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Transcript

AEDP Therapy · System Speak: Complex Trauma and Dissociation

• 0:08
  Speaker 1: Over: 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 longtime 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.
• 1:02
  So we went to this training today that we want to tell you about, and there were some pretty trippy things to include. It was also kind of triggering for us, I think, it was so much about the therapeutic relationship and we're kind of in this phase after having transitioned from the therapist to interviewing new ones and sorting out family therapy and DID therapy and what to do about both of them. And so I think in our grief for the therapist and in these layers, I think all of that, just the timing in our lives, made it a way harder training than what it meant to be. And I think it made it way more triggering than what was intended. Although in this kind of therapy, everything is about the therapeutic relationship.
• 2:04
  And so that is super important and a big thing and in its own way triggering anyway. But I think part of what made it so hard for us was the timing of it. The training was on accelerated experiential dynamic psychotherapy, which is called AEDP. I actually had never heard of it. Some of you, when I mentioned it, said that you've heard of it or had that and you liked it.
• 2:27
  So that's great. We just wanted to share. The fun thing was that he opened the training by talking about all the different research that it sort of came out of. And so he talked about Sigmund Freud and how that was psychoanalytic and Fritz Perls and about here and now and John Bolby and attachment and Carl Rogers with unconditional positive regard. And so it was fun to hear all of that because that's just theories that we know and familiar with, right?
• 3:03
  But then he talked about Peter Levine and somatic and Dan Siegel with interpersonal neuroscience, and Richard Schwartz, IFS for internal family systems and parts, and Steven Porges for polyvagal theory, and Bessel van der Kolk with Trauma in the Body and Conversion Out of the Body, getting the trauma out of the body. And it was super fun because we knew all those people from the podcast. And so he had people raise their hand if they had heard of these people. And I was like, we've talked to these people. So that was kind of fun.
• 3:40
  He said the best thing about AEDP is that there's less vicarious trauma because the therapist is processing and discharging feelings at the same time. So I guess that's a helpful thing. He also quoted someone that said, To be fully awake is to be healthy. And I missed the citation. I couldn't understand what he said and I missed the citation on that.
• 4:03
  But he talked about how sleeping, not really meaning being asleep, but kind of sleepwalking through life, is when we're having feelings or memories or senses that we're using defenses to keep away. So it's our defenses that actually keep us asleep, so to speak, and that we only wake up in relationship. So it requires connection for any kind of actual healing to happen. They showed some clips, which if I can find, I'll put them on the blog, but they showed some clips of AEDP being done. The lady's name was Diana Fosha, and he made a joke about how it took all these fancy guys to come up with these different bits of science, and it just took one woman to put them all together into one theory.
• 5:00
  So that was funny. And we watched some case studies, which we can share on the blog if we can find the links to them. But it kinda showed how it how it worked. A session opened up was sort of an invitation for the person to open up about why they were coming. But immediately, what she pointed out was the way the person was breathing.
• 5:28
  And he said that the reason this is so important and that breathing is such a big deal is because it's the only autonomic response that we have any control over. She also commented things on when the person was smiling and pointed this out as a defense, which surprised me because smiling was a positive thing. But she was pointing out how it was incongruent with the words the person was saying. Because the session was just starting, the person was super nervous but was smiling. And so there was incongruence between what their feelings were and what their affect on their face was.
• 6:08
  But then later in the session, when she helped sort of bring her out of her head down into her heart and she was being more authentic about her feelings, then her words didn't match. So when she was actually feeling then her words were about how she was fine and everything was okay. So it was interesting seeing that from the outside perspective, how those defenses kept sort of a disconnect there just to help the person feel safe enough to manage and handle what was going on. So part of what's very important in AEDP is going really slowly to notice and integrate all parts of yourself as you go. And by integrating all those parts, what they're talking about are memories and sensory and affect and all of those experiences, like the different layers of an experience.
