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Recap: 2023 ISSTD Annual Conference, Part 1 · System Speak: Complex Trauma and Dissociation

• 0:12
  Speaker 1: Welcome to System Speak, a podcast about Complex Trauma and Dissociation. It's our story, our learning, and the ideas we've been working with as they've unfolded over time. Earlier episodes give context for where we are now, and current episodes may engage more advanced material, harder content, or reference earlier conversations. A few things to remember as you listen. The podcast is education, reflection, and storytelling.
• 0:41
  It's not therapy, and listening doesn't create a relationship. Although I am a therapist, I am not in that role here, and nothing that I share is individualized clinical advice. Every system, every internal world, all of your own stories are all different and you take up your own shape. What we share about ours won't translate directly to yours. It isn't meant to.
• 1:06
  We're all different, and all of our stories matter. As always, take care of yourself during and after listening. We are so glad you're here.
• 1:25
  Speaker 2: We are ready to give a recap of day one of ISSTD conference, which was actually pre conference. So I ended up bouncing around a lot because somehow by default I don't know what happened I got in charge of the social media accounts. So I was pulling quotes and listening to different sessions and sharing that to give live tweeting so that people knew what was going on in ISSTD. And so I got to see different things. You went to the classic every year dissociation one zero one conference with Christine Forner, which is super intense.
• 2:14
  I
• 2:14
  Speaker 3: love that.
• 2:18
  Speaker 2: Let's back up a minute to get everyone on the same page because they've just heard our blast of our road trip.
• 2:25
  Speaker 3: It was so fantastic.
• 2:28
  Speaker 2: Right? It was good. And then we flew to Kentucky of all places. Hello, Kentucky. And we rode our car from the airport to the hotel, and that was a late night.
• 2:47
  But we got up we got here a day before the conference started. So we had one day off between parenting, the road trip, and traveling a day off, and then the conference started. It was amazing. It is warm enough here, which my brain cannot fathom because it was literally snowing when we left up north. Oh my goodness.
• 3:14
  Still snowing in the North, but here, it is literally warm enough we could swim. And so we got to go out in the morning and have a morning swim and soak in the hot tub after traveling. And then we got cleaned up and had a very relaxing day with journaling and markers and pens. Some of us did journaling. Some of us observed journaling that we got all ready.
• 3:45
  And then what did we do for dinner? We went to the troll I don't even know how to explain the troll pub. The trolls under the bridge pub. It was perfect. We ordered just for fun.
• 3:57
  We tried an appetizer, and we ordered fried pickles, which were super fun and delicious. But also, it was like this southern basket of fried food where there were other fried things that just had gotten lost in the fryer that were in our basket. So we also got onion rings and we got some chicken fried pickles. That's gonna be my new cuss word. Frickles.
• 4:24
  Oh, we need a hat or a shirt or something that just says prickles. Oh my goodness. And then I got you got some chicken and fries. I got a burger with mushrooms and Swiss. It's my favorite way to have a burger.
• 4:43
  We don't have burgers very often, but when you do, you need Swiss cheese and mushrooms, and it was so good. It took a hot minute to eat them. Oh my goodness. But also it was fun because it was a bit of a walk. And so we had a lovely walk, but also it was warm.
• 5:04
  What? That's different than snowing. And we got all set up for the conference, got our clothes laid out and got ready and pretended not to be anxious. And then we had to behave ourselves and go to bed on time so that we could get enough sleep instead of playing and get up on time because I had to be ready like at 06:30 to be at my post. Oh, are you still time zone?
• 5:33
  I don't even know what time zone I'm in anymore. My life is not very particular to time zones. Oh my goodness. So we have some things to look forward to. We have already met with a couple friends that we got to see.
• 5:51
  Peter, I can say his name. He has permission. I mean, I have permission to say it. Peter is coming, so we'll get to have dinner with him. We have some other friends we wanna meet with here, getting to see our colleagues and clinician friends, many of whom also have lived experience, whether they're public about it or not.
