What do we need as aging survivors?
Our voice....
Our voice is what has been stifled for years, an for some it has
been decades - from the first day, the
first moment, of the first abusive sexual encounter in childhood. ALL of
the therapy we ever received has encouraged each of us to re-find our voice, to
grapple with the intense shame, and to speak out regardless of the shame we have
felt (for decades). We each need to find ways to claim our voice -
now - before we die in an aged body as a terribly hurt and abused child.
Support....
We need continued support of friends, family, and therapists.
Far too often, we hear "Why can't you JUST get over it?" Or we
hear platitudes and empty "praise" for having survived things that
were so bad that other people cannot even imagine what we describe.
Instead of praise and platitudes, or condemnation for not "letting it
go," aging survivors need to know the presence of one or a few who will
walk the journey with the survivor, as much as possible. Just walk along
with the survivor. If one - or both - of you find a new way, a new
possible solution, explore it together. But, when times are rough,
flashbacks reappear, the survivor stumbles or falls, the survivor needs to know
that someone is there who won't judge or condemn. We need to know we
are not alone!
Drop the expectation of "integration"....
Therapists in the 1980s focused (so) strongly on integration,
based largely on the concept of there "always" being an ISH (Internal
Self Helper) and a "Core Personality." From these two, it was
believed that "integration" could be attained by every DID survivor.
But, this has not been true for EVERY survivor! Many, many survivors were
actually harmed by over-zealous therapists who believed the only path to healing
was through integration. In fact, many, many, many survivors have lived
better and easier lives by concentrating on "cooperation" among and
between their parts/alters. Yes, it is an ongoing, sometimes daily
process to find and use cooperation, but it is imperative and useful if one is
striving for a calmer daily life. Cooperation can be used "on the way
to" integration -- if integration ends up being what the survivor WANTS.
But when a therapist focuses on integration as THE GOAL, they are missing the
intervening time: What does a person do, and how do they live day-to-day if
there is constant upheaval, constant interruptions, constant acting-out,
constant stress, constant fear of being found out by outsiders when their alters
are constantly acting out, and living in constant....hell ? There has got
to be a middle process and that process needs to focus on cooperation.
Survivors (and their alters) can continue to work towards integration, if that
is what they want, but in cooperation they can have some semblance of a calmer
life.
Drop expectations of a magical moment of healing and recovery...
I truly think that therapists of survivors have not only missed
the mark, but have inflicted damage on survivors by creating the false hope and
belief that there is some magical point of "healing" and
"recovery." Childhood sexual abuses and other abuses are
not like a trauma like needing emergency surgery for an appendectomy! That
kind of surgery has a point at which "recovery" is
"expected" -- the person can get up within a day, start walking, and
probably be home within a week. "Recovery" though is longer,
while the incision heals and the body repairs itself. But even weeks and
months later, the scar can hurt and burn and 'pull' - often at unexpected times.
Years later, the surgery may just be a long-ago memory, but it can also come
back in various, even though temporary, reminders. My grandmother had her
gallbladder removed, only to deal with intermittent diarrhea for over 60 years
after the surgery. Persons with disk injuries may have spinal surgery but
need to take extra care in doing certain activities, or they will create back
spasms or other pain. So, why do therapists seem to think that YEARS OF
ABUSE have some magical moment of healing and recovery???
Instead, the survivor might benefit by being treated much the
same as a "recover-ing" alcoholic. I do NOT mean to imply in any
way that sexual abuse is the same as alcoholism or drug abuse -- but that there
is similarities in that there is a process of ups and downs and ongoing
struggles and recurrence and that stress can worsen the issues and symptoms.
Dissociation and Post Traumatic Stress Disorder are so similar, yet therapists
still cannot get Vietnam Vets to the "magical moment of healing and
recovery" that therapists talk about when treating a person with
Dissociative Identity Disorder!! Sooooo, WHY do therapists create this
false hope, false expectation, and put undue stress on a survivor who does not
achieve that milestone??? I submit it is because it is the need of the
therapists to believe that a supposed "healing" and
"recovery" can be found. After more than 25 years of
working with DID and survivors, I would think that therapists might have
realized by now that survivors of childhood abuses have ongoing issues that
do not just go away in a few years of weekly sessions!
