Latest / System Speak: Complex Trauma and Dissociation / Guest: Cathy Kezelman, MD (Blue Knot Foundation)

Transcript

Guest: Cathy Kezelman, MD (Blue Knot Foundation) · System Speak: Complex Trauma and Dissociation

• 0:00
  Speaker 1: Welcome to the System Speak podcast. If you would like to support our efforts at sharing our story, fighting stigma about dissociative identity disorder, and educating the community and the world about trauma, please go to our website at www.systemspeak.org, and there is a button for donations where you can offer a one time donation to support the podcast or become an ongoing subscriber. We so appreciate the support, the positive feedback, and you sharing our podcast with others. We are all learning together. Thank you.
• 1:15
  Our guest today is Doctor. Kathy Kesselman. She's a medical practitioner, mental health consumer advocate, president of Blue Knot Foundation National Center of Excellence for Complex Trauma. She's a current member of New South Wales Child Safety Standing Committee for Survivor and Faith Groups. She is past director of the Mental Health Coordinating Council, past member of the Mental Health Community Advisory Council, and a foundational member of the National Trauma Informed Care and Practice Advisory Working Group, member of Independent Advisory Council on Redress.
• 1:58
  Kathy worked in medical practice for twenty years, mostly as a GP. Under her stewardship, Blue Knot Foundation has grown from a peer support organization to a national center of excellence, combining prominent consumer voice with that of researchers, academics, and clinicians advocating for sociopolitical trauma informed change and informed responsiveness to complex trauma. She is a prominent voice in the media and at conferences, as well as author of a memoir chronicling her journey of recovery from child sexual abuse, A Tale in Parts. She is co author of multiple seminal Blue Knot Foundation documents, including the long awaited for twenty nineteen practice guidelines for clinical treatment of complex trauma. This is what we have been waiting for and this is what we've been telling you about.
• 2:55
  The Blue Knot Foundation is Australia's national center of excellence for complex trauma. It empowers recovery and builds resilience for the more than five million (one in four) adult Australians with a lived experience of complex trauma. This includes those experiencing repeated ongoing interpersonal trauma and abuse, often from childhood as an adult or both as well as their family and communities formed in 1995 blue knot foundation is at the forefront of pioneering trauma informed policy practice, training, and research. It provides direct services to survivors, specialist trauma phone counseling, and educational workshops for survivors and their family members, partners, and loved ones, as well as an extensive professional training program for workers, professionals, and organizations from diverse sectors supported by supervision and consultancy services. It also has extensive resources including fact sheets, videos, publications, and website information at www.bluenaut.org.au.
• 4:11
  It has launched the new twenty nineteen updated practice guidelines for clinical treatment of complex trauma. These guidelines have been endorsed by us as well as others from the ISSTD. The twenty nineteen guidelines have also been extensively endorsed by leading academics, clinicians, and researchers in the complex trauma and dissociation field prior to their release. They provide an integrative guide for diverse practitioners working with complex trauma and dissociative clients. In addition, a companion guide to the twenty nineteen guidelines combine complementary guidelines, which provide an overview of the differences between working with complex trauma clients and standard counseling approaches, as well as a guide to therapist competencies for working with complex trauma and dissociation have also been released.
• 5:07
  Hard copies and free downloads of each publication are available from Blue Knot's practice guidelines portal. These links will be provided on the blog. What you need to know about this episode is that before we talk about the guidelines, which everyone has been waiting for and is super excited about that we promised were coming, Doctor. Kesselman first shares her own personal story. She does this without trauma dumping or overly triggering but it is a difficult story like the rest of ours where it is not trauma specific in the things she shares in this interview but it is very vulnerable and raw in sharing the difficulties of the process of the healing and therapeutic journey.
• 5:53
  So if this piece is too triggering for you, fast forward to halfway through the episode. But there's no specific trauma disclosed or discussed during the interview. As part of sharing her story, she does reference the struggle with suicidal ideation. While this is not at all discussed in-depth, I do want you to be aware of it as a trigger warning going into the episode. As always, keep yourself safe during and after listening to the podcast.