• 6:11
  And, that is just like, there's something it's kind of like healing together in a different way, a little more nerdy because all the sessions are super nerdy. But getting that reunion of getting to see friends, and it's a reminder that ISSTD is the people, the faces, friends that we know and love, others who are trying to make a change. And we've come so far in in these years of grow not just growing the field or research, but connecting with lived experience. I, am anxious to see what kind of response there will be about the social media stuff. It will just be in response to people.
• 7:09
  And so we advocated for some with that. Other good, safe, wonderful clinicians are talking about that and what does that mean? And really this was already in process before any of that happened. You and I talked about it last fall, and there's been so many different kind of conversations about that. I can't even I I can't I don't even wanna focus on that tonight, not to dismiss it, but to focus on our experience and what is good and positive while we're here and being present in that, even though that's also in the background.
• 7:47
  Like, I can't not acknowledge it.
• 7:48
  Speaker 3: Yeah.
• 7:49
  Speaker 2: Does that make sense? But it was absolutely part of the conversation today. People brought it up in sessions. Different clinicians, including the president of ISSTD, current president, was giving a session today and people asked about it. So it is absolutely on topic and part of what is being addressed in a variety of ways even though I know that there has not been a public statement as of the time of this recording.
• 8:16
  It is absolutely being addressed. It's hard because social media moves so fast and that delay in care or what feels like a delay in care compared to, like, having to wait for scheduled meetings for things to move forward is different than being able to post as individuals really quickly. So I know that there's a timeline difference and that that is like misattunement. Right? A delay in care feels like and is neglect.
• 8:52
  So that is a hard piece. So there's that happening. And then just to sort of summarize very quickly what was happening today, there it is the preconference, which means all the sessions today were all day long sessions. Six hours, super intense, and there were several different options to choose from. One was a session about veterans and trauma and treatments of dissociation with veterans.
• 9:28
  One was an organized abuse session by Michael Salter, who is the current president of ISSTD, and he is talking about we will talk about what that is and what that means and how he's presenting it because it's kind of shifted what that means and what that's looking like and what the research is showing. So we can talk about that. Then I have to go in order of the rooms, like, around the building so I don't forget anyone. The next one was Christine Forner's, which she does every year, Dissociation one zero one. And then around the corner, Rochelle Sharp did a session about somatic experiencing and sort of an introduction to that and why we need to heal in the context of our bodies, not just our minds and talking.
• 10:22
  And then the last one was Ben Israel, who we actually know in real life, and he's very kind and a sensitive, humble person, I think, very receptive and has some inpatient experience. So that's actually where I met him first was on the inpatient SIG, which means special interest group. So meetings about inpatient care specifically because I have done that in the past. And he was presenting about the treatment frame in therapy and has sort of fleshed out what that looks like between what symptoms people actually present and what treatment looks like, not according to a specific model or something, but in response to what people are actually bringing to the room and what that looks like in the context of the treatment frame. So that's what we're gonna dig into.
• 11:22
  Okay. We had to pause for a minute. I heard a sound.
• 11:30
  Speaker 3: And I said, I don't know if I
• 11:33
  Speaker 2: can stop laughing long enough to share this. So I'm just gonna tell this story. I heard a sound, and what I said was, was that a bird or was that your phone? And I think that's a normal and appropriate question. But also I'm a deaf girl and so you and Damien were like, what I heard was an ambulance.
• 12:00
  I said,
• 12:01
  Speaker 3: oh, that's why I thought it was a bird. And you were like, what? And I said, you know, like when it hits the window. And you said, no. When a bird hits the window, it makes a fun sound.
• 12:17
  And I said, oh, I thought I thought this is so terrible. I didn't know. Deaf people have to learn this along the way. Okay?
• 13:05
  Speaker 2: Oh my goodness. So now my sides hurt. My face hurts a little bit too. Oh my goodness. Oh my goodness.
• 13:17
  Where were we? We talked about we kinda went around the like, the different rooms. I had to do it spatially to get everything. We also talked about meeting safe people. Some of the cool safe people we saw, we saw a lot of people.
