Latest / System Speak: Complex Trauma and Dissociation / Guest: Richard P. Kluft, M.D., PhD.

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Guest: Richard P. Kluft, M.D., PhD. · 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.
• 1:00
  Our guest today is Richard P. Cleft, who practices psychiatry, psychoanalysis, and medical hypnosis in Pennsylvania. He is a clinical professor of psychiatry at Temple University School of Medicine. He serves on the faculty of the Psychoanalytic Center of Philadelphia, where he is a waiver training analyst and on the faculty of the China American Psychoanalytic Alliance. He has published over two sixty scientific papers and book chapters.
• 1:31
  Most of these papers concern trauma, dissociation, dissociative disorders, therapeutic impasses, boundary violations, hypnosis, and psychoanalysis. His recent book, Shelter from the Storm, is a compassionate approach to the abreaction of trauma and won the twenty thirteen Written Media Award of the International Society for the Study of Trauma and Dissociation. His edited books are Childhood Antecedents of Multiple Personality, Treating Victims of Sexual Abuse, and Incest Related Syndromes of Adult Psychopathology. He and Katherine Fine co edited Clinical Perspectives on Multiple Personality Disorder. Doctor.
• 2:13
  Cluft was editor in chief of the journal Dissociation for ten years. He is currently Clinical Forum Editor of the International Journal of Clinical and Experimental Hypnosis and advisory editor of the American Journal of Clinical Hypnosis. He has presented over a thousand scientific papers and workshops. He was co founder and an early president of the International Society for the Study of Trauma and Dissociation. He has been president of the American Society of Clinical Hypnosis and the Society for Clinical and Experimental Hypnosis, an international conference chair of the International Society of Hypnosis.
• 2:53
  He has received numerous awards for his published research and his clinical and teaching contributions. These include four Erickson Awards for the best scientific paper of the year in hypnosis and the 2019 Ernest Hilgaard Award for the best paper addressing the history of hypnosis. The Journal of Trauma and Dissociation has established the Richard Clift Award to honor its best scientific paper of the year. He has held several visiting professorships. He was the director of the Dissociative Disorders Program at the Institute of the Pennsylvania Hospital for eight years.
• 3:27
  He has extensive experience in treating victims of sexual exploitation by psychotherapists and has served as an expert witness in several malpractice cases involving boundary violations. He also has served as an expert witness in cases in which the diagnosis of dissociative disorders or matters of memory were major issues, including those involving murder and serial murder charges. Doctor. Clef served as a consultant to the DreamWorks and Showtime series, The United States of Tara. He was featured in the Showtime documentary, What is DID?
• 4:00
  With Richard Cluft, which won the 2,009 Media Award of the International Society for the Study of Trauma and Dissociation. Please note that this episode contains discussion of some of the unfolding history of therapy and how therapy is done, which can be a sensitive topic for some survivors. In addition, he also references his friend and colleague, Cornelia Wilbur, who treated the client known as Sybil from the book by that name. We also discuss some of the experiences of therapists learning as we go, as well as different clinicians having different opinions and certain modalities being taken out of context or the benefit of including them in the historical context of what we know as clinicians. Again, this may be sensitive to some listeners, And as always, please care for yourself during and after listening to the podcast.
• 5:02
  Thank you. Welcome, doctor Clough.
• 5:07
  Speaker 1: My name is Richard Clough. The p is for Philip. I'm an MD PhD. I I'm an East Coast product. Pretty much the Philadelphia, Boston, e Eastern Route.
• 5:24
  That's where I've been most of my life, and that's where I've been trained. That's where I grew up. And I am as perplexed I'm still perplexed today as to how I wound up where I am because it certainly wasn't where I started to go. I wound up being a traumatologist and a specialist in a very funny way, which was sad at the time. See, I, in medical school, my mentor was John Nemaya, who wrote the chapter on dissociation for the first version of the Freeman and Kaplan comprehensive textbook of psychiatry.
• 6:11
  And the he was my mentor. He's a wonderful teacher, a wonderful role model, and he made sure we read about Pierre Jainet as well as Sigmund Freud because, John Namaya was an amazing cultured man, knew and read many, many languages. His father was a classics professor, and he thought he needed to know Jainet in order to know psychiatry. So that that tells you right off the start that my background was very unusual. So I entered my psychiatry residency in a very, again, unusual state of preparedness.
• 6:54
  Unlike anyone else in the residency or the or the department where I was trained, I didn't think there was anything unusual about dissociation, dissociative disorders because I had read Chaney as a medical student. Now one of the really monumental moments in my life was in 1970, still a resident. Henri Ellenberger published probably the best book in psychiatry ever written, The Discovery of the Unconscious. And he described all the old cases that are legends in various schools of psychotherapy. And of course, he introduced me to how dissociative disorders came about as secular expressions of the same kind of things that were being described in possession states.
• 7:50
  And in that book, I learned how people learned in the late eighteenth century, actually around the time of the of the American Revolution, how it was the birth of hypnosis. It was the birth of interest in dissociative disorders. It was about the time that Benjamin Franklin was our ambassador to France, a part of the French academy that investigated Mesmer. And this wonderful book told us about all the old syndrome that were described in the seventeenth, eighteenth, nineteenth nineteenth centuries. Among them, of course, was dissociative identity disorder.
