Psychotherapy Self-Evaluation Form

I filled it out

source

I’ve taken a whole afternoon to fill out this thing. I’ll bring it to therapy Wednesday. Maybe I will, unless the wind changes direction before then. Even the idea of posting this makes me feel very vulnerable. The greatest fear is that I won’t be believed. Or maybe the greatest fear is that I’m a total fraud and shouldn’t be believed. One of those. Here we go — practicing for Wednesday. You can access the form for your own uses here.

I’ve been playing around with the idea of dissociative identity disorder for a long, long time. My intuition, the resonance I felt, suggested, with every book I’ve read on the subject, that this was relevant to ME. It’s taken me 20 years to own my own feeling about it and ask my therapist very directly, via this form, for more help. I’m realizing more and more that there are parts of me that don’t get what they need in therapy, therefore, I am not getting everything I need from her.

I think my therapist will be pretty shocked by some of her “scores” and what I’ve written, because “the front person,” as I’m calling her, the one who goes to therapy, is always very complimentary of her. I grew up believing, correctly I think, that I had to take care of my parents so they could take care of me. That is still the front person’s job…

Stirred by my recent crisis — I need to earn some money, but parts of me are blocking the idea of going to work — I ordered a book by Richard Chefetz, Intensive Psychotherapy for Persistent Dissociative Processes. I’ve only read the first two chapters, but his clear, compassionate descriptions of what these “processes” feel like and what they look like, have helped me already. Such a relief just to have someone describe how it feels to be me. Now I’m planning to ask my therapist for what I think I need. (Sign of progress — I never do that!) I hope she is up to it. I’d be crushed if she says she can’t do it. Chefetz is very clear about what the therapist has to do, which involves being much more active, asking questions, deliberately engaging the walled off parts in the conversation:

“Creating a broad span of conversational attention that absorbs more than one plot of mental real estate is a linking activity that creates association where once there was just a dissociative gap.”

The Scarsdale Psychotherapy Self-Evaluation (SPSE)

Introduction

How do you know if your therapy is working successfully? The Scarsdale Psychotherapy Self-Evaluation (SPSE) is one way you can look at therapeutic effectiveness. Each item in the self-evaluation focuses on an aspect of therapy that is believed to be related to results. The intent of the self-evaluation is more to help you think about what is important in your therapy rather than to come up with a specific numerical value.

This tool is unique in that it is designed to be independent of the theory or school your therapy may follow. Instead, it is based on the universal processes and principles laid out in How We Heal and Grow: The Power of Facing Your Feelings (Jeffrey Smith).

You will be asked to rate statements in three categories: The Therapeutic Relationship, The Tasks of Psychotherapy, and Do You Feel Safe in Therapy? In all there are eighteen items, each to be scored on a scale of 1 to 5 with 5 being the most positive.

Part One: The Therapeutic Relationship

Please give each item a score from 1 to 5, where 5 is most positive.

1. First few sessions felt “right” (Score__5___) This has been shown to correlate strongly with overall success of therapy. If you tend to give too much benefit of the doubt or not enough when you first meet someone, ask yourself if your first impression of this therapist is better or worse than your first impressions of other people.

Yes — solid, stable, strong, comforting, friendly and non-judgmental

2. Therapist shows “accurate empathy” (Score__2–3___) Empathy isn’t just being nice. It is a natural connection that occurs when you are able to let the therapist in on your personal world and the therapist understands just what you mean on an emotional level.

The front part of me feels very good with you, but other parts of me do not feel seen, heard, or even wanted. I don’t like it that I have to make all of the effort to bring out alternate parts. I wish you would notice them and invite them to speak. I don’t want to have to help the therapist this much to be the therapist I need. The main place I feel misunderstood is in the importance of working with the dissociated parts. Nothing can move forward without that. I don’t want to be the driver of this aspect of therapy. I can’t be. I need more help.

“When a False Self becomes organized in an individual who has a high intellectual potential there is a very strong tendency for the mind to become the location of the False Self and in this case there develops a dissociation between intellectual activity and psychosomatic existence.

