- Is CPTSD an official diagnosis, or is it just a term?
Complex PTSD (CPTSD) is a diagnosis in the ICD-11. However, it is a relatively new diagnosis to be recognized officially and does not appear in the DSM-5. This often causes confusion about whether or not it is an official diagnosis or more of a generally accepted term amongst the community. It is, however, a real diagnosis.
- What is the difference between PTSD and Complex PTSD?
PTSD comes from witnessing or experiencing a singular traumatic event. This could be something like a car crash, a natural disaster, a sexual assault, a wartime atrocity, or a violent act.
CPTSD comes from long-term repeated trauma. CPTSD often develops in those who have been abused by someone who was in a caregiver or protector role, often developing in children. Examples include survivors of ongoing childhood sexual assault by a relative or caregiver and survivors of human trafficking. Other long-term traumas that can result in CPTSD include (but aren’t limited to) childhood neglect, ongoing/long-term physical, sexual, or emotional abuse, living in an area of war, or being a prisoner of war.
- Can Alters Communicate with Each Other?
Some alters can communicate with each other; some cannot. This can be worked on over time, and therapy can be a great tool to assist with this communication. Some alters will communicate auditorially (hearing voices), some will speak out loud, some will write notes to one another, some will journal, some will share memories, some will communicate through loved ones. There are many ways alters find to communicate with one another. See DID/OSDD Survival Guide (System Communication Techniques) for more information.
- Can Alters Have Different Genders or Ages?
Yes. Alters can be any age or gender. The mind created alters during trauma when the brain tried to think of what the body needed to survive. Maybe the body was a 9-year-old girl, but the brain thought a 30-year-old man could survive what they were experiencing at the time. Now that 9-year-old girl’s body has a 30-year-old male alter.
- Can Children Have DID?
Yes. DID forms in childhood, so everyone with DID has it as a child. That said, DID often goes undetected by the person who has it until adulthood.
- Can DID Be Cured?
DID can be treated, but it's a lifelong disorder. That being said, there are many healing paths to take with DID, and many people with DID can live very functional and happy lives. See The Different Healing Goals for Systems
- Can You Have DID Without Trauma?
No. However, part of what DID does is cover trauma memories with amnesia. Not remembering you have trauma is fairly common for people with DID, especially early in their journeys. DID can not form, however, without repeated trauma before the age of about 7-9 years old.
- Can You Switch Whenever You Want?
It depends on the situation, who is currently fronting, who is co-conscious, the phase of the moon, and whether or not the groundhog saw its shadow. Sometimes, it is possible to purposely trigger another alter out to the front. In our system, that could be via a negative trigger, like being in a lot of pain, or a positive trigger, like pulling out the stuffies and putting on Winne the Pooh cartoons. If two alters were already very blendy, like Janet & Saoirse get sometimes, it’s relatively easy. However, that doesn’t mean it always works.
In general, to have an easy switch, both parties need to be co-con and open to passing the baton. This happens most often in therapy, where we’ve all agreed to have a switch-o-rama hour. It’s still tiring and can give us a headache if we’re switching a lot, but it does allow our therapist to talk to multiple parts every session… in theory. Sometimes, Saoirse has a hard time letting go; sometimes, parts don’t want to come forward or are just offline.
Sharon wrote a piece for our blog that describes how she can push herself to the front and force a switch. Not all of us can do her trick, however.
For us, most switches are still involuntary to at least some degree. Sometimes, it’s possible to feel a switch coming on and fight against it, but it’s exhausting and can make us feel physically ill. Other times, switches happen with minimal warning. These can be very disorienting to whoever pops up. If we’ve felt a switch coming on, it may have given us time to get at least a vague understanding of the current situation before fully coming forward. If we switch in rapidly, though, we may have no idea WTF is going on.
While there will be exceptions to this answer (particularly relating to systems that have been through decades of therapy to develop skills that take an incredible amount of communication and work and do not happen easily or overnight), 99% of the time, the answer to this question is no; systems generally cannot control switches.
Now – let’s get into the details and into the intricacies of how systems might be able to work on managing, guiding, and sometimes even intentionally switching.
Switches happen because a system experiences an external trigger. Triggers in this circumstance can be traumatic or not, but switches do have to be ‘triggered’ by something that caused a different alter to take the front. This could be something that brought up a traumatic memory and pulled that alter who held that memory to the front; it could be a thing that caught that alter’s attention and brought them to the front (their name, something they like, something they relate to, a memory from a time they were fronting), it could be an immediate need that they are most equipped to deal with so they are pushed to the front for the system’s safety and protection because of the system’s internal functionings, or one of many other potential reasons that could bring an alter to the front and cause a switch.
