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In Session (Part 1) · System Speak: Complex Trauma and Dissociation

• 0:12
  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 longtime 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.
• 1:13
  Speaker 2: Do you remember when someone wrote into the podcast and told us about the book called In Session? The Bond Between Women and Their Therapists by Deborah Lott. We looked it up and ordered it, and it has come, and it has shaken us to the core. I don't even know what to say. Like, it has made me so nauseous, and I can't even say how disturbingly correct and accurate and beautiful it is, except also highly traumatic to read it because therapy is awful, and it describes so well why it can be when things are difficult or when there are ruptures or why it is such an intense experience.
• 2:09
  I don't even have words, but I'm gonna share some about it today. So she opens up explaining how this book came to be, that she was a journalist and that she and other writers used to get together for regular, like, get togethers as friends socially, but they were also all in therapy and started talking about their therapy experiences and sharing some of their stories. And she says, It struck me that our exchanges resembled nothing so much as accounts of love affairs. We felt the same urgent need to get every detail straight, every word right. We could be unduly vulnerable to our therapist's actions, assigning profound importance to their seemingly trivial remarks.
• 2:58
  Sometimes we felt like graders admiring our teachers. At other moments, we resembled adolescents in the throes of a crush. On some days, we reported our reactions with an anthropologist detachment. Other days, we'd find ourselves totally in their sway. And so she started to realize that there's this relationship between women and their therapists.
• 3:23
  And what is that relationship and what is the same, like, patterns that we all experience and what is different that are unique either to ourselves or to the therapists that we have. It is fascinating. It is women specific. It is gendered because it is about from the early nineties, I think. It's a very old book, actually, but the responders to her survey were all women.
• 3:53
  And so it is about women specifically, but I'm sure that much of it or many pieces of it or aspects of it could be applied otherwise. And as she talked about the questions that she asked in her survey and these different things, it reminded me a lot of what we did with our survey and some of the responses and stories we got. And I thought, what an interesting thing would that be to follow-up an interview qualitatively these lived experience stories and to talk about that openly rather than just quantitative stories from a clinical perspective that's not at all accounting for lived experience, which seems to be a pattern. And if that's where I have opportunity to contribute, then we need to do that. And so it got me thinking about some different things that we'll keep sharing as it unfolds, but this was fascinating stuff.
• 4:56
  But she was focusing generally on the therapeutic experience she and her friends were having. She said, We found the very structure of the therapeutic relationship problematic. It was inherently unequal. We needed our therapists more than they needed us. They were much more important to us than we were to them, and the whole alliance was sustained only by our paying considerable fees.
• 5:23
  To what extent was this even a real relationship? And if it wasn't real, what exactly was it? If it wasn't friendship, and yet it was different from any other professional relationship we had ever had, what was it? It was intimate and at the same time, formally conscribed. It encouraged us to expose ourselves while imposing tight constraints on the encounter.
• 5:49
  And then she talks about how she discovered that the name for that relationship between a person and their therapist, that that's called transference. So she goes all the way back to Freud, and she talks about how, quote, According to Freud's theory, therapists were stand ins, the feelings directed at them unresolved remnants of their clients' most profound and unresolved feelings from infancy and childhood. People had a tendency to unconsciously create and then globally apply these templates, which had been forged in early childhood relationships. These internal models shaped people's perceptions and expectations in all the significant relationships that came afterward. They influenced how we picked our lovers, how we responded to criticism from an authority figure, how we interpreted their unspoken cues that passed between strangers.
• 6:47
  In short, these templates provided the emotional rules for how to function in relationships. And then how therapy becomes an arena, she says, to observe those templates in action, in the context of the therapeutic relationship where it's only about our stuff, and how that feels unequal because it's only our stuff and not a mutual relationship, but that it has to be only our stuff, not because the therapist has more power, but so that we can see our own layers in action because it's only our stuff that we're looking at. And if the therapist puts their stuff in the middle of it, then things get tangled. And so she separates actually in a really fascinating way of why that matters and why it's good and important, even though it's also difficult, and she does not at all minimize how difficult it is. So because she was a journalist, she actually started to research this, And she said, quote, It began to seem to me that a complicated and often dogmatically interpreted theory had quickly subsumed direct naturalistic observation of the full gamut of client experiences.