• 8:30
  So in this book, I learned how the inquisitors saw possession states and how that was reflected in the later expression of the dissociative disorders and what they thought and how they approached it. And I read a wonderful 1830 case study by Dibin, and, in it, it was the first medical cure of a case of DID. So when later, that year, I found my first case, and I couldn't get any reasonable advice as to how to treat it, I actually went back to that eighteen thirties case and found that Dipine was using what we now would call hypno hypnotic suggestion excuse me. Hypnotic suggestion, hypnotic imagery to contact per the personalities in the case, to talk to them, and to facilitate their coming together. Now granted, this was largely directed by the patient's own personalities, of which she stood in awe.
• 9:40
  But the most interesting thing about all that, as I look back on it, was something I later read in the original French. And that is, the opinion said, oh my goodness. This is a magnetic psychopathology, which is one of the most profound understandings of dissociative disorders. Basically, what that meant is, oh my gosh. This is a case characterized by high hypnotizability and symptoms of a disorder that are very common in high hypnotic subjects.
• 10:11
  And indeed, I was taking hypnosis training, and what we did in the hypnosis workshops had tremendous similarities to what was described as the psychopathology of dissociative disorders. So although there were experts on hypnosis in the area, they were very skeptical and pooh poohed thought that I might have seen such a case, poo pooed Cornelia Wilbur. So I wound up treating my first patients using the methods methods derived from my understanding of dapine, and they were wonderfully successful. Now you have to understand here, I've seen this rare case that I'm not supposed to be able to see while I'm still a resident. Seeing one taught me to identify even more, and I'm actually treating it successfully using hypnosis in a way that many people would have thought would make it worse and all that other stuff.
• 11:14
  So within a few years, I successfully concluded a few cases, and I was pronounced an expert on dissociative disorders because I'd seen three cases, three cases. Well, I then tried to figure out, well, if I've seen three and it's supposed to be rare, it can't be rare. And, you know, I'd like to say, well, I'm the smartest guy around, so, naturally, I found them. Well, that's that's Dutch. That's patently not true.
• 11:44
  I was prepared to see them because I had this wonderful teacher named John Namaya. I read this wonderful book by Henri Ellenberger, and it impressed me so much I actually sought out Henri Ellenberger. I actually talked to him, tried to learn from him. So I was in a very unique and advantageous position. Although everyone around me was thinking that I was crazy and couldn't possibly be on the right track.
• 12:08
  So what happened to me is something that is, again, hard to believe, but I was a community psychiatrist. I was one of these Kennedy era idealists, and I got a community psychiatry job in an impoverished area. I was going to do great for the world and for minorities. Well, after a few years, the minorities decided they didn't want a white Caucasian male in my position, and I was unceremoniously fired with the thought that they would recruit a person of color. Problem is that they quickly found what I told them in the first place, that people of color who'd worked so hard to get a medical degree and go through a psych residency were not going to be prepared to to accept the crazy low wages that that a an idealistic white liberal might accept.
• 13:03
  So I was replaced by an Irish woman and precipitated into private practice. Now I had three private patients, two children, a wife, and an analyst to feed, so I was eager to see anything. I did I did something that people might think of as clever, but it was really desperate. I let it be known I was interested in treating refractory borderlines. So I figured, hey.
• 13:33
  Who wouldn't wanna get rid of a refractory borderline? Because I always heard people complaining about them. And Otto Kernberg's work was the most prominent thing people were talking about. So I said, hey. I'm I'm gonna make myself an expert in refractory borderlines.
• 13:49
  So people dumped their their absolutely impossible cases on me, and almost ninety five percent of them turned out to be multiples. So I found myself with a large practice largely full of people with dissociative disorders, and that is the crazy truth of how it happened. I I was I sought out Cornelia Wilbur after deciding she couldn't be as crazy as some other people said she was, and she was wonderful. She was brilliant, and she invited me to be to join the faculty of a course on dissociative disorders, and it quickly emerged that in my crazy little way. I was doing some research, which led me to develop a screening interview.
• 14:41
  And by the time I appeared for the first time as a faculty member, I had the largest series of DID cases ever reported. And, again, it was very simple. If you if you learn the hidden characteristics of something and and that the usual idea of what a DID patient looks like is incorrect, It's not a flying circus. It's not a mouseketeers roll call, everyone jumping out and saying, I'm Joe. I'm Jill.
• 15:10
  I'm this. I'm that. It's a psychopathology of hiddenness. So by looking at it with subtle questions, I found I had a nice screening measure and was finding cases right and left. In fact, some of those questions I used wound up in Marlene Steinberg's SkiDDR.
• 15:30
  Wonderful researcher, much better researcher than I was. And my while my interview never got published, I was delighted to see that many of its questions are preserved in Marlene's work, which I I use clinically because it's very much like what I was trying to construct myself but failed but failed to get funding to do. So that's long and the short of it, with the possible exception of the following, that because I was seeing a lot of patients who had never been expect suspected of the condition, never thought to have the condition, and I was the only game in town, people were amazingly cooperative, unlike my patients today. I mean really cooperative. They they they look to me as if, oh my god, this person may actually be able to help me.
• 16:26
  The therapeutic alliances were amazing Almost no matter how hard the problems, those patients back there in the 70s and early 80s were just they'd throw themselves into it heroically. As a result, I published a lot of series of very rapid, and successful treatments, and some of those patients I've some of those patients I've followed up for over forty years in in states of stable integration. The rest is detail.
