Latest / System Speak: Complex Trauma and Dissociation / Guest: Shelly Itzkowitz

Transcript

Guest: Shelly Itzkowitz · 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, finding stigma about dissociative identity disorder, and educating the community and the world about trauma and dissociation, Please go to our website at www.systemspeak.org, where there is a button for donations, and you can offer a one time donation to support the podcast or become an ongoing subscriber. You can also support us on Patreon for early access to updates and what's unfolding for us. Simply search for Emma Sunshine on Patreon. We appreciate the support, the positive feedback, and you sharing our podcast with others.
• 1:05
  Doctor Shelly Itzkowitz is an adjunct associate professor of psychology and clinical consultant at the NYU post doctoral program in psychotherapy and psychoanalysts, guest faculty, the eating disorders compulsions and addictions program, the William Allen White Institute. He's on the teaching and supervisory faculty of the National Institute for the Psychotherapies and the trauma studies program of the Manhattan Institute for Psychoanalysts. He is an honorary member of the William Allen White Society, a fellow and member of the board of directors of the International Society for the Study of Trauma and Dissociation. Doctor Itzkowitz has published several articles on the topics of trauma dissociation and DID and has presented his work on dissociation and dissociative identity disorder, both nationally and internationally. He and Elizabeth Howell have a chapter, The Unconscionable and the Unconscious, The Evolution of Relationality in the Treatment of Trauma, appearing in the recently published volume, Dissociation and the Dissociative Disorders, Past, Present, and Future, the second edition of The Brick from Paul Dell and John O'Neil.
• 2:17
  They are co editors of their recently published book, Psychoanalysts, Psychologists, and Psychiatrists Discuss Psychopathy and Human Evil, which received the twenty twenty one media award written by ISSTD. They have also co edited the Dissociative Mind and Psychoanalyst, Understanding and Working with Trauma, which received the 2,016 media award written by ISSTD. Doctor Itzkowitz received the lifetime achievement award from ISSTD. He is in full time private practice in Manhattan, working with both individuals and couples, and provides consultation individually and in groups. Welcome, doctor Shelly Itzkowitz.
• 2:59
  Well, I am excited to have you today. Do you want to introduce yourself just so that people can orient to your voice?
• 3:08
  Speaker 2: Sure. Hi. I'm Shelley Atzkowitz. I'm a psychologist living in New York City, and I practice psychotherapy and psychoanalysis. And my office is in Manhattan.
• 3:21
  Speaker 1: I am so excited to talk to you today. I have had the most fun adventures with you in meetings and and office work with the ISSTD, and, it has just been good to get to know you over the years. How I wanna start at the beginning. How did you even learn about trauma and dissociation, or where did that journey start for you?
• 3:52
  Speaker 2: Okay. Well, let's go back to 1968. I think that's the year. I took my first psychology course, and oh, I'm sorry. No.
• 4:04
  I'm mistaken. I did take my first psychology course in 1968, but the event that I'm thinking about was in 1970, and that was my first, of course, in abnormal psychology. And, when we got to dis well, with multiple personality disorder
• 4:22
  Speaker 1: Right.
• 4:23
  Speaker 2: The book, talked about how rare it is and only a few cases, maybe a century. So that that always caught caught my attention, and I was always interested in that. And, of course, you know, you could you see these things on TV that don't accurately portray, multiple personality disorder or dissociative identity disorder, but, nevertheless, they were fascinating. And I have twenty years of experience working on inpatient units, locked inpatient units with the most seriously disturbed, people. And they're just filled with trauma.
• 5:12
  Trauma is not unknown to me from my background. My father's entire family was killed in the holocaust, and so that that end association was part of my upbringing. And in 1993, I was a supervising psychologist at a hospital here in New York City, And the unit chief approached me and said I have a patient, that you might be interested in working with, and I was very surprised to hear this because I don't normally take people right out of inpatient units. That's just not the kind of practice that I have. And, and when he told me she had multiple personality disorder, I said, please send her to my office.
• 6:00
  And this is what really got me started. I spent two or two and a half hours in my initial consultation with her. It was incredibly moving. And, of course, I was naive at the time thinking that, wow, I have a a rare situation on my hands, and I'm gonna get to see something that most people don't get to see. Little did I know in 1993.
• 6:25
  And at the end of the the consultation, I said to her, if you're looking for an expert in multiple personality disorder, I'm not the guy, but I'll help you find someone. And she looked at me and sweetly said, no. I don't need an expert in in multiple personality disorder. What I need is a sensitive therapist. I'll teach you the rest.
• 6:52
  That was a quote. And that's what got me started.
• 6:59
  Speaker 1: That is so powerful, and I think it's so true. It's it's such a relational experience. And and for many of us with developmental trauma, that aspect is such a key component to healing. Like, no matter what models or techniques you have, if you don't have that, it's not going to work all the way. And so what insight that that person had and what a gift your sensitivity has been in that way, I just wanna thank you.
