I Don’t Want to Cope: A List of Therapy Tricks Without the BS

This post contains affiliate marketing links.

CW: Brief descriptions of childhood trauma.

I sat in my therapist’s office at 16, soft spa music lilting in the background.

Breathe in, 2…3…4…, Breathe out, 2…3…4…

I followed her directions, but I couldn’t help but roll my eyes. I had been assaulted a year prior, my parents were in the process of a messy divorce, and I had lost almost all of my friends in a short period.

And this woman wanted to solve that with breathing?

I hated going to therapy. It was a waste of time. I was tired of BS tactics to try to “regulate” or whatever.

Another therapist had erroneously suggested I had BPD. Queue the big book of worksheets and attempt to “fix” me instead of the traumatic environment I was in.

I saw another therapist that told me I was too dysregulated to do EMDR. She presented the “window of tolerance,” this imaginary window of emotions that you can realistically regulate, and extremes on either end of extreme dysregulation. The next 6 months of therapy with her consisted of chastising me for not being in my “window of tolerance” and any progress squashed by her enormous case-load resulting in her not remembering what we had done session to session.

And that’s not even getting into my traumatic inpatient experience.

I began to think I was the problem. Therapist after therapist failed to help me. I was an “extreme case.” A case no one wanted to take because I had a severe mental illness, something many therapists are not truly equipped to handle.

With an industry that was supposed to help me, why was I struggling so hard to find a therapist? I was told that was the solution. But none of their “tricks” worked on me.

Eventually, I met my current therapist. I had never understood people telling me I just had to “find the right therapist” before I had met her.

I saw progress in a short period that exceeded all of my therapy combined. She used many of the same techniques as the other therapists (breathing exercises, trauma-focused CBT, etc.), but suddenly they were successful.

How can the same technique that didn’t work be successful? I didn’t understand until I got further in my psychology courses.

Therapeutic Rapport > Therapy Technique

One of the most significant concepts I learned in my Bachelor’s program was The Three C’s of Resilience presented in Change 101 by Bill O’ Hanlon.

Resilience to psychologically damaging events requires connection, contribution, and compassion.

In short, you have to feel connected to your community, feel like you can contribute to the world, and be in relationships that allow you to fully express yourself and be met with compassion for your experiences.

This rang true for my own journey to resilience, and I quickly saw how my therapist played a crucial role in that.

Therapeutic rapport, building a relationship with a client through unconditional positive regard, is key to success in therapy. And it’s one of the biggest reasons (in my humble opinion) to do the work to find a therapist if you have the means.

The techniques themselves (the grounding exercises, cognitive techniques, or other mindfulness practices) can be helpful, but don’t do much when your problems extend beyond “cognitive distortions.” Unlike Cognitive Behavioral Therapy (CBT) would lead you to believe, your problems aren’t all in your head. There’re real problems in the world you’re dealing with.

My favorite philosophy book by Susan Brison discusses how the violent sexual assault she went through left her with a broken sense of self. She discusses how having a narrative of trauma and telling it allows for a re-integration of that fractured self. A supportive therapist that you connect with can be the audience to that challenging event, mitigating any risk and helping you heal yourself.

It’s also why a bad relationship with a therapist can be so damaging. If your self-narrative is met with judgment, coldness, or indifference, you internalize that. It makes it difficult to heal. You lose connection and compassion.

In a perfect world, all therapists would be helpful, open-minded, and compassionate. Unfortunately, we don’t live in one.

Doing the Work on My Own (and you can too!)

Luckily, most techniques therapists use can be found on Google or in a library. That doesn’t mean you’ll be able to apply them with the same skill as a therapist, but ultimately therapy is only successful if you can find a way to make the techniques work for you.

Since everyone is different and many therapies take a one-size-fits-all approach, my experience hating all mentions of “mindfulness” is not unique.

For a while, I was without insurance and couldn’t afford housing, much less a therapist. It was a luxury, something only people who already have their life together could do. Mental illness makes it hard to work, not working makes it hard to afford basic life necessities, and not having basic life necessities aggravates mental illness. And so, the vicious cycle continues.

During this time, I made progress without a therapist. I figured that I had all the tools at my disposal, why not therapize myself?

(Note: I am not saying do this INSTEAD of therapy. This is meant to be a guide only if a therapist is unavailable to you or as supplemental to therapy. There are some risks of doing therapy homework by yourself, like no barriers stopping you from pushing yourself too far or not having someone present if you’re at risk of harming yourself. Exercise extreme caution and keep someone close to you in the loop with what you’re doing.)

I delved into self-help books and autobiographies, examining how someone with extreme trauma went from completely falling apart to a functional human being.

List of Coping Skills and Why They Work

Mindfulness

Mindfulness is beaten like a drum for coping skills. It’s often accompanied by images of uncomfortable chairs, gurus, and boredom. Mindfulness is often a rigid process, and it seems like there’s a “right” way to do it.

The truth is, mindfulness can be many things you wouldn’t even think of. We naturally turn towards mindfulness in our lives to help us calm down.

Mindfulness works by engaging the parasympathetic nervous system. This relaxes the body and helps essential processes. It doesn’t matter how you’re mindful, just as long as you are fully aware in the moment. It also works well for dissociation.

Mindfulness techniques you might not think of:

  • Eating a fine meal and really savoring the flavor
  • Riding a roller coaster and being aware of how you feel
  • Writing in a journal
  • Creating a piece of art
  • Listening intently to a new (or favorite) song
  • Holding your breath
  • Ecstatic dance or dance that makes you aware of your body
  • Metacognition (e.g., I am on the couch, reading an article, I feel thirsty)
  • Self-hypnosis (youtube videos)
  • Driving in silence
  • Stimming breaks
  • Going for a nature walk
  • Blowing bubbles
  • Watching cartoons (be aware this can trigger littles if you’re a system)
  • Pet an animal
  • Walk barefoot
  • Sing a song
  • Scream in your car or isolated place
  • Build a lego set

Vagus Nerve Stimulation

This is one of my new hyperfixations because it is SO COOL. The vagus nerve is a nerve that runs through your body that controls your heartbeat and has a part in the autonomic nervous system.

You stimulate this nerve subconsciously every day by completing different activities. It can also be a handy trick for reducing anxiety because it reduces your heart rate and can help kick the parasympathetic nervous system in gear.

It is important to note that if you’re prone to heart attacks, manual stimulation (particularly the modified Valsalva) of the vagus nerve can be risky without a doctor present.

Things that stimulate the vagus nerve:

  • Modified Valsalva Maneuver – a maneuver used in medicine to slow down the heart
  • Cold showers, putting your face or hands in ice water
  • Pooping (no, really)
  • Meditation or prayer
  • Singing or chanting (this is part of why “om” is chanted during meditation)
  • Laughing
  • Massage (here’s how to give yourself a massage)
  • Hugging (yourself, a stuffed animal, or a loved one)
  • Cough
  • Sit-ups

Environment Changes

If you’re in an unsafe environment, it can feel like life is hopeless. While completely changing your life situation takes a long effort, small things can help you feel safer.

One of the protective factors for people in difficult situations is a sense of control and a sense of purpose. You can control the smallest things and see positive psychological benefits.

Environment changes:

  • Create a YOU space. Wherever you can go to make a safe space, create it. It may be your room, your closet, the local coffee shop, Mcdonalds, a friend’s house, a park, a classroom, a car, or anything else where you can get away. Having a safe destination can make a big difference in maintaining some level of stability.
  • Purchase a non-lethal weapon
  • Get a pet, even something as small as an ant farm
  • Get a plant
  • Volunteer for a cause you care about (think mutual aid, what would you want help with?)
  • Create a portable coping kit
  • Set a goal and create a to-do list to accomplish it (can be silly like learning to do the splits)
  • Create a safety plan (who you would call, what you need to grab, and things that help you calm down)
  • Dye your hair (even one strand or the bottom with help from a friend)
  • Donate something
  • Make an eco-system

Distractions

Sometimes nothing works. You’ve tried all the coping mechanisms you can think of and you’re still overwhelmed. It’s okay to distract yourself in a healthy way before you can get to a place to confront the experience or emotion.

Distraction is good when you’ve tried other things and they haven’t worked or your experience is so distressing you need to buy yourself time to calm down.

Healthy distractions:

  • Video games
  • TV or a movie
  • Talking with a friend
  • Exercise
  • Going for a walk
  • Making art
  • Watching comedy
  • Baking or cooking
  • Hobbies
  • Go to the library
  • Coloring
  • Do something outside the house
  • Wreck this journal

Recommended Resources

Let me know in the comments if there are any resources I missed!

Autistic ABA Practitioners – The Canary in the Coal Mine

[I]t was a traumatic experience as an RBT and can’t imagine how these kids feel getting the “treatment”. I will never forget my time there and how I was treated. It will stay with me forever.

Nancy Cervara, autistic ex-RBT

This experience reflected my own. I will forever be impacted by how working in Applied Behavioral Analysis (ABA) traumatized me, and I was troubled to hear that I was not alone.

