Latest / System Speak: Complex Trauma and Dissociation / Guest: Peter Barach - All About Attachment

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Guest: Peter Barach - All About Attachment · System Speak: Complex Trauma and Dissociation

• 0:08
  Speaker 1: Over:
• 0:11
  Speaker 2: Welcome to the System Speak Podcast, a podcast about Dissociative Identity Disorder. If you are new to the podcast, we recommend starting at the beginning episodes and listen in order to hear our story and what we have learned through this endeavor. Current episodes may be more applicable to long time listeners and are likely to contain more advanced topics, emotional or other triggering content, and or reference earlier episodes that provide more context to what we are currently learning and experiencing. As always, please care for yourself during and after listening to the podcast. Thank you.
• 0:58
  We are very excited to have today's guest back on the podcast. Doctor. Peter Barish attended Johns Hopkins University and the University of Michigan. He received a Ph. D.
• 1:10
  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 Horizon's Counseling Services. His clinical approach is relational and supportive. He specializes in working with people with dissociative is a
• 1:47
  Speaker 1: The road
• 1:48
  Speaker 2: is other the The year. Field, he is known for having first highlighted the link between disordered attachment and the origins of DID. He also chaired the committee that produced the first set of treatment 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 a script consultant for broadcast media and as a reviewer for several journals.
• 2:29
  He has also as an expert witness in civil and criminal matters. In addition to maintaining a private practice, Doctor. Barish currently works for the Cleveland VA Medical Center, where he evaluates Doctor. Barish.
• 2:59
  Speaker 1: Good morning.
• 3:00
  Speaker 2: Good morning. Thank you for talking to me again. I really appreciate it. I'm super excited.
• 3:05
  Speaker 1: Me too. I'm glad to talk to you again.
• 3:08
  Speaker 2: So we can just jump in. What you know about attachment?
• 3:11
  Speaker 1: I learned about attachment in my first year as an undergraduate at Johns Hopkins. The one of the first psychology classes that I took was developmental psychology, and the professor was Mary Ainsworth who did all of the observational studies early on that supported Bowlby's theory of attachment. So can I talk a little about Bowlby?
• 3:33
  Speaker 2: Yes. Yes. So that but she was your teacher?
• 3:36
  Speaker 1: She was.
• 3:37
  Speaker 2: That's amazing.
• 3:38
  Speaker 1: Yes. It was it was a long time ago so long ago that you could smoke in class, and she used to chain smoke when she took questions from from the students. Wow. So Bowlby was a psychoanalyst who became interested in actually understanding how children became connected and attached to their parents. And he developed an attachment theory.
• 4:02
  It's sort of mechanical when you look at it, but you have to remember that he started developing this in fifties and sixties. But he talked about person system that involves babies who are hardwired to do things to reach out for their caretakers and to bring their caretakers close. So the baby emits attachment behaviors, you know, things like crying or reaching out or verbal or visually searching for a mother or whoever the caretaker is. And those behaviors turn on a system in the caretaker who then provides caretaking behaviors. So you pick up your baby, you comfort your baby, change your baby, feed your baby, whatever you can best you can figure out as to what the baby needs.
• 4:48
  And then the attachment behaviors stop, the reaching out, the calling, the crying once the need is met. So he describes it almost like a a thermostat kind of a system, and this where this is where the mechanistic kind of approach came in, where there are these behaviors that are emitted. There's a response, and then the system shuts off as if the furnace has warmed up the room and no more heat is needed. The reason he felt it was necessary to develop this theory is earlier people in developmental psychology seemed to believe that babies looked for parents only to get food and nurturing. But it was pretty clear from experiments that had been done with monkeys by Harry Harlow that babies wanted comfort.
• 5:31
  That finding was generalized to humans. So Baldy said, looking at his results from an ethological point of view or at his theories from an ethological point of view, it's necessary for the survival of the species for a baby to know how to reach out for caretaking and for the parent to have a way of responding and to be driven to respond. I think many mothers have had the experience of having their baby cry and then having a letdown reflex that causes milk to come. That's also an example of one of those systems that exist to make sure that when we're infants and we can't take care of ourselves that hopefully we can draw someone near. So does that make sense so far?
• 6:14
  Speaker 2: So there's two pieces to it. One is what the infant does and one is what the mother does.
• 6:20
  Speaker 1: Right.
• 6:21
  Speaker 2: Okay.
• 6:21
  Speaker 1: So Mary Ainsworth had done a couple of things. When I started in her class, she had just come back from Uganda where she had done observational studies of families there where there were multiple parents, multiple moms taking care of a baby, and she wanted to look at how that how well that worked. Her results showed that parents that children could become attached to parents when there were multiple parents. She was also developing the strange situation experiment, which I think one of your other guests had described. This is sort of a way of evaluating how well attached a child is to its parent.
• 6:58
  And there are lots of examples of this on YouTube. If you look up Ainsworth's Strange Situation, you can see some videos of actual experimental sessions. The way that it works is you have a child typically between one and two years of age. The child is in a room with its mom and another person, like probably a graduate student experimenter, and the baby is playing with toys and then the mom leaves. And when the baby gets distraught and starts to reach out and cry for mom, the mom comes back.
