Latest / System Speak: Complex Trauma and Dissociation / Guest: Teri Pokrajac, PhD

Transcript

Guest: Teri Pokrajac, PhD · System Speak: Complex Trauma and Dissociation

• 0:08
  Speaker 1: Over:
• 0:11
  Speaker 2: Welcome to the System Speak Podcast, a podcast about Dissociative Identity Disorder. If you are new to the podcast, we recommend starting at the beginning episodes and listen in order to hear our story and what we have learned through this endeavor. Current episodes may be more applicable to long time listeners and are likely to contain more advanced topics, emotional or other triggering content, and or reference earlier episodes that provide more context to what we are currently learning and experiencing. As always, please care for yourself during and after listening to the podcast. Thank you.
• 1:01
  Speaker 3: Our guest today is Doctor. Terri Pakarajak, a licensed psychologist in California who received her doctorate in clinical psychology from Pepperdine University in 1994, a master's degree in counseling from Loyola Marymount University in 1989, and a BA in psychology and speech communication from Pepperdine in 1984. Doctor. Pikurajak completed her internship at Tufts Medical School and the Boston VA Medical Center. She also completed an advanced fellowship in behavioral medicine with emphasis in trauma at Harvard Medical School's Cambridge Hospital.
• 1:38
  Dissertation research on dissociation and child abuse in multiple personality and borderline personality. She previously directed trauma and dissociative disorders programs inpatient and partial hospitalization programs. For over twenty years, she has been in a private practice where she specialized in the assessment and psychotherapy treatment of trauma based disorders and serves as an expert witness for civil and criminal cases related to PTSD, sexual trauma, sexual harassment, traumatic loss, auto accidents, and dissociative disorders. She is also an adjunct professor at Pepperdine University Graduate School of Education and Psychology, where she currently teaches trauma in diverse populations to graduate psychology She is a frequent presenter at local, national, and international conferences on trauma related topics. This episode has a trigger warning for mention of rape and sexual abuse, but only in passing reference with no details or further discussion and no examples given.
• 2:42
  As always, please care for yourself during and after listening to the podcast. Thank you.
• 2:49
  Speaker 1: Good morning. I'm doctor Terri Pokerjack, and I'm a licensed psychologist in the, state of California. And I am a clinical and forensic psychologist and with primary focus in the trauma field. So in terms of my background, I've been doing trauma work since really since I was getting my master's degree and working in the field of child sexual abuse, sexual trauma, and then expanded to all different types of trauma and then various components of trauma. And now I do both treatment evaluations and then expert testimony in court related to a variety of issues related to trauma.
• 3:34
  Speaker 3: How did you get involved in specializing in trauma and learning more about trauma?
• 3:40
  Speaker 1: Well, when I was in my master's program at Loyola Marymount, I did, like, a, some clinical experience working with the homeless. And I saw a lot of different types of struggles that people were having in a homeless shelter. And I somehow connected with a colleague who mentored me, and she was working in the field. So she was working with a lot of child sexual abuse cases. And so she gave me an opportunity to further the experience I had been seeing when I was working in the homeless shelter.
• 4:16
  And so I started working with adolescents. I was pretty young at the time, so it was better if I work with children or adolescents because I didn't have probably much credibility with adults. So that's how I got started. And I worked with adolescents who were preparing to go to court, in particular, related to allegations of sexual abuse. And so I was helped facilitate a group.
• 4:44
  And so I was really found it such interesting work. And then I worked with children who also were preparing to go to court. And so I started kinda went off from there. Then I got more experience and then started doing other groups, a lot of groups related to child sexual abuse.
• 5:03
  Speaker 3: How did you start learning about dissociation specifically?
• 5:08
  Speaker 1: Well, so at one point in my training, I was working at Pepperdine University Counseling Center, and I started seeing clients that had gone through rape and also other types of sexual trauma, like child sexual abuse. And I started seeing fair amount of people that had dissociative disorders or not disorders. I would say just dissociation. And then at some point in my training when I was working, I I had an experience where I had a client that was probably more more challenging in terms of some of the experience I've had previously, and I was trying to understand more about dissociation. And so I felt that a lot of the supervisors I had were amazing supervisors, but none of them really had training in dissociation or certainly assessing or treating dissociative disorders.
• 6:01
  So at that point, I think it was maybe in the late eighties, '19 eighties, believe it or not, that I in the beginning of nineteen nineties that I decided I needed to get more training. So I just started reading books and went to conferences and started attending conferences where I was learning more about dissociation. At that time, it was multiple personality disorder. And I was really fascinated with it. And and partly, I developed this need out of a case or a couple cases I had.
• 6:36
  And so that was really helpful in learning that. And then I kinda fought for, you know, getting more a supervisor with more training. And so I I got some more training from somebody who had a lot of experience with dissociative disorders. And then I ended up somewhere in that process getting my going to get my doctorate degree at Pepperdine University. And there, I decided to do my dissertation on this subject.
