Latest / System Speak: Complex Trauma and Dissociation / Guest: Richard Chefetz, MD

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Guest: Richard Chefetz, MD · System Speak: Complex Trauma and Dissociation

• 0:00
  Speaker 1: Welcome to the System Speak podcast. If you would like to support our efforts at sharing our story, fighting stigma about dissociative identity disorder, and educating the community and the world about trauma, please go to our website at www.systemspeak.org, and there is a button for donations where you can offer a one time donation to support the podcast or become an ongoing subscriber. We so appreciate the support, the positive feedback, and you sharing our podcast with others. We are all learning together. Thank you.
• 1:15
  Speaker 2: We are excited to have as our guest today Richard Sheffetz, who is a psychiatrist in private practice in Washington, D. C. He was president of the International Society for the Study of Trauma and Dissociation from 02/2002 to 02/2003 and is a distinguished visiting lecturer at the William Allinson White Institute of Psychiatry, Psychoanalysis, and Psychology. He is a faculty member at the Washington School of Psychiatry, the Institute of Contemporary Psychotherapy and Psychoanalysts, and the Washington Center for Psychoanalysts. He's also the author of the book Intensive Psychotherapy for Persistent The Fear of Feeling Real.
• 2:05
  He's also the winner of the International Society for the Study of Trauma and Dissociation Pierre Genet Writing Award in 2015. More information about his book and his related links are included on the blog. We do have a trigger warning we want to share for this episode in that Doctor. Shafetz does use hypnosis in his practice and because we get lots of questions about that from listeners we asked him to explain a little bit about what that's like and we do talk about it some in this episode so just be aware of that if it's a sensitive issue for you you can skip that part of the podcast or go on to the next episode. As always, take care of yourself during and after listening to the podcast.
• 2:55
  Thank you.
• 2:59
  Speaker 1: Thank you so much for taking the time to talk to me today.
• 3:03
  Speaker 3: It's it's a pleasure, Emma. I know you do good work.
• 3:06
  Speaker 1: Oh, I appreciate that. That's very kind of you. If you want to go ahead and introduce yourself
• 3:14
  Speaker 3: My name is Richard Sheffetz, and I'm a psychiatrist in private practice in Washington, DC. I've been in practice as a psychiatrist since about 1992, and before that I was a family physician in rural Virginia, the Blue Ridge Mountains, and originally from New York. I'm primarily a psychotherapist even though was a psychiatrist, and most mostly do long term psychotherapy informed by hypnosis and EMDR and so on. My approach is mostly psychodynamic.
• 3:50
  Speaker 1: And our listeners may know you already from seeing you on many sides of Jane as well.
• 3:59
  Speaker 3: Yes. That's true. That was that was an interesting experience, and I've I've never met Jane. I got got I never talked with her, and I I did sort of get to meet her by watching.
• 4:11
  Speaker 1: That is it's such interesting dynamics trying to do the show, and I do know Jane, and she very much appreciated your comments and thought it was well done.
• 4:19
  Speaker 3: Oh, good.
• 4:20
  Speaker 1: I just wanted to help people connect dots for those who are still learning and connect names and and the different experiences you've had and sort of consults that you've done in a way of just consulting for the show a little bit. And I appreciated that they reached out to experts who knew what they were talking about as part of this show.
• 4:41
  Speaker 3: Yeah. People may wish to know that I've been for many years participating in the activities of the International Society for the Study of Trauma and Dissociation.
• 4:53
  Speaker 2: Yes.
• 4:54
  Speaker 3: And was president in I think 02/2023. And I was also the co director and administrative director for the Dissociative Disorder Psychotherapy Training Program, which was originally designed with Elizabeth Bowman, a psychiatrist who was in practice for many years in Indianapolis, Indiana, and also a past president of ISSTD. And I was with the training program for about eight or nine years, and it's still ongoing. And I think probably at this point, it's trained over 3,000 people.
• 5:30
  Speaker 1: That's amazing. I didn't know any of that.
• 5:33
  Speaker 3: Yeah, by the time I finished, we were at 2,000. It's been a bunch of years since then. The program includes modules now for children, adolescents, as well as adults. And it's been very satisfying to see the program go on. And some people may wish to know that I've written a bunch of articles, which
• 5:56
  Speaker 1: Yes.
