Latest / System Speak: Complex Trauma and Dissociation / Guest: Rick Hohfeler, PhD

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Guest: Rick Hohfeler, PhD · System Speak: Complex Trauma and Dissociation

• 0:00
  Speaker 1: 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.
• 2:26
  Speaker 2: Doctor Rick Hoffler is a clinical psychologist graduating from Forest Institute of Professional Psychology in 1986. He has maintained a private practice in Milwaukee, Wisconsin area for the past thirty years, specializing in psychological trauma since 1986 as co manager of an inpatient program treating survivors of abuse at Rogers Memorial Hospital, where he also co managed an inpatient program treating children and adolescents until 1995. He continues to treat adults, children, and adolescents suffering from disorders associated with severe developmental trauma, including a special emphasis on dissociative disorders in private practice. This specialty was also applied within the Wisconsin Department of Corrections from 02/2008 to 02/2020. He has provided supervision consultation to therapists and case managers from a variety of agencies in the Milwaukee area for the past twenty years, with consultation affiliations having expanded internationally.
• 3:32
  Rick is a faculty member of Wisconsin School of Professional Psychology in Milwaukee, Wisconsin, where he teaches courses in traumas and dissociation. He is a member of ISSTD and was elected to their board of directors in 02/2016. Since 02/2014, he has acted as a moderator for the virtual book club sponsored by ISSTD. He has presented professionally on topics related to trauma and dissociation locally, nationally, and internationally. He has published papers relating to working with trauma dissociation in forensic settings and is in process of releasing a paper regarding the regulatory aspects of shame in dissociative disorders.
• 4:15
  Welcome, doctor Rick Koffler.
• 4:19
  Speaker 3: Okay. Very good. Hi, everyone. This is Rick Hoffler. I'm a psychologist in practice in Milwaukee, Wisconsin, and I've been seeing and working with, complex trauma and dissociative disorders in particular for more than thirty years in various venues, in inpatient venues, as well as prison venues and outpatient private practice.
• 4:47
  So So I've seen a variety of people who are very traumatized in, in a variety of place settings. So that's kind of my blurb. I'm starting to write a little bit more, and, that's been gratifying too.
• 5:08
  Speaker 2: How did you first get involved with helping people or even learning about trauma and dissociation?
• 5:17
  Speaker 3: Well, it's a little embarrassing to say, but, in my first years as a licensed psychologist, I was steeped in inpatient adolescent treatment And, myself and some colleagues began an adolescent program in a small private psych hospital and did very innovative things. This is back in the mid eighties and, was psychodynamically based and it was, done without seclusion rooms or restraints or even locked doors. And so acting out was always dealt with in a in a very intensive psychodynamic form. So, we were pretty successful in that in that, area. It turns out that when we would do, weekly family sessions with these kids that we ran into an alarming number, especially mothers, who reported, childhood abuse.
• 6:27
  Now back then, nothing much was being done, especially on an inpatient level about that. And so we being the young Turks that we were, we decided this was a good market niche because no one else was doing it. And even though we knew very little about it, you know, we knew that, we wanted to learn about it and wanted to create an environment that would be accepting. And that's what we did. So, we learned from the people we treated, essentially.
• 6:59
  At least I did. And, I I had been exposed to DID prior to that, on a couple of occasions, during my training, but, nothing very, intensive. And so we we learned by that, and that that program ran for, I think, between '88 and '95. And after that, managed care sort of obliterated everything, meaningful in hospital work, and, we got displaced. I did do some consulting.
• 7:40
  I one of my colleagues is a psychiatrist who specialize in eating disorders, and he established a residential program for that back then. And, he called on me to consult with, patients he had that, had complex trauma or dissociative disorders. So I sorta kept my feet wet in the in that way on the inpatient level. So that's how I learned about it.
• 8:11
  Speaker 2: How do you explain about dissociation to people who are just learning what that is?
• 8:19
  Speaker 3: Jay, it depends on if you're talking about clinicians or if you're talking about laypeople. There's a a difference. With clinicians, if they usually, when they ask, and I have quite a few supervisees and consultees. I'm I supervise a pretty large clinic, about 20 therapists. And so, because I'm locally known for treating this population, we get a lot of referrals in our clinic with for that issue.
• 8:51
  And so the therapist that I supervise are getting that fallout. And, thankfully, they've taken an interest in it. And so we, we discuss this a lot. And, so typically, they are encountering things they've never really seen before. Because when people are referred for that purpose, they're not hiding quite as much.