Something that is very rarely explored in the ABA discussion is the clinician’s experience with it. I am unaware of a source that has examined autistic ABA practitioners’ perspectives.

I was pleasantly surprised at the outpouring of support from autistic ABA clinicians and ex-clinicians that wanted to share their perspectives. There has been a valuable voice missing from a nuanced dialogue.

“New ABA” is at the heart of contention, with parents and providers swearing it’s changed so fundamentally that it is now ethical and safe. ABA survivors and autistic people have warned that it is the same therapy with a new coat of paint.

One of the significant problems in this conflict is that most survivors of ABA abuse experienced what has been cleverly categorized as “old ABA.” Often, their experiences are dismissed by parents and ABA providers alike because they didn’t go through this “new ABA.”

One group of autistic adults has an inside look at exactly what the “new ABA” is all about.

Autistic ABA practitioners. One of the most hated groups in all of ABA. They are patronized and subjected to ableist situations daily by their peers and rejected and despised by their own community. And yet, they are one of the most valuable resources in reflecting the current state of ABA.

A common critique of ABA is that there aren’t enough autistic individuals represented in leadership and research.

Why is that?

I obtained interviews from six current or former ABA practitioners that provide valuable insight into barriers autistic people face in the field and changes that need to be made.

Who Was Interviewed?

Current Practicioners5/6
Practiced Discrete Trial Training (DTT)6/6
Practiced Naturalistic Teaching (NET)5/6
Worked in “All” Settings (Clinic, School, Home)3/6
Diagnosed After Working in ABA5/6
Has/Had BCBA Credentials4/6
Interview Demographics

Barriers Placed by Neurotypical ABA Peers

Weaponizing Professionalism

“I told the HR director that that supervisor was in violation of the ADA and that individual’s rights…I pointed out that if the organization claimed to be trauma-informed then they needed to be trauma-informed for both their learner and their employees. The HR director was not happy with me, and later on, before I left, there were attempts to entrap me with write-ups for things that had been resolved months before, which I resolved as soon as they were brought to my attention.” – Brian Middleton, BCBA

“I opened my mouth about how I did not like the things we did. Someone told on me and I was harassed for two weeks and they lied about me leaving kids in dirty diapers and other things. They eventually had forced me to quit and told me that if I ever want to come back to the company, that write up will follow me.” – Nancy Cervera, ex-RBT

“I would like to be quoted anonymously…Too many good people in the field have had their credentials questioned. Sad that I have to fear for my credentials but I do.” – Anonymous BCBA of Divergence and Dissonance

“The director of one of the companies I worked at is the president of our state licensing board and I am concerned I could face repercussions for speaking out against her, as I know other people who already have.” – Anonymous BCBA 1

Anti-Autistic Sentiments

“I was definitely discriminated against for common characteristics of autism-my direct way of speaking, especially-and it was always a situation with an overly sensitive neurotypical person. I was always giving them the benefit of the doubt… but they never did the same for me when it came to how direct I am. They automatically assumed I meant the worst.” – S. Adams, BCBA

“Disclosures about my challenges have most often resulting in people trying to manage me so that my challenges impact them less. Usually in ways that are not only unhelpful, but also make my job harder.” – Anonymous BCBA 1

Woman holding head in hands, looking at computer screen with multiple notebooks. She looks frustrated.

Do you think ABA is a safe environment to work in as an autistic person?

“No, not in the slightest.” – Anonymous BCBA of Divergence and Dissonance

“Yes and no. It depends on whether the people in charge of the organization understand what autistics need or not.” – Brian Middleton, BCBA

“No, definitely not. I am autistic and knew it was terrible the moment I stepped in for my first day. I didn’t know I was autistic then, but realized it after.” – Nancy Cervera, ex-RBT

“No. Based on my experience, its an unequivocal no. I honestly believe that the stress and trauma I have experienced in this industry has contributed to me developing fibromyalgia.” – Anonymous BCBA 1

“As long as the environment is genuinely supportive and provides accommodations, it should be safe. Every clinic is not the same, but I can’t confidently say that most are genuinely safe spaces for autistic voices…If you’re a neurotypical person reading this, you can make ABA a safe place for us to work by first listening to our voices. It’s possible.” – Tee (she/her), RBT

Reactions of the Autistic Community

“I’ve received death threats. I’ve been called racial slurs, and I’ve been called an abuser.” – Tee (she/her), RBT

“I have received a lot of hate. It hurts, but I understand why. I have been told that I am a token. I have been compared to someone who has been through conversion therapy. I have seen the ban lists where my name was next to some other people with whom I completely disagree. I have received hateful messages, including some threats… I have learned that my best course of action is to keep teaching and modeling how to be a humanistic behavior analyst.” – Brian Middleton, BCBA

What Needs to Change?

Woman holding a microphone and talking into it pointed directly at a man

Better Education

“More well-rounded educational requirements for clinicians, higher standards and better training for RBTs, required learning directly from autistic people in some format.” – Anonymous BCBA of Divergence and Dissonance

“First, inclusion on extensive training on autism & neurodiversity awareness, acceptance, and inclusion training in all ABA programs, and a requirement that all BCBAs that serve such populations received that training as well… Second, there needs to be extensive training on how the commonly accepted and used techniques used in behavior analysis can and do cause harm. This includes training and demonstrating how assent-based interventions work in a contrast to compliance training.” – Brian Middleton, BCBA

“I firmly believe that extensive knowledge of childhood development and psychology should be required to work in this field of work. When you understand and acknowledge these subjects, you will understand why specific ABA techniques and expectations are problematic.” – Tee (she/her), RBT

Focus on Self-Advocacy and Autonomy

“[G]reater focus on self advocacy and autonomy and less focus on “problem” behaviours that are generally symptomatic of a problematic environment and unmet needs.” – Anonymous BCBA of Divergence and Dissonance

“The goal should not be compliance; the goal should be cooperation. We should be working to improve the quality of life of the autistic individuals we serve.” – Tee (she/her), RBT

“[T]here needs to be an emphasis on self-management, autonomy, and generalization practices in behavior analysis. There is extensive research in ABA on these topics, yet there is not a lot of it being applied.” – Brian Middleton, BCBA

Better Success Measures

“I also think a way needs to be found to shift away from productivity and worth being measured in hours, an arbitrary social construct that is meaningless to large numbers of ND people.” – Anonymous BCBA 1

“[B]etter social validity measures involving the client rather than just the stakeholders.” Anonymous BCBA of Divergence and Dissonance

It Can’t Change

“I would eradicate ABA completely. The worst type of “therapy” there is.” – Nancy Cervera, ex-RBT

“I’m honestly in a place where I’m not sure if the field can be reformed…” – Anonymous BCBA 1

“[I]t is more than obvious to me that advocating against the oppression of Autistics (mainly children and those with high support needs in various life areas) within the field of ABA is toxic and detrimental to one’s mental and emotional health. ” – NT ex-practitioner*

* NT ex-practitioner wasn’t formally interviewed but I requested to use their quote as I felt it was a good summation of some of the other sentiments expressed here.

Silver Linings

“When I realized that this field of work had caused so much damage and destruction, I had a major meltdown that caused a downward spiral for a few months. I didn’t think there was a way to practice ABA ethically, but there is. It’s not necessary to use intensive interventions; it’s not even essential to use punishments. We can change motivation from extrinsic to intrinsic. It’s hard work, but it’s possible and worth it.” – Tee (she/her), RBT

“I believe that ABA can be a humanistic approach to learning and teaching. I believe that there is a better way. I am committed to making it so that the dominant species of ABA is one where the autonomy and individuality of the individuals served are respected. I fully accept that I will be hated and reviled by people on both sides for my view, and I also hope that there will be meaningful change in this field sooner rather than later. In fact, I am already seeing it. That, more than anything else, tells me that ABA can be and is able to do and be better.” – Brian Middleton, BCBA

“I’ll likely choose to leave the field at some point, but at the moment I try to improve my own work and provide ethical and affirming supports. The work I am taking on allows me a great deal of freedom to do so.” – Anonymous BCBA of Divergence and Dissonance

“I guess I could walk away from all of this by recognizing that the rigidity and ableism in this industry is what exacerbated my struggles to the degree that I was actually able to recognize I had a disability. I was able to cope and mask effectively enough to get by until ABA made it abundantly clear that I was not enough and was not valued.” – Anonymous BCBA 1

Catatonia – More Than Just Freezing

My heart races as I freeze, my whole body flexed in an uncomfortable position. I cannot move or speak, and I am stuck staring ahead. This feels like sleep paralysis, but I’m awake?

It feels like I should be able to move. I command my legs and arms to move, but nothing happens. My brain is trying desperately to maintain this illusion of control.

Like sleep paralysis, I have the urge to scream, but nothing comes out. The more I fight, the worse I’m pulled into this sense of helplessness. It’s a waking nightmare.

I’m experiencing catatonia.

Over time, catatonia becomes another mental health symptom I greet with resigned familiarity.

At least 1 in 10 people with severe mental illness will experience catatonia at some point.