This is not to say that every survivor - or any survivor - needs
weekly therapy for the rest of their lives, but I do not believe the past or
current therapy practices since the 1980s really address what survivors need.
New coping methods to replace old, and
reinforcement of useful coping methods....
Survivors often feel they live in an ongoing "war"
inside. It is tiring to live with constant triggers, constant flashbacks,
constant unresolved feelings. Most survivors can, and do, bury the
issues for short or long periods, until things overflow and nothing will contain
the pain or emotions.
In my experience of therapy in my teens and 20s, there was much
more focus on "who is there" and "mapping the alters" and
the therapist saying "I want to talk to ___"(alter), rather than
focusing on ways to cope and increase communication.
I will admit, the one coping method therapists pushed was not
something I thought would do much -- writing or journaling. I thought,
"heck I already write! So what! What good does that do?"
And, in fact, I did write obediently, and took my writing to the therapist to
read. And......... that was that! Nothing was done about what I
wrote, nothing was really discussed about what was written by me or an alter.
Same with drawing.
When I returned to therapy years later, the new therapist
actually asked me questions about what was written and drawn -- AND -- discussed
what she saw or felt when reading the journal and seeing the drawings! It
was then that I could start to "see" what others saw, to understand
what I (and my parts) were trying so hard to make ourselves and outsiders
"see" and "know." But previous therapists were so
intent on "who's there" and who would talk today, along with pressure
to integrate, that the therapist forgot to teach me a skill I needed -- to be
able to stand back to see and hear myself and my parts! Read
more about Coping
Through Drawing in the sexual abuse articles and look at the artwork on this
website.
An elderly professor I met helped in this, by talking to me
about perception and how one "sees" in the world. We have
all seen the photos and drawings where a picture can look like an old woman's
face AND something else in the same picture. When a person changes
their focus in looking at the picture, thoughts and feelings can change with
what they "see." Once you "see" the two-images-in-one,
it is much easier to switch one's focus back and forth between two, very
different images that can often create very different emotions! This
shifting of perception, what one "sees" (and thus "feels"),
and the ability to shift between the two, is a valuable tool for those with DID.
It helps to be able to shift one's focus between two "images" of two
alters/parts, while being able to "see" both or either of them,
together, or one, all at the same time. Read more about Coping
through Writing.
Later, I came to the realization that music could help me and my
parts, in two ways. First, music can be used to match the feeling one has,
especially when it is hard to be in touch with that feeling. Sadness,
shame, guilt, along with joy, happiness, and playfulness, are often hard for
survivors to really feel. But, music that matches those feelings, or
matches moods, can bring it to the surface. "Concrete Angel" by
Martina McBride is powerful in dealing with shame, as is "Sisters" by
Cris Williamson. I wrote about Coping
With Music if you want to read more. But, music can also greatly
change one's feelings or mood! Ever see people react to the
old song "Don't Worry - Be Happy" or a favorite song with a great
dance beat? Try it. You'll be surprised how much your mood
(and feelings) will change in the time it takes to play one or two songs.
When you realize an average song is under 3.30 minutes, you'll be amazed at what
one song or two can do for you.
Illness and Coping.....
Many skills therapists preach in early therapy just don't work
after one has become chronically ill.. Taking a walk, doing physical
activities, or pounding pillows with fists or a baseball bat just don't work
if you are stuck in a hospital bed because of illness, or are unable to get up
and walk, or have caregivers around so that you have NO privacy.
Other than writing, drawing, or "dancing" in bed, or having someone to
talk to, coping methods are very limited.
What is outrageous though, is when a person becomes too ill to
go out of their house, almost no therapists will agree to do therapy by
telephone -- at a time when an physically ill survivor needs support the most!
One therapist I heard about demanded the client come in person to the office,
and said that "if the client wanted to get well badly enough the client
would come arrive in person" -- despite the fact that this client was on
mandatory bedrest on orders from their medical doctor! Another patient was
bedridden and could not get out of her house.