• 9:19
  And so it's a little more out in the open. And so what I try to help them understand is how to how to lean into the subjective experiences of of their patients. Now as we know, dissociative disorders or dissociative dissociation as a process, precludes much subjectivity. At least it limits it to a great degree. And one of the things that psychotherapy has really gotten away from in the mainstream is that is that.
• 10:05
  You know, it typically focuses more on behavior and thought. And while those things are are important, they they miss the underpinnings of those expressions. And, so what I tend to help therapists focus on is the subjective experiences of their clients or patients. And what that helps them do is that helps them see, the ways that their patients self protect from that process of subjective discovery. And I think that's hugely important.
• 10:51
  And when we lean in to people, with the intent of examining subjective experiences and we are met with what we typically call resistances, which I call self protective mechanisms. We have to also lean into those mechanisms. So they beg the question, how did you learn to protect yourself that way? What were the circumstances that compelled you to do so? And so what I try to help, people understand, especially clinicians, is that dissociation is a way to, circumvent subjectivity.
• 11:44
  And I think that's a hugely important, factor that, many therapists don't really grasp very well. And, and it becomes kind of intimidating for many, at least beginning therapists. Because when we lean into subjectivity, we usually get a lot of anxiety in response. And we also get a lot of shame in response. And so learning how to work with with anxious self protective mechanisms is really important.
• 12:29
  And, and shame is is usually the mechanism that underscores that.
• 12:38
  Speaker 2: This this is actually why I asked you to be on the podcast because of what you share about shame. Where do you even wanna start with that? It's so Trixie.
• 12:51
  Speaker 3: Well, I I it is, and only because it it, there are many ways. And, you know, Nathanson, many decades ago '92, I think it was, that wrote about shame defenses. And, it's a huge it was a huge contribution. And it helps us, conceptualize how this works. But I think that, what we have to understand is that shame is an acute experience initially.
• 13:24
  And we've all all experienced it. You know, when we, bring a feeling or an idea to to a relational moment and it is dismissed abruptly or criticized. And the feeling that we have when we are presenting that to another person, when we have a certain amount of anticipation or excitement about sharing something with somebody, and it is kind of thrown away, what happens to the feeling that we bring to that moment is that it immediately deflates. It's like falling off a cliff. It's very painful because of that, and it's an experience that most people don't wanna repeat.
• 14:13
  Now when we we think of, kids who are being traumatized by caregivers, that children have a hardwired hardwired expectancy to be received and accepted, that becomes a huge issue. So when you have a child who is exposed to persistent shaming in that regard and even abuse that accompanies it, it it deflates the sense of self. It's not just deflating affect in the moment. It's deflating affect and the self because it is done repeatedly. So this becomes what chronic shame looks like.
• 15:02
  Chronic shame means that that you learn quickly how to not be visible to the people you need to be visible to. And that's that's a huge dilemma. It's part of what, of what compels, dissociative self states. Because it's impossible for one mind to, to contain feelings, while at the same time knowing you're going to get annihilated if you show them. So you can't house those two those those two frames in the same mind.
• 15:45
  You can't. So what ends up happening is that because when we're little, we feel things all the time. And not that we don't as adults, but as kids, we need help with it. We we don't know how to regulate them. And so as kids, kids learn how to not only be invisible to to an abusive caregiver, They also learn how to be invisible to themselves.
• 16:17
  And this is one of the hallmarks of of dissociative process. When you become invisible to yourself. And, Rich Jeffords has, you know, coined that in his in his book, calling it, a mind hiding from itself. And that's exactly what happens. And that's very shame based in my view.
• 16:43
  And it becomes a chronic orientation. And, what I'm also what I've been presenting about and also write about is that, that kind of hiding becomes regulatory because it's something you have to rely on, on an ongoing basis. And this is what chronic shame really does, is it regulates affect. And dissociation and shame work together in this in this regard. So you have dissociation that compartmentalizes mental activity or affects, and then you have shame that keeps it deflated.
• 17:29
  And dissociative systems, and DID in particular, typically, are constructed in a way to prevent, attachments from occurring. And, at best, you have road attachments or you have accommodating attachments. But, it's imperative when you grow up like that to not have a visible self either to to yourself or to others. And so dissociative systems become based on disallowing that kind of visibility either within or without. And this is what, what we see protector alters, orchestrating.