• 7:31
  And what Ainsworth was looking at is how does the baby respond to the mother's return? And she identified several different types of responses that babies show when they return to their mother. Babies who were easily comforted when their mom returned and went back to play, she considered that to be a secure attachment. Babies who were extremely anxious when their mother came back and were extremely clingy and took a long time to settle down, she called she called that an anxious attachment. Then there was another type of response where when the mother came back, the baby did not look at the mother, did not respond to the mother, she called that avoidant attachment.
• 8:12
  So as she and her students and her colleagues continue to use this research method, they found that these different types of attachment were reliable and could predict a lot of things that children did at the age of six. It's unusual to find much that you can predict well between the ages of two and the age of six. But children who were securely attached were able to explore and grow and build relationships with other people pretty well. Children who were anxiously attached had a hard time trying new things, were often anxious in new situations, were anxious about losing friends and so forth. Children who were, who had avoidant attachment really didn't explore much, didn't connect too much to other people.
• 9:02
  And those are the types of attachment she identified. But there were some children who couldn't really be classified because their responses were inconsistent. They would do things like reach out toward the mother when the mother came back from being out of the room in the strange situation. The child would reach toward the mother but look away or look at the mother and cry but crawl away. And they didn't know what that meant.
• 9:27
  So around 1985, obviously, much year many years later, Mary Main, who was a child developmental psychologist in California, named this behavior disorganized attachment. And she set out to measure to find out about types of attachment in adults. And she developed what was originally a research tool called the adult attachment inventory that involves asking people a lot of questions about their relationships and listening not just to what they say, but also rating the manner of speech that they display while they're talking about it. Are they coherent? Are they logical?
• 10:07
  Do they stop talking? Do they lose track of the discussion? Things that people in our field know are dissociative behaviors. So she identified four types of behavior in adults, four types of attachment styles in adults that correspond to the four types that were observed in children. And there's some published research now showing that among people with DID, disorganized attachment is quite common.
• 10:38
  Speaker 2: Interesting.
• 10:39
  Speaker 1: So all of that came out and Mary Mary Main first published articles on the adult attachment interview and disorganized attachment in adults. They came out in 1990, but I didn't know any of this. So as I think I said in the last podcast that we did, I had started working with people with DID some years before that, say, 1983, '19 '80 '4. And I had one client who came in, and she really didn't seem to care too much about other people. She could take it or leave it.
• 11:11
  She was just having problems with panic attacks that were coming out of nowhere, and she didn't really know why. And, eventually, she began to write some letters that she would give to me during the appointment, sometimes in different handwriting, that started to talk about childhood abuse that she had experienced. And the part of her that was coming to therapy didn't remember what she had written and didn't know about these memories at all. So what I noticed, and this is going back to the attachment material, what I noticed after a while in treatment is that once she started to recover memories, her whole way of connecting with me changed dramatically. She became very anxious, was having thoughts of suicide, was calling a lot.
• 11:56
  And I'm trying to understand, well, what the heck happened here? And then I remembered what I learned from, you know, the classes with Mary Ainsworth and reading John Bowlby's work. And my thought was that this was someone who was showing a dismissive kind of attachment when she came in. I'm here, you know, it's like someone would go in to change their oil. I need to be fixed up.
• 12:17
  I've got these panic attacks. Could you fix that up and just give me a bill? It was almost like that. And now that she was getting some caretaking responses from me, her attachment behaviors had been reactivated. And now she was reaching out because she was feeling overwhelmingly frightened by what was coming to her mind.
• 12:35
  And she was wanting someone to be there for her. So that's kind of what fit together for me. And I started to think about MPD as it was called then as attachment disorder. So my initial thought was that the dismissive part of attachment, the dismissive response was really what many therapists might see initially in people with DID. And I thought that that was true.
• 13:00
  And part of the reason has to do with some other research that Baldi was familiar with. He had some associates, the Robertsons, and they had made a film in 1952 called A Two Year Old Goes to Hospital. This was a boy in England who went into the hospital for a hernia operation. So in those days, that meant a five day overnight stay with very, very limited visitation from the parents. So parents were only allowed in an hour or two a day.
• 13:28
  So they set up time lapse video, or not video, but filming of how the baby responded to the separation from parents. And initially, the baby was crying a lot and was inconsolable. And eventually, the baby settled down. The staff thought, well, the baby's settling in. He's gonna be fine.
• 13:49
  He's handling this fine. And then what you can see in the video, which unfortunately you have to buy, there are only like two minute excerpts of it on YouTube. But what you see in the video is that when the parents would come to visit, the baby would be detached, would not be responsive to them, would play with toys and not really look at them. And that happened over just the course of a week. What Baldy said when he saw this movie and in other and also in other things that he observed with children, he said that these children had defensively detached from their awareness of their needs to be comforted and held and taken care of because there had been no response, meaning during the time when the parents weren't permitted to come to the hospital.
• 14:35
  So that's basically dismissive attachment. And I thought, well, this is what I saw when client came in. She acted like she really didn't need anything. And then once she was getting some caretaking responses from me, because all of us, male and female, we have the ability to caretake and we have those responses built into our brains, when she started to get some responses from me, then it reactivated her attachment system.
• 15:04
  Speaker 2: Wow.
