Latest / System Speak: Complex Trauma and Dissociation / Guest: Peter Barach, PhD

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Guest: Peter Barach, PhD · System Speak: Complex Trauma and Dissociation

• 0:26
  Speaker 1: Doctor. Peter Barish attended Johns Hopkins University and the University of Michigan. He received a PhD in clinical psychology from Case Western Reserve University. He is clinical senior instructor in psychiatry at Case Western Reserve University School of Medicine in Cleveland, Ohio. Since 1984, he has been in private practice in the Cleveland area with Horizons Counseling Services.
• 0:53
  His clinical approach is relational and supportive. He specializes in working with people with dissociative disorders and adult survivors of trauma. He also works with depression and anxiety. He is trained in EMDR and clinical hypnosis. Doctor.
• 1:11
  Barish is the author of scientific and clinical articles on Dissociation and Dissociative Identity Disorder. He is a past president of the International Society for the Study of Trauma ir also chaired the committee that produced the first set guidelines for adults with DID in 1993, and has participated in revisions of the guidelines. In addition to his writings on dissociation, Doctor. Barish served as consultant for broadcast media and as a reviewer for several journals. He has also served as an expert witness in civil and criminal matters.
• 1:57
  In addition to maintaining a private practice, Doctor. Barish currently works for the Cleveland VA Medical Center where he evaluates Veterans who have applied for disability compensation. He is not appearing on this podcast as a VA employee. The opinions he expresses are his own and do not represent Department of Veterans Affairs or its policies. I was delighted to have Doctor.
• 2:21
  Peter Barish on the podcast and to interview him. I very much appreciated his perspective and gained new insights as clarified some of my concerns. He also answered some of the historical questions we had about treatment guidelines. We also shared a history of the VA, as both of my parents worked in the VA as I growing up, and we also did our post doc residency for chaplaincy at a VA hospital. So while he is not at all representing the VA on this podcast, we shared that cultural history together, and it was something that connected us from the beginning.
• 2:59
  Welcome Doctor. Peter Barish.
• 3:01
  Speaker 2: Doctor. The VA is going to be an awesome place to work. Did my pre doctoral internship at the Pittsburgh VA and I learned so much. I want to tell you a story about my experience there. The person who was Chief of Psychology at that time, his name is Arnold Friedman and he has recently retired from his private practice in Pittsburgh.
• 3:27
  On my first day in the VA, he and I and another psychology intern went to see a veteran who had been admitted to the hospital because he had phantom limb pain. They couldn't figure out how to relieve it. And he had lost his leg in a kamikaze attack on his ship during World War II, so that tells you how long ago this incident was. This was about 1980 when they really hadn't even named PTSD yet or were just about to put it in DSM three at that time. So the man had phantom limb pain which basically means he's experiencing pain in the limb that he lost.
• 4:08
  So the pain is really coming from the central nervous system. So Doctor. Friedman is totally awesome at getting rapport with people quickly. So he had never met this man. There was no reason this man would have to trust him.
• 4:23
  But within a few minutes, they had a good working sense of an alliance between them. And I was watching along with my fellow intern. And Arnie, who used clinical hypnosis for many years, asked if he could help him to deal with his phantom limb pain with hypnosis, and the man said, Sure. So Arnie helped him get into a hypnotic trance and had him go back and basically relive what happened when he lost his leg. And at that point, the man was really there and re experiencing what happened in his trauma.
• 5:08
  And the thing that came out that was new for him as he was reliving this experience was how much guilt he felt that he had survived and others had died. And in the most gentle way, Arne suggested to him that, you know, it might be okay to let go of that guilt for now if you really don't need it. And maybe you don't need to have your pain as a way to remember how guilty you felt. Wow. And then he said, and you know, this has been a very difficult memory for you to have And if you wanna leave it behind when you come out of trance, that's okay or you can remember it all when you come out of trance.
• 5:47
  So then he helped the man get out of trance and get reoriented to being in his bed in the VA hospital and Medical Floor. The man didn't remember what happened but his phantom limb pain was gone and in a six month follow-up, it hadn't come back.
• 6:02
  Speaker 1: Wow. So
• 6:04
  Speaker 2: I learned two things from that. The first thing I learned was how important it is to make a personal connection with somebody as soon as you can so that there can be the basis for development of trust. And the other thing I learned was the power of hypnosis. So I did a whole year's rotation in that internship and had a lot of experience working with traumatized people. But the other thing that I took from that is what you get from a mentor.
• 6:36
  Ernie is one of the people who is behind me in my imagination, obviously, that I can call upon anytime I need him. I can think about what it would be like if he were here right now, what would he help me do? Now, he is 92 and he's still alive and still in Pittsburgh and I saw him a couple of years ago. He didn't remember this incident but he was pleased to hear about it. So all of us, whether we are somebody's client or somebody's therapist, have had experience with somebody that we can take with us and keep with us on our shoulder or standing behind us in some way to provide support during the difficult times that we have.
• 7:19
  And that was one of the people I learned that from.
• 7:23
  Speaker 1: That's really powerful.
• 7:25
  Speaker 2: I thought so. So before there was EMDR, there was hypnosis and a lot of people in those days, back in the 80s, used hypnosis to help trauma survivors process what had happened, abreact it or relive it in a therapy session as a way to process trauma. And many therapists still use it and I do also along with EMDR But it's one way to help people process what happened and to kind of move away from reliving it so much.
