PTSD (Post Traumatic Stress Disorder)

EFT on DID and PTSD

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Note: Immediately following this post on DID and PTSD is an article submitted by a client. It is an insightful reaction from "the other side of the table."


By Dan Dunlap

A few weeks ago I took advantage of Gary Craig's generous offer and requested his Emotional Freedom Techniques (EFT) training videos. For the previous three weeks I have been employing EFT with four dissociative and two severe PTSD clients. In ALL cases there have been very positive results and unprecedented progress.

I have worked for over one year with a client (severe PTSD, possibly DDNOS) who had for decades heard a voice inside her/his head saying something s/he believed to be true, terminal, and inevitable. Using clinical hypnosis, we actually contained this voice internally, so client was not bothered all the time. However, this internal voice (of a familiar, abusive person) continued to be heard intermittently. After one session with EFT, and the initial Subjective Unit of Discomfort/Distress (SUD) of 10 went to 0 (it required about 4 separate sequences). This client smiled, chuckled, stated s/he felt philosophical about what happened, was surprised not to feel any anger about it, but felt like a sensation of vibration throughout the body. S/he reported no affective response to the thought voice - or abusive experience - despite efforts to exaggerate it, and was able to recount all negative aspects associated with it. Another aspect emerged with a SUD of 10 associated with being told not to cry. This lowered to a 0 and a testing of affective response to " ------- don't cry" remained at a reported 0. At the beginning of the session, my client had stated, "I guess I will have this (negative belief from thought voice) all of my life." After EFT, client could still visualize the abuser, but was not reporting any distress.

My clients report experiencing significant reductions in SUDs related to issues that have been bothersome for decades. One client said, "This is amazing . . . will it last?" A dissociative disordered (DD) client who felt sorry for those who abused her blamed herself for that. Initial SUD was a 10. Within three trials of EFT the SUD was a 0 and with that a migraine headache not impacted by strong medications lowered to a 5 (the headache had not been included in the EFT treatment). Another DD who had been bothered by intrusive recollections of a nightmare for the previous 3 days (SUD a 10), gained immediate relief (one trial required to lower to a SUD of 0) and stated that her considerable headache and pain in her eye was vanished. She was ecstatic. The nightmare had evoked a strong fear response. But during the course of EFT, client noted that the image of nightmare changed and was neutral and non-threatening. She also reported apprehensiveness regarding one college course she was retaking. Again, her SUD was a 10. after 2 trials, it lowered to a 0. She stated, "I honestly don't have any more fear about taking this class."

About three weeks ago and after having read Gary's manual and viewed his videos, a trial of EFT was employed with a client in a suicidal state. The suggestion of "trying" the EFT came after 40 minutes of my standard therapeutic approach (cognitive-behavioral) which appeared not to be very helpful. After trying the EFT, no significant reduction in her SUD was realized despite persistent efforts on both of our parts. She continued to report numbers varying between 10 and 8 and back up to 10 again. She reported feeling overwhelmed and had difficulty focusing on just one problem or aspect. She did feel somewhat relieved, and IMO her facial expression appeared somewhat less distress, but the lowest we got was an "8." Yesterday, EFT was successful in bringing a burdensome experience of "feeling responsible" from a 10 to a 0. This client wondered if it would last and indicated that this had been the most helpful treatment experience to date.

I really do not care how one wishes to explain these results. I have seen these clients from 1.5 to 6 years and have never in my experience with them - employing clinical hypnosis, insight-oriented or cognitive-behavioral approaches - had these kind of results reported. Not only are these clients feeling free of distress associated with certain of the affects/beliefs processed with EFT, they are reporting little hesitance in exploring aspects associated with them. It is like the apprehensiveness to "look at" old stuff is just not there for the particular issue.