• 7:30
  Speaker 2: This has been quite an experience for me. And quite honestly, Emma, this is the most meaningful work I've ever done in my career, working with people who are suffering with DID. Oh, my goodness. Clear to me almost immediately.
• 7:50
  Speaker 1: Can I can I ask a question about what you said about your childhood, or is that too personal?
• 7:56
  Speaker 2: Nope. You can ask.
• 7:58
  Speaker 1: You you mentioned your father's your whole father's family dying in the holocaust. Mhmm. How how was that story shared with you growing up? What was your experience of that awareness and as you were growing up?
• 8:21
  Speaker 2: Well, two different two two things, two ways to answer the question. I was born shortly after World War two. So I'm one of those one of those folks, a baby boomer. And I had a significant experience with antisemitism in the neighborhoods that I grew up in. And, I was also sent to religious training, and they have they're, they the the torture of Jewish people is heavily emphasized, historically that is.
• 9:05
  So that's one kind of trauma. But but the trauma you're talking about is my father having lost his mother, his sisters, their children, and his brother. My father actually never told me about that. The person who told me about that and explained it to me was my mom. And this is what I'm talking about in terms of dissociation, personal dissociation.
• 9:32
  My father really, hardly ever spoke about this. And if he ever did, it was with no emotions attached to it. So in in a way, by experience growing up and knowing that it happened to to his family and other family members of ours, but not really being able to speak it, that that I think created some intergenerational transmission of trauma, or at least it helped to do that. And quite frankly, it wasn't until fairly recently, talking with a friend of mine whose father was a concentration camp survivor, he's a psychologist as well, I suddenly realized I never knew the names. I was lying in bed one night, and it suddenly dawned on me.
• 10:35
  I didn't know the names of my aunts and cousins, uncles and and grandmother. My father never spoke of that. And clearly, this is something that's been lingering in inside of me. And, I don't think about it that often, but when I do, it's it's very powerful, very meaningful to me. In fact, I named my son after my father's brother, who died in the holocaust, and I had a call in my father was deceased when my son was born.
• 11:15
  So I had to call an uncle to find out what another uncle to find out what my father's brother's name was, and I learned some things about him that was really meaningful for me.
• 11:29
  Speaker 1: I'm crying. I'm sorry that that is that is so powerful and intense, and I think it's an example of, we think these things were so long ago and they were not, and that the trauma did not just end when the war finished. It shows up in so many ways.
• 11:52
  Speaker 2: Yeah. The unfortunate thing is it doesn't feel to me like human beings are learning from history and experience. It this is a human tragedy.
• 12:06
  Speaker 1: I, just this last weekend, took my children to an holocaust exhibit that was at the local library, and we walked through that. I, I I wanted to show them, but this particular exhibit was interesting, different than other ones that I have taken them to before because it was focused specifically on the Holocaust experience in America. And so it talked about things like what you just said about how, like, are we learning from this experience and how in how complicit we were for so long before we did anything and talked about, 20,000 refugee children we could have rescued but voted not to. And, the the the boycott of the Olympics and wanting to make that statement. But also at the same time, we had African American runners and and people of color that were like, you you you can boycott this, but also what you're doing it to us because it was still doing segregation.
• 13:31
  And and my children are all adopted, and, my my all three of my daughters are biracial. And so it really connected with them in a different way from just when we read books together or watched movies together or traveled to see different things in museums and tried to impart this or to help them understand it it landed differently this time. And they are they're all 14 and under, and so their very earliest memories of of politics are the change from Obama to Trump and then the experiences that they witnessed. We lived in Kansas City during Black Lives Matters and the protests, and so they could see that the protests outside our window and and heard that and watched that and lived through that and then were at different times targeted, during the during those resulting politics after that because we lived in a very conservative area where people were pretty aggressive and and said mean things and did mean things, and they experienced that on such a small, small scale. So for this to connect to them and understanding better as they grow up the implications of that and learning from that was a very different experience for them than just reading about it in the past has been.
• 15:13
  Speaker 2: I I mean, we as a species, we have this incredible ability to be compassionate and empathic. And at the worst times, the best of us can come out and and wanna help and save people. But at the same time, our species is just horrendous at what we do to each other, how we humiliate, shame each other. Kill each other, like the situation that's going I mean, there are many situations going on in the world in Sudan right now and, Russia's attack on Ukraine, what's happening in our own country, the the refusal to acknowledge gun violence. Well, although what I mean by that is people really want some limits placed on guns, but somehow the people who have we've elected to represent us don't seem to listen.
• 16:15
  The same could be said about abortion. We don't we don't listen carefully enough to each other.