• 6:24
  Thank you. After she shares her story, we speak more about the Blue Knot Foundation and the new guidelines and why we think they're so important. We will talk about the guidelines themselves and the research behind them more specifically with another interview. But for now, we welcome Doctor. Kathy Kesselman.
• 6:52
  Speaker 2: Yep, so my name's Kathy Kesselman. I'm a doctor by training. I also have my own lived experience of complex trauma and dissociation. And I'm president of the Australian national organization, Blue Knot Foundation.
• 7:07
  Speaker 1: Can you tell us a little bit about what Blue Knot is?
• 7:10
  Speaker 2: We're the National Centre of Excellence for Complex Trauma. We've been around since 1995. And our focus is firstly advocacy around the needs of adults who have experienced different forms of trauma, usually repeated interpersonal trauma as a child, as an adult or both. And we focus on empowering recovery and building resilience. We do that in a number of ways.
• 7:40
  We run a number of different helplines to support people where they can get short term counselling support, information referrals. We run educational workshops for survivors and their loved ones. And we also have a very extensive professional development training program around the country, where we seek to build the trauma informed literacy of workers, professionals, diverse people across multiple sectors. Around that, we wrap supervision and consultancy. We're really helping trying to drive a trauma informed change process through the community.
• 8:21
  And we also run programs for clinicians as well around working clinically with complex trauma clients, and also around mitigating vicarious trauma. Part of what we do is develop a lot of resources. Our website is is rich with fact sheets and videos and information as well as a lot of publications.
• 8:45
  Speaker 1: That's just incredible. Tell me about the publications.
• 8:48
  Speaker 2: Yes. Look, in in 02/2012, we published a set of practice guidelines nationally, internationally claimed called the last frontier, practice guidelines for treatment of complex trauma and trauma informed care and service delivery. They've now been downloaded over 25,000 times. What they did was elaborate and recommend embedding the core components of effective complex trauma treatment across all different psychotherapeutic modalities. Since then, we released an economic report around the cost of unresolved childhood trauma, a specific publication for the legal fraternity Trauma and the Law, and then a paper around memory, the truth of memory and the memory of truth, looking at the different types of memory and the significance of trauma.
• 9:37
  Last year, we released a Talking About Trauma series that was talking about trauma both for the general public, for services and then for primary care practitioners. Because as we know, people are very reluctant to scratch the surface of conversations. But I suppose over the last seven years since those first practice guidelines in 2012, there's really been a burgeoning, I suppose, of neuroscience and on this clinical insights. And so we felt that it was time to update the 2012 guidelines, and that's what we've done recently. We've just released the twenty nineteen practice guidelines for the clinical treatment of complex trauma.
• 10:18
  And they include substantial additions to the underpinning research base in a number of areas. Looking at the nature of complex trauma, much more about dissociation, and the related challenges of working with dissociation, looking at phased therapy, and current debates around phased therapy. New and many emerging treatment approaches, and issues with respect to what is evidence and what is evidence based treatment. So that's a very significant publication and that's just been launched. It's already been endorsed internationally by a significant number of leaders in the field of trauma and dissociation.
• 11:00
  And it's also been launched with a set of combined complementary guidelines, which look at the differences between working with complex trauma clients and standard counselling approaches. As well as what are the competencies for working safely with people who've experienced complex trauma. And next year, not to slow down, we're anticipating releasing a set of guidelines around trauma related dissociation and also for clinical supervisors of people supporting practitioners who work with complex trauma clients. It's a big program, but one we feel is much needed because there remains a real lack of understanding around complex trauma. And it's different from single incident trauma.
• 11:52
  And really an inability because of a lack of training across counselling colleges and universities around dissociation, identifying it and working with it. And so, you know, we're very keen to, you know, contribute our bit to filling that gap.