Therapists need to evolve to serve the needs of the aging
survivor. If the client cannot come to the office, Medicare and most State
Medicaid WILL pay for telephone services. Paperwork and intake forms CAN
be done via postal mail. The bottom line is, all survivors who are
medically disabled or incapacitated and who are in need of therapy should be
able to receive services, despite the physical limitations.
If you, like many ill or disabled survivors, cannot get therapy
by phone, or via internet services (please check the State Licensing BEFORE
doing internet therapy), you'll need to have a strong support system in place.
Many of us, though, don't have a good support network -- and while therapists
preach about having a support system, few therapists actually teach HOW to build
a support system.
Teach HOW to build a Support System....
Most friendships are built around common interests or sometimes,
even problems. A mother may meet people through a parent support
group focusing on their child's ADHD, but if the only thing the friends discuss
is that disorder, the friendship won't be long-lasting. Many
survivors find their support people don't stay around very long -- and cannot
figure out why. Therapy itself creates a false world where every
thought and every feeling is openly discussed, and is seen as
"normal." But therapists do a disservice to clients when they
never address the differences between therapy and friendship, and what skills a
client needs to build a support system where there is mutual give-and-take in
communication, disclosure, talk about common interests and what 2 people need to
have a friendship. So in the initial therapy, one focus should be HOW most
people build friendships. Therapists should assume the person may NOT know
how, given how much of childhood was spent dealing with abuse with few to no
common interests to "share."
My therapist in 1986 harmed me when I mentioned I was thinking
of applying to college; his reply, with his head down, face reading disapproval
and skepticism, was "I don't think that is a good idea..."
That little statement said to me "there's something so wrong with
you," that people would not like me, want me around, that I'd stick out and
be so different and that others would somehow "know" I was "not
right." It was what he did NOT say that gave me ample
opportunity to fill in with plenty of negative and shame-filled endings to his
statement. Later, I would wonder endlessly WHY he thought it wasn't a good
idea! Why was it not positive that *I* felt ready to expand my world?
Why didn't he support me? Why did he have so little faith in me? His
words haunted me a year later, after a bad termination with him, both causing me
to struggle everyday with whether I should be a college student, or go home!
Therapists (or you could do this on your own) should ask the
client to write down every interest and hobby they have, and discuss local
places where a client might find like-minded persons. Let's say you
have interests in: acting in plays, quilting, collecting glass wares and old
dolls, and drawing. Locally, you could join the local theater (even as a
stage hand if you don't feel comfortable acting yet), find a quilting group,
attend auctions or flea markets for collectibles, and maybe enroll in a weekend
drawing class. You don't have to do all these at once ;-) [I know
multi-tasking!] but you could focus on one or two. While engaging others
about your common interest, you may find other commonalities and a new
friendship. With guidance, you can learn more about what it takes to
build the new friendship into a long-term relationship.
The computer and internet access is almost imperative for the
disabled or ill person. Search for chats or mailing lists on subjects that
interest you, join and watch for awhile to get to know the people and to feel
safer. Then jump in. You might find yourself becoming one of the
"old time regulars of the group," able to assist others with the
subject of interest, or with your personal experiences. Some of these
contacts may turn into friendships that last years and may extend to telephone
calls, cards and letters. Over time you can build supports for regular
chit-chat, a few for shared interests, and a few buddies to share your personal
journey. (See http://www.cyberparent.com/friendship/build.htm)
Dealing with fears...
Fears seem to grow as survivors age, especially after grown
children leave, after divorce, after major illnesses are diagnosed, and as one
struggles to deal with the continuing issues of the abuses. As other
non-abused folks, we come to realize just how alone we are in the world.
But unlike non-abused folks, we still carry with us an internal
"family" who remains totally dependent on us to manage life in the
outside world ... [and yes, often some alters manage aspects of the real world
better than we can or do]. Yet, we are painfully aware that we are
alone. The good part of this is that we realize that no other person,
anywhere, understands our alters/parts better than WE understand them. The
bad part of this is that realization can feel like a scary burden.
One fear that goes with this scary burden is "what is to
become of 'us' if I cannot care for my parts/alters like they need of me?"
And if diagnosed with a major physical illness or if one becomes disabled, that
fear becomes so tangible, it's feels like you are actually in a crowded room of
parts who are all looking to you for direction.