• 5:56
  Speaker 3: A lot of a lot of people with my experience do and then I wrote a book that was published in 2015 by Norton and their interpersonal neurobiology series. And the book is called Intensive Psychotherapy for Persistent Dissociative Processes, the fear of feeling real.
• 6:16
  Speaker 1: Wow.
• 6:18
  Speaker 3: And the books been well received. And that's that's been a thrill for me. You never know what's going to happen when you write something, whether it'll be accepted, or not. And so as a 69 year old person, it's nice to have something that I know will be around even after I'm not around.
• 6:38
  Speaker 1: Part of your legacy.
• 6:40
  Speaker 3: Yeah. Yeah. Which which was a satisfying thought.
• 6:45
  Speaker 1: You've really contributed so much, and I'm so excited that we get to talk to you today. How did you start I mean, where did you first learn about dissociation, or how did you even get involved in all this?
• 6:57
  Speaker 3: Well, know, a way it would be true, although it's an odd thing to say dissociation got involved in
• 7:04
  Speaker 1: me. Right.
• 7:07
  Speaker 3: And dissociative disorders got involved in me just by happenstance because a lot of people have made a lot of contributions to this field. And I was fortunate in being able to move from family practice to psychiatry at Shepherd Pratt in Baltimore, where Richard Lowenstein had been doing work with dissociative disorder patients for a bunch of years. And lo and behold, when I got on my first unit treatment unit, my first two patients had dissociative identity disorder. And I thought, well, that's kind of odd. I thought that was like rare.
• 7:52
  And then my third patient had DID. Then I had person to treat who was schizophrenic, and then my fifth, sixth and seventh patients had DID. So it was sort of sink or swim, and I actually very grateful, especially to my first two patients, who one of them confided in me after I had been working with them for a couple of months. And I had been on call the night before. And she said, I don't understand why you kept your appointment today with me.
• 8:28
  And I said, well, we had an appointment. And she said, well, but you know, a lot of the other residents when they've been on call the night before and they're tired, they go home early. But you didn't. Why didn't you do that? I said, well, we had an appointment and I won't die from being tired and I know you're counting on me, so you know, I'm here.
• 8:52
  And she said, that's what I told my buddy And she said, well, check it out. And if it's true, then let's help him. And that was the beginning of a tutorial of sorts, and a very open treatment that was wonderful. She was basically saying, okay, if you're gonna make a commitment to really be on my side and really treat me, then I'm not gonna throw up roadblocks. It's like the treatment, I'm gonna join you.
• 9:22
  So it it was a wonderful year of working with her, and I continued working with her after my year on the unit, and she was discharged. And I saw her as an outpatient for a bunch of years after that.
• 9:33
  Speaker 1: What a profound gift of presents you gave.
• 9:37
  Speaker 3: Well, I showed up.
• 9:38
  Speaker 1: Exactly.
• 9:40
  Speaker 3: Yeah. It can be hard to do. I mean, people who come to treatment are often terrified, and just showing up in the room is is an enormous victory. And and, you know, therapists get frightened also by the things they hear and have to tolerate that and continue to show up and to lean in and engage. And so it's challenging for everybody.
• 10:07
  Speaker 1: It's it's an intense experience for sure.
• 10:11
  Speaker 3: Yeah. Yeah. There aren't really words to talk about the intensity. It's just I I don't think there's anything else like it. I'm not sure.
• 10:22
  If anyone had tried to explain to me how intense it would be, I would have said, well, yeah, okay, maybe. But it's it's it's really a profound experience and one that's deeply moving.
• 10:34
  Speaker 1: How did you take that learning curve and learn more about DID all the way through your path of than becoming president of ISSTD? That's such a journey.
• 10:48
  Speaker 3: Well, it it is, you know, and I it's around November or December of that first year, and that's the time of year now. One of the other residents who was also what we called a retread because he had had a different career in his life. He was actually a couple of years older than I was. I was about 40 at the time and he took me aside and he said, Rich, I'm taking you out to lunch. I said, Wendell, that's ridiculous.