Systems can – over time – learn how to identify alters’ individual triggers and can make personal decisions on whether or not they wish to move towards utilizing these positive triggers actively to intentionally cause switches to happen. Just because it’s considered a ‘positive trigger’ doesn’t mean it can’t be jarring, and stressful, and can cause massive interpersonal issues between alters without appropriate communication and consent.
Even if a system is able to build this as a consistent ability – to be able to regularly utilize positive triggers – even for multiple alters – that still is not the same thing as being able to control which alter fronts when or being able to control switches. Being able to intentionally invite someone to the front is a wonderful skill to have, but that is not the same thing as being able to prevent a switch from happening in a triggering moment, which is really a core part of what DID is and is not something that systems who have not fully fused can control.
- Do All Systems Have an Inner World?
No. Generally, the answer to any question that starts with “Do all systems” will be "no". There is no "one size fits all". Systems are created in a child's mind, and they’re not following any rulebook. Some systems have inner worlds; some don’t; some work to build inner worlds in therapy, and some have inner worlds that only some alters can access. There is no hard and fast rule that all systems experience inner worlds.
- Fronting? Masking? Alters? What Do All These Terms Mean?
Consult your friendly neighborhood Dissociative Dictionary.
- How can you tell if someone is faking?
The Short Answer
Unless you are an experienced professional who treats DID/OSDD patients and has spent time with the potential system in session, YOU CAN’T.
The Longer Answer
Do people fake dissociative disorders online? Yes. Is it our (or your) job to weed them out? No. We’d rather accept a fake system into our fold than risk rejecting a real one. We think all people, systems or not, faking or real, deserve respect and a chance to prove they aren’t a total ass.
There is a lot of misinformation about these disorders, but it’s not our job to censor it or call anyone out. Instead, we choose to take the high road and provide our own life stories and information to combat it. You are welcome to join us.
- How Common Are Dissociative Disorders?
Disclaimer: We are not professionals; we are just doing our best to compile trustworthy information and statistics. These disorders are still heavily under-studied. There are many factors to consider, such as studies only done in inpatient populations, which could result in skewed percentages. Many of these disorders also often go undiagnosed. Different studies had different findings, so we provided findings from multiple studies instead of giving one absolute number. We believe it’s essential to look at all of the studies rather than choosing one ‘right’ one. Generally, the correct finding will land in the middle of all of them.
Here is a table with other disorders for reference, using the DSM-5 & NAMI as sources. If someone says, “DID is so rare!” you can put that into perspective versus OCD or Bipolar disorder.
Dissociative Identity Disorder (DID)
The DSM-5-TR states that the prevalence of DID among adults in a small U.S. community study was 1.5%. The prevalence of DID was 1.1% in a sample of women in Turkey.
The National Center for Biotechnology Information (NCBI), part of the United States National Institutes of Health, states that approximately 1.5% of the international population has been diagnosed with DID.
The International Society for the Study of Trauma and Dissociation (ISSTD) states that 0.1-1% of the general population and 0.5-1% of the psychiatric population is diagnosed with DID.
Depersonalization/Derealization Disorder (DPDR)
The DSM-5-TR states that the prevalence of DPDR in the United Kingdom was 1-2%.
The NCBI states that 1-2% of the global population is diagnosed with Depersonalization/Derealization Disorder(DPDR).
The DSM-5-TR states that the prevalence of Dissociative Amnesia was 1.8% in a study of adults in a small U.S. community study.
The Cleveland Clinic states that 1% of people assigned male at birth and 2.6% of people assigned female at birth are diagnosed with Dissociative Amnesia.
- How does DID/OSDD develop?
The theory of structural dissociation assumes that no one is born with an ‘integrated’ personality. That every person is born with different ‘parts’ of themselves called ego states that are more tied directly to needs than to complex emotions. Over time, these ego states will naturally integrate into one seamless and coherent personality, generally by the age of about 7-9.
However, repeated childhood trauma can disrupt this process of integration. Ego states will be unable to merge and integrate with one another due to conflicting needs, trauma responses, trauma memories, or learned actions due to trauma. A coherent sense of self cannot seamlessly form when the child is safe in one moment and in fight/flight/freeze/fawn the next, putting their body in survival mode.