• 13:34
  I did talk to Lynette Dental check. She came to give me a hug, and I so appreciate her. She is one who has changed her presentations. She's one who calls me Emma, and, she has been very kind to me since I got to know her. Last year in Seattle, she came to my presentation and actually learned a lot from it, and I've seen her presentation since then, and she incorporated some of what she learned.
• 14:01
  And I love that because it's an example of all that we're asking. Like, that we learn from learned experience, but we also learn from lived experience and integrating, if I can use that word, those two together and weaving them together just brings such an enriched form of wisdom as well as clinical information. So I appreciate that about her. Good thing. So lots and lots of people, and and that is by no means all the people that we saw.
• 14:33
  There's like a 100 people already, more people coming tomorrow and more people coming even the next day. So, anyway, back to what we learned. I think I was not in those session for veterans very long, so I don't mean to be unhelpful with that one. I just had to bounce that around so much. But I think one of the most useful things that I learned from the veteran session was they talked about EMDR, not the whole time, but it was one of the things that they discussed.
• 15:10
  And one of the things that they said was that the reason EMDR can be really useful for veterans specifically is because it is a way to process some of what is going on internally with people who are literally not at liberty to disclose the details of their trauma. Right? And I actually appreciated that because I'm not a veteran as far as the military, but because of my deployments and working in those kinds of situations in my own context, I've actually done that with my therapist where I have literally said, we need to do eye movements. I cannot talk details, but here's how we're gonna communicate what is too much or when to stop or, like, we set it up very carefully. And I think that takes someone who knows trauma and dissociation as well as psychodynamic, like transference, all the things for safety.
• 16:10
  But within that context, using that as a tool to either contain until I can home or to process stuff I can't actually literally cannot talk about has been really helpful for me. Another one I did not get to see a lot of, in part because I've seen part of her presentation previously, was Rochelle Sharp, who is amazing, and also very kind in real life. I like her a lot. I appreciate her a lot. I did get to speak to her today as well, but her session was the one that was about somatic, and it was an experiential, meaning they practiced with each other to, learn how to incorporate those things in session.
• 16:56
  And one of the things that she talks about frequently, and even in other times that you've seen her present, is about how sometimes it's important to finish the movement from trauma. So for example, if you were not able to push someone away, for example, push a perpetrator away, to be able to physically push your arms out to finish that motion, that sometimes our body in different ways, the trauma gets trapped in there way and about how it's freeing. But something I've not heard her say before was about sort of alignment. And I didn't hear all of that, so I can't speak to it fully, but she talked about how it's important that we're not pushy with our survivors when we're working with them because we can get like the body aligned, but that just increases awareness of what is not aligned internally, which can bring down those dissociative barriers too quickly. So I'm not sure I have the right language to explain that further, but I appreciated the caution of it.
• 18:10
  She also talked a lot about consent and awareness of where someone is, like how in touch are they with their body or not, and how that works differently in different sessions, or like how like proximity experiments, like how close can you be to someone with them still being comfortable that some people really need more, like bigger space bubbles. Right? So that was really good. Ben Israel's, I did not get to see lots of, but he had really fascinating slides. It reminded me of a community where we talk about a concept like in the workbook group or one of the therapy groups, and then she's like, oh, that could look like this and makes an amazing diagram.
• 18:54
  She's actually gonna help me with the next workbook on some pieces of putting in some of these diagrams that we've talked about. An advanced topics workbook. Did I even tell you that? I don't know if it'll be a workbook or a clinical book, but it is in process and at very early stages. So he has kinda done the same thing.
• 19:19
  Like we talk about, remember, like in PTP classes with ISSTD, we talked about the treatment frame and different things, but it's such a vague concept. But he actually like came up with this diagram about these are the things you incorporate in a treatment frame, and then this is how a client presents what it looks like in each of those little sections of a treatment frame, and then how we actually respond to that. So that, like, acting out isn't really acting out. It's not bad behavior. It's trauma, or it's this struggle, or it's attachment, or like so that you can stay focused on where the hurt is and where the wound is and not with these preconceived notions of people being resistant or people being uncooperative or It was really, really fascinating.