• 8:11
  Notably absent from the professional literature were clients' descriptions of what it felt like to be in the difficult and asymmetrical relationship called psychotherapy. So, she talks about how the literature is full of things about ethics and boundaries and the professional relationship, including transference and countertransference, but that there's almost nothing about what it feels like or the lived experience of being the client within that context, including whether it's actually helpful or not. She says, quote, In my writer's group, many of our perceptions of our therapists were idiosyncratic and tied to personal history. Others seem to reflect more universal wishes, a deeper yearning for meaning, and even transcendence. Many of us harbored a secret wish to be understood perfectly and loved completely in a way that no human had ever loved us before.
• 9:22
  This was a love with a redemptive potential. Those lines were so powerful to me and made me so nauseous because when you talk about a relationship that has redemptive potential, that feels like God or reflective of God, like a savior, not just a rescuer, but something that establishes worth in the process. And it feels bigger than that. And I think that is why it is so devastating when something goes wrong. Because what is the opposite of redemption?
• 10:05
  It's condemnation. And if you think that in the therapeutic relationship there's going to be some sort of redemptive potential and there's no redemption, or at least that's what it can feel like when there's a rupture that can't be repaired or you lose your therapist or something goes wrong in therapy, then it feels like you are condemned to not just this state that you're in as you are, but to your past and everything people did to you and said to you because you can't change it. It's not going to be redeemed. That's what it feels like. And so go back to what Laura Brown said about this and about the death of hope.
• 10:56
  I think that's what we went through two years ago. Not just the death of hope, but the death of life. It was the death of redemption. Because losing our therapist cured us of needing to be loved and needing to love. Because the loss of it hurt so much and so deeply we no longer had that desire.
• 11:26
  And we lost the belief that anyone could actually help us, much less actually care. And I think that's why things went so far downhill last year, Because it wasn't just the death of hope, it was the death of redemption. No wonder our life was in danger. No wonder it was difficult. That's huge.
• 11:59
  That's intense. And it made me sick to read about it. But at the same time, it made so much sense, and it helped to find words for what had happened. So the author goes on talking about moving from psychoanalysis to the more recent relational views and how it acknowledges, quote, that what goes on between client and therapist derives as much from the vicitudes of their unique connection as it does from the influences of the client's past. So then she introduces countertransference, which is the transference from the therapist back to the client.
• 12:44
  And so she started asking with her friends, How do you know what's your therapist and what's your stuff? Like, all of this agonizing about that therapeutic relationship, what belongs to you and what belongs to your therapist. And she said, Transference is a concept that can be turned against the client, used to discredit her perceptions and validate the therapist, which really goes back to gaslighting. And I think that trauma of that experience is what underlies the whole movement of lived experience. Because it is re traumatizing and we as a community are saying we will not be abused in that way.
• 13:33
  And we are speaking up and standing up to say our experience matters and we have a right to choose what is helpful for us or not and a right to give feedback about what feels good or not. And I don't just mean feels good in a comfy way because I know therapy can be uncomfortable and I know therapy can be so difficult. I hate therapy, I get it, But there's so much good in that process of untangling, and it can be done in ways that are healing, not just re traumatizing. And then another quote blew me away that she said this. She said, Much of my therapy occurred outside of my sessions in my own processing of our exchanges and my own reconsiderations of the lessons of my childhood.
