The Dynamics of Opposition: Understanding therapeutic conflict with parts in OSDD/DID

[@Cathy-xi8cb]

Nicely done. Never underestimate the defensive reactions of people who have been traumatized. This could be even more true for trauma survivors who appear to be functioning very highly. It can be extremely brittle. Assuming early and frequently that defense responses could be the reason for aggressive or avoidant reactions is a good plan.

[@bridgetj3008]

^ ^ ^ This.

[@ichi_san]

This is really important, thank you for this video. Building trust in therapy can be extremely difficult. It's so hard to find someone who understands.

[@imjustjules]

This video made me feel validated about why therapy didn’t work for me before. I’ve seen so many therapists on/off since childhood. But I finally got a DID specialized therapist and am hoping she’ll know how to do all of this stuff ! So far she’s done different things with me than other clinicians. Sometimes we rly do just need specialized care.

[@ellissvannish5788]

"having a need = weakness", a really great way of summing up a lot of the issues I'm facing. Honestly, I feel like I resonated with all your examples in the video. :') But I'm seeing a DID trained therapist now and I'm definitely going to try and be aware of these internal conflicts. Thanks for your insights as always, Dr Lloyd.

[@emmalyckajacobsson590]

Thank you, I tell how I feel so my therapist get to know things from my point of view. Like two years ago; "I sensed some kind of trust for you. It is an unusual emotion to me, but It felt good". Or this summer: "This week I felt I can never come back to therapy again, last session was awful".. So much of my recovery is about to heal that distrust I was brought up with. And that is developed in therapy.

[@thectadclinic]

Thank you for your insight. Trust never gained in childhood is so much harder to heal from and gain a sense of than that learned and taken.

[@alittlespacetime]

Seems like a video needed to learn from during some earlier to middle stages. Answered some concerns and worries we have with our own psychologist from a clinical perspective. Thank you for all that you do without causing harm toward any of your viewers or patients. Education and resources shared this way is far more beneficial. 😊

[@thectadclinic]

Thank you, it’s how we approach things here in the clinic.

[@alittlespacetime]

@thectadclinic ♡☆

[@olivefusse483]

Such a real subject - are we all not on the edge of shutting down, rejecting the “danger” of relationship? Being scrutinized by the meerkats made us laugh out loud - thanks for that lovely moment!

[@goldhalva]

Mike, (therapist and client here) I'd love to see a part two to this where you unpick a bit more how therapists and clients can talk undefensively and collaboratively to differentiate between things that are defensive responses and things that might need to be altered in the therapeutic frame that the client is finding too challenging or unhelpful. It's a proper minefield I think and tricky for both. Just as it is easy for a client to get drawn into quite a rigid, fearful or rejecting place, therapists can also find this really hard to work with too and the work can end up quite polarised. Common issues I see are clients perceiving every action through a defensive lens AND therapists seeing every response through a particular framing, whether that's transference or defenses or another theoretical framing. I think what can get missed then is the opportunity for repair because the therapist is by then finding it challenging to own that their client might need something different and a client may not find it easy to perceive the therapist's intent to o help. Some practical dos and don'ts for approaching these delicate conversations to bring people back together would be super helpful I think.

[@thectadclinic]

It’s a great idea, but this is a whole training course!

[@goldhalva]

@@thectadclinic It totally is. But I have every faith in you. 😂❤️

[@progressnotperfection1839]

Explained PERFECTLY!

[@IndigoKali]

Thank you. This is timely and helpful (almost spookily so)

[@thectadclinic]

I'm so glad!

[@katrinabongi6295]

I wish you could be my therapist. 😕 I'm stuck in Texas. I have no clue what "Right " therapist will take my insurance, all the while suspecting I have a dissociative disorder and right now in limbo. You make everything sound so clear and easy as far as a knowledgeable therapist goes. I'm sure we have those in Texas, I just don't want to have to jump through hoops to find one.

[@thectadclinic]

We’re working on a plan to see if this can be changed in the US. Our talks in Ohio next week could be quite instructive!

[@katrinabongi6295]

@@thectadclinic Thank you so much, you just don't know how watching your video's have helped me. God Bless you.❤️

[@miraclerats2989]

Very relevant and well timed video. The urge to completely cut off our therapist has been strong at times, especially times like right now when we’re in a vulnerable spot or start to feel “too much” trust, or both. (Even really small things can trigger that reaction, like noticing a tiny shift in our therapist’s gaze where he was clocking our body language-we’re not used to really being seen, and it’s scary.) Funnily enough, one of the most constructive things I’ve done is to show up anyway and immediately start off the session with “so I have the urge to either drive several states away to avoid you or square up.” It’s been huge to finally notice some of these defense mechanisms and choose to talk about them. In the past we’d either try to sabotage the therapeutic relationship or just cancel the next appointment and never come back. It’s still really hard to deal with, but it turns out you can learn a lot from these defensive responses and grow when you’re honest about them and you’ve found the right clinician.