Despite this, information on catatonia is not widely available. I didn’t learn the name for my catatonia from any doctor or therapist. I had to actively search to find a name for what I was experiencing.

Who Experiences Catatonia?

Catatonia is a prominent feature in schizophrenia (up to 35% of people with schizophrenia). It is classified under psychotic disorders but “can occur in the context of several disorders, including neurodevelopmental, psychotic, bipolar, depressive disorders, and other medical conditions” (DSM-V, 2013).

Nearly one-third of people with bipolar have it, roughly 3-12% of autistic people have it (across multiple studies), one small sample found 87% of people with Tourette’s met the criteria, and in one sample of inpatients with catatonia, 57% had experienced childhood trauma (ACEs). Psycho-physiological symptoms, BPD, dissociative amnesia, and paranormal experiences may also be correlated with catatonia.

What is Catatonia?

While they are under the same definition in the DSM-V, catatonia is often split into two categories. There are two main types of catatonia, akinetic and excited.

Akinetic is the most common. It is characterized by at least three of the following symptoms:

  • immobility
  • mutism
  • withdrawal
  • refusal to eat
  • staring
  • echolalia
  • echopraxia
  • atypical inflexible postures (posturing)
  • resistance to movement
  • repetitive movements
  • declining requests or not responding for no apparent reason (negativism)
  • grimacing

Excited type may be characterized by any of the symptoms in akinetic type but is also characterized by agitated psychomotor behaviors, which may express as meaningless movements or vocalizations and may result in self-injury or aggression.

Considering the prevalence of catatonia in autism, there are significant implications with excited catatonia type. Self-harm and aggression may be expressions of catatonia in autistic people, which further raises ethical concerns for behavioral interventions if catatonia is not considered as a differential diagnosis.

In extreme cases, there may be malignant catatonia which can be lethal. This is generally descriptive of drastic physiological changes (like blood pressure and hyperthermia) in catatonic episodes or other complications like malnutrition from a prolonged inability to eat.

Catatonia exists on a continuum of severity ranging from minutes to weeks. Historically catatonia was only diagnosed if it was extreme, but now it is considered commonly associated with many mental and medical diagnoses.

Treatment for Catatonia

Treatment for catatonia typically uses electro-convulsive therapy (ECT) or benzodiazepines. In addition to these treatments, psychological therapy also seems to help some people with catatonia. Transcranial magnetic stimulation (TMS) is a potential treatment for catatonia, though the evidence is preliminary.

For less severe forms of catatonia, formal treatment may not be needed. Catatonia is not an extreme enough symptom for me to need treatment for it. Things that have helped me personally are grounding exercises and anxiety coping mechanisms, as anxiety from catatonia can often aggravate it.

If you experience catatonia, you are not alone. Since the condition is not well known and carries some stigma, it can feel very isolating. But it’s far more common than people realize.

Please let me know your experience with catatonia in the comments or reach out to me through the contact form.

I Think I have Dissociative Identity Disorder (DID), Now What?

This post contains affiliate marketing links.

Check out Pt 1: How Do I Know if I Have Dissociative Identity Disorder (DID)?

When I was diagnosed with DID, I couldn’t believe it. It felt like I must be faking it. I was obviously just exaggerating symptoms and lying to the clinician, right?

Even though logically, I knew the recognition was coming from a genuine place of seeing me switch in therapy, experiencing amnesia, and even starting to put names to my alters, it felt unreal.

Self-doubt seems to be one of the universally experienced symptoms post-recognition of DID or OSDD-1b.

Add any doubt you receive after revealing your recognition to other people or seeing people online who present the way you do being called fake. It can be unbearable at times.

I still sometimes feel that creeping self-doubt after seeing comments discussing how a creator is “obviously faking” for symptoms that I also experience. That’s the danger of fake-claiming.

If your system has a host, this can be especially difficult. To a host, the world feels like a singular experience. Sure, you sometimes feel “influenced” in particular directions, but that’s just how most people think, right? Don’t people experience conversations in their head with people that don’t exist in the outside world?

(Note: Before you self-diagnose, please understand the importance of differential diagnoses and DID)

One of my favorite metaphors for being a system vs. not having distinct parts is to think of your thoughts like a tree. For non-systems, thoughts are like roots stretching from the ground to make a singular tree. There may be many different roots, but they’re all part of the same tree. For systems, thoughts are like the same root system that makes up multiple trees. Each is its own distinct tree with unique thoughts, still tied to the same root system but do not form just one tree.

That is to say, non-systems don’t have conversations in their head with people that aren’t in the external world. They aren’t “influenced” by other voices in their head. They have one singular voice. It’s the same voice regardless of where they are.

So, while the hosts in our system were desperately trying to cling to this idea that they were the only people there, a gatekeeper, Penn, decided to try to prove that we were a system.

He binged research pointing to case studies that fit our description to a frightening degree. He categorized photographs by alter to show the physical differences in our presentation. He examined evidence on different dissociative disorders and tried to log dissociative amnesia. It’s hard to know what you don’t remember.

I was consumed with trying to “prove” to myself that I didn’t have it. It was professionally confirmed, and I still felt there was no way. No matter how much evidence was presented, it felt like I was just looking for signs to trick others.

And then, one night, an event happened that made me never seriously question being a system again. I accessed memories.

I wish I could say that I magically recovered a significant portion of my past when I started working with my system instead of against it. But it was an external event that triggered a dissociative episode so bad I could see myself outside of my body.

And then I was flooded with memories of traumatic events like a psychological dam had suddenly been broken. I wrote and wrote everything that was coming to mind so that I didn’t lose it. At that moment, I finally felt like I couldn’t be faking it. How do you fake suddenly remembering years of your life?

Forcing Myself to Remember

Whether you’re a newly recognized system or questioning, some common experiences come up.

When you have dissociative amnesia, you can’t control when you remember your past. It’s so tempting to go digging for it, to try to intentionally trigger yourself to find out your own history. I’ve done it, and I’ve heard many others do it.

It feels like this, desperately trying to connect the events in your life:

Don’t do it.

I know, easier said than done. There’s a kind of distress that people without dissociative amnesia won’t understand. It feels like information that’s on the tip of your tongue, something you should know, but you just draw a blank. Only the information you’re blanking on is severe, stomach-wrenching trauma.

It’s further reinforced by trying to remember to “prove” you’re not a system.

“If I can just force myself to remember, then it’s not dissociative amnesia. I have a right to know my history!”

I can assure you, if you don’t remember it easily, forcing yourself to remember isn’t going to work. It’s like trying to force yourself to not be sad. Chances are you’ll only make yourself more miserable.

Siding with Abusers by Gaslighting Myself

CW: The following section contains descriptions of child abuse.

Something that seems true in almost all trauma victims is that they feel at some point that their trauma wasn’t bad enough to be “real trauma.” This goes for DID as well. Many times I’ve seen new systems say, “but my trauma wasn’t bad enough to create DID!”

When you hear stories of other people that experienced trauma, it’s easy to feel that self-doubt. It’s not like I experienced that. Mine was mild.

Comparison is an act of violence against the self.

Iyanla Vanzant

Who does that voice sound like? Does it extend the same compassion you’d give a friend?

When you’ve experienced complex trauma, you internalize the voices of your abuser(s).

Every child develops a mental representation of their caregiver to self-soothe as they grow older. When your caregiver is also an abuser, you internalize a mental model of an abuser that is central to your understanding of yourself.

You may have heard your abusers say things like, “you’re being dramatic,” “it wasn’t that bad,” “you’re remembering that wrong,” and “I did what was good for you.” How else would they be able to get away with abusing others?

Your internalized abuser says those things too. They tell you that you do not remember things accurately or the trauma wasn’t that bad.

You’re not your abuser. Don’t gaslight yourself and give them that power.

Your trauma was bad enough. It was real. And your experience is not comparable to others because it’s what you experienced.

It Doesn’t Matter if You’re Faking

Chances are, this article won’t permanently change your mind on whether you’re faking being a system. You’ll likely go through the ups and downs of believing you are and aren’t.

At the end of the day, it doesn’t matter if you’re faking.

Wait, but what if I’m taking resources away from ‘real systems’? What if I’m spreading false information by saying I’m a system?

If the label fits and it helps you, use it. You’re not taking away resources by using resources that help you. It’s not selfish to use what works.

Both non-systems and pro-dxd systems can spread misinformation. Spreading accurate information is not a prerequisite to being a “valid system.” If you’re making it clear you are only speaking for your experience, it doesn’t matter if you change your mind later. You’re being honest about what fits and helps you now.

You’re not saying you’re a system to gain anything. You’re looking for answers that fit your situation. It doesn’t matter if “you’re faking.”

And if you’re seeking a professional diagnosis, it’s been demonstrated multiple times that people who intentionally fake DID (actors) can be easily distinguished by professionals from those that experience real symptoms.

Now What?

It can be incredibly lonely and confusing when you first realize you’re a system. That’s why it’s important to find others that share your experiences.

Logging Tools:

Here are some of the groups I recommend joining:

Here are some resources to get you started:

Learning you’re a system is a very overwhelming and exciting process. You are not alone in this process, and there are resources you can use to learn more about yourself. Please reach out through the contact form if you have any questions.