• 7:58
  Speaker 1: What do they do in a hypnosis session? I mean, I know it's unique to each person just generally, what is that like?
• 8:07
  Speaker 2: Well, since the reason we're talking has to do with DID, I just want to say that many people in the field understand that DID is a form of hypnosis that people have developed to cope with trauma and to deal with daily life. So when people switch, when their alters take over, they're going through kind of a mini hypnotic moment of going inside and changing their focus of what aspect of themselves or what part or what alter is on the outside. With DID, they're very easily able to get into hypnosis in a situation where they feel safe enough to do that. So it's really useful as a way to try and make some communication with some of the parts that haven't presented themselves. It's also a way to help the parts learn to get better connected to each other.
• 9:00
  One of the first presidents of ISSTD, International Society for the Study of Trauma Dissociation, was a guy from Ohio, a psychiatrist named David Call. David unfortunately died before he took office in 1988 But David invented a technique called the conference room, which is imagining inside that there's a big table in a conference room and that whatever parts of you, whatever alters are willing to be there can sit around the table and take a look at each other or talk to each other or listen to each other. It's a way to start to build some connections.
• 9:37
  Speaker 1: Wow!
• 9:38
  Speaker 2: So he developed it first and then George Fraser who's a Canadian psychiatrist used essentially the same technique under a different name called the dissociative table technique. Both of them published about this. So hypnosis is the way to help someone do that, to begin to use their resources of imagination and building bridges within to make some connections and get some cooperation going or at least some negotiation for common goals.
• 10:05
  Speaker 1: That's amazing.
• 10:06
  Speaker 2: Yeah, it's really useful.
• 10:08
  Speaker 1: How is EMDR the same or different?
• 10:11
  Speaker 2: Doctor. Well, EMDR is much more structured than hypnosis. It's got standardized protocols that the therapist follows unless somebody gets stuck. One way that it's similar one way that it's different than hypnosis is the experience of EMDR is kind of like you're in two places at once. When you're doing the eye movements or hearing or watching the the lights move back and forth, you are just allowing yourself to go with that experience.
• 10:41
  And whatever feelings, memories, sensations, and beliefs in the trauma, that you're working with, you're in them, but you're also, in the present moment connected to a stimulus in the room with you, the lights, the therapist voice, whatever is going on. So you shuttle back and forth much more easily in EMDR between the past and the present, which a lot of people like because you don't get so swallowed up in the trauma. You get to step in and out of it a little more. It's like you put your toe in the water then your ankle in the water and maybe your knee and when you've had enough, you can just open your eyes or say to the therapist, Stop, and that gets respected. With hypnosis, it's less there's more of a sense of being inside reliving it and it can get pretty overwhelming.
• 11:30
  Although there are ways to modify what goes on so that it's less so.
• 11:33
  Speaker 1: That's amazing. Why are some of these being lost, which is maybe an overstatement or a generalization, but I mean, with the and I know there's practical answers like managed care and limited sessions and
• 11:49
  Speaker 2: You mean why is hypnosis not being used?
• 11:52
  Speaker 1: Yes! Why are not more people doing that if it's so
• 11:54
  Speaker 2: I agree. Well, Richard Clough has been saying for years that knowing hypnosis and understanding it is an essential part of being able to work with people who have DID and I couldn't agree more strongly. Where things started to go wrong with using hypnosis was really with the onset of the false memory syndrome people because they started to claim that hypnosis was causing people to develop false memories based on suggestions that their therapist gave them while they were in trance.
• 12:25
  Speaker 1: Which was false and we've come so far. Like I feel like just now, we're sort of rising above that and moving past it which is the impact of it was like twenty years.
• 12:35
  Speaker 2: Sure. One of the reasons they got involved, the false memory people got involved as strongly as they did in fighting the treatment of dissociative disorders was because there were some people who recalled abuse and then went to sue their parents or whoever the perpetrators were. And then when they get into court, it turned out that some of their memories had been retrieved during hypnosis. And of the people who was on the scientific advisory board of the False Memory Syndrome Foundation at the time, Martin Orn, really written a lot about why hypnotically retrieved memories shouldn't be admissible in court. And generally, they aren't nowadays.
• 13:19
  So by having a scientific advisory board say that this was going on and that there was something called recovered memory therapy, it scared a lot of therapists who were afraid of being sued and scared some who were being sued out of doing this work. A lot of really talented people dropped out of treating dissociation at that time which is a real tragedy. And yeah, I do think things are coming back now.
• 13:47
  Speaker 1: I feel like you've just answered a different question for me that I didn't even have words for in that. Oh,
• 13:53
  Speaker 2: what was it?
• 13:54
  Speaker 1: Well, you know, next week is the ISSTD conference.
• 13:58
  Speaker 2: Yes.
• 13:59
  Speaker 1: And so
• 13:59
  Speaker 2: And I wish I could go, but I can't.
• 14:01
  Speaker 1: Right. Me either. I have to speak somewhere else already. And but at the same time so there's me and a few other advocates for DID survivors.
• 14:13
  Speaker 2: Mhmm.
• 14:14
  Speaker 1: That got together at the Infinite Mind Conference in Florida.
• 14:19
  Speaker 2: Uh-huh.
• 14:20
  Speaker 1: And while we were there, we have planned a counter conference during the same time as the ISSTD conference.