• 7:04
  So I looked at the difference between just at the time, it was multiple personality disorder and borderline personality disorder. And I wanted to understand the different types of dissociative experiences they had and the different kinds of child abuse experiences they had. And so I did my my research on that. And I met a lot of incredible people and, interviewed a lot of really, incredible survivors, as part of my research. And so I ended up doing my dissertation on the topic.
• 7:35
  Speaker 3: How do you define dissociation when you talk about it or speak about it?
• 7:41
  Speaker 1: So just in dissociation as a whole, I think it's a a disconnection, a disintegration, like, in the sense of a lack of integration between consciousness, memory, you know, and awareness. So a person you know, so there's different components to that that a person usually under stressful conditions sorta disconnects. Maybe they can disconnect emotionally. They can disconnect from their body. And it has a, certainly a very functional purpose.
• 8:14
  It's really helpful for people, in midst of a very stressful or traumatic event. If someone can disconnect or sort of feel just detached from what's happening to them, like it's not happening to them or it's not happening to their body, that serves a purpose. Right? Because then you don't feel as horrible because you feel it feels further away. It doesn't feel as real.
• 8:36
  So there's elements of that that are quite helpful. But then what ends up happening is that under other stressful conditions, a person learns to utilize that as a coping strategy. And so while it's, quite effective and numbs one and gets one away from a really painful experiences, then it becomes more maybe, the go to, coping strategy. And when it becomes the go to coping strategy, the person doesn't learn other coping strategies. They they, miss out on learning other affect regulation tools and ways of dealing with feelings.
• 9:15
  So in some ways, they learn the capacity to sort of turn it off, turn off the emotions, turn off the memories, or turn off the sense of awareness. But then yet, when the when the the kind of the light switch goes on with the emotion, it's like intense and it floods them. So I think that, you know, one of the things that happens is, like, I think it's pretty incredible that people can do that and has a hefty capacity. Its long term use, though, ends up having some diminishing returns and that it usually has negative effects later on. So which then leads to people developing, you know, disorders.
• 9:58
  Meaning, so that dissociation in and of itself is not a disorder. It has but when it's now used to this extent that now it's impairing a person, their functioning, their, you know, capacity to engage in relationships or capacity to deal with their emotions, then, you know, it develops a a disorder.
• 10:19
  Speaker 3: You talked about your dissertation. What did you learn about the differences in dissociation between something like DID and what you studied with borderline personality? And then also, how does it overlap, or what's different?
• 10:33
  Speaker 1: Yeah. So what I learned was both groups have high levels of trauma and child abuse and dissociation. Where what I saw more with the people that had a diagnosis of borderline personality disorder was that they had what we call more depersonalization, derealization. And so meaning that they felt disconnected from who they were. They kinda felt unreal.
• 11:00
  They may sort of feel like they're walking through the motions of their life, feeling detached. Maybe it have moments where in certain states, like, it's kind of a more of a state of dissociation where they feel like things around them don't seem real to them. And so, and that often is what leads to some self harming behaviors. But they also, can have some dissociation where they might feel like they're different at different times, like their identity kind of they don't know who they are. And so that can feel a bit changeable and kinda feel a bit dissociative, except it doesn't reach the degree that we see with, like, what we now call dissociative identity disorder.
• 11:47
  So the what they share in common is a shared association. I think in terms of the where we see DIDs being different is certainly we have more personality like states. People sort of have more issues around memory and more of a comprehensive picture in terms of dissociation. So that's more intense, more pervasive, sort of more of the focal point versus in with the clients that I've certainly seen in those that I interviewed for my research project, that it was seemed more in moments, certain states, they would experience dissociation, dissociation. Where some of the more severe clients that have dissociative identity disorder, it's dissociation is so pervasive in their lives, some form of dissociation, whether they walk they have different parts of them.
• 12:43
  And so kind of they live with that level of dissociation all the time. So and then in terms of what was different, think or what may be similarity and difference, they both groups, the dissociation kind of served a purpose, I think. And both groups had problems with affect regulation. Where I what some of the differences that we're seeing is that the the research showed that the group that was identified as having borderline personality disorder tended to be more impulsive and they tended to have more difficulties in interpersonal relationships. And the group that at the time, it was called multiple personality disorder, but that what we now know is DID.
• 13:31
  That group had a had some kind of sparing from their interpersonal relationships. It may be tended to, as a whole, be on the more avoidant side with relationships. But they had that's in terms of the study showed that they were fared better.
• 13:53
  Speaker 3: I heard you speak. You were presenting for ISSTD about shame. Can you explain about what shame is? Like, I know we've talked about it some on the podcast, and so there's a general understanding with listeners about guilt being feeling bad about what you something that you've done or something you did, but shame being feeling bad about who you are. And we've also talked on the podcast a little bit about relational trauma and misattunement and some of those roots of shame.
• 14:28
  But can you explain how how you define shame and what that has to do with trauma?