Congrats on getting a little closer to understanding yourself, and good luck on the path of self-discovery ahead!

How Do I Know if I Have Dissociative Identity Disorder (DID)?

Disclaimer: I am not a licensed professional. I cannot diagnose you, and my advice should be taken with a grain of salt. I know what it’s like to be a system, but I don’t know your unique experience and if another diagnosis might fit your experience better.

“I love my job,” I told my therapist, detailing how the social interactions were challenging and invigorating.

In the next session, I walked in and proclaimed, “I hate my job!” and detailed all of the horrible interactions I had to deal with every day.

My therapist smirked and took down detailed notes to confront me with later. Alex would front (take over the body) in the mornings for our sessions, and he loved the job, and I would front in the afternoons and absolutely despised it.

Anytime I’d go out to eat, it felt like I had many different voices talking over each other about what I wanted. Choosing was nearly impossible, and no matter what, it felt like I wasn’t fulfilling my needs.

Sometimes I loved writing with a passion. Other times I couldn’t stand it.

My “style” consisted of various clothing styles across different genres. I had low-cut sparkly tops, cargo shorts, flowy robes, polos, and ripped jeans all in the same drawer.

If you asked me what music I listen to, I’d have to say “a little of everything.” And I didn’t mean that I mainly stuck to a few genres but was open to others. It meant I had playlists full of classical, punk rock, rap, country, EDM, folk, etc.

My gender expression and sexuality fluctuated wildly, but I never felt “genderfluid.” I felt like a man, woman, or trans at any time, but I didn’t feel like I was fluid between them.

I had male and female pseudonyms that I would use online in different interest groups. I wrote papers under pseudonyms not because I wanted to remain anonymous but because I “liked how it sounded.”

When I was upset, I acted like a child, my voice getting higher, my cognitive functioning through a fog, and only finding comfort in items “made for children.”

It’s easy to look back now and see how being a system affected how I interacted with the world. When I found out I was a system, there was a click. I finally had an explanation for my unstable, shifting sense of self (which had been misdiagnosed as BPD). I understood my “zoning out,” my dissociative hallucinations, rapidly changing emotions, and being told I was “like a different person” sometimes, and why I felt the need to have so many names.

Wading Through the Sh*t

I have Dissociative Identity Disorder. And if you’re here, you think you might have it too.

It can be scary suspecting you have the diagnosis. There are so many different sources pulling you in all directions.

When I looked up “Do I Have DID?” going through this process, there was quiz after pseud0-scientific quiz asking for your credit card information. There were articles pathologizing and referencing systems as if we were rare monsters causing chaos everywhere we go.

YouTube videos sensationalized and demonized the disorder, saying, “come one come all! See the DID System perform the fantastical switch to become a whole new person!” References to Split and other problematic media are littered with connections to real systems.

All the scientific articles were arguing about the existence of DID, with little on what it actually looks like. And if you want to find research from the last 10 years, you’re pretty much out of luck.

Tik Tok, Reddit, and other social media users have loudly degraded anyone public about being a system. When there’s so much wrong information and incentive not to figure out you’re a system, how are you supposed to work through your own experience?

Finding out you’re a system is not just about wading through pools of bullsh*t to find good information. It’s also about deconstructing what you’ve known your whole life of what it means to be a person.

A Breakdown of the DSM Criteria

Let’s first examine the DSM-V criteria for DID. Since I am American, this is the criteria I am most familiar with but the ICD criteria is similar. Try to read this non-judgmentally. You are trying to find a label for your experience, not fit your experience to a label. I’ve paraphrased the criteria below to help with readability.

Dissociative Identity Disorder Diagnostic Criteria (F44.81)

  1. Two or more distinct personality states with their own sense of self and change in consciousness, memory, perception, cognition, and/or sensory-motor functioning. Discontinuous sense of self and agency. It may be described as a possession. It can be noticed by the individual or other people.
  2. There are gaps in remembering everyday events, important personal information, and/or traumatic events beyond normal forgetting.
  3. Clinically significant distress or impairment in functioning.
  4. Not attributable to cultural/religious practice or physiological effects of a substance or medical condition. In children, it can’t be better explained by imaginary play.

(American Psychiatric Association. (2013). Dissociative Disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). doi: 10.1176/appi.books.9780890425787.x08_Dissociative_Disorders.)

It’s one thing to look at the criteria, but it’s another to understand it. One of the difficulties of any diagnosis (but especially uncommon diagnoses) is that it’s hard to know what the symptoms look like in application.

Criteria 1 Examples: Two or more personality states

  • Your brain functions like a conversation of multiple people talking or thinking at once
  • You hear voices that aren’t yours
  • You regress significantly and feel powerless
  • You regularly feel like you’re a different person altogether, or others have mentioned you’re a different person
  • You’ve had an experience of possession
  • Your preferences shift dramatically, you may have opposite food, gender, etc. preferences, and this happens regularly
  • You have body or gender dysphoria
  • Others comment that you sometimes talk or act differently, or you’ve noticed this change. This could be significant changes in vocal tone, vocabulary, posture, situation assessment, facial expressions, etc.
  • You feel non-human at times or like you’re the wrong age
  • When someone mentions you did something, you don’t feel like “you” did it
  • You can identify distinctly different “versions of you”

Criteria 2 Examples: Gaps in Memory Recall

  • You cannot remember a period in time beyond what would be considered normal forgetting (e.g., you can’t remember anything between age 12-13)
  • People mention how forgetful you are, or you notice you feel your memory is unreliable
  • You can recall specific memories very vividly sometimes but can’t remember those same memories at other times
  • You remember details of an event but can’t remember anything emotional, as if you read it out of a newspaper instead of experiencing it
  • You sometimes forget your name, address, phone number, or other vital information
  • You minimize when you do forget something most people wouldn’t forget, blaming it on other factors like being tired
  • You can’t remember a particular location at all that you visited frequently
  • You find yourself “waking up” somewhere, especially when stressed with no recollection of how you got there
  • You sometimes forget significant skills like driving, your job, your ability to write or speak, etc., especially while stressed
  • You recall the same memories very differently at different times, with no explanation for why your viewpoint changed
  • You have to write things down regularly if you want to remember them. You find notes you don’t remember writing

Criteria 3 Examples: Distress or Impairment

  • Your poor memory makes it difficult to work, attend school, parent, or take care of yourself
  • You feel haunted by not knowing parts of your past
  • Being a different version of yourself makes it hard to maintain friendships or has gotten you in trouble at work, school, or in public
  • You struggle to date because there’s a conflict in your head about who you’re dating, or your partner complained that you were “inconsistent”
  • You struggle to remember important deadlines or meetings
  • Losing the memory of how to perform certain skills makes it difficult to take care of yourself or affects other areas of your life
  • You find it overwhelming that you can never make a consistent decision on a direction in your life or a sense of self
  • You spend an inordinate amount of time deciding what to eat, wear, listen to, and it makes making any decision difficult
  • You feel like you have no control over your life
  • You regularly feel helpless
  • You feel like you’re constantly on the verge of a breakdown
  • You struggle to maintain relationships because people have said you’re “unreliable,” “wishy-washy,” or “unstable”
  • You experience any of Criterion 1 or 2 symptoms, and that causes you trouble in some area in your life or a lot of stress

Differential Diagnosis: The Biggest Risk of Self-Diagnosis

This is where Criterion 4 comes in. Self-diagnosis is sometimes necessary, especially when only 55% of clinicians believe the diagnosis is valid. Unfortunately, many clinicians don’t have any experience diagnosing DID, and the psych field has not treated DID systems well. That leaves a lack of information in a situation where a professional diagnosis is needed.

I am not against self-diagnosis because financial and cultural barriers are insurmountable for many minorities and impoverished people. This is an unfortunate reality of our current medical system.

But there are dangers to self-diagnosing DID that need to be addressed. The most significant one is differential diagnosis.

Since DID is so complex, many disorders mimic DID symptoms that may be difficult to spot without a trained eye. If you misdiagnose yourself with DID when you don’t have it, this could have serious consequences.

For example, simple partial seizures are where someone is fully aware but frozen. They may experience hallucinations, deja vu, and headaches. All of these symptoms may mimic a dissociative episode and cause a misdiagnosis.

Absent seizures (the most common type) are similar, where a person freezes and gets a blank look on their face. It is very short and results in a lapse in memory. This can look like dissociative amnesia.

The only way to diagnose seizures is through an EEG which requires a doctor. The last thing you want to do is have epilepsy and misdiagnose yourself as having dissociative identity disorder. The two have very different treatments, and untreated seizures can be fatal.

DID and epilepsy can co-occur as well, so it is worth looking into even if you receive an official DID diagnosis.

A few other differential diagnoses that are important to rule out are BPD, characterized by a discontinuous sense of self and dissociation similar to DID. OSDD is characterized by dissociative amnesia without alters, vice versa, or other specific circumstances (like intense brainwashing or only occurring for a short time). PTSD – which could present as gaps in recall or personality disturbances. Schizophrenia – shares psychotic symptoms with many DID presentations, and negative symptoms could be interpreted as dissociative or personality disturbance.

