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Dissociative Identity Disorder: A case study, Part 1.

Updated: Aug 10, 2022

I hear a twinkle as the front door bell is rung. My client walks into the small waiting area just outside my door. Reception greet the client and I ready myself.

This client came to me in the break of a lecture I was presenting. They queried if I saw clients with Borderline Personality Disorder. I responded that I would not say I 'specialise' in the disorder, however I certainly accept referrals for the diagnosis. The client reported that they have "a history of BPD symptoms" and would like to see me for therapy. I told them to contact me using the contact details at the end of my lecture.

Sure enough, not even a week later there is a referral on my desk for this person. When I receive the referral I wonder, as I often do, what does this person need from me? How can I support them and in what way? These are questions that only they can answer, much to most of my clients surprise I do not have a magic wand or ability to read minds.

I finish up what I am doing in my room and step into the waiting room with my usual warm smile that seems to initially put clients somewhat at ease. I invite the client in but as I do I hear a soft rumble, I realise I'm still hungry after my lunch and luckily there are some biscuits in the reception area.

"Before we go in, just give me a minute." I walk away and the client looks slightly confused. I pick up the biscuit jar, grab two out and hold it toward my client. "Cookie?" My client politely declines, as many do, and I comment that I don't understand this concept of "not hungry".

Ready now, we enter my room. It is modestly furnished with three wicker chairs and cushions on them. I sit on one and the client sits opposite me. The client looks around, taking in their new therapists world. They look ... uncertain and scared, yet somehow comfortable in a strange way. It's something about the way they cast their eye over everything that makes me feel their fear. Then something about the certainty in how they sit that tells me they are comfortable.

"So, you mentioned in my lecture that you have BPD, but I would like to get to know more about your story." Clients often expect the therapist to start.

With this client, I get the sense that they feel comfort in having a name for their struggles, a "disorder". Makes it more legitimate right? That's what they feel. What I want them to see though is that their struggles are just as hard with or without the name.

The client dives into their story. It seems slightly unremarkable, no events of notable concern such as trauma or early childhood concerns. However, this can often be the case. Clients sometimes know the source of their troubles, some do not. This client just knew that from the age of around 13 they have had a range of behaviours that caused issues for them, self-harm, alcohol use, drug use etc. They could not give me an answer to why other than "Because I am a failure." They explained that they have chosen to attend university as a way to find some passion.

After the session, I see the client to the waiting room and explain that appointment regularity will be their choice from here on in. This client feels they have no control over their life, they feel as though they fail at everything they try at. This means I need them to fully invest and feel as though they are driving this therapeutic relationship, in order to feel that they can take away any of the gains made.

I desperately want to consider and reflect on this client, however it's my turn to pick my children up from school. I go back into my room, pack my things and rush out through the lunch room to my car. I am sure my client sees me driving off as they walk out the door.

As I drive, my mind wanders, wanders to my client. This client has achieved so much in such a short period of life. Four years in the police force, now to be attempting university to go on to develop a career. Yet they cannot see any of this. They are stuck in this sense of not being worthy. During the session I saw a strange mixture of shame, guilt, and sadness... almost sadness form what "could have been", like the client see that whatever "it" is, it still can be.

I pull up to the school and visualise separating my clients experience from my own experience. I am now in parent mode. Until I receive an email from that very same client in a matter of hours.

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