• 16:24
  Speaker 1: I it's interesting you brought that piece up. I had a client this week who was pregnant and had a and she and her husband were very happy to be pregnant. And, she had a medical complication. And in the state where we live, it they could not treat her even even though it was not that kind of abortion or even though it was not that choice. They had to drive seven hours, and she almost died.
• 17:00
  And it was the first time that I had a case like that, like, directly, not just the philosophical argument or or things like that. It was really, really scary, and she is still very sick and in the hospital and has not awakened yet. I don't know if she's gonna make it. And, the the whole maternity ward in the town where we live, like, the entire unit has closed. And, like, I don't know where those women are going who who are just having healthy babies or healthy pregnancies.
• 17:34
  It's it's so many questions of
• 17:36
  Speaker 2: Yeah.
• 17:38
  Speaker 1: Why is it we are trading care for hate?
• 17:42
  Speaker 2: Right. Yes. And, it's very misogynistic. In the forty years that I've been in practice, forty plus years, I've had a a couple of women or a few women that have had to undergo abortions. And what people don't seem to understand is this is not a pleasant experience.
• 18:02
  People don't necessarily want to have to do this. It and it has profound emotional consequences for the woman when she needs to terminate her pregnancy. Whether she became pregnant purposefully or accidentally, this is not something that's an easy road for a woman to walk down. Dentitians don't don't act like they they don't act that. They don't know this, and they don't act like it like they know it.
• 18:34
  Speaker 1: And and even when someone is confident or at peace with their decision, the the struggle for safety and the recovery from the whole process is just so much. Absolutely. I I think too I I didn't know we would be so political today. But in the in in the context of what you just said, I think what paused me for a moment was that aspect of wanting to save lives or to protect babies and things like that. But as someone who fostered 87 children in foster care and the six that got adopted, like, we fight for the services they need and for the support they need and working ourselves literally to exhaustion.
• 19:27
  Right? Just trying to feed them. And and not because I'm not trying and not because and it's hard because the same people who say that they wanna protect the lives of babies don't help, and they don't want how do they say it in English? Cradle to grave. They don't want cradle to grave
• 19:49
  Speaker 2: From
• 19:50
  Speaker 1: provision or care or benefits or something. And and it's like I'm I'm not someone who's just on the street trying to live off free benefits. Like, I'm exhausted just trying to meet basic needs, and there's so much that we go without.
• 20:09
  Speaker 2: Mhmm.
• 20:09
  Speaker 1: But they're here. Who's gonna care for them? They're here. And I never planned to adopt six children, and I don't I don't mean that I don't love them or I don't want them, but it was never on my radar. It was never something I thought, oh, that would be a great adventure.
• 20:26
  It was literally these are the six that can't go home. What what do I do with that? I can't what do you do with that? And so here we are in the trenches. But how how do you since we're talking about this sort of that hate or even the, some people would say, evil or these kinds of concepts that are out in the world, this is actually one of your books, which I didn't mean to talk about, but we've gone there.
• 20:51
  Tell me or how would you tell about your book?
• 20:59
  Speaker 2: Well, it it it it emerged out of the first book that Elizabeth Howell and I, worked on to try to understand how, how to how can we understand the acts that the evil behavior and the evil acts that human beings cause upon each other. The book is Psychopathy and Human Evil, Psych psychologists, psychoanalysts, and psychiatrists discuss psychopathy and human evil. It's a it's a really eye opening book, looking at psychopathy and evil from several different perspectives.
• 21:50
  Speaker 1: It's it's all it's such a I'm trying to think of the word. The it's a unique experience going from focusing on survivors to looking at that intently Mhmm. To also looking at even that with compassion. It is it is a tricksy thing. I my first six years of my career were on and my dissertation, like, the very beginning.
• 22:23
  I don't know how that was the job I landed to start with. But the beginning of my career was, working with sex offenders and on the residential inpatient unit. And that's what I did for years and years and learning what is helpful and not and researching that and how to literally love the enemy. Like, that's that's what it is. It comes down to of how do I still see this person as a human?
• 22:54
  Because if I don't if I don't, there is no healing, and harm just continues.
• 23:03
  Speaker 2: Right. Right. It's it's it's really a testimony to you as a person and as a human being that you you did that kind of work. I, I can't work with perpetrators, after having worked with so many women in particular who've been victims of sexual assault, rape as children. It I I don't I don't want to work with a perpetrator because I don't think I can be fully present.
• 23:42
  Speaker 1: Well, I did not keep working with them as I began my therapy process. Right? Because Yeah. I think ultimately never intentionally, but I think when we we always have our own therapy or our own consultations and looking at our own stuff. Right?