• 14:28
  Speaker 2: Yeah. I saw that. That's really a cool idea. I wish I could listen in more, but I'm I'm seeing clients that day.
• 14:33
  Speaker 1: Well, it's here's what we wanna do, though. Like, I wanna be clear that we are not, like, ISSTD haters. I don't want Yeah. The media to misinterpret that or turn it around. Mhmm.
• 14:47
  But we want information accessible to survivors who don't have clinical access to that.
• 14:55
  Speaker 2: Yeah. I think that's a great idea.
• 14:56
  Speaker 1: And we want it accessible to deaf people and blind people so everything is being transcribed. Everything all the pictures are having caption descriptions, and it's also free. And we're recording it so that it will all be either on the podcast or on YouTube. And so people at any time can go watch these or look at it. And because of some people because of our limitations in our first year, they're they're I mean, we're gonna do our best and put on the best that we can or whatever.
• 15:33
  You know? But I one of the things that I talk about because I'm giving the keynote for this. And one of the things that I talk about is how there's this strange gap of this twenty years where almost nothing happened other than as far as research or new treatment other than older treatments being repackaged into smaller models or faster models or this or that, but not this full reclaiming. And I think part of it really is about what you just said and what happened with the false memory. Like, we as a system, meaning clinicians and survivors together, not just the internal system, but the greater system as a whole, have really been wounded by this.
• 16:16
  Speaker 2: Oh, yeah.
• 16:17
  Speaker 1: And it's taking time to recover from it and we're just now getting our feet back under us.
• 16:23
  Speaker 2: I'm really glad that this is happening too. Also, there's some good outcome research. There wasn't much before. Colin Ross and his associates did a little bit. But now there's some published outcome research that's a lot better that Doctor.
• 16:43
  Brand has spearheaded. Long term treatment outcome studies with very clear goals and ways to measure progress. I think it's wonderful that that kind of thing is going on because it wasn't present at the time when we first wrote treatment guidelines for DIT back in 1993.
• 17:02
  Speaker 1: Right, right. So, what's happened in those twenty years I'm using 20 as a generic number, but what's
• 17:10
  Speaker 2: happened in
• 17:13
  Speaker 1: years though, while everyone like almost had to go on pause, is that people who were already in treatment just had to continue with what they had access to. And then now, there's like three or four generations of new survivors who can't get access to treatment or have very limited access to treatment, and clinicians who are really good at what they do, but are scared to do DID, so to speak. Yes. And so there's this divide, like a wound systemically between clinicians and survivors where it's hard not just to find a therapist, but as an educated person or as a person trying to educate others to connect or collaborate. Bring healing to that womb to help all of us.
• 18:06
  Speaker 2: Yes, I know exactly what you're talking about. We used to have an Ohio Society for Clinical Dissociation that had annual conferences. 100, one hundred and 50 people used to come. And when Medicare rules changed so that it became impossible to really give people any length of hospital treatment, People would then end up going in the hospital and get told that we don't want to hear from your personalities. You're not allowed to come out here, which was just destructive.
• 18:40
  And this happened around the same time as these lawsuits against therapists became a serious issue in the 90s. So as a result now, I only know a few people in Ohio who work with DID and only a couple in the Cleveland area, two or three. So it's not good.
• 19:02
  Speaker 1: Right. I drive four hours to see my therapist in another state Wow. Because it's the only one that I could find. And also she's really good, so I'm happy with her now and I want to stay there. But Mhmm.
• 19:17
  When Kathy Steele, I live in Kansas City now, and when Kathy Steele came to town, like, a 50 people came out of the woodwork to come hear her speak. I was like, where have you been? Yeah. What have you been doing?
• 19:32
  Speaker 2: I heard your presentation or your episode about shame in which you discussed a lot of what she said.
• 19:40
  Speaker 1: Oh, right.
• 19:41
  Speaker 2: That was very well argued. I agreed with some of what you said and disagreed with some but you really did a good job at explaining what her position was and where you thought it was lacking or where you disagreed with it. I really got a lot out of listening to that.
• 19:57
  Speaker 1: Oh, well thank you. I appreciate that. I have continued to study more of what she said and looked up more and so I feel like that's a progression. It was just a like, that's the one thing that's difficult about a podcast, right? Like, it's not the
• 20:11
  Speaker 2: same person.
• 20:11
  Speaker 1: Yeah. So it's like a snapshot. So I feel like that's continued to evolve and I understand it more. Mhmm. But but I'm learning and trying to grasp it and hold on to it.
• 20:24
  In your office or or with someone with DID, how do you explain what trauma and dissociation is?
• 20:31
  Speaker 2: Well, I explain that trauma is basically defined as an experience that is too overwhelming to deal with at the time. So that's a pretty broad definition.
• 20:42
  Speaker 1: Right.
• 20:42
  Speaker 2: And dissociation is one of the ways that people cope with being overwhelmed at the time of a trauma. Example, I was driving home from work and the light turned green for me and another car hit the front end of my car as I was going through the intersection. Nobody was injured but my car was nearly totaled. And I remember the feeling of watching it happen in slow motion. You know, I slowed down the motion.