• 7:02
  And they said that it's really important to give that cognitive understanding of why it does move so slowly because when people are really far in their heads that they want to understand why you're doing what you're doing and how it helps so that they don't at all feel coerced or manipulated or forced into trying something, even if what you're trying is helpful. And so I really like the way he put that into words about kind of a part of consent to treatment is understanding what's going on, even in an ongoing kind of way. They also focus so much on the relationship, and I'll talk about that in a minute. But he said that people can only take others in when they themselves have been taken in. And that that's why this model of therapy builds on the relationship between the client and the therapist because the person can't do what they haven't experienced.
• 8:06
  So if no one has been there for them or supported them, they can't do that for themselves. So in the video, as the therapist was present with the person, the person said at the beginning, I'm calming down because I know I will be okay. So they were still using their cognitive understanding as a defense, but they were not smiling anymore because they knew they were not okay right now, even though their words are still that they will be okay. So there was still some incongruence, but it was making progress. And so he talked about interception being connection with others and neuroception being connection with self and how people with insecure or avoidant attachment struggle with both of those things and that that's what makes them so well defended and why it makes them so hard to connect with others.
• 9:02
  But what he said was that no one comes out of the womb when they're born just completely independent and like I got it. But that all of us initially when we're first born are dependent on other people and so there's this relationship that's required for development. And when we don't get that relationship for development, then things in our development are impacted so that it makes us hard, so that things are made harder than they need to be because we never experience them in order to develop. So again, it's not about us failing, it's just a complete thing, It's just a complete experience that we missed out on, and we can't really heal without also healing that piece. And when talking about how hard and intense healing that piece is, he said that it's so intense and so difficult that the adults in therapy won't come back because it hurts too much and it's so raw and it's so hard that you just want to run and you just want to get out and you want to quit therapy because the depth of how much it hurts to face what you missed and what you need and the fact that you're an adult still needing this infancy experience is so, so painful.
• 10:33
  But he said the little ones, and he specifically said, I'm talking about parts of all people, not just DID, but the little ones are who keep the person coming back to therapy because they recognize that they do need it and because they've been waiting for it so long. He said, What makes it so difficult is that this kind of processing in the lower region is so fast that we're not even aware it's happening. So we're actually technically like half a second behind what's happening in reality all the time. And the only way to target the lower region of the brain and to heal the limbic system is through relationship. And so this kind of trauma healing that is relational trauma, which is not necessarily but can be the same as or go along with developmental trauma, the only way to rewire the brain and bring healing to that is through relationship.
• 11:38
  And he said that EMDR and somatic experience, both of which we've talked about on the podcast, work in the same way. EMDR helps access the inside and somatic experience helps access the body resources. But what's different about AEDP is that it does those things through attachment and relationship because to bring complete healing and solidify that healing to maintain it requires connection. The challenge for survivors is that disconnection is intolerable, but keeping our defenses up against not having it is exhausting. And that's why survivors are both anxious and depressed.
• 12:27
  So when we're struggling with our defenses, which we'll talk about more later, we increase safety through connection and decrease defenses through relationship and make the implicit explicit by building attachment. So this goes back to the same things we've been talking about and learning just in the last year or last six months even about how when we most want to run away is when we need to stay. And when we most want to avoid is when we need to reach out. And when we feel most alone is when we need to connect and ask for help. But it's really hard because it's literally the opposite of how our brain is wired.
• 13:11
  So it creates this tug of war inside between parts, whether you have DID or not, where part of you wants to be exposed so that you can be cared for, but part of you knows that that's dangerous because you've not been cared for in the past. And he said, Understanding this tug of war gives us compassion for ourselves and the people that therapists work with because as soon as we judge the defenses, then we also shame the person. Shame shuts down awareness and connection both. And that shutdown that we feel, whether that's dissociating or a literal freeze response, it happens because we have been squashed developmentally and relationally before age four. And so we've already been taught by age four how to filter things, shut it down, and keep it quiet, and how to think and act like them because that's the only way to create a shared reality with our caregivers, which is what keeps us safe from them.