• 16:58
  Speaker 2: What do you think shifted that patients now, generally speaking generally speaking, now are not throwing themselves into their healing work as in the same way that you saw in the seventies?
• 17:14
  Speaker 1: There are many, many factors. First, back in the early to mid seventies, there were maybe a dozen people in the country with even a minimal level of competence. And if someone got to one of us, oh, boy, did they work hard. I mean, I had some impossible cases that I wasn't doing well with. I sent them to Connie Wilbur for consultation.
• 17:40
  They stayed with Connie Wilbur. She got them well in a very short period of time. Connie Wilbur picked up my hypnotic techniques, and one of the nicest things anyone ever told me is she said, it took me twelve years to or whatever to treat Sybil, but if I knew these techniques, it would have taken me four years. So we were seeing a lot of patients we could get well very nicely. It was very exciting.
• 18:03
  There the relational school of psychoanalysis and psychotherapy had not yet developed. Now the advantage to that was there was no one walking around claiming the importance of, postmodern concepts and and the co construction of the mutual of of reality between two subjectivities, it was really understood. Oh, I have a problem, and this guy can fix it. It was almost a very medical medical model. I have a problem.
• 18:40
  You have the the expertise to fix me. And it wasn't a matter of a, a situation in which, one expected enactments, one expected regression in which there were other schools of thought out there about therapy saying, oh, I don't think there's such I don't think people can integrate because that they always have ego states. That didn't that didn't help because people took that as a way of saying that there didn't seem to be a difference between the normative thing we call ego states and the somewhat different thing we call altered personalities. People would another thing is people didn't talk about their trauma, so there wasn't a big hullabaloo. They there was, so it was my my medical school classmate Judy Herman.
• 19:38
  I had not yet filed a published father daughter incest. I think that was 1980. Major textbooks were saying that father daughter incest occurred in one in a million American families well into the late nineteen seventies, it was a secret confidential therapy. It wasn't all over the place. People weren't looking for support.
• 20:00
  People weren't looking to talk to people like themselves. It was a very different atmosphere. And in that much more intensified crucible with with third parties not as big an influence, with a wish not to talk about it, to get well and go home, a much more intense therapeutic crucible was formed, and it was worked through more effectively and efficiently. A lot of my patients, went through their entire treatment without another person knowing it. They regard it as their private business.
• 20:39
  Now come the, you know, come the eighties and, more and more of the relational things, more and more of the interactive things, more and more people talking openly about their abuse experiences, many autobiographical things published, people forming support groups for themselves among people with these conditions, and with an attempt to normalize DID in in a problem that continues today, you have a difficulty. See, if everybody if everyone who comes to you says, oh, this is a problem. I agree. Let's take care of it. That's a very different therapeutic environment from one in which a person says, well, I'm not quite sure I'm not quite sure I wanna get rid of these parts.
• 21:36
  I kinda like the way I am. So in a period of very few years, what was a very private enterprise became a very public one. There was much more public attention. There was much more controversy, and that intensified, of course, into the nineties. When I started working, I will I'll I have to tell you, was trained at incest.
• 22:06
  Memories were fantasies, and I had the fortunate experience of having an abuser confess early on in my career with with DID patients. As a matter of fact, my first one. So I didn't I wasn't treating peep people in an atmosphere of doubt about what they said. It's not that I took it all at face value. I actually have the same conservative values I that I have today, that some things are true, some things are not true, some are a mixture, sometimes you never know.
• 22:37
  But the job is not to judge but to heal. Now people are sitting around wondering whether their memories are accurate or not, whether they're bad if they make an accusation, even the privacy of the office, when they're not sure with whether something happened or not, then it's not a therapeutic enterprise. There's an implied set of other judges in the room that, the patient may feel more beholden to than the therapeutic process becomes very, very complicated. And so we go from a situation where we had a very classic isolated kind of therapy that was very, very private to one that is was more public enterprise with a lot of people pitching in, with patients hearing things in from the media and others that really had a lot of very different things to say about about their memories, about their understandings of themselves, and and the like. Now I say this as an observer of a historical set of events that, you know, has certain therapeutic implications.
• 24:07
  It's not a matter of a good or bad judgment. Certainly, it's more convenient for therapist if if there are fewer moving parts, so to speak, in the therapeutic enterprise, but that's that's not mind call. I have to I I I have to live in the historical moment that I'm in.
• 24:28
  Speaker 2: I'm just reflecting on this and and from what you described in the beginning of there being such a small base of support or almost no support other than the therapist to now, and again we're generalizing, I know that's not true for everyone, but now there can be sometimes such a broad base of support whether it's the online groups or different books to read or things that reflect your experience and then sort of identifying with that. But and I and I was aware of that external change historically, but I did I was not aware of that historical shift in the clinical setting and that it sort of diffused the focus of the energy put into therapy.
• 25:22
  Speaker 1: Yes. And it's it's and, you know, we we we live where where and when we live. I can give you an example. A a patient these days has heard all sorts of things about me and what I do or they think I do on the Internet from friends, from previous therapists. Earlier this week, a patient said, well, I don't know that I should trust what you say, enlisted three people I'd consulted whose points of view about certain things disagreed with mine.