“When there has taken place this double abnormality, (i) the False Self organized to hide the True Self, and (ii) an attempt on the part of the individual to solve the personal problem by the use of a fine intellect, a clinical picture results which is peculiar in that IT VERY EASILY DECEIVES (my emphasis). The world may observe academic success of a high degree, and may find it hard to believe in the very real distress of the individual concerned, who feels “phoney” the more he or she is successful.” (Winnicott, as quoted in Chefetz, 2015, pg.72)

This explains why it was so upsetting to a certain part of me the day you said you weren’t smart enough, that you could be tricked. The front part of me was designed to trick! How can I know how much of my “self” is a trick? This is extremely confusing. I need you to be smarter. I need you to learn how not to be tricked. I would like more help.

3. Therapist warmth (Score__5*___) Therapist warmth has been confirmed through much research to be correlated with therapeutic success.

Yes, warm, at least towards me, the front person. To others she feels distant, tentative.

4. Therapist “realness” (Score__5*___) Humans are very sensitive to others being fake. Falseness or artificiality creates a barrier to any real connection and prevents empathy from working, while realness makes it easier for a patient to open up.

You are a wonderful therapist for my front part, and feel very real to me/her. *Strange to say, there are parts of me that feel you are a big fake. This is very scary.

5. Therapist helps me take healthy risks (Score__3___) Almost all change processes involve emotional risk-taking when doing so is not really dangerous. Effective therapists help you feel connected and safe and push you a bit to go ahead.

I am worried about money. I would like to start working, but feel very stuck. I have a lot of bad habits. I am also very resistant to being pushed. Don’t know how to deal with this, but at least we could talk about it. Primarily, my feeling is that if the core worries are being correctly addressed in therapy, the anxiety will go down, along with resistance to focusing on life tasks.

“My experience is that naming dissociative processes and identifying constellations of experience that fit a multiple self-state model of mind decreases anxiety, greatly increases the feeling of being understood and heard, and often relieves generalized depression and despair reflecting the fatalism that can develop regarding ever being understood.” (Chefetz, 2015, pg. 61)

My feeling is that if we can do this, name it, and really begin work on the main problem, which is dissociation, then the executive front part of me might be freed up enough to study and work.

6. Therapist has a plan, a focus, and direction (Score__3___) Effective therapies feel like they are going somewhere. If yours doesn’t give you a sense of direction, then raise questions about it. Some therapists tell you explicitly what to expect and work with you to develop a kind of contract. In other traditions, you follow a method that in itself gives direction and focus. Whether it is said out loud or not, therapy should soon feel like it is leading you in a purposeful way towards what you want in life.

I have no idea what your plan, focus or direction is. For me, your opaque style feels frustrating. I have to read books and blogs to find out what should be happening, so I know how to direct the therapy. I like it that you let me set the pace and direction, but maybe there are other parts of me who need you to intervene so the front person does not keep walling them out!

“Dissociative process isn’t going to raise its hand and speak up. It has no intention of being recognized. That’s the whole point, in a way — to hide.” (Chafetz, 2015, pg. 67)

I am very interested in the therapeutic process, but you never share the thoughts behind your presentation. That feels demeaning. I wish we could work together more. Your hiding of all therapeutic thought makes me feel like you think you’re up on a pedestal, above me, with superior knowledge. If you have superior knowledge, then by all means, I want you to use it! And maybe it’s better if I don’t know everything you think. But you know, I never knew what my parents thought. Everything was a cover-up. A bit more transparency and inclusiveness might be helpful. I am not stupid. I think you could trust me with some knowledge.

Part Two: The Tasks of Psychotherapy

Each of these items asks you to rate the performance of your therapy on one of several core tasks. Sometimes you may do a task without even noticing and sometimes you may have to work quite hard at it. There may be some overlap between tasks. Score how well your therapy is helping you do each task or mark “NA” if an area is not relevant to the work you are currently doing.

7. Stop “running” from feelings (Score__?___) There are many ways we avoid feelings, and they all interfere with healing and growth. Negative behaviors, rationalization, keeping busy all the time, acting out instead of feeling, even anger can be cover-ups for pain. How well is your therapy helping you to stop running and to face your uncomfortable or painful feelings?

I can’t even answer this. I don’t know. The front part of me has been in therapy for a long time, and has faced the feelings she has, but the back parts, where other feelings are hidden, have not had much air time.