Whenever a survivor with DID needs to be hospitalized or needs
tests or procedures, the person must draw on every skill learned over the years.
Alters get in an uproar so badly sometimes that all but the most critical
medical tests are skipped. Of course, this doesn't make doctors very happy
-- and it is often too difficult to explaain, especially if you don't want your
DID diagnosis making its way into your medical or hospital record. Too
often, staff don't understand the diagnosis; telling medical staff runs the risk
of being treated like an unstable, histrionic "psychiatric" patient --
which seems to harm rather than help most DID persons I've known.
Therefore, like many, many rape victims, survivors of sexual
abuse and those with DID avoid medical and dental exams and treatments.
Survivors try to ignore physical symptoms or are not complete in describing
symptoms. We hope doctors can help us with a medical problem, yet we are
too frightened to tell a doctor ALL of our symptoms lest they say we need to be
hospitalized. And, ignorant of our struggle about our background of abuse,
a doctor remains unknowing about our real physical problems -- or, thinks we are
hypochondriacs or histrionic because they only hear bits and pieces of unrelated
symptoms that don't fit any specific medical diagnosis. I venture to bet
that if DIDs had a real complete medical and dental work-up and exam, most would
have one to a few medical and dental problems which require urgent attention and
treatment. Yet, most of those same survivors would still have a hard time
going for treatment and would resist or fail to follow through with the
treatment recommended. Indeed, most DIDers even have trouble getting all
alters to agree to take medications, to take them at the dose prescribed (most
often survivors take LESS than the prescribed amount), or to take medicines on a
regular basis. DIDers also often have differing and unexpected reactions
to medicines, including many side effects to low-level doses. These
reactions are often difficult to explain to doctors.
The more one ages, and has to deal with often chronic and
serious illnesses or disability, the more a person fears the unknown future.
"Who will take care of me (us) if I need help? What will happen IF I
have to go to a nursing home?" One DID friend put off knee surgery,
even though she could remain awake (and feel in more control), because she felt
her alters would get out of control in the hospital setting. Another
friend feared back surgery for the same reason, plus she feared going to an
in-patient rehab center for the post-surgery rehab her doctor was recommending.
Another friend can barely bring her body in for blood tests to control her
thyroid disorder because of her alters' reactions to needles of any kind.
A DID woman who lives in Washington State, a dear friend of mine, simply
accepted the poor condition of her teeth, which became so bad that the dentist
wanted her to be admitted to have all her teeth removed in surgery - but to date
she refuses to go, and she is constantly battling infections. If these are
the difficulties DIDers and survivors face about going to the doctor's office or
hospital, HOW much harder would it be if age, illness, or disability requires
that they are admitted to a nursing home?
Medical and dental doctors need to be aware of these issues.
The primary doctor needs to work in tests or bloodwork during the office visit,
and do one of the long list of exams that have been neglected, often for years.
If done in the office (rather than giving a prescription order to the patient),
the survivor cannot put it off as easily as when they are supposed to
do it on their own. For more personal exams (breast; gyne; rectal ;
prostate) the survivor MUST have a good, trusting relationship FIRST
-- or -- the exam is just - not - ggonna - happen!! The person may
even need to discuss their fears and aversion with a therapist who is very
knowledgeable about these issues. (Unfortunately, though, there are few
therapists who have the background and professional knowledge to assist
survivors through medical and dental areas.) More professionals need to
specialize in this area - kind of a Medical-Dental Therapist. The need is
certainly present in society, and the need for specialized therapists will only
increase as survivors age!
Nursing homes and caregivers need educated.....
While I'm on the subject of education, if survivors have
difficulty getting themselves health and dental care NOW, in their 40s and 50s,
HOW will these same survivors fare if they do need to go to a nursing home in
their 60s, 70s and 80s? If survivors feel so shamed and distressed
about telling their doctor or dentist about their abuse background NOW, how will
survivors tell their 24 hour caregivers in home care or nursing homes?
I've been living this issue for the past several years of receiving home care,
but it has not felt safe to reveal anything to the caregivers in my own home.
I deal with the issues as best I can, but still, in all honesty, the best time
of every day is when the helper goes home and I no longer have to hide my issues
so completely. But, this would not be the situation in a nursing facility,
where staff remains 24 hours a day. So I've thought A LOT about this
issue, given my health and lack of other options.