With my one of my DD clients, I inquired how the EFT experience had felt. This client noted that 3 alters were laughing internally, but felt that it had been surprisingly helpful. In the absence of any literature with respect to employing EFT or TFT with DD clients, my approach has been to offer a full explanation of the technique, employ it only on some problem we have info about or that is pressing at the time of the session, not pressure the utilization of the technique, give lots of permission to discontinue for any reason, assure that no internal parts object to it. So far, during sessions that have been no reported ill effects. However, two clients are reporting the emergence of previously unknown alters or - in one case - of emergence of an alter that had not been present since the 1980s. Fortunately, we had already had a positive experience meeting new, emerging alters. Without that, this probably would have been quite distressing. I might add that with one particular client who suffered a particularly physically abusive childhood, the EFT procedure has twice ended up with a regressed child state being present (previously unknown to the system). Recently, the child state present could not use the SUD 0 - 10 system and relied on describing the distress in terms of a big vs. small ball.

I would be very interested in comments (backchannel or to list) regarding experiences with TFT, EFT, or EMDR with similar clients.Author: Dan Dunlap


A Client Responds to EFT on DID

Hi Everyone,

After Dan Dunlap's superb articles on EFT's use on Dissociative Identity Disorder (DID), I received a response from the client's side of the problem. He gave his views as though he was DID himself but didn't say so directly. I then asked him if he was, indeed, DID. He doesn't like the label and asked that I publish the following two introductory paragraphs BEFORE publishing his original response. He is quite articulate and I think we have much to learn from him. How often do you get a candid look inside the thoughts of your client when they have a chance to give them anonymously?

One more point. By his own admission, he is a bit wordy and he included much of the previous correspondence (which you've already seen) within his already lengthy letter. I eliminated the previous correspondence in the interest of brevity but placed comments in [brackets] to bridge the gaps where references were made.

THE TWO INTRODUCTORY PARAGRAPHS:

"Gary asked me if I am DID. I am not diagnosed with any psychological or psychiatric condition or disorder. I am an example of the sexually abused children who need to hide their experience from the world for many years and constitute themselves in a fragmented manner in order to achieve that end. I have needed almost five years of intensive emotional work to recover and corroborate my memories of sexual assault in childhood and to start adapting my behaviour to that knowledge. In the process of sorting myself out I have experienced numerous dissociative episodes or abreactions. I have mild amnestia barriers, it would be difficult to determine whether these are severe enough to divide 'alters' but I certainly have different personality states. I have a great deal in common with people who have been diagnosed DID, DDNOS or DD and know about twenty in RL or through the net. We think the same way, have the same sort of problems and find similar things help us with those problems. On balance I would answer 'Yes' to Gary's question,reference to GC's question as to whether or not he was diagnosed DID but do not prefer to be so described and have not found it necessary to be so diagnosed in order to make progress in healing. Nowadays I am learning to move on.

DID is an American Psychiatric Association diagnostic category. _Please_ check the definition and criteria in the current DSM and do not ascribe this label, even conversationally, without caution. The social and political atmosphere surrounding this diagnosis is a very cruel aspect of what is already a very cruel situation - remember that if a client _is_ DID then at heart you are almost certainly dealing with a sexually assaulted child who is yet to come to terms with that assault and in some sense may not even have 'felt' the assault yet. Fragmentation and other DID characteristics are normal reactions to abnormal stress - it is surprising how much progress can be made by using common sense and accepting that extreme symptoms may simply represent vastly magnified ordinary reactions. The last point I want to make is that in my comments to Gary I use various terms of proportion in reference to the dissociative community - words like 'many', 'some', 'most of', 'lots of' and so on - please do not infer any specific sense of probability from these terms, my experience is limited and my sense of these proportions may well be skewed by my own interests. I am only offering my own views gleaned from about two years of regular interaction with highly dissociative people (including myself). <sings>

"Getting to Know Me"."

THE ORIGINAL RESPONSE:

"Dear Gary, A wordy bastard at the best and worst of times and usually all times in between, I cannot figure the ones to say right now. Ain't enough belief in the world to believe how much I appreciated reading your responses and this story. It was also kinda fun seeing the sort of difficulty your end of the client-therapist relationship has in coming to conceptual grips with DID and dissociative personality structure <cheeky grin>. I'd like to say a coupla things lower down, not a shadow of a criticism among them!

