With DID, it is not rare at all to experience bad therapy. There are a multitude of reasons why therapists fail us and not being properly trained is just the most common one. Returning to the tasks of therapy with someone else will be exponentially more difficult after we got hurt. When we first started therapy we had to overcome our fear and we invested trust and we got hurt, again. An old lesson from TraumaTime was repeated: We are not safe. And we can’t trust anyone. So where do we go from here? Very few people will somehow manage to stabilize using resources like this blog. Most will need help and that means contact with professional helpers, and our bad therapy experience will have an impact on how that will play out.
Different kinds of bad therapy
I believe that there are different categories of bad things that can happen in therapy. Depending on how and why things went wrong, we might approach our healing from it differently.
The technique failed/ attunement failed
Sometimes therapists use the technique they were trained in correctly and it just doesn’t work for us. That is not as rare as we might think. Different studies for EMDR show a non-responder rate of 30-40%. That is a lot and EMDR is considered a pretty effective treatment for trauma. It happens and it is nobody’s fault. Sometimes clients don’t respond to techniques and therapy time was wasted but we gained some knowledge on the way: We don’t have to keep trying this technique. Very good trauma therapists know more than one technique for trauma therapy because it is not rare at all that things don’t work for everyone.
A therapist might also just be a bad fit for us. They are ok, we are ok but when we work together it is not ok. We don’t understand each other easily, there is a lot of miscommunication and misunderstandings. The therapeutic relationship is considered the most important part of success in therapy and when we simply don’t fit together and there is no attunement, it is best to try with someone else. I personally prefer struggles with attunement over working with someone who is not trained in DID at all. I can feel safer knowing that my therapists knows what they are doing and we are just miscommunicating a lot than I would feel with someone who is a better fit but doesn’t know what they are doing. But you might have other priorities. These choices are not easy.
Therapist used the technique wrong
Not all therapists are actually good at what they are trying to do. Some can’t use their techniques in more severe cases. They have no clue what to do when we dissociate or switch. They end up doing harmful things. In these cases we might be able to try the same technique with someone else who constantly shows us that they know better than our former T.
If this is the path we choose, our therapist should know that we had failed attempts. We can explore where things went wrong and how this new T would respond differently. They have to show that they know better and do better. We take things extra slow and keep comparing what happens now to how it is supposed to go to make sure that we notice the difference to former experiences. One of our goals on this platform is to show how ‘mainstream’ CBT-heavy DID therapy could look like so that you have something to compare your experience with.
It might be easier to switch techniques and look for a therapist who works differently to avoid triggers of retraumatization. Then we would consider the technique that brought us harm as ‘burned’ and move on. DID therapy, like trauma therapy, is its own thing and therapists only use the foundations of their specific main training to support it. We can get good therapy with different foundations.
Misdiagnosis led to mistreatment
A diagnosis has no value in itself. It is still extremely important because it dictates the therapeutic approach. A personality disorder will be treated differently than a major depressive episode. When we get misdiagnosed we will receive treatment that does not match our problems. Best case, it simply does nothing. But often it does come with side effects or we will find ourselves in a complex setting where nothing fits but it is done with utter conviction that this must be the solution to our problem. It can have Alice in Wonderland vibes where everything feels off, doesn’t fit, doesn’t make sense. The treatment plan becomes a systematic approach to gaslighting us. We often do our best because our trauma response that tries to protect us is appeasement and trying to please but this treatment will just leave us utterly confused. (More about misinterpretations of dissociative symptoms)
We need a fresh start. I believe it would be best to start with thorough diagnostics using the gold standard (SCID-D). It is not so much because our new therapist is in doubt of our diagnosis. We need to come to a conclusion together to make sure that they believe us and we can believe ourselves too. The treatment plan should be discussed with us and we need lots of transparency about why a specific intervention helps with the thing we really have. It will need a lot of confirmation that the T believes us and understands our actual problems and has the right framework to help us with them. Every step needs to be explained, we have to consent before we move on and then we can evaluate if this really helped or not. We can expect doubt and denial of the diagnosis to get triggered when we face difficulty or a rupture in therapy. The misdiagnosis can become our go-to place when we get confused. Therapists might have to return to the results of the diagnostic process again and again to re-orient us in the present reality. Denial is already a strong defensive strategy in DID even without mistreatment reinforcing it.
Therapists created an unethical unprofessional mess
Some therapists are just bad therapists and it has nothing to do with the techniques they learned. They mis_treat us. Issues we might face are crossed boundaries, any form of abuse, role reversal, manipulation, coercion, gaslighting, shaming, exploitation, a breach of confidentiality, partiality against us, experimental or new age treatment not suited for our problems, and the list goes on. When we finally manage to leave a situation like that, we are retraumatized. Old lessons were repeated and we automatically believe that it is our fault somehow because therapists know what they are doing and they have to be right. No, they don’t. They are just people and some are not suited to be in a helping profession.
A surprisingly helpful thing when explaining this to child parts is to claim that this person was not a therapist at all. Therapists behave in specific ways. They are safe, understanding, respectful, protect our boundaries and help us to get better. A person who did none of that simply isn’t a therapist. That is a super simplistic way to explain this to younger parts and our adult brain will tell us that it is wrong. That person had some credentials. It doesn’t matter. Younger parts need an idea of what a real therapist is and it is ok to tell them that those who don’t act that way are not real ones. That saves a lot of trouble later on when we try to find a new and real therapist who actually helps.
When we experienced a hot mess in a therapy setting, we can take our time to stabilize ourselves as best we can and use other support that is not therapy. Self-help groups, forums, online community, books, charities that support people with DID, peer support. There are a lot of people out there who are not therapists who know a thing or two about stabilization. When we are ready, we can try to find a new therapist.
The very first thing I did with the therapists I am currently working with is to tell her about our history of mistreatment. This is important information. Ts have to know when they don’t just face our regular trauma but they also have to help clean up the mess someone else in their profession made. Some therapists even specialize in helping people who have experienced mistreatment in therapy. It needs the slow steps, transparency and consent we already mentioned. We might also start by working on our No. We had to survive bad therapy because we were unable to leave earlier when we first noticed that things are getting weird. We kept trying to make it work because of an inner pattern that needs to be addressed. Our first task in therapy is to learn how to stop every small thing that does not feel right. Learning how to notice that and how to express it is a therapy goal in itself. We need the ability to say No to eventually be able to say Yes to trying something new. It gives us the safety that bad things will not repeat, not because this therapist is so much better (which they hopefully are!) but because we can make it stop. Agency. We don’t have to rely on the T to keep us safe like we used to last time we tried. We can support ourselves in this process and step back when it does not feel right. I support patients learning about therapy techniques for themselves because it can work as a guide that creates peace of mind. When we notice that things are done properly it can build more trust than trying to somehow ‘feel’ trust in a therapist after having bad experiences. There will simply be more meta conversations about therapy than usual. We are aiming for collaboration with less of a power imbalance.
Understanding past experiences
I don’t think that it is easy to just ‘forget’ about bad therapy and try something new. It left a mark. I do believe that it can sometimes be helpful to understand what went wrong just to understand it. If we keep ruminating because there is no resolution, the experience will stick to us even more. An explanation is no excuse. Like with abusers, understanding their perspective does not take away any of the harm they have done. What it does is that it takes the responsibility and places it where it belongs. We often carry shame or guilt over failed therapy that is not ours to carry. Our new therapist can help us to make meaning of what we experienced. It was not our fault, that former therapist wasn’t trained properly. It wasn’t our fault, they had their own issues that got mixed in. It wasn’t our fault, that person was misinformed about structural dissociation.
Our new therapists will benefit from learning about typical reenactments that we have in therapy settings. It just helps to notice them early on when they happen in this new therapy. Reenactments are a byproduct of dissociation in DID and not our fault but the patterns are important and awareness is an important part of detecting them early on within countertransference and before they become enacted.
Because we were retraumatized in a therapy setting, we might notice stress responses that show up when we enter a new therapy setting. These are not signs that it is unsafe per se. They are signs that we got triggered and we are reexperiencing an old threat. It might be important to make this distinction and focus on reality-checking and grounding before we dismiss a new therapist.