• 12:11
  Speaker 1: It's it's beyond description what you all have done and, the first set of guidelines and now updating them. I it's just powerful. The community has been asking and pleading for this. And people, since I talked about on the podcast that I would be speaking with you, I have gotten email after email after email people just begging to know more.
• 12:36
  Speaker 2: That's very lovely.
• 12:37
  Speaker 1: Yes. They're they're so excited, and so I know everyone's gonna be thrilled to hear about this. But before we jump into the guidelines a little bit, do you do you wanna tell me more about your story? I mean, what you feel comfortable sharing and how on earth you got from your story to all of this?
• 12:55
  Speaker 2: Yes. So look, I mean, my story is, you know, just part of obviously many, many stories. But obviously, for me, it's unique and it's a long story of a recovery. So let me just paint the scene a little bit. I was a medical practitioner.
• 13:13
  I mean, still am. And I was working away in a busy group general practice. I was also a wife and mother of four young children. And life was frenetic. And I used to manage everything with the parentese.
• 13:28
  But in retrospect, I had very little self awareness and really didn't know how to acknowledge my needs or be present in the moment. My life was very much about doing and not about being. And I poured weakness, especially my own. And I really didn't know how to ask for help. I was emotionally detached and expected everyone, especially myself, to just get on with it.
• 13:53
  I measured life by achievements and was often intolerant, judgmental and mocking. And I'd really perfected my own form of black humor, which some medicos are also very good at. Other medicos, it was and what they did was reinforce the barriers I'd erected from preventing anyone, to prevent anyone from getting too close. So that's not a great picture, but there are reasons for it. Despite that, I was a successful doctor.
• 14:21
  And being a doctor really gave me an identity, which I didn't didn't have otherwise in my personal life. And of course, in my role, I'd referred people to psychiatrists and psychologists, but I perceived that as for being for people with weakness and frailties to which I couldn't relate. When I was in my forties, mid forties, my niece, who I was very close to, died suddenly in a car accident. And her death paralleled another sudden death that I'd experienced as a child. And that was the trigger, which started my inner world unraveling.
• 14:57
  And after Angela died, grief subsumed me, but it didn't abate at all over time. And I was soon overwhelmed by what for me were uncharacteristically intense emotions. My practice, my home life suffered. And it took a near crisis in my medical practice for me to admit that I needed help. Doing that meant acknowledging the vulnerability I'd always denied.
• 15:25
  I didn't want to see a psychiatrist. They were for mad people and that wasn't me, of course. So I took a massive leap and made an appointment with a female clinical psychologist who I'd referred to before. So of course, from my fiercely independent attitude, I thought it would be a few quick sessions just to steady the unbalance, the seasonal unbalance in my unseasonal imbalance in my system. That was two decades ago.
• 15:49
  So within a couple of sessions, and we'll call the psychologist Kate, she delineated the boundaries around sessions, contact and cancellations. But I really resented being the patient. Most of all, I really hated being asked to talk about myself. The first session was excruciating, the next few intensely uncomfortable. There were many lengthy, embarrassed silences, as I endeavored not to relieve a thing that was personal.
• 16:16
  Kate was empathic and warm, and her office was comforting and containing, but I still felt like a lamb to the slaughter. In those early weeks, I continually fantasized about bolting and tried to out silence her by staring her down so she'd be forced to speak rather than me. But she was a past master at sitting with silence and all my attempts at asides and distractions started to fail miserably. So before long and without me really knowing how it happened, I was seeing my very own psychodynamic psychotherapist twice a week for fifty minutes a time. And those sessions provided me a space where my feelings and thoughts and needs could be identified and listened to and heard for the very, very first time in my life.
• 16:56
  And the space which was safe, in which ultimately my trauma could be explored and processed. So I'd been in therapy for a few weeks when Kate asked some innocuous questions about my childhood, about childhood friends, school teachers, classrooms, favorite foods, etcetera. I was shocked at how little information I could recall. And I blurted out what had become a very standard line for me, and that was I had a happy childhood. My mother told me so.