• 23:59
  What am I bringing into the room and need to get taken care of so that they can bring their stuff into the room? And I think and I've never said this out loud before, but I really have reflected on that a lot of what on earth was I doing there. And it was also in the same season that I had, left my family and had no contact with my family. And I wonder if, like, I didn't have any contact with my family for two decades and before my parents passed. And I think that part of what was happening in that season of my career was not intentionally or not consciously, but I think there was this attempt to understand, like, how, how does this happen?
• 24:54
  Why does this happen? And I think in a kind of study that I don't think I was doing consciously, but for safety, for trying to make peace with what never was peaceful, All of these things, I think, it was the closest I again, I'm using the word enemy, which is terrible. That's not a therapeutic relationship. But in the context of what we were saying earlier about, psychopathy and evil. Like, how close could I get to that and learn, and what information do I need to stay safe in the future or something?
• 25:37
  I don't know what that was about. Identifying, like, all these kinds of things that there's so many layers there that was really as that began to surface, I thought, okay. I need to pull back and and focus on other things while I figure out what that was about because it was very intense. It was very intense.
• 26:02
  Speaker 2: Yeah. You you were really working something out and along you're on the road to healing yourself. So what what comes to my mind is I have had a few, people who I've worked with who had German ancestry. Oh. And as it became clear when their parents or grandparents what their ages were, it became clear that they were alive.
• 26:35
  The parents or grandparents were alive during the Holocaust, and I found it really necessary for me to engage in a discussion about the Holocaust and understand their experiences or the transmission of bad drama from generation to generation and what what it's like for them being German or of German descent. And it it really opens up a powerful communication between us, and that allows me to continue to work with a person, because I can feel the their pain. I can feel the the guilt, which is which is their trauma that they inherited. So the making it speakable makes room for it. Making room for that discussion allows a a deeper connection, I I think, between me and the the person I'm working with.
• 27:45
  Speaker 1: Making it speakable. I think there's something there. I think what I was doing in that phase of my life was facing my fear. I was learning to not be afraid. My if I was going to survive because I had escaped all this, I'd run I literally ran away when I was 17.
• 28:06
  If I was going to make it on my own, I could not be afraid anymore. For me, that had to be the difference between childhood and adulthood. Even though now I've done more work so that I know there are some things I should be afraid of or that that fear informs me. Right? But, also, I think that that was part of it.
• 28:27
  I had to stand up and face those fears.
• 28:33
  Speaker 2: Which that was incredibly courageous. And it sounds like in some implicit way, you knew what you had to do, and you you knew you felt you had an escape from your family. And you had to find the courage and the strength to survive. And we're lucky that you did.
• 28:58
  Speaker 1: I think it was a season that also taught me a lot about boundaries because it was a population that could not get better if they did not have consistent boundaries, and I had not had any boundaries and any consistency. And so it was really tough for me at first of, like, why do we have to be so hard on them or or what it how how hard is too hard? And learning to find that balance to stay within a therapeutic threshold and not just this or that or black and white. That was a Trixie thing for me.
• 29:34
  Speaker 2: Yeah. Boundaries are really important for babies, little kids, tweens, teens. It's very, very important to know where I end and someone else begins and what's tolerable and what's acceptable and what isn't. Those kind of boundaries are really crucial. It actually helps kids feel safe.
• 29:57
  Speaker 1: Right. Right. The the I think I I had to learn that experientially, I think. Going back to yours your clinical story, how did you get from that first case where they wanted a sensitive therapist to working with that as much or or finding ISSTD? Or how did you learn about trauma and dissociation once you two had agreed to work together?
• 30:27
  Speaker 2: Okay. I'll I'll take you through this journey. After working with this woman for I'm not sure how long it was. A few months, six months, seven months, I realized, oh, I'm I'm in over my head. This is much more than I ever dreamed of.
• 30:48
  So I sought out supervision from one of the people who was a favorite supervisor of mine when I was in psychoanalytic training at the New York University postdoctoral program in psychotherapy and psychoanalysis. I told her about the case. I asked for supervision. And to be fair to her, she said that she didn't believe in multiple personality disorder, but she was very happy to try to be helpful. It was a tough year for me and my supervisor and for me and the patient.
• 31:25
  It became clear to me towards the end of the academic year, while even though I was getting some help and I found some help in the supervision, things weren't going well for my patient and that if I stayed with the supervisor, I was gonna lose my patient. And I didn't want that, so I chose to lose my supervisor and stop supervision. And a year later, a friend of mine was working with a social worker who was psychoanalytically trained and very knowledgeable in working with dissociation and what was now called dissociative identity disorder. And I was delighted to hear about this. So every other Friday afternoon, I would take the railroad from Manhattan up to, one of the towns in Westchester.
• 32:27
  And my friend would pick me up, and she and I would drive to our supervisor's house. And I would bring my notes, and we talk about my case for an hour and a half every other Friday. And that lasted for several years until my daughter was born, and then I said to the supervisor, I really wanna spend time with my daughter. So we simply switched to phone supervision. That's how I got help.