• 14:23
  So the question in therapy becomes, what is it like for you to have me noticing you, to have me holding you in my mind and heart? And when that's too much and too new and too raw, then what it feels like is just being scattered or too much without our defenses, like too raw. And that's what leads to dissociation and feels traumatizing. And so the therapist has to make explicit what has been implicit, meaning literally asking what do you need right now to feel safe? What would help you feel safe right now?
• 15:01
  Those kinds of questions. And that's not only how you reestablish safety, but also how you help yourself become more aware by making space for that affective experience when you have feelings, which is the first step of being able to integrate the thoughts and feelings and sensory experience altogether. And you know that's happening when you start to mourn yourself, meaning the totality, the wholeness of the experience that you had to go through or what you didn't get when you needed it or those misattunement experiences. And when it starts to get overwhelming in therapy and that freeze response starts to set in, then being aware of the affective is part of what helps bring you back up that polyvagal ladder. But when it gets really hard and really intense, that's when we want to bolt and that's when we want to run away.
• 16:02
  And this is a huge piece because obviously this is a piece we've shared on the podcast that gets really hard for us where we want to leave. And he said, The grown up part feels that urge to walk out or to leave therapy because you could never leave the situation you were in before. And so it's actually, it's sort of that somatic experience rising to the surface where it's not just wanting to leave in the moment because it's hard. It's literally that physiological experience of wanting to run away when it was hard when you were little and you couldn't get away or couldn't get out of it, and part of you knowing that now you can get out of it and wanting to act that out. And so honoring that is not necessarily a bad thing if you do need to leave sometimes, but also staying and realizing that you're safe now is also important and part of what needs to be practiced.
• 17:07
  He also talked about how a grown up part may want to be angry, but how there has been plenty to be angry about. But again, that the younger parts want to stay because they need connection and they need to be seen and they need to be known. And again, he was not talking about DID specifically. He was just talking about how everyone has parts and all these parts of self. And he said it's the same thing when survivors push people away, that it's not because they don't want to connect.
• 17:43
  It's because connection literally is so painful because of how the brain is wired from what they experienced in the past And that rewiring the brain for connection literally hurts. And they can really only tolerate so much at a time. And over time, that capacity can increase, but that the difficulties in relationship are not always sabotage and not always even almost a choice. That sometimes it's really literally that's all that is tolerable because even positive connections bring up so much hurt and that that's how healing happens. And so that's a good thing, but that it's also a very painful thing.
• 18:35
  So building healthy relationships with survivors can be a very slow but very intense experience, but also always has a little bit of that push pull because of the tug of war that's literally inside them about because the more that they heal, the more aware they are that they need connection. But connection, the more they realize why they need connection. And the more they realize why they need connection, the more aware they are of the hurt that they have pushed away for so long and the more they're aware of how long it's been without connection. But in this case, he says, the pain that they're trying to push away is exactly what we want to move toward. The closer you get to that level of pain and that level of hurt from all of the misattunement and shame and disconnected experiences when you were so young, the closer you are to actually discharging it instead of carrying it around with you.
• 19:45
  But the more you avoid it or push it away, the louder those feelings have to stay to be able to get your attention. So with AEDP, he said it's about HEART, which is an acronym for have it, experience it, absorb it, reflect on it together because everything is in the relationship. And then the adaptive expression of emotions moves you towards integrating the memory and the sensory and the feelings about your experiences. But pathogenic emotional expression are defenses that block or defend against actual feeling congruent with what you went through or your experience now. So for example, if you were hurt and you're feeling angry about getting hurt, that's actually a congruent, adaptive, positive, healthy experience.