• 20:20
  I was super impressed. Right. Except also it wasn't manualized at all. Even in the case studies, they did some case studies at the end. And even then in those little snippets, they sort of filled it out together and what would that look like and practiced.
• 20:35
  I was really impressed. It was really well done. What else is left? So then Michael Salter talked about sort of the concept of organized abuse, but specifically talking about his focus on research, which is about child exploitation online and talked about online or offline being, sort of differential factors and contact or noncontact differential factors. He said the modern definition of child sexual exploitation is defined as the abuse of a child when it involved an exchange such as with child sexual abuse materials, which is what they used to call child pornography, money, drugs, or other children with distinctions of online or offline and contact or no contact.
• 21:40
  He also talked about, which I thought was really relevant, about bystander trauma and about vicarious trauma of people who are exposed to other people's trauma and either in caregiving like therapists or with bystanders. And he said that trauma is, this is not a quote. I just mean what I heard and understand. Like he said that, he talked about how when we experience trauma, it's not just catastrophic, but it also but it is also lonely because we're alone in it and no one rescues us from it. And so he put that kind of together and called it catastrophic loneliness.
• 22:41
  Right? And then said that it gives us because that's an experience, but kind of like without the mirror that we've been talking about, that it gives us what is called, quote, a formless dread, end quote, vulnerability. That we dread vulnerability because it was so horrible, horrific when we were victimized. But that because we were so alone in it, that dread doesn't actually have a shape to take. So it kind of goes back to what we talk about, like, with emotional flashbacks.
• 23:28
  And so he said that same catastrophic loneliness and formless dread of human vulnerability prompts conflict that prompts that prompts complex trauma is also the same catastrophic loneliness and formless dread that results in its denial. I know, right? It's hard to address. And even for the bystander also that they can see that it's catastrophic, and they can see and experience the loneliness and dread of I see something terrible happening, and I can't actually stop it. And so because of that, then they also dissociate almost like a victim except in a different way because they're not able to stop it or prevent it.
• 24:24
  Someone also in that conversation asked about the social media clips controversy from the presentations. And I thought he answered it really well actually, but again, that we're gonna come back to it later. But, he talked about this in that context as well about people's big feelings, but also watching that and how we can't stop it because it's actually already happened. But because social media is bam, bam, bam, bam, bam, it feels very big. It feels very right now.
• 24:55
  And because these are real people involved, then we have a bystander experience of seeing people we know and actually care about being at risk or being vulnerable. And so then we all have this, it becomes a collective trauma together, which, which made sense and really spoke to some of what we've experienced. So that was kind of powerful. Oh, I have to go back to Ben Israel. I'm sorry this is out of order.
• 25:28
  But one of the things that he said was that if you get the treatment frame to set up the conditions for healing, that healing takes place automatically even without any specialized interventions. So back to Michael Salter, he also shared research that just came out at the end of last year, so the end of twenty twenty two, about the prevalence of victimization, where they they studied almost 3,000 young adults and asked different questions about technology facilitated abuse. That's kind of his specialty. That's what he he's from Australia, if you don't know him. He's from Australia, and he works kind of, speaking to governments and with researchers, clinical researchers, and that intersection of actually changing the laws.
• 26:26
  And actually, he he's written some great papers with Heather Hall about dignity and about honoring the stories of respecting survivors in research. Like, he's actually done some really powerful work that's very important, and he absolutely listens to lived experience, helps defend lived experience, researches it in safe and appropriate ways, and then takes that information to governments and changes things. Like, it's very powerful what he's doing. That's why he's, an important part of ISSTD even though he is not a therapist. Does that make sense?
• 27:11
  That's the Reader's Digest version. But he talked about that and it said that out of those 3,000 people or almost 3,000 people aged 18 to 28, sixteen percent of them experienced online child sexual abuse. Eleven percent experienced image based sexual abuse. Seven percent experienced nonconsensual sexting. Five percent had been groomed online by adults.
• 27:49
  Three percent had experienced revenge pornography. Four percent had experienced sexual extortion, and two percent experienced online commercial sexual exploitation. Such hard stuff. Which Christine Forner actually talked about as well. So let's so let's look at hers.
