outcomes of working on these goals.
2. Celebrate successes! Even small wins can be huge for some parts.
3. What number am I on the Crisis Continuum right now?
4. Did we experience any triggers today?
5. Is anyone having intense emotions right now? (If so, are there self-soothing skills, grounding skills, imagery, or other things that might help you contain?
6.  Do I need to ask anyone (external) for help right now?  If not, try to engage with an outside person before bed in a positive way (e.g. give 1 complement to them).

Then when we get into bed and get ready for sleep, we’re usually in a safer space.  We pay attention to our body to help parts relax any muscles they have tensed (facial, neck, or lap muscles) and do deep breathing to fall asleep well.

Tomorrow is therapy day! So, here’s to a good night’s sleep!

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Doing Memory Work with No Memory

After my last post, I lost about 36 hours of time.  The good thing is, whoever was fronting didn’t jet off or go anywhere.  During this blank period of time, I apparently self-harmed, forgot how a cell phone works, and even talked to my therapist on said forgotten-how-this-works cell phone.

I had a 2nd session with our therapist, K. after coming out of this dissociative episode on Thursday evening.  I don’t remember much of this session   It’s really vague.  I just remember going back and forth with her on intense feelings of suicide and depression.  She kept trying to remind me that these thoughts are from a time in the past when I was being hurt, and I am safe today.

Yesterday (Friday), I stayed home from work.  I was exhausted, probably from all the switching.  Around 2pm my cell phone rang, and it woke me up.  K’s name is on the caller ID, so I answer.

“Good Afternoon, Nel, it’s K.” She cheerily says.  “Where are you?”

“Ah…hi, K.  At home.”  I groggily answer.

“And you were sleeping.” She states.

“Yah.” It doesn’t surprise me by now that she can read me through the phone.

“Then, I’m glad I called.  I was thinking you could have your regular Monday session early tomorrow (Saturday).” She says.

“What? Why?” Now I’m confused. Why is she calling me?  Why does she want me to come in early?

“Well, because now you’re missing work.  I think we should meet before Monday, so we can work a little on what’s going on, to increase the probability you won’t call out sick on Monday, too.” She responds.

“Oh.” I say, flatly.  “I guess, ok.”

“We could meet on Sunday, if you prefer.” She waits but I don’t respond, “Or if you’d rather keep your Monday session, that’s fine, too.  I just thought I’d offer.”

“No, it’s ok.  I’ll come in tomorrow.”  I say.  “I trust your opinion, so if you think coming in before Monday is important, I’ll do it.”

“Great! Since I know you’ve been sleeping so much, how about we meet in the morning tomorrow?”

I sigh, “Ok.”

“And you’ll bring your homework.” She adds.

“My homework? What homework?” I’m totally confused.  Not even a vague, ohhh yeah, she assigned homework.

“Mm-hm.” K. says. “You were going to invite Clara to do some collaging.”

“I don’t remember.”

“I know.” K. says seriously.

“This is what I hate about dissociation.  It makes me scared when I can’t remember what I’ve done.  Like, it’s not there at all.  Not even a vague recollection.”  My stomach is now curled up in knots due to the anxiety.

“Nel, I’m sorry you’re so scared.  I can only imagine how frightening it must be to not remember things you’ve done.”  She says empathetically.

As always, I’m uncomfortable receiving kind words, so I move to end the phone call.  Surprisingly, she allows me to direct the conversation this way.  But not without repeating she will see me tomorrow with homework in hand.

After the phone call, I dig up an envelope full of magazine cut-outs that I brought home from Sheppard Pratt.  I internally ask Clara if she would like to help choose some things for the collage.  I don’t get any verbal response.  I don’t even feel like she’s there.  But it’s not hard to start picking out things.

I go through 2 more magazines and pull out some more things.

Then, someone pulls out our acrylic paints.  Pink, blue, and purple gets dropped on a blank canvas page, and we go to town.  Someone makes an imaginary landscape of brightly colored trees alongside some water.  The cutouts are purposely placed above or below the water.

When we’re done, Mina and I come back forward.  I’m floored.  I have no idea who has done it, but the artwork is both beautiful and frightening.  It draws you in with its beauty and then floods you with fear.  It’s like a deception.

As if to purposely trigger.

I know I should put it away, but I want to keep looking at it.  Eventually, after a couple hours, I do place it aside.

We went to therapy this morning at 10am as promised.  We brought in the painting/collage, hugging it to our chest.  Switching is all over the place.  I switch to Clara, which I believe is in System 3, but a different layer of the system.  I switch to an O—- part in System 5, or maybe a T—- part in System 4, I’m not sure.  There’s so much deception and flooding going on, and it’s all vague to me at best.

I’m not sure what work got done, if any, and now I’m co-conscious with Mina and Meg (Meg is one of our teen protector parts).  We were so tired when we came home from the session, we managed to each a bit of rice and passed out.

I wonder if she gave me any homework.

Multiple Pathways to DID Recovery

My thoughts on tumblr.

Phase One and Symptom Management

As I’ve been doing more work with our therapist, K., I’ve been reviewing some of the tools I learned at Sheppard Pratt this go around.  Some visitors who have never heard of the skills I’ve brought home have been asking for a better understanding of what I’m referring to.  Before I start sharing these skills and how I use them, I thought I’d talk a little bit about why I use them.

Sheppard Pratt follows the Triphasic Model of Trauma Treatment.  The three phases are:

1. Safety and Stabilization – Establishing safety, Recognizing symptoms, Creating emotional stability
2. Processing Trauma Memories – Done in outpatient therapy, using Phase One skills to not be stuck in avoidance or overwhelmed with traumatic material.
3. Integration – Referring to an integrated understanding of the current day, present, healed self. Trauma is part of your life story, but not the main focus anymore. This does not refer to integration of alters or parts.

[Source, Adapted from Herman, 1992]

Since Sheppard Pratt is an inpatient hospital, their main goal is to return the patient to their outpatient team with Phase One goals of safety and stabilization accomplished.

Before learning skills, safety is paramount.  In our case, we had to work with parts and our inpatient team to identify who was unsafe, their thoughts about safety, and their reasons for a lack of motivation to remain safe.  As is always the case, we discover underneath the chaos of safety issues, an immense emotional pain.  Helpling parts understand this isn’t “bad” behavior, they aren’t in “trouble”, and most importantly they aren’t alone–that we don’t have to hurt the body anymore in order to be heard–is vital.

Once risky behaviors have been identified, and there is some kind of mutual safety agreement, and safety plan in place, we can begin working on symptom management.

Many of the symptom management skills are specifically learned in Phase One of trauma treatment.

Side Note: I feel it is important to be clear, here.  I have twelve years of trauma treatment under my belt.  Even after all this time, I learned helpful tools going back to Phase One.  There has been a wealth of research on DID over the past twelve years.  I had no idea I was missing out on skills.  Many of the skills gave me a sense of power and control back over my life.

Symptom Management skills are basically lumped together under the following categories:

1. Crisis Planning
2. Grounding techniques
3. Breathing/Meditation/Imagery
4. Medications (PRNs)
5. Addressing Co-occurring Disorders
6. Hospitalization if needed to prevent harm to self or others

Besides establishing safety, the overall goals of symptom management include (1) enhancing awareness, (2) emotion regulation, (3) decreasing affect (or part) phobia, (4) building distress tolerance, and (5) enhancing effectiveness in personal relationships (and with parts). [Source]

In the upcoming posts, I plan to talk a little bit more about what each category is, and the things I learned to support our DID System find things that worked.