• 18:31
  And so many times, protector alters are you know, we we tend to think of traumatized people as being as over interpreting danger and they're externally hypervigilant. My take on that is that, yes, that's true. But it is also equally true that they are internally hypervigilant. And they are hypervigilant to science of enlivened affect because that is anathema to, what a dissociative system is designed to do. And so when you this this is why we see so much, in in DID.
• 19:16
  This is why we see so much self harm go on. It's it's why we see, very diminutive sorts of presentations. It's because there is a mandate to have a self that is not visible. And, when there is when there is the threat of visibility, even internally, so like, you know, a young child alter is beginning to cry or as happens in psychotherapy where we are engendering attachment. We're engendering subject subjective awareness.
• 20:02
  And so as as psychotherapy progresses, you'll see at some point, you'll see protector alters protest either secretly or or externally. And secretly usually happens secretly first, covertly, but they begin to act out internally. So after sessions, they your client may say that they were cutting themselves or drinking heavily or doing something to, to deflate affect. Many times, protector alters use the rhetoric of abusers who, acutely shamed them as kids They use the same language. They use the same threats.
• 20:49
  And, this is how, many dissociative people regulate their affect.
• 21:01
  Speaker 2: So just to I wanna recap a little bit of what you said sort of in the shared language of the podcast for listeners who maybe have a dissociative disorder and, are maybe overwhelmed a little bit by all of that because it was so dense and so good, and there was so much in that. But what you are saying when we and this is why I asked you to come on the podcast. What what you are saying is when we talk about shame with dissociative disorders, we are not talking about being ashamed of ourselves in a stigma kind of way. We are talking about shame in a process way because of relational trauma when we were little
• 21:49
  Speaker 3: as
• 21:49
  Speaker 2: part of the process of making ourselves more invisible so that we are safe and also because of the, let me think how to say this in terms that people are familiar with who listen to the podcast. So so when we talk about abuse, there are things that like, bad things that happen. But, also, we had Steve Gold on the podcast, and he talked about how deprivation is more than just neglect. It's the the good that is missing. And and so with relational trauma, we have this kind of deprivation and these these interactions that instill shame in a way either for control or as part of deprivation and neglect where that like you said, that deflating of the ego, not just not just that moment of affect or my feelings being hurt, but literally not being tended to.
• 22:59
  I don't exist. I can't exist. I don't have permission to exist. I'm not allowed space to exist. And the shame in that process that then becomes part of the process of how our internal system literally exists.
• 23:15
  Speaker 3: Yes. That's that's what I've observed. And, you know, unfortunately, once, therapy is underway and, our clients begin to know themselves to some degree, and they reach out for help in, say, the psychiatric realm, because there are some things they need help with symptomatically. And and then then what what you mentioned earlier takes place, but it's secondary. You know, it's secondary shame.
• 23:49
  And, unfortunately, it does occur. And so and and not just professionally, but, you know, with other people. And so so you I'm sure, that your listeners who, are DID or have DID can attest to this. That they don't want, you know, their friends to know or at least not many of them. They they keep it rather secret, and, it's not hard to understand why because it's often met with met with, what?
• 24:20
  Are you kidding? And, you know, they they no one wants to be seen as as an alien. And sometimes that's how other people make make you feel. So, yeah, there's that level of it too. But the primary issue here is is that, there's a fear of visibility.
• 24:46
  There's a sort of anxiety that people who are suffering from chronic shame, whether they're dissociative or not, experience. And, you know, we we tend to, experience anxiety when, when there are affects that are momenting. And we have decided not to acknowledge them because they weren't acknowledged by others. And when we when that happens, it creates pressure. And, pressure creates anxiety.
• 25:29
  Anxiety is sort of like emotional white noise. It's it's like feeling that it's not differentiated. The other thing that happens as a she has she based anxiety is that, because attachment is a hardwired thing. In other words, we are hardwired to connect. And then and if we do not do that, we have to fight against that instinct all the time.
• 25:59
  And so when we when people who are chronically shamed, when they know that they have to interface with people, they have a sense of dread. It becomes there's anxiety, but it has a different color to it. It feels like dread, like something terrible is about to happen. And that comes from shame. That comes from the from the fear of of visibility.
• 26:26
  And, that that's pretty universal experience for people who are very chronically shamed. I also wanna make mention of something that I I really like Steve Steve Cohen and what he has to say. And I I read his book when it first came out, and I found it very important. And I still do. And, the idea that, of deprivation, it's deprivation of experience really.