• 15:05
  Speaker 1: The outcome is pretty different for for the child in the in the movie, and this is something that doctor Ainsworth talked about in class. That when the baby came home, she told us the baby was clingy after that week in the hospital and eventually calmed down and had a normal attachment relationship with his parents. About a year after the hospitalization, the Robertsons came over to show the parents the movie that they had made of their son in the hospital. So they're showing the movie in the living room. The child who had really said nothing about the hospital experience for months and months woke up, came down the stairs, and was looking at the movie and cried out, mommy, why was it you left me for so long?
• 15:48
  So those experiences, it's so sad, isn't it? That that's a child who recovered from the separation.
• 15:54
  Speaker 2: So it can be something that's healed?
• 15:56
  Speaker 1: Yeah, but that was a weak separation with a baby who had a secure attachment to his parents. Now I think the situation is pretty different with children who grow up in abusive families. There's something that goes wrong with the attachment relationship with the parents. And then abuse either follows or is going on at the same time. And that's what I think leads to the development of DID.
• 16:21
  So if something bad is happening to a kid and the person who's doing it is the person who they would look to for comfort, how do you cope with that? You come down for breakfast in the morning and there's the person who hurt you making eggs and toast for you. How do you handle that? Well, one way to do it is to detach from the memories, and that is part of what may lead to the dissociative amnesia for the abuse. So then you can have a seemingly normal relationship with this parent who would hurt the child, go off to school and do reasonably well, maybe with some periods of spacing out.
• 17:00
  And all of these things have been pushed into the background and put behind amnestic barriers in order to cope with going through daily life. But this can become a child who really doesn't know how to reach out for interpersonal support because their life experiences have taught them you really can't expect much from other people. You can't expect them to be there for you and your expectation may be that they will hurt you. So if you grow up in a family where parents are reasonably responsive, not perfect because no parent parent has to be perfect, then you develop an inner sort of model. Baldy called it a working model of what to expect in close interpersonal relationships.
• 17:44
  Ideally, what you get is a secure base sense. So if a child is crying and comes back to mother and the mother comforts the child and that happens enough, then the child expects that other people will do that. And the child also has sort of a library of built in experiences of being comforted and having responses to his or her needs. And that becomes the working model for how do you handle a new experience when there's nobody there to take care of you at the moment, like going down a slide on the playground or meeting new kids. If you have enough experiences of safety within, then you expect that that will go really well and that your anxiety will diminish after time.
• 18:28
  So you can go down a slide or you can go on a swing or jump off a diving board or ride a bike. And you have that inner sense of security that's developed from many, many experiences of having a good enough response from your parents. So nowadays researchers are starting to call that an attachment script, an expectation of what will happen when you have relationships with other people. So because people with DID have had to deal with many different kinds of relationships, it may be that they have multiple attachment scripts as well. And that's what disorganized attachment may be.
• 19:06
  So some of the parts or alters may be okay with forming new relationships while others may be terrified of them or may be aggressive as a way of protecting from the danger they expect. So when someone comes into treatment, the question that I think is really central is, is it possible to change or rewrite some portion of the attachment scripts? Obviously you can't change what happened, but is it possible that the treatment relationship and other social relationships that someone develops in adulthood can change the attachment script so that a person starts to be able to expect more favorable responses from their environment.
• 19:48
  Speaker 2: You have blown my mind. I mean, I I know about attachment, and I've studied attachment, but I never thought about it from this perspective or about in DID, the role it played in DID or about different ones having different styles of attachment. I never considered any of that. So there's so much stuff happening in my head right now. One is that Okay.
• 20:12
  Speaker 1: Sorry.
• 20:13
  Speaker 2: No. No. It's good. It's really, really good. I'm so grateful.
• 20:17
  I'm just gonna spew them out, and we can address whichever ones you One is that when you talk about Bowlby's working model, that sounds to me like what Kathy Steele has rephrased as mentalizing.
• 20:31
  Speaker 1: And Yeah. I think it's connected. Sure.
• 20:33
  Speaker 2: Okay. And then this whole the different attachment styles in the script and all of that sounds like the I'm just framing to, like, solidify in my head what you're teaching me.
• 20:47
  Speaker 1: The the
• 20:47
  Speaker 2: it sounds like the foundation for the other stuff I've been studying about shame theory and attunement because that's where the connection happens, right, in the meeting of the needs?
• 20:59
  Speaker 1: Yeah. It it's true. So tell me about how this, connects with shame theory.
• 21:05
  Speaker 2: Well, if if attunement and misattunement, if that has to do with being responded to and being heard and being seen, then it goes back to what that's attachment. That's connection. Okay. Going back to what you said about me being able to express what the need is and someone being able to respond to that need.
• 21:29
  Speaker 1: Okay. So then if if I express a need to you and your response is basically like, I don't care, then I'm gonna experience shame because I've been vulnerable in the presence of someone else who has not responded.
• 21:43
  Speaker 2: Right.
• 21:43
  Speaker 1: Is that is that what you're saying? Okay. I see what you mean.
• 21:45
  Speaker 2: So in a way, part of dismiss dismissive what did you call it? Attachment? Dismissive attachment. Dismissive attachment is kind of in a way because they feel dismissed. And so then they do the dismissing?
• 22:01
  Speaker 1: They've been dismissed. They've been ignored or not responded to in their needs. So what they do is detach from their awareness of what they need from other people and they look like they don't need other people very much.