If you have the means to get a diagnosis, it is important that you seek a professional for DID. If you’re looking for a website to help find someone that can diagnose DID, try this or this.

If you don’t have the means, you are welcome to self-identify but know that there are certain risks of missing a serious medical or other psychiatric condition.

Now What?

After reviewing all the information, if you feel like you are a system, I recommend checking out my next article, I Think I have DID, Now What?. I detail common experiences of newly discovered symptoms and resources you can utilize to further investigate your experience.

Growing Up as a Closeted Trans Man in the Mormon Church

CW: The following article contains descriptions of transphobia, sexism, and sexual assault. Reader discretion is advised.

“Gender* is an essential characteristic of individual premortal, mortal, and eternal identity and purpose…We further declare that God has commanded that the sacred powers of procreation are to be employed only between man and woman, lawfully wedded as husband and wife.”

The Family: A Proclemation to the World

*”The intended meaning of gender in ‘The Family: A Proclamation to the World’ is biological sex at birth.” – churchofjesuschrist.org

I sat in a dark classroom inside a church, my nine-year-old body fitting perfectly between the chalkboard and wall. I cried quietly as a Boys Scouts ceremony happened in the next room. My brothers received awards for activities I wasn’t allowed to do, receiving merit badges for shooting, hiking, and woodworking.

I couldn’t articulate my deep sense of injustice then or the looming gender dysphoria as I was painfully shown my place as a woman.

Everyone knew I was different. I was an ugly duckling, making waves in the regular ducks’ pond.

I was taken to a pitch-black room at my first “young women’s” activity (a youth group for girls 12-17). A leader placed a gold bow on my back and sent me inside. I stumbled through the room with obstacles placed around me and someone shuffling in the dark.

I tripped over a chair and caught myself on the hard gym floor. The person shuffling about snatched the bow off my back at that moment. I persevered to the end of the maze, where a picture of white Jesus was illuminated.

I was admonished for losing my virtue. The leaders told us that we would have our virtue taken from us if we weren’t careful and that navigating the world would be like navigating that dark room. Only through Jesus would we be forgiven.

The boys played basketball in the other half of the gym while we received this lecture.

That night, I wrote in my diary that I would swear to protect my virtue at all costs. I anxiously scribbled away, feeling the world’s weight on my shoulders. I was responsible for keeping every bad thing from happening to me, or at least that was the message I got.

Sexism and Dysphoria

“Why are women not allowed to have the priesthood?” I asked once again. Adults never seemed to answer my questions straightforwardly, and I was determined to get an answer.

“Because women have an advantage over men. They can have kids! God had to give the priesthood to men to make it more even.”

“Women do have the priesthood! Women are lucky they can receive the gifts of the priesthood without having the responsibilities of holding the priesthood.”

“Wives exert priesthood power through their husbands. They don’t need the priesthood to receive the blessings.”

“The prophet speaks for God, and he has revealed that men have the divine right to the priesthood. We don’t know whether that will change in the future.”

I didn’t understand their answers. Women universally couldn’t have children or were married. I was more than willing to take on extra responsibilities if it meant I could hold an esteemed position of spiritual power. Believing something because someone said it was true didn’t make sense to my autistic brain either.

I still don’t understand their answers, and at some point stopped trying to understand.

Every time I asked, I was reminded that God had made a mistake. I wasn’t meant to serve underneath a man. I deserved the same rights as my brothers. And I didn’t have any path to correct that mistake. If God was so perfect, why did he place me in harm’s way?

That’s what I asked myself when my “virtue” was stolen in real life. I learned it was my fault, that I hadn’t done enough to protect it. I had fallen like in that dark room.

Because I had been born a girl, my assault was seen as a personal transgression. I was rejected by my peers and left to process the feeling of discordance with my own body.

Finding My Body in a Starbucks

Years later, I sat in a mall Starbucks in North Carolina. I anxiously filled out pages in My Gender Workbook.

I meditated on my life and understanding of myself. I was prompted to think about “what makes a woman a woman?” My experiences flooded, reminding me of every stereotype and attitude I had internalized. I quickly shot them down with the thought, “But is every woman like that?”

I couldn’t ontologically address what the essence of womanhood was. And at that moment, the binary bullsh*t became clear. There was no single essence of womanhood. I was lied to my whole life. And if there wasn’t a singular definition of woman or man, which did I want to be? The answer was clear. I was born in the wrong body.

“Lieu!” the barista called out, my new masculine name on the cup. I grabbed my cup, grinning. Years of gender suppression had been lifted all at once. I was a free man.

Trading One Injustice for Another

Last month, Utah became the 12th state to forbid trans kids in sports, overturning a veto from the governor. Out of 75,000 kids in Utah high school sports, only four are trans, and only one was in girl’s sports. The bill literally targets four individuals. There is no excuse for this.

BYU is currently under investigation for its treatment of LGBTQ+ students, which alleged discrimination goes beyond their exemptions as a private religious institution under Title IX. Half of the LGBTQ+ students surveyed said they didn’t feel safe at BYU.

82% of trans youth in Utah have experienced some form of mistreatment. 56% of trans people that interacted with police said they experienced some injustice, 34% had been mistreated by a healthcare professional, 43% have experienced homelessness, and 1 in 5 had a professional try to stop them from being trans (U.S. Transgender Survey Utah Report, 2015).

Being trans in Utah is not just inconvenient, it’s life-threatening. There is discrimination on every systemic level, and there are many contributing factors; political, cultural, structural, and interpersonal. 

There has to be a fundamental shift in how we view gender minorities in Utah to solve this problem.

We’ve already gathered data. We need to increase education for professionals so there are more trans-friendly practitioners. We need to improve education in the general community about what being trans is and separate it from politics. We need to teach children about their trans peers, teach adults about transition’s realities and understand transitioning is not a choice but a medical necessity.

I’m a program director at a small non-profit called  Genderbands that focuses on helping fund transition. When 29% of trans people and roughly 40% of BIPOC trans people live in poverty, one of the most significant barriers to transition is financial.

You can help by supporting trans-led organizations like this and writing or calling legislators. Attend protests. Let them know that transphobia is unacceptable.

The steps to fix the problem are not small. It requires a community to move forward with this level of action. We need allies rallying behind the cause through volunteering and being public about their support. We need funding for local trans organizations and greater access to low-income care. We need education on a broad scale in schools and health offices. There is a lot of work for trans people in Utah (and everywhere) to be accepted.

Validating the Hurt

One of the most shocking parts of my transition is what it’s like to live in the world as a white man. I can confidently say my life has gotten much easier because of how others see me. Before transitioning, I understood that my struggles were largely due to my gender but being validated in such a concrete way broadened my understanding of gender and intersectional privilege.

Some of the ways I experience privilege now are that I’m no longer harassed when I’m going about my daily life. I’m taken more seriously, my ideas are seen as more credible. I’m not critiqued for being “outspoken” and I don’t have to be as hypervigilant about my surroundings.

My experience seeing my PTSD improve after transition both supports the medical necessity for transition and the idea that treating symptoms of trauma like they are isolated from systemic oppression doesn’t work. My hypervigilance improved because of removing the system of oppression that required me to be hypervigilant, not because of any groundbreaking therapeutic technique.

I have the unique experience of living as both a man and a woman and can validate that women are not crazy in their experience of oppression. Living as a man in Utah has been a much more positive experience, as long as I’ve passed.

It’s about time that we stop gaslighting minorities living in Utah and take steps to understand and uplift minority experiences.

A Professional Educator’s Guide to Dissociative Identity Disorder

(Infographic Below)

Finding accurate information on DID as a professional educator can be challenging due to widespread misinformation and under-recognition. Use this guide to help inform your curriculum and your practice.

DID Systems are incredibly vulnerable

Approximately 61%-72% of DID patients attempt suicide, and 34-38% engage in self-harm (Brand, 1997). Samples of people with high levels of trauma have also been related to increased substance abuse, risky sexual behavior, and decreased life expectancy (Felitti et al., 1998). This is why educators must be informed about the condition and spread scientifically supported information to future clinicians.

DID patients are waiting >3 years for diagnosis

25% of dissociative disorder patients had >10 years delay to get a diagnosis, and 57% had a > 3-year delay (Leonard et al., 2005). This is striking compared to the 1.3 year average for anxiety and mood disorders (Jorm, 2012).

DID Myths Vs. Facts

Myth

  • Therapists create DID, and acknowledging alters makes symptoms worse.
  • DID is overt, you can easily tell when a person has it.
  • DID is incredibly rare.
  • DID is a dubious condition.
  • Integration is the only proper treatment for DID.

Fact

  • DID is formed from trauma and can only be successfully treated by acknowledging alters (5th ed.; DSM–5; American Psychiatric Association [APA], 2013; Brand et al., 2014).
  • DID is primarily covert, which is why the DSM-V criteria was expanded to include self-reported identity states (APA, 2013).
  • DID affects approx. 1.5% of the population, or ~5 million Americans (APA, 2013).
  • DID is well-established in research and can’t be replicated fictitiously (Brand & Chasson, 2015).
  • Integration can be beneficial but not practical or possible in all cases (Ringrose, 2011).