8. Healing your shame, fear, anger, and pain (Score__3___) When you hold an uncomfortable feeling for at least ten seconds in a context of safety and connection, the feeling (or at least a portion of it) is transformed and no longer has the power to generate the distress it once did. This is what I call catharsis, the most common and important healing process in therapy. How well is your therapy helping you to use catharsis to heal your difficult feelings so they no longer hold you back?

Only working with the parts that hold the feelings can accomplish this. The times when we’ve been able to get there have moved the therapy forward a lot. But I am frustrated that it seems so hard to get there, and I, the front part, have to drive it, when those parts are actually in competition with me, the front part, for attention. I need more help.

9. Gain knowledge of yourself (Score__4___) All therapies depend on some kind of understanding. Progressing from a vague sense to a clear concept gives us a handle on ourselves. How well is your therapy helping you to make sense of your problems and how you can heal and grow?

I am angry that it has taken so long, been so expensive, and seems to have been largely left up to me to self-diagnose and ask for help with a significant dissociative problem. I know this kind of delay is standard. Somebody told me once that it usually takes 7 years in the mental health system for a DID diagnosis, which I definitely have some degree of.

“My experience is consistent with that of Richard Kluft’s broader experience that only 10 to 15 percent of patients who meet criteria for DID will present in a classic manner with a fully developed alter system and obvious switching.” (Chafetz, 2015, pg 58)

I’ve been feeling it for all these years, suggesting it tentatively, but have felt insecure and largely not validated until now, reading Richard Chefetz, Intensive Psychotherapy for Persistent Dissociative Processes. Until now, I THOUGHT I MIGHT BE MAKING IT ALL UP. Of course, that is the classic fear. I am now fairly convinced that I am not making it up. I wasn’t ready to take a stand like this until now. I needed some backing. I’m angry that I had to get the backing on my own, from a book.

10. Reform your conscience or core values (Score__3___) Our superego or conscience judges things according to strongly internalized templates. These templates include values, attitudes, ideals, and prohibitions. When we live up to them, we feel pride. When we don’t we feel guilt or shame. The problem is that sometimes those templates are wrong or unhealthy. When they are, we may feel shame or guilt when we shouldn’t. How well does your therapy help you identify and resist unhealthy values and judgments?

Once again, this has been very successful for the front person, and unsuccessful for the hidden people.

11. Voluntary Behavior Change (Score___3__) Behavior patterns can undermine our lives by covering up feelings we need to face and by supporting unhealthy attitudes or values. Many kinds of dysfunctional behavior patterns can sabotage your life. Most of the time these started out as ways to shield you from feelings that once were too much to handle. How well is your therapy helping you to make healthy changes in behavior?

There’s been progress, but now I don’t know how we can fit attending to my desire for more education, a real career instead of menial jobs, my need to get to work soon and make some money, plus attending to the hidden parts and difficult feelings, into a one hour therapy session per week. I don’t feel I can afford more therapy time. Maybe we can talk about this. If I run out of money, that will end the therapy altogether. I don’t want to get into a financial crunch. But if we don’t attend to the hidden parts, they will sabotage progress for sure.

12. Reevaluate secret wishes and plans (Score___3__) Do you repeatedly find yourself blocked from the things that are most important to you in life? Could you be sabotaging yourself? If so, you may have a secret world of wishes and plans in conflict with secret prohibitions. How well is your therapy working to help you clarify these issues and get unstuck?

Ha! He’s not talking about dissociated “parts” with their own wishes. Yes, I could be sabotaging myself! Secret prohibitions abound. My therapy could be more helpful with this.

13. Restart arrested development (Score__4___) Regardless of your age, growing emotionally and maturing involve taking emotional risks, practicing new behaviors, and going through the feelings that result. Often pride and shame block us from recognizing areas of immaturity. How well is your therapy working to help you face areas where you need to grow, practice more mature behaviors, and go through the uncomfortable feelings that accompany change?

The front part of me has gotten a lot of help with this. She still needs support. Blah, blah blah. Same answer. There are dislocated, angry “terrible twos parts” maybe, adolescent parts maybe, parts that will sabotage unless they can be helped.

Part Three: Do You Feel Safe in Therapy?

Please give each item a score from 1 to 5, where 5 is most positive.

14. Therapist makes it safe to criticize or disagree (Score__4*___) This is important in any therapy, and may be the key to resolving unfinished business from the past that has been “transferred” to the therapeutic relationship. Therapists should put personal feelings aside and work with you to see what part of the problem is yours and what part is theirs. How well is your therapy working to help you resolve difficult issues with your therapist?

