An excellent blog about the myths preventing some people from seeking trauma therapy.
Considerations for survivors of extreme trauma and ritual abuse
Timescales for healing
The treatment guidelines for Complex PTSD by the ISTSS give a longer healing than the article above – between 18 months and 2 years is suggested, but this will depend on the degree of trauma and your current situation in life. If you are one of the many survivors who is still living with domestic violence or experience a bereavement during treatment, for example, then it may take longer.
Myth No. 2: No therapist can handle all of my trauma and emotions. It is just too much.
Firstly, in common with the Complex PTSD treatment guidelines, the Dissociative Identity Disorder treatment guidelines describe the first stage in treatment as focusing on Safety and Stability – learning more ways to cope with difficult emotions and trauma symptoms before trauma is discussed directly. Ways to contain existing trauma memories for a time may be needed. Therapists should also be comfortable working with clients who have additional diagnoses, self-injure and have previously had multiple suicide attempts. These are all common in survivors of severe and prolonged trauma.
Secondly, it is true that many therapists cannot manage the severity of trauma that many people with Dissociative Identity Disorder, Other Specified Dissociative Disorder (DDNOS) or extreme abuse have experienced. It can be particularly difficult because both disorders are caused with very early repeated trauma, typically at pre-school age or younger. Consequences can be either the vicarious traumatization of the therapist, or denial and minimization because he/she can’t face the reality of it. Things that help include:
1. Looking for a therapist who has worked with similar disorders or trauma before, rather than someone mostly familiar with simple PTSD. E.g. try Find a Therapist on http://isst-d.org or Trauma / Dissociation professional organizations, and ask for recommendations if none are close by/or available for very long term work.
- A therapist who has a supervisor with experience in the same field can help your therapist by spotting very early signs of difficulty and suggesting ways to handle this without while continuing therapy, this won’t you involve directly. An old publication by Kluft (1989) provides a way for therapists to handle this if it happens and includes indicators of when continuing therapy could be harmful (generally avoidable if earlier action is taken).
The rehabilitation of therapists overwhelmed by their work with MPD patients.
- Therapists working with such complex clients need to be available for long term work, and willing to spend additional time on professional development. Therapists considering working with ritual abuse survivors can find valuable guidance in Dr Alison Miller’s book, Healing the Unimaginable (2012). Chapter 7 by survivor Stella Katz describes her ‘job’ in the cult, containing graphic descriptions of her role in torturing children, and explaining why she did this before she left the cult and ultimately healed. The ISST-D ritual abuse special interest group (for professionals) may be helpful.
Therapists who are suitable may be very difficult find, but some exist.
Myth No. 5: The therapist will judge me if I tell him or her what happened.
A trauma therapist’s role is to help guide and support someone who has experienced trauma, not to criticize or blame.
The DSM-5 diagnostic criteria for PTSD (criteria D) include distorted thinking surrounding the trauma resulting in self-blame, persistent shame, guilt, horror and/or anger, and negative beliefs about yourself, example ‘I am bad’. A therapist will be able to work through these with you, along with the additional symptoms of Complex PTSD and Dissociation.
All victims have been forced to perpetrate against others, usually since early childhood. All perpetrators are victims of severe abuse. Keeping this in mind is critical in treating survivors. Black-white or evil-good frameworks feed into survivors’ fears that they are irredeemably evil.
Dr Ellen P. Lacter, clinical psychologist
If you experienced ritual abuse then it is extremely likely that you were forced or tricked into doing things which horrify you and carry immense shame. You may have been forced to harm or kill others (forced perpetration) or have been forced to make impossible ‘choices’ such as choosing between having another child harmed or being harmed (double binds). These are common ways that abusive groups use to damage children and vulnerable adults – it is one way that abusers use to keep survivors silent, they often blame you or pretend ‘choice’ when you were not free choose to do normal childhood things or to leave. This is so awful and unbearable that it commonly creates different alter identities to do what abusers demand, an identity lacking empathy may be needed. Feeling intense guilt and shame now shows that you regret what happened, a sign that you are not truly ‘bad’.
Therapy should be able to help you understand why you acted as did, the effect of previous trauma on your mind, and help you reinterpret the trauma with an adult perspective.
Lastly, the no particular type of therapy is recommended above others for complex Dissociative Disorders, a good alliance between therapist and client leads to the most effective therapy. According to Kluft, Dissociative Identity Disorder will not spontaneously resolve without treatment (a small number of cases of PTSD without a dissociative disorder do resolve without treatment).