• 11:16
  I have too much work. I can't possibly go out to lunch. It's this. It's very kind of you, but I I just can't do it. And he said to me in great seriousness, he said, no, you don't understand.
• 11:26
  I'm taking you out to lunch. You don't have a choice. You have to go to lunch with me. And I thought, okay, that sounds serious. And it was then that he sat me down and said, look, if you keep on working as hard as you're working, you're gonna burn out.
• 11:45
  I've seen that with other residents. You have to slow down, know, you you have to get your footing and I know you're taking this very seriously, but you know, wake up, you can't you can't keep up like this. So, you know, he he woke me up to the risks of becoming so absorbed in the work that you might end up not really not being able to function well. And so that was the beginning of learning how to pace myself, which was a new concept, and things kind had a life of their own. I mean, you know, if you apply yourself and you read and you're reasonably articulate and not afraid to speak up, then you learn a whole lot.
• 12:34
  So I learned a lot and you know I had great teachers. Wonderful supervisors at Shepherd Pratt. Lowenstein was fabulous. My last year there there was illness in his family and he couldn't be at the hospital, so I did his consultations. Wow, and so I met fifty, sixty, 70 people with dissociative disorders, some not, but I did a lot of consultations and then he would come in at the end of the week and we'd review the consults.
• 13:04
  It was an incredible opportunity to learn and it was life life changing for me.
• 13:11
  Speaker 1: What a mentorship that must have been.
• 13:13
  Speaker 3: Yeah. Was very cool. It was it was very cool.
• 13:16
  Speaker 1: And you you through your experience and these connections that just developed naturally through your career, there's this network of just now in hindsight incredible people that I don't forgotten and I want people to understand how they're all connected together in brilliant ways, what they've done for this field and for survivors. And so I'm so glad you're talking to us. Thank you.
• 13:45
  Speaker 3: Yeah. You're very welcome. You know people extend themselves when they see someone who's interested, and I try to do that for people new to the field. Now, you know one of the things that happened toward the end of my first year at Shepherd, I started reading literature about the use of hypnosis in the treatment of DID, and I asked around and no one at Shepard did hypnosis clinically. So I I forget who it was I talked with, but I learned that the current editor at that time of the American Society of Clinical Hypnosis, the American Journal of Clinical Hypnosis was a psychiatrist down at the University of Maryland, Downtown Baltimore.
• 14:24
  So I called him up and I made an appointment. I went to see him and asked him to teach me how to do hypnosis. And I said, so who do we practice on? And Thurman Mott, Thurman looked at me and he said, Well, we'll start with you, Rich.
• 14:41
  Speaker 1: That's amazing.
• 14:43
  Speaker 3: I said, well, I can't be hypnotized and he said, well, you know, let's let's see. Maybe maybe you can. You probably have some hypnotic capacity, so let's test that out and then you'll have your own experience that you'll be able to understand your patients a little bit better. And about five minutes later, hand was floating up in the air and I was looking at it like it was about onetwo mile away. And I had my first hypnotic experience that was intentional.
• 15:09
  So hypnosis has been essential in my practice. Not for the things that people usually attribute, which is, you know, searching through the past and so so on, but more so for teaching people how to regulate thoughts and feelings, especially feelings.
• 15:27
  Speaker 1: So I actually love this about your work and I've seen you talk about this before. But before I ask you about that, let me back up to how do you describe dissociation or define it for people when you're working with them or even to other colleagues who maybe don't really understand it?
• 15:47
  Speaker 3: Well, I sort of listen to my own drummer in that regard. My approach is a little bit different on a theoretical level. My my take Emma is that dissociative processes are like associative processes. That that it's paired with association in the following way. So like we we all understand that to associate something is to connect it with something else, and associative processes pull together things that are relevant, and then we make a coherent story in our mind, and then we create a narrative and we speak about it.
• 16:30
  So we have an associative experience, but it's also true that there are things we come across as we're trying to sort out reality that are not relevant to making something coherent. It's just sort of the the trash that shows up on the playing field or. You know the notion of of wheat grains and chafe and so on. You have to get rid of and prune the things that are not relevant to what's going on. That's that's a dissociative process that unplugs, disconnects, removes things from awareness that aren't necessary to provide salience.