[@liahansen8291]

This is so incredibly timely and helpful, thank you. We had a rough therapy session today and some of us are having the reaction of wanting to immediately stop all therapy and never try it again. Looking at it in hindsight, it more seems like we are rushing into trauma therapy way too fast (our therapist is quite inexperienced unfortunately, but it's what we can afford at the moment) and this is causing a lot of instability. I plan on bringing this up with her next week, with ideas about checking in and communication from this video, as something to prioritize. So thank you very much, this was incredibly helpful for us to think about what is best for us in therapy.

[@kellyschroeder7437]

Thank you. Relate 💔😢💙👊

[@debbiev.1311]

SO HELPFUL!!! 🙏🏼💙

[@theresadutcher4750]

I can'tstop wondering about avoidant parts who cope through being overly independent. They don't engage in conflict and barely engage with the therapist at all but therapy comes to a stillstand because they are so distant nothing is happening anymore... not even sure if that is a common thing in DID. It doesn't end therapy. It just leaves the therapist feeling utterly useless because the system is doing everything alone and just report about progress in the therapy room. No clue how to resolve it when it didn't change over many years of staying in therapy.

[@thectadclinic]

That can absolutely happen as well. A kind of distance is created that can challenge and leave therapists feeling useless.

[@theresadutcher4750]

@@thectadclinic any suggestion how to approach it?

[@binarystar11235]

OMG I think I (as a system) am doing all of these things... but I think my therapist doesn't take it personally and seems to understand how this works. So I guess she is a good one 😊 Thank you for this video.

[@thectadclinic]

Thanks for sharing!!

[@chameleon-tq9mm]

Excellent, very helpful. Many thanks Dr Mike, I hope you are well 😊

[@thectadclinic]

Thanks, you too!

[@jessqinn7702]

Thank you for another great video. Question, could this defensiveness play out in relationships other than therapy? I have a support worker that comes twice a week and I’ve known them for years now, and this has happened with her numerous times. When I had a therapist, we worked with her and made a ‘if Jess says to leave and never come back, don’t listen, give space and revisit next time’ system - as so many supports were lost from me canceling or telling people to never come back. However i no longer have a therapist, and this still happens… I don’t think we ever got to the bottom or figured a way to make it stop.

[@thectadclinic]

Absolutely, I just used therapy as the working construct as that is where the conversations about process often take place!

[@sthomas4634]

I began to feel to dependent on the therapist so I pulled back and changed my appoints to be much further a part. I didn’t know other people did that.

[@yj-kh5to]

Thank you!

[@thectadclinic]

You're welcome!

[@pensidosyroconesyava]

Always insightful and with perfecto y timing no your suggestions D.R. Lloyd 🙂

[@thectadclinic]

Thank you kindly

[@pensidosyroconesyava]

Think this is a very young part. She told me not by words short ago

[@rugdealer1729]

It was great to meet you yesterday! I would like to apologize to you though. I brought my mother and girlfriend along and when i initially invited my mom I was under the impression that she was still sober. I feel like she didnt behave appropriately at all and some other things happened outside of the event that made me realize its time to create distance again. I cant help but feel partially responsible for the fact she was nodding off and took "secret" photos. Again i apologize and i hope to meet you again under better circumstances.

[@thectadclinic]

Please don’t, clearly not your responsibility! If you could make sure no photos were taken during patient segments, that would be helpful. Good seeing you too, I hope it was worth the effort!

[@randomlilith]

Hi Mike, I was wondering if you could do a video (if one doesn't already exist) talking about how all and any childhood traumas can cause DID/OSDD. I am aware that there seems to be a lot of conflict and misinformation especially online, surrounding the validity of 'lesser' traumas. I remember being in the position years ago without support or knowledge on if what I was going through was 'enough' to even have DID, and I know now that the common belief about DID/OSDD only coming from objectively severe traumas is not the case. However, I see many people without support who are searching for help, just to be shut down by others telling them that it's not bad enough to get DID, which is awful. There's particularly a lot of conflict surrounding if you can develop DID without having disorganised attachment to primary caregivers, and people will go as far as to say that you *need* some form of abuse or neglect or similar going on within the home, which again is simply not true as someone with school trauma and supportive parents. I feel so invalidated in online spaces, and have been attacked before because what I went through isn't 'enough' clinically according to these online DID spaces. It's disheartening, because I know so many others like myself are looking online for support and the idea that only a certain type of trauma counts will only further denial. I would really appreciate it if you could make a video on this topic!

[@emmalyckajacobsson590]

Just a reflecion: What if the focus isn´t a diagnosis, but for you to have a life where you are in control? The "severity" of trauma is not what matters, (who can compare,) but how you feel; How you can find new perspectives in your ordinary life and heal. Just a thought.

[@Yourfitnesscoachbern]

... very, VERY, helpful! 😮😢

[@Kazbundacek]

If all these dynamics are present also in other potentially good relationships, could that be also one of the reasons why osdd is often misdiagnosed as bpd? I can identify with this so much!! Just didn't have a clue what is happening inside. Thank you for this clarification, it feels good to have an explanation..