• 14:27
  That's like the entire podcast, right? She said, In some respect, I incorporated my therapist as a new voice inside. There was the therapist who sat across from me in his office and the therapist I carried around with me in my head, someone to whom I could address what was too frightening, too disorganizing to think about by myself. And I think that we absolutely did this, and I didn't even know that we did this until I read this. I think then that's what happened, or part of what happened, that we had an actual therapist who was a good person and a good therapist and really great at presence and helped so much, and we shared on the podcast things that helped.
• 15:13
  But the person that we knew from that office and in our head is not a real life person. The real life person has their whole own life, that office isn't even there anymore, and they have a whole world outside the office. Right? And so the incongruence of that plus DID where there can be introjects and actual alters and things that are more than just putting your therapist's voice in your head, but an actual, like, alter or interject. And the confusion of that, plus not having the access to be able to resolve that, I think, add to really adds to the confusion of things.
• 16:04
  And when there's a rupture that you can't repair, then you're left swimming in the middle of all of that mess, and no wonder it felt like drowning. She said, surely the people who are important to us exist as much as internal icons as they exist as in the flesh others. So then she talks about the other hard piece, that the therapist is not your parent, the therapist is not your friend, and the therapist can care deeply, but it's not a kind of love that is like a mutual relationship where there is turn taking and sharing from both sides because of the context in which that arena takes place. She says, What the therapist offers is always in some ways an approximation. It can never be true love.
• 17:12
  It is always to some extent an approximation of love. It has resonances of other significant relationships, parent child, brother sister, lover beloved, but it is not exactly like any of them. It does not have in the world viability. It is always delicately balanced between the symbolic and the real. It is important for clients and therapists to appreciate and protect the fragile approximations that characterize their relationships.
• 17:46
  There is something inherently tragic about the client therapist relationship. The therapist can never bring all of herself into the room. The client will long for what she can never get. The relationship is doomed to end, but treating the bond as either ordinary friendship or as a strictly professional exchange of goods and services only diminishes its therapeutic potential and hurts the client. I literally threw up right in the middle of the living room when I read this.
• 18:24
  I appreciate, no matter how difficult or painful this is, I appreciate that if that's the truth, that someone said it out loud, that it is on paper, in a book, in words explaining what that is. So all of that's just from the introduction. Like, that's powerful, you guys. I was hooked on the book from the beginning. I so appreciate that it was recommended.
• 18:53
  The next section she just explains her research, that there were 400 surveys and that there were respondents from all over The United States, one from UK, and she followed up the surveys with personal interviews. And then she also interviewed famous clinicians, therapists, psychiatrists, counselors, to ask questions and understand why therapists do what they do and what it means. So then the chapter she talks about Anna Oh. So Anna Oh is a famous case going all the way back to the time of Freud, but it wasn't Freud that saw her, it was Doctor. Brewer that saw her.
• 19:45
  She was a young Jewish woman who still lived with her family because she wasn't married, and her father was very sick and in the process of dying. And it was her role as the oldest daughter of the family to sit up with him during the night. So this is how it began. And as his illness continued and she began to feel more and more helpless, she had been very close to her father by all accounts that we know, but there's not a great deal that she shared that remains of her own words about what happened. But basically, they were pretty close, and the longer she had to nurse him overnight and the sicker he got over these period of weeks that he was very ill and dying, she became more distraught about not just his condition, but her helplessness to save him or her inability to be able to actually help him.
• 20:55
  And so she started having some hallucinations. She started having some symptoms in her body where her body literally couldn't move, but they matched what she experienced. So like when she was her father asked her what time it was, but she was crying because he was so sick and dying and didn't want her father to know she was crying and she couldn't see the hands on her watch because of the tears in her eyes. And when that happened, she started having episodes where she couldn't see at all. And there was a time where she couldn't hand him something that he needed, and so then she couldn't feel her hand anymore.
• 21:40
  So she started having these physical symptoms that matched emotional experiences that happened to her, and things escalated until she was basically not functioning anymore. And so her family called Doctor. Brewer, and Doctor. Brewer came out to meet with her, to check on her, And he ended up doing analysis with her, but this was back in the days where there were, like, zero boundaries at all. Right?