• 14:36
  Speaker 1: First of all, shame is a very intensely painful experience. So people feel, you know, I I think you probably talked about this on the podcast, you know, they feel bad. Right? So there's this innate sense of unworthiness, badness that a person might feel that they're just not acceptable. And, like, it's like this core feeling.
• 14:58
  Like, I think you can distinguish between shame states and and just like sort of an overall trade of shame. But those shame states are extremely painful, you know, that people just feel like, oh my there's like there's something about them that everyone could see that they're, like like, covered in this guck here. You know, that, one of my clients had done a sculpture once and just had this brownish guck that she, you know, kinda put all over the side of the sculpture. It was kind of a sculpture of herself. And it sort of captured shame.
• 15:34
  Right? It's just like, oh, that's it's in me. It's around me. Everyone could see it. And so there's this feeling.
• 15:40
  Obviously, we don't see it on the outside when we look at the person. But it now I think what's important to understand it from trauma because it's like when people go through really horrible experiences when they've been sexually violated when that, violation happens over and over again, there's this feeling of feeling flawed. Like, something's really wrong with me. You know? Why why do these things keep happening?
• 16:04
  And it must be some fatal flaw about them and this sort of reasoning and emotional reasoning to try come up with that. But it's just this state now that now if you feel so flawed, it's hard to be vulnerable. It's hard to let people see you to be known, which then allows you to actually take in support or take in empathy if you're more vulnerable. So there's a sense of people feeling like they need to hide. They need to hide those parts of them because of the trauma they've gone through.
• 16:34
  And then there's this carryover. Carryover into other areas of their life. So when they're getting to know people, when they're at work or wherever they are in life, they there's this underlying feeling. They're just not worthy. They're not they're flawless.
• 16:50
  There's something really wrong with them. And so you could see that, you know, it affects a lot of areas of one's life. It leads to people isolating more. You know, it leads to really addictive behaviors, self harming behaviors. I think it has its roots in a lot of psychological problems.
• 17:13
  Speaker 3: Why is it so hard to shake off? What is that about? How come we can't just think our way out of shame?
• 17:20
  Speaker 1: Well, I think there's some neurobiological elements to it so that people get in these shame states, and it's like they're flooded with all this emotion. And, you know, there's you know, I'm not a neurobiologist or but, you know, in terms of lot we know about neurobiology, not only with trauma, but also with shame. And so, you know, it it can activate areas in the brain, you know, that can flood the person with emotions. And so then the person is in the state, this heightened state of arousal, is feeling really bad. And and then what happens is it then maybe they have difficulties thinking when they're flooded with all of that emotion.
• 18:11
  And then they you know, they what happens though is then they're less likely to reach out. They're flooded with it. And, you know, what might actually soothe or help one is to share that and to have somebody see them and say, you know, I don't look at you that way or they they care about them and they say, you know, it can kind of challenge the lies that shame kinda gives. But then often what happens is they're alone in that. And then it just it's like, you know, being in a dark place alone, it it just feeds off of itself.
• 18:46
  And, certainly, the neurobiology of all this doesn't help because their person's just flooded. And then they don't share it. And what would really be helpful is to be able to share it and have that corrective experience of somebody really being empathetic and caring and accepting, where it just feels too dangerous, too vulnerable, too scary. You know? Like, the person's in such a state, they couldn't tolerate if they got rejection or if they got judgment or so it's difficult.
• 19:21
  It's difficult in psychotherapy because you gotta get the client in that you're saying to, oh, I have to get them to open up, not get them. But, you know, you wanna create an atmosphere of safety and trust where the person can start to share so that they can start to reduce what I think is really toxic for them internally and all this shame.
• 19:41
  Speaker 3: I hate that's so true. Just speaking from some lived experience with shame, I have been in that place that you described so well just now where cognitively, I am aware and have made enough progress in my own therapy or in my own life that I can cognitively tell myself the only thing that's going to help this feeling right now is connecting with someone else. That's the only thing you called it a corrective experience. The only thing that's gonna resolve this feeling is connection because of relational trauma and relationships and and the brain and all those things you referenced. And yet it's so difficult to do when that is really, really big.
• 20:32
  Those shame feelings are really, really big because I think when I either either I am in such a state I literally physically cannot reach out, or what I have to give when I do reach out is such a hot mess that then I'm, like, extra ashamed, or I feel unsafe enough that it's not safe to give someone else. Like, why would you pass that off to someone else? It makes it really, really hard to reach out, whether you're talking about a safe friendship or whether you're talking about with a therapist. It makes it so hard to do the very thing that would actually help.
• 21:19
  Speaker 1: Yeah. It's it's a really a very good point. It's also hard because, you know, the purse you can't like, you're as you're describing, it's not like you can say, hey. I really need to talk about something, you know, that's been bothering me. You know, like, some normal you know, do you have a minute?
• 21:35
  We could talk or, you know, some sort of thing. It's just like and what gets out, it gets almost garbled. You know? It's like, oh, I shouldn't be I'm so sorry to bother you. Oh, never mind.