Many DID's have (one or some) very knowledge-thirsty part(s) - some would say it's a matter of necessarily hypervigilant emotional states being translated as personality fragments - might passively soak up information and thus only be observant, or may be more active and ask endless questions. Or both, separately or in combination. A DID person can seem to spend half an hour staring at the floor saying nothing and then launch into a half hour analysis of your entire bookshelf without looking at it, the titles of the books having been read and remembered one by one each time you blinked. Really. You'd notice them look away once or twice. Not saying it's common (or particularly clever or useful), just that weird little tricks like that seem to develop for each individual (and may be specific to a particular 'alter' or may be more shared) and can be clues about what's 'going on' at any given time

- which 'alters' are most present for instance. They're often the sort of things you might have done as a kid with a teacher or parent when you were first realising you had a little more independence than you

thought, so they're not particularly 'special' things, just unusually well-developed and practised and relatively surprising in an adult.

On terminology - you've probably figured this out anyway but there's no really exact model for DID that everyone accepts, including the APAs or the clients. DID is a psychiatric diagnosis really, and has a diagnostic criteria list which a very precise psychiatrist would use but for most DIDs and dissociatives I know terms like 'alter', 'part', 'ego state', 'personality fragment' are fairly equivalent. People tend to have their own personal preference so it can be a touchy subject; some people are very determined to have a strictly labelled and described 'system' and some couldn't give a hoot as long as there's acceptance of some sort of different personality states within one body - whether they're numbered, named, labelled, logged, filed, counted or anything else. Makes it a battle of tact sometimes. Golden rule is (IMHO) to be accepting of the way the client sees themselves - this also means that the client feels more comfortable as they heal and deal that they can change the way they're put together as and when and if they choose.

Very difficult aspect of DID work. [reference to Dan Dunlap's client's propensity toward suicide] There's usually a suicidal drive :( and self-destructive behaviour :( One of the fundamental things to DID/severe dissociation could be described as the prohibition of being the self - most of us, one way or another, believe or have been taught that to 'be oneself' is to die. That's my theory anyway, and seems to be born out amongst those I know. That's a hard belief to challenge, especially when the belief was developed in early childhood and has remained unchallenged for so long. Most DIDs have very little or no central sense of self or life. It's hard to find the right words but there's commonly no belief that one's life is one's own - it's more something demanded of you than something you have or go through. And there is often, very often, a lot of pain in that understanding - it's like your life is something you *have to do*, not in a vital sense but purely as a responsibility, every day getting up and being inexplicably required to live in various patterns not of your own choosing. In some ways it could be described as the purest form of slavery, when it's really bad. Locked in a cage in your own mind would be another way of looking at it, your soul carried by an automaton over which you seem to have little control. I could think of a million more gloomy analogies, so I won't. That's the suicidal part, the central self that has been hurt and hidden for (sometimes) decades and never seen a different view.

All dissociatives I've known also have hysterically funny sides to themselves as well :) But healing (IMHO again, and this is the case for me; I do not think this is invariably possible) does require getting down to that traumatised child and letting them find the light again. "It can be done... We have the technology" (Remember The Six Million Dollar Man?).

Thank you for your care and your reticence in advising any particular course of action here. reference here is to GC's not advising Dan Dunlap re: what to do regarding his client's suicidal tendenciesI'm glad to say that this is what I expected you to say, rationally, but there's always the fear in me that people will just not 'get' that dissociatives are virtually 'programmed' to self-destruct and tend to need an even more responsible and careful approach than average on suicide. I don't honestly believe anyone can 'prevent' a suicide (in a fatalistic sense) so I would never 'blame' a therapist for getting it wrong or something, but it's certainly true that you can help someone to find a way to live. The basic trauma and associated circumstances that usually form a dissociative personality are, thank God, quite rare of course but a part of the usual circumstance is the belief that to be 'helped' would mean to be annihilated. This is one reason why it's such slow progress - every step

in the right direction can be interpreted by the client on some level as the risk of death, and they usually have some experiences which are pretty close to that already. The fear that you have to go through can

be absolutely physically debilitating. Therapy can be an incredibly exhausting process - I often need to sleep for a day or two afterwards and I only see my therapist once a month or so. Then again I've got a lot of other problems.