The Iatrogenic/Sociocognitive Model is Harmful and Demonstrably False

Only 55% of clinicians believe DID is a valid diagnosis despite scientific evidence (Leonard et al., 2004). It’s no surprise that there are considerable delays in diagnosis and treatment.

Edit: 40% of clinicians were unable to identify DID from a clinical vignette. This directly correlated with their skepticism of the disorder (Perniciaro, 2014). It’s no surprise that there are considerable delays in diagnosis and treatment.

The false belief of DID as an iatrogenic condition has led to under-diagnosis, rampant misinformation, and lack of research. There are no excuses for clinicians or educators to assert this belief still, considering the extensive literature supporting the trauma model and disproving the socio-cognitive (APA, 2013; Brand et al., 2014; Loewenstein, 2018).

Conclusion

It can be challenging to get accurate information as a professional educator on Dissociative Identity Disorder with the medical and cultural attitudes surrounding DID and the lack of research and education. As a professional educator, you directly influence the way future clinicians will treat patients with the disorder, which is why it’s essential to ensure the information is accurate. DID is a valid, scientifically supported disorder that is more common than many clinicians believe. DID patients are vulnerable and experience significant delays in treatment which actively harms this population. Luckily, as an educator, you can help change the stigma around DID and support it as a traumagenic condition, assisting in shaping the future of DID research and treatment.

References

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM- 5 (5th ed.). American Psychiatric Publishing. https://doi.org/10.1176/appi.books.9780890425596.dsm08

Brand, B. (1997). Establishing Safety with Patients with Dissociative Identity Disorder. Journal of Transnational Management Development, 2(4), 133–155. https://doi.org/10.1300/j130v02n04_07

Brand, B. L., & Chasson, G. S. (2015). Distinguishing simulated from genuine dissociative identity disorder on the MMPI-2. Psychological Trauma: Theory, Research, Practice, and Policy, 7(1), 93–101. https://doi.org/10.1037/a0035181

Brand, B. L., Loewenstein, R. J., & Spiegel, D. (2014). Dispelling Myths About Dissociative Identity Disorder Treatment: An Empirically Based Approach. Psychiatry: Interpersonal and Biological Processes, 77(2), 169– 189. https://doi.org/10.1521/psyc.2014.77.2.169

Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults. American Journal of Preventive Medicine, 14(4), 245–258. https://doi.org/10.1016/s0749- 3797(98)00017-8

Jorm, A. F. (2012). Mental health literacy: Empowering the community to take action for better mental health. American Psychologist, 67(3), 231–243. https://doi.org/10.1037/a0025957

Leonard, D., Brann, S., & Tiller, J. (2005). Dissociative Disorders: Pathways to Diagnosis, Clinician Attitudes and Their Impact. Australian & New Zealand Journal of Psychiatry, 39(10), 940–946. https://doi.org/10.1080/j.1440- 1614.2005.01700.x

Loewenstein, R. (2018). Dissociation debates: everything you know is wrong. Controversies in Psychiatry, 20(3), 229– 242. https://doi.org/10.31887/dcns.2018.20.3/rloewenstein

Perniciaro, L. A. (2014). The influence of skepticism and clinical experience on the detection of dissociative identity disorder by mental health clinicians

Ringrose, J. L. (2011). Meeting the needs of clients with dissociative identity disorder: considerations for psychotherapy. British Journal of Guidance & Counselling, 39(4), 293–305. https://doi.org/10.1080/03069885.2011.564606

Is “Pairing” in ABA The Same As Therapeutic Rapport?

CW: The following article discusses the implementation of ABA interventions. Reader discretion advised.

I was sitting with my non-speaking client, him holding up some blue edible playdough his mom made. I smiled back, and we both snuck a bit to eat, enjoying the salty-sweet-doughy taste.

I had spent weeks just playing with him, developing a relationship. He felt safe and loved because I played with him and gave him my full attention.

A couple weeks after that, I began implementing his programming. Our fun playdough time of making weird shapes and eating the playdough turned into a rigid activity to teach him letters.

I asked him, “touch A!” as I laid out letter stencils. If he chose the correct one, I would press it on the playdough, and we would get to play with it. He enjoyed our game and responded correctly the first few times.

I was inexperienced and didn’t understand autism well enough at the time to understand the following events. He seemed happy, grinning at me and playing with his playdough. I felt pressured to get in as many trials as possible, counting them on my iPad because they proved to my superior that I was a good therapist.

I pushed him repeatedly, rewarding him only when he gave the correct answer, or I grabbed his hand and had him touch the right answer. I followed the prompt hierarchy like I was supposed to.

Suddenly I asked him, “touch O!” and he threw himself onto the ground, banging his head and crying. I was distressed, trying desperately to calm him down. I put safety mats under his head and panicked, telling him it would be okay. Eventually, I learned that if I stopped talking, he was able to self-regulate.

I didn’t understand how our positive relationship had instantly turned into a distressing one. It seemed like the behavior “came out of nowhere.” I didn’t understand the stress he felt when I switched from showing him unconditional positive regard to suddenly making it conditional. He wanted to do what I asked because he cared about me, but I wanted more and more and more.

I was doing a process called “pairing” in ABA. Pairing is the process when a practitioner develops a relationship with a client to become a source of reinforcement themselves. When the therapist is a reinforcer, success in changing behavior in ABA skyrockets.

Often the first few weeks with clients are spent exclusively pairing. From an ABA therapist’s standpoint, the benefits seem like a no-brainer. The kid should want to spend time with you and enjoy your time together. You should learn what they like and don’t.

For survivors of ABA, the motives are more sinister. Pairing has been called manipulative because many therapists then weaponize that relationship to gain compliance.

Both have strong arguments with significant consequences. Therapeutic rapport is well documented as one of the most necessary steps in therapy, but it creates harmful results if it is manipulative.

So, is pairing manipulative or good therapy?

Therapeutic Rapport

Therapeutic rapport has been long established as a necessary part of successful therapy and medicine.

Research on therapeutic rapport suggests that to develop rapport, a therapist or other healthcare provider should use active listening, maintain an open posture, be honest, and alter their behavior so their client can interpret it (pg. 151).

Clinicians must focus on cultural competency with therapeutic rapport and considering their client’s unique circumstances. When there is a discrepancy in power, whether cultural, economic, or social status, there’s an increased need for caution. A therapeutic relationship could quickly become manipulative or harmful if these factors are ignored.

Altering behaviors so clients can interpret them is especially relevant to autism. A therapist’s body language must be able to be interpreted by their autistic client, and consideration taken for whether their body language can be easily decoded. Without this, the therapist could easily convey meanings that are not intended and/or further distress the client.

Eye contact is also something that should not be present in therapeutic rapport for autistic individuals, though this is often recommended. With non-speaking clients, active listening of vocal language may not be possible; though active attention to non-vocal signals is necessary.

So, therapeutic rapport for autistic people is necessary for robust therapy. Is pairing a good way to go about it?

Why do Some People View Pairing As Manipulative?

Love bombing is the process in which the person in the relationship is showered with gifts and positive regard with the goal of emotional dependence. After the person develops feelings for the person they’re with, the gifts and attention are removed and become conditional, creating an inconsistent, stressful environment. This can further lead to abusive situations if the person doing the love bombing isn’t receiving compliance.

“Lieu, this sounds pretty extreme. Weren’t you just talking about therapeutic rapport and its benefits to clients?”

You’re right, it is an extreme comparison. But it is necessary to understand the difference between healthy therapeutic rapport and manipulative rapport that fosters dependence on the therapist.

Pairing gives children unconditional access to reinforcers like their favorite items, activities, and even food preferences. The therapist provides the child with their full attention and doesn’t make any demands, showing interest in whatever they are doing.

After the child is bonded to the therapist, the reinforcers are conditional. The attention is contingent. And the child has to comply with demands to receive this loving support to which they’ve grown attached.

Add to this the power dynamic between an adult in complete control of the child’s access to their preferred items, with the powerlessness of the child to control what is targeted in therapy. The relationship is set up to create ethical issues.

That isn’t to say every relationship with children after pairing will become manipulative. But all it takes is one therapist who doesn’t apply a goal correctly, acting under the wishes of a parent over the child’s interests, or is facing pressure to meet a quota of goals. It becomes clear how this relationship could easily be weaponized.

Practices like “planned ignoring” and “extinction plans” require therapists to withhold their positive regard or access to reinforcement until the child completes the behavior they need to see.

This creates a distressing environment because children are desperate to get back into the therapist’s favor. They want that positive attention and want to feel loved by their therapist. Making that contingent teaches children several problematic lessons like compliance as love, non-compliance as unworthiness, and positive regard being conditional.

“Pairing is Just Therapeutic Rapport!”

Now that we’ve examined therapeutic rapport and pairing, it is necessary to understand why pairing should not be considered therapeutic rapport.