• 21:09
  My brain slowed down the motion so that I wouldn't get completely swamped and terrified by what was going on. So the police came, they gave me a ride home which was really nice and I was very calm until I got home then I started shaking And then I was, you know, very upset. Even though nobody was injured, it was like I dissociated my fear until I got home and I was in a safer place. So those are small examples of it. So dissociation is a way that people protect themselves from overwhelming experiences and when it starts, it's not voluntary, it's just something the body does because trauma happens in the body obviously and it lives there.
• 21:51
  Speaker 1: And you've actually connected two pieces for me again. I'm really enjoying speaking with you. Thank you. I'm glad to talk with you I just got the Coping with Trauma Related Dissociation workbook.
• 22:04
  Speaker 2: Oh, that's really helpful. I've given it to a bunch of clients, so.
• 22:08
  Speaker 1: Oh, well, I just got it for a group and one of the things I was just reading about today was talking about time speeding up and slowing down. And that is the first time I had seen it described and now you've just talked about it. Mhmm. And so my brain is very very focused on that because I just found words for that experience.
• 22:30
  Speaker 2: Yeah.
• 22:31
  Speaker 1: So I have a question, a follow-up question. Sure. Would that happen can that happen over an extended time as well and not just in the crisis moment?
• 22:42
  Speaker 2: Like, what do you mean?
• 22:44
  Speaker 1: Well so for example, without going into detail, just adverse experiences kind of list In recent years, both of my parents died and we fostered 70 kids and we adopted six with special needs and the youngest one has been on palliative care and in and out of the hospital for three years. And I feel like all of this happened really quick and we didn't know any of it was gonna happen and it all like, piled on each other faster. That's part of how we ended up getting diagnosed because it was more than we could keep up with. And so that's when sort of everything fell apart and I got the diagnosis, found the therapist. But what's happened is I feel like those it all happened in about a period of three or four years and I feel like those three or four years were like ten or twenty years.
• 23:45
  Speaker 2: Oh, yeah.
• 23:46
  Speaker 1: Yeah. And now since finding the therapist and have been in therapy for a year actively, like, actually participating with her, another therapist that didn't know about DID before her, and now the podcast and in group. And the more that I talk about these things and process these things, I feel like my life is speeding back up. And it feels like not in an anxious way, but in a I'm moving back towards a baseline kind of way.
• 24:16
  Speaker 2: More like you're living in the moment instead of just being swept along by events Yes. That were too much so they had to slow down for you to cope.
• 24:25
  Speaker 1: Right.
• 24:26
  Speaker 2: Is that it? Yes. Oh, yeah. Sure. Yeah, well, you answered your own question.
• 24:30
  Your experience tells you the answer.
• 24:32
  Speaker 1: That's fascinating.
• 24:34
  Speaker 2: Yeah. Well, what you said was fascinating but yeah, it makes complete sense to me. Yeah, I never had anything like that happen But I could see how that would would have occurred with all those things going on so quickly simultaneously and one after another.
• 24:50
  Speaker 1: So were you in the ISSTD as well?
• 24:55
  Speaker 2: Doctor. Yes. Well, let me tell you how I got started working with dissociation. The first time I saw somebody with a dissociative disorder was in my first placement in graduate school which was in a state mental hospital for people who were chronically mentally ill. It was a long term hospital and this was at the beginning of the movement to try and get everybody out of these hospitals in the community, which was an unfortunate mess.
• 25:26
  Speaker 1: Yes, yes, yes.
• 25:27
  Speaker 2: Yeah. Everybody in the hospital was diagnosed pretty much with what they used to call SCUT, which is a horrible acronym for schizophrenia, chronic undifferentiated type. And they were all on heavy, heavy doses of antipsychotic medication. So one of the people there there were also people there who had been sent there by the courts. They'd been found not guilty by reason of insanity of committing various kinds of felonies.
• 25:53
  And one of them was a woman who looked like the other patients in that she was heavily medicated and she was not able to do much other than walk around and ask people for cigarettes, which they had in the hospital in those days. She had gotten pregnant by another patient and the hospital was trying to decide how she would function in the community, whether she was going to be able to manage taking care of the baby and so on. The reason she was there was that she had set the house on fire and her mom had died in the fire. So nobody really understood why she had done that. There was no clear reason as to why she'd done that.
• 26:33
  We know that she'd been abused. We, meaning my co therapist and I, knew that she had been abused by her father but we didn't know what the issue was with her mother. So while talking to her one day and asking her to think back to those days, now I know what happened. She switched and she relived the fire.
• 26:52
  Speaker 1: Oh, my goodness.
• 26:54
  Speaker 2: After after doing that mosession, which, like, shocked the heck out of me because I'd never seen that happen with with a client before. I mean, like I'm telling you, I've been in school for a year, in graduate school. I remembered something I'd read in in the police report that was in her file. After the fire while they were putting the fire out, she'd been found in the bushes down the street, just sitting in the bushes, the police officer asked her what her name was, and she said, Fick. So I asked her at the end of the session, What do you think that meant?
• 27:24
  She says, Well, I don't know. I guess that meant I was a figment of somebody's imagination. So I thought this was a great therapeutic breakthrough. Wow! I went home all pleased with myself.
• 27:35
  Gee, I helped this happen. I came back the next day and she didn't remember the session, any of it. She didn't remember that we'd met or anything at all like that. And I didn't realize what that was, that this was someone who had DID and had never been diagnosed until I saw the next person with DID which is a couple of years later in a completely different setting. It was an outpatient mental health center.