Depending on the severity or degree to which the ego states are unable to integrate, this can result in a variety of disorders. It can result in PTSD, c-PTSD, BPD, or – if it gets to the point where amnesiac barriers get built between the ego states to protect them from the knowledge of what’s happening to one another – it can result in DID.
Have you ever seen a really little kid seem to feel ‘melancholy’ or ‘bittersweet’? Probably not! No, they’re usually happy, sad, hungry, tired, angry – the extremes. That’s because – according to the theory of structural dissociation – everyone starts out ‘separate’. Yeah, happy and sad can talk to each other but they aren’t “there” at the same time. It’s one and then the other.
Around 7-9 years old, those parts start naturally melding together so that kid can feel those complex emotions and so they aren’t so all-or-nothing anymore – it’s a natural part of development, right? Well, trauma kind of messes with that.
Let’s say a child lives with her mom and her mom has a boyfriend who stays with them on the weekends. On the weekends that boyfriend sexually abuses that child. And she knows her mom knows. This goes on for months or even years and she mentally can’t get through the week knowing what she will have to deal with on the weekend without breaking down. She can’t talk to her mom and feels that she can’t talk to anyone else – she’s a kid and doesn’t know what to do. But her brain is still young and her ego states (happy sad mad scared) are still separate.
This is when she develops structural amnesia so that she just “forgets” the weekend. And the part of her that experiences the weekend might just forget the week. They both live their own lives. Now one girl is able to get through the week and be a happy child with no knowledge of the trauma that’s happening every weekend because her brain has sectioned that part off away from her knowledge and awareness, because that’s a scared part or an angry part or a strong part and she doesn’t have communication with that part anymore. Now that child has DID. That child has developed that coping mechanism for further trauma and may split again in the future and can develop more and more sectioned off parts or “alters” to deal with other traumatic things for the rest of her life because her brain learned that this works. This keeps her ‘safe’… at least mentally. That’s structural dissociation.
End Trigger Warning
Core theory is the theory that there is one ‘original’ or ‘main’ personality. There are other alters who split off from that core. If there were to be a final fusion of a system – viewed through core theory – they would fuse back to be that core once more, just with more memories and understanding, and perhaps a few shifted traits from the alters who fused, but the core personality is generally seen as dominant in the sense that it will be withstanding throughout the system’s life.
Core theory is less used nowadays, with structural dissociation being the leading theory in the field. That being said, with some systems identifying with a core, some people struggle with validating those alters if you still believe in the theory of structural dissociation. Firstly, identity should be respected and if that’s how their system identifies just respect them – it doesn’t matter your views outside. However, there’s also a reason some systems could identify more with a core while they still were formed through structural dissociation.
If a system went through their trauma after the majority of their ego states had already merged – they may have had what was an almost fully-formed identity with only one or two ego states left to merge when they ended up forming DID/OSDD. If that’s the case, they may have formed more of what might feel like a ‘core’ – rather than a system who had all their ego states separate still when they formed DID and therefore started out much more fractured. This is of course just a theory, but for systems out there who are struggling with feeling like they have a core but also believing in the theory of structural dissociation, this could potentially be an explanation.
- If One Alter Has a Disorder or Condition, Do All the Alters?
The general understanding is that if a disorder is something that comes from life experience (depression, anxiety, PTSD, etc), singular alters can have those disorders without other alters having the disorder. However, if the disorder comes from birth/genetics (autism, ADHD, etc), that will affect every alter in the system. That being said, it’s important to recognize that every alter might manage that disorder differently, and the disorder might present completely differently. One alter’s ADHD symptoms might seem much more ‘extreme’ from the outside than another’s, simply due to how they feel about it, how it affects them, and how they manage it.
Similar things can apply to allergies, diseases, accommodation needs (things like glasses, wheelchairs, canes), and more.
Take, for example, someone with a mild peanut allergy. Most alters in the system barely even notice it, and many might still eat peanuts because they just get a scratchy throat and decide it’s worth it. Some decide not to because it’s not worth it. One, however, has wildly extreme allergic reactions to peanuts whenever they eat them and gets hospitalized, and they don’t know why. It must mean alters can have different allergies, right? Wrong. In fact, that alter simply has extremely intense anxiety surrounding health concerns and allergies. They may even fit the description of a hypochondriac. The second their throat became itchy, they began scratching at it, worrying, hyperventilating, and quickly panicked. Not only did their response to their symptoms and agitation of the area massively irritate it and make the symptoms far worse and inflame the allergic response, but they were also admitted to the ER partially simply because of their own panic. This could be tied to trauma or not, but either way, when combined with amnesia, it gets very confusing for a system trying to figure out why suddenly they had a massive reaction to an allergen that has never been a big deal for them in the past.
