This article was published in 1937. Unfortunately the Psychology Industry failed to heed the insight and, as a result, we still have charlatans masquerading as mental health practitioners.
The future of clinical psychology.
by Woodworth, R. S.
Journal of Consulting Psychology, Vol 1(1), Jan 1937, 4-5.
Abstract
The future of clinical psychology or “personal service psychology” is very promising. The field of work will be varied but unified. At present there are many charlatans and half trained practitioners*, but “as the profession grows in competence and in numbers its influence and authority will increase.”
(c) 2010 APA, all rights reserved)
*bold typeface by blogger
Questioning Dissociative Identity Disorder, Multiple Personalities, and Plurals 
Keith_hodges
/ 12/21/2011Oh one really obvious thing I did not mention is that in hospital you have to cope with the other patients!
This is a lottery at the best of times, of course most will be harmless, especially if they are drugged up, but the potential risks involved are huge.
One psychotic person with a “push peoples buttons mentality” can wreak absolute havoc. (remember ‘Girl Interrupted’) There is no way that being triggered 10 times a day and being re-traumatised continually in a hospital situation can be offset by a twice weekly or even daily therapy session, or some quack idea like doing yoga.
I was recently in an internet chat room with three people with various forms of DID/MPD, they all set each other off, it was horrendous, an experience not to be repeated.
The ideal situation is for recovery to be based in an intentional community, a family so to speak. But a family of people having ordinary interests and having ordinary lives, while being aware of the issues, available to talk and help with emotional processing in a low key manner, with recourse to specific interventions as needed on demand. The individual being helped should have complete control over their life, the space they need, and the friends they keep.
Recovery is really only possible from a place of extreme emotional safety, certainly initially without the pressures of work or time regime, while having a routine in place for things like meals. Periods of R&R, and holidays are also very important, the emphasis being on normal life.
When I have been called on to support people having an emotional breakdown, the relational support I have found myself offering is 24/7, with the additional support of others in my household providing meals/transport etc. We may do upwards of 6 or 7 trauma resolving therapy sessions a day. A pace and intensity that no hospital or professional could withstand.
Keith
LikeLike
Jeanette Bartha
/ 12/22/2011Keith, In a hospital you have to cope with other patients – not easy. Having been the cause of many a DID havoc melt-down, I can speak volumes about how one person can upset a hospital.
I applaud you for recognizing how one person in a mental health facility can initiate a cascading of emotional wreckage for others in their presence.
I also like that you include R&R into therapy.
How can anyone endure 6-7 trauma sessions daily? That seems counter to building in R&R. Best.
LikeLike
Keith Hodges
/ 12/22/2011Hi Jeanette,
you would only have to do 6-7 sessions in times of considerable stress, when lots of issues are arising in rapid succession. Either its lots of different issues, like panic attacks for a million different reasons. Alternatively it could be one big issue which is overwhelming and gets exposed in parts, or it could be one small issue shared by lots of different littles that you have to look at from different points of view.
Newcomers typically take 1-2 hours to successfully complete a session through to total lasting resolution on a significant issue like a major trauma (e.g. victim of attempted murder), especially if this is new territory, and trust issues and so forth need to be worked through. Once you get into the swing of things sessions don’t have to be a big deal, the hardest part of a normal session from a cold start is getting in touch with, feeling and expressing emotions.
If you are supporting someone in the process of being triggered, then that bit is already done for you; they are in the middle of it. From there you need to calm things down, then you can break things down and analyse what the problem really is. Once you have got that far all you need then is some resolution which only takes 30 seconds or so. So the time from triggering to permanent resolution of that particular issue would typically be 15-20 minutes or so, and half of that time is spent arranging the chairs, hanging the do not disturb sign up and getting comfy.
So the 6-7 sessions a day, become 15 minute sit down chats in which the issue arising actually gets dealt with, never to return! Its great to see the change unfold day by day. Once the emergency is worked through, and you are no longer firefighting triggers a more regular routine is more pragmatic.
After a while the process of working through things becomes so routine as to be almost part of daily conversation. It is important to take R&R and to have lots of fun. One needs to avoid building a dependency on therapy, so as to avoid building emotional associations about it. To ensure this therapy itself should be restricted to short seasons over a month or so, and can be followed by a holiday and several months of normal fun life to the full.
Significant healings and milestones should be celebrated, and I often make a card as a gift and a reminder. Those with MPD/DID often have difficulties with remembering things, especially in the early stages, forgetfulness is a very useful defence mechanism in childhood, but it hinders therapy, so mementos are a useful tool.
In my framework, the diagnostic manual that I am conceiving, there are 12 categories of emotional damage and interventions. Only 2 of these involve specific therapy for resolving trauma. At least 6 of these categories of emotional damage need to be treated in the process of building a life and relationships. These categories include, overcoming childhood neglect, learning lessons towards maturity, resolving attachment issues, etc. In comparison the trauma resolving therapy is the easy bit! Enabling a person to rebuild their entire life, while still being vulnerable, prone to triggering etc, thats the hard bit and this is the bit that the doctors and hospitals least understand and interfere with most.