• 26:00
  Three friends, a person had spoken to that weekend about her therapy, and they all had different opinions. Now I never had to deal with that early on, and it's not for me to judge whether that's, good, bad, or indifferent, but it does create something in which the old intense confidential dyadic therapy has been replaced by a very open and complex field in which it's not just me doing a therapy with a with a patient who's come to me for help, but it's it's a drama played out in in multiple dimensions and with and with multiple inputs, there is there is a built in, what we call, a distributed transference. In other words, it used to be that a person had a, something based on a past relationship, it would show up. The odds on I'm sorry. The odds would be that it would show up in their relationship with me.
• 27:14
  Now now I often take I often don't see some very important things for a long time because they're being projected not onto me, but to some other therapist who's a social friend and has a different perspective. And, you know, it's it makes things very, very much more complicated. And, again, it's it's not for me to judge good, bad, and different, but I have to call it as I see it. There are benefits to its being a more open situation. That's for sure.
• 27:51
  But, when you have to slug your way through the your patient's experience of reading maybe dozens of books or articles or website contributions and hearing from friends about this, that, or the other aspect of therapy, my god, it's it's it's kind of like a a free for all at times, and it it can be a trip.
• 28:30
  Speaker 2: I've noticed in my own office, I I I don't have as much history, but when I started practicing around 02/2001, I think, 02/2001. So so certainly not as long, but just in that time, I've noticed this shift of people would come and sort of that feeling of waiting for me to help them and us working through whatever we were there to work through together. As opposed to now, so often people come to me and say, I don't want this, and I don't want this, and I don't want this. I need you to do this and this and this. And it's a very different clinical experience.
• 29:18
  Speaker 1: You you are doing a very good job of of bringing my story into the present day. And, I think, you know, it it used to be that, you know, there are several models of helping that have been described. And when I started working, was using the medical model. I had some authority, some recognition. It was understood I knew more than the patient, and I had something to offer.
• 29:48
  And now the the therapist is more a a consultant very often and one of many consultants. And the patient comes in with a sense of what they think of as enlightened consumerism, but which dynamically may, I'm sure I'll ruse some some people's feelings by saying this, but it what enlightened consumerism is the manifest level. A deeper level is a defense a narcissistic defense. Philip Bromberg, wasn't talking about dissociative disorders, but the patients in general. He was an expert, of course, on dissociation.
• 30:33
  When he pointed out that the patient comes to the therapist highly motivated, deeply deeply, determined to get help and to resolve his or her problems, and in short order demonstrates just how desperately he or she wants to evade the work of therapy and wants to hold on to some of those ostensibly problematic behaviors, ideas, and notions. And Brownberg is is quite correct. We we encounter much more resistance. There's been a much more of an eroding of the authority of the therapist. And, you know, if you just look at all the news stories, all the attempt to erode the white male patriarchal establishment.
• 31:34
  I have no problem with that as an evolution, But one of the unintended perhaps unintended side effects is that there is a general diminution of the idea that people before you knew anything. And as as a result, there's a lot of dismissiveness toward a lot of ideas and notions that could be very helpful because they don't fit the major paradigm. I I recently had an article of mine criticized by a number of people, and I I was very upset because they didn't say anything about the article and what I'd written in the article. What they said is they didn't like the theoretical, model they thought I was working from, and they thought I should have used theirs. Well, that's the bringing of the this is what I want right into academia and scholarship, and you'd never see that, even 2,000 thereabouts.
• 32:55
  You you unless it was an area of disputation, but not just, oh, I prefer this model to that model, so I don't really care what you say.
• 33:05
  Speaker 2: That is a shift I have seen as well. I want to clarify for listeners earlier you when you mentioned about narcissism. Currently, in modern language with pop culture psychology, that is such a term that has become equated with abuser or or something negative as opposed to Right. As opposed to a process. And what you're talking about is the process of us, like in the therapy example, just to super, super simplify things, in the therapy process it would be even just focusing on myself while I'm on therapy, how much I wanna hold on to my old coping skills that have become now maladaptive but used to help me or how even the time and energy spent into therapy focused on myself and and all of that work.
• 33:58
  And so just clarifying the distinguished I I I want to make sure your words stay in context.
• 34:04
  Speaker 1: No. I was I was just going to agree with you completely. I think that, and it's ironic just last night I was teaching a course on treating the narcissistic personality, and I was talking about my class about how many different ways that term is used and how it's very problematic because, at this moment in time, it's pathological narcissism that is has the focus, and there's always been a another line of narcissistic wounds, narcissistic injury, narcissistic hurt, narcissistic vulnerability that is not necessarily associated with with rage or being better think one is grander than anyone else, but feeling actually diminished and uncared about and wounded in one sense of self. And what I was talking about is earlier was to say, if someone walks in using their preferences as a shield to say to define themselves and what they want, it becomes very hard for them to allow the therapist to help them learn more about themselves as they are rather than as themselves as they're defined by those stated preferences.
• 35:25
  Speaker 2: I think that's really significant in in what's happening in the survivor community right now, and that has given me a lot to think about that I may come back to with you later in another conversation. The the other thing I wanted to go back to right now was what you said about the peace being lost or left out or set aside about sort of the history and schools of thought and traditions, not not in a Tradition will be misheard and misunderstood as well. But but that background of why you do what you do and why you think the way you think or or what framework you're using or what theory you're using and how that has changed over time because even, well, even going back further, your story of sharing how you got to where you were from school all the way through becoming the expert. That that that is a fascinating story to me because we actually so often have fewer choices than we think in some ways and have to sort of all of us in a very normalized way navigate our circumstances. And so for me, my experience was that I was a foster child and to be able to go to college, even though the world could say, you have all the choices, the same choices as everyone else.