• 26:56
  I think that's his point. And the deprivation of experience happens because when you don't really have a co cohesive sense of self in order to experience, your life, in other words, when you can't afford to know what you feel about anything, you can go through the motions of it. And people who are who are persistently traumatized and or dissociative know this only too well. That they go through the motions of life, but they don't really feel it. They don't really experience it, and so they miss out on quite a bit.
• 27:34
  You can learn things in school. You can learn skills, but you don't really feel it. I have a good case example of that in one of my current patients who was, very egregiously, abused, by an an organized group that, had a relationship who was related to her family of origin. And, so she was abused that way without anyone else knowing about it. And she didn't, she was dissociated from it as well.
• 28:07
  But she she knew from an early age that, she she was just scared all the time and, you know, she she had a, you know, a a a good enough family, but they weren't terrible. You know, it was a kind of a very busy family. And, that's what enabled her to be abused under their noses. But she, would say, you know, there are things I I liked and but I couldn't really experience them. And she, you know, like, she had a particular example of her brother, her twin brother, actually, who, walking to school one day and during the fall, stopped her on the way and said, can you smell that?
• 28:56
  Can you smell that that smell of fall in the air? The leaves and and all of that. It just I love that smell. It just it just makes me feel good. And and she could say, yeah, I smell it, but didn't really have that meaning to her.
• 29:13
  And as we as she is working with me and she is learning how to engage her subjective self, Now things have a totally different meaning to her. She's discovering foods that she liked as a kid, but now when she eats them, it means so much more. So there's a depth of experience that she's regaining. So I think that's what Steve is talking about. There's a deprivation of experience because there's a deprivation of subjective, of the subjective experience of anything for people who grow up like that.
• 29:48
  Speaker 2: I think that part of that deprivation too comes with the lack of repair with relational trauma. And so that's part of the experience that's missing. I'm trying to think of a safe and neutral example for listeners. My youngest daughter, I was picking her up at the airport, and she was excited to see me and ran from her gate to where I was walking towards her down the hall. But one of those carts that beeps and carries people was coming down, and it was going pretty fast.
• 30:26
  And so I put my hands out and shouted for her to stop because I didn't want her to get run over. And she stopped, but she also just was so brokenhearted when she was trying to be excited to see me. And that's that image that comes to mind when when you say a deflated ego. She was sad. Like, her affect was sad, and she was she had tears because I had said no when she was trying to run to me.
• 30:59
  But she also curled up in on herself because she in that it was a moment of rejection, a moment of not being wanted. But because I tend to her, I could get to her and I could hug her and hold her and talk to her and show her what happened and explain, and very quickly she was okay. But when we have relational trauma with bad things happening and and that deprivation and then the lack of nurturing and the lack of repair, we're just left in that curled up state.
• 31:36
  Speaker 3: Yes. You are.
• 31:37
  Speaker 2: And so I wanted to find a way to describe what we mean when we say deflated ego.
• 31:45
  Speaker 3: Mhmm. What's a deflated deflated ego? That's a ego is more, man made. What I'm talking about is a deflated sense of self, which is, I think, a little different. Because a sense of self is what we feel.
• 32:00
  It's who we feel ourselves to be. It's not a skill set. It's not what we're proud of. It's just a it's just who we are in a felt sense, and that's what goes away. Of course, the ego goes along with it.
• 32:17
  But what you're describing is very great to it's a it's a an iconic example of acute shame. And the reason we're hardwired for it is because it's an it's a it gives us a way of inhibiting behaviors and feelings that, that in that in any particular moment are either unnecessary or dangerous. And so in this case, it was dangerous for her to run to you. Even though she was excited about having a reunion with you and, there it's a it's an excited feeling. It's an excited affect, and it's attachment based.
• 32:57
  And so shame is what parents use to shape behavior. Right? So, because kids are, not always aware of the consequences of what they did of what they do and what they want. And so there it's an inhibitory, mechanism that, that caregivers have to use on occasion. And what it does essentially is it uses misattunement in a very, in a very deliberate way.
• 33:36
  And so when, you know, one of the examples I give is, is, you know, a a toddler who was just all about good feelings and exploring and finding interest and excitement and novelty, and they're exploring the living room and the and mom is watching. You know, the best thing in the world for them is to find something new, touch it, and then look back at mom and mom smiles and it amplifies the feeling. That's how we work. So what happens, you know, when, you know, that child reaches for the glass base on the coffee table and looks back at mom and says, isn't this cool? And mom, it doesn't have that same smile anymore.
