Latest / System Speak: Complex Trauma and Dissociation / Recap: Dolores Mosquera

Transcript

Recap: Dolores Mosquera · 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 long time listeners and are likely to contain more advanced topics, emotional or other triggering content, and or reference earlier episodes that provide more context to what we are currently learning and experiencing. As always, please care for yourself during and after listening to the podcast. Thank you.
• 1:01
  I went to a training with Dolores Mosquera, and it was about working with parts in dissociative disorders. And I wanted to share some things from that because there were some insights and sort of breakthroughs that I had not thought of before or had considered before. So it was super helpful in that way. She opened by talking about how when you're working with someone with a dissociative disorder, you really have to continue to clarify if the person is actually with you and understanding, because they are very good because of trauma, very good at appearing present and appearing to have the correct responses, but may not actually be following what you're talking about or understanding what you're saying. She talked about how there's so much energy put into not letting others see what's going on or know what's going on.
• 2:06
  And so it can be very hard to even have a conversation, especially when you're working with a part that has triggers or is experiencing trauma, or when there is current or ongoing trauma happening externally in the present. And that could be anything from domestic violence to the pandemic, to relational trauma happening somewhere in their life. And so that actually explains a lot of what we went through last year and was meaningful to me and made me pay attention right from the beginning of her presentation. She also talked about how with phobia and avoidance, which we've learned about in the workbook and have read about and studied, that it's not just a phobia about DID, that there's specifically three layers of phobia, a phobia of parts, a phobia of past trauma, and a phobia of inner experience. And I had not thought about the layers of it before so explicitly, and that makes a lot of sense because it's not just being afraid or concerned about having others there or the incongruence between being aware that I am a person, but that there are these other parts there, but also I'm just a person.
• 3:30
  Like, it's so much to just process that piece alone, but especially also to think about the past and that being my past and having to face what they have already endured or what I have already endured. It's so much to process. It makes sense why we avoid it because it really was that hard. But then along those same lines is the phobia of the inner experience and how different parts may interact differently or have internal worlds or experience the inner world differently than some parts who have a phobia of even knowing about that or wanting to participate in that. And all of those layers impact not just the daily living experience, but also treatment itself.
• 4:22
  When she was talking about processing memory work or that kind of thing in that phase of therapy, she said that when you focus on specifically asking which parts can be present, then it helps people focus on our differences and the avoidance, which can in some cases be helpful, but that it may be more helpful to focus on participation being voluntary. So asking more generally instead, such as, Is anything about this doesn't feel okay? How are all of you feeling? Are there any thoughts or concerns or questions that anyone has to help us focus on our own voluntary participation in treatment in a general sense, as well as the present parts being able to tolerate being present in a way that increases awareness amongst parts and as part of the inner experience. So traditionally, we would talk about co consciousness here, but anytime we just start throwing out co consciousness, it so often implies a division because when you're talking about co consciousness, then by default there's a co, which means by default there's more than one.
• 5:47
  And when she rephrased it this way, what it opens up is the capacity and opportunity to just whoever is there, however much of you is there, to be present with all that there is to feel and just noticing that in that moment and for what it is, rather than having different feelings or different responses or different experiences assigned to different parts. And this was fascinating. And I felt like without even using any kind of word like integration or fusion or all these old school words that we really just don't want used anymore, that there it was a concrete example of focusing on functional multiplicity or even just increasing awareness and cooperation and collaboration and just presence, In a way, mentalizing, as Kathy Steele talks about in the workbook. But just presence and reflection and the experience of being present and the experience of reflecting and increased awareness of all the layers of what's going on, which is very different from focusing on this person or this part has these feelings and this part feels this about it. Just being aware and feeling and noticing all that comes up generally.
• 7:27
  The other thing I really appreciated is that when she was talking about complex PTSD, she talked about the pattern of how difficult it can be to work with such clients when there's this dynamic that so often happens where you have a really good alliance with someone with complex trauma, but they still have difficulties in trusting. And why is that? Because if you have such a good relationship and have worked so long on safety and stabilization and building a rapport and all of these things, and if all of that has been so positive, then why is there still such a trust issue? And she talked about how that's directly related back to the trauma and that as the relationship between the therapist and the client improves, then they actually become more aware. And part of becoming more aware includes letting those feelings of fear or anxiety or distrust surface.