• 27:59
  And this woman had come in and the reason she wanted help was, I want you to tell me, she would say with a smile, I want you to tell me why I stay with my husband when I don't love him. So we've been doing like standard talk therapy for a couple of months and after she left, I made my notes and I opened my door and then she was sitting on the floor crying like a little girl And in talking to her, I realized this was another part of her. So that was the first time that I saw that she had alters or parts. And I made some connections with other people in the area who had had some experience working with MPD as it was called back in those days and started to get very interested in learning more obviously so I could figure out what was going on and try to help her. So around 1986, I started going to ISSTD conferences and presented a couple of papers there and then got asked to chair the writing of the treatment guidelines that we first put out in 1993 so that's how I got into
• 28:58
  Speaker 1: it. Oh, wow!
• 29:01
  Speaker 2: The impetus for the treatment guidelines actually came from someone at an insurance company. One the presidents of ISSTD had a good friend from medical school who was the medical director of a large insurance company who told him, You guys really ought to have some treatment guidelines because we don't know what to do with approving visits for these people. So then I got asked to chair the committee and we spent three years writing the first set of guidelines. So, it came from an insurance company. That's one of the few good things that comes from them.
• 29:33
  Speaker 1: That's amazing. Do you know why they've not updated them?
• 29:38
  Speaker 2: Doctor. Well, have. I mean, the last update was in 2011. So that's now on the ISSTD website.
• 29:46
  Speaker 1: But that was before the DSM-five?
• 29:49
  Speaker 2: Yeah. I don't think that's going to change much because DID itself really didn't change much from DSM-four to DSM-five. Yeah. I mean, there's more research to support the guidelines but I don't think the general recommendations have changed at all.
• 30:04
  Speaker 1: Right. We talk about it at the counter conference. Thing that we would like would just change in language to from patients to clients because that's just more modern now?
• 30:16
  Speaker 2: There's mixed feelings about that and I sort of alternate both because I work in a hospital now but the word client comes from a Latin root meaning to lean on somebody. Oh! So some people don't like that for that reason because it implies a kind of dependence.
• 30:34
  Speaker 1: Interesting, I didn't know hospitals and I do know that there the language is much more patients just because of the general population, whether they're psych patients or not. So I understand that culture of it. But you gave me another piece I didn't know and I'll be glad to explain that.
• 30:52
  Speaker 2: I mean, people who are medically trained or work in medical facilities are going to use the word patient and a lot of people with other training, psychology, social work counseling and so on, have been trained to use clients, especially recently.
• 31:06
  Speaker 1: Do you think that there will be any big impact from the ICD 11 being with PDD instead of OSDD? The partial DID? Or is it just a language change?
• 31:18
  Speaker 2: I don't know. I never get to see the actual definitions of those terms in ICD-eleven. It's really unfortunate that developmental trauma disorder didn't make it into the DSM-five. It should have because that really is complex trauma or complex PTSD.
• 31:36
  Speaker 1: That was shocking.
• 31:38
  Speaker 2: Yeah. It was terrible.
• 31:40
  Speaker 1: That was really well documented in the Body Keep score. Yeah. I appreciate he provided that written history of it and gave the whole context of it.
• 31:50
  Speaker 2: Yeah, that is such a wonderful book. I recommend it to a lot of people and learned a lot from it. I wish I had training in body oriented therapies. My experience as a patient or client, however you want to call it, in gestalt therapy and in gestalt therapy workshops, which are offered a lot around Cleveland, that has really helped me to understand how to be aware of what's going on in my own body as a client and also as a therapist.
• 32:18
  Speaker 1: Right.
• 32:19
  Speaker 2: And to help clients, generally direct clients, to just notice what's going on.
• 32:26
  Speaker 1: Interesting. How you manage that when you were working with the intensity of past trauma?
• 32:34
  Speaker 2: I think it starts on the first day. When somebody comes in, I tell them that, you know, this may seem odd if you've had other therapists and they haven't done that, but there are going to be times when I ask you to notice, you know, what's going on in your body. What do you notice physically? Because trauma lives in the body. Emotions are a body experience.
• 32:50
  And sometimes it's another source of information for you to get more connected to you. So I may ask you those questions. Let me know if it's uncomfortable. But if it isn't, just play along with it and see what you find out.
• 33:06
  Speaker 1: How you manage it for yourself?
• 33:09
  Speaker 2: I mean, I'm very much a skeptic about supernatural things but I can't explain exactly how this happens. But recently, I had an experience this was last week. I was sitting with somebody who does not have a dissociative disorder that I worked with for several years. This is a person who's very depressed but has a lot of anger and he was talking very softly in a very kind of depressed way and I noticed that I was like tapping my fingers like that on the arm of my chair and I thought, what's going on with that? So I asked him to just notice what's going on inside and he said he was feeling agitated and then he said he's feeling a little angry.
• 33:52
  And I said, and I've been tapping in the arms of my chair, I guess I'm picking it up. So we had a laugh together about that and then he was able to talk about his anger.
• 34:00
  Speaker 1: Wow. Another
• 34:03
  Speaker 2: experience also last weekend because I see patients on Saturday, oops, clients, whatever words you like.
• 34:08
  Speaker 1: No, you're fine, you're fine.