• 33:05
  That helped me tremendously. I learned a lot more about trauma and how to work with transference, countertransference with a trauma survivor. And then I got a second and a third DID patient, continued in supervision, and continued learning. And simultaneously, I I was in a couple of different study groups, from in the nineteen nineties. I was in a study group with Steve Mitchell, who died in February, and we never really got around to talking about trauma dissociation in his his study group.
• 33:55
  But I subsequently joined a study group with, Donald Stern, and I think I've been in it for fifteen, eighteen years. And and in 02/2005 or 02/2006, he had us read Elizabeth Howell's book, The Dissociative Mind, and I was tickled pink. I just loved the book. I learned so much more. And during these years, I was struggling with what do I do with this experience?
• 34:30
  How do I communicate this? This is really important for people to understand. And I was bumping up against hospital staff, psychiatrists, psychologists who didn't believe in dissociative identity disorder, like my supervisor didn't believe in dissociative identity disorder, and a lot of the people who I came in contact with didn't believe it because either their supervisors told them it didn't exist or it didn't fit the model of psychotherapy or psychoanalytic thinking that there there was no room for someone to have DID. They would they would meet a DID person and misdiagnose them as psychotic, schizophrenic, bipolar disorder, borderline personality disorder. So this was very challenging and to me.
• 35:27
  And the first two patient the second and third patients allowed me to video tape my work with them, and I would bring the video tapes into supervision. And I forget the year. It was maybe 1998. No. No.
• 35:46
  I'm sorry. 02/2008. I was on a committee that was hosting the division thirty nine annual conference in in Manhattan, and I finally got the courage up to wanna bring one of these recordings and show the recording and show the reality. This is not like these people are human. They're suffering.
• 36:11
  They're not I don't consider someone with DID crazy. They're not animals. They're not to be mocked. They're not to be humiliated. And and I I really wanted to try to do some teaching, and I I was able to offer a presentation.
• 36:33
  I contacted Elizabeth Howell. I I didn't know, but I had read her book and asked her if she would consider being a co presenter with me, And that's how our relationship got started, and that's how we started working together.
• 36:53
  Speaker 1: That's beautiful. That's amazing. How how I I wanna start at the beginning of that. How how did you work through that transition between the first supervisor where you were going to lose your supervisor or your client? And then later, more pragmatically, I've just I need to spend more time with my daughter.
• 37:15
  Just the pragmatic issue of time, even though we have a good relationship, that's not working. And you were able to talk about that and transition to phone sessions. In just for newer clinicians, maybe, how did you come to terms with recognizes you with recognizing you needed a shift in supervision? What was that like, sort of a healthy ending so that you could have either something different or or more appropriate for what your needs are or your patient's needs were?
• 37:49
  Speaker 2: Well, many of the things that the supervisor was many of the suggestions she was offering did not work, and she was not really hearing my experience. Here's an example. One day, the the patient came in, and she had done something unusual. And I said, wait wait wait a minute. Let's back up.
• 38:20
  Can can you back up a minute? And so the patient walked backwards, which which was hilarious. So we had both had a good laugh. And then we started talking about what had taken place. I presented this to my supervisor, and her response was you have to say to the patient, why can't you address me like the adult that you are?
• 38:42
  Speaker 1: Oh.
• 38:42
  Speaker 2: That's an that's an example. And and what I was asking her to back up into was the child part that had come into the room so I could talk about why she was present on that particular day. And and it just became clear that it was just not working out. And I so in a some kind of a parallel process, I felt that my supervisor wasn't understanding me. I felt like the medicine she was giving me wasn't helping.
• 39:20
  In the same way that my patient had experienced hospital after hospital of not understanding her, not helping her, and misdiagnosing her.
• 39:34
  Speaker 1: Your your boundaries with your supervisor and with yourself of needing something different helped stop that reenactment that was happening circumstantially.
• 39:46
  Speaker 2: Yeah. Yeah.
• 39:50
  Speaker 1: What a gift to your the person you were working with to recognize, like you said, the medicine was not helping and that you were there to help. And it was worth meeting your person where where they were and what they needed and offering that care and tending to that rather than trying to squeeze the person into someone else's model that was not actually applicable. Like, her her comments and her supervision, like you said, in many ways was really good. So Mhmm. That's great if it fits those people, but that was not fitting this person.
• 40:37
  Speaker 2: No. No. No. I I mean, I learned more about other things from her, but but it wasn't helping the current situation. In the long run, it just wasn't working.
• 40:50
  Speaker 1: So after you and Elizabeth Howell presented together, what what came after that? How did you find ISSTD?