What am I trying to get to? Oh yes, the suicide thing. Well, as you can see it hasn't proven an insurmountable obstacle for me. I can tell you my own experience with this problem and how it was resolved for me - and I can advise you that three others I know had the same experience and resolved it in the same manner. Eventually, simply, I decided I wanted to live, for better or worse. Simple of course. I made that decision. I'll try to explain. Perhaps it's something that kids naturally do at some age - realise that if they really really wanted to they could kill themselves and they decide not to. I have no idea. I did not grow up believing I had a life, I always thought I had either been killed and it hadn't quite taken hold, or was in permanent imminent danger of being dead anyway. The idea that I might kill myself was certainly more an act that I could reserve as one of defiance than submission - since my life was not my own then to kill myself would be a rebellion against the pain and confinement. But that in itself is not a very pleasant view of the world, of course - and one that is frowned upon quite blatantly. Can you imagine for a moment? Your life is a burden, a responsibility, a task that you are required to carry out, and the only thing you can use against that is the posibility that you can be the one who ends the contract - but it is wrong and shameful according to your peers and your society to take that path. Your only sense of hope is in itself one of the most heinous of crimes. In a mind that is already overwhelmed by rules of conduct and division and prohibitions against freedom of action

there is one more rule - you must not free yourself by that last hope. Not allowed.

Eventually I broke that 'Not allowed'. I said, yes I am. I was inspired by an interview with a Dutch multiple and her psychiatrist who, in a very safe setting, after they had been working together for about three years, let the woman know that if she wanted to she *could* take her own life, that it *was* up to her, whatever the moral or spiritual implications, it *was* her choice to take. On the tape she cried, at home I cried. And that's about when I knew I was alive for the first time since I'd been a kid. It was like coming home - it was the most significant emotional turning point in my life. The others I mentioned had similar experiences in different ways. They came to the acceptance that it was their choice. I don't have any idea how a therapist can possibly assess whether someone is ready to hear it said gently and lovingly that if they want to then it's entirely okay if they commit suicide. I don't think I will ever say it to anyone. My friends agree; it is something we each think should be left to the person's own internal workings, or some matter of chance as happened with me. I'm not suggesting that there is some way I think this sort of thing could be orchestrated, and of course people come to the decision to live in all sorts of ways. But for DID people there seems to be a significant turning point along a healing path where the former 'burden' of being alive and constantly suicidal does expire and the realisation dawns that yes, the decision is in our own hands.

I don't, by the way, mean that your thoughts about clearing the jungle are not valid. That could certainly help in many ways. But I don't know if the connection to the suicidal drive is quite right since some parts might see it as threatening to 'help' and still be so wrapped up in the belief that help equals danger that self-destructive capacities come to the fore. You can't really work with a DID client in terms of parts, you see, because even though you may only see one or two parts and the client may not be aware of which parts are present or active - well basically they're still all there all the time. So, well, you can work on separate parts but you have to accept that all parts are *actually* going to be working together in order for you to successfully work with one. You need to be sure of that whole system's trust before going into the 'jungle', just as Dan [Dunlap] said earlier - 'should any part of the system have any concerns about the process, I should be informed' - so if some part of the system sees the clearance as potentially too revealing (and thus potentially a suicidal act in itself) then there's a clear acceptance that just shutting down and stopping is the first option.

Oh God this is complex for me. I have no idea if any of this is helpful to you Gary, or if you've really got the time to read all this or if I'm just going round in circles and not making much sense anyway <G>. Nothing new if that's the case.

I hope some of what I've written is useful to you. It's been useful to me to write it, so I guess that's *something* positive.

One more time, Gary - Thank you so much for what I read here. Maybe just you tapping a *keyboard* helps, huh? <G>

Author's name withheld for privacy reasons.

 

 

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