• 34:10
  Speaker 2: I was working with someone who does have DID and I noticed a feeling of moisture around my eye and I said to the client, I know what you're experiencing but I'm feeling some sadness and then she said, I feel like crying. So somehow we have that shared moment of communication that I can't explain.
• 34:28
  Speaker 1: Wow.
• 34:30
  Speaker 2: Or if I'm holding my breath, I might say, I might point that out to someone, I notice I'm holding my breath as you're talking and then they will often just take a little notice of what's going on internally and just go from there.
• 34:44
  Speaker 1: That's amazing though, that just being in tune with that. And that feels like a physical expression of some of those shame theory attunement talks as well.
• 34:56
  Speaker 2: Oh, I think so, yeah. Of course, the risk is if it's coming from something that the person has triggered in me, I have to be careful to own it. So, I made a comment like that and they're going, no, I don't feel anything like that, then I'm not going to go, Yeah, right. You're not being honest with yourself. I won't think that way.
• 35:17
  I'll say, Okay, well, I'm not sure where this is coming from and just sit with the experience.
• 35:22
  Speaker 1: How do you handle having to listen to the hard stories that people tell?
• 35:27
  Speaker 2: I know there was a time some years ago when I stopped doing private practice for a while and did full time courtroom work and then I missed it and realized that I had really gotten burned out because I wasn't taking care of myself. So I was really happy to get back into private practice and to have had some therapy of my own to get better connected with what was going on with me. But, you know, it's not my trauma. I can feel a lot of feelings about what has happened to someone else, but it didn't happen to me. And I'm talking to someone who somehow got through that and has resources that I don't possibly I can't possibly understand at the moment, but we're gonna figure it out together because that's a strength that they have that they don't usually credit themselves for.
• 36:18
  And this is a really good quote I found from Harry Stack Sullivan who is a psychoanalyst who died in 1950 or so. He said, Your emotional life is not written in cement during childhood. You write each chapter as you go along.
• 36:34
  Speaker 1: Oh, that's powerful.
• 36:36
  Speaker 2: It's very powerful. And he also said something to me when I saw this. This is really something I think about almost every day. He said, All of us are much more human than otherwise. And I've worked with all kinds of people and assessed people in the court system who had done just horrible things to others, horrible things, the kind of things that we treat people for who experience those things.
• 37:01
  And I have to keep that in mind. So if I'm talking to somebody who's been through horrendous trauma, they're human beings just like I am. And I want to understand with what what they brought to themselves, what resources they had, what what people that they encountered in their life, what they built in themselves to help them survive it. And if I focus on that, then I tend not to get overwhelmed. But it also helps that I work in an office with people I trust and if any of us really get swamped one day by what we're hearing, we can go and talk to each other.
• 37:38
  And that helps tremendously to not do this work alone.
• 37:41
  Speaker 1: Right. Wow. Yeah. Yeah. I was just thinking that I mean, that's such a whether that's personal or professional, that's such a important thing, both having support and having connection with others, but also knowing those limits of when you need to care for yourself or
• 38:02
  Speaker 2: Oh, yeah.
• 38:03
  Speaker 1: Burnout or preventing. I know that I worked early in my career with adolescent sex offenders and then Mhmm. Even later in private practice. And then when my parents both died, it was just bam bam. And one expected and one not expected.
• 38:23
  And I wasn't even aware of, like, the other layers that would complicate that grief. And so I definitely during that season had to limit my practice. And then when I found out about the DID, I did not take clients in the office anymore. It's just not my season for that to be appropriate. And it was a challenge to adjust or to realize those self care pieces in a new level.
• 38:53
  Speaker 2: I I think it's so important that you did that, not just for you but for your clients.
• 38:57
  Speaker 1: Oh, absolutely.
• 38:58
  Speaker 2: I'm sure you know of cases where people have had therapists who couldn't stay connected with them or who got blase or cynical or doubted what they were saying because the therapists were burnout or because they had their own trauma histories and did not dealt with them.
• 39:17
  Speaker 1: Right.
• 39:17
  Speaker 2: So do an annual presentation at the VA to the post doctoral psychology students about private practice and a lot of it is the nuts and bolts stuff of how do you get referrals and how do you get on insurance panels but I always tell them at the end that many of us in this field and I say myself included have had some trauma in our life and it makes a huge difference in the work that you in how you can help people when you do get care for yourself first or so while you're doing treatment that you know you have your own issues and you're working on them so that they don't get in the way of you being present and available and genuine with your patients or clients.
• 39:58
  Speaker 1: Right and that's such powerful wisdom and I know that when I started private practice, I specifically didn't take trauma clients I
• 40:09
  Speaker 2: That was wise.
• 40:10
  Speaker 1: Right. But I didn't understand why. I just intuitively knew that was not an area for me. There are other people that are good for it and I was okay with setting those boundaries. But the further I got as I gained experience, I guess, over the years, the more I realized that trauma really comes in a lot of different forms.
• 40:30
  Speaker 2: It sure does.
• 40:31
  Speaker 1: And you can't just completely avoid everything. So
• 40:35
  Speaker 2: Well, one way you can is if the only kind of treatment you're gonna do is cognitive therapy because then you cannot get connected to your emotions and you can help your client not get connected to them and it's all just nice and superficial. And I think it's a bunch of BS if that's all you do. Right. But that's all they're teaching people in graduate school nowadays and it's a darn shame. I mean, it's a great tool but you can't stop there.