• 34:20
  And it's a misattunement and it deflates the affect. It it deflates the excitement and the interest. And everything stops like the world stops. And so the point is made and so the behavior is is stopped. Then ideally mom comes over and says, it's okay.
• 34:42
  I still love you. I just didn't want you to break my vase. And then the the affect is reinflated. The attachment is is, is attuned again. And then exploring can continue.
• 35:01
  So, you know, instead of, you know, mom coming over and standing over the kid and screaming at him and sending him to his room, you know, then it's not repaired. So, shame is a is an inhibitor. And, and when it's used chronically, it's an it's a chronic inhibition. And so it's a way to live in an inhibited state. What makes it, in a in a perverse sense, kind of, it becomes regulatory.
• 35:43
  Speaker 2: So rather than using it as a tool for what's necessary or for safety, it becomes a weapon.
• 35:52
  Speaker 3: It can become a weapon. You bet. And it often does in in abused kids.
• 35:57
  Speaker 2: That's interesting. I I also I I was laughing to myself that I I dissociated enough just in a conversation to to use ego instead of self That's still so vague for me. Like, I've made a lot of progress, but that's that's still so slippery for me. It was easier to land on ego than it was self. So I wanted to thank you for clarifying that.
• 36:25
  The the other thing I noticed with what you were just sharing about the toddler in the living room story was I think that sometimes as a survivor myself in my own parenting of my children, I think I sometimes so pre wanted to prevent that deflating that what ended up happening was struggling to give them a sense of boundaries, like, to to teach boundaries because there are some things that are necessary and safe. And I love how, like, that language really helps me hold on to that. But what I have had to shift since being in therapy is that it's that some things are deflating in in a in a healthy way, and that's okay. And what I've had to learn is repair and how to help them reinflate. And
• 37:23
  Speaker 3: Yes. Yes.
• 37:25
  Speaker 2: I don't know, like, yet how to do that for myself very well. That's still a struggle, which, of course, makes it hard to teach them. But how would you speak to that for survivors or clinicians helping survivors?
• 37:43
  Speaker 3: It it really for me, anyway, it it shame repairs what psychotherapy is for me. That's that's really what it is in a nutshell. I I know there's far more complexity to it, but this is really the process of it in my view. And, because what ends up happening in in in dissociative folks is that in psychotherapy, when you are engaging them in a subjective sense, you're trying to help them see themselves objectively. And, and they and when they manage to do so, they wanna shame themselves pretty quickly afterward.
• 38:36
  And so, sometimes there are admonitions that come from me, and I what I tried to do is I tried to head it off the pass because it's like, anytime, you know, it it's sort of like, you know, that that living room thing, you know, when that toddler is reaching for the glass vase, you know, he's fully it it feels like a good thing. But if you've reached for that glass vase before and and you're and you're attracted to it again, it can feel okay, but there it's also gonna feel, dangerous too. So our our patients did go through the same thing when they're growing. And they begin to say things they've never said before, feel things they've never felt before or at least not for a long time, or, you know, fully embody some some experience. I usually, say, oh, that was really cool.
• 39:43
  You you did something that you're not used to doing. And, I'm really glad you could do that. Now tell me this, when you when you look inside, is there any part of you that either feels afraid of that or objects to it? And can can you give voice to that? So what I'm trying to do is is head off the shame response before it is enacted.
• 40:12
  I think that's hugely important. I think it's something that a lot of people don't realize to do. Because when you have someone who is has been in hiding and regulating themselves by hiding, when you invite them out and they start to come out, it it scares the hell out of them. Even if it feels good, it still scares them. And you still have various protector states who are going to object to it.
• 40:45
  And even if they're being quiet in the moment, they won't be once they leave your office. And so I'm always asking, what was it like for you to say something novel? What was it like for you to feel this when you haven't felt it since you were three? What is it like for you to say something out loud that has always been forbidden? What is that like for you to do?
• 41:11
  I use that that sentence, that question over and over. I must use it a hundred times a day. What was that like for you? So you're you have someone experiencing something relatively new that has always been scary for them. And then you have them reflect on the experience of having done it and reflecting enough and asking.
• 41:36
  You need to ask sometimes. You know, do you notice anything any anything in your mind that doesn't that that doesn't really like what you just did?