• 22:10
  And so he would sit with her for hours and hours just letting her share anything she wanted to share, listening to her talk. They would go for carriage rides. He would help her to eat. He was very attentive to her. And basically, this chapter talks about how it seems like she transferred, right, from the transference experience with a therapist, she transferred her feelings for love for her father to loving Doctor.
• 22:44
  Brewer. And so they became very close. This goes on until her father has died. It was very traumatic for her, And he continues to see her and kind of culminates in this big case of her sitting by the empty bed, allegedly the empty bed, just like when she was nursing her father and him listening to all the things that she went through doing that and what she endured. And obviously this is a very brief recap.
• 23:20
  He says that she's cured and, like, basically disappears from the family and doesn't interact with them anymore and writes off the case and says he never wants to repeat an experience like that. But also, other records show that she wasn't actually cured, and he got called back to the home because she was writhing around on the floor saying that his baby was about to be born. Now she wasn't actually pregnant, and she ended up spending more time in an institution. She wasn't actually pregnant. But at the time, in that time period in Vienna, saying something like that was really the only evidence a woman had that she had been with a man was if she had the baby, right, the child.
• 24:16
  And so even though she wasn't actually pregnant, she was expressing this love for him, this transference, these feelings. What other trauma, we don't know. I don't have records for that. But, and she would never speak about it really after that. Once she was better and had been reportedly away from him much later in her life.
• 24:41
  But they talk about this as an example. And really, she has a lot of very dissociative symptoms. But in the context of this book, the reason that Doctor. Brewer's case is mentioned is because it's really one of the times we have documented about the therapeutic relationship and what it is that's curing her. So is it the talking cure?
• 25:07
  Is it actually the talking that is helping people feel better, or is it the relationship that helps people feel better? She writes, Brewer's treatment may have consisted of talking, but the cure appeared to reside in who was doing the listening. Anna talked only to Brewer, and only when Brewer responded did she feel better. Freud was to claim years later that in the case of Anna, the personal emotional relationship between doctor and patient was after all stronger than the whole cathartic process. And she says Anna's distress had more than a little to do with her relationship with her father, and her cure had a great deal to do with her relationship with Brewer.
• 25:55
  And so it's really understanding both relational trauma and healing, but it also points out this fascinating pattern of whenever she failed her father, she developed a self punitive symptom, which I think we could talk about in a whole other podcast. But the author writes, According to Freud, patients transferred feelings unconscious, primitive feelings that they had developed for significant figures in infancy and childhood onto the analysis. It was the therapeutic relationship itself that evoked this transference. Transference love derived from the analytic situation, not the person of the therapist. So it wasn't about the therapist specifically, but the relationship with the therapist.
• 26:51
  And she says, Freud also claimed that the psychotherapeutic relationship, as well as the client's transference, were apt to stir intense and unresolved feelings in the therapist. This countertransference was equally dangerous. When therapists did not help clients understand their own feelings and instead reacted to these feelings, fireworks were likely. When patient and therapist acted out their transference and countertransference feelings, disaster could ensue. So the example I can think of this is that one time we had a therapist who actually struggled with depression.
• 27:32
  Well, that's happened to us three times, actually, but I mean one who was really struggling to cope. And she was a very present and attentive therapist, actually, except for when we were sad. And she had no tolerance for us to be sad or to struggle for two reasons. One, I think it triggered her own depression stuff, which I understand because I feel that sometimes with the husband and his depression. And so I get how that happens in a relationship.
• 28:06
  And because of that, I recognized it when it happened in therapy. So in that way, we just knew that she was not gonna be a good therapist for us because she couldn't handle her stuff and it was gonna get in the way of us learning to manage our stuff. But the other layer of that kind of goes back to toxic positivity, which maybe is why that's a trigger for us, has to do with it being part of her faith tradition that thinking badly or feeling badly is like anti God somehow and is like a lack of faith and that you just have to speak goodness into the world and that's what's going to happen. And so it was a conflict with her faith that was also getting in the way of our actual lived experience. And so both of those layers interfered with our therapeutic process.