- Is DID the Same as Being a Different Person at Work Than You Are With Friends?
No. This is where you get into the distinction between personalities and identities. To start with, in implying that DID is the same as having a different personality for different situations/scenarios in life, you’re entirely discounting the amnesia aspect of the disorder. A massive aspect of this disorder is that alters are separated by amnesiac barriers, keeping them separate and distinct from one another. There are many more aspects that are getting overlooked (particularly trauma), but amnesia is the main aspect that gets massively forgotten in this comparison. This idea of plurality connected to being a different person in different scenarios would connect much more to Internal Family Systems (IFS), a therapy model that is used for anyone in the world to give names to the different parts of themselves to understand how their different ‘parts’ communicate with one another and work with or against each other to understand themselves better. Is that an okay way to view yourselves, and is it okay for someone to view themselves potentially in a plural way because they employ IFS in their daily life? Yes. Do they have a disorder connected to plurality? Do they have DID? No. The amnesia is what makes DID, DID and shifting your personality based on your circumstance is something almost everyone does.
- Is there Medication for DID?
There is no medication for DID. However, there are medication options for co-morbidities that are common with DID.
- What is an Introject?
Introjects are alters who formed with some degree of inspiration taken from someone or something in the system’s life. Remember that alters often form in moments of high stress and trauma and at the start they form from the mind of a child. A child’s brain might not ‘think up someone new’. It might not be that creative or original in that moment. It might instead think “if I were my gym coach I could get through this because they’re strong and they could get through anything.” And then that child has an alter who is an introject of their gym coach. That alter may have many similarities or very few, but they’re an introject because there was a source the brain pulled from. This can also come from animals, media, mythology, television, history, family, and more.
Fictives come from fictional sources. Fictives can be introjects of any type of fictional character (i.e. a TV or movie character, a character from a book, a mythological creature, etc).
Factives come from real life sources, whether alive today or not. A factive could be an introject of an abuser, a friend, a teacher, a historical figure, a celebrity, etc.
Misconception: Introjects are an exact copy of their source. They are that person/character/being.
Reality: Introjects may feel very disconnected from their source and are very different from them. They may only have the same name or look the same internally or have one similar trait. Often introjects may be hesitant to share their source if it’s something people might be familiar with because people will compare them with their source and they know they’re not similar and people will have judgements based off how dissimilar they are to their source.
Misconception: Introjects are always aware of their origin.
Reality: Introjects often might not know their source and might feel entirely disconnected. If or when they do realize that they are an introject that can be a very difficult realization for them and can cause a lot of denial, self-doubt, self-hatred, internalized issues, and more.
Misconception: Introjects are unchanging or static.
Reality: Just because an alter may have at one point had a connection to an external person/character/etc, that doesn’t mean that they can’t change and evolve throughout their life and become someone completely unique through their lived experiences, just like anybody else.
It’s important to know that not all fictives/factives will be comfortable sharing with you that they are an introject. If they do, they may not be immediately comfortable sharing with you who they are an introject of. This is often due to the fact that there is a fear of being compared to their source, when the similarities can be on a very wide range – some introjects may be very similar to their source while others might be very different. Please do not take this as an offense – view these people as their own individuals and recognize that if or when they decide to tell you about the details of their source is up to them and has nothing to do with you.
- Why is There a Gender Gap?
Note: “Men”, “Women”, “Boys”, and “Girls” in this article refers to cis assigned sex at birth due to the fact we are discussing gender socialization. This is not meant to be about or connected to identity – it is about socialization. That is not to discount anyone’s identity, but merely to discuss the effects of society and gender socialization.
Likelihood of Being Victimized (Particularly in Childhood)
One of the main causes for developing these disorders – particularly DID – is experiencing repeated sexual trauma in early childhood. Statistics range across multiple studies but all agree that young girls are disproportionately abused in this way at a higher rate than young boys. There are – of course – issues with societal pressures of silencing of male victims and lack of reporting, but the numbers are clear and there is very obvious majority of female children that are targeted and abused. Therefore, there are going to be more women likely to develop these disorders.