• 20:44
  But if you're using rage towards yourself or towards your abusers or caregivers or to parts of yourself or towards littles and being aggressive with them or locking away any part of yourself or oppressing any part of yourself, then what you're doing is using rage to exclude yourself or part of yourself from those core emotions. So the rage is actually a secondary pathogenic emotion in that example instead of the primary core emotion. And so in that example, the primary core emotion would be the sadness for needing in the first place, for not having needs met, for the misattunement, for the hurt and the pain. But you're using rage to keep that sadness away and projecting it instead, like blaming the little part or yourself, some part of yourself. So in that way, the rage is a defense that needs to come down and stop acting out against those other parts instead of rage being the core emotion where you were legitimately angry that you were hurt, which is absolutely valid and a core emotion.
• 22:06
  So we talked about how every emotion, kind of going back to adaptive and maladaptive, how every emotion or defense could have an actual authentic experience that is integrated with the sensory input and the memory of the experience, or it could be working against those experiences to block our exposure to feeling them. And so our brains, he said, are wired for both war and for healing. Meaning our brains try to hold ourselves together outside of connection, which requires all these defenses because it's not how we are wired naturally. We're naturally wired for healing, which is how we hold ourselves together within connection and how within relationship we can heal, we can grow, we can feel safe. And that brings healing to the surface, which is transforming.
• 23:11
  We see expansion, we see liberation. We speak and respond to the desire to be known, seen, and recognized. And there is vitality and energy, which is neuroplasticity. So healing can only happen in the context of connection and relationship. Joy and sorrow only happen with others.
• 23:34
  Suffering is only adaptive when it's in the context of relationship. Otherwise, it's just hurting and there's no meaning or growth that comes with it. So when we're on our own and suffering because things are so hard, if we stay on our own instead of connecting with others, then it just stays hard and it just stays that bad. But when we connect with others and we grow through it, then we progress beyond it because we've experienced it to the fullest. And so he talked about how we can endure anything and tolerate almost anything when we are tethered to someone else.
• 24:15
  And he said, and you guys, this was so powerful that this connection or this tethering that we need that anchors us to other people is so powerful and so necessary, not just for healing, but for survival, that this is why when we dissociate, our brain creates others. Do you get what I'm saying? He's like, Your brain could dissociate in response to trauma and do all kinds of things, But what it does is create others. And the reason that you create others is because the only way to have healing is in relationship. And so when you don't get that externally, it happens internally.
• 25:06
  So the goals of AEDP are to maximize attunement, repair disruptions, ruptures, and misattunements, to process emotions while feeling supported, to be present while they access and process previously overwhelming experiences, including that which has been dissociated, to say and feel and do what you never could before alone, to have whole body experiences and to accept all parts, To undo aloneness, learning to be and trust others, able to feel and deal, to experience care, concern, validation, and authentic presence, the capacity to express and to receive, and to experience love, care, and understanding. So in the context of relationship, you can bring emotions to completion because attachment needs are met. And so he talked about how the three attachment needs are acceptance, protection, and comfort. And the core emotions that come as you feel those are integrative instead of pathological. So for example, grief transforms you into acceptance, and anger moves you to strength and clarity and empowerment, and fear helps you find safety, and joy helps give you energy and expanding your life, that these are transformational.
• 26:46
  And there's four kind of different layers. Mastery would be feelings like joy, confidence, and pride. Tremulous would be new experiences internally. Healing would be movement happening inside and gratitude being expressed. And realization would be wonder and awe.
• 27:09
  In the dyadic environment with the therapist, again, healing only happens in relationship. The limbic system literally has to learn how to tolerate it and be aware that it's happening. So even the therapist literally asking, Do you have a sense of me? Because when the limbic system is not online, then that's when we have those experiences of not being able to see the therapist, not being able to look at the therapist, not being able to remember the therapist, kind of in an object relations kind of way when they're not there in front of us, we can't retain that. That's because the limbic system is not online.