• 41:49
  Speaker 2: I think that hugely significant in in, some of what we've been talking about recently on the podcast even about religious trauma, how we grow up in that context with such binary thinking of everything, what is good and what is bad, when some things are just developmental.
• 42:10
  Speaker 3: Yes. Things are learned. So it behooves us as therapist to always ask even when things are going very swimmingly and especially when they're going swimmingly. I ask, what's that like for things to for you to start feeling better or for you to start feeling things you're not used to? What's it like for you?
• 42:34
  Speaker 2: Is this part of why when things are going well, they're sort of I mean, I know there's the pattern of the abuse dynamic of of waiting for the other shoe to drop. Someone is gonna get set off. Something bad is gonna happen. But also internally of that shame response like you were talking about earlier, like, littles starting starting to become aware of littles or or littles reaching out or littles connecting that it indicates becoming more visible and engendering attachment. But in response to that, like, the protectors, not necessarily and always trying to be punitive so much as being being visible is not safe.
• 43:19
  We have to sort of Yes. Contain that and squash it back down. And shame is how we do that because it's what people used against us when we were little.
• 43:29
  Speaker 3: That's right. And it works. It works quickly.
• 43:33
  Speaker 2: So that's how it's regular regular
• 43:35
  Speaker 3: to you. Absolutely. That's my viewpoint.
• 43:39
  Speaker 2: Wow. What what else do we need to know about shame or clinicians need to understand about shame?
• 43:46
  Speaker 3: You know, a a shame can play out in, in different ways too. Again, Nathanson pointed out different brands of shame defense. And, most of them most of the most of those mechanisms that we're used to in DID, are very self punitive or they're hiding. So, you know, the four the, he suggested, an access of of four different ways that this happens. One is withdrawing or hiding, which is obvious.
• 44:25
  Another shame to fail because you're trying to prevent further shame. Another is just avoiding, And avoiding can take many different forms. Avoiding can be using substances, OCD, you know, becoming very externally focused, in other words. Okay. Just to, not pay attention to what your internal life is is doing.
• 44:58
  Okay. And then on on another axis we have, what do you do if something that well, this is something I should probably mention too. That, being shamed repeatedly is also, usually when abuse accompanies shame, it's humiliation. And humiliation is on the same continuum of shame, except it's it's much more intense because it feels like, when you know you've been humiliated, you also know that someone intended to do it. Someone intended to would push your nose into the dirt.
• 45:44
  And they wanted you to hurt. They wanted you to look bad. They wanted you to be exposed to to other people as being bad. And so that's usually part of abuse. When someone tries to humiliate us, there's a natural instinct to fight back.
• 46:10
  There is an intrinsic, rage reaction that accompanies humiliation. Now typically, rage is, dissociated because in the moment, of course, when you're being abused by a parent or someone bigger than you, you can't afford to use it. And in the case of a of a parent, an abusive parent, you can't even really afford to know that they intend to harm you, and that's why they're doing it. And so shame is a way to tell oneself, is to is to make confusing experiences of someone that you need hurting you. There becomes a one note way of making that coherent, which is say, oh, I'm just I must have done something wrong.
• 47:15
  I'm I'm just bad, you know, and that's why they're treating me like this. They don't really wanna hurt me. They're just doing it because I did something bad or that I am bad. Humiliation is the re is realizing that the motive of the abuser was to hurt you.
• 47:34
  Speaker 2: That's so hard to sit with. I think there's so much truth in that. And in in some ways, it feels so explicit and obvious. In other ways, it feels like really at the root of things that's really hard to hold on to.
• 47:51
  Speaker 3: It really it really is stark, isn't it? Yeah. And that's why dissociative people have a hard time with it because, it's easier to make sense out of what happened to you when you just think to yourself, well, I I was just a bad bird bad kid. A lot easier.
• 48:06
  Speaker 2: The I the idea even just the concept saying out loud that they wanted me to hurt, that they wanted me to be exposed to people and things. They it's just,
• 48:23
  Speaker 3: Yeah. It's really difficult.
• 48:25
  Speaker 2: That's really raw.
• 48:27
  Speaker 3: It really is very raw. And that and that's why people sit in shame for so long because the alternative is not viable. Now so another axis of shame defense is using that rage. And so we'll on rare occasions, we see DID folks externalizing rage. You have protector altars, for example, who come out and hurt people.