The Stifling of Conversations About Men’s Mental Health
One thing we do need to recognize when having these conversations about statistics of the disproportionately higher rate of women being the victims of sexual abuse, of women being diagnosed with these disorders, etc., is that we also need to have the conversation about men’s issues that could be stopping them from being included in those statistics.
Men are socialized not to speak out about being victims. They’re supposed to be the protector – even the aggressor – never the victim. Especially when it comes to any type of sexual violence, men are going to be much less likely, based on how they are socialized, to report. Additionally, men are extremely socialized away from speaking about/getting treatment for mental health. Therefore, men are less likely to get diagnosed with anything, much less to be in treatment long enough to receive a complex diagnosis.
All of these factors need to be understood and considered when discussing the gender gap. There is a gender gap and these factors definitely don’t close it – there are still many more women being sexually abused than men, and there are still many more women with dissociative disorders. That being said, it’s important to recognize that there is going to be a fairly large piece missing from any study or statistic due to society and socialization of men and boys around mental health.
Being Socialized Towards Different Trauma Responses
There are four main trauma response categories – Fight, Flight, Freeze, and Fawn. Growing up, boys and girls are socialized to respond differently when in a traumatic scenario. Boys will be socialized to respond with Fight, maybe Flight, rarely Freeze, and never Fawn. Girls, on the other hand, are socialized entirely differently. Girls are socialized to respond with Fawn or Flight or Freeze, and rarely Fight.
Dissociation is going to be less likely to develop naturally in a child’s toolbelt of coping mechanisms if their response to traumatic situations is Fight. Dissociation will more likely develop in people with Freeze responses – though also potentially in those with Fawn responses in some specific situations. Therefore, due to the socialization of women and men/boys and girls in society and our trauma responses, women will be more likely to develop dissociation as a coping mechanism when in a traumatic situation.
Supporters & Allies FAQ
- Fronting? Masking? Alters? What Do All These Terms Mean?
Consult your friendly neighborhood Dissociative Dictionary.
- I Want to Write About Someone with DID in an Informed, Ethical Way. How Should I Do That as Someone Who is Not a System?
You’re not going to like this answer, but don’t. While it can be okay to write about a character with DID if they simply happen to be in your story, their having DID should not be the focus of the story. That is not your story to tell.
To put this into perspective, let’s imagine a white writer decides they want to write about the experience of what it’s like to be black in America. They want to do that as ethically as possible and ask lots of questions to ensure they’re doing it right. Is that okay? No. As a white person, they should not be writing about someone else’s experience like that. They’ll never fully understand what it means to be black in America.
That said, would it be wrong for them to write a black character into their story? Of course not. Could there be moments where issues of race come up where they consult people to ensure they’re handling it ethically? Yes. But the entire point of the book shouldn’t be to tell someone else’s story.
If we replace that example with DID, this makes more sense, right? DID is fascinating to many people, and they want to write about it. Their hearts are in the right place – they see the media misrepresent us and want to do it right. However, it’s not their story to tell. Plenty of systems are capable of writing and creating their own art. Boost our voices and support our projects, but don’t try to be our voice. Sure, you can write a character who happens to have DID, but please DO NOT write about someone’s lived experience with DID. Unless you have the disorder, you’ll never fully understand. Recognizing that is the sign of a true ally.
- Should I Ask Who is Fronting?
This is a common question. You might default to asking who is fronting to try to be a good ally – thinking that knowing whom you’re talking to helps validate that alter as an individual. And for some alters in some situations, it might. However, the consensus answer to this question is that no, you should not ask who is fronting until you have established with a system that it’s something that makes them feel validated and they want from you.
If a system is not specifically talking about DID/OSDD they are often naturally masking, even if the ally doesn’t know it. Even if they’re out to you as being a system, masking is a natural defense mechanism that systems have built up throughout their lives. For many alters, it’s a more comfortable, easy, and safe feeling than unmasking. When someone asks who is fronting, it can feel very unsafe. Having your disorder called out like that can feel incredibly jarring and frightening. Remember that DID exists to be hidden! Having it brought into the light outside of the system’s own control can create panic. Additionally, if the alter who was fronting wanted to continue masking, you’ve now put them in the uncomfortable position of feeling like they need to lie to you that they’re not themselves.
For these reasons as well as others, don’t ask this question until you’ve established whether the system is okay with it. Even if one alter loudly proclaims their presence every time they’re out, that doesn’t mean the system as a whole has agreed to give you that kind of information whenever you ask.