One of the key things that separate it from therapeutic rapport is the intentional removal of reinforcement.

Imagine starting therapy with a cognitive therapist who showed unconditional positive regard, openness, and altered their behavior to help you interpret it. You feel comfortable expressing your vulnerabilities and may even cry, breakdown, or tell them things you’ve never told anyone.

After five sessions of doing this, the therapist suddenly becomes cold and closed to you. They tell you for therapy to work, you have to stop crying when you come into therapy. It’s labeled as a “maladaptive behavior” and targeted for reduction. When you go the whole session without crying, she smiles at you and shows you the same level of attention you received in the beginning. You may feel confused or distressed by this sudden switch in demeanor.

Would you go back to this therapist? What if you didn’t have a choice?

There’s no point in therapeutic rapport in any other therapy type where the aspects of therapeutic rapport are reversed.

Further, suppose this is at a clinic where the therapists receive little to no education on aspects of autism. They may be incapable of modifying their behavior to be interpretable to clients. They may assume that their behavior is perfectly fine and it’s the client that is refusing to make an effort to interpret.

“My Client Loves Being Around Me, I Would Never Harm Them”

It’s a thought I had when I was in ABA. How could I be harming anyone if I was met by smiles, excitement, and unprompted bids for attention?

I certainly had no intention of harming anyone. I was there because I wanted to help, and in my mind, I was! I was taught that a behavior change was a marker of success, so I was clearly succeeding through a tangible measure of progress.

I ignored how “maladaptive behaviors” that clients experienced during my sessions may be an indication that everything wasn’t rosy. I ignored the meltdowns, the non-responsiveness, the times when I pushed too hard or didn’t understand the cause of their behavior. I ignored my contribution to the behaviors that “seemed out of nowhere.” And I saw it happening with other therapists, but no one seemed to see anything wrong.

It’s a scary thought, but you can harm someone without intending to. And if you’ve dedicated years to something to try to help someone, you have a lot of incentive to ignore those adverse outcomes.

If you’ve read this far and are an ABA therapist, I genuinely applaud you. It’s hard to examine your own flaws, and it’s clear you’re trying to do better. Otherwise, you wouldn’t be here.

If you’re looking to do better, look into how to develop therapeutic rapport. Do research on autistic traits and how to make your behavior easier to interpret for an autistic person. And replace pairing with developing evidence-based therapeutic rapport.

Clients deserve transparency in their therapy, including their expectations beyond initial impressions. Don’t set a false expectation of the treatment you’re practicing through pairing.

One Year Traumaversary of My Job at “The Good ABA”

Here is my experience with ABA: https://lifeoflieu.com/2022/01/22/i-was-part-of-the-good-aba/

Working in ABA was genuinely traumatic for me. Every night, I woke up in a sweat, nightmares plaguing me with how I was treated and my powerlessness. When I worked my next job, I had a hard time expressing myself because I was so scared of being hated for being autistic. I didn’t just burn out, I imploded.

To gain sanity with a situation where I was gaslit daily, I started speaking out. I never intended to become an advocate, but I naturally found myself in advocacy when I needed validation that what I was experiencing was as bad as I felt.

It’s incredible that it’s been a year since I left my job in ABA. So much has been accomplished in such little time. I’ve been able to tell my story to over a million people, have received letters from countless practitioners thanking me for helping them understand the problems in their field, and was able to get an autism diagnosis.

But the first-year traumaversary is always the worst. You start getting triggered over the most random things, nightmares rear their ugly head, and emotional flashbacks come in waves. So, to put that energy somewhere productive, I’ve come up with some takeaways from my experience.

While reflecting on this year, here’s a list of 5 things I learned about myself and ABA.

1. Don’t sign a contract that requires you to pay money if you quit.

When you want to work a job badly enough in a field you’re passionate about, it’s easy to overlook the warning signs. Seems obvious, and yet I still did it, so you could too. It indicates high turnover and locks you into the company. It’s the “don’t marry a man you just met” of the professional world.

Because ABA often hires young 18-22 yrs old fresh out of high school, many are inexperienced with the professional world. This leaves them vulnerable to exploitation from their companies and toxic power dynamics with their superiors.

I’d imagine my experience with this is also not uncommon. Companies that do this restrict their practitioners from leaving which leads to bad outcomes for everyone involved.

2. ABA is omnipresent and restricts access to services.

ABA is EVERYWHERE. It has dominated autism therapy. Even other therapies like occupational therapy and speech-language therapy are now using ABA. If you don’t want ABA, you’re out of luck in most places.

ABA shuts down valid critiques by dismissing them as “not understanding ABA” or having some vendetta against the science. It has portrayed itself as the “only cure to autism” to the point that other therapies are no longer available and shuts down the voices of the population it serves. I’m not the only one that believes this. Researchers have remarked that it’s “ideological warfare.”

Callahan et al. (2009) ran a study where they de-identified ABA and TEACCH (a therapy focused on working on the underlying elements of the behavior of autistic people) and showed that when they removed the labels ABA and TEACCH, people rated the treatment by their descriptions as equally effective. This finding was contrary to the “ABA is the only way” advocacy done by ABA professionals and parents. ABA advocates present non-behavioral interventions as not evidence-based, which is just false.

This attitude is pervasive among ABA professionals and parents. I remember ABA presented as a miracle cure for autism. This evidence supported changing problematic behaviors like self-harm and aggression while increasing communication.

It came as a shock to me later that there weren’t investigations into outcomes other than behavioral as far as what was considered successful. ABA was replacing other evidence-based practices and claiming it was the only one. It made all of these claims and yet didn’t educate its practitioners on fundamentals like communication, autism characteristics, and other therapies.

3. Unethical practice isn’t usually committed by “Unethical People.”

“It requires conducive social conditions, rather than monstrous people, to produce heinous deeds.” – Albert Bandura.

To sum up my experience, people that cared deeply about autistic children committed the unethical practices I witnessed. This care doesn’t excuse their actions, but it was astonishing to watch the step between having excellent intentions and doing horrible things. The two are much closer than is comfortable.

So, how does abuse happen? When you believe what you are doing has such profound consequences that you are saving another person, it’s easy to justify any “momentary discomfort.”

Discomfort is inevitable in life. What becomes necessary discomfort vs. unnecessary? It’s easy to see how someone might believe what they are doing is necessary discomfort when comparing it to the usual things we encounter in life. Particularly if that person is neurotypical, they may not fully grasp the physical pain experienced by sensory stimuli that they find as just annoying.

My supervisor wasn’t a monster. She was an overworked, underpaid practitioner who genuinely wanted to help the children she worked for and tried to study contemporary literature/practice. She was in a clinic run by a woman who viewed herself as saving her son with “severe autism” through ABA, which enabled the social conditions for anything to be justified in pursuit of a cure.

And that’s why my supervisor objected to me “calling her actions abuse.” In her mind, it wasn’t abuse. It was “allowing mom a moment of free time,” “keeping the child safe from extreme behaviors like self-harm,” and “teaching him to tolerate the sensory harshness of the real world.”

I want to emphasize that what she did was absolutely abuse. She tortured a kid for 20 mins to make them cry and laughed about his PTSD symptoms exhibited after. But, it’s understandable how she committed that unethical act despite her attempting to be an “ethical person.”

4. The BACB is one of the most ineffective ethical bodies.

The BACB has incredibly loose guidelines around ABA’s ethics, allowing almost anything to count as ethical. Most of the ethics focus on treatment fidelity, not on client dignity. And for them to investigate a case, you must come with documentation. They will not investigate themselves, only look over the evidence you present. It’s why I ended up not reporting.

They are also not overseen by any department. State to state, there are differences in how licenses are involved, but there is no overarching licensing body that is not tied to ABA. Unlike therapists, they are not required to report to a “state ABA licensing board”. And even in states that allow BCBAs to be grandfathered in as licensed practitioners, RBTs are often not.

And that’s not to mention they allow shock devices to be used with autistic people due to this loose ethical code like in the case of Judge Rotenberg Center. Shock devices. In 2022. This isn’t the “ancient” history of doing barbaric things to psych patients. This is modern history and not only legal, but ABA’s main ethical body also approves of it. If that’s considered an acceptable aversive, pretty much anything goes.

Carol Millman puts it well: “Only three subsections in the Behavior Analyst Certification Board’s professional code of ethics even address the wellbeing of the learner…The BACB says nothing about inflicting pain. There’s nothing in the BACB ethics code [that] says you can’t use electric shock. In fact, it doesn’t say anything at all about what type of ‘aversives’ are acceptable.”

I remember first learning about shock devices as a practitioner, and my gut reaction was, “well, our clinic doesn’t do that!”.

To practitioners reading this, listen closely. The problem is more extensive than shock devices (though that should be a red flag). The problem is that the governing ethics body allows the use of shock devices, which means that there’s a lot of unethical conduct that they also allow.

Just because you haven’t had the BACB contacted, or you have, and they deemed your actions ethical, does not mean that you are acting ethically. And that’s a poor standard for an ethics body.