Lessons learned
It is not rare that trauma was somehow reenacted within therapy and the events hit us right where we are the most vulnerable: the places where we already have trauma. Our new therapist can help us explore how the past trauma and the new trauma are related. It usually helps to become more aware of old lessons we learned during TraumaTime that were confirmed or re-activated through this bad therapy experience. Write these lessons down, in one clear sentence each. Even just getting clarity about what this did to us and what it taught us can be tremendously helpful. This is how it hurt us. This is the wound that our new therapists have to be especially careful with. This was freshly reinforced and it will need special attention. It will come up repeatedly through the new therapy process and has to be dismantled layer by layer. Therapists need to be constantly aware that these lessons will show up in their therapy process over and over again and especially when there is a rupture or things get difficult. It is not done with talking about it once. In my personal experience, these lessons are the most important part of resolving the effects of bad therapy.
Parts
There are a multitude of ways how parts of us can get hurt in bad therapy. It starts with being completely ignored and unwanted and ends with attempts to force fusion. It is important to learn more about the way specific parts got hurt and how they tried to defend themselves against that. We might experience these defenses more often in our new therapy setting. Sometimes parts are not aware we switched to a better therapist and keep expecting more trauma. Other times they are aware of the change but they don’t have any expectation that this will be different. It is too difficult to do this ourselves, our therapists need to keep an eye on defenses and how they show up in therapy. They need to know ways how to work with them. The defense is often connected to the need that a part carries and how that played out in the bad therapy relationship. Noticing the need behind a defense can usually be a way to approach a part with a real offer of support. It can also make parts feel extra vulnerable, exposed and cautious. It is necessary to examine what bad therapy did to individual parts and what the consequences are. That is what we have to work with in the end. Trauma therapists can use their processing tools to help us gain distance from bad therapy memories. Just understanding it and reframing it might not be enough. Bad therapy will be treated like any other trauma in this case. The goal is to turn it into a memory instead of something that is constantly reactivated in therapy today.
Good enough therapists
we won’t get a perfect therapist. They are humans, too. It would be an impossible expectation to demand that they never make a mistake. Mistakes should still be rare and not something we have to face every other session. When a mistake happens, we observe how the therapist tries to repair it. Will they own it? Will they explain it? Excuse it or ask us to forgive? Will they be aware of the real problem this has caused for us or get stuck on the level of behavior and rules? Someone who is able to admit a mistake and offer a plan on how they will do better is worth more than someone who tries to be perfect at all times. There is something like ‘good enough’ even when they aren’t perfect. There is also something like ‘not good enough’ and when that is our conclusion, we can decide to look for something better. If there is no active harm happening, we can stay with this helper until we find someone better so we won’t be on our own while we search.
For helpers
Don’t try to protect your colleagues who messed up. If we are this hurt, they messed up. No excuses. No attempts to make us understand why it wasn’t that bad after all. Your job is to acknowledge the damage that was done and to be partial for us. The impact bad therapy had on us is more important than the intention of that therapist. They might even be excellent at what they do but they messed up with us and that is still a mess they made. Even if you can see how our own inner structure contributed to misunderstandings, it was still the job of that therapists to be helpful instead of hurtful. There is no way to identify with your colleague and protect them and also win our trust. In the end, we have to work with the real impact that bad treatment had on us, no matter who was right or wrong. The worst problem will be the attachment trauma that was reactivated. That is why attachment approaches will be more important than other interventions. Trust will be hard to come by and it is ok to go for a collaborative relationship with a focus on working together instead of getting attached. It helps to build this kind of cooperation with protectors first and agree on the common goal of keeping them safe from bad therapy.
Clinics usually don’t leave us a choice when it comes to our therapist. They schedule therapy in a certain way and we get whoever we get and it is hard to switch because of the fixed schedule. When a clinic knows that a patient has experienced bad therapy, it is an investment into future therapy success to allow a change of T when the fit is bad. They should not be forced to try to work with someone who is a bad fit, again, because that will just increase the difficulty of going to therapy at all. This is an important moment to make an exception from the rule because it is more therapeutic than the rule.
The effects of bad therapy are not easy to overcome. It needs a lot of courage and it needs really good therapists. And then it needs time. Some of my own bad therapy experiences were resolved within a few months simply by experiencing better help. Others have stuck with me for a decade now and I still feel stress responses when I recall them. The ones that stick are often related to prior trauma and messed with our sense of identity. The wound goes pretty deep. We can still have the opportunity to make new and different experiences if we dare to give a new therapist a chance.