• 22:16
  Speaker 2: Wow.
• 22:19
  Speaker 1: So in therapy, that might be for me a client who doesn't look at me very much. And I said opposites, someone across a pretty small room. They're on a couch and I'm in a chair. So they have to actively, you know, orient their body or their head so that they're not looking at me.
• 22:43
  Speaker 2: Wow.
• 22:45
  Speaker 1: But it begins to change. And another thing that I I figured out has to do with why why it is that so many therapists get so over involved to the point of being unethical with clients who have DID or extensive histories of abuse. I mean, were some bad acts who were definitely out there trying to exploit and hurt people and they don't care. But there are also a lot of people who have gotten over involved trying to rescue their clients or re parent them in all kinds of ways. And those are not how does that happen with therapists who have been ethical and maintained good boundaries with other clients?
• 23:31
  I think it has to do with therapists' lack of awareness of what gets activated in them when they're dealing with clients who have a history of long term childhood trauma, and that's the caretaking responses. So I don't like to feel helpless. That's one of my things. So I had a tendency early on to get over involved with clients like telling them they could call me whenever they wanted to. And I thought at the time that I was doing that, that this was because they needed my help.
• 24:01
  I mean, who doesn't want to be the white knight? But as I look back, it's because I felt helpless in the face of the pain and suffering and the fear that they were dealing with. So I wanted to take care of them, but it wasn't helpful because it encouraged dependence. It didn't help people learn how to calm themselves at all. So I think I said in the last podcast that I had to back down from that.
• 24:26
  Speaker 2: So you mean, like, self soothing like an infant in the attachment process itself?
• 24:31
  Speaker 1: For me or for the for the client?
• 24:34
  Speaker 2: Either one, but the client the the person.
• 24:37
  Speaker 1: Yeah. They have to find I have to help them find ways to take care of themselves. I don't have to be the caretaker all the time. If I try and do that, then I'm acting like they have no resources of their own. And it makes me feel better because I feel like I'm doing something instead of helplessly watching someone suffer.
• 24:55
  But that's not therapeutic for me to jump in and I can't be a new mommy. I can't be a new daddy. Nobody can be that for an adult who didn't get what they wanted as a kid. There's a lot more that we can do to help people as therapists, but we can't replace the parenting they never had. So when therapists go way overboard in ways to try and re parent their clients, we're not helping them.
• 25:23
  We're not helping them get strong. We're helping them to stay young and helpless, and that's not good.
• 25:30
  Speaker 2: Right.
• 25:31
  Speaker 1: An example of that is a colleague of mine was visited another therapist out of state who was doing some work with clients who had MPD. So this was decades ago. And so this out of state therapist picked my friend up at the airport and opened opened the car trunk to put my friend's suitcase in, and there were there was a package of adult diapers in there. And person who was picking her up saw my client's face and said, oh, those are for my patients. Not a good way to treat somebody.
• 26:04
  Speaker 2: What?
• 26:06
  Speaker 1: Yeah. She was diapering her adult patients because she believed that you reparent them.
• 26:14
  Speaker 2: Oh, wow.
• 26:15
  Speaker 1: She's not active anymore. So
• 26:19
  Speaker 2: Wow.
• 26:21
  Speaker 1: I've been an an expert witness on some malpractice cases on both sides, either for the defense or for the people who are suing their therapist. And there were therapists who have traveled out of state to visit their patients and stayed with them in their house. There have been therapists who sort of more or less adopted their patients and had them move in with their family and take care of their children. And then they'd have a flashback. They'd wake the therapist up in the middle of the night and have a therapy session.
• 26:51
  They just got billed to Medicare, which is not a good thing. There are lots of those kinds of things which I think in those situations started out of an earnest wish to help and not out of an intention to exploit the patient. But that's what happened. And so for me, the lesson in this is to be aware of my own discomfort with feeling helpless and knowing that I have to soothe myself, as you said. And I think that was a really good choice of words, by taking care of myself rather than by trying to make my patient or client feel better by trying to be there for them a % of the time.
• 27:31
  Speaker 2: What how does that process apply to just the therapeutic process or the client trying to engage in therapy or practice what they're learning in therapy between sessions? So there's that literal distance in time where there's an actual separation. So whatever your time is, whether it's one week or two weeks or a month or whatever between sessions, there's that opportunity to practice self soothing or the attachment skills you're learning or whatever to stay connected between Well,
• 28:08
  Speaker 1: the client that I mentioned, the one who helped me really figure out about the attachment issues and how they were playing a part in her work, She began to leave messages on my phone answer on my telephone answering machine. So this is the old days when we had machines to do this. Other clients have done that since then, leaving brief messages in my voice mail where they don't ask for a callback. They just wanna hear my voice for twenty seconds, telling them to leave a message after the tone. Some people make notes, write notes in between sessions to talk to me about how they feel, and they'll bring them in and read them during the appointment.
• 28:49
  Some people have had their child alters bring like a teddy bear or stuffed animal to the appointment that, of course, then goes home with them. So that's a sign of a connection for them. Like, you know, Little Bear was in the appointment too. So now Little Bear is here with me, and Little Bear knows that we will be going back. Things like that that are just basically ways to remind the person that the therapist doesn't go away when when he or she is out of sight, that they'll be coming back.
• 29:19
  And those can begin to change some of the attachment scripts over a long period of time.