• 40:59
  Speaker 2: Okay. So let me just say one thing before I talk about that. I felt a real obligation to my patient because I was very honest with her about my lack of knowledge. And the fact that she was willing to trust me made me feel much more, I don't the word obligated comes to mind, but I don't it wasn't obligated. I felt well, I felt an obligation to learn as much as I could, that it was my responsibility to learn as much as possible to help this person who was in big trouble, who was willing to put a trust in me.
• 41:54
  So okay. Just wanted to throw that out. So you asked me about Elizabeth Howell. At some point, Elizabeth invited me to, be on a presentation with her at ISSTD.
• 42:11
  Speaker 1: Oh, wow.
• 42:12
  Speaker 2: I had no idea that ISSTD existed. I only wish I knew in 1993 or 1994 in those beginning years. It would have saved it would have saved me and the patient a lot of time. So so I was delighted to be invited to present with Elizabeth. I brought, some of my videos.
• 42:39
  I think I brought one video to that first presentation. I brought subsequent videos to subsequent presentations. And when I when I walked into ISSTD, it was like feeling like I was coming home.
• 42:59
  Speaker 1: Yes.
• 42:59
  Speaker 2: I would I was with people who understood the suffering
• 43:05
  Speaker 1: Yes.
• 43:06
  Speaker 2: Who understood the the the trauma that creates a dissociative, the structured mind, and nobody was telling me I was crazy. Nobody was telling me the patients were crazy or the patients are lying. And, boy, did I feel comfortable and relaxed. And, I really wanted to keep presenting. I I really it I really enjoyed it.
• 43:36
  I really enjoyed presenting it. It really meant something to me. It felt felt like I was doing something, something really useful.
• 43:47
  Speaker 1: I just I think you've spoken to something, about this feeling of being with others who understand and the experience, especially in the context of those days or or even still today when so many don't know or don't understand and have not even been exposed to accurate understanding or education so that they don't even recognize when they have encountered it and not realized it. And to have so many layers of connection in that way, it makes it makes our gathering so tender. And
• 44:51
  Speaker 2: and
• 44:51
  Speaker 1: refueling somehow, restorative somehow, nourishing somehow to have those whether it's a training or the big conference we just had, to have those connections and time together, almost a respite from not the work, but the fighting and the advocating for understanding in places that should be offering care already.
• 45:20
  Speaker 2: Right. Right. There's there's something to be said for being amongst like minded colleagues and not feeling isolated. Yes. And that that was my experience early on.
• 45:37
  And I'll I'll say, the unit chief on one of the units I worked on, during the nineteen nineties, was a psychiatrist who was very honest with me and, said she doesn't believe in it. And she acknowledged that she was trained at Johns Hopkins with Paul McHugh. I think you probably recognize that name, who was one of the members of the false memory syndrome group. But every time there would be a DID patient on the unit and there was a crisis, the psychiatrist happened to find a way into my office and asked me to come help out. And I would often walk into a a patient's room, and the patient being in some kind of crisis and a nurse standing there with a a syringe filled with medication and trying to give the patient antipsychotic medication.
• 46:48
  And all it and all it the patient needed was somebody to just either sit right next to them and have a cup or or stand next to them and and just talk to them, find out what they're feeling, find out what triggered this experience, how could we be helpful. It's not magic.
• 47:11
  Speaker 1: It's care. Mhmm. It's empathy, connection.
• 47:17
  Speaker 2: Right. Yep.
• 47:21
  Speaker 1: Is there anything else that you would like to say to people with a dissociative disorder?
• 47:32
  Speaker 2: Don't stop. Don't quit. Keep fighting. If the therapy that you're in is not working, try to work it out with the therapist. Try to give the therapist a chance.
• 47:51
  But if you're confronted with rigidity and a refusal to learn or be flexible, Find somebody else. Contact ISSTD. See if there are people that are members of ISSTD in your area. Work with someone who knows what you're going through. Try not to be alone and hold on to hope.
• 48:24
  I think that's what I would say.
• 48:27
  Speaker 1: That's amazing. Thank you. What about for clinicians who are just learning about dissociative disorders?
• 48:37
  Speaker 2: If you're a young clinician or new clinician or someone who's a an emerging professional, I'm very envious of you that you're learning so early on in your career. There is so much to learn. Make sure you go at a pace that's tolerable for you. Don't fill your practice with DID patients right away. And I don't mean anything I don't mean to be insulting or hurtful.
• 49:11
  What I mean is this is hard work. This is really hard work, and nothing touches my heart like working with a DID patient. And it takes a toll on your your mind and body as a therapist. So I would suggest ease into it slowly, get supervision, make friends with other therapists who are working with PID patients, create your own group supervision that, where you're supervising each other so that it's not, an additional expense. Take classes.
• 50:01
  Take classes in the, professional training program that ISSTD offers. Ask for help. Don't be ashamed of anything you might be feeling or thinking in your work. It all has meaning, and it all has meaning for both you and the patient. And stick at it.
