Latest / System Speak: Complex Trauma and Dissociation / Guest: Steve Gold

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Guest: Steve Gold · 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.
• 1:09
  Stephen Gold is professor emeritus, Nova Southeastern University College of Psychology and was founding director of NSU's Trauma Resolution and Integration program, known as TRIP. He has served as president of the American Psychological Association Division of Trauma and Psychology, inaugural editor of the division's scientific journal, Psychological Trauma from 02/2008 through 02/2014, recipient of the Division's Award for Outstanding Service to the Field of Trauma Psychology in 2014, the Division's Lifetime Achievement Award in 2022, and was a Division fifty six Delegate to the APA Council of Representatives. In 02/2004, doctor Gold served as president of the International Society for the Study of Trauma and Dissociation. He received ISSTD's twenty twenty Cornelia Wilbur Award for outstanding clinical contributions to the treatment of dissociative disorders and ISSTD's twenty twenty two lifetime achievement award. He is a fellow of ISSTD and of APA.
• 2:16
  Doctor Gold has published and presented on abuse, trauma, dissociation, hypnotherapy, and psychedelic assisted therapy, and has been an invited speaker throughout The United States and in Canada, Colombia, Argentina, Spain, Switzerland, and Austria. He is editor in chief of the APA Handbook of Trauma Psychology, a co editor of the second edition of the book of Dissociation and Dissociative Disorders, and author of books, Contextual Trauma Therapy for Complex Traumatization and Not Trauma Alone. Doctor Gold was founding co editor of the Journal of Trauma Practice and guest edited a special issue of the APA journal Psychotherapy on the treatment of trauma related disorders. He is a certified traumatologist with the Traumatology Institute, a certified consultant in clinical hypnosis with the American Society of Clinical Hypnosis, and sits on the board of directors of the Sidron Institute for Traumatic Stress Education and Advocacy and on the advisory board of the Leadership Council on Child Abuse and Interpersonal Violence. Doctor Gold maintains an independent psychology practice in Plantation, Florida and is regularly retained as an expert witness in expert witness in legal cases in which trauma and dissociation appear to be relevant issues.
• 3:35
  Welcome, doctor Gold.
• 3:37
  Speaker 2: Hello. My name is Steve Gold. I became involved in trauma treatment, initially through my private practice. Although, for most of my career, I've been a faculty member in doctoral training programs in psychology, but pretty much always ran a private practice parallel to that. And early in my private practice, I was being referred, clients on a regular basis by the division of vocational rehabilitation, which is a federal program that helps people with a disability, which includes, psychological as well as physical disabilities to either become employed or increase their level of employment.
• 4:34
  And so I was doing at least one or two evaluations for them a week, and those evaluations included extensive personal histories. And I was hearing from these folks repeatedly, about very chaotic childhoods, childhoods of deprivation, as well as abuse. But this was in the early eighties when PTSD was a relatively new diagnosis. For most of my graduate training, actually, all of my graduate training, there was no PTSD diagnosis. There was no widespread recognition of trauma within the field of psychology.
• 5:26
  And so it was only after I graduated that that area began to become more prominent. And so what really struck me about these folks having had an undergraduate background in development was how much they had missed out on developmentally because of their backgrounds of deprivation. And the abuse that they experienced struck me as landmarks within a much broader landscape that made them vulnerable to abuse, and that compounded the impact of their traumatic experiences as kids. So that's what got me started, with an interest in the area. And then in 1990, at Nova Southeastern University in Fort Lauderdale, where I was a faculty member for thirty eight years, I started a trauma training clinic for doctoral trainees where we exclusively treated folks presenting with trauma related and dissociative disorders.
• 6:36
  And that was a very rich experience for me because in addition to my own trauma cases, I had the opportunity secondhand through supervision to be exposed to a much larger number of trauma cases than I would have been able to as an individual practitioner.
• 6:57
  Speaker 1: How were you able to not just treat, but approach how to help these people and the missing skills and developmental issues you were noticing before it was even a diagnosis?