• 8:35
  And so new feelings come up that they were not aware of before. And so even though it feels like a setback, it's actually progress in treatment. She said that most often being stuck in therapy revolves around this, and it means that there are parts that are not feeling safe or that there's been an actual rupture in the alliance, but it also happens because the client becomes aware of those things in ways they were not aware of in the past. So like that was actually already happening all along, but as part of dissociation, the client didn't know it. And as that starts to surface, then it can look like problems in the therapeutic relationship when it's not actually and can just be an opportunity to explore and repair.
• 9:30
  The other thing that I liked that she talked about was the adult self. And this is interesting to me because Kathy Steele and lots of structural dissociation people really focus on only working with the A and P or the apparently normal personality or the adult. And their idea is that to make progress, you have to have a functioning adult who can participate in treatment, which technically makes sense, but it steps all over the toes of survivors and never lands well when they talk about it because of all kinds of issues. There are layers about which ANP is the one that they should be working with and how do they know that's the actual one that's actually fronting? Or what if the host and the ANP are actually different ones?
• 10:22
  Or what about all the other parts that also have absolutely valid needs, but the A and P is not even aware of them? Like all kinds of reasons why that doesn't work. But again, she rephrased this in a way that actually felt safer and more accessible because she distinguished what exactly the adult self was or is and what she means by that. And she was not talking about the A and P or only working with one alter. She said, quote, The adult self represents an emergent set of self capacities not yet developed in any part of the personality.
• 11:14
  Now as someone who does not subscribe to the one personality theory, I would say personalities. Like, I would make that plural. But I do love what she's saying here, and I think it's something that needs to be kept in this unfolding model we're creating in our own brain, right, is that there is a healing, unfolding self that we are not yet, but that is already in process. And that's the adult self that is referenced in therapy and that can be working on things in therapy, which is very different from just picking one of your ANPs or only the host or something like that. And I think for some systems, that's actually what they would call the framework or the window or the lens or the machine that is the structure of the system where others have accessibility to that.
• 12:15
  And so I think that's something we could actually flesh out pretty easily without it feeling overwhelming or dangerous. So we're gonna come back to that piece about the adult self. The other thing that I really like that she clarified that was so, so important is that when working with the adult self, she specifically said that she did not mean don't work with other parts. She just means it's best if you can also keep that new emerging adult self online, even if you were working with other parts. And that the reason this is so important is because you are always working with the whole system, and especially because you don't actually know who all is listening or watching.
• 13:06
  And I loved how she phrased this. And so again, I felt like this took the best part of structural dissociation and actually made it more accessible and more culturally sensitive and more therapeutically gentle somehow. I'm not even sure the right words to use there, but there's a big difference between, no, I only want to work with this one part and then rejecting all the other parts. And let's practice keeping more of you online and aware and increasing awareness and communication, that's fantastic. And that's kind of the point of therapy, right?
• 13:50
  So I felt like that took the best of both worlds and gave it good words that we can start working with. And she compared it to a seed that we work in therapy from the implicit understanding that the future self where healing has already happened and where they are becoming a whole, not a whole person as if they're not whole now, but where they're more wholly accessible to each other and communication and things are smoother and more intentional, that that is already present as like a little seed. And so she talks about not working with the adult self as in instead of everyone else, but working with the adult self that doesn't even exist yet, that you're always nurturing and growing and communicating with and including this adult self that will be. And as part of that, one of the main goals is, quote, to show the client how to trust, how to talk and communicate with all the different parts, and quote, we help the adult self learn how to understand what they need, how they feel, and how to take care of them. That in itself is powerful.
• 15:18
  There are days I don't know how to do any of those three things, and other days I feel so silly because it's so simple. And so that makes perfect sense, and I really loved how she broke that down. That being said, she did also explicitly say that the various aspects of a person are not different people. They are just parts of the people, which is very structural dissociation. And while I disagree with that, because those of us who experience it don't share one body.