[@thectadclinic]

Yes, I would say the presentation of conflict from defensive parts is absolutely misdiagnosed as BPD/EUPD at times.

[@LizK-xd5qh]

I am learnng so much (about myself) from your videos . Thankyou for sharing your wisdom and knowledge. It may be just me being over sensitive but I find the increasing amount of banners, texts (which are not really readable in the time given) and extra pictures which come up parallel to you speaking, are very distracting and even stressful. For me, it takes away from the value of the "one to one" session. Sometimes less is more? Your talks are brilliant on their own. 🐈 🎉 ❤

[@janeappleton8357]

I find sometimes I can't read the text because it's shown too briefly but I do like the summary boxes and the introduction bullet points.

[@LizK-xd5qh]

Thankyou for your reply. I actually felt quite bad about commenting on this, I'm sure it's just my overreacting as I really am helped by these talks. I wish I could go to the CTAD clinic but I live abroad. Maybe I should just breathe and go back and watch it again 😂

[@Sophie-ur2qb]

I wish I could find a doctor as compassionate as you 😔 Trust is so hard. I stopped going to a therapist. She said some things that made me shut down and dissociate. I tried to talk about how my mother hurt me. All she said was "oh she must of have a bad childhood too" When I tried to explain how my mother puts me down and i believed it all. She said something about what she does. She shows people they are wrong or something. I get where she was coming from but it made me just think I was weak and seemed like she cared more about my mother than me. I'm not responsible for my mothers childhood so quite frankly I don't care anymore about my abuser. I'm sick of it. I don't care what her reasons or excuses are. Just because they are family doesn't mean it's okay to hurt me. Why should I pay a therapist that's going to sympathise with my abuser? Sorry! It makes me angry. I have been compassionate towards my mother all my life. It is used against me so she can continue to hurt me. I'm going to try going through the NHS next. I rushed into seeing someone privately because the flashbacks were so bad. But she was not a good fit. It is discouraging 😞

[@mksparrow5398]

After being misdiagnosed, dismissed and doubted by over 40 years of therapists, I absolutely do not trust American doctors, especially therapist. I do not trust the medical establishment at all.....I do trust you, Dr. Mike...but I am so sad that the only therapist who truly believes in DID and truly wants to help us suffering with this, is in another country...victims NEVER get the help we need, especially here in America...

[@thectadclinic]

I am going to the States specifically to see what can be done to improve things there.

[@parker3185]

😭😭😭thank you

[@roosameri4756]

I have these issues in my trauma therapy that has been going on for 3 years now, struggle through all that time. Too bad my therapist doesn't understand the situation at all. Then again, I got low score on DES and thus my doctor or therapist don't think I have issues with dissociation, and theory of structural dissociation is not in their toolbox to my knowledge. I don't know what to do.

[@Cathy-xi8cb]

Ask them to administer the SCID-D or even the MID. The DES is not diagnostic, which should be one of the first things to realize if you have any experience as a licensed therapist. That said, you can have huge trauma issues and not have DID. People with dissociative PTSD can suffer more. Really.

[@dc3561]

You're proposing that therapy is too good and that is triggering and it's the patient's fault that the theraputic relationship has broken down and stalled? Might it be that the clinician has the perception that therapy is going great but the therapist is chipping away at the relationship bit by bit, and then the therapist has caused their own problem?

[@bridgetj3008]

Dr. Lloyd, is there hope that trust can be gained and comfortably experienced in DID or OSDD? Can it ever be a normal, integral, functioning part of a person who rejects anything caring?

[@emmalyckajacobsson590]

I'd say for my own experience that yes; there is hope. Trust is the most beautiful yet fragile thing.

[@thectadclinic]

It can, and must be looked after and used carefully and wisely!

[@lilithwhite2982]

How do clinical boundaries impact on this re trust and crisis? We had a recent experience where we were very triggered by the insurance removing support ( transport home) making it unsafe and our T refused to get involved saying she was protecting the therapeutic space end result is she us no longer trusted to provide safety and containment to do the trauma work. We feel she'll just sit there and watch us decompensate and SH

[@Theantinarc]

My therapist says everyone has parts and doesn't think I have DId or OSDD but my parts have names voices physical attributes and they often interject thekselves into my life and I can't stop them. I also dissociate severally. My personality also reacently stretched like bubble gum and snapped and my voices got quieter after severe stress and now I feel different. I have seen her a year but I think I need a second opinion.

[@thectadclinic]

Is that from an IFS approach?

[@leaf2309]

What to do when a therapist doesn't contain? And gets frustrated at you for your defensive responses

[@deborahanne675]

Why why WHY Do You keep hitting your desk??? This is the 3rd time I’ve asked you to be aware of the noise it makes (ever since you got the new mic set up). It’s almost impossible to listen to your videos because of the fear it induces with each thump that judders through my body every time. Please Mike… !🙏

[@thectadclinic]

The microphone is incredibly sensitive, the noises are simply me putting my hands on the desk. It’s either that or background noise which people told me they didn’t like. This isn’t on purpose, so please accept my apologies that it upsets you.