• 29:25
  Speaker 2: As an example, what you described earlier when you were talking about the mixed attachment response Mhmm. We've had a crazy couple of weeks where just normal things were wrong. It was not about trauma. It was not about any kind of drama. There was no offense anywhere.
• 29:46
  But just through, like, the coincidence of circumstances right now, things were hard.
• 29:51
  Speaker 1: Yes. I heard about some of those in
• 29:53
  Speaker 2: the Sorry.
• 29:54
  Speaker 1: Sorry you're going through so much right now.
• 29:56
  Speaker 2: Well, and I don't mean it as a complaint, but looking at it now, last two weeks through the filter of what you just taught me helps so much. Because what I can see is that, like, our son had surgery, our husband was sick, we missed therapy, so we didn't see the therapist, but nothing was actually wrong. And we did touch base with her, but she's not going to, like, do therapy on the phone or long conversation. Like, she has good boundaries in that way. So she's like, you're gonna figure this out.
• 30:26
  It's fine. Like, okay. And and then even our friends, like, we're trying to make friends, trying to reach out, and even, like, we try we got to the end of the rope and was like, okay. This is so bad. We have to actually do what we're supposed to do of reaching out to a friend, which is a big deal for us.
• 30:44
  Like, that's new and awful still. And so we tried to call her and it was in the middle of prom and she couldn't talk right then. And so, like, no one was doing anything wrong. Nothing was wrong. I understand that.
• 30:59
  And no one was, like, trying to hurt us. Like, we've made enough progress to stay that much connected.
• 31:05
  Speaker 1: That's amazing.
• 31:06
  Speaker 2: Is huge. I mean, it feels like an accomplishment, even though it was really distressing in the moment. But what happened internally was exactly what you described a minute ago, where there was this anxiety that was sort of escalating of I need someone to help me because this is too much for me to deal with on my own. And I cannot like I'm at my limit. I don't know what happens next.
• 31:30
  And then trying to reach out and trying to reach out and trying to reach out in different ways. And there wasn't connection just because of circumstances. No one failed us. We didn't do anything wrong. Like, we can connect enough to hold that, which counts as progress.
• 31:45
  But then Sure. When it didn't play out where someone could respond, then there was just this complete shutdown of, okay. It doesn't matter anymore. Like, nothing matters. Like, I'm
• 31:57
  Speaker 1: over it. Best thing you could do is just you know, as as marines have said in combat, when something terrible happens, they they are taught to suck it up and drive on, and that's what you have to do sometimes.
• 32:09
  Speaker 2: Yeah.
• 32:09
  Speaker 1: So did you get through that okay?
• 32:12
  Speaker 2: Well, I'm talking to you today.
• 32:15
  Speaker 1: Well, I guess that's good. So and, you know, from what I've heard from your podcast, it sounds like there's a lot of internal communication going on among you all.
• 32:25
  Speaker 2: Why does that change things so much?
• 32:28
  Speaker 1: It makes such a difference because others can watch and see what's going on and how the one that that's that's on top or out is is handling things. They're learning too from observing, and it's gonna change their attachment scripts along with yours.
• 32:42
  Speaker 2: Oh, wow.
• 32:43
  Speaker 1: Just guessing. I mean, you have to ask them, but they feel a little differently about how to cope with overwhelming things going on like that and they have a little more security about it, then they're they're you're all learning together, and that's wonderful.
• 32:58
  Speaker 2: So almost in an exposure kind of way of we can handle this and actually doing it even though it's really hard.
• 33:05
  Speaker 1: Nobody nobody said, oh, let's have some trauma this week and experience dealing with it all along. But it just happened, you and you got through it really well. It's really difficult.
• 33:14
  Speaker 2: I didn't even think about that piece as just being a trigger in and of itself of things are over are hard and I'm overwhelmed and I'm alone. Like, when you say that back to me in that way is a different even perspective of the dynamic than what I realized.
• 33:31
  Speaker 1: So yesterday I heard on another podcast called, I think, Therapist Uncensored, an interview with Daniel Brown. I don't know him. I've never met him. But he he teaches at Harvard and has done a lot of work on trauma treatment. And also he's worked on a lot of forensic cases where there were abuse.
• 33:53
  I try not to get into trauma memories, but these were people who were suing perpetrators. And he has done a lot of evaluations of the victims of people or the victims who recovered memories of abuse later in life. And he's also done this adult attachment interview on people who have had these experiences. So there's this whole concept that's been brewing around for some years called complex PTSD. And the literature has really suggested that this is because somebody has had layers of trauma and that makes them more difficult to treat because they develop a whole bunch of various disorders like six or seven or eight different diagnoses.
• 34:37
  But what Doctor. Brown has concluded from his work is that complex PTSD is really caused by disorganized attachment to start and abuse that comes later.
• 34:49
  Speaker 2: Wow.
• 34:49
  Speaker 1: It's an interesting idea that has led him to believe that the three phase treatment model that almost everybody advocates for trauma is not always a good idea. That what he thinks should happen is that you should help someone resolve the attachment issues first and then if any trauma processing needs to be done, it'll be done pretty quickly through CBT or some kind of exposure therapy. I'm skeptical, but it sort of turns sort of the general idea of what people believe in treatment to work kind of on its head. So I ordered his book, which he's written with David Elliott, Elliott on I think it's called a dull detachment
• 35:34
  Speaker 2: I'll contact him and see if he'll let me interview him.