• 28:18
  And this is huge. It's so important, not because it's just brain stuff, which obviously is valid and now we're getting more and more research about, but because it's one of the reasons we can not compare traumas. When people say, oh, my trauma doesn't count because it's not like this person's trauma, or my trauma doesn't count because it wasn't on Dateline, or my trauma doesn't count because, because, because, That doesn't have anything to do with trauma. Trauma literally is your brain or your central nervous system in a state of emergency that cannot get out of by itself, Which also, just because it's on my mind and in my heart, because it's happening in the background, right? But it goes back to the plurality discussion of whether someone has DID or not.
• 29:14
  If someone is coming to treatment, we tend to what is hurting. And that's an example, because even if they are not otherwise a, quote, trauma based system, or if they are, they're not, it becomes irrelevant. The point is we're in this crisis and cannot get out by myself and that's why I'm coming to treatment. Whatever the crisis is, it can be all kinds of things, but it also really, really broadens our understanding of trauma period for anyone and gives context to all of these things that we talk about relationally, like co regulation and attunement and all of these things, because that is the experience of the central nervous system having the support and resources and resiliency to come out of a state of emergency. Well, and not being able to ask for your needs and then your needs not being met, even if it's not physical or sexual abuse, then becomes like neglect or what Steve Gold said was deprivation.
• 30:28
  Mhmm. Where it's trauma because the central nervous system is literally not getting its need met. She said something really beautiful about that, that if I can find the quote, we'll come back to, maybe at the end for closing, because I think it it would be a beautiful place to close. It it was kind of at the end of her presentation. It was a beautiful place to close, but we'll come back to that because I think it was really fabulous.
• 30:57
  One of the things I heard her say in response to that was also about how the opposite of that brings such critical healing. Like, you can't heal without needs being met. So in the context of therapy or in relationship, she said being cared for and tended to in response to really horrible circumstances and experiences is one of the most pivotal moments in healing. She said specifically that eye contact removes dissociative barriers. Peter Behrs has talked about this in the context of eye contact can help stop a flashback, but she talked about how those dissociative it can remove those dissociative barriers too.
• 31:49
  Mhmm. And that that can be too much too fast. And so not to force that or to push And so I loved that she shared not only a do's and don'ts, but also the examples of here's how I do it in safe ways and working with the central nervous system to bring increased safety rather than being punitive about it or adding to the state of emergency. Let's bring out of the state of emergency instead. She said, along with that, with what you were saying about the state of emergency being the thousands of delayed care or lack of care, she said detachment from caregiving experiences is harder to face than physical or sexual abuse, which we already know and agree are bad, which comes from Simone Randers.
• 32:49
  Right? Detachment is a lack of good. The bad cannot happen if the good is not already missing, which John O'Neill also said. Detachment is harder to remember because those aspects of harm are absolutely harm, but the crisis is for your central nervous system not having help responding to that or getting out of that. So the dissociation happens not just because of the physical or sexual abuse, but because of the detachment that either was a part of that or allowed it to happen.
• 33:30
  Oh, that's really uncomfortable. It goes all that relational trauma. She also said part of healing is the difficult work of facing the past, but the other part of healing is the difficult work of facing what is still happening in the present. So, like, for example, I see this with my outside kids where they have been physically removed from their dangerous situations, where now when we have contact with their biological families, they are not being beaten or harmed or abused in those ways. But there is a difference in the children who have built relationships and now have those families as safe resources in addition to us as opposed to the children whose families still do not know how to actually develop relationships with their child.
• 34:42
  Those children are struggling more. I know that that's something, and we don't have to get into this right now, but that's something that ultimately I had to face with my family. And that was decades before my parents passed away, was it's literally not safe for me to be with you even though I'm an adult and you're not, like, beating me up. Relationally, affectively, emotionally, attunement, misattunement, like, for all those kinds of reasons, this is a source of pain and a source of deprivation, not a source of support or resource. And that meant removing myself.
• 35:29
  That's hard. That is a hard place to be. That is good to know. I had years like that with a lot of panic. I don't have panic like I used to, but well, I did recently, but only briefly, and I was working too much.