• 37:06
  I didn't really, I didn't really have those choices because even if I got scholarships or I got different re different help to go to certain places, I couldn't necessarily get there or I couldn't provide for myself while I was there or things like that. So for my actual education, I did not get to go to a school that I wanted to go to. And I don't mean just as in preference, I mean it was a terrible school. But it got me through school so that when I got to licensure, I thought I want someone for my supervisor and if I get to pick those things at all, I want to pick really good ones so that I can learn more than what I can already tell my education actually lacked. Does that make sense?
• 37:57
  So I studied under someone who had trained with Masterson, who had directly studied under Jung, who studied under Freud. And and even though these days, few people call up and say, hey, I need some Freudian psychoanalysis. You know, but but there was still that conversation at that time even back in the end of the nineties of I studied under this person who studied under this person who studied under this person. And now it's with managed care and all these changes you've talked about and and just every school teaching everything or the quality even in training has changed so that people who are not seeking out better learning or educating themselves differently really have a lack there, which complicates even the therapeutic process further. There are things that I have learned in the ISSTD certificate program, for example, the PTP program, the professional training program that I have never heard before because it's not talked about at all in mainstream education now.
• 39:12
  And so just coming full circle to, I think that whether even as a side effect of patriarchy, I mean, even people who wanna talk about matriarchy, it's still the same thing. There's a connection to history and connection to the past that's so so critical that we carry with us in good and healthy ways. And if we don't do that clinically, it makes it a lot harder to model that for the people who come to ask us for help and healing.
• 39:44
  Speaker 1: What I said when and when I urge you to go on was that you sound like my doppelganger or my double. The I I don't have I don't have didn't have those disadvantages, but I made the same determination to seek out the best teacher, and I couldn't keep on doing it because I didn't think anything had the whole story. So let me give you one comment and one story that inspires me every time I remember. My friend and colleague in the analytic institute around here is a woman named Susan Levine, and she's written a wonderful book describing a whole bunch of theories in in it. And then she refers to the to the theories as useful servants.
• 40:27
  And I think that I don't think the term is original with her, but she explains it very well. And the issue is how do you learn everything and then when to use it? And the before Susan Levine probably graduated high school, Henri Ellenberger gave me a experientially that attitude. I met doctor Ellenberger, in the early nineteen seventy, shortly after I'd met my first DID patients. Patients, I was going to the American Psychiatric Association, and what we young residents did is we you'd look at everyone's name tag, see if it was somebody whose articles had been recommended to you.
• 41:11
  And there was a guy who bent over like a question mark by looked like he was older than dirt. He wasn't. He just just the spinal deformity made him look that way. And when he finally turned, I saw his name tag was doctor Henley Ellenberger. Well, I was like a young puppy for god's sakes.
• 41:29
  Here was my intellectual heroes. I'd read his book three times in a row just the year before, and it it taught me so much. So apart from making a slobbering fool of myself, he was tolerated me as a as a young pup. But when we were done with our cups of coffee at refreshment stand, the afternoon sessions were about to begin. And here's when he taught me the lesson that really changed the direction of my life.
• 41:58
  I said, he asked me I asked him, doctor Ellenberger, how are you planning to spend the afternoon? He said, oh, I've signed up for a workshop in basic behavior therapy. And I said, what? Doctor Ellenberger, you're the most famous existential psychoanalyst in the world, and you're taking a course in basic behavior therapy? And he said, well, yes.
• 42:27
  I've cured a number of people with phobias using existential analysis, but I think there may be some more things I can learn that can help me do a better job. And I was thunderstruck. I sat there for twenty minutes because I was wondering, am I gonna be for the analyst? I'm gonna be at this. I'm gonna be at that.
• 42:46
  I was thinking in terms of very strongly defined senses of professional identity that early in my career. And here was this man who I respected so tremendously who said, without saying it in so many words because he's a very courtly gentleman, he said, you know, Clough, that's a bunch of crap. Learn everything and use what works best for every individual patient, which is exactly what Susan Levine was saying from a completely different perspective about theories, not about techniques, but about theories. And what Susan Levine said and what Henri Ehlenberger said together, it really defines what's made me very different because I've tried to learn a large number of things, and I've never respected the way the people who are primarily identified with those things think you should think. I am a trained Freudian analyst.
• 43:47
  I will tell you that I think Freudian classic Freudian interpretations, you know, and libidinal things and death density kind of thing with a trauma patient is exactly the wrong thing to do. I think it's destructive, and I've written about it. But the delivery system psychoanalysis is magnificent and underrated. And, I I bring in into a lot of things I do even if you wouldn't think it looks at all psychoanalytic. I learned hypnosis from many people who thought hypnosis was very different things.
• 44:24
  And the problem is it'd be nice if I just could become like an Ericksonian hypnotist or this or that. But the reason there's so many ideas out there is not only because a lot people are narcissistic or want to put their name on something, but even more importantly, because nobody understands everything. So here's Henri Ellinberger who dies shortly thereafter, and telling me as an elderly man something about keeping your mind forever young in a way that was more lively than I still in my twenties was capable of thinking. It was it was quite quite an experience, and, it stays with me every day because, I I I think it's very dangerous. It's with a book in the eighties, was very popular in the counterculture cult.