(If you’re having a conversation where who is fronting is highly relevant, or the conversation is surrounding their disorder already, it may be a more appropriate time to ask who is fronting, but only if you’ve established it’s okay first. Respect the system’s boundaries.)
- Should I Use Plural or Singular Pronouns?
Systems and individual alters will have their own preferences, so it’s always good to ask what pronouns they’d like you to use. How things generally work, though, is that the entire system is plural – it is multiple alters, and therefore, you would refer to them collectively with plural pronouns (they/them). However, when referring to an individual alter, you’re referring to a single person (he/him, she/her, etc.). This can become a little blurry with non-binary alters who may use singular they/them pronouns. When in doubt, ask.
The main thing is not to be a jerk. If you feel the person fronting doesn’t want you asking about who they are, refrain from referring to them using pronouns, or use the pronouns for the host, who they may be masking as. If an alter tells you their pronouns, though, respect them.
- What Do I Do If I Think the System I’m With is Switching?
There will never be a one-size-fits-all answer to this type of question. Not only is every system different, but every alter within a system is different. There’s no consistent answer that will always be correct. In general, though, it’s best to err on the side of caution and give them space unless explicitly asked to do otherwise.
- What Do I Do If I’m With Someone Having a Flashback?
If you haven’t spoken with the person experiencing the flashback on how they prefer to be assisted, it is best to err on the side of caution. Trying to help, no matter the intent, can often cause more harm than good. Stay calm, and don’t ask too many questions. They are probably in too much of a crisis to answer them. Instead, step aside and give them space, but stay nearby. Let them know you’re there if they need anything, but then start using your phone or something so they don’t feel like they’re being watched. Be there if they choose to reach out, but leave the person alone if they are in no immediate danger.
Please, DON’T touch the person experiencing the flashback unless they have made it clear that’s okay. A hug or a hand on a shoulder may seem like it would be a comforting gesture, but the person is in sensory overload, and it may make things much worse.
- Will Someone With DID be Constantly Forgetting EVERYTHING Due to Amnesia?
The person you know will likely have a fairly steady memory of daily things, but if they switch, that’s when you’ll notice the severe amnesia pop up. Amnesia may also come up in smaller things or things that have to do with trauma – but is the person you know going to randomly completely forget who you are? Almost definitely not. Just be prepared for them to switch, for someone else in their system not to know you, and to recognize that they’re not the same.
- Can Therapy Make My Problems Worse by Bringing Up Painful Memories or Trauma?
It’s very important that you have a therapist who is trauma-informed if you are going to therapy to process trauma. Processing trauma is something that needs to be done delicately and at the correct pace for the patient. If it is rushed, it can cause harm, so therapists need to be careful and well-trained. Rushing trauma processing can be very harmful, and this is not just something for the therapist to keep in mind but something for you – the client - to do as well.
It can be easy to get frustrated as the client and feel like you’re not making enough progress. Maybe you feel like you’re not doing ‘good enough’, your therapist isn’t working hard enough for or with you, you’re upset because therapy costs money and you want to be seeing results, or maybe you simply want to be better. It could be a combination of these factors or something unique to your situation. Checking in about these possibilities is never a bad idea – talking to your therapist about these concerns can be good. Sit down and talk about how you feel you’re not making the progress you want. They might see more progress than you do and be able to reflect that, or they might be able to adjust your treatment approach. However, trying to push yourself to ‘get to the hard stuff fast’ isn’t a healthy approach to therapy.
- How Do I Know If I’m Making Progress in Therapy?
Measuring progress is a very important part of therapy and can be easy to forget. Without actively measuring your progress, it can be easy at times to feel like you’ve plateaued or like you’re being vulnerable, spending money, and doing a lot of emotional labor for nothing. In reality, you are likely making a lot of progress; you simply aren’t tracking it, which is why setting up a system to do so is important. Here are some ways you can do this:
Set goals: Setting goals with your therapist can help you know what you are trying to achieve. Goals should be specific, measurable, achievable, and relevant. This will not only help you, but also assist your therapist in helping you. As you progress, you and your therapist can check in on where you’re at along the way in regard to your goals.
Feedback from your therapist: Ask your therapist for feedback. It’s okay to ask them questions – it might feel scary or like it’s something you’re ‘not supposed to do’ – but why? You’re literally paying them to help you – you should be able to ask them, in their professionally trained opinion, where they think you’re at and how you’ve progressed with their assistance. If they think you haven’t made enough progress, maybe other techniques need to be used, and this conversation could be a good starting point to begin moving towards more productive treatment for you. Ultimately, the goal is for you to get the treatment that will work best for you. Ask questions and ask for feedback.