• 21:49
  You know? It's like, and then it it just comes out and the person's, like, now spinning. Like, I shouldn't even be talking to you. And then the person on the other receiving end, you know, it has to really just be patient. It just kinda let the person do talk the way they need to talk.
• 22:06
  But that's so painful. The person's like, oh, no. I'm really botching this up. And then they read the cues to the other person who's just kinda maybe confused. I'm not sure what you're feeling.
• 22:16
  I'm not sure what's going on. And then they go, oh my gosh. You really do think I'm terrible. And then there's, like, this disconnect. So there has to be, like, this space.
• 22:26
  The person can find some way to just get it out however they're gonna get it out and a person that's safe enough to be able to sort of allow that space. But it's difficult. Right? Because it because a person's you'd like yours had a nice description about the process. It just gets it's communicated messy too because a person's flooded and they're not able to think through everything.
• 22:51
  And then there's this heightened fear that if you share this, what's that person gonna do with this? And then then there's feedback like, oh, how you're sharing it, that might not even be good enough. You know? That that's coming across wrong. You know?
• 23:05
  And now they're gonna really see because, you know, then you start crying or start panicking or you're you're having difficulty breathing or you know? And then it's like, you know, what was it you were saying? You know? So it's kinda like it's difficult. That's where I think as a therapist, I, you know, really believe in because of trying to create a place where people can just be and where you help people to share that and then also deal with the feelings that come with sharing because people are so have so much fear in being vulnerable or even how it is they are being vulnerable.
• 23:46
  Like, is there a right or wrong way to being vulnerable? And, you know, believe that there's the right or wrong to it, but they now start judging that. A lot of the clients that I see, they'll start jet they'll start being open, and they'll be that not hot mess kind of thing of sharing. And then now they have to apologize or they feel they have to apologize. I don't feel they have to apologize, but they now start taking it back or I shouldn't be talking or you probably think this of me.
• 24:14
  And and then I don't even sometimes might not understand their whole story yet because they're in process, and now they're trying to take it all back because they feel so terrible about what they're sharing. And, you know, it's it it is challenging. Very dysregulating.
• 24:30
  Speaker 3: Dysregulating is a fantastic word for it because, again, like, cognitively, you can't even express what those feelings are because it's not a cognitive experience. It's not one of the things I can talk myself out of. It's not one of the things I can logically work through because it's not that part of my brain. And understanding that now has helped me so much because I can at least also understand that, and it gives me a framework. But that feeling is bigger than my life is in danger, and that feeling is bigger than my life is in danger, and I can't fix it, And it's bigger than my life is in danger and I need help fixing it.
• 25:25
  Like, it's so bigger. And even if I I've I've got to the place where I can say, okay, these two people are my safe people, and in an emergency, I can call them, I can connect with them, and I can feel better. But when it's a shame trigger or when it's shame that's gotten stirred up, that doesn't work. There's something that blocks that reaching out process, and there's something that you feel worse even for trying. And because you don't make sense when you feel it, because it's not a cognitive thing you can put into words, it's exactly like what you said.
• 26:07
  It's so you're apologizing because you're aware that you're not making sense, because everyone else would be like, actually everything's okay because da da da da da. But it's not about those things. And at the same time, there's also the layer of as long as I don't reach out to these two people, I know that they are still there and on my side and part of my safety plan. But if I dare to reach out to them and it doesn't work or through that confusion like you were describing where there's misattunement just because I'm not able to communicate, then that feels more dangerous than not reaching out. And so then you get trapped in like this ball of shame, and it's so, so distressing.
• 26:55
  Distressing. And dysregulating is such a good word for it. That's such a good description.
• 27:00
  Speaker 1: Yeah. It's it's like a free fall. So sometimes people just feel like, oh my gosh. No control. No you know?
• 27:05
  Every it it'd be it's safer to keep it inside. But then what that does is just sort of reinforce the shame. Right? Because now you've there's you know, gives you the message. Well, if people really knew, then they wouldn't be there.
• 27:22
  You know? If people really knew, they'd know how bad, how flawed, how whatever that emotional state. So if I just keep that kinda box inside, then maybe I I won't risk losing people or finding out maybe that people won't love me or won't care about me when they see all this. So how But then so it's it's a trap. You know?
• 27:45
  It's really kinda traps a person, I think.
• 27:48
  Speaker 3: Yes. Yes. So how does the relational aspect of the therapeutic relationship, how does that bring healing?
• 27:57
  Speaker 1: Well, I think it's a combination. I think sometimes you have to help people get in their body and calm their nervous system. So a big proponent of that. So whether it be with their breathing or mindfulness and really getting there. But I I'd like to integrate that into the the work so, you know, we're not just focusing on a technique.
• 28:18
  But, you know, people have it, like you said, about sharing, you know, and how difficult that is. It's hard to make use of the therapy relationship if a person is just like so dysregulated. You first have to sort of be able to get them to calm down. You have to get them in their breath, get them in their body, get them saying, okay, we are here or not on a free fall. So that, you know, comes with some very kinda, I think, some real visceral kinds of experiences.
• 28:48
  One with one's breath, getting in touch their breath, getting in touch with where they're sitting, getting grounded, feeling the ground. And I I think in terms of my voice with the client, our eye contact, which often can feel so painful when somebody's feeling ashamed. They don't wanna look at the therapist. They don't wanna look at someone. Right?
• 29:12
  There's this tendency to wanna curl up. So I try to gently, you know, get someone to say, let's just breathe for a moment. Let's get you know, slow things down because, you know, shame starts spinning out of control. It's just this this regular state, you know, person's just feels like they're spinning fast, fast, fast. Oh my gosh.
• 29:32
  You can't breathe. Oh my gosh. You know, the world's gonna come crashing down. All my relation everything. And it's just gonna end here.
• 29:39
  And so just, okay. Let's slow it down. Let's breathe. And then I tried to, like, work with them on just starting very simply with, hey. Do you you know, I'm right here with you.
• 29:51
  Can do you think we could you could look at me for a second or and just sort of take in that I'm here? So they may not have even shared anything that I know how to respond to yet because they're just so dysregulated. Right? So and even if I did respond verbally, they're probably not gonna hear it. So I just start very simply.
• 30:12
  Let's breathe. Let's be can we be present, grounded in the room together? And when they can say, okay. We could slow down and be present, grounded in the room together. And maybe they can look at me, and they could see I don't well, hopefully, I don't look scary.
• 30:30
  And if I do, maybe Shane's talking. And so we have to get them more regulated. And, you know, and we just kinda kinda slow it down. And when the person starts in there, their nervous system starts to slow down. They start to kinda get back in their body.
• 30:47
  They know I'm here. They know I, you know, I certainly could handle whatever the state that they were in, that it's okay. They're okay. And then we can eventually get to words to talking about it or getting some feedback or getting that normalized that, yeah, you know, what what just happened? Did they get triggered?
• 31:07
  You know, what what happened? Because a lot of times, the person might not know in a moment. They're just so flooded. But we first have to slow it down, and I just use some very basic, you know, simple things. Just like I would, you know, as a mom.
• 31:22
  You you know, you if your kid's upset, they got injured. Something happened. They had you know, and they're crying, and, you know, the the world's coming to an end that day. You have to just be very you know, if it's physical, you just let me look. Let us clean the wound.
• 31:38
  That's okay. Be calm. Okay. But the band what what is it that needs to be attended to? You attend to what needs to be attended to in a calm manner.
• 31:48
  And then what happens is that usually the child, if they've had enough good enough parenting, regulates. They just go, oh, okay. Now I'm okay. And they can kinda shift gears. And that's what I think what therapy needs to do in that safe context is help the person regulate.
• 32:05
  And then through those repetitive experiences, person, like, learns how to do that, internalizes that.
• 32:12
  Speaker 3: So even using some co regulating to help build attunement and to open open that connection a little bit through attunement.
• 32:22
  Speaker 1: Yes. Yeah. So if I'm attuning to whatever the the individual's, their body language, but then I may help regulate that by maybe slowing that down a little bit. You know? Like, they're really let I just feel a need to breathe.
• 32:38
  Let's why don't we both just are you okay with that? Are you you know? And so we kind of, okay, take a little step.
• 32:47
  Speaker 3: How have you seen that impacted through the pandemic when different groups of people were on isolation? Or even in California, there were you know, the people were at home because of the fires or or or moving because of the fires and all these different contexts. How does that increase of social isolation because of those different circumstances impact that ball of shame or being able to come back down to regulate again?
• 33:19
  Speaker 1: Well, that's an interesting question you asked. I think one of the things that I've noticed is that a lot of the clients I have, they have complex trauma and really struggle with shame, that shame about sort of, I think, normal responses. So what I found is individuals, I you know, in daily life, I find people talk, you know, kinda run and, you know, take a walk or something. People are more likely to talk about the effects of the, you know, pandemic or the fires. Everybody's talking about well, my clients that really struggle with shame, they're not talking about it at all.
• 33:56
  I have to kinda prompt them. Like, okay. So how is all of this affecting you? And let's talk about and it's almost feeling unworthy to talk about the things that all all of us are affected by. So almost, like, the lack of, like, they can't be normal.
• 34:15
  Like, not that they say I can't be normal, but it's just, like, the things that people are venting about. I feel like, you know, that maybe that's not big enough of a thing. I'm like, oh, you know. And so, you know, all of a sudden, one week, I noticed that everyone wasn't talking about anything. And I kept, you know, being the one that asked, well, how is it affecting you being isolated?
• 34:39
  Or how is it affecting you with the fires? Or how is it affecting you know, all these things are are also often people with complex trauma have a lot of fear and anxiety. So I I know that they often might have anxiety and actually more than some peep other people that don't struggle with anxiety. And there'd be kind of a disconnect or dissociation from them until all of a sudden, felt like one week. Like, everyone now suddenly, okay.
• 35:08
  I guess all of it's accumulation, all these stressors. The world's gonna collapse. You know? Maybe this is the apocalypse kinda thing. You know?
• 35:17
  The convergence of the fires and the pandemic and the political conflicts and whatever the and so all of a sudden, it's like, all of a sudden, the floodgates came. It's like trying to help people normalize. Yeah. This is what people talk about. Are you reaching out?
• 35:34
  Are you talking to people? Are you talking to your partner? Are you talking to your friends? Are you doing FaceTimes or Zoom or taking walks? And this tendency was that people thought they they should be able to handle all this.
• 35:48
  This is what everybody handles. And it was actually the opposite. So I found most people in my own personal life, people were all talking about it all the time. You know? So so it's like the opposite of, like, feeling like, okay.
• 36:04
  And so part of this helping people to say, well, actually, it's helpful to talk about it. And the other part, I think, that was difficult is that a lot of people that I've worked with it, there was this tendency to initially sort of very feel very comfortable with the lockdowns or, you know, in the early part of this whole thing. It's just like, well, no. They feel very comfortable. They don't have to go anywhere.
• 36:31
  And so then we had to watch that, uh-oh, they're a little too comfortable. How do we not have this be, like, a regression from some of the work they had done before to get themselves out or to connect more? And how how do we not have this be that? So really was pushing people, okay. Let's make sure you're doing those Zoom calls or you're FaceTiming.
• 36:53
  And and, and so, you know, that, I think there's this this notion that somehow they had to be better than the this assumption that everyone's handling it alright and that they should even be better than the average person.
• 37:12
  Speaker 3: It's interesting that you mentioned that because I've seen that as well. In the online groups for survivors, there was this community reflection that those people who had therapists that were taking lockdown seriously, actually, their clients felt more connected to them than they did before because they recognized that their therapists were able to respond appropriately to danger. And watching their
• 37:47
  Speaker 1: Oh, interesting.
• 37:48
  Speaker 3: Yes. So there was some congruence there. And then the other thing that helped them was when they had a therapist who not not taking over with self disclosure, but when they had a therapist learning what it was like to be locked down and how hard that is, recognizing that that's what survivors live like all the time. And having a therapist now understand trauma in a different way because they were going through all of the protests and the politics and the pandemic and all of these things, it actually built the relationship with a therapist. But at the same time, people who had therapists who either did not speak out in whatever platforms that they had or who did not take the pandemic seriously or who did not respond to those big issues that were collective traumas for us as communities and as people, they felt more dissonance instead and felt disconnected from their therapist instead of closer to their therapist.
• 39:02
  And it was interesting to watch those discussions this summer as sort of the timeline unfolded and everything continued to play out even longer than we ever thought. But then at the same time, the other piece that you talked about was how at a different level, people who were already had high anxiety or a lot of depression or really good at dissociating, the lockdown because of quarantine was like the best thing that ever could have happened to us. Like, we no longer had to leave the house. We no longer had to leave the house. We no longer had to do these social engagements that are so stressful.
• 39:46
  We felt safe and protected because no one was coming to our house. We didn't have to let the children go to school. Like, we literally could bring everyone in our external world into our internal world, and it all sort of became fluid in a way that was very, very much a surreal experience. But you're right. You're absolutely right.
• 40:11
  Even though I don't like it, you are absolutely right that that also led to some regression. And if I think now about leaving quarantine, and in my personal context, just so you know, I have a medically fragile daughter with a restricted airway. So we were on quarantine before the pandemic even happened, and we would be on quarantine during the winter, during cold and flu season anyway for her. So so that's not unusual for us. But outside of that context, just to the thought of quarantine lifting later, which isn't gonna be anytime soon if we look at the charts of how things are going in America.
• 40:55
  Speaker 1: Yes.
• 40:56
  Speaker 3: But but the idea of quarantine lifting and us having to return to things like public school and church and this and this and all these meetings and social activities, it makes me want to, like, crawl under the bed and cry. It it's so overwhelming to me. And my friend said to me last week, she just said to me what you just said. That like, she called me out on it, and she was like, we worked so hard to get you out and participating in some things that now I don't know how to get you back out. And, of course, that's not her work to do.
• 41:33
  It's my work to do. But she had the same point you did about how even though in some ways it was appropriate and necessary because of what was happening, like, when now time really isn't safe, we have to pay attention to danger in in in whatever that form is. That's that's absolutely true. But as that danger resolves and coming back to a healthy place and a response to safety and reengaging, that's gonna be really hard for a lot of us.
• 42:07
  Speaker 1: Yes. No. Because for, like, the therapy for people who have fears or what they call exposure therapy. Right? Get out there.
• 42:14
  Go do the thing over and over and over again. Well, if all of sudden, you know, you just learn to okay. Well, then there there's a lot of support to to isolating and staying inside because of the pandemic. But then at some point, okay, it lifts. Well, how do you what what I found is that people are struggling to kind of do things that maybe take a little step that actually is safe enough.
• 42:39
  You know? So it's like, oh, no. They've gotten used to it. And they got a lot of validation. Well, don't go to the stores.
• 42:44
  Don't go here. Go don't go there. You know? And then when all of a sudden, it's like, well, maybe it is okay to go to the store or maybe it is okay to do these things. It was hard harder.
• 42:54
  You know? And how do you take maybe little steps to say, okay. You still wanna be safe. You know? You don't wanna be reckless.
• 43:01
  You wanna put yourself at risk. But how do you take steps that will kinda keep yourself more flexible and more open to be able to kind of face things that you'll eventually need to face. So it's a fine balance. Obviously, you don't wanna be reckless. You don't wanna put yourself or your family or people that you know are compromising your case, your daughter.
• 43:29
  You don't wanna put people at risk. But then you also don't wanna put yourself at risk because you're now so far on the other side that now, you know, it's gonna take a lot of things, you know, to go to take steps again.
• 43:44
  Speaker 3: It reminds me of what you said at the beginning about how dissociation starts out as an adaptive skill and then becomes maladaptive. And I can see that in this current context because at first it was adaptive. Everything shut down quickly, and we're all isolated, so we're all there was congruence in that. But then when some people stopped isolating, there started to be incongruence. And so then that felt like danger even if it was just, I respect your choice.
• 44:15
  This is my choice. Here's what we have to do for our family. It felt like incongruence, which felt like danger because, oh, yeah. There's relational trauma under all of this. I forgot.
• 44:27
  And then Yeah. At what point does and then that relational trauma, that incongruence became a trigger of I don't feel safe because I I don't feel safe with how you're handling the dangerous world. And even though that's your choice, it feels like danger to me. And so now I don't know if it is still safe to connect. So can I text or can I not?
• 44:58
  Can I call or can I not? And even besides other people's choices or or that incongruence, the longer it went on and the more comfortable we get internally with shutting down, whether it's dissociative just specifically or the lockdown as an external example for quarantine, it does become harder to do those things, to reach out, to connect, to initiate, to try. And the greater that you sort of feel, the more you sort of feel left behind by everybody else, the bigger that shame gets. And it just complicates everything. So then even what was adaptive is now maladaptive, but also it's scarier and also it's danger, and it just escalates very quickly.
• 45:51
  So going back to those things that you talked about like in the office with connecting back to your body, connecting with other people, slowing that response down, and doing what will help so that we're choosing our responses or regulating in ways that are effective and adaptive instead of just maladaptive or habit or out of fear.
• 46:21
  Speaker 1: Yes. That's great. And then also so it just become, like, the on or off switch. Right? So either you know?
• 46:27
  Okay. And I think some of our culture can you know, we get people that are sort of don't believe in mass and don't believe you know, are kinda more on the side of, hey. You know, no one's gonna get it hardly. And then we have people on the other extreme. You know, like, so how do we no.
• 46:43
  I I'm not saying one extreme or the I'm not certainly criticizing either extreme or anything. I'm just saying ever like you said, everyone has to make their own choices. Obviously, we have to think about be sensitive to other people because some people are more risk than others. But how do you take those steps that at least allow you to be more open open and flexible in a safe way. Like, I I've had clients that are so they've just been, like, in lockdown the whole time.
• 47:12
  Like, so they really haven't gone anywhere. That there's still all food comes to their house. They don't, you know, really only go walking in the neighborhood at certain times, like, when no one is in the neighbor. You know, either really early or, you know, like, just literally have then become completely isolated and just saying, okay. Well, having some clients that okay.
• 47:36
  They drive. You know, they drive to some place that they can see the beach or, you know, and they're in their car. And they don't even have to leave their car, but they go there and they have their coffee looking at the water because they can sit there in their car. No. They're they're not increasing any risk.
• 47:51
  Right? We don't know that, you know, where they park, that there there's no they're not gonna get the it in their car because, you know, the the way that they've you know, we've structured this. But then it sort of makes them feel more free, less trapped. Right? And now everybody's different.
• 48:07
  But finding some step, it's like, well, you didn't really increase the risk. It might feel like you increased the risk, but you didn't really. And how to kinda that going. Like, I one one of my clients who was starting to feel like, uh-oh. I'm just so comfortable in the house all the time.
• 48:25
  Like, I don't any need to leave and was getting worried about it. And so then decided and and one of the things the client was missing about coming to therapy was driving to the therapy session. This whole, like, what am I gonna talk about, you know, driving there, sitting in the waiting room, then going to the session. And so the client decided to drive somewhere, sit somewhere in a pretty place, and do the session in her car. And this was like, wow, so freeing.
• 48:52
  You know, like it became a scary first and then it became freeing to just say, okay, there was no more risk to her in her health, but it felt like, wow. She took this step. You know? And I think sometimes we have to make sure we okay. We keep ourselves challenged appropriately, but yet regulated so we're not sending you know, kind of overtaxing ourselves so that we can continue to take those steps and have the freedom to take the steps when we're ready to take the steps.
• 49:26
  Speaker 3: That's beautiful. What a wonderful example and a good challenge. I feel like you've you've given all of us clinicians and and clients alike a challenge for sort of reclaiming our response as this second wave that was never squashed in the first place is now roaring up, and lockdowns are starting to happen around the country again. And, I feel like you issued a challenge of how to or just to to remember that we can be creative in caring for ourselves and connecting with others even while also being physically safe. And that that's one of the ways that we actually have the power to make now time safe even while lots of hard things are happening around us.
• 50:15
  Speaker 1: Yes. Yes. Well and I think even the whole idea I know, you know, the very beginning, I did a lot of Zoom calls with friends, you know? So we do like a a call at the end of the day or something and several friends would be on a Zoom call. Then I noticed as things started opening up, well, maybe I met a couple people in sort of a very socially distant kinda out the park or, you know, the backyard where there's everybody could keep their distance to people at mass and those kinds of things.
• 50:48
  And and then also we dropped off the Zoom. Right? And then, oh, people got busy. Well, you can't meet. You know, we didn't do that very often.
• 50:57
  And so but it was like, oh, you know, we need to really kinda work at keeping that because it was there was something really precious, which is what I'm actually finding with the online therapy, which I had really not done very much of. I've done a little bit. But I'm finding, you know, that face to face contact. You're closer. You really couldn't I couldn't you know, I really like being able to sort of see someone, that close, you know, you can see, on video.
• 51:30
  And so, you know, how do we keep that going? Like, even as we're heading to lockdowns, how do we make sure? I need this. I need to have face to face con I need to see peep not sometimes we can't always see them, but, you know, I need to keep that going. And how am I gonna do that?
• 51:46
  And how am I gonna keep myself flexible and open and engaged in life even if there are external lockdowns?
• 51:54
  Speaker 3: I love that conversation so much. Thank you for sharing. Did not mean to go off on a tangent about the pandemic. I apologize for Is there anything else specifically that you wanted to share or that you had in mind?
• 52:10
  Speaker 1: Well, I think I'd I actually don't think you went off on the pandemic because I think it's, you know, it's just like it's life. You know, it's different than any of us most of us have ever faced. Right? But it's a a real stressor, real concern, it's a real thing we have to face. And how do we I think it's not just about survive things, it's how do we be resilient.
• 52:34
  You know, how do we learn how to use whatever life brings as a way as a challenge, as a way of saying, okay, I'm not going to I might for a minute or for more than a minute. Might have a bad day. I might go into a shame spiral. You know? But how do I kinda get back, get grounded, be resilient to sort of know, yes, this affects me, this affects other people?
• 53:03
  And I think whatever it is, whether it be natural disaster that came or a loss of a loved one or life goes on, you know, when when people have had a lot of trauma, new events are very triggering, and they can remind them of old events and old feelings. So the feeling is like a kind of like a tunnel. It takes you that one feeling triggers all these old feelings, and then it feels so huge and so out of control. And it feels unmanageable. And so how do you learn how to ground yourself, regroup, say, and remind yourself, wait.
• 53:39
  I've survived. I've been able to get through other difficult times. What do I need to get through this difficult time? What are the skills that I need to manage? Some I might have, some I don't have.
• 53:51
  How do we get those skills? I just sort of have a you know, when your brain's working again, how do you help get your brain to help you? You know, I would like to say, okay. Well, I am I do I have some strengths that have come out of this difficult time? And then be easy on myself for things that sort of, well, I wasn't as strong in that or I could have made more use of my time or, you know, whatever.
• 54:15
  I just being a little more gentle and accepting. And I think that those are all things that help us. You know, how do we be more accepting? And that certainly helps reduce our shame and how do we be less judgmental of ourself and others. And then how do we, you know, take steps and still engage in life no matter what the circumstances are, no matter what whatever, the pandemic or the politics or, you know, how do we still engage fully in life the best we can.
• 54:42
  Speaker 3: Thank you so much for sharing with us.
• 54:46
  Speaker 1: Sure. My pleasure.
• 54:48
  Speaker 3: Do you have anything else that you wanted to share or that any questions for me?
• 54:54
  Speaker 1: Well, I guess my question was just who you know, I think it's one first of all, it's great that you have a podcast out there, and I think it's really helpful for a lot of people. These kinds of things can be really like a lifeline and the source of really, encouragement and kind of emotional fuel and, you know, food for their soul.
• 55:32
  Speaker 3: Thank you for listening. Your support of the podcast, the workbooks, and the community means so much to us as we try to create something together that's never been done before, not like this. Connection brings healing, and you can join us on the community at www.systemsspeak.com. We'll see you there.