• 7:11
  Speaker 2: Well, the diagnosis came about in 1980 with the publication of the DSM three. That's the first time there was a diagnosis for PTSD. In a in a way, I see it as being fortunate that there wasn't a whole lot available at the time on how to treat this in the early eighties in the wake of the emergence of the diagnosis. There was a lot of skepticism about whether there even was such a thing as PTSD. So there wasn't an awful lot on how to treat it.
• 7:51
  So I had to rely on allowing my clients to educate me and guide me, which continued to be a cornerstone of my approach to working with clients and our approach at the trauma clinic at the university, though, that I was running, that was known as the TRIP clinic, which is an acronym for trauma resolution and integration program. We started early in the years of TRIP after I'd had a number of years of experience in private practice working with traumatized people, to follow the model of encouraging people to talk about their trauma and face what they've been through and very quickly concluded that that often did more harm instead of good. In retrospect, the vast majority of people that we were seeing at the Tripp Clinic had complex PTSD, extensive histories of childhood abuse and deprivation that led to a much more complicated, clinical picture than you see in PTSD as it appears in the DSM. And so realizing that that was not a great way to go, that focusing on the trauma, especially early in treatment, could be more detrimental than helpful, we fell back on relying on our clients to guide us. And that continues to be a major strategy of mine in that I see therapy generally and especially therapy with people who've been through extensive trauma as being a process of collaboration where people who've been in extreme situations of not being in control, of being controlled, need to have a large measure of control over their therapy.
• 9:57
  So I generally explain to people at the beginning of therapy, it's up to you, in collaboration with me, but it's up to you to identify what you want to accomplish. And once we identify, okay, we're going to work right now on this particular goal, I'll present a number of ways to go about it. And then we, together, will figure out how to tailor what we're going to do to meet their particular needs and their particular preferences.
• 10:31
  Speaker 1: So you were listening to patient feedback and experience and helping empower them to choose their own course of therapy before lived experience was ever a buzzword.
• 10:46
  Speaker 2: I I guess so. And that's a term that I'm very fond of. I think it's absolutely the center of therapy. One of the things that I find disturbing is that strategies, canned interventions, manualized treatment, full therapy away from lived experience in a way that I think really limits, the effectiveness of therapy. Ironically, the objective is let's find something that works, and let's find something that works for everybody.
• 11:21
  And I just don't think that's an effective way to go. So I draw on various manualized kinds of treatment. One of the things that we provided at the TRIP program because most of our, folks had complex PTSD and big gaps and warps in development was providing dialectical behavior therapy groups, which is kind of a crash course in developmental skills, parallel with the individual therapy we were doing that where we could do a lot more tailoring to each person's individual objectives and needs.
• 12:04
  Speaker 1: Can you tell me more about that? Because that is interesting to me. I know that things like some CBT and and DBT certainly can be really useful for crisis intervention, for intervening in behalf of oneself and having, like, skill building kinds of things, and that's so good in a left brain way. How does that connect to big feelings and right brain sort of things that have to be experienced and can't be thought through. And and I don't mean it adversarial at all.
• 12:39
  I'm really curious. The I'm not I'm not taking it that way. The the left brain being left side of the and I know you've got you I've seen you present about some of that, like, modal network kind of things too and we can get to that later if you want. But how does this, like, when I'm thinking about left brain things and sort of being able to have frontal cortex online or that cognitive approach of, okay, this is what I'm experiencing, this is intervention I need to use, this is what would help me in having those skills in a left brain kind of way and having access to that. But when that's not online and it's more right brain or more, emotional needing to experience and less like, more affective and less cognitive, how does that balance when the skill based stuff is not accessible?
• 13:37
  Speaker 2: Well, in PTSD, it may not be accessible because the skills are there, but the distress and other aspects of PTSD are getting in the way of accessing and carrying out those skills. But central to my conception of thinking about complex PTSD is that there are many skills that the person's never learned, or never acquired or never developed because they grew up in a situation where the resources weren't there. And one of the cardinal resources that promotes development and sophistication both cognitively and emotionally is a close relationship with caretakers. And very frequently, that's just not present for folks who experience ongoing trauma as kids that leads complex PTSD and other trauma related disorders beyond and more complex than PTSD. So the frontal cortex, the thinking brain, is likely to be underdeveloped for lack of stimulation, which largely occurs interpersonally, leading to your kids at bedtime and interacting with them in a way that, encourages critical thinking as well as a lack of sophistication emotionally.