• 17:09
  So there are these two processes intention, and if you have associative processes working nicely in tandem with dissociative processes, then you can sort through things and link them up and create a coherent narrative. So that's that's when dissociative and associative processes are working properly. But with experience that's overwhelming, experience that outstrips our ability to tolerate the emotional tension or the reality of something like ing of the Twin Towers in New York on nineeleven. Dissociation can go into overdrive and persist rather than just doing normal pruning. And when that happens, when dissociative process ramps up.
• 18:03
  And especially when it persists, then we start losing data that would be useful to understand what's going on. The problem being that. While it'd be useful, it would also overwhelm us. So dissociative process is merciful. And at the beginning when it saves us from the impact of a traumatic event.
• 18:24
  But then it becomes a problem when it won't let go. It continues to save us from trouble, but depriving us of our ability to know what's real, or even to feel real if the perceptions that are pruned have to do with being able to sense our own body to know what we feel, and so on. So dissociation then becomes a thief, and rather than it being a fortress where we can hunker down and just get through a trauma, if it doesn't let go, then the fortress becomes a prison And becomes a real problem. So that's that's a different kind of view than talking about dissociation as pathological. And one of the things that happens with dissociative process is that when it persists, and we have recurrent similar experiences, then we tend to anticipate experience along the lines of dissociative experience and the normal organization of mind, which Frank Putnam recently wrote about elegantly in talking about states of being in his his 2016 book called The Way We Are.
• 19:42
  States of being tend to organize and glom together in the context of lived experience, and they organize into aspects of self, self states that have enduring qualities. So those those self states become the focal point of dissociative process when when there's been trauma.
• 20:12
  Speaker 1: Can I ask a question about that?
• 20:14
  Speaker 3: Sure.
• 20:14
  Speaker 1: I I know I'm interrupting and I'm sorry. I don't want you to lose your train of thought and I don't mean to be disrespectful. But as you're explaining that, I'm trying to keep that framework you said in the beginning about associating and dissociating.
• 20:28
  Speaker 3: Right.
• 20:29
  Speaker 1: And so when you're talking about these self states, what came to my mind was if because of the dissociative processes happening and then these self states developing, is that part of, like, how those become more solidified? Because then the self states are there and things get associated to them.
• 20:53
  Speaker 3: I think that's very astute, Emma. I think that does happen. It's speculative. I mean, all this is speculative because we're not there when something's happening, but we don't have the opportunity to really see these things emerge most of the time. And everybody has self states, not just people with dissociative disorders.
• 21:16
  And that's one of the things that's very, very important about, at least for me, the way I think about a human mind is the human mind is a conglomerate to collection of self states. And people who have a nice balance between associative and dissociative processes have a free flow of knowledge and feeling between one state and another, and can move from one context to another without difficulty, and maintain their memory for what went on and have a full feeling life and so on. When there's a associative process, the self states become isolated, and they wall off, they wall off. So, I mean, a typical thing that someone experiences in DID is to begin to come become conscious for the presence of self state, but also to have a sense of that that's not me. I I don't do things like that.
• 22:10
  I don't say things like that. I don't feel that way. I don't behave that way. That that's not me. And so the not me position in reference to self states is pretty much typical of identity alteration.
• 22:26
  So everyone has self states and people with dissociative disorders have isolated self states. And that's a blessing when there's trauma, and it's a kind of burden, sometimes a big burden when the trauma is stopped, and we're trying to live our lives, but we don't have access to big chunks of our mind.
• 22:45
  Speaker 1: You've given me a whole different framework to think about it.
• 22:48
  Speaker 3: Well, there's a lot of different ways to think about dissociation.
• 22:51
  Speaker 1: Yes.
• 22:53
  Speaker 3: And, you know, much of the world thinks about dissociation simply as detachment. And there's another chunk of the theoretical world that thinks about it as compartmentalization. But you know, the French Canadian colleague of mine once said conversation we were having about Freud's idea of ego. That ego sometimes refers to organizing principle, and that sometimes Freud used ego to refer to a sense of self. And I said, yeah, we ought to figure out which way it is and then just stick with that.
• 23:25
  And she said, that's the trouble with you Americans. You always want it one way or another. Why just can't you accept that sometimes things are both? And I thought, okay, Louise, you got me. But but the the thing is that theoretically, we tend to become very fond of our own theories at the expense of other theories that have utility.
• 23:48
  And so there's a lot of different theories that have utility, and I use all of them when they fit. But I tend to lean on the things that I was explaining to you because it's just conversational sense, and it just makes sense. And and there's not a whole lot of theory language in what I was talking about. So I like I like it a lot for that quality. I don't like technical terms when it comes to talking about being human.
• 24:17
  Speaker 1: I I think that's just one piece that's so fascinating is how the way that your perspective that you shared sort of normalizes it. But then also, the piece that really got me was that associating piece because just at least for me, I've not been able to understand. Like, I can understand, okay, trauma was a hard piece, and because of that, there was this dissociating to deal with it, but then I don't understand how like, time is so fluid to me in my own head still, And so it's hard for me to understand how something that was supposed to be a long time ago can feel so present and how, quote, quote, someone who dealt with that peace can be so developed into something else. But when you when you at least gave me the language, if nothing else, the language to express that this piece, not even necessarily a part, but this piece of the past or whatever, even parts as well, became this and sort of evolved like this because that piece got associated and that piece got associated. It answers that for me somehow internally and bridges a gap that I didn't understand.
• 25:35
  But, also, in the same way, it answers a question that I had about healing and about getting better because just undoing something in the past, which we can't change the past, but undoing the understanding or redoing the experience of it, like talking through it isn't always what makes a difference. Sometimes what makes a difference is that connection, like the presence that you offered that first client that you shared about. Right. If that's part of what gets attached to that and I don't mean attachment, but but that associating. I don't even have words to express it well, but you've helped me understand something that I can't yet verbalize.
• 26:17
  Speaker 3: Well, in in your articulation of what you are understanding, you've given me a gift because I've thought about something in regard to the fluidity of time that you mentioned that I haven't thought about before. And so I'll share that with you. Maybe it'll use be useful to you. And here here's the idea. You know, we have one head as human beings, but in some ways, have two or more brains and when it comes to cerebral cortex and most people know, I'm sure you do, that the right brain tends to do things that are without a time and date stamp and have more to do with emotion and flow and music and dance and movement and stuff like that.
• 27:01
  And the left brain does things that are more logical, language bound, mathematical, and time related. So I was thinking as you were talking, does that have something to do with what Emma is saying? And so here here's the thing that you gave me. I was thinking that time as a left brain thing is dangerous, in the sense that it provides coherence about the sequence of events, some of which are traumatic. So if you get rid of time, then it's hard to know the sequence of things.
• 27:41
  And then anticipating what's going to happen next, of becomes not relevant. But in healing, one of the things that occurs is there's less confusion about threats. In other words, the dangerousness becomes located as something that occurred in the past rather than in the present. And when there's less fear, I think it's easier to have a sense of time, because it's less threatening. Time provides a kind of coherence that's unique, just like knowing feeling provides context and meaning for experience.
• 28:28
  Time helps to create a coherent narrative by creating a beginning, a middle and an end. And without that experience is less discernible. And that's of value, if not knowing what happened is really important. But in healing, knowing what happened is very important. And so time slowly is restored as a quality that people experience, as there's less fear in their mind, and as they heal.
• 28:58
  And I haven't put it together quite in that way, although it's something that's not, you know, astonishing. But saying it like that, I think makes a lot of sense.
• 29:08
  Speaker 1: I think it's brilliant. I I mean, brilliant in in, like, an authentic of the experience way. It's an authentic expression of the experience. Going back to what you were sharing earlier when you were talking about learning hypnosis and using it or utilizing it differently in trauma treatment or with dissociative patients, you were talking about using it with feelings? Do you mean like containment or or what are you talking about there?
• 29:37
  Speaker 3: Well, containment is a psychoanalytic term. There's containment and there's holding, which are two terms that have to do with the frame of a treatment. And containment is about feelings and holding is about the sort of nuts and bolts of treatment like starting and stopping on time and providing proper billing and so on and so forth. And containment is a really big deal. Containment sometimes occurs by example, where the clinician is able to tolerate their feelings, and it's sort of obvious to the patient as they're sitting with their therapist.
• 30:15
  And hypnosis is a way to be absorbed in a given moment. Absorption is one of the qualities of the essence of hypnosis. And being able to tune into feelings and tolerate feelings and know about feelings is not easy. So, yeah, hypnosis can be a tool through which people can learn to contain their feelings and not be overwhelmed by them.
• 30:47
  Speaker 1: If a survivor wanted to learn more about what hypnosis is like in a session, what would you tell them?
• 30:54
  Speaker 3: Yeah, well, what what I I tend to joke about hypnosis when I teach about it as an introduction. And when I'm when I'm lecturing in a room full of people, like I was a week or so ago up in Boston, I'll say, I wear glasses. Okay, so I'll look around the room and I'll say, okay, look, you're wearing glasses. Right? But you weren't aware you were wearing glasses until I mentioned that you're wearing glasses.
• 31:21
  But of course, you know, you're wearing glasses. You wear glasses all the time. Right? But where was your perception of you're wearing glasses? Where did it go?
• 31:31
  And, you know, that's both dissociative process, pruning perception, and hypnotic absorption in the sense that you're absorbed and focusing your attention on the speaker. And so your peripheral knowing about things that are of no consequence disappears. And a lot of hypnotic quality is about absorbing and focusing attention. So hypnosis is about having a wide open view of the world like, if it's okay to think about a beach, then a person sitting on a beach and feeling the sun's rays on their body just warming their skin and looking at the little puffball clouds of white up in the sky and hearing the sound of the waves and all that kind of thing. And absorbing one's attention in that means that consciousness shifts, because consciousness is not limitless.
• 32:41
  We don't usually talk about consciousness and its limits, but consciousness has limits. It's like a tabletop, you can only put so much stuff on there. And if you start if it starts getting crowded, then things fall off the tabletop, they get lost. With hypnosis, the hypnotic metaphors occupy more and more space on the tabletop until there really isn't room for anything else. And that's that's part of of how it works.
• 33:09
  It's the focused attention and absorption is a big part of hypnosis. Just like suggestion is, and post hypnotic suggestion, and these are things that are part of the essence of hypnosis that Martin Orne described back I think in the nineteen fifties, maybe '58, '50 '9, something like that. So hypno hypnosis can be used to focus attention in a way that stops panic attacks. It's it's it's the best thing since sliced bread, Emma. If someone is fortunate enough to have a panic attack when they're sitting with me, even in the first session, and I asked them, would you like me to help you stop your panic attack right now?
• 33:52
  And they say, well, yeah. And I say, Well, okay, just do exactly what I say. And then I asked them to focus their attention. I hold my fingers up high above their field of view. And then I will introduce them to hypnosis and their panic attack stops like on a dime.
• 34:12
  It's really cool.
• 34:13
  Speaker 1: That's amazing.
• 34:14
  Speaker 3: I didn't believe stuff like that when I heard about it at first. And then I did it. And it's like, Oh, okay. That wasn't that hard. And then you can teach people self hypnosis, and then they stop their panic attacks on their own.
• 34:30
  And what could be better than that to have, you know, you you come in for an hour and you leave and you've got a tool where you can stop your panic attacks. It's not that I don't do the cognitive therapy about educating about adrenaline, rapid heart rate and all that stuff. But that's really secondary to their sense of empowerment, because they have this cool tool that they can take with them. And out of that kind of experience rose the capacity to dial perception down to create focused absorption in the service of reducing emotional reactivity when somebody gets upset. And people can learn how to deal with insomnia using hypnosis.
• 35:15
  Did you know that hypnotic states are states that are associated with increased immune competence?
• 35:22
  Speaker 1: That's amazing. I didn't know that.
• 35:24
  Speaker 3: Yeah, and the treatment of HIV aids, killer T cell activity increases with hypnosis. That's kind of cool. And you can treat warts with hypnosis by increasing immune competence and warts just sort of fall off. They just go away after a couple of weeks, so
• 35:45
  Speaker 1: That's crazy.
• 35:46
  Speaker 3: Well, thought that was crazy. How could hypnosis get rid of a wart? But by increasing immune competence, the warts kind of go away because they get established because they have a kind of beachhead where the body doesn't realize they're kind of there. And I thought that was nuts when I first heard it. How could that be possible?
• 36:08
  But it makes sense once you realize that you can influence immune activity by using hypnosis.
• 36:15
  Speaker 1: How would a clinician learn more about getting training for that?
• 36:19
  Speaker 3: Well, there are three really important organizations. There's the International Society of Hypnosis, which is really worldwide. There's the Society of Clinical Experimental Hypnosis, which also has worldwide membership. And in The US, there's the American Society of Clinical Hypnosis. I know in Australia, there are Australian societies of clinical hypnosis.
• 36:49
  And those organizations are thoughtful and pay attention to ethics properly. Hypnosis is a medical tool. It should not be used on a stage, you know, like stage hypnosis. In Britain, in England, in The UK, Hypnosis is a medical procedure officially, and stage hypnosis is not allowed, which I think is terrific.
• 37:19
  Speaker 1: That sounds really good.
• 37:21
  Speaker 3: So any of those organizations do trainings, and especially the American Society of Clinical Hypnosis, which I'm very fond of and a member of for many years, has very organized systematic training and hierarchy of learning for people to become consultants and teachers and so on. And they have they all have websites. So anybody can look up hypnosis training in their area, and clinicians can learn. It's three weekend thing really to get people really up to speed. And you can do that in a year.
• 38:02
  Plus, people who use hypnosis as a rule and are willing to teach it are some of the nicest people I've ever met. So the weekends are generally a real pleasure. They're they're a lot of fun.
• 38:17
  Speaker 1: I have to say that I have been amazed at the response of this is not the hypnosis group, but with the ISSTD since sort of coming out to the ISSTD on on the listserv and, the ISSTD one and the forums, I guess, and the kindness that people have shown and the respect that they've given this tiny little project that we're trying to do that's turned into such a big thing and our own healing process and just the welcome that we've received has been incredible. I was shocked. I was shocked. I had no idea that it would be such a positive experience. And you sharing about that group being so nice and authentic in that way, It that's what it reminds me of.
• 39:13
  Speaker 3: Yeah. Well, I'm with you 100%. I've been part of ISSTD since like, I don't know, nineteen ninety three, four or something like that, maybe earlier. And it is a group like that. People are tremendously caring.
• 39:29
  And, you know, you can't do this work alone, Emma. Yeah, there's so much that goes on that's so curious, odd, different, overwhelming, exhausting, interesting, fascinating. And what one mind isn't enough to be able to take all this stuff in. So you really need your colleagues to be able to talk about your experience and what's going on just to sort of remain coherent yourself. True.
• 40:00
  Which reminds me for clinicians listening, if you feel isolated, then you know, find a group that you can be part of, but especially reach out to your colleagues and meet for peer consultation and supervision. I've been doing that in my office since 1998. And every month on a Wednesday for an hour and a half, a bunch of senior people in town come in and we sit down and talk. And it's it's marvelous. It's really sustaining, and it's it's really important.
• 40:34
  Speaker 1: What an opportunity for attunement for yourselves to have each other and to connect and have that support.
• 40:41
  Speaker 3: Yep. Absolutely.
• 40:43
  Speaker 1: Is there anything else about dissociation or DID that you would want to share or insights that you have?
• 40:52
  Speaker 3: Well, couple of things. One of the things I'd want to say for sure is that people can be helped. It's it can be so confusing, and there can be so much misdiagnosis before someone finally gets to the place where they understand they have a dissociative disorder, but people can be helped. We have what we need in terms of psychotherapy methods, and appreciation of how mind is when it's been traumatized. And help is available.
• 41:27
  So I you know, if if there's any doubt in anybody's mind who's listening, then please put that aside. It's not easy, but people can be helped. So that's I think that's that's super important. And another thing that I think is is super important is that people often experience enormous conflicts between different ways of being themselves. The language I use to talk about what other people call alters or parts or self states.
• 42:03
  It's all interchangeable. I like different ways of being you as a sort of humanizing conversational way to talk about differences between different ways of being me or different ways of being you. And and but people get in conflict between these different self states and and often the conflicts are are are really powerful and feel sometimes life threatening in song. But I want everyone to understand that those conflicts occur because of the desperation that exists in the service of efforts for self protection, which sometimes go a bit awry. And the intent for self protection can sometimes create the sense of using methods that are extreme, but always the interest is in is is in self protection, like reducing emotional turmoil or reducing or eliminating the occurrence of somatic flashbacks, which are a big problem clinically that people have terrible time with.
• 43:13
  So for people listening who have DID and experience tremendous conflict inside, remember that the the conflicts aren't intending to to hurt. I mean, sometimes they do hurt anyhow, but the the intention is to protect, and it's important to appreciate that. And and somebody listening may say, yeah. But I have this part of me who keeps on threatening me and telling me they're going to kill me and so on and so forth, and my clinical experience is the same for aspects of self parts of self who make those threats. The threats are really in the service of self protection, and and my job is to figure out what the logic is for that part of self that they're making those threats and why they're doing it, and how how to understand where the protective aspect and nature of the threat comes from, and why it's there in the first place.
• 44:17
  So those are couple things that come to mind immediately that I think are important for people to know about in general. They're a little bit different one from the other, but in one one other thing that dissociative disorders are in a lot of ways primarily a disorder of emotion regulation. And what happens to people when we're overwhelmed? We usually don't think of dissociative disorders having to do with a failure. A failure of associative processes, but that happened.
• 44:53
  You know about the theory behind assimilation and accommodation? Well, assimilation is where you just sort of take into your thoughts and experience that you're having because it's it's a match for other experiences that you've had. You can assimilate it easily into the things that seem like everyday experiences. And then there's accommodation. And that's where you have an experience that's just sort of like pushing the envelope about what I can tolerate knowing about because that's it's just feels like really on the edge.
• 45:31
  Trauma, very much so is where assimilation and accommodation fail. You can't associate your experience with something from the past. And it's so outstrips, and so strips your gears and trying to figure out how to understand what's going on, that associative processes fail. And in a lot of ways, that's what kicks dissociative processes into overdrive. So that's an additional way of understanding what happens and the assimilation accommodation fail because of emotional overload.
• 46:10
  Primarily fear, but not always. Sometimes it's the terrible pain of profound shame or humiliation. But either way, it's emotional overload. So a focus on emotion and emotion focused psychotherapy is very important in the treatment of DID. Cognitive therapies alone aren't adequate, and some CBT which is third wave CBT that pays attention to emotion can be extremely helpful.
• 46:44
  And CBT in general can be helpful to a point, but CBT without any focus at all on the emotional life of a person is not going to be an adequate treatment alone for dissociative disorder. We've really been going far and wide in our discussion. It's been very interesting.
• 47:01
  Speaker 1: I'm going to have to listen and re listen and re listen to that last bit. There was so much in there that I had not at all put together with DID and or the dissociative process. And, again, putting that framework with what you gave me at the beginning, I really feel like I learned a lot, and I'm gonna have to process that for a little while.
• 47:25
  Speaker 3: Oh, cool.
• 47:26
  Speaker 1: That that was really good. So we'll continue talking about that on the podcast as as that kinda gets processed, but I really appreciate it. Thank you so much.
• 47:36
  Speaker 3: Oh, it's my pleasure, Emma. And thank thank you for doing the work you're doing, and you're really making a contribution to the lives of many people, and and that's great.
• 47:48
  Speaker 1: I I I am I'm grateful for people's positive reception and their support. I had no idea that this is what it was going to turn into, and I I'm grateful that it has been something that's helpful.
• 48:04
  Speaker 3: Yeah. Well, you have an inquiring mind, and you're very articulate and behind your questions is is a lot of energy and intellect. So it's very cool being asked questions by you. Thank you.
• 48:21
  Speaker 1: Well, thank you so much.
• 48:23
  Speaker 3: You're welcome. Thank you.
• 48:25
  Speaker 1: Sure. Thank you for your time today.
• 48:26
  Speaker 3: You're welcome, Emma. Thank you. It's a pleasure.
• 48:44
  Speaker 1: Thank you for joining us with System Speak, a podcast about dissociative identity disorder. You can listen to the podcast on Spotify, Google Play, and iTunes, or follow along on our website, www.systemspeak.org. Thanks for listening.