This is why Sam and I feel lie “kindred spirits”, because we agree on the importance of the home life as a therapeutic setting of its own which has far broader scope and contributes to healing in far more dimensions. We appear to be somewhat alone in this belief.
regards
Keith
LikeLike
Keith_hodges
/ 12/21/2011Hi Jeanette,
I have never heard of a psychiatrist offering talking therapies in the UK, so no shift is even possible there. The route to talking therapies is via the local GP, if you can persuade the GP you have minor depression or something that he will not refer to the mental-health team, then you might get a referral direct from the GP for CBT. The standing joke is that you can have 12 sessions of CBT. (In my experience as a therapist we can usually cover much the same ground in a <2 hour session, but I digress)
http://talesoftherapy.wordpress.com/2010/11/16/doh-therapy-tales-110/
The route to other therapies is via referral from the psychiatrist, so this depends on them arriving at a half decent diagnosis, realising that their drug-based regime is not sufficient, having the humility to actually refer and the budget to fund the treatment being sought.
This works fine for something easy to categorise, for example there is a specialist clinic in London for people who have a fear of vomiting. If you are a teenager with erratic behaviour the favourite catch all “we haven’t got a clue” diagnosis these days is BPD (borderline Personality Disorder) and the flavour of the month for this is now DBT, and DBT looks to be the first attempt at a providing a comprehensive potentially whole-life therapy process.
Technically speaking though there is not much of substance in DBT, my unkind characterisation of DBT is that is it basically giving attention seeking teenagers the attention that they crave. The truth is, that these teenagers need attention, relationship, support, and mentoring (i.e. parenting) and finally they might just get some through a DBT programme. DBT is the only method in which the “professionals” are encouraged to give a little personal involvement, they are encouraged to give out a phone number for emergencies.
On the subject of traumatising people in hospital, I could write books about it – perhaps I should. I am frequently undoing damaged caused by hospitals and therapists for that matter! There are still people around who were strapped to their beds 24 hours a day in the bad old days, but I am not even talking about that, I am talking about our so called modern enlighten practices, even what we now call care in the community.
This is a post I did 4 years ago as a complaint to the NHS (new comments in parenthsesis) :
Title: DID/MPD sufferers are being routinely abused, and retraumatised in the NHS
I have had it up to here with psychiatrists who make decisions based upon 5 minute interviews, being considered more knowledgeable than someone who has 4 years full time hands on experience of helping an individual. They never even ask. The fact that you have been a carer for a person for more than 4 years carries no weight at all. {now 9 years, but it makes no difference}
It is absolutely 100% essential that an MPD (Multiple Personality Disorder)patient have a supporter, someone who knows their background involved with all consultations. Otherwise significant, and dangerous mistakes will be made. [details on request] The practice of patient confidentiality which is used to shut out concerned friends from involvement has to stop. There should be a nominated "trusted friend" for all psychiatric patients.
Signed letters were provided from the patient asking for me to be consulted on treatment decision making. These were ignored.
{as a carer, now paid via the NHS, I do try to inform Doctors of a carer’s eye view of symptoms, letters I write to them are discarded without being read}
Firstly, DID, is not an illness, there is no chemical imbalance, it is an emotional disability. The mind is working perfectly well considering the traumatic memories it is coping with. Every behaviour is a result of logical causes and effects rooted in actual traumatic experiences. Medications cannot change the memories and past experiences that a person has had.
Therapy based treatment is reasonably well understood and documented, and is expected to be successful over a 5-10 year period. We are 10 years behind the US on mental health treatments for Dissociative Disorders.
Treatment with drugs is not helpful at all and is documented as being potentially counter productive. Yet this is typically the only option the NHS considers.
{the NICE guidelines for PTSD/Dissociation do acknowledge this now, there are no NICE guidelines for MPD following consultation with the survivor run charity “First Person Plural” – a mistake I think}
The words "we will just take a fresh look at the diagnosis" is a nightmare waiting to happen, since each of 30 personalities has their own problems, and will collect a different diagnosis. The doctor will get the tippex out on the previous guess, and the game starts all over again.
Once someone has the diagnosis of MPD, there need to be guidelines that state, this diagnosis should not be changed,just because you don't know anything about it, or the current presenting symptoms look like X,Y, or Z. Consult an expert in MPD/DID, do not treat, do not medicate, do not coerce in any way at all!!!! (i.e. re-traumatise).
If you coerce a victim of severe trauma against their will you are likely to trigger them to relive that trauma. For example, if they were abused as a child and you come up behind them to administer an injection against their will, they could relive their traumatic experience, and it is your fault.
Every MPD/DID (Dissociative identity disorder), sufferer is being abused by NHS because of this ignorance.