• 15:06
  People aren't born knowing what they feel. They're not born knowing the vocabulary that would help them distinguish shades of feeling, distinguishing melancholy, nostalgia, moroseness from sadness, learning the more fine tuned shades of feeling beyond the primary color feelings, and learning, how to think ahead in a way that counteracts impulsivity. So the therapeutic relationship is often people speak about it, but not in a lot of detail. And it's often thought of as be nice, and that's important for your client. But really making an effort to be attuned to the person you're working with and, to understand them as much as you can and to have a dialogue to try and clarify between the two of you what they're experiencing, what their history has been, how it affects them now.
• 16:15
  Is a tremendously large part of therapy that's effective as far as I'm concerned that is not going to be a focus of most manualized treatments, especially ones that are mainly focused on let's resolve the traumatic event. So both thinking and emotion tend to be underdeveloped in folks who've grown up in horrible circumstances. And so focusing on one to the exclusion of the other is like trying to teach somebody to walk by only using one leg. The emotional stuff, the experiential stuff, you referred to presentations, that focus on the brain. That brain piece is largely thanks to my partner in the practice, doctor Michael Quinones, who's done a deep dive into the brain and development and traumatized brains and counteracting traumatization, in brains through therapy.
• 17:24
  So so the kind of detail that I can speak to in terms of the actual brain issues underlying therapy for trauma. But, often, in terms of the emotional piece or the experiential piece, to counteract the devastating experience of being triggered into traumatic reactions, we handle via teaching people self hypnosis to counteract traumatized states, teaching people breathing techniques and meditation techniques to counteract traumatized states. And we really emphasize the need to practice those kinds of techniques on a regular basis in the same way that you would go to the gym on a regular basis if you want to achieve, noticeable lasting results in order to be able to stably emerge from traumatization. All of which means that we're not exclusively relying on revisiting the traumatic event in order to resolve the trauma itself. And it means that we can wait till later in therapy when the person is better equipped to face some of the most disturbing things they've been through in their lives, in order to confront that, and that there's a lot of gains that we can help them make before we ever get to that point.
• 19:01
  And that some people can resolve trauma without ever having to go directly confront the traumatic event through building up their, their developmental capacities, their functioning capacities, and through the therapeutic relationship.
• 19:22
  Speaker 1: I think that goes back to what you shared earlier about why manualized treatment in and of itself is not enough, because it really needs that relational aspect for healing, for development of skills, for for not just addressing things from the past, but but for building those new skills that we never had opportunity to build in previously without it.
• 19:49
  Speaker 2: Exactly. Exactly. And even when it comes to addressing trauma, some folks are going to benefit from prolonged exposure. For other folks, it's it's not it's either not gonna be effective for them, or it's going to be too much. Some people will benefit from, being exposed to the results of the trauma, things that they avoid because they're related to the trauma.
• 20:19
  Other people, will be able to benefit from directly repeatedly thinking about and talking about the trauma. For other folks, focusing on the thinking and the cognitive framework that's emerged from the trauma and doing a cognitive approach to addressing the trauma is going to be much more effective. For some people, EMDR is gonna be really effective. For other people, it will do nothing, at least in my experience. And for other people, it will be damaging.
• 20:54
  So even when it comes to those kinds of manualized techniques, it's a question of identifying what's going to be most likely to be effective for this particular person. And are there ways that we need to be heretical and violate, treatment fidelity and change the manual in some way that's going to be better suited for this particular individual and be more effective for this particular individual.
• 21:28
  Speaker 1: How did you recognize or come to learn about dissociation specifically, and how do you explain it to patients?
• 21:38
  Speaker 2: Well, it's interesting. I don't know that I can identify or remember how I first learned about dissociation. It's something if you're working with folks, to put it in nonprofessional terms, if you're working with people who grow up in hell, you're going to bump into dissociation very quickly. And especially recognizing that the dissociative, territory includes a lot more beyond, dissociative identity disorder or what used to be called multiple personality disorder that you're likely to run into psych, psychogenic amnesia, depersonalization, derealization, spacing out, which I think of as being the foundation of all the forms of dissociation. You're going to run into it, and it's going to require, being addressed.