• 48:54
  I used to see that in prison when I work with dissociative folks. But most of the time, the rage is turned inward. So there's attack self. So that access is attack self, attack other.
• 49:11
  Speaker 2: Attack self or attack others. I see that, also, sometimes in sort of the politics of the community of that that rage coming out in a way that is to attack or to discredit or to undo the things that are foundational to, what therapy is to where therapy can help. So whether that is clients sort of sabotaging their own therapy in different ways or their own progress in different ways or the difference between wanting to improve care through lived experience, for example, or, that the trauma drama of attacking in ways that are not effective effective or helpful communication. And I don't mean disrespect to anyone or or even meaning to get into that so much other than I see it happening in the community, and I can't not acknowledge that that there's a difference between advocating for change and rage that is only attacking.
• 50:47
  Speaker 3: Yes. Yes. Yeah. Yeah. Yeah.
• 50:50
  People get caught up in that quite a bit. I mean, as a as a therapist, I feel rage all the time about about the people that hurt my patients. I do. I I feel it. And a lot of times, my patients are very phobic about about that rage for a number of reasons.
• 51:09
  One is that, they don't it because having that rage means that you understand that the person that hurt you meant to do so. And that was their primary motive. The other impediment the other impediment to that, or the reason they fearful fear, the rage itself is because they don't wanna become like their abuser. And they're always afraid of becoming like that because they have certain feelings they don't want to acknowledge. And it's a natural response.
• 51:49
  And a lot because a lot a lot of them have you know, at some point, they begin to have fantasies of hurting their abusers. And that's very common. And they're afraid of it because they're afraid they're gonna become like them. And, most of my I most of my patients don't have the capacity to do that. I'm not saying I've never had one that could, but most of them can't.
• 52:15
  And I will usually tell them, okay. You you have you have this fantasy of walk me through it. Tell me what it's like for you. And that usually is very helpful because it helps them know that actually talking that through, talking through the feelings of it or the actions of it, they know that they really couldn't do it. Many times they are surprised when I tell them, you know, when they have this issue and I say, you know, as as you as you told me so many things of what happened to you and who did it to you, I've had fantasies very similar because I care a lot about you and I I find myself having thoughts about hurting your abusers too or taking them to court or, you know, doing whatever, having retribution.
• 53:19
  That's pretty normal for us humans.
• 53:23
  Speaker 2: That's so interesting. I think that I don't know. I mean, I don't know what I'm aware of or not still, but I don't know or I'm not aware of, any kinds of fantasies like that myself because to me, it feels so big and dangerous that I couldn't win. But that takes me back to that shame cycle of Yeah. Where it's being used as a weapon to keep me under control and things like that.
• 53:51
  What I have said a lot, even on the podcast, is that I don't want to identify with my rage and don't wanna be that kind of advocate because for me, it does feel like becoming the perpetrator, and I don't want to to be that. And, it's interesting in with what you've shared about those who do identify with their rage. I've even I've even talked to someone who was all about their rage and very proud of their rage, and they're like, this isn't about shame, and it's not about hurt.
• 54:30
  Speaker 1: I'm not hurt. I'm not hurt.
• 54:32
  Speaker 2: But they're expressing pain and struggle. And as they came to terms with that in their own therapy, to circle back to that conversation and, like, not realizing they were literally acting out what they said they were not having. And we all we all do that. I mean, that's part
• 54:50
  Speaker 3: of the association. Yeah. Yeah. Yeah. Yeah.
• 54:53
  So it that's how it becomes a shame defense. Right? Well Yeah. Yeah. But the feelings, it's the feeling itself is not defensive.
• 55:05
  That's a pretty natural reaction to being treated like that.
• 55:10
  Speaker 2: Right. Well and that's what I said to that person was I I just don't wanna identify with the rage, but that's that's not a moral issue. It doesn't make me a better person. It's that I'm still afraid of rage, and And I know that. So that's that's more therapy work for me, but, oh my goodness, what what a conversation that became about shame that wasn't at all related to stigma or being proud of myself or not proud of myself or pride in being or any of those things.
• 55:42
  That that was just the emotional expression of shame or avoidance of it in my case. Mhmm. Mhmm. Yeah. Also, let's avoid shame.