• 35:38
  Speaker 1: He's very interesting. He's he's basically done a pilot study, But part of what involved what's involved in the treatment is having people imagine what an ideal parent would have done for them in various situations. And the idea is that it sort of rewrites their attachment scripts, although he doesn't use that term. I don't know. What Honestly, I don't know, but it's an interesting thought.
• 36:02
  Speaker 2: Where does disorganized attachment come from in the first place?
• 36:06
  Speaker 1: I I it comes from parents who are frightened or frightening when dealing with their child's needs. And many of them have had their own trauma so that when they're faced with a crying baby, they may be getting flashbacks or they may be frightened of their own emotions and they don't respond well to their children. So there's a famous article by an analyst called Selma Freiberg called Ghosts in the Nursery where she talks about mothers who have their own trauma that they have not processed who are not emotionally responsive to their children.
• 36:38
  Speaker 2: Wow.
• 36:39
  Speaker 1: And I think that's part of what leads to disorganized attachment.
• 36:42
  Speaker 2: How does that impact the this is maybe way off topic, but what came to my mind was how does that impact the whole years of the whole crying it out theory?
• 36:53
  Speaker 1: I don't know. You know, sometimes babies can learn to settle themselves down and, can fall asleep.
• 37:00
  Speaker 2: So we don't have just a whole generation of disorganized people out there?
• 37:04
  Speaker 1: No. No. It's more of a frightening response by the mother to the child's needs to this thought to bring on disorganized attachment.
• 37:12
  Speaker 2: So the mother is frightened or the child is frightened?
• 37:15
  Speaker 1: The mother is frightened or frightening to the child, and then the child is not getting a coherent response. Mother might pick up the baby but yell at the child, for example, or pick up the baby but not really offer any kind of feeling of connection or comfort. It may not find the baby's gaze, which we all know can help settle down a child as well as an adult to, you know, to have someone who cares about you make eye contact with you can make a lot of difference for for a baby as well as for an adult.
• 37:46
  Speaker 2: Is that what makes it such an intense experience?
• 37:50
  Speaker 1: Which one? You mean in therapy? Or
• 37:52
  Speaker 2: In therapy or when you start to apply those to friendships or relationships or other healing connections in attunement kind of ways.
• 38:02
  Speaker 1: Yeah. Mean, to me, eye contact is essential, but then I'm not blind. And I know there's a couple therapists who are, and they must have other ways of doing it. And I have never asked them how that works for them or their clients. Eye contact, breathing in tune with the client's breathing, unconsciously adopting their posture, how you sit or whether you cross your legs or not, how relaxed you are.
• 38:24
  Those things happen, and they're all nonverbal. They're usually out of awareness of both parties, And those things all create attunement.
• 38:34
  Speaker 2: I don't know, honestly, if we've ever even looked at our therapist.
• 38:38
  Speaker 1: Uh-huh. It would be interesting to to experiment with it if you're interested and and see how different that is.
• 38:46
  Speaker 2: I'm pretty sure we don't breathe for the entire two hours.
• 38:50
  Speaker 1: You must have wonderful breath control. It's time to pick up.
• 38:55
  Speaker 2: Oh, fascinating. And all of that makes a difference.
• 39:00
  Speaker 1: It does. And then sometimes things come up and you don't know where they come from. A couple of weeks ago, was doing an evaluation on a veteran. And as I said in the last podcast, these are not people I treat. These are people who have filed claims with the VA for service connected disabilities.
• 39:18
  So this was someone who had PTSD, had been previously diagnosed with PTSD and was receiving compensation for his combat related PTSD. And he felt it had gotten worse so he filed a new claim to get increased compensation. That's why I was evaluating him. I do a lot of those. This is a man in his thirties.
• 39:41
  He's living with his mom. He hardly ever went out of the house. He let his mother do everything for him. He didn't have to deal with crowds. He didn't have to deal with frightening people.
• 39:51
  He didn't have to deal with controlling his anger because he felt safe with his mother. So there's clearly a secure attachment. And as I'm listening to him, I started thinking, you're just a lazy son of a bitch. And I said to myself, where is that coming from? I never use the word lazy.
• 40:07
  It's so judgmental. I never think of people that way. And I figured out a day later or so that was him shaming himself that I had somehow picked up on. And things like that come up in therapy all the time if you're open to open to hearing your unconscious mind speaking to you. So I knew that wasn't my thought because he's just very impaired with PTSD, and he's managed to find a narrow way to live where he's not exposed to any triggers.
• 40:33
  And a lot of things are triggers for him.
• 40:35
  Speaker 2: You've given me so much to think about again.
• 40:37
  Speaker 1: Oh, good. I'm sorry. You've got enough on your mind.
• 40:41
  Speaker 2: No. I'm so glad you're willing to talk to me,
• 40:44
  Speaker 1: and then
• 40:45
  Speaker 2: it takes me, like, two months to process everything that I learned.
• 40:48
  Speaker 1: Making me think. You told me some things that I have to think about too.
• 40:52
  Speaker 2: Well, how does that impact okay. So when you talk about the marines having to just push how do you
• 41:00
  Speaker 1: Suck it up and drive on.