• 22:40
  I think of dissociation as being different manifestations of spacing out. And I think of that as being an issue of undeveloped attention. And so interventions that will help people develop their capacity to attend and maintain attention, which is codified to some degree in the dialectical behavior therapy module of core mindfulness. In the original version of the dialectical behavior therapy group manual, the first thing you focus on is helping the person develop mindfulness, which is another way of saying, as far as I'm concerned, teaching them the attentional skills that they weren't able to develop growing up in incredibly chaotic, and unstimulating circumstances. So, that as well, I think of as being very much a developmental issue, which is consistent with the observation that at the most extreme end of the spectrum, dialectical I'm sorry.
• 23:59
  Dissociative identity disorder begins in childhood, which is, I think a reflection of the fact that it's an expression among other things, not just of trauma, but of undeveloped, capacities.
• 24:17
  Speaker 1: What are some of those other capacities besides just the trauma itself that are undeveloped? I I know we've referenced a few of those things, but how does that tie together in addition to the trauma?
• 24:31
  Speaker 2: Okay. So anything that falls under the heading of psychological development, and, unfortunately, taking for for example, the training of doctoral level psychologists, part of the core curriculum in in training to the the doctoral psychologists, the biological basis of behavior, the social basis of behavior, other areas. But what's not consistently or widely focused on in doctoral level psychology training is developmental psychology. So anything that equips somebody to be a well functioning adult, cognitive development, emotional development, social development, the development of attention. We're talking about an entire branch of psychology in and of itself that clinical psychologists, practicing psychologists are are not often exposed to with in a lot of detail.
• 25:44
  So trauma will interfere with someone's abilities or traumatization will interfere with somebody's abilities. But growing up in a an interpersonally deficient environment will not provide the person with the atmosphere that will help, establish those abilities to begin with. So one of the things we're looking at in the form of treatment that I developed for complex PTSD is not just how is traumatization interfering with the person's functioning, but what are the capacities that they never acquired to begin with that we need to help them develop in a remedial kind of way, so that their lives are a lot more gratifying and effective.
• 26:45
  Speaker 1: That makes so much sense, not just as in parts or self states or alters, but literally the development itself not having what it needs to grow and to finish, not having what it needs to be assessable. How can you give some examples of ways that trauma or neglect might impact some of those areas?
• 27:09
  Speaker 2: So a real obvious example is if you're growing up in a household where you're not getting a lot of attention from the adult especially from the adults in the household where people are not specifically aware of and responding to your feelings, a real effective adult will see that their child's upset and say, what's the matter? And the child may not even realize they're upset until the adult comes along and and recognizes that there's an expression on on their face or a tone of voice or a body posture that suggests that it that the child is experiencing some emotional disturbance. And so simply saying what's the matter will help the child, tune into or pay attention to what they're experiencing and begin to identify what's going on, within the sphere of their experience that the adult is responding to. And then by discussing the situation with the child, the child begins to learn how to express what's going on, how to identify emotional words, how to match up those words with what they're experiencing, how to notice on their own that there's something in their realm of experience, that constitutes an emotion that requires attention. So folks who end up with complex PTSD are either growing up in households where there's so much chaos and so little structure that it gets in the way of those kinds of developments or so little interaction and attention that there aren't the resources there to foster those kinds of developments.
• 29:07
  I try and avoid the word neglect, although that's off that's really a lot of the territory we're talking about. Because often when people hear the word neglect, immediately, they jump to blame. Why isn't the family why aren't the parents, being more responsive to their children? But there is a whole host of circumstances that can get in the way of attentive parenting that may or may not be intentional. But when we hear the word neglect, we tend to think, well, you could be doing otherwise, and you're either choosing not to as a parent or you're you're just, not interested as a parent as opposed to maybe you have to work long air hours and you're a single parent and you're not able to be there.