• 50:32
  I guess that's what I really wanna say.
• 50:35
  Speaker 1: I am so grateful for you and for a friendship with you and for Bagels from New York and for for all the sensitive, tender conversations that I feel safe with you just to share that that I have appreciated that about you, and I think it's one reason that I keep tagging you and keep talking to you and bothering you and and appreciating you and connecting with you. I saw the face on the bothering. Sorry. That I know that is old stuff.
• 51:12
  Speaker 2: You're not bothering me. It's it's a pleasure to know you and to talk with you.
• 51:20
  Speaker 1: I am always enriched, and I always laugh, and I always feel better. And I hope in some ways you get to receive that as well. Is there anything else that you would want to share or talk about today?
• 51:35
  Speaker 2: Well, I have to say, you have the world's greatest laugh, And and that motivates me to to wanna keep you laughing.
• 51:49
  Speaker 1: That's funny.
• 51:56
  Speaker 2: Anything else I would wanna say? I probably will think of some things after this is over. I'm happy to answer a couple more questions if you want.
• 52:10
  Speaker 1: Well because
• 52:10
  Speaker 2: I can't really I can't really think of something, something else I'd like to say.
• 52:16
  Speaker 1: I I just I wanna make sure that I thank you for sharing so vulnerably about your, family and your history there and for speaking truth about how to address that when it comes up in session because that's true for all of us, whatever our issues are. And I guess the the other clinical question I would ask is just simply when you do have someone who is learning about their dissociative disorder, how do you explain dissociation? How do you engage in that conversation with them? What does that look like for you?
• 52:55
  Speaker 2: Well, I've studied I studied with Philip Bromberg for about fifteen years, in group supervision with three other psychologists. And so the cell state language has become an intrinsic part of me and my work. And what I what I introduced to DID patients or non DID patients is really simply we're all made of parts. We used to think, or cognitive neuroscience used to think that people were singular and bounded, human beings, but we've learned that we're a system of multiplicity. And in the absence of trauma and in the presence of secure attachment, healthy attachment, our different selves, our different ways of being learn how to communicate.
• 54:00
  There's no need to create dissociative barriers between the different ways we are experience ourselves, so we're not even aware of our multiplicity. So and then I'll I'll say, you know, how many times have you been in this situation where you're talking to a friend and you say, you know, I feel I feel like going out for Chinese food tonight, but, you know, there's another part of me that would really like to go to the Italian restaurant. Those are parts. Those are potential parts, and people get it right away. With the DID patients I work with, one of the things I try to explain as early on in the work as possible is that your mind found a way to protect itself, and that people may be critical of you or giving you a diagnosis.
• 55:03
  But what most people fail to see is that your mind's dissociative capacity is actually a form of resilience. And if you hadn't had the ability to compartmentalize your experience to develop the parts, You wouldn't be where you are today. You may not be today, and you need to recognize this as as a gift, a gift that you need to learn how to use in a way that's most helpful and useful to you. And I'm saying and I'm speaking to all the different ways of being you, especially those angry parts inside.
• 55:47
  Speaker 1: I was with you until you said that bit about the angry parts.
• 55:54
  Speaker 2: Well, but but you know how important it is. It's so crucial to to be able to engage and withstand the intensity of a patient's anger. And one of the things I've heard, I don't know if it was Richard Cloughton, years ago saying you're safer in a room with a DID patient than you are walking in the streets of New York City or any large city for that matter. In my in my experience and it's not like I treated 10,000 DID patients. That's not how we work in our profession.
• 56:39
  Most of the angry parts that I've met were frightened and hurt little kids. And once once we can work through the anger, then we can make some real progress. I should say that I do set boundaries, and there are limits to the expression, of how people express express their angry, hateful feelings. They're free to think and say whatever they whatever they want, but you can't act on those feelings. I also say I have to feel like I'm safe with you as well, which surprises lot a lot of people.
• 57:22
  Speaker 1: It's interesting to me that we've come full circle talking about anger because it's something I've been working on in therapy myself. And I recently had a conversation about anger with Laura Brown, of all people. And I I know that anger is a feeling just like any other emotion. I know that anger informs me just like other emotions do and in particular informs me of injustice and informs me that something is not right, and that it is important to pay attention to that.
• 58:05
  Speaker 2: Yeah. Very important.
• 58:07
  Speaker 1: It is still daunting to me to know how to express it in ways that are not just healthy, but also effective.
• 58:18
  Speaker 2: Mhmm.
• 58:19
  Speaker 1: And so far, that still comes out for me a lot through art and poetry Right. Because maybe those are containers. Right? Like, words on the page can be contained on the page, and, a canvas can contain the edges. Like, so I have these visual boundaries.
• 58:44
  Maybe that's part of it. But
• 58:47
  Speaker 2: I think you're right. I think it it I for for especially DID patients, anger can be very frightening, and the the intensity of the anger must feel enormous.