• 45:21
  If you meet the Buddha in the road, kill him. And believe it or not, it was about the same theme, the danger of being trapped in someone else's ideas to the point that you never could grow, never could expand your thinking, and never could master all that was possible to be mastered. And I think that's very important with the trauma victim because no matter what people may say, I have never seen a single approach to trauma treatment that in and of itself is sufficient. I'm always looking for something else, And I I continue to do that with Ami Ellenberger sitting on my shoulder as a ongoing reminder.
• 46:10
  Speaker 2: That's so funny. That's such a funny story. That just happened to me in a doppelganger. There we go. That just happened to me in a funny way.
• 46:21
  When the pandemic started early on, my friend Peter Barrish invited me to join a group of his friends for a consultation group, but sort of just make sure, you know, we had a place to talk about this and all the changes with telehealth and all these kinds of things. And we had become friends through the podcast, and I felt comfortable with him. I felt safe with him. That was fine. I'm not particularly a very social person, and so that, was a challenge for me to go ahead and do that, but I knew it would be good for me, and I trusted him.
• 46:57
  And so I joined that group, the people were delightful. I got to know them, I got to know, sort of a new part of myself in that, not in a part way, but in a, having colleagues again. It had been a long time because of different circumstances that I had felt close to colleagues and I had joined the ISSTD and feeling more comfortable in meeting people that way and it had been such a healing experience professionally, I think. I had just had professional traumas in my own Like during my clinical supervision, the therapist that was my site supervisor had an affair with his client during group. And so like the group got transferred to me so that he could marry her.
• 47:44
  Just like all kinds of things that are like, how is this even happening that when I try so hard to get it right, that all these things are still happening. And so, I, it had just been a long time since I had even tried to be close to colleagues. And this was such an unfolding for me, the experience of ISSTD and meeting different people and, and starting to interact and volunteer and help because I had been so helped by them. And then I took the EMDR class from ISSTD and that was a different experience. That's a different story.
• 48:20
  But in the class, they quoted this book and they kept referencing The Brick by John O'Neill and Paul Dell, and the more that they talked about them, I kept thinking, I know those names. I know those names. And so I finally just texted Peter and asked him. He's like, those are they're in our group on Sundays. Like, you know them already.
• 48:41
  And and I just hadn't even connected that, oh, these people are also clinicians, and they're doing real things. I had just met them in the Sunday group and had not even processed who they were.
• 48:53
  Speaker 1: Yes. And just to to go of the idea of the open mindedness, when I put together a special issue of the American Journal of Clinical Hypnosis called Hypnosis and Psychoanalysis, John O'Neill, psychoanalyst and expert in hypnosis, and Ira Brenner, psychoanalyst and expert in hypnosis, and both of them knowledgeable about EMDR were contributors to to that issue. There are a lot of these people who, really do good work have bumped up against the constraints of various paradigms. They understand what Natan Lohr, an Israeli analyst and philosopher, has described as a secondary loss, that every model brings with it. Because every model becomes a thing to itself by putting certain by privileging certain ideas and and information and disregarding other, information ideas.
• 49:59
  And so every time there's a game with paradigm in one area, there's always a little bit of a loss. And that's why your point of knowing history is so is so important. Because if you don't, the stuff that slips between the cracks, but really is very, important, gets lost, and you lose a chance to become a more nuanced and thoughtful, clinician. And you may know everything that's new and hot and be completely lacking in major areas of wisdom. And so I think, again, you hit you hit on the head and nail on that very, very nicely.
• 50:37
  But one of my major one of my major concerns and gripes that, you know, if I could read a read a case report from 1834 and '8 republished 1840, figure out how to treat DID in 1972, not 1971, '19 '70 '2, Imagine if I hadn't. All the techniques I developed were inspired by my writing by reading a few pages of old French because I couldn't get ahold of the whole the original book, which was 1836 and 1840 editions. Catherine Fine later
• 51:17
  Speaker 2: Yes.
• 51:17
  Speaker 1: Translated the whole thing, and I was delighted to actually read the whole thing. But, you know, all the stuff I've gotten awards for developing and and for putting together, yes, it's original with me by and large. But the reason it is original by for me is because, Antoine de Pines senior gave me gave me a starting point that was otherwise absent from the literature. And it was impressive enough that when I taught Connie Wilbur the stuff, was I was, coming up with she was saying, oh my god. This this makes the treatment much, much faster.
• 52:04
  Speaker 2: Well, and I think the history also gives a context. Even talking about Connie Wilbur, and and I know that in the memory wars, they tried to debunk Sybil and all of that. But she talked Peter told me a story about her coming to speak in Ohio and how she talked about people not publishing because she was a woman and because she was writing about dissociative or multiple personality disorder at the time. And that part of why part of why the book came out is because it was the only way she could get the material out. And so she asked her friend to write that more fictionalized version of it to to get the story out.
• 52:49
  And I think in that example is reflective of so many other things we see on the news. This happens or or or rumors about this or that. But when we don't actually have the context of what was happening or why it was done this way or the politics of what's going on or or or those pieces, we don't have the whole story and we make assumptions and it causes trauma, new trauma to each other as survivors or as clinicians, and that that just complicates things. The
• 53:21
  Speaker 1: idea that Connie asked Flora Reddish Schreiber to write this, is new to me. I've I've never heard that, and I've known known known Nukani a long time. Maybe true. I don't know. But what is true is she she was excluded.