I cannot imagine staff reaction to a child alter popping out to
speak to them, or how staff would deal with alters who are afraid or angered.
Wait, yes, I do know. The fearful would get quieted with anti-anxiety
drugs; the angry ones would be sedated, or given Haldol for supposed
"agitation." No staff would be able, or capable, of dealing with
"issues" that can (and will) arise.
So I see a great need to start educating doctors and medical
staffs NOW, to prepare for a population who has very specific issues and needs.
And to develop protocols for dealing with DIDers who strived for cooperation
among their parts along their life's path.
But will medical personnel get the education survivors
need? I'd guess no -- or at least not before the time I might need
increased services.
Dealing with our parents who may have been our abusers......
A dear friend of mine has a beautiful blonde-haired, blue-eyed,
gifted and talented 7-year-old boy who plays soccer and has a great numbers of
friends. Her whole world has been about creating the best life for her
son, giving him the love and attention she was robbed of as a child. The
majority of the rest of her outside world is devoted to making a quality
marriage with her soul mate. All this energy going to these two precious
people in her life leaves little energy to deal with her inner world of DID.
And she faces a huge quandary at least every week. Her parents.
Her parents were her primary abusers. Yet, they are also
now grandparents to her son, and they don't act like they acted with her as
a child. It might be easier if they acted the same as back then
- because then it would be easier to cut off all contact. But, the
grandparents act the same as the majority of non-abusing grandparents - they are
loving, attentive and giving to her son.
The abusive father half-acknowledges his past abuse: "Are
you going to punish me forever for my past bad actions?" In one
sentence, he "admits" his wrongdoing, but places the guilt right onto
the daughter he abused. Her mother is much the same, but it was mostly her
passivity in not protecting her daughter that remains so painful now. And
the daughter, now striving to do the best for her own child, faces the dilemma
of many adult survivors: "Do I let my abusers near my child? Am
I sure they are not abusive now? And, how can I deny my child a
relationship with his grandparents?"
In the past, therapists often encouraged and even pressured
survivors to "cut off ALL contact" with family, especially the
abuser(s). Often, this meant cutting off relationships with both
parents or any married pair (e.g. such as an aunt and uncle). Many
survivors followed this advice in the 1980s and 1990s. But, the fact is,
the baby-boomer generation is now having to deal with these relationships,
especially if there are grandchildren, or if the parents are elderly or ailing;
Society still expects children to care for their parents. Survivors must
struggle with what it means to be "a good child to their parents,"
balanced with what it means and what they value of "being a good parent to
their own offspring." Resolving that struggle often feels to
the survivor like they are betraying themselves in the process!
Therapists also encouraged and often insisted that survivors
confront their abusers, and many survivors went through terror before, during,
and after such confrontations -- which were rarely beneficial to the survivor.
Rarely did the abuser react in any way that was healing or that was good to the
psyche of the survivor. And since many abusers were a parent or both
parents, the relationship has never quite been easy since the confrontation.
And now, the survivor is expected to care for the "abuser" in that
person's old age. Quite a quandary. But, in that quandary,
rarely is a therapist present now to help a survivor deal with these issues.
Therapists needed to think more ahead in time, to consider the
fact that family never really goes away (no matter how much we might wish this).
Long-range, it becomes impossible for most survivors to not have contact with
their once-abuser-family member(s). And, hopefully, the
current group of therapists have realized that their old advice often caused
more problems than it resolved.
I know others who have confronted their abusers, as I did also
with some of mine. A brave woman even did a television documentary of
preparing to confront her now-elderly father, filming the process she went
through beforehand, their meeting on the front porch where he simply denied any
memory of what she was talking about.... followed by her out of control raging
and tears after their meeting. Unfortunately -- most abusers DO deny doing
those awful acts they once perpetrated upon daughters, sons, nieces, nephews,
and family acquaintances. More than one survivor has undertaken a
confrontation, only to be devastated and emotionally anguished when the abuser
denied any abuse whatsoever. Given how devastating it has been for
so many clients, I've often wondered if therapists have ever done a study of
those survivors who did confront? Have therapists ever documented the
benefits - versus the calamity caused to the survivor? I've never seen
such a study.