• 41:01
  Speaker 2: Yeah. That when they do that, how does that impact us when we do that, whether them in their roles with their jobs or us as survivors?
• 41:12
  Speaker 1: Because of all the stuff that happens in the body to make that possible to suck up and drive on, which, you know, your speech on the polyvagal theory described very elegantly, those things still happen. The the instruction that they get on sucking it up and driving on just supports them becoming detached and prevents them from collapsing and getting into the that state of polyvagal response. But it gets them energized so they can move on and do the next thing, the next part of their job. But the effects on the body and the brain of all that hormonal activation and trauma, those still happen just the same as they do to the rest of us who haven't had those kinds of that kind of training and, you know, exposed to trauma.
• 42:01
  Speaker 2: So for survivors, that's a moment where that kind of detachment may help you go get through a week like this, where the trauma is really just normal life. It's not actually anything wrong. Everything's actually really good, in fact. But
• 42:20
  Speaker 1: But it's pretty overwhelming.
• 42:21
  Speaker 2: Right.
• 42:22
  Speaker 1: So whatever trauma responses a person has, you know, will get activated at the level required by that situation. Some people though become completely immobilized in the face of trauma that other people, other survivors can manage. And those are the people that have the hardest time coping with daily life. So people who have become that impaired as a result of extreme trauma, often they have a hard time holding a job or staying in a relationship or taking care of themselves like bathing and taking care of their basic needs or eating and things. They're in a state of immobilization so much by the normal kinds of things in daily life that are not even as dire as what you went through this week.
• 43:11
  So those people need help from a therapist to be able to get to a calmer place where they can listen to themselves, get grounded with their breathing, and notice what's happening now so that they're living in a moment where it's safer. And then they can recognize things like, oh, I need to take a shower or I haven't eaten for a couple of days.
• 43:32
  Speaker 2: Right. So this is the kind of time where it's important to stay in therapy, not quit therapy.
• 43:39
  Speaker 1: Oh, definitely. Yeah. Not a good idea.
• 43:42
  Speaker 2: Okay. Well, we did go and sell some paintings yesterday, and so we're going to make it to therapy on Monday. We got a nurse approved for our children on Monday. So we're we are gonna make it to therapy tomorrow.
• 43:57
  Speaker 1: That's good.
• 43:58
  Speaker 2: Yes. I'm
• 43:59
  Speaker 1: grateful. Is kind to you too. I don't know what you've got going out there.
• 44:04
  Speaker 2: Finally, the snow is gone.
• 44:07
  Speaker 1: Well, we're having rains. So
• 44:09
  Speaker 2: Oh, it is tornado season is beginning, so that's a whole different kind of excitement.
• 44:14
  Speaker 1: Yeah. Well, I hope things are okay with you there.
• 44:16
  Speaker 2: Growing up in Oklahoma, I think you become detached to that trauma because it just is an ongoing thing in its own way.
• 44:25
  Speaker 1: Uh-huh. So I wonder if that's similar to people in Israel who aren't so concerned about rockets most of the time unless they land near them. That this is what I hear from friends who have visited Israel and have seen the population generally not too worried about getting attacked.
• 44:41
  Speaker 2: That's true, actually. We've spent a lot of time in Israel and in Syria and Gaza, and Wow. That's a whole different podcast. But that I hadn't connected that to our own experience other than we did respond as first responders to a really bad tornado that was in Joplin, Missouri. Uh-huh.
• 45:04
  A couple years ago and were in Syria shortly after that right before the war broke out and we got out of Syria in time. Thank goodness. But our nightmares for a while after that were, like, the two things combined. Like, we couldn't tell the difference in our nightmares if we were in Syria or cleaning up after that tornado. Boy.
• 45:28
  Was bizarre. That was not helpful.
• 45:32
  Speaker 1: I've never been in that kind of a dire emergency, but I can imagine that used all the resources you had to cope with that.
• 45:43
  Speaker 2: Why would we be drawn to that when obviously we've already had enough trauma until finally it's almost like a reenactment kind of thing, until finally realizing, okay, we've been through these things. We're in therapy now. We need to not sign up for that sort of thing.
• 45:59
  Speaker 1: Well, you didn't decide to create injuries that you had to respond to like, oh boy, I should go there and wait for a tornado. That's not the same thing. Well, one theory that people have regarding PTSD is that some people sort of become addicted to the adrenaline rush. But I'm not so sure that's true for people outside of combat trauma. But a lot of the veterans I interview have Harleys and like to ride 100 and some miles an hour on the freeway without a helmet or they climb ladders when they have balance problems.
• 46:35
  They take a lot of unnecessary risks, and that's one of the symptoms of PTSD. But it didn't sound like you had done that.
• 46:43
  Speaker 2: Well, no. But we signed up for those programs. And then we also worked in a hospital in the and that was pretty pretty that's where I see your veterans who have been on Harleys without helmets. Mhmm.
• 46:59
  Speaker 1: Oh, boy.
• 47:00
  Speaker 2: Interesting. Oh, you've given me a lot to think about today.
• 47:03
  Speaker 1: You've given me some things to think about as well. It's it's always great to talk to you.