• 41:02
  Speaker 1: I feel like that's one reason I wanted to include the interviews on the podcast is because I feel like there are so many gifted clinicians who it goes back to it's not just a science but also an art. I don't want that lost. And it's I want this
• 41:19
  Speaker 2: Oh, yeah.
• 41:19
  Speaker 1: Recorded history of these people that did real therapy and and who who have so much to give and to pass on and to I feel like it's somehow it's time for it all to come full circle somehow. And I don't know what that means or what that looks like exactly and I don't know what small part I can play in helping that. But conversation seems like a place to start.
• 41:45
  Speaker 2: Oh, absolutely. You're doing so much and one of the things you're doing is making available to the people who listen to your podcast information about what good therapy is like and what you can talk about in therapy. And if you get a therapist who doesn't want to hear any of this, run away. Right. You you've got somebody who's gonna hurt you.
• 42:07
  Speaker 1: Right. And I think, I mean, kind of in an attunement way again, if you start to resonate more with what therapy can look like and what the process can look like and having an accurate depiction of that, then you're more likely to see it when you encounter it. And so we've moved from a society where the abuse cycle repeats or we have people who are abused when they're young and so then they get in all these abusive experiences when they grow up. We've moved now because of all these systemic wounds, I feel like, where people are abused when they're little, grow up and get in domestic violence or substance abuse or whatever else goes But then they also go through one bad therapist after another and then stop. Like, look for the people who are really knowing.
• 42:58
  And then also for clinicians, helping them connect to how to get trained or how to do it well and what that looks like for them on their side as well.
• 43:08
  Speaker 2: I think you're right. I like working with therapists as clients including a few who have had DID.
• 43:16
  Speaker 1: My first one in January at the conference in Florida and I couldn't believe there was another one.
• 43:23
  Speaker 2: That Oh, yes.
• 43:25
  Speaker 1: It it really surprised me. And then when I interviewed Susan Peace Bennett, I had a very powerful experience with her talking about that and sort of coming out. I get I mean, it should have been obvious, but for me, my personal process, I'm sort of coming out loud even to myself of this is my identity and it includes this piece and I'm gonna have to deal with this piece.
• 43:51
  Speaker 2: Yes. And you're doing the responsible thing at at figuring out where your limits are for what you can and can't do while taking care of yourself too.
• 43:59
  Speaker 1: Right.
• 44:00
  Speaker 2: That's huge. I was interested about what you said about working with adolescent sex offenders. What was that like for you?
• 44:09
  Speaker 1: Interesting on a lot of layers. It was I got assigned there for my for my doctorate
• 44:18
  Speaker 2: Mhmm.
• 44:18
  Speaker 1: As how I landed that job and how I got involved with that. And my experience with them was that every one of them that I worked with had also been traumatized.
• 44:33
  Speaker 2: Mhmm.
• 44:33
  Speaker 1: And there was a lot of what I now know and understand as triggers for myself. And so self care was very hard for me during that season.
• 44:46
  Speaker 2: Oh my goodness.
• 44:47
  Speaker 1: But I didn't understand that. I didn't understand why at the time. And I I resonated with them in a lot of ways that the other clinicians didn't. And so I didn't have a problem with running groups or walking into really escalated situations. It was not an issue of I had bad boundaries with them.
• 45:09
  I don't mean like I was hanging out with them but I think there was somehow a stigma and a fear that some of the other clinicians on the unit had that they tried to pretend they didn't have that I was just in tune with and okay with and talked about out loud. And and so I think in some ways, had something to offer, and in other ways, I understood differently. But at the same time, there were the scariest thing was always having to do the court reports and talk about recidivism and are they really okay to go home or not or feeling a responsibility for that. That was hard.
• 45:54
  Speaker 2: Oh, yeah. I can't imagine. I I used to say that I don't work with perpetrators And I know that when I said that, this is a long time ago, it was out of my anger at what people had done to my clients who I cared about. And I had to eat those words because I'd been working for some time with a woman who had DID and a history of ritual abuse and knew both those things when she came to work with me. I had to eat those words because she started to talk about how she had perpetrated as part of what she'd been forced to do.
• 46:28
  Speaker 1: Right.
• 46:29
  Speaker 2: And part of her very much liked that and other parts of her were horrified by it. And she had to really sort of test me out to make sure I was okay with that. And it was difficult for both of us, but it worked. So, I was able to stick with it and I stopped saying that.
• 46:48
  Speaker 1: Those are those are intense layers to get to.
• 46:52
  Speaker 2: Oh my gosh.
• 46:53
  Speaker 1: Where I worked and where I lived, there are it's a very rural area area between Kansas and Oklahoma and over into Arkansas and up into Missouri where the four states meet. It's a very, very rural area. And my experience, and I know I'm stereotyping, is that there are these pockets of very, very good people and very, very scary people. And there was there's a lot of ritual abuse in these little pockets. And even when we were fostering there would be like an entire box on a whole community and have like 30 kids at once that needed placement.
• 47:33
  It was really hard and realizing that this was a layer prevalent in this area and there's no one treating it. There's no one talking about it. Until I found this therapist. But very, very few people that even know how to deal with it.
• 47:55
  Speaker 2: So I mentioned David Call earlier and the conference room technique. What are the other things that he said? Unfortunately, he never wrote much but he said this when someone asked him about what the goals of treatment were for MPD. Remember, it's the 80s, right?