Assess the frequency and intensity of symptoms: Clients can assess the frequency and intensity of their symptoms. For example, if a client was experiencing daily flashbacks before therapy, but 6 months in is only having two flashbacks a week, that’s significant progress.
Journaling: Keeping a journal can help track your progress in therapy. Write down your thoughts, feelings, and behaviors, and reflect on them over time to see how far you’ve come and how patterns change over time.
- How Much Does Therapy Cost?
This is written from the perspective of someone living in the US. The situation in your country may differ.
Therapy costs can vary widely based on different factors (i.e., the therapist's credentials, the type of therapy, insurance, etc). We’ll go over a few different things to look into & different ways of paying that will often be offered by therapists in your area:
Out-of-Pocket: If you choose to pay without insurance, therapy can range often from $50-250+ per session.
Insurance: Many health plans will cover mental health services. Check with your insurance policy to see if therapy is covered, what your copay or deductible might be, and if it only covers a certain amount of sessions/year.
Sliding Scale: Many therapists will offer sliding scale fees. This means they will adjust their rate based on your income, making therapy more affordable for lower-income people.
Community Clinics/Nonprofits/Universities: There are some organizations that will offer lower-cost or free therapy services.
Employee Assistance Programs (EAPs): Your workplace may grant you access to a certain number of free therapy sessions.
Online Therapy Platforms: Online therapy often has different pricing structures, which can be more affordable than in-person therapy.
- I Had a Bad Experience with a Therapist, How Do I Get Back Into Therapy?
Having a therapist betray your trust in such a vulnerable situation is a really awful thing. If this has happened to you, I am sorry. It’s very important, however, to not allow this to shut you off from professional help as a whole or to associate what one therapist did with what all therapists will be like.
It’s okay if it takes a long time for you to open up to a new therapist, and it’s okay if it takes a long time for you to trust them. When you begin working together, you can tell them (if you’re comfortable) that you’ve had a bad therapist/client relationship before that’s caused you to mistrust therapists and that it may take some extra time to open up and trust them. Any good therapist will be understanding and respectful of that. Give yourself time to heal, but don’t give yourself so much time that you allow that to turn into fear of returning to the work. Do virtual sessions if those are easier for you, and give yourself time – just don’t let one bad therapist take away from you a massively valuable resource in your healing journey.
- I Have My Friends, and They Help Me Through Things – Why Do I Need a Therapist?
There are many reasons that your friends are not a replacement for therapy. Not only is putting that burden on your friends unfair to them – your friends are not your therapists, and no matter how much they swear up and down they want to be there for you and don’t mind, they are not equipped to be giving certain advice and oftentimes may be not only steering you down the wrong path or worsening your own mentality surrounding a situation but their own mental health may be negatively impacted by trying to act as a counselor-type role when they’re not equipped to do so.
A therapist is not only removed from the situation but they are trained on how to help you and take care of themselves in doing so. It’s an ethical way to be able to talk about intense things and to vent about your life on a regular and lengthy basis – with your friends, it is not appropriate and can cause serious damage both mentally and to those friendships.
Additionally, in a therapist-client relationship, you don’t need to worry about your therapist's feelings. Obviously, they’re still a person, and you can’t disregard that, but they’re there to help you with your problems, and they have signed up (and are being paid) to help you with difficult things – you don’t have to worry about being a “downer”. You also don’t have to censor or self-edit your speech because you don’t want to hurt their feelings or out of concern of being judged. Therapists are trained to be understanding, and chances are they’ve heard 10000x worse.
With friends, you often might get advice for the short term (and therefore gain short-term relief and gratification), but with therapists, you can chart a path of plans for how to work towards long-term goals, and therefore making much more significant progress and a much more significant and positive impact in your life.
- What Are the Different Types of Therapy?
There are many types of therapy, and therapists will often be trained in several different approaches. You might try a combination of these approaches with your therapist. You might find that one approach works better for you, and that might change over time. One approach might work for you with one therapist but not with another. It’s important to keep trying new things and be open to them so long as you trust the therapist you’re working with. You may never have considered play therapy, and it might feel silly at first, but it might end up being incredibly helpful for you and end up causing some big breakthroughs.