I'm not saying survivors should not use their voice to stand up
to past abusers. But therapists rarely prepare clients for the very real
and very common outcomes to confronting. And there is NO attention given
to how a survivor can re-build some type of relationship with parents who
abused. When survivors are middle-aged, they suddenly HAVE to
figure out the relationships that therapists only had told them to
"confront the abuser" and "cut off all contact." Even
those survivors who continued contact through the years cannot help but notice
the irony of now having to care for an ailing parent when in the past, the only
advice a therapist ever gave was "don't talk to them."
Forgiveness.....
Therapists also bring up forgiveness of abusers, almost
insisting the client "forgives" the abuser, but never really bring a
survivor through the process of forgiving. To many of the survivors
I've talked to, the reaction is totally negative to just hearing the word
"forgiveness." Therapists throw around obscure (at least at
first) concepts like "black and white thinking" in sometimes
brow-beating clients to get on with forgiving those who hurt them in the past.
And when a client cannot figure out how to forgive, the therapist (again)
accuses the person of "not wanting to heal."
Since the word "forgiveness" is almost a dirty word to
most survivors, I think therapists need to revise this whole part of therapy,
which borders on instilling a religious type of guilt in the client (and
religious guilt can be SO very aversive to so many survivors).
I can still hear the therapist: "Forgiving doesn't mean
what the person did was okay, but that you let go of what they did to you so you
can get beyond it and heal. You forgive, but not forget." Oh
yeah? First, this puts that false point of "healing" into
the picture again. And there is inadequate explanation of
"forgiving" for any person to really grasp.
When I could let go of some aspects of my pain was when I went
to abusers, intending to confront, but realized that they were emotionally
incapable of understanding what they did to me physically or emotionally.
One of my abusers was a miner with a 5th grade education and was emotionally
stunted as far as realizing how inappropriate he had been. I visited him
in the hospital during his "last illness" (before he died a few months
later) and I saw an emotionally barren man who sought feelings of
"love" by sexually abusing his young relatives -- as his relatives had
also done.
My mother was already dead by the time I was in therapy, with my
counselor insisting that I forgive my mom. I couldn't quite grasp it.
But when my own daughter was about a year old, I found myself having to make
choices sometimes between "bad" and "bad." After I
left my child's father and struggled every day as a single parent, I could see
my own mother better as a person. Her passivity in the face of
difficult circumstances made sense when I thought about her having then 4 young
children: she stayed in-part because she had to, and in-part because of her deep
commitment to the marriage vows. I could see her as a woman facing her own
struggles, not just as a mother who "didn't protect me." So what seems
better to me is to replace the word "forgiveness" with
"recognition of the abuser's actions, along with the abuser's flaws and
remembering they were a human being." When I got ill 7
years ago and living in daily physical pain that even doctors could not
understand, I could better see my dad's situation of living in constant pain.
Neither of my realizations about my parents excused their actions, but I gained
understanding through recognition of what their lives had been like for them.
So for me, recognition is my forgiveness of them. But without recognition,
I would still be grappling with what forgiveness meant and what exactly did my
former therapists mean! I belief if therapists started discussing
recognition of an abuser as a person, rather than calling the parent(s)
"evil" as so many therapists do, more survivors wouldn't get so stuck
in the opposites of "goodness" and "badness" of their
abuser. Their actions were "evil" but they were flawed
human beings as well.
Likewise, well-meaning friends, clergy, and therapists suggest
"you must forgive yourself" -- which sets off most survivors.
"Forgive MYSELF??!! For WHAT??!!" we ask, demanding an explanation
that we won't hear anyway when reacting so strongly. I asked a friend
again the other night what she meant by forgiving myself. Her opinion is that
survivors need to forgive themselves that the abuse happened! WHY, I asked
her, WE didn't cause the abuse!
I believe we can come to a place of seeing the abuser as flawed,
and understanding why those spiritual flaws let the abuser think their actions
were ok. But, I think just the word forgiveness causes survivors to
immediately put up a wall around the vulnerabilities and anger that is stirred
up.
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