• 53:37
  She's part of a lot of symposia that were turned into special sections of journals, and hers was the only paper that was not included. So one of the things that Buddy Brown and I were most proud of as individuals, you know, that makes you feel good in the heart is we got Connie's first two articles published. I got the first one, but he got the second one. And we we were editing special journal issues, and we we knew the history. So he said, okay.
• 54:07
  We we got this one we got this one knocked. So, we we invited a Connie Wilbur contribution to both of those, and Connie Wilbur finally had the opportunity to be published about psychotherapy in professional journals. Now she had been one of the authors of an art of an article before that Jeff Branswell was the first author. But we got the first Connie Wilbur articles out there and very, very heart heartwarming experience for all of us, and we're very proud of it.
• 54:43
  Speaker 2: That's amazing. That's amazing. So with all of that as your context, how do you explain dissociation or talk about dissociation, just summing up that piece of things from your perspective and experience?
• 54:58
  Speaker 1: Dissociation basically is a little kid crying in the night with no one to console them and the inborn ability to make the pain go away. You have to be a high hypnotizable, which is genetic predisposition in order to be a major dissociator. There are four factors you need. You need, unfortunately or fortunately, you need the biological diathesis because not everyone can dissociate to a major extent, and that's hypnosis is has been known to be a genetic trait since Josephine Hilgard's wonderful work in the 1970s. The second thing you need is overwhelming experiences so that that biological trait is enlisted in the service of psychological defense.
• 55:54
  The third thing you need is some structure to hook it onto, and that can be developmental or cultural. Depends on when when it happens, what the issues are, what the nature of the trauma is, and also what culture you're from because there are major differences depending on culture. And the fourth is an absence of consolation. In other words, if you look at the fact that everyone has potential substrates for dividedness because we're you know, we develop into relative wholeness. We were not born with it.
• 56:30
  And if that's interrupted, of course, we don't get to even a facsimile of wholeness. A lot of people are have hypnotic potential in this all too much trauma around. The question is why don't we have multiples coming out of the windows? You know? Now granted one percent of the population qualifies for that diagnosis, but why not even more?
• 56:51
  Because the percentage of high hypnotizable people who are traumatized early in life is, killing itself, massive amount of people. And the answer is that most of us have healing experiences. Someone, something provides us with the nurture, the attachment, the mirroring that and the idealized object that Kohut writes about. And if that occurs, the fragmentation aspects of self when bad things happen, it's much mitigated. And I have seen children who have formed personalities one week after their first major abuse, and I I know how quickly they can form and how quickly it can, be be healed if you are lucky enough to be right there at the moment.
• 58:01
  And most people don't believe that because they prefer to think of an attachment rather than a trauma origin these days. But, you know, it's bad care, bad experiences, fortunate enough to have a dissociative capacity so they don't shatter their ego and it's more towards a psychotic, or or completely borderlining realm. And, of course, dividedness is natural and substrates and identifications are universal. So that's that's what I thought from the beginning, and I've really, never, had any reason to think otherwise. I think that having seen the cases I saw early on, the some of which had what we now would call attachment difficulties, some and some not, I don't think attachment problems are essentially a part of the psychopathology.
• 58:57
  I think a failure of important soothing functions is necessary, but that can happen to someone who was going along pretty well and then runs into a massive amount of trauma. They may not develop a tremendous amount of attachment psychopathology, on the surface of things. They sure can develop dissociative identity disorder.
• 59:26
  Speaker 2: That the lack of consolation piece feels connected to some of the research that was presented at ISSTD this year about relational trauma as far as the misattunement piece or that lack of repair of the rupture, I guess.
• 59:45
  Speaker 1: Well, the I think the problem the problem with that is, again, and and and and sitting on my on my shoulder and saying, that doesn't cover everything. And what the you know, what has happened over and over again in history of every kind of thinking is ideas get oversold. And right right now, relational trauma, attach and attachment issues are the dominant paradigm. As a matter of fact, that's because I didn't use that language. Some people criticized one of my articles for no other reason.
• 1:00:25
  The but the fact of the matter is there are a lot of people with DID that I saw, and some have been stable for forty years after integration, who did not have major attachment issues that really had major nasty trauma issues. And some of them had very nice parents, put some other nasty people around. I think it's very important to realize that all the field was focused on trauma and then the false memories things started coming out. And I was the editor of the association who published Irish's first article only Liadi's first article on these subjects. It's not like I didn't know about it.
• 1:01:19
  I I'm I'm the editor who accepted them and edited the papers before they were published. But the problem was that the field took those things and ran because now this now you could say it wasn't all trauma. It wasn't all ritual abuse, you know, and you could stand up to the FMS people and say, oh, it's it's relational. It's, attachment. And there were many people who suddenly started talking as if, trauma really wasn't a factor.
• 1:01:48
  It was just except for relational trauma, which was didn't even exist as a term that struck that prominently. Now that was defensive. It's the same kind of retreat into the Oedipal formulations that Freud did in the eighteen nineties, but no one wanted to hear that. They just wanted to avoid being sued for creating false memories of childhood sexual abuse. And right now, we we have a situation in which that paradigm is so powerful that sometimes it drowns out an entire literature that says it's one of many factors.
• 1:02:29
  One of many.