• 47:08
  Speaker 2: I appreciate it. Really, you have you have been so kind, and you have shared so much with me and with the podcast. And the response to your episode was huge. People had so many questions, and and I had people that send me messages about getting started in therapy when they had, for a long time, not wanting to even ask or reach out for help. And so you really modeled that for them as well.
• 47:34
  And I appreciate the difference that that's made in our listeners.
• 47:37
  Speaker 1: Well, let me share this after after we I did the podcast with you. I went into my own little shame spiral of, you idiot. Why did you say this? And why did you say that? And you sounded terrible, and your speech was halting.
• 47:49
  And, you know, this is just really a bad thing and you should have said this other thing. And it took me a while to calm down and what helped was getting some feedback from friends I trust who had listened to it. And then I realized, oh, you know, this is very familiar. That's something I could work on in therapy in the future.
• 48:05
  Speaker 2: It was really well done, and I'm grateful.
• 48:08
  Speaker 1: Thank you.
• 48:09
  Speaker 2: That's very courageous of you to share too. Thank you for sharing.
• 48:12
  Speaker 1: Well, like I said the last time, we're all more simply human than otherwise. Right?
• 48:18
  Speaker 2: That's true. That's true. Even in therapy, I feel that sometimes when I see this play out on our phone, like I'm not aware when it happens, but I see it on the phone when things are hard enough and one of them finally reaches out to the therapist to say, this is what's happening. I know you can't do anything, but it's bad enough. I just need to reach out.
• 48:39
  And then someone else is like, stop. Don't bother her. Why are you acting now you sound crazy. You weren't crazy before, but this is what the line was that made you sound crazy. Like, just stay away from her.
• 48:51
  Leave her alone or whatever instead of just letting it be and everybody relaxing and working together and letting it just be safe.
• 49:00
  Speaker 1: So if you have if you have good enough parenting, it becomes easier to kind of talk yourself down out of that kind of shame thing. You can become more compassionate to yourself. And it sounds like you've had some experience that have helped you be able to do that for yourself.
• 49:17
  Speaker 2: Well, we'll keep practicing.
• 49:19
  Speaker 1: Okay. Me too. My therapist helped me a lot with this. So
• 49:23
  Speaker 2: There you go. That and the chapter on avoidance has pretty much stumped us. It turns out we're really good at avoidance.
• 49:30
  Speaker 1: Oh, yeah. So which workbook are you were you talking about? Is that the the one by Kathy Steele and her associates?
• 49:37
  Speaker 2: Yes.
• 49:38
  Speaker 1: Oh, okay. I like that book a lot.
• 49:39
  Speaker 2: It's good. And we're continuing to move forward, but the avoidance chapter was pretty much the line of, okay. This is no longer just learning about things. We're gonna have to actually make some changes. Yeah.
• 49:52
  So
• 49:52
  Speaker 1: And they could and they could be really good.
• 49:55
  Speaker 2: I think they are good changes, but it's still in the phase of it feels like everything is falling apart because some of those walls are coming down, which is good, and it's progress and what we need to happen, but it's absolutely terrifying.
• 50:09
  Speaker 1: Yeah. I'm I'm sure you and your therapist can figure out how to pace it so that it works for you and feels safe enough to try some new things.
• 50:18
  Speaker 2: She is very, very safe, and I am grateful for that and very, very connection. And so that's definitely in our favor.
• 50:28
  Speaker 1: Great.
• 50:28
  Speaker 2: Okay. Any other things about attachment? I'm sorry I'm got off topic.
• 50:34
  Speaker 1: You didn't. And I can't think of anything else about attachment. So I'm I'm kind of attached out, I guess.
• 50:41
  Speaker 2: That's okay. That was really good. Thank you for sharing.
• 50:44
  Speaker 1: Oh, glad to talk to you. I really enjoyed it.
• 50:47
  Speaker 2: And I appreciate especially that firsthand knowledge and that firsthand experience of the original research because so much gets repackaged now into either short term stuff or just brief versions of it that people forget all of this foundational stuff it's built on. And so what you shared was really important today.
• 51:09
  Speaker 1: Great. I just remember the excitement of learning about Baldi because he wrote a three volume set called Attachment and Loss. And the first volume was our text. When I took another class from doctor Ainsworth the following year, his second volume was in galley proofs, we got to have galley proofs of this book that wasn't in print yet. That was so exciting.
• 51:30
  Speaker 2: Wow.
• 51:31
  Speaker 1: I felt like really on top of what was going on in the field. It was amazing.
• 51:35
  Speaker 2: That is exciting. Yeah. It's such good stuff, and it really makes a difference. And there's hope in it when you can step back and look and see this is a process and how it works, and this is what's happening inside me, and here's what I can do about it, as opposed to only being overwhelmed or overstimulated or giving up because you just can't do anything.
• 51:58
  Speaker 1: So many people with DID feel that they're crazy or they've been told that, which is, you know, just wrong. It it I can imagine how it must feel crazy, but it all makes sense when you consider how things happened that got that way.
• 52:13
  Speaker 2: It helps a lot. Thank you very much.
• 52:15
  Speaker 1: Oh, thank you. It was great talking to you.
• 52:21
  Speaker 2: Thank you for listening. Your support of the podcast, the workbooks, and the community means so much to us as we try to create something together that's never been done before, not like this. Connection brings healing, and you can join us on the community at www.systemspeakcommunity.com. We'll see you there.