• 30:03
  And a host of other factors, external or outside of the parent's control that may get in the way of optimizing the child's development. So we're talking about the territory of neglect, but I try and avoid that word because often people immediately jump into blame. And the thing is that this territory is not gonna respond to the in interventions that we have for traumatization because they're not about resolving trauma. They're about teaching capacities or, passing on capacities that the person hasn't developed. And people think, oh, neglect.
• 30:46
  That's traumatizing. But prolonged exposure, EMDR, and so on are not likely to do much in terms of fostering development. They're great for neutralizing traumatization, but they're not well suited to helping people acquire skills that were never acquired.
• 31:06
  Speaker 1: So to make sure I understand, aspects of addressing trauma has to do with addressing things that went wrong and caused harm or were wrong and caused harm. And this area that we're not calling neglect because it's sensitive in those ways has to do with harm that was caused by what was missing?
• 31:34
  Speaker 2: Exactly. So trauma is a result of harmful kinds of circumstances that were there, and the developmental territory or the lack of development is the result of beneficial conditions that weren't there.
• 31:55
  Speaker 1: That makes so much sense. It reminds me of something John O'Neil said once about how even with things that happened that were bad, those things could not have happened without the absence of good. And I think also it's a really important thing to address because both in clinical experience and as well as interactions with listeners for the podcast, it seems like something a lot of people really struggle with is validating their own distress and that life is sometimes hard because of these issues that you're talking about right now. I think sometimes when we see something terrible that happened on Dateline or the 05:00 news or when we hear someone's trauma story where that's really, really terrible, it makes sense. Oh, of course that would impact the person.
• 32:50
  But when we have the absence of good in different ways or the absence of that passing down of capacities and those interactions and the relational traumas that you're describing, it really impacts us just as much in but in completely different ways.
• 33:11
  Speaker 2: Exactly. So take, for example, a child who's upset and crying, and either the parent doesn't interact with them at all, and so they're likely to end up feeling foolish and thinking, well, nobody is responding to my upset, so I must be upset for no reason, or my upset must not be valid. Or they might hear, what are you crying for? There's nothing to cry about, which explicitly conveys to the child that, that what they're experiencing isn't valid and has no reason. And so very, very often, what I encounter when I'm working with people with complex PTSD is they'll say self critical things about, I don't know why I can't get speaking about their trauma, I don't know why I can't get over this.
• 34:05
  I don't know why I made such a big deal about it. I don't know why I overreact this way. And so there's a lack of compassion for self because they did not grow up in an atmosphere that was compassionate. The way you learn, self compassion, the way you learn to feel good about yourself is through the compassion and responsiveness of the people that you grow up around. And if that's absent, then those capacities are likely to be very weak to nonexistent.
• 34:40
  Speaker 1: So that goes back to the metaphor of attachment as a mirror where we are treating ourselves the way we've experienced being treated when we are little.
• 34:54
  Speaker 2: Yes. There there was, a brilliant psychiatrist in the mid twentieth century, Harry Stack Sullivan, who talked about, people as being each other's mirrors. We look in a mirror to develop a notion of what we look like. Other people's reactions to us are the stuff out of which our image of who we are as people develops. So often, what I'll explain to clients who grew up in chaotic or, dep detrimental circumstances is that they grew up either with an absent mirror, and they'll often say, I don't always feel like I exist.
• 35:43
  I don't always feel like I'm here because no one was responding to them or more often with distorted funhouse mirrors because what they the reactions of other people they were growing up with and the things they were being told about themselves were grossly inaccurate. But when you hear these things or get these reactions repeatedly throughout your formative years, you walk away with the conviction that what's been reflected back to you about yourself by other people must be who you really are. And so this is not something that's undone quickly, or with a predetermined strategy, helping people, disabuse themselves of the distorted image that they have of themselves and go about developing a much more accurate and almost inevitably a much more positive image of themselves.
• 36:43
  Speaker 1: Oh my goodness. There were so many things so powerful in what you just said. You just said. I know you know what you said, but I want everyone listening to be sure that they heard what you said, that part of healing is disabusing ourselves. But then also this other learning to have compassion for ourselves.