5. Trust your gut.

Okay, this one seems obvious, but it’s easy to lose yourself at a job. Capitalism is a cruel master that conditions you to trust your boss and enforces a strict hierarchy. As an RBT, you are motivated to shut up and listen to your BCBA. This creates a culture of compliance. I’ve seen it now in other clinics and the one I worked at where BCBAs will try to use ABA on the RBTs they supervise. This is wildly inappropriate and not within their scope of practice. Not to mention is a massive break in consent.

Something deep inside you lets you know whether what you’re doing is moral. We’re all biased towards believing we are moral (and often ignore signs that we’re not), but if you’re questioning whether a decision you made is ethical, it’s a sign to take a step back and assess the situation. Get opinions outside your field, especially from the clientele you serve. Reach out to ethics hotlines and ask the internet. Find information from unbiased sources. And listen to your gut. If something feels off, it probably is.


I’m so grateful to be out. I’ve learned a lot from my experience, and I hope this can shed light on others’ situations so they don’t have to learn the lesson I did the hard way.

It’s funny how the most traumatizing experiences can fundamentally shape your life. I can thank my old clinic for that. It showed me I was autistic by ruthlessly punishing autistic expression and gave me a direction for the therapy career I’m pursuing. So thanks, I guess.

14 genders, 1 body: How to Navigate Gender Identity as a DID System Pt. 2

Check out Pt. 1

A man named Alex took over my* body for 6 months. (*This story is from the primary host, Marion’s perspective.)

If you’re not a system, you’re probably confused. How does someone take over a body? Was I possessed?

I have been the main person that has interacted with the world since my DID system was about 11. Most people that know my system think of me when they describe us. I didn’t realize that there was anyone else inside my head.

Following a traumatic event, I disappeared. It wasn’t a conscious choice. I got so overwhelmed and so traumatized that a new alter split.

He’s a trans man. I am not. (I’m trans non-binary, but I identified as a woman at the time)

So, you can imagine my surprise when I woke up for the first time in months, sitting in a coffee shop halfway across the country, wearing men’s clothing.

We fought for control and became more dissociated and amnesic. I wanted to identify as a woman, and he wanted to identify as a man. He had spent all summer going through the painstaking process of gender questioning, meeting other trans folks, and coming out to everyone in our life. He had been harassed for being trans and dealt with discrimination I hadn’t experienced. He had a whole life that I was suddenly interrupting. Meanwhile, he had taken my life and changed nearly every aspect.

During this time, he went into a clinic to get trans hormone replacement therapy (HRT). He was doing what every trans media and resource encouraged him to. He was pursuing his true identity and becoming more comfortable in his body.

When he went to the clinic, things devolved pretty quickly. Several alters fought to control the situation, and we became so dissociated a child alter fronted (became conscious and in control).

The doctor acted within WPATH standards of care (top trans medical standards) for dissociative identity disorder and gender dysphoria and denied us hormones. Alex and the other men in the system were devastated. The child alter was overwhelmed waking up in a medical clinic, and we ran to the car in tears.

The doctor made the right call, but Alex had worked months to get to that point. He had taken all the steps only to have his efforts destroyed at the last second.

Sometimes transition isn’t a straightforward process. That’s especially true for systems. It’s okay to wait until everyone’s ready. It’s okay to be trans and never medically transition or come out to others.

My Alters Want to Transition, What Do I Do?

If alters in your system want to transition, your system has a tough call to make. See pt. 1 for some of the considerations like what degree of transition and how public your transition is.

This is where communication is essential. Use your system’s form of communication to discuss if everyone’s on board. If you’re not sure how to do this, there are a lot of options which I discuss in Pt. 1

What’s important is that every person in the system agrees with whatever decision is made.

To resolve our conflict, we had a meeting in the headspace and voted. We texted each other (I recommend either Simply Plural app or Plural Kit Bot on Discord). We also discussed it with several friends and our therapist, who could tell us what other alters were thinking.

One alter that had a challenging time was Rose. She still identifies as a woman and now lives in a trans masc body. She was worried about giving up having biological kids, being comfortable when she’s out, and losing feminine characteristics. She loves singing and had to sacrifice her voice when we medically transitioned.

Ultimately, she decided that she was willing to give up some of her qualities for the system’s good. It was altruistic and came with a sense of grief that most trans people don’t experience. It wasn’t just losing an old life; it was losing a fundamental aspect of herself.

A few unique considerations have to be in place before a system transitions. One of the largest is how do we support alters that identify with the body’s assigned gender?

You may be trading gender dysphoria for some alters for gender dysphoria for others. It’s a good idea to be well versed in the counterpart transition to your own. For example, if you’re AFAB (assigned female at birth) and transitioning to appear masculine, you should be versed in how AMAB (assigned male) individuals transition to appear feminine.

Ways that we support our female alters now that we present masc are always having feminine clothes on hand (including feminine undergarments), negotiating as much as possible before switching in and out, keeping makeup around, and allowing them to present female when they’re out. We don’t suppress the feminine traits they express and give them space to still be women.

We’ve found that keeping a fairly androgynous appearance allows for fluidity. We have long hair, mix traditionally feminine and masculine clothing, and only accentuate masculine or feminine qualities depending on who’s fronting. This was part of our system’s compromise, so everyone is comfortable.

Find your non-negotiables. What qualities about identifying as man, woman, non-binary, etc., are crucial for alters to feel comfortable? Respect non-negotiables and work around them.

You will need to compromise with your system so everyone feels supported. Otherwise, you will enhance your gender dysphoria and may be denied trans care.

And remember that one compromise you can make is doing some medical or social treatments but not all. Many people choose to go on hormones to get some of the features and then go off. Some people get surgery without ever doing other treatments, and some people socially transition but never medically transition.

If you decide as a system not to transition, there are things that your system must do to help alters that do experience gender dysphoria.

Best Supporting Trans Alters if You Don’t Transition

If your system ultimately decides not to transition, you need to plan with trans alters.

Learn in great detail how to reduce gender dysphoria. This may mean that you need to purchase gender-affirming clothing items like a chest binder or a gaff. You may need to get clothes and accessories in line with your trans alters (I always thrift items because of how diverse my wardrobe has to be). You could learn new skills like how to do makeup, voice training, or spend a lot of time people-watching.

People-watching is one of the best tips I have for trans alters. The way you carry yourself, speak, and use body language has one of the most significant impacts on how people perceive your gender (without medical procedures). Find somewhere you can sit and observe, like a mall, and notice how men and women act differently. Practice the mannerisms you see and notice any difference in how you feel.

Another gender dysphoria busting tip is to do something traditionally associated with the gender you want to be perceived as. It was incredibly validating for Alex to go to the shooting range because he was always perceived and treated as masculine.

Negotiate with trans alters before and after you plan on fronting if possible, and keep a change of clothes handy if you think that it’s possible that your trans alter may want to change when they’re out.

Connect with local trans groups. Other trans folks may not understand your specific experience of being a system and having trans alters, but they will understand what gender dysphoria is like and encourage you to present comfortably regardless of who’s out.

Like a system that decides to transition, you have to treat your individual alters dysphoria. Make sure they feel supported and like they can be as comfortable as possible when they’re out.

And if dysphoria hits a point where you are feeling suicidal or need help, please reach out to a therapist or crisis line.

Helping the System in My Life

When watching someone go through a gender crisis, it can be challenging to see them struggle with such a big decision. If you’re a partner, you may wonder how that will affect your relationship and sexuality. It gets even more complicated when that person is a system because you may be hearing opposite things when different people are fronting.

Some of the ways you can support the system are listening and giving as much information as the system is comfortable, respecting whatever the system decides individually and as a whole, and being informed on transition.

Some systems may value talking to someone and having them help relay what other alters are saying with their consent. Others may feel that’s a breach of privacy. Ask what they would prefer.

As the system in your life is deciding, they may change their mind several times. They may want specific pronouns only used sometimes or not used at all. Respect their wishes and refer to them however they’d like. If they change their mind, respect that change. Their crisis is for them to figure out, and it’s not going to be a static process. If you’re having trouble with the number of changes, seek a therapist to talk through your experience.

The final thing you can do to help the system in your life is to be informed about transition. Look up what is typical in a transition and ways to help gender dysphoria. Be informed so that the system doesn’t have to spend the emotional labor to explain transition. It will also make them feel heard and validated. You may also look into systems experience with gender, though resources are few and far between. However, knowing more about how alters work may help shed some light on some of the dynamics.

There are groups for supporters of trans individuals and groups for supporters of systems. Seek out these online spaces to learn from others in your situation.

There is No Wrong Answer.

The last thing I’d like to emphasize in this series is there are no wrong answers. Whether you make a decision and stick with that decision the rest of your life, or whether you change your gender a million times, there are no wrong answers. There’s no wrong way to transition because your gender experience is unique to you.

I hope that some of the tips I’ve given serve as a resource for systems going through gender crises. If you have any questions or want to have a conversation, please reach out. If you’re still unsure of where you stand, feel free to revisit the questions in Pt. 1.

%d bloggers like this: