Latest / System Speak: Complex Trauma and Dissociation / Recap: Virtual Congress

Transcript

Recap: Virtual Congress · System Speak: Complex Trauma and Dissociation

• 0:08
  Speaker 1: Over: 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.
• 1:03
  Speaker 2: Mark Linnington presented at the ISSTD Virtual Congress on an attachment based approach to working with people with dissociative disorders. He talked a lot about the circle of security, but it's talking about the same thing in the previous podcast episode about how the parent attends to the child needs. So he's got this circle where there's two hands and the circle kind of comes out of the two hands. So one hand is offering a secure base so that the parent can support the child's exploration while keeping them safe and delighting in them and helping them and enjoying them, but then also as a safe haven with the other hand so that they are welcomed and protected and comforted and organized in their feelings. And so he says that we should, as parents, always be bigger, stronger, wiser, and kind, and whenever possible follow my child's need and whenever necessary take charge.
• 2:08
  So we need to let children have as much autonomy as possible, use their agency as much as possible to make their own choices and to meet their needs, but always be bigger and stronger and wiser and kind. And I would say with that calmer as far as regulating, you're helping them regulate. And so just like a toddler will sort of run off from the parent when there's good attachment or development, toddler will run away from the parent and sort of go play and come back and check-in and then go off and play and come back and check-in. And as the child gets older, sort of that circle gets bigger. They go a little bit further away for longer and then come back and check-in.
• 2:55
  And until you see this with children as they grow up, this longer away and doing more away, but then still coming back to check-in when there's this secure base and safe haven. And so that gives the child exploration and also attachment, this ability to go and to return, explore and to remain attached. I found this chart fascinating because I think that's what makes therapy so hard for so many of us when we talk about this because we don't have the secure base to start out from. And so it's hard to get to therapy and explore what's going on. We don't have a safe haven to come back to in the therapy space because we don't have attachment.
• 3:43
  And so it's really really hard to organize all that's going on internally and externally because we don't have those pieces. And so it makes sense to me in a new way with a visual of why just the process of going to and from therapy is so hard. Why starting to talk once we get into therapy is so hard. I mean I know about Broca's area and all of that but why it's so difficult to explore things or go there because there's nowhere safe to come back to. It's not just that that content is hard.
• 4:19
  It's that you want me to be grounded and notice the room where I'm at but I don't know that that's safe yet. And so maybe that goes back to why it really does take such a long time of phase one therapy in the phased approach of safety and stabilization. Maybe that's part of what that provides and even as we look for a new therapist that's something we need more than what we thought because it's not just about the content, it really is also about the attachment. So he reviews sort of attachment patterns and insecure giving attachment patterns include dismissive avoidant, preoccupied anxious, frightening and frightened, which is disorganized. So he shared a quote from Judith Lewis Herman from 1992 that the will to deny horrible events and the will to proclaim them aloud is the central dialectic of psychological trauma.
• 5:19
  So in dismissive avoidant caregiving attachment what happens is that those two hands that offer the secure base and the safe haven are too far away from the actual circle of exploration and coming back to the caregiver for attachment. So because the parent is avoiding that re attachment, there's just this circle of, okay, I have to go explore the world by myself and when I come back I'm dismissed and avoided and so there really is no attachment. So it makes a smaller circle that is set apart from the caregiver because the caregiver will not let them into their world. The preoccupied anxious attachment has the opposite problem. The circle is too close to the secure base and safe haven so that they can't actually get out to explore the world because the attachment is only with the parent.
• 6:20
  And then disorganized attachment happens when there's both of these things. The world is not safe to explore because it's dangerous and the attachment is such an effort when it's not happening because of relational trauma. So Lions Ruth, who is the same person who did the presentation we talked about in the previous episode, said an infant's display of disorganized attachment behaviors is thought to occur because the infant is faced with an unresolvable paradox. When fear is aroused, the infant experiences unresolvable conflict with respect to seeking comfort from a frightened or frightening caregiver who is also the only haven of safety. So that goes back to what we know about mammal brains turning towards the caregiver but the reptilian brain turning away from danger and the conflict that happens when those are the same thing.
• 7:17
  The caregiver is the danger. And so what happens is that there's not the two hands because there's not a safe haven and there's not a secure base. And so the child sort of goes out and it turns into this scribble where the child sort of leaves them and tries to circle around but can't get back and so has to just keep going and find an attachment of sorts or an illusion of attachment or resolve without having an attachment into the external environment without returning back to the not safe haven He said in such chronic trauma as child abuse autonomic arousal occurs again and again in an ongoing situation of physical and relational impingement, in which the child cannot intervene effectively. Autonomic arousal becomes a generalized reaction to stress in which the connection between the severity of the perceived threat and the degree of arousal is broken. So he gave the example of a chronic trauma, like going through foster care, for example, when you bounce from home to home.
• 8:28
  That's what the attachment line looks like. There is no circle. It just goes from one place to the next place to the next place in this sort of serial touchdown so that instead of going out to explore the world it's just going from one secure base that turns out not to be secure to the next secure base that turns out to not be secure over and over again. And so they still never get a secure base and they don't actually build attachment even though it looks like because they don't get to stay there. So he talked about the McCluskey model and the circle of security and how self defense plays a role in that.
• 9:09
  He talked about what helps with caregiving, providing a sense of steady centered other, consistently available and responsive, establishing the framework, recognizing the validating feelings, especially fear and its effects, introducing emotional regulating practices, paying attention to the intensity of one's emotional and relational responses. And then another kind of caregiving would be hearing the narrative of abuse as an empathic other, receiving the feelings of the person and their identities, exploring and understanding the impact of the abuse, exploration of emotional and relational repetitions, acknowledging the vitality and competence of the person's identities. So I have to admit there's this whole section here where he talked about the steady centered other and people who are consistently available and responsive and this is so new to me in my one friend and in the husband and maybe in Peter. Sorry Peter for putting you on the spot again. But I think those three experiences are so new to me that is the only examples of steadied centered others I could think of who are consistently available and responsive and that's not even in therapy or in life that is a constant to me because my friend is far away, Peter's far away and the husband and I have to take turns with the children.
• 10:43
  So he's far away even though it's not geographically. And so I think it's something that's still so difficult for me and so foreign to me that I've not quite absorbed it. So this whole section of his presentation, I have to admit, wasn't triggering in a way that some of the content in the other attachment presentation was a little bit triggering. This was triggering in a different way in that it was so foreign, it was hard for me to focus on it. So the dissociation was a different kind of experience that it was just it just got blurry and sort of went past me.
• 11:20
  I had trouble focusing on it. I had trouble processing what he was sharing. But then he talked about intragrams as a way of representing the dynamics of internal environment and the attachment based ways of relating by a person with dissociative identity disorder. And so if you think of a genogram where you map out a person's family, an external family like family of origin, right, He is doing a similar thing with alters so that it's the family inside but there's a key for different ways to connect people inside who have distressed care seeking, who are hostile or cruel caregivers, who have sexualized ways of relating, who have cooperative mutual relating, who have effective caregiving, who are excluded from therapy, who are partially excluded from therapy. So dotted lines and dashes and light colors and dark colors and arrows.
• 12:30
  He talked about how to map this out not as a way of showing who the alters are or where they are in relation to each other but the alters in relation to how they interact with each other and how they interact with therapy and the outside world. So that was really fascinating and I'm going to have to think about this and I promise to work on it and maybe I can share an example of part of ours if I'm able to do this. But right now is a really hard time for access to any of this just because everything is sort of on pause for our own therapy. And so allegedly we have a new therapist again and we start that next week as far as the timing of the recording of this. So if things stabilize enough there see stable secure base if we're able to engage with that and have some stability enough that I can access this and work on it then as I share maybe I can do another episode of trying to do this introgram exercise because it was really fascinating and it was different than any kind of mapping that I have seen done before.
• 13:49
  Although I think it's what many of us try to do intuitively but he gave enough of a cognitive framework that I think it made it more accessible to me specifically. So we will work on that and maybe share what we learn. I did invite him to be on the podcast later so we'll see what he says but maybe he can tell us more about it. There was another session called an integrated addiction model recognizing the addiction blueprint and we did not attend this one because we were already registered for a different one at this time but we had a friend who went to this who was also a doctor and helping people with addiction and so she went to that session and we're going to interview her about it later. But she said it was a very good lecture and very applicable to work with the general population because such a large percentage of people come to us, meaning doctors, because of the impacts of addiction on their health.
• 14:51
  Speaker 1: And so if you are interested in addiction, that would absolutely be worth your time looking that training up and doing it.
• 15:00
  Speaker 2: There was also a training on global resilience when dealing with trauma as a result of terrorism or mass violence and we are doing that one later because of our work with natural disasters and war zones And so we're going to be watching that, and we're really excited that it was included. There was another session called dissociative amnesia, update from the DSM five text revision. And that one, what you need to know was super nerdy. The nerdy professionals were super excited about it. The language of understanding was different than what our friend who is a medical doctor understands because this was so specific to clinicians and it was hard to apply it outside the clinical setting.
• 15:51
  So people who are not clinicians, it was not an accessible session but it was specifically a clinical session and so that makes sense and in context it was really good and enjoyable but you have to be
• 16:05
  Speaker 1: a clinician to really appreciate it.
• 16:08
  Speaker 2: But they will be available online if you want to sign up for them and still watch them. It's really really good stuff. Another session was Befriending the body: a sensory motor psychotherapy perspective on treating complex trauma. Again, this is something that you really have to work into very gradually because it is difficult to tolerate if you've not done it before but it works very well as you learn to tolerate it and can be very useful as part of integrating in the whole experience. So that would be associating, right?
• 16:47
  If you're able to understand and notice the sensations and experiences of the body and also know the feelings and thoughts and emotions that you're experiencing as a whole part of that experience. But it can be very beneficial and the presenter was very kind and compassionate and we're going to talk about it with our friend on a separate episode. Books by Peter Levine are referenced in this and talked about it, and we have been back and forth with their office whether he's going to be on the podcast or not. And we invited Peter Levine on the podcast, and
• 17:28
  Speaker 1: he was scheduled to be
• 17:30
  Speaker 2: on the podcast but then the pandemic happened and we've not heard back from the office yet. So I don't know if he's coming on the podcast or not but he could certainly tell us more about it. But our friend who is a medical doctor very much appreciated this and has some cool stories that they can share in appropriate ways about how it's helped some patients of theirs as well and this was maybe their favorite lecture I think. So we'll talk about that more on another episode. Depth of self care finding the capacity to care in the field of constant tragedies was another clinical session for providers who are needing to pay attention to self care and in some ways that looks the tamest but it triggers a lot as far as what you're not doing right and so that I think we will also talk about separately but it was very very good.
• 18:30
  Neurobiology and etiology of DID and beyond was the most brilliant science and the most recent science of being able to detect DID in the brain and verifying those studies in the presentation of all of this and they will also be on the podcast later so we'll talk about it. So we'll continue sharing about other pieces of what we learned from the ISSTD conference as it continues to unfold but mostly again but you can also watch them or listen to them online if you want to especially those of you who need CEUs you can get CEUs when you pay for the classes and it's just such fantastic material. I'm so grateful for those who worked so hard to present the ISSTD conference virtually and for it to be offered to us in this way after missing out on California which I know was so sad and tragic for so many. It was, just heartbreaking the timing of everything but I really think it was handled as best it could and the last minute cancellation was because of government regulations not because of any last minute change of heart on ISSTD part. We really have follow the guidelines for things like CEUs and that can be so frustrating those kinds of red tape things and again it is just a board of people who are very human and two hard working educated women in the office and me with my tiny job and that's it and so I would continue to ask for respect and kindness interacting with the ISSTD or the office of the ISSTD because everyone really did so well it was an intense wonderful weekend of a bit of a respite from the pandemic and just almost a sense of normalcy for the first time in ages for these months that we've been in quarantine to come up to the office and have food and activities for the children already planned so that the husband was engaged with them and we just sat in the hammock and listened to the conference and it was incredible and amazing and restful.
• 20:58
  It was spring so the windows were open and it was really just a lovely experience both in those sensory ways, in the self care and rest of it, and in the cognitive learning and the list of things that it gave us to process. So much to learn and so much to practice and so much to do but even in that there's so much empowerment both as we improve as clinicians and as we grow through our own therapeutic process and so I'm very grateful for that. It also motivated me not to give up on trying to find a new therapist and so what I've decided to do since everyone is on telehealth anyway for now is to reach out further than just the Kansas City area and so I went to other cities in Kansas on my searches and sent out more emails and got a couple of responses that may be beneficial so we continue to try to engage and try to not give up above all else and to care for ourselves as best we can and our family as is so important to us to do so. We also continue to try to maintain connections as we can, even through this.
• 22:19
  So in a consultation group with Peter Barrish and sending him messages sometimes and checking in with him and checking in with our friend in Oklahoma and sending her messages or things or mail so that she knows that we've thought of her and receiving that back from her. So doing the hard work three months into this pandemic of staying connected and the ISSTD Virtual Congress really supported that and helped us connect with colleagues even a new friend from Kansas City who is treating DID patients and is not going to be my therapist because I met her as my friend and I want to keep her as my friend but is someone who is safe and understands locally and so that's new for me and we'll see how that goes but all of these things count as connection, and all of these are attachment builders, and all of these are attachment healers. And I'm just so grateful for the experience and as much as we learned. So we have a few guests coming on to still talk about it more, just in time for the Alaska Regional Conference, which will come up next month. And so there's lots to share over the summer, and I hope that will help as we continue to adjust and transition and grow and learn together.
• 23:46
  Thank you. And with that, I want to close with something special that Peter sent to me, which is from the first issue of Many Voices, the survivor's newsletter about DID ages ago in the 90s. It's available on the ISSTD website or at manyvoicespress.org But the very first issue included a letter from Doctor. Cornelia Wilbur, who was the therapist to Sybil, from the book, which I have not yet read and a movie I have not yet watched, but maybe it's time. And they think the quality of her work and her contributions to the field remain and stand intact despite what happened in the nineties or the books against it.
• 24:35
  The letter is dated 11/22/1988. She says, I would like to make three points for every multiple personality disorder patient to cling to in times of crisis and stress. So remember, in 1988 DID was still called MPD, but it's the same thing. And now with the pandemic, we are in a time of crisis and stress. And so I thought these would be good reminders for all of us.
• 25:03
  So thank you Peter for sharing this with me. Doctor Wilbur said, number one, if you have a therapist who is helping you and you stay with that therapist, you will eventually recover completely. The end point for dissociative disorders is recovery. You guys, that offers us so much hope. There's also still a bit of grief for us and leaving our long time therapist because it's the first time we stayed that long.
• 25:33
  But also I understand we've processed enough to be able to hold on to why that was necessary and that we had to and that we've got to keep trying and this is a reminder of why it's so important. Number two, she says. There is no doubt about your intelligence. No matter how stupid you may feel or how stupid you have been made to feel, each of you has intelligence that is above average. You can depend on it.
• 26:02
  Number three, you are not guilty of anything that has produced depression, fear, dissociation, or any other symptoms. Often, many of you have been told that you were bad. The fact is that you were victimized, not bad. So guilt can be dismissed as you understand the situation into which you were born and tried to develop. That almost made me cry because it's exactly what the ISSTD conference was about this year over and over again, from science in our very DNA to all our understandings of attachment and attunement, it was not us.
• 26:43
  There was nothing wrong with us. It was not our fault. We have never been bad. It was, as doctor Wilbur said, the situation into which we were born and in which we tried to develop and struggled to do so because things were so hard and because we did not have caregivers who provided caregiving. Doctor Wilbur closed the letter saying, my very best wishes for all of you in your struggle to recover.
• 27:14
  Keep working. And that, I think, is a piece of history that still lives on. Keep working. Keep working. Keep working.
• 27:46
  Speaker 1: 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.