• 59:03
  Speaker 1: There's a lot I think I know that right now in the community, especially online, there is a lot of turmoil and hurt and concern, and some of that has come out in anger, which I can respect. But also it has been very overwhelming to me because of the particular issues I was already working on personally, and so the overwhelm has been very quick. And so it is hard to know how to respond or what to say or not say, and I have struggled with that. And one of the things my therapist said, I sent her a poem last night, and she replied with the reminder that some of it is just impossible, that I can't fix it all, that I don't need to fix it all by myself, that I don't need to speak for others who are speaking clearly for themselves. And just speaking for myself is enough.
• 1:00:08
  And Yes. And so finding ways to do that has been a different kind of container, maybe that I just need to carry my own container and not everybody else's. So that's interesting that we we came to that in in our conversation.
• 1:00:31
  Speaker 2: So, I I just wanna comment. I think what you may be alluding to is a community of people that define themselves as lived experience.
• 1:00:44
  Speaker 1: Yes.
• 1:00:45
  Speaker 2: Okay. Whether they're therapists or not. So you know that there's a a lived experience group that is trying to get together and form a special interest group at ISSTD. And when I saw that it's open to everyone, I immediately, signed up and asked asked to become part of the group. Because I I I think we as therapists, whether you have DID or not, we as therapists really can come in upon us to really be able to understand what the world looks like to someone who has suffered in that way and to hear how they felt othered, stigmatized.
• 1:01:44
  And I have I have more to learn. And during my analytic training, many of my supervisors said, your patients will be your best supervisors. And that's been the case. So I wanna keep learning, and I I hope that the people with lived experience, who I will come across with, will understand. I hope I can help them understand that, there are people who really care about them and wanna understand and learn how to be better clinicians for them.
• 1:02:31
  Speaker 1: So we have begun and ended this conversation with me crying. Thanks a lot, Shelley.
• 1:02:37
  Speaker 2: I'm I'm sorry, Emma.
• 1:02:41
  Speaker 1: Oh, it is hard. You know, I got asked to do the plenary next year, and I Wow.
• 1:02:47
  Speaker 2: That's great. Congratulations.
• 1:02:49
  Speaker 1: Oh, I I talked to some of the people of lived experience because I know there's there's this controversy and this this pain, and they're still needing it tended to, and I didn't want to add to pain. And but they said they said, no. Please, while you have a voice, keep speaking. And and so I took that back to therapy again and said, it looks like I'm gonna do the plenary. It looks like even the community wants me to move forward and that I have that support even though there's all these other issues.
• 1:03:22
  We're still learning and untangling. There's so much hurt, and we want to be sensitive. And she said the same thing again, so I guess I'm learning this. Just speak what you know. Share what you see.
• 1:03:40
  You you do it. She said you do that on the podcast already of you're saying your process. You're just showing what you're learning. You're talking through the process. That has been lived experience the whole time.
• 1:03:53
  And people who listen have access to that and see the process unfolding. And so whatever you say at the plenary next year will be the right thing because it is what you see and what you're noticing and what you're sharing, and that's all they're asking you to do. And so once again, when I can just contain it to that frame, it doesn't feel as overwhelming or as terrifying even though it still is overwhelming and terrifying.
• 1:04:24
  Speaker 2: Well, I'm thrilled that you're gonna be giving the plenary. I will be there. I'll try to sit in the front row.
• 1:04:30
  Speaker 1: Oh. And I come.
• 1:04:31
  Speaker 2: I promise I won't make you laugh.
• 1:04:35
  Speaker 1: There's no telling what will come out of me. I will try. I will try. I am so grateful for you, your sensitivity, your kindness, your friendship. Friendship.
• 1:04:48
  I'm so grateful that you have been with us here today and, that just thank you. You have been consistently kind to me since I have known you and worked with you through different things in the office or or in committees and meetings and things, and, it means the world to me. I think that that is one thing that by default we know comes from lived experience, right, for any of us, even DID or not, of recognizing what feels safe and what does not feel safe. And and you have been a safe place in my world, And I just wanna thank you for that and appreciate you.
• 1:05:32
  Speaker 2: Well, you're you're very welcome, and I wanna say that I felt really honored that you invited me to speak with you on the podcast, and I've enjoyed talking with you.
• 1:05:40
  Speaker 1: Thank you. Thank you.
• 1:05:41
  Speaker 2: You're very welcome. Thank you so much.
• 1:05:44
  Speaker 1: Thank you for listening. Your support really helps us feel less alone while we sort through all of this and learn together. Maybe it will help you in some ways too. You can connect with us on Patreon by going to our website at www.systemspeak.org. If there's anything we've learned, it's that connection brings healing.
• 1:06:05
  We look forward to connecting with you.