• 48:12
  Speaker 1: Right.
• 48:13
  Speaker 2: He said, It seems to me that after treatment, you want a functional unit, be it a corporation, a partnership or a one owner business.
• 48:21
  Speaker 1: Oh, I
• 48:22
  Speaker 2: love I really like that.
• 48:25
  Speaker 1: Oh, wow! That's amazing.
• 48:29
  Speaker 2: Yeah. He really saw so much. Wish he'd lived to write more.
• 48:33
  Speaker 1: That really gives a context and a familiar application to express that. Mhmm. The model of it.
• 48:40
  Speaker 2: Yeah. I mean, it's a very down to earth way of saying things because that's how he was. He was very much like an old farm kind of guy, very matter of fact in what he said and he didn't put on airs and he said what he thought. I really wished he'd been around more to contribute to the field, but he unfortunately passed away.
• 48:58
  Speaker 1: Obviously, anyone who chooses integration in in a formal sort of solidifying way and does that work and it works well for them, that's wonderful. And I think the idea of having functional multiplicity in some form on that continuum to focus on functioning and and getting there as part of the process when something else feels so far away, I can see why that makes sense. I am Yeah. Uncomfortable with the with and this is gonna be a bit controversial for some of my audience, but I am uncomfortable with identifying as plural as just for a lifestyle because for me and I'm just speaking for myself, and I know I'm about to speak at the plural conference. That sounds contradictory but I don't want to identify with the maladaptive process that's a response to all that trauma.
• 50:02
  I don't want I don't want this to be the end of my story. And I know that they are trying to make it a positive thing and a welcoming thing and an accepting thing in whatever part of the journey they are in. Mhmm. But I like for me and maybe that's just because I have a clinical perspective. But for me, I like to focus on the functional piece.
• 50:24
  Speaker 2: I guess I take a matter of fact attitude about that too and part of what I I wanna say here is based on an article that Richard Clough wrote in the nineteen nineties that a lot of people got upset about. But the article really was trying to explain why people who had childhood trauma were more prone to be re abused in later life, domestic violence, getting raped, so on, than people who didn't have that kind of trauma. And if I remember the gist of the article, what he said was if somebody has, you know, been harmed enough, then they may detach or dissociate from the warning signals that something bad is about to happen. And so they become what he called a sitting duck for getting retraumatized. So that's of the risks I see in trying to maintain a plural lifestyle without trying to share connections, perceptions.
• 51:22
  I mean, it's okay if somebody has parts, but if some but if a part on the outside is not letting the others know that there might be some danger here so that those gut feelings don't get passed around, then that could be really risky.
• 51:36
  Speaker 1: Right. I think that's true in a similar I mean, different, but a similar way even with the podcast or some of the YouTube channels or different things. If we over identify with that in and of itself, that becomes an expression of it and then and more of a maladaptive response as opposed to an expression for the process of it or a way to document the process of it. Mhmm. And so that's something we talk about with the husband a lot of Uh-huh.
• 52:08
  Making sure that our focus is that the podcast is an expression and not an identity and that we're documenting the process, not becoming something that then is ongoing.
• 52:21
  Speaker 2: That's good. I think that's important. So many people with abuse histories end up in abuse getting retraumatized in their later relationships and they're unable to pull their resources together because dissociation helped them survive it. So they continue to do it and end up feeling more trapped than they may actually be and it's just tragic. It's really hard to help somebody to start to make connections inside when their life is dangerous today.
• 52:54
  Speaker 1: Wow. I appreciate your time today. I would love to talk to you again Oh, much.
• 52:59
  Speaker 2: Anytime. I like talking to you as well.
• 53:01
  Speaker 1: I really learned a lot and you have a lot of context that really answered some of my questions. I'm I'm even gonna have to rewrite some of my keynote there to explain that because that's really helpful. I appreciate it.
• 53:13
  Speaker 2: Your conference is on the twenty ninth, right?
• 53:16
  Speaker 1: The third yeah. The thirtieth at the end of the month. I'm not that's a time question. It posts on Saturday morning, I think. Ah.
• 53:27
  That might the the I'm doing one on I'm doing the keynote and I'm doing a very very simplified version on polyvagal and both of mine will
• 53:38
  Speaker 2: be on the That's great. I intend to listen to it and some of the other presentations as well. I learned from my clients. I don't have this inner experience of separateness except in those very small ways that I mentioned. So, I'm not the expert but my clients are.
• 53:55
  Speaker 1: Well, I appreciate your receptiveness to me even as a person.
• 53:59
  Speaker 2: I know. I I
• 54:01
  Speaker 1: I I do. I there's I mean, my own shame issues, yes, but also that cultural wound has caused some separations. And so those of you that have been gracious enough to speak with me on the podcast, I think it's really, really I mean, I get emails and emails and emails about it but it's really bringing a lot of to the community as a whole and to individuals and I'm grateful.
• 54:23
  Speaker 2: Well, thank you for the opportunity to talk to you. And I really appreciate what you're doing with your podcast and I'm looking forward to learning more from you.
• 54:34
  Speaker 1: Thank you. Thank you for joining us with System Speak, a podcast about dissociative identity disorder. You can listen to the podcast on Spotify, Google Play, and iTunes, or follow along on our website, www.systemspeak.org. Thanks for listening.