• 28:56
  But this author talks about how with Anna loving Doctor. Brewer, that when he reciprocated, he lost his scientific objectivity and he fled out of fear and shame. And that is also what we've seen happen with therapists who tried to be too flexible with boundaries or felt they could be appropriately flexible with boundaries, but then recanted or tried to change it and either punished us for the choices they made or promised something that then they changed their minds about and took away in a way that caused damage to the relationship. And what that looks like is when they feel guilty, like that maybe they've done something wrong or guess themselves about the flexibility of boundaries and then punish us for it. And that's not okay either.
• 29:58
  So she says, Clearly transference theory can illuminate some aspects of Anna Oh's relationship with Doctor. Breuer. But to talk about their relationship strictly in terms of transference is reductive. Breuer fulfilled needs in Anna that had long gone unmet. He allowed her to speak the unspeakable, to express her deepest feelings without fear of censure, to behave in the most socially unacceptable fashion.
• 30:28
  He responded always by attempting to understand her in her own language, by validating that her language had merit and meaning in the world. He knew her to the extent that one person seldom comes to know another. And this intimacy, while skewed one way, was genuine. And I think that's part of what happens in therapy. Their interest really is genuine, which I think is why it feels like such a betrayal when things go wrong or why it hurts so much when that's taken away.
• 31:02
  Because those ways in which it helps, that is real, even if it's confined to the four walls of the office. She says, When Anna Oh revealed herself completely and Doctor. Brewer seemed to accept and understand her completely, how could that not feel like a love? And then losing him, particularly without his acknowledging the significance of her loss, was not just a repetition of the loss of her father, but was an occasion for grief itself and perhaps rage in its own right. Again, I was just nauseous.
• 31:43
  I had to literally put down the book and go for a walk because I was so sick from reading the truths of this and understanding the layers of it. Here's what she says next. To even engage in the talking cure with Doctor. Brewer, Anna had to make a leap of faith, investing Brewer with the power to help her. The very strength of her wish to be helped, the very act of giving herself up to the wish, evoked her deepest longings and desires.
• 32:17
  She allowed Brewer Entre into her most interior life, and he embraced the intimacy. Their relationship became emblematic of what any relationship with another person could provide, important beyond its literal limits. If he loved her, she was lovable. If he did not, then she would be alone always. And I think that's why it's so devastating when you lose a therapist, not because the love within that context is inappropriate or because anyone has done anything wrong and not that it's any kind of erotic love.
• 32:56
  It's not. It's that genuine being cared for love, that attunement that you experience at the root of presence and connection that brings such deep healing. But when you lose that, when it's taken from you or there's a violation or there's a rupture and it's not repaired and so that there's an actual loss there, that's the piece that you lose, the possibility that you can be loved. It's not just about the therapist. You lose the possibility that you can be loved and cared for.
• 33:35
  That's why there's despair. That's why there is the death of hope, that death of redemption potential. That's why it's so big. That's what that wound is so deeply spiritual and emotional and mental beyond just the physical loss of the person that was your therapist. It's devastating.
• 34:03
  And I think that finding the words to express what happened in just a sentence like that, or seeing the words in black and white of why it hurt so much, that I was not crazy that it hurt so much, that I was not dramatic for not being able to just snap out of it after a year or even two years. No wonder. And I appreciated that with all of my being. And we are so grateful that that person, I don't even remember your name and I'm sorry, I can't even find the email to thank you. But for the person who sent us this book, who recommended this book, I am so grateful because it puts so much into words.