• 35:45
  But but that's that is, like, reassuring to know. The panic attack is attach cry. Shut the front door. Panic attack really is an example of attach cry. That comes from Rich Shevitz.
• 36:00
  He calls it attackment instead of attachment. Oh my goodness, that makes so much sense because the time in my life when I was really struggling with panic was when I was with the first therapist and knew that it was not working. My panic was increasing. It was a slow motion train wreck. Oh, that hurts my heart.
• 36:29
  It also makes sense because historically, when I look back and think about it, the other times that I have experienced that would be times and I know Christine I know I know that she went there about shame, and we can talk about that in a minute. But the other time that I've had great panic, not great, like, woo hoo, but, like, big panic, were times in my life where things were really bad with my family. So in the same time, I'm feeling rejected, that attached cry reaching out of, please, my life depends on being connected to you. Because I wasn't getting connected or there was not attachment, then there was panic as attached cry. Oh my goodness.
• 37:26
  That is yucky. Okay. Okay. What else? That's really So you're saying rather than saying I am bad, we really have to do the therapy work of, I felt bad when this happened, and what happened was bad, and my feelings were this because of that, not because of who I am.
• 37:59
  Ugh. Hard. She said care is crucial, that you can't heal without it. It doesn't matter what modality you're using or what techniques you have that care is crucial. And not just care, but that it has to be consistent.
• 38:19
  That's what settles the nervous system. And how and and with developmental trauma, how long do you have to experience consistent care? Balance it like as long as, also very uncomfortable. I'm just gonna let that settle and not think about it right now. I did.
• 38:47
  Before my last quote, one of the things that she pointed out that I thought was really helpful is that she said borderline and dissociative diagnoses are not the same and they have different neurology. She pointed out that dissociative diagnoses are the freeze response and borderline diagnoses are the fight response, but that both are in response to trauma and neglect and both need care and attention. Both deserve dignity. Oh, the other thing she said yes. What?
• 39:24
  That was good. She also snuck in there that infants experience abandonment the moment they don't experience caregiving. And she called out kind of the cry it out method, not shaming parents. And she gave her own story and example of that and was very non shaming in how she talked about this. She was very sensitive.
• 39:50
  But she was saying that we were taught wrong and that, physicians and pediatricians were taught wrong. And really, that comes from behavioralist stuff, which came from animal stuff, which was never meant for humans, but applied to babies and infants and talked about how it was for so long thought that that was how to train or that was how to this or that, but that that's not what we know now. And that is always so painful. We've talked I'm trying not to cry. That's heavy.
• 40:38
  That's really heavy. Yeah. Well, kind of in along those same well, I have several, sorry.
• 40:51
  Speaker 3: Along
• 40:53
  Speaker 2: those same lines, she talked about boys specifically and kind of gendered trauma a little bit. She said the neglect of little boys from ages zero to three is tantamount to the abuse of girls from three to 13, sexual abusive girls. I don't know why I've blocked that out. She said this traumatic neglect sounds like things such as man up, stop crying, don't cry, stop coddling him, Put him down. And she talked about the misogyny of this.
• 41:31
  She said all children need attention. They are children. It is impossible to be a bad child. Okay. Here's the quote.
• 41:50
  You referenced this earlier, but I found the quote. She said, what I can't even read it. It's so hard. What is thirst needing? A drink.
• 42:07
  What is hunger needing? Food. What is cold needing? Warmth. What is fear needing?
• 42:22
  Safety. What is shame needing? Connection. She said, and we talked about this before, and we're like, where did she get this? Someone said this to us once and we're like, she just made that up.
• 42:39
  Where'd she get this? This is where she gets it. Christine said, when there's a feeling or a self state, there is a need. That makes me nauseous. She said, as therapists, our job is to help people connect that their needs are not bad and their bodies are not wrong.
• 43:03
  It is impossible to be a bad child.
• 43:25
  Speaker 1: Thank you so much for listening to us and for all of your support for the podcast, our books, and them being donated to survivors and the community. It means so much to us as we try to create something that's never been done before, not like this. Connection brings healing, and healing brings hope.