• 55:55
  We all have shame defense. I do too. Well, so I guess my last question for you is I've heard you talk before about how some of that internalized process of shame again, we're not talking about, like, ashamed of myself or stigma, but this shame dynamic from relational trauma, from deprivation, from abuse, neglect, all of that, and shame being used as a weapon when we're little, how that leads to internally as a system that covertness that can happen from avoidance of other parts or avoidance of awareness, all of that. Can you speak to that just a little bit?
• 56:41
  Speaker 3: Well, you know, shame is covert. And because we we it's something it it it invokes hiding. That's what it really does to us. And so processes that try to keep us hidden are usually covert. And, protector states who sort of, are in charge of maintaining that dynamic of hiddenness, they're hidden also.
• 57:10
  They don't like being visible. And it's why in in psychotherapy, we don't really hear from protector alters until we're until we get some real traction going. And, when attachment begins to form in that relationship, that's when you see protectors start to, become more active. And again, they might do it in a hidden way. Many times I will call them out, especially if I'm beginning to see signs of that symptomatically.
• 57:47
  And I'll I I will talk through to them. So, you know, I'm I'm pretty sure someone is there that, is objecting to what we're doing here in therapy. And I'd appreciate it if, if you could tell me what your objections are because I'm sure you have a lot of valid points. So I try to invite, when I know there's covert, dynamics going on in the mind like that, I usually call it out.
• 58:21
  Speaker 2: I think that that's an example. I mean, ultimately, that's an example of attunement in therapy. I I can think of my my first therapist, there was ultimately a pretty big rupture that, really had to do with there were other issues involved, but one of them was that we cannot have some of those negative thoughts or feelings, but because she could not deal with it, I could not learn how to deal with it.
• 58:56
  Speaker 3: Yes. Yes. Yeah. You know, it it it's it's very frustrating, and I hear that story a lot. And, it's very frustrating that, you know, that I'm sure you could attest that, when you're in therapy and you are exhuming things that you're not used to either seeing yourself or having let alone having someone else see, that there is tremendous anxiety that goes with it.
• 59:36
  And typically, what happens in a therapeutic relationship, at least if there is some kind of relational traction, is that the therapist begins to feel that anxiety too. And it becomes contagious just like shame is contagious. And, and if a therapist isn't aware of that, they they tend to vilify their their client. They'll say, well, they'll and they'll say they're being resistive or they'll they'll say they're too negative or whatever it is. But it's very frustrating because the that those moments invariably come in good therapy.
• 1:00:16
  And if you don't know how to to work through them, then things just get stuck and they and they get, you know, they things get so the process becomes very negative and many times ends therapy. So I'm very aware of that dynamic, and it happens routinely in people who don't understand that.
• 1:00:42
  Speaker 2: So many pieces to put together. So many pieces to put together. Is there anything else that you would want to share today or that you could direct clinicians to if they wanna learn more about shame for clinicians specifically?
• 1:00:58
  Speaker 3: Well, there's been a lot written about shame. Martin Dorje has done a tremendous job. He's he's the person that that I really first started to appreciate, how shame and humiliation work, that I was describing to you. And he had a great article in, in the, Journal of Trauma and Dissociation on that in 2017. Rich Sheffetz is very articulate about how shame works in in, traumatized people.
• 1:01:41
  And, he's, describes it in great detail. The idea of shaming regulatory regulatory is is sort of my creation. And, my paper has not been published yet. It's sort of languishing, but but it'll get there. But there's there's a there's a lot of literature now on shame and trauma.
• 1:02:14
  And, those are two two places. Oh, I should say my friend Ken Benode has written a lot about it. He doesn't have a lot of experience in dissociation, but he does talk about relational on trauma and shame and how that works. He just came out with a book. So I'd recommend that too.
• 1:02:34
  Alright. Just looking at it now, shame, pride, and relational trauma. Ken Bonhomme. Nice piece.
• 1:02:42
  Speaker 2: Yes. He's the one who talks about pride and being, meaning pride as in dignity of self. And
• 1:02:48
  Speaker 3: Yeah.
• 1:02:49
  Speaker 2: How that is that is some good stuff in there. Thank you so much for sharing with us.
• 1:02:56
  Speaker 3: Hey. Sure. It's a pleasure, Emma. Good to good to be with you.
• 1:03:03
  Speaker 1: Thank you for listening. Your support really helps us feel less alone while we sort through all of this and learn together. Maybe it will help you in some ways too. You can connect with us on Patreon by going to our website at www.systemspeak.org. If there's anything we've learned, it's that connection brings healing.
• 1:03:23
  We look forward to connecting with you.