I repeat the issue for clarity, every DID sufferer has traumatic memories that you will cause them to relive if triggered. Triggering may occur in any situation that is reminiscent of the original experience. If the abuse involved playing "doctors and nurses" then even being in hospital will be triggering, (think about it)
The ONLY way to avoid this is to listen intently to what they know about how to live with their condition and what those who care for them also know from experience.
Why have you no Psychologists, or anyone who knows about MPD on staff at my hospital?
Why do you administer ECT rather than offer talking therapies?
==
Thats what I wrote a few years back.
Since any situation can potentially be triggering, you cannot know in advance how to avoid triggering, you need to work in close relationship, you need to start by establishing rules of how emotional safety can be ensured.
This is one example of how I do this http://www.safeprayer.com/Articles/safety%20briefing.html
I know people who have traumas triggered by many different things, certain patterns on tea-cups, facial hair, burnt dinners, injection needles (obviously) you name it.
One example is a friend of mine that I am not currently helping who in certain situations goes into a panic terror state due to “fear of eyes”, so in order to talk to them, I hide under a blanket. The day I see a psychiatrist hiding under a blanket will be the day that I can say my work is done!
– Hospitals have too many people, too many strangers. The hyper alert state watching for danger will be a regular problem.
– Coercion in any form whatsoever is a problem
– Trapped, secure facilities are a problem.
– Doctors who aren’t good at listening can be so traumatic as to lead people to elective mutism.
– Subjected to a room full of doctors/tribunals etc is traumatising. Would you subject a 5 year old to this kind of treatment. As far as DID/MPD is concerned you have to assume you are dealing with someone as delicate as a one year old who doesn’t know anything better than whatever they are doing. Example, a one year old who has decided to be a lion in order to protect themselves! So when I am bitten, I say “how sweet!”. I can’t see a doctor taking that the same way.
The care in the community option is where they arrange home visits on a daily basis, rather than hospitalisation. Those with MPD may have many characteristics in common with those who are autistic. For example they need time to plan and think things through, they may not like surprises, they need issues to be resolved right away, otherwise the issue may become overwhelming.
So… the care in the community approach involves being visited by random strangers on a daily basis having you home (your safe place) invaded by up to 3 people carrying drugs and needles. They are frequently late, or arrive unexpectedly each incident of may have serious implications, but they are totally unaware of this. There is no let up, no emotional space within which to reflect and recover. At least before when you got out of hospital you were free at last, but not any more!
I could go on forever…
Keith
LikeLike
Sam Ruck
/ 12/21/2011Hey Jeanette,
Does the new name of your blog mean you are expanding your scope?
Keith is a good guy. I think he and I are “kindred spirits”
Merry Christmas or Happy Holidays!
Sam
LikeLike
Jeanette Bartha
/ 12/22/2011Yes, Sam. This blog has been evolving & expanding as I learn and grow.
Happy Holiday to you as well. Jeanette
LikeLike
Keith_hodges@yahoo.co.uk
/ 12/20/2011— many charlatans and half trained practitioners
The charlatans and half trained practitioners that I know are all Doctors and Psychiatrists who have no experience of working with people in emotional need. Their knowledge of the field is usually extremely limited, and few have even read seminal works such as “The Link Between Childhood Trauma and Mental Illness: Effective Interventions for Mental Health Professionals” by
Barbara Everett & Ruth Gallop.
All of the following are IMHO negligent practices. In the UK these are actually considered best practice!
– Appointments in which life changing decisions are made in less than 15 minutes.
– Hospital regimes which are by their very nature traumatising or re-traumatising.
– Reliance on drugs, without considering or upholding the social context of friends, family and supporters.
– Ignoring past history completely, diagnosing presenting behaviours only.
– Treating the diagnosis label, not the person.
– Lack of awareness or appreciation for the individuals convictions of faith and its importance
I could list many others
Keith
LikeLike
Jeanette Bartha
/ 12/21/2011Hi Keith, I don’t see a huge difference here in the US.
Someone recently posted about the UK cancelling appointments if the patient doesn’t show up due to a waiting list? Are you privy to that?
There has been a shift in the US from psychiatrists doing talk therapy and only doing medication maintenance. How about in the UK?
I have a million questions for you. 🙂
I am particularly interested in your statement about hospitals being traumatizing. I agree, yet they are used to treat DID where people get worse. I sure did and my behavior became outrageous as well.
Any other insights you have to share, I’d love to hear them! Best.
LikeLike
Anonymous
/ 12/21/2011You might want to rate yourself among frauds and pseudo psychologists who can’t see the forest from the trees
LikeLike
Jeanette Bartha
/ 12/21/2011Hello, Anonymous,
I am not a psychologist.
What have I said that makes you call me a fraud? If you want to shout out, do so, but leaving comments without context is silly and makes no sense.
LikeLike