As a college student majoring in the discipline of psychology, I feel daunted by the seemingly constant shifting of approach and methods to counsel a mentally ill client toward mutual goals. Obviously the mechanism of client referral is significant. In the scenario of a new client interaction the first question that I thought of was; did the client self assess and recognize need for change due to inability to perform or function or emotional pain or did another professional or family member intervene to require that services be provided?.
Once the client comes to the session how does the novice set up a dialogue that allows growth from both parties? I am beginning to understand that phenomenology according to Corsini and Wedding ( 2014) is based upon the reality in the present moment of the counselor /client relationship. The authors describe the therapist as being in the present moment , not mentally theorizing next cause of action and not trying to control the outcome (p. 307). Another aspect of this approach that I really did not think about is that the relationship is two way.
Both the therapist and the client must be willing to change and be dynamic. Both parties influence each other as noted as transference and countertransference. Also I believe that Dr. Daniels uses this approach in his therapy practice. My understanding at this point is that this process appears to require that the therapist keep in mind his self mental state and the client’s while not being authoritative but a partner in the process. How does the therapist maintain this balance?
How does the therapist remove his own stereotypes and snap judgments to guide the client but not control the mutual progress? Also how does the therapist and client decide their mutual goals? I always thought the end result of therapy was to heal brain dysfunction and assist the client in processing and interpreting his life in a healthy self sustaining manner. As a topic of personal interest and often the cause severe mental dysfunction is dissociative identity disorder.
According to the Diagnostic and Statistical Manual of Mental Illness -5(2013) the criterion for dissociative identity disorder requires two or more altered states that have a distinct patterned changed affect, sense of relationship with environment ,sensory-motor functions, perceptions and cognitive behavior and memories and time gaps for important personal information and must be unable to function in at least one aspect of daily life. My initial interest in this pathological state is from the exaggerated media examples.
From the Psychology Today website, NYU professor Robert Muller noted that dissociated states are often uncontrolled ,disruptive, where alternate identity takes over the individual and self is not often conscious of the other’s presence , thus the passage of time without recall or memory, called dissociative amnesia ( Dissociative Disorders,2016) . Dissociative identity disorder is described in Psychology Today (2013) as a feat of survival as the brain‘s ability to compartmentalize a trauma too overwhelming or too painful to have in conscious memory and the individual continuing to be able to function .
Memory of the trauma is not integrated in an easily accessible manner, it is separated from the physical or body component of the action(Muller,2013). In researching both how to counsel and understand the complex pathology of dissociative identity disorder I came across an article where the therapist describes her self assessment conflicts and therapeutic and relationship development struggles(MacIntosh , 2015). Struggle with two approaches
MacIntosh (2015), at McGill University describes her long term relationship and process efforts to provide the best mutual outcome with her client Emily who was diagnosed with dissociative identity disorder. MacIntosh discusses that Emily came to her through self referral as her long term therapist of ten years was no longer in practice. The author describes Emily’s abuse and chronic childhood trauma in the setting of an impoverished family. From a young age Emily was cared for by her father in order that he have sex with her,also her brother and, brother’ s friends gang raped her.
Emily’s mother appears to have looked the other way. Her mother even performed an abortion on her. From my limited perspective Emily appears to have had no chance for secure attachment, trust and nurturing. The case starts when Emily is forty-eight and the counselor is conflicted as to therapeutic strategy to use to help Emily become integrated, after three years of using primarily the trauma model theory approach. MacIntosh’s goal appears to be integration of Emily’s alters into one interconnected accessible self.
The author infers that Emily’s goal may be different. The author describes the multi phase process used by the prior therapist and herself as that of the trauma model techniques. Emily is given a safe haven and containment for experiencing her traumatic memories. The counselor would try to work through the described memories with Emily as she has no memory of them except that the narrative described is remembered by the counselor. MacIntosh seems to be frustrated as Emily appears to be reliving these memories through her shattered self but not integrating.
During the session times using only trauma models with Emily, Emily committed to keeping a self journal. The author details that in Emily’ s opinion MacIntosh is a counselor of the head and her prior older counselor, nurturing and of the heart. According to McIntosh, Emily is rigid in her internal compartmentalization of painful memories. MacIntosh appears to be very motivated to make progress in her relationship with Emily and uses self assessment and supervision as she decides to balance a more psychoanalytic interpersonal relationship approach,in conjunction with the trauma model.
MacIntosh concerned that each enactment where Emily relives a past memory it is like the first time. The author is worried about even more deeper, less accessible fragmentations. MacIntosh describes that focusing on their dialogue based relationship will help the therapist be more engaged and less involved with her own anxieties. MacIntosh notes striving to hold multiple realities in her mind ,her self and Emily’s narrative, difficult but allows her be in the moment with Emily.
The author relates that Emily describes no dreams and is not integrated but appears to be able to function. The author appears to want Emily to be more than her trauma and feels a more psychoanalytic dialogue will help Emily recognize her emotions, pains, dreams, hopes and needs. The focus of their increased therapy sessions is to be moving beyond the trauma in the setting of a partnership relationship, MacIntosh details that Emily would close her eyes and dissociate into an alter such as tiny invisible Lynn who holds intense pain, and Emily does not remember.
As Emily was dissociating frequently in sessions, MacIntosh asked her to keep her eyes open, Emily stopped journaling with this request and Emily appears to not be amenable to psychoanalysis and alters amenable to the trauma model. comfortable MacIntosh expressed that she is fearful and feels hopeless. MacIntosh slowly starts to integrate external world and change focus of sessions to Emily’s experience of life with others and their counselor /client relationship. MacIntosh describes that Emily expects failure, as from a young child her basic emotional needs and safety were unmet.
The message from MacIntosh’s first hand description of her role as therapist with personal and professional struggles for the best process to empower Emily is that sometimes she pushed too hard to get Emily to move forward and other times not enough but her overall was able to use both her trauma model techniques and her psychoanalytical relationship to allow growth for both herself and Emily. Another most important point that MacIntosh describes is that there are two subjects in the counseling session and no authority.
From here? I think that the honesty described in Dr. MacIntosh’s struggle to move Emily to embrace herself as more than just the negative trauma aspects of her life, through their struggles as equal partners in self exploration and genuine reaction and actions with each other, using self assessment and discovery, extremely helpful. I do not know if Dr. MacIntosh verbalized to Emily her personal anxieties and fears of the traumas narrated in their sessions, but since MacIntosh sought supervision, I assume that she received helpful feedback to allow them both to be true to themselves.
I am hoping to generate a literature search dealing with severe trauma of dissociative identity disorder and how therapists use multiple methods to handle this illness and help the person find their functional self and at the same time the therapist is enriched by the empathic journey. Prior to reading this article I had thought that the literature was more involved with data analysis but there is literature regarding the