• 15:52
  Like, I hate when people talk about, but you just have one body. That's not really true because when so and so is out, I need this pair of glasses, we're allergic to these things, and my hair does this. But when someone else is out, then my hair does this, and I'm not allergic to that, and I need these other glasses instead. Like the body is so different. It's not just perception.
• 16:15
  And while the perception is also the example they often use about the delusion of separateness and these kinds of things that have been big conversations in the past, it's not actually a perception. It is an actual experience that shows up both neurologically and physiologically. So yes, we have the same presence in the bod like, I understand the point of what they're trying to say. It's not that I can't cognitively process that. It's that I don't think it means what they think it means.
• 16:49
  I disagree adamantly that it's one body other than obviously there's one body. Like I get it, but it's so much more nuanced than that. And you can't just say that because it's such a different experience for everyone and not just at a perception kind of level. The thing I do agree with is that there is one brain, and our brain is doing different responses based on what has happened to the body and what has happened to the brain. That makes sense, and I can go with that.
• 17:24
  But it's not what she said, and I think that's another layer of what we need to adapt in our own presentation. While she was talking about keeping the whole system in mind, she also mentioned specifically that we need to always make a point of not ignoring different parts and that we may not always be aware of all the parts that are present or not participating. And I like how this brings up that chance for irreparable rupture because that rejected part, if they get rejected by the therapist, it confirms them as bad or wrong so that they can't actually get better because they're not having access to help or hope. And if they focus only on one present part as acceptable, then it also confirms that abuse dynamic where nothing has changed, they can't get better, and only can you be acceptable if you do this, or if you perform this way, or if you present in this mode. Because even if those parts of them who present that way are very authentic and genuine, there are other parts of them not present at the moment or at the time or as part of that dynamic that are also just as valuable and just as acceptable.
• 18:55
  And when that rejection comes externally, whether that's rejecting a part of them or a part of the system, or whether that is disrespecting like the parents or abusers, for example, that may isolate loyal parts or trauma parts or add shame to interject parts that are modeled after those people. And that can also be an irreparable rupture. So we have to be aware of everyone. We have to respect everyone. And part of that is respecting everyone's timing.
• 19:32
  And some people can be in therapy for years and years and years before we even get to some of those layers or some of those parts. So it's super important to just be curious and to be aware that when something comes up that we don't understand, it is very likely that the client also doesn't understand. And to be aware that avoidance of PARTS and trauma and the inner experience is a part of DID. So if there's someone who comes to therapy who is pro PARTS and isn't bothered by all of those things, they don't actually have DID because they are not disturbed by it. Their functioning is not impaired.
• 20:22
  They may have other versions of multiplicity or or not a diagnosis, but have that plural experience and also wanting help with depression or anxiety or something else. And it's okay to address those layers, but phobia of parts and avoidance of parts is a part of the DID diagnosis. So we wanna validate what their experience is. We wanna validate what is working and what resources they already have, as well as accepting what the struggle is that's not working or what we offer that isn't entirely accepted throughout the system, even when our therapeutic alliance appears strong in other ways. This is critical because understanding and compassion and empathy comes before communication and cooperation can happen.
• 21:20
  And that has to come from the therapist before it can come from the self or be done for the self. And even then, it takes practice because it's brand new. She also talked about parts who repeat the same things over and over again, and we actually have one of those. And one thing that she helped me understand is that sometimes when that happens, like we have one that says, I don't need no one, and like writes it in our journal, says it in therapy, scribbles it on things we try to do for therapy, that that is something in response to a specific trauma from the past. Other times, things that are replayed over and over again are trauma parts who are still acting out or still waiting for closure on a specific incident.
• 22:17
  An example of this from our book is that we had one who was waiting for the father to rescue them, even though the father was also one of the abusers. But you can also use that. So for example, one of our Kellys from the past, right? A previous therapist was able to use that to sort of shift to repeating that now time is safe mantra and kind of became a stabilizing force in that way. Instead of repeating what they were still waiting for, they were able to grow to the point of being able to repeat what actually is currently safety, which helps reorient everyone, even though at times she's still a little disoriented herself.