Here are some of the common approaches you’ll see:
Cognitive Behavioral Therapy (CBT): CBT is a type of talk therapy that helps you change unhelpful ways of thinking, feeling, or behaving. It focuses on identifying negative patterns and is often used for anxiety, depression, and other mood disorders.
Dialectical Behavior Therapy (DBT): DBT focuses on mindfulness combined with CBT approaches. It’s often used to treat Borderline Personality Disorder (BPD) and to help people dealing with suicidal ideation.
Mindfulness-Based Therapy: Mindfulness-based therapy focuses on mindfulness practices such as meditation to manage stress, anxiety, and depression.
Family Therapy: Family therapy works with families – sometimes together, sometimes separately, sometimes in the office, and sometimes in the home, to resolve conflicts and improve communication.
Couples Therapy: Couples therapy will also sometimes be done together and sometimes have sessions individually, working to improve communication and resolve conflicts to strengthen a couple’s relationship.
Trauma-Focused/Trauma-Informed Therapy: Trauma-focused therapy is designed to address trauma and its effects.
Art Therapy: Art therapy allows patients to use their creativity to explore their emotions. This can be very helpful for people who struggle to find words to explain feelings.
Exposure Therapy: This is mostly used for phobias and anxiety disorders. Exposure therapy gradually exposes people to what they’re afraid of to show them they don’t need to be as afraid of it.
Narrative Therapy: Narrative therapy focuses on rewriting personal narratives and stories to change how people perceive themselves, others, and their experiences.
Play Therapy: Play Therapy allows people to communicate and express themselves through play. 🙂
Internal Family Systems Therapy (IFS): IFS therapy involves understanding the different parts of yourself and how they work together.
- What Do I Do If I Don’t Feel Like My Current Therapist Is the Right Fit?
Please know that it’s a normal experience to go through a few therapists to find the right fit for you, and don’t get discouraged. Finding the right therapist for you can be a process, and it’s okay to take your time to find the right match for you.
Just like any other professional relationship, the therapeutic relationship depends on a good fit between the therapist and the client. You need to feel comfortable and safe with your therapist in order to be able to open up and work through the challenges you’re facing in your life and the things you wish to process with them. Sometimes, finding the right therapist you can connect with takes a few tries.
It’s very important to remember that finding the right therapist doesn’t reflect you or your ability to navigate therapy. Therapists are trained to work with a variety of clients, but it’s possible the first or first few therapists you see simply may not be the right fit for you. It’s very important to remember that therapy is a collaboration, and it’s okay to communicate your needs and preferences to your therapist and let them know if there’s something you need from them that you’re not getting.
Don’t be afraid to ask questions or express concerns during the initial consultation or first few sessions. This can help the therapist to know if you’re a good match for one another. Trusting your gut and paying attention to how you feel during and after each session is also very important.
Remember that therapy can be very valuable and transformative to your life. Additionally, when working with a therapist, there are bound to be uncomfortable things you’re speaking about, so there is a degree to which you want to push yourself out of your comfort zone. So long as you don’t feel red flags that seem potentially harmful, try to stick with your therapist for at least a handful of sessions to see how things pan out because sometimes pushing through discomfort is necessary. If you have truly given a therapist your best shot, however, and you simply aren’t meshing, it’s okay to accept that a therapist isn’t the right match for you and decide it’s time to find a different therapist.
Keep trying, and don’t give up hope – you will find the right therapist for you!
- What is the Difference Between a Psychiatrist and a Psychologist?
This answer reflects the situation in the United States.
A psychiatrist is a medical doctor who can prescribe medication.
Psychologists typically hold doctorates; however, they do not attend medical school and are not medical doctors. Instead, they study human thought and behavior.
Both psychiatrists and psychologists can diagnose disorders and can provide counseling and therapy; however, only a psychiatrist can prescribe medication.
- What is the Difference Between a Therapist and a Psychiatrist?
This answer reflects the situation in the United States.
A therapist is a licensed counselor. They help clients treat mental health symptoms and work through managing their stress, relationships, daily and lifelong mental health issues, processing, and more.
A psychiatrist is a medical doctor who can diagnose and prescribe medication for mental health disorders.
Oftentimes, patients will work with both a therapist and a psychiatrist on a team (they’ll meet separately generally, but there should be communication between the two) – with their therapist meetings happening on a more regular basis, while they will meet with their psychiatrist more infrequently for medication check-ins and prescriptions, diagnosis meetings, and more.