• 27:48
  So learning to have words for that was really helpful and made us feel a little less crazy. Breathing together helps with attunement, offering support, comfort, assistance, and care, being receptive to it. He also talked about how empathy can trigger more disturbances, which we have talked about before on the podcast and so many have experienced because that's a new thing, because that new experience of empathy is so unfamiliar that the brain literally doesn't know how to process it, and that's why it gets perceived as danger. So it's not that the therapist is doing it wrong, and it's not that the therapist doesn't know enough. It's literally that the brain has not experienced it and so interprets it as danger to be wary of, which means we didn't fail therapy.
• 28:40
  And I think we had felt some of that in the past, which I'll talk about later. So we talked about how clients come to therapy in the beginning and bring what they can most tolerate looking at, but we pay attention to the wall that blocks processing instead of paying attention to the content that's causing the walls to go up. Does that make sense? So when there's something hard we need to look at, he said instead of looking at it harder, attention to the walls that are going up because that honors their role in protection and in safety and makes it less intense than looking at the content directly. That when they're ready, the content will come, but not to just push through the walls instead stop and notice the walls.
• 29:32
  That this relational sensitivity will cause an upward spiral that only happens through connection. So focusing on increasing safety through maintaining that connection. And then healing comes as we acknowledge what happened, acknowledge all that happened, acknowledge all the layers of that experience, and acknowledge that it happened to you. That this visualizing and visceral experience is the most powerful kind of processing. And that the therapist really has to stay in the present with them and in that experience with them, even when it's in the past, almost as if the therapist feels it is happening to me while it's happening to you.
• 30:19
  But you have to believe in yourself and have your own safety and wellness enough to be able to connect that much with the other person so that you can say to them, let's hold this together. And you can say to them, stay with it and stay with me because you're really there. And an example of making those hard moments explicit when you were just feeling the implicit and wanting that urge to run away from it because it's so hard, things that are true to stay with them in the moment would be like, there were times when you tried to trust and move toward and it didn't work. So your body is literally pulling away right now. But continue to trust and I'll continue to prove it.
• 31:09
  Stay with me, stay with it, stay with me. And just reminding them that you're still there. So again, whether you're talking about working internally or whether you're a clinician helping your clients or a therapist working with people, all of this is that real. And if you can practice it there, then you can learn that it's also real and possible outside the therapist's office. And he even talked about an example of a client saying that, of a client saying that that's only true in the therapist's office because the therapist has paid for it and that just made them hired help.
• 31:53
  And I know it's a very real feeling, but it was interesting. His response to that was that you pay for my time, but my heart is free. That we choose to connect because we want to connect and we choose to do that level of relationship healing because we care about that relationship, which is different than just doing therapy to get paid. So he talked about connection in the therapeutic relationship being as a metabolizer, that healthy attached clients will always become healthy, independent adults, And not to worry about dependence in therapy because that's what happens relationally, not just developmentally, but relationally. Babies are born dependent on their caregivers.
• 32:48
  And so there's nothing wrong with creating safety enough that there's some dependence for a season. Because in a healthy therapeutic relationship or in any healthy relationship, it will shift from that dependence to independence and interdependence on its own. And that it's only people with insecure attachment who stay and are unhealthy about it. And so creating a healthy attachment and a healthy dependence will lead to a healthy independence and not to be afraid of that for a season. He said there's unethical about showing up, nothing unethical about creating a healthy dependence for developing healthy independence, that that's the way it's done naturally.
• 33:41
  And then he gave just specific examples finishing that up, that attunement means I see you. Empathy means I understand you. Eye contact means I connect with you. Mutually shared experiences mean I am in this with you. Affective experiences mean I feel you.
• 34:04
  And playing together means I delight in you. And that all of those things are exactly what a healthy parent would do with their baby. And so not to be afraid of those deeper connections or those deeper relationships because that is actually developing and healing attachment styles and those early experiences, that can even happen before the child is born. So it's actually a healthy and healing thing. And when it's done well and it's done safely, then that will lead to healthy independence as that person relationally develops in the same way that developmental and relational trauma impeded development.
• 34:52
  The healing will help create development. And that it will happen naturally. The other thing that he said that I wanted to share when he was talking about this piece and about how far back trauma can be that you may not even realize it counts as trauma because it's relational instead of developmental or physical or emotional or sexual or something, that it can happen not only just in utero before you're even born, but that epigenetically, which we actually do another podcast with this about it with Veronique Mead later, so you'll hear that. But epigenetically, in your code, in your DNA, it goes back five generations that the research now can see at a cellular level the trauma responses from five generations ago, even before your own stuff. That's huge, guys, especially those of us with intergenerational trauma.
• 36:02
  We're carrying that around. He said you can literally have flashbacks and dreams like nightmares about trauma that happened five generations ago. You can literally have trauma responses to things that happened to your ancestors five generations back. And he showed that research and talked about that as well. So I'll include those links on the blog also if I can get them directly from him.
• 36:32
  I saw the videos and I saw the science and I saw the articles, but I don't have them in my packet here. So I emailed him to ask for them, and if I get them, I'll put them up on the blog. But it was a fascinating thing about how really how far back it goes. And that again is another answer to some of those people who don't feel like that they have trauma, as well as understanding the heaviness of those of us who do. And also talks about and explains why it's so very, very hard to heal what looks like and should be such a simple thing, that it's really bigger than that and it really is that hard.
• 37:17
  The husband actually thought of an example of this in that his great great grandfather was a goat herder in Idaho. And one night they thought, the family thought, that they heard a thief so he and his son went out to stop the thief. They went around opposite ways around the house and the son, so the husband's great grandfather, ended up shooting and killing his dad on accident. And that trauma has been passed down in a way where the husband still feels like that sense of doing the right thing and doing his very best, but still failing anyway. And this theme really is an integral part of his depression.
• 38:09
  So a lot of his work he's done with the therapist with EMDR is not just about depression or about feeling safe or using coping skills, but processing different ways that theme has shown up with his parents or with him or in his family so that it can really, really be worked through, even in a way for his ancestors of healing this trait that keeps getting passed on because it's still unresolved from generations ago. Does that make sense? So it's kind of a big thing and kind of amazing that science now understands it. So I don't know if that's helpful to anyone or not, but it was really interesting. And there were a lot of layers that brought up a lot of stuff for us.
• 38:58
  Us as far as our own experiences with therapists in the past and in recent transitions. So it gave us a lot to think about, which we'll continue to share on the podcast later. But this was just a quick introduction training. There's actually, like, four more days of the training that we're not doing right now, but this just introduction was interesting, and we learned a lot. I don't know if it's helpful to anyone, but we'll put some more videos and links on the blog if you're interested in accelerated experiential dynamic psychotherapy.
• 39:34
  The trigger for us personally that came was that he spent so much time talking about the therapeutic relationship. Like there are other things that are part of AEDP as well, like the experience triangle or the triangle experiences and these four states that talk about where in the process you are with integrating your memories and your affect and your thoughts and all of these layers with your body as well. And I don't mean to butcher the whole thing by this very quick summary, but that's just the introduction part that we went over in this one day training. So ultimately, the reason the day was so hard is not because the content was so difficult, but because we had to kind of go through the process ourselves to do the workshop. And so it triggered a lot, but it was good because we sort of knew what the issues were, but the exercises we went through in the day helped us to feel those things, connect them to our body, and then go back through and look at them again with all of those pieces on board.
• 40:44
  And so it was like a small, small example of a very integrative process and we got to experience that in this one tiny context. So it was a really good thing, but it was really difficult work. So by the end of the day, we were just spent and done. Like it just ate us up and spit us out is how it felt like. And it was interesting to learn about that model of therapy.
• 41:11
  I don't know if I'll go back to the full workshop for how to do the whole entire process because I don't think that we really work in a way that conforms to any model well enough or consistently enough to make that worth our time, but it was interesting to learn how AEDP works and to kind of put those pieces together and through the practice of it, kind of put one of our pieces together. 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.systemsbeat.com. We'll see you there.