• 1:02:30
  Speaker 2: I think that happens with some of the new so called techniques that are perhaps useful tools in some cases, but people are trying to apply them as a quick fix and just sort of it takes care of everything, and you just sort of wash it away. Almost like we can get the benefits of having done therapy without having to do therapy, and that there's something off about that even if it's also useful in some specific instances.
• 1:03:04
  Speaker 1: Well, again, you're you're completely, we're in complete agreement on this. I think the problem is I try to teach that the treatment DID is a long term process therapy in which are imbricated all sorts of short term interventions, some of which are highly driven by techniques. But the the point of these techniques is they're they're relatively powerless in and of themselves. They're rituals of healing, And even if they're very, very good, unless they're applied in a context that supports a transformation of the patient's mind rather than experience in the moment, their effect is going to be far less dramatic in the long term than in the short term. And EMDR horrendously oversold itself, And it's it's not that it's it's a bad approach, but, you know, a lot of these techniques that have come along fail to recognize or acknowledge that what they're doing was well known in the world of hypnosis for a long, long time, but it's being packaged as very as as very different.
• 1:04:25
  And, if you think of most of the things that are associated with EMDR these days, it's not what was associated with EMDR when it was put forth by Francine Shapiro. It's more an amalgam of things derived from well known hypnotic techniques. I mean, ego state therapy was developed by a bunch of psychoanalysts who also were skilled in hypnosis. And it's important to realize that when the EMDR literature talks about this stuff, they talk about it as if it's theirs. That's been unfortunate because the lack of of modesty by any technique and its proponents really makes it hard for it to find find a real place in the armamentarium with thoughtful clinicians.
• 1:05:23
  I use EMDR, but I only use it on on occasion, and I use many other things as well. But the, the thing is that the relationship has to be developed to create a holding environment, place of safety, to create an environment in which a therapeutic alliance can occur and in which expertise can be applied. And empathy is not a gooey sticky thing. Empathy is accuracy of understanding. And if you look at Bachrock's, analysis of articles defining empathy, you find empathy turns out to be very hard headed notion of accurate understanding.
• 1:06:14
  We would now call that accurate attunement. But, it's the ability to tell someone what's really going on in a in a warm, caring way pointing towards understanding and change. And ironically, that's the same sort of thing that's at the core of Luborsky's research on the core conflictual relationship theme, dynamic therapy. You find out what's going on and you address that topic in a way that's meaningful for the patients becoming stronger and able to address their difficulties intrapsychically, interpersonally, existentially, and all in all other ways. But the moment you think you've got the end all and be all just as you said, but I'm gonna say it more strongly and less nicely, you become a mountebank selling snake oil at a carnival.
• 1:07:19
  You become a pitchman for, quack cures because inevitably you oversell even a wonderful technique. I mean, in in a funny way, EMDR is something very much in common with Sigmund Freud's original psychoanalysis. And, this is for the real theory wonks who who might be listening. I've I've written about eight scholarly papers on Freud's theories and its relationship to hypnosis and the ideas of the time. One of the most amazing things Freud did is in the era in which hypnosis was the main therapeutic modality that was effective, he found a way to treat people who weren't hypnotizable.
• 1:08:14
  Now he developed it hypnosis. It's very it's got hypnosis all over it. But because it doesn't actually need trance, it Freud psychoanalysis allows you to approach a person whom you can't use trans in a formal sense very effectively and bring about some of the same curative impact. Now look at EMDR. EMDR actually works wonderfully well and best with people who are high empathicables, but EMDR has this wonderful capacity that's not realized or thought of in with enough respect.
• 1:08:53
  And that is it's one of the dandiest ways of doing trauma work with a person who's a lousy hypnotic subject, and you can't use any of the old classic hypnotic interventions with the kind of power that you might have otherwise. So there's much much much admirable about EMDR that is not being recognized. And I I I love being able to pull it out of the you know, out of my quiver and use it, but I don't use it that often with dissociative patients because I I'm much more expert with hypnosis, and I find it more flexible. But for people who come to me are traumatized and have not had a do not have a high degree of hypnotizability, Sometimes EMDR can be like a hot knife through soft butter, and the results can be so gratifying and helpful to the patient.
• 1:09:47
  Speaker 2: That's so wonderful. I have so many more questions, but I wanna respect your time, and I I appreciate you you coming on to talk. It's so much, and I I appreciate the context of the greater context in which we work and in which we do therapy, whether we're receiving it or seeking it or helping give it or do it, however, whatever perspective anyone is in, understanding how things are connected, I feel like, is such an external reflection of what's happening internally for all of us. And I think that we are often so good at using a microscope and focusing on one piece and saying, oh, now that explains it. When we really need, and and that may be wonderful, but we also really need to keep that connected in context to all the other pieces we can explain so well.
• 1:10:45
  And and I think you've just talked about that beautifully. Thank
• 1:10:48
  Speaker 1: you. Absolutely. Well, it's and it's not a very abstract concept because if you've ever seen a lighthouse, you notice that the arc that it illuminates is drenched in brilliant illumination with a quick fall off to darkness on either side, and some of our our ideas are just like that.
• 1:11:07
  Speaker 2: I feel like you've given me a framework to be able to take some of the pieces I've learned in the last year, and and while I appreciate them and they've been breakthroughs and and so fascinating and so helpful, You've helped give me a framework to sort of stitch them back together in a way and I appreciate that. Thank you.
• 1:11:26
  Speaker 1: My pleasure. Great talking to you.
• 1:11:38
  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.systemsspeak.com. We'll see you there.