• 37:06
  So when we go back to the mirror example, which we have been talking about a little bit in the community, so, that's part of why I wanna bring it up again, is is that there are some people who may have these experiences of depersonalization or derealization or feeling like they don't exist or they're not worthy or they don't matter, and it's because there was no mirror at all. And other times, we may have these experiences of more extreme dissociation like OSDD or DID where there are self states or alters or personalities or parts, whatever language people use, that has to do with the mirror that we had was broken and these different reflections that we saw of ourselves in those experiences?
• 37:59
  Speaker 2: Well, from a developmental perspective, I would argue the people who end up with dissociative identity disorder and a sense of being fragmented, their mirror wasn't broken. Their mirror was never developed. People are not born with a coherent sense of self. That comes from consistent interactions with other people. And if your, family is tremendously inconsistent and their reactions to you depend on their own internal states.
• 38:35
  So if they're feeling good, they're gonna be affectionate towards you. If they stub their toe and they're upset and they're angry, they may start yelling at you or hitting you. And what I'm saying is that often, their behavior in interacting with the child may have nothing to do with the child's behavior, but the child does its best to adapt to whatever the the parent, for example, is presenting to them. And so they have to be, develop a number of orientations to interacting with other people because they never know how the other person is going to react to them.
• 39:18
  Speaker 1: So almost like lots of mirrors, except none of them were about them. So it's almost like it was glass. It wasn't even a mirror at all.
• 39:29
  Speaker 2: And and not consistent mirrors. Mirrors that reflect back very different, in inconsistent images of who they are. One of the things that I find interesting is that we think of dissociative identity disorder, multiple personality disorder, as being about somebody having a bunch of senses of self. But in some respects, it's about having no sense of self and not having a core clear notion of this is who I am because there wasn't a consistent, accurate reflection back to them of who they are.
• 40:16
  Speaker 1: So then over the course of a lifetime, it becomes these different efforts of trying to find a mirror and trying to be good enough at one of them or experiencing it different amounts of time with one that, like, those different efforts get more developed, but still are not getting good, healthy, consistent mirrors.
• 40:38
  Speaker 2: Mhmm. Mhmm. Yes. And, you know, this isn't exclusive. This is something that's true for all of us.
• 40:48
  Our notion of ourselves, our sense of ourselves is very strongly affected by the people around us. That happens in a marriage. You your your image of yourself is changed and shaped by your partner's reactions to you. And it's kind of like, does a fish realize it's surrounded by water? This is such an everyday kind of phenomenon that we really don't realize that it's happening.
• 41:27
  You certainly see that, in people with domestic violence relationships whose sense of them themselves is very strongly affected by the very extreme reactions of physical abuse, gaslighting. And to a large extent, gaslighting is what you think is going on is not what's going on. The person you think you are is not who you really are. So, clearly, that has a very strong impact on the person's image of themselves even though very often, these relationships, first occur once the person is an adult. But someone who grow up in chaotic or depriving circumstances is going to be more vulnerable to perpetrators of various kinds because they feel deprived of love.
• 42:23
  They basically feel I've gotta conform to what other people want from me if I'm going to get any kind of positive feedback. So that unassertiveness and desperation for affection, is the sort of thing that perpetrators are looking for in a potential victim, and they're gonna zero in on that person who they recognize is hungry for love and who has difficulty asserting themselves and pushing back when they're being overpowered or when someone's attempting to control them in various ways.
• 43:00
  Speaker 1: So, again, not that we're failing and getting ourselves into these situations, but literally can't see a mirror to tell us we're in these situations and then have to build capacities before we're able to get out of them.
• 43:15
  Speaker 2: Right. And there is a whole literature that developed asking the question, why do people who are mistreated as children keep seeking out mistreatment as adults? And I think that's based on the misunderstanding where the failure to recognize that in an abusive relationship, there's at least two people. And that what, is largely responsible for people repeatedly ending up in relationships where they're being mistreated is the people who are invested in controlling and mistreating other people are looking for a certain kind of person who they know they can have their way with. It's not the people who are actively seeking out being mistreated.
• 43:59
  Speaker 1: So it's almost like reenactment is really someone else's reenactment, but we have the mess of it.
• 44:07
  Speaker 2: Yeah. I mean, there that is probably the primary driver of somebody who repeatedly finds themselves in these relationships is they're being taken hostage again and again.
• 44:22
  Speaker 1: So what does setting ourselves free look like? Building capacities?
• 44:28
  Speaker 2: Building capacities, and chief among that those is developing a more accurate, more positive view of oneself, recognizing what, what is one's do, what one deserves, recognizing when somebody is taking advantage of you. Really chief among valvus is having the capacity to feel good about yourself so that you can say, I don't deserve this kind of treatment. I'm not going to accept this kind of treatment. I'm going to push back when somebody tries to do this sort of thing to me. And those capacities, a solid sense of self esteem, the ability to assert yourself without becoming aggressive and attacking yourself without becoming aggressive and attacking, negotiating relationships, being able to size other people up and assess where they're coming from, these are all developmental capacities.
• 45:41
  They're all skills that someone is unlikely to learn if they grow up in a situation, that's marked by deprivation or chaos or both. And that's why it's so important that that be a major aspect of therapy, not just assuming that resolving the trauma is going to take care of everything, but looking at what's been missed out on and helping to the person to, establish what they missed out on.
• 46:14
  Speaker 1: So more advanced capacities then become putting those pieces together of, for example, feeling what I feel, learning to tolerate what I feel, but also connecting that to not having had a mirror or having having a funhouse mirror that was distorted and not accurate and that the way I'm treating myself is actually not just a reenactment of previous relationships, but specifically how people have treated me before and that I know that that is not something I wanna repeat. And I know that is not something I wanna act out again or do to myself. So not or so then what you said earlier, what was that word? Disabusing myself and not or sort of intervening in that process and making different choices and talking to myself differently, but also learning how to add the good back in.
• 47:17
  Speaker 2: Yeah. And and what I mean, there are so many capacities that someone needs to, acquire in order to be a well functioning adult. And one of the key ones is being able to soothe yourself when you're upset. And if you don't have the ability to soothe yourself when you're upset, you're going to turn to call to soothe you, drugs to soothe you, the intensity of nonsuicidal self injury to soothe you, drama, interpersonal drama to distract you and soothe you. So it's not just a question of saying, I'm not going to mistreat myself by drinking, drugging, engaging in non suicidal self injury, but learning how to soothe yourself in ways that don't have that kind of cost and don't create that kind of damage.
• 48:19
  It's understandable if somebody doesn't know how to reduce their distress, how to lower their anxiety, how to feel better when they're shaken up, they're going to turn to the things that require immediate that provide immediate relief, but at the same time, may carry a tremendous cost.
• 48:43
  Speaker 1: That's amazing. There's so much in that for listeners who are themselves struggling with trauma and dissociation. What would you share specifically with clinicians who are trying to help them? Is there anything you would add specifically for them?
• 48:56
  Speaker 2: Well, I said before that I will negotiate with the clients I'm working with. What do you wanna accomplish? And what order are we going to do this in? And, of course, they'll establish certain goals at the beginning, and then we might accomplish that. And then it's okay.
• 49:15
  What's the next thing that pops up that you wanna work on? But often, I'll encourage clients that one of the most powerful things we can work on at the very beginning is learning how to reduce their distress, learning how to suit themselves, learning how to shift their mind state out of anxiety and terror and distress into one of feeling calm and a sense of well-being. Once they learn that, that helps them sleep better, reduce reliance on addictions, think more clearly. So there's a and then, if they're able to reduce their distress, they're much better equipped to face the inherently distressing matter of revisiting their trauma without being bowled over by it. So what I would say to clinicians is priority one is helping your client to learn not only how to reduce their distress when it spikes, but how to practice procedures that will reduce their distress on a regular basis so that their level of distress at any given moment is lower than it was when they entered treatment.
• 50:50
  I'll talk a lot with clients about assessing their distress on a zero to 10 scale. Life at a two and below is a whole other territory than life at an eight at an eight and above. And many people with complex PTSD and serious dissociative disorders have been living most of their life at an eight and above. It's hard for them to imagine that anybody gets below a five on that scale. It's a revelation for them to hear that that's the case.