• 34:53
  So the next chapter, chapter two, talks about that approximate relationship, the relationship that is so close to what love is in every way and yet confined to the boundaries and the context of those four walls. And she tells this story about how she wanted to understand what transference was. And so she went to interview some hotshot New York therapist, and he started being, like, weaker and weaker and weaker as the interview went on. And she noticed he was shaking and that he looked pale. And then before the end, like before she could leave, he basically collapses and almost passes out on the floor.
• 35:39
  And she suddenly has this flashback of when her father had a stroke and died and her helplessness as she watched her father die from this stroke. And she's having this flashback in that office and suddenly cares for this man that is a complete stranger she just met. She is caring for him, and has these feelings for him like she did for her father. And so suddenly this guy who was this hotshot therapist to her is this very frail old man that she wants to rescue and help, but freezes because of the trauma of her past with what happened with her father. And of course, she didn't plan this.
• 36:23
  There's no way she could have known this would even happen. But it turned out he just had some low blood sugar. She was able to help him find his glucose tablets. And after a little while, started to feel better and she was able to process this what happened and figure out and experience literally what transference is and how it so easily happens between all of that that's just the dynamic of the relationship between any of us and the people around us or in our lives. So she shares what his response when she asked him to define transference.
• 36:59
  Here's what he said: If you play according to the analytic rules, the patient begins to relate to you as though she had some prior contact with you, as though you were a person of significance from earlier in her life. And she says, Of course, transference does not occur only in therapy. We have transference to our neighbors, transference to our friends, but we also have information about them that serves as a reality check and reality corrective. Transference is maximized in analysis because the analyst withholds information about himself, refrains from intruding his needs into the therapeutic interaction. So she's talking about how with transference with other people, like other important people in your life, your neighbors or your friends or your family, you know things about them that help correct those false ideas.
• 37:55
  So for example, I could feel like the husband is going to abandon me the way my mother abandoned me because he shuts down with his depression. But it's not actually true because he is one of the most faithful and loyal persons that I've ever met on this planet. And so I had this corrective thing so that even though his depression is sometimes hard to live with on my end, which is not at all to insult or minimize how hard it is for him to live with. But even though that's hard as the spouse of someone who is sometimes so depressed that I don't have those actual fears or that transference in the same way I might with someone else because there's that correction there that informs me about capacity and about intent and the evidence of the pattern of his behavior that he has stayed by my side through tons of hard things that have happened to us in our life, right? Whereas with a therapist who has a very flat affect and is struggling with their own depression and is not good at being responsive, either because of their personality style or their own capacity, that to me reads as danger because I don't have any information to correct that transference, that they aren't really caring about me and they don't actually want to hear from me or they don't actually care because I'm not getting those signals.
• 39:35
  And because I don't know them in real life, I don't have any way to correct that information. And so it just stays there and festers, right? And then to add to that, when we're wanting that transference to heal us, because that's why we go to therapy is to get better, then we have these high expectations for other humans to perform or be or do something that can't actually heal what's damaged, in that they can help us make progress, they can help us learn new skills, they can help us tend to pains in the past, but they cannot undo what has already happened. Right? They are not that powerful or that magical.
• 40:26
  They are humans who can be present with us in our pain or tend to pain or struggles from the past or help us with skills in the present, but they can't undo what has already happened. She says, Our therapists are objects not only for our projection of feelings and experiences from the past, but also of our wishes for the impossible. We long for our therapists to be perfect, immortal, so that their existence can somehow validate and redeem our own. And we long for these immortal beings to love us perfectly, unconditionally, in a way that we have never been loved before. And really, no one can do that.
• 41:12
  Period. Like, not because we don't deserve it, but because other people are human.
• 41:25
  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. One of the ways we practice this is in community together. The link for the community is in the show notes.
• 41:52
  We look forward to seeing you there while we practice caring for ourselves, caring for our family, and participating with those who also care for community. And remember, I'm just a human, not a therapist for the community, and not there for dating, and not there to be shiny happy. Less shiny, actually. I'm there to heal too. That's what peer support is all about.
• 42:20
  Being human together. So yeah, sometimes we'll see you there.