It has taken a LONG time for me to get here, but I wouldn’t be able to fill out this worksheet and bring it into a session to discuss these issues unless I did feel safe to criticize and disagree. *That’s speaking just for the front part. I can’t speak for the others, but I sense some anger and distrust.

15. Therapist makes it safe to share highly personal material (Score__3___) Many thoughts and feelings come up in therapy both from the past or in the present, including feelings related to the therapist. Therapists need to be respectful and professional while making it as easy as possible to make these feelings part of what you talk about. Sometimes the therapist’s feelings and emotional reactions may be part of the interaction. These, too should be handled in a way that keeps the focus on your treatment.

“Therapist” can’t make it safe enough all by herself. I mean, how long does it take to feel safe, even if the therapist is doing her best, which I have never doubted? Safety is established through collaboration. I have not taken as many risks as I should have, if I’d been able before now. Today I am taking a risk. Safety is established by testing. I need to take more risks, but the parts won’t talk unless THEY feel safe. I can’t make that happen without more help. We need more help. It’s embarrassing to say “we,” because I’m afraid you’ll think I’m putting on an act, trying to get out of getting a job and being a grown-up, really just want too much attention, an impossible, unreasonable amount of attention. But “we” feels appropriate, and if I am ever going to get better it is “we” who need attention. Who knows that? Hard to say. I am such a good faker. My mother was right when she said that about me. The thing is, I’m not doing it on purpose. I can fool everyone, but I don’t want to. I need help to stop fooling my therapist.

16. Therapist only makes promises that can be kept (Score__5*___) Therapists can be tempted to promise more than they can realistically deliver. However, you need and deserve a therapist who will be reliable and firm, even if you are putting on pressure. When promises are broken, it is hard to forgive, and the relationship may be seriously damaged. How well does your therapist manage expectations and set limits?

Very reliable. *Except that now I am worried she is out of her depth, has been all along, and has failed to let me know this, or even failed to realize it herself.

17. Therapist avoids setting bad precedents (Score__3*___) Bad precedents are similar to unrealistic promises but are unspoken. For example, if your therapist goes along with you in avoiding an important task — say, not addressing a certain difficult area — you may feel better in the short run but see your progress blocked in the long run. How well does your therapist avoid setting bad precedents?

I do feel we have been avoiding important tasks. By we, I mean my therapist and the front person. The main task I mean is finding the missing parts and helping them. If she’d realized the importance of this, she’d never have avoided it. As I said, I trust her to do her best. But I feel she’s missed something very important, and that makes me sad. I was feeling angry before I started to write all this, but now I feel more hopeful that we can fix it. The life tasks I want to get to are calling, but so far it’s been impossible for me to do more. The tasks are being avoided, but it’s not my fault. It’s nobody’s fault. I don’t want to blame you, my therapist, for anything. Other parts of me will do that, I have a feeling. I don’t like to think about it…

18. Therapist maintains safe boundaries (Score__5*___) Therapy is about you, not the therapist. The reason why therapists don’t tell you too much about themselves is to avoid making the therapy about the therapist and his or her needs and to keep it focused on you. Physical boundaries are maintained to prevent arousing natural feelings that have the power to take the focus away from your healing and growth. If it feels as though your therapist is dealing with you in a way that is (or feels) inappropriate, or if his or her self-interest is getting in the way, then you can be hurt and your therapy damaged. Do you feel safe about the boundaries in your therapy? If you have questions, talk to an outside person you trust.

The boundaries have generally been very comfortable and good for the front person. Strong and clear, but also generous and somewhat flexible. Other parts might need something different. That is scary. It can’t be up to me. I tend to very respectful, maybe cautious would be a better word, of boundaries, when I don’t want to alienate the people I need. We know that other parts of me are willing to piss people off, even scare them, and laugh about it. I would never say your self-interest had gotten in the way. But I am worried that fear, or obliviousness to the real situation, or even lack of competence in the arena of dissociation (sorry, but that is a concern right now) might get in the way. I’m afraid not of boundaries that are set up consciously, but of any unconscious ones my therapist might have that could block progress. For instance, if she got to feeling “in over her head,” what would she do? Fake it?