• 51:22
  And when people do, start living you know, gradually reduce the number between 10 that they're living at in terms of their degree of distress and are living on a consistent basis at the lower end of that scale rather than the upper end, the entire quality of life changes. And what they're capable of doing, expands tremendously. So that might be the single most important thing that somebody who's grown up with extensive trauma and deprivation can accomplish.
• 52:00
  Speaker 1: Thank you so much for sharing with us today. Is there anything else you wanted to add that we did not get to talk about?
• 52:08
  Speaker 2: We covered an awful lot of territory. I really can't think of anything else. I wanna thank you for asking questions that really helped me to identify the things that I think are most important, for both therapists and people who've been traumatized, to know about how to overcome the effects of both trauma and deprivation. So thank you for having me.
• 52:36
  Speaker 1: Thank you so much. That was really, really helpful and had a lot of really powerful information that I think will be good for people, especially in the context of things we've been talking about on the podcast podcast recently. So it's gonna put a lot of pieces together in a beautiful way I didn't even expect. I so appreciate that.
• 52:55
  Speaker 2: Great. So I I have a 03:00 appointment, but I do have a few more minutes. I'd be curious to hear how you came to be doing this podcast.
• 53:09
  Speaker 1: No. That's a good that's a good question. I started the podcast I got diagnosed with DID when both of my parents died unexpectedly. Well, one had cancer and then my mother was killed by a drunk driver on the way home from the funeral. So it was like bam bam and just sort of threw everything into chaos.
• 53:28
  And I had a good therapist and I was making good progress, but I couldn't find resources that were both accurate and lived experience and, accessible to me. Like, I'm not a YouTube person. I'm not a I just so I couldn't find a podcast and I have cochlear implants and I was having to call and do this listen and talking thing every day and my husband just said, why don't you just do a podcast about what you're learning about DID? Then you don't have to call the number and talk about fairy tales and you can actually be learning, like, doing two things at the same time that are helpful for you. And then and so I started that and clinicians have been very kind to participate.
• 54:13
  I think primarily because we do focus it on the accurate information and the healing process. It's not just like a parade of altars or something like that. And and it's I really have been so grateful to the clinical community for their support because we would not have been able to add this resource without that. And so to be recognized by ISSTD and, I do a lot for them as well and and, to connect with other resources like your program or to learn about things like that have just been so wonderful, and it just grew. I didn't know it would turn into something, but it's all over the world now in in 93 countries and a million downloads.
• 54:57
  Like, it's just a lot. So
• 55:01
  Speaker 2: That's wonderful. Congratulations.
• 55:03
  Speaker 1: We'll we'll go as long as it's helpful. But
• 55:06
  Speaker 2: If if there were one more thing I would have added, now that I've heard what you have to say is that there's a lot more dissociation than DID in the same way that there's a lot more to anxiety disorders than obsessive compulsive disorder. And often people equate dissociation with DID and don't realize that there are a lot of people out there who don't have a sense of different identities, but don't feel real, don't feel things around them are real, are forgetting major episodes in their life or long periods of time in their life. And therapists often either assume, well, that must mean that you have parts. That must mean that you have DID, or they don't recognize what they're seeing because it doesn't fit that assumption that dissociation exclusively equals DID.
• 56:05
  Speaker 1: I appreciate that because there's a lot of listeners who ask, like, I don't they said I'm OSDD, but that doesn't quite fit. They said I'm DID, but that doesn't quit. Or I feel more like this or less like that. And so I think really broadening that understanding and seeing it more clearly is so important. Thank you.
• 56:25
  Speaker 2: Thank you. I really appreciate that you asked me to do this.
• 56:28
  Speaker 1: I appreciate you coming on. I do. I know your time is valuable, and I so appreciate that. Thank you so much.
• 56:35
  Speaker 2: Okay. Thank you again.
• 56:37
  Speaker 1: Bye.
• 56:38
  Speaker 2: Take care. Bye.
• 56:45
  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.
• 57:06
  We look forward to connecting with you.