• 23:03
  The other thing in the context of the emerging adult self that she talked about was how integration is not like a final step, that it's something that happens little by little and that it doesn't have to be a goal in and of itself. She also talked about functional multiplicity. She never used those words, but I think that she could have. She talked about how we don't have to like or love or understand each other internally to work more effectively together. And how therapy models, not just that acceptance, but navigating differences and honoring all parts, even when there's one particularly strong part in front.
• 23:51
  That awareness that, yes, you're saying this and this is there in front of me, but also I'm aware of these parts of you and these parts of you and these parts of you and that I honor those as well. And then in fleshing out being curious, which I also learned from Jill Hosey, who was on the podcast, and from our ISSTD classes, just that being curious about when questions about parts come up, whether that's in therapy or internally, just being curious and being willing to hold those questions and kind of explore more about that. And so asking questions like, how long have you been around? What do you first remember? What is it that you need?
• 24:33
  What is it that you enjoy? What is it that you're afraid of? Like being sensitive and gentle and pacing all of that, but that it's okay to be curious and ask questions and then just be receptive to what comes back. She also gave a reminder, which I think was really, really important, whether that's someone for DID to remember or someone who's OSDD and trying to struggle with, do my parts count because they're not DID? All of it counts.
• 25:04
  And she pointed out that some parts really are more general, that we don't have to force details to create or elaborate on what's not there. And I know even though we have a DID diagnosis, and even though we have some pretty specific parts and a handful who front sometimes or alternate hosting, there are other parts that really are not like formulated as quote, quote people or alters even so much as this is the space that we're in, or I go into when this piece of whatever is brought up. And being aware of that and being able to honor that or hold that in therapy or make space for it in therapy and sit with it and bring healing to that, even if they don't say, Hey, I'm an alter and my name is such and such, and I'm this many years old. Like, still, even without those details, those parts of aspects of ourselves or those other parts of ourselves, or however you want to say it, they all matter. She also gave the reminder that all parts are helping the system and that when you first meet a part or when you first notice a behavior or when there is something specific getting your attention, it may not feel like it's being helpful, but that when you get to know what's going on and why that's going on and more information comes to the surface, you can see and learn how it was helpful, at least originally, and what their purpose in doing those things are, and then you can come around and sort of help work with them to meet those needs more effectively.
• 26:52
  And that at the same time, remembering that just because someone is fine or appears that they are present and participating doesn't mean they're actually oriented or grounded. But regardless, each part has its reason for doing what they are doing, and we must always validate these reasons. Remember too that all parts are initially created to perform a certain role. So accepting those parts and what their experiences have been or are is part of that increased awareness of just tolerating those layers of what am I experiencing in the moment? What do I need to tend to those experiences?
• 27:41
  What are the thoughts? What are the feelings? How can I offer comfort and tending to those experiences, no matter what kind of parts they are or what roles they had? It's a reminder that we all have options now and can make decisions based on our needs and wishes. We can think of alternative responses.
• 28:09
  We can suggest useful or adaptive ways in which we can help the whole system or even individual parts in more effective ways. And that encourages us as far as improving our level of functioning. So I know that was super brief and a very quick overview, but there were really some significant pieces that I wanted included in the conversation as our own healing continues to unfold, as we work to improve the care that we want to give others, and as we share with you what we are learning so that we can all get better together.
• 28:55
  Speaker 2: Thank you so much for listening to us and for all of your support for the podcast, our books, and them being donated to survivors and the community. It means so much to us as we try to create something that's never been done before, not like this. Connection brings healing. One of the ways we practice this is in community together. The link for the community is in the show notes.
• 29:23
  We look forward to seeing you there while we practice caring for ourselves, caring for our family, and participating with those who also care for community. And remember, I'm just a human, not a therapist for the community, and not there for dating, and not there to be shiny happy. Less shiny, actually. I'm there to heal too. That's what peer support is all about.
• 29:50
  Being human together. So yeah, sometimes we'll see you there.