• 17:24
  But I had nothing to back it up. And I'd always dismissed my poor memory, cringing whenever friends would reminisce, and I simply couldn't. So over many months, it became apparent that I had virtually no memory for ten years of my childhood. And it really started to trouble me. Because I was a doctor, I should have been reasonably smart.
• 17:42
  If I was smart, then why couldn't I remember? I didn't, of course, know anything about traumatic amnesia back then. And Kate didn't explain it. She let my story unfold in its own time. So in those first few months, I really struggled to trust Kate and to feel safe.
• 17:59
  And my anxiety just grew. Then I had my first panic attack, the first of many. My medical training was useless. I thought I was going to die. Kate explained what they were, and before long, and despite myself, I started to depend on her.
• 18:14
  But not without testing her arriving late to sessions and cancelling appointments. She patiently and consistently held the space and boundaries. My approach to avoid behaviours, of course, reflected my distrust and attachment issues. But she was consistent, and that availability started to address them. As time went on though, I became more depressed, withdrawn, and felt less safe overall.
• 18:39
  Yet my relationship with Kate was evolving, and I did feel safe in her office, just nowhere else. And as soon as I walked out her door, I no longer felt held at all. I couldn't internalize her caring or know that she could keep me in mind as this was an alien experience for me. But as Kate became the maternal thinking mind I needed, I tested her availability by calling her repeatedly. I didn't want to talk to her.
• 19:04
  I just wanted to hear her voice. When she did answer, I'd hang up as I didn't know what to say. I didn't know how to communicate my needs at all. Yet I was incredibly needy, and by now, extremely anxious and more agitated than not. Sometimes I'd leave a message on her answering machine and then anxiously wait for her to call back.
• 19:24
  But when she didn't call straight back, I knew that she didn't really care about me, or so I thought. So my first flashback scared the living daylights out of me. And again, my medical training didn't help. My mind kidnapped me and my body adopted a life of its own. I experienced it outside of therapy, in the safety of my husband's arms, and it terrified us both.
• 19:47
  As I writhed in pain, terror and confusion, I thought I was losing my mind. I didn't know about flashbacks or that these fragments of dissociated experiences from the past couldn't hurt me. As they intensified and became more frequent, I told Kate about them, but was too ashamed to reveal their content. She understood. Maybe I wasn't mad after all.
• 20:09
  She suggested that I should write about them, and I did that and brought the writing to therapy. At first, I couldn't read what I'd written, so withering was my shame. I'd hand the material to her and she'd read it. Eventually, I could speak some of it out loud and we explored it together, the terror, the sensations, the intense emotions, the body contortions. But there was little to no context.
• 20:31
  And that made it hard to interpret. And what was incredible was it just seemed to be outside of my realm of experience. And yet, here it was. As my flashbacks intensified, my depression deepened and I considered suicide. My life became my memories and the past subsumed the present with my everyday life all but disappearing.
• 20:50
  Kate worked hard to ground and orient me back into the world in the present. After each session, she would scrutinize my plans. By now, I was profoundly depressed and barely functioning, and was forced to wrench myself from my role and identity as a doctor, which of course cut me further adrift. But the reality was that I could barely get out of bed, and I struggled to attend to my home and my children's needs. As I flipped repeatedly between my daily life as a middle aged mother of four, to being a four, six, 10, 14 year old, terrified and agonized child, my husband picked up the pieces of home and family.
• 21:25
  Kate made herself more available and remained reliable and predictable, running, really running late for a session or being uninterrupted during one. Seeing her became my lifeline. I would start the countdown to a next session as soon as I left her office. I longed to feel safe, if only for fifty minutes a day, now three or four times a week. I still regularly tested her in our relationship, but she held firm when she needed to be.
• 21:51
  But she was always patient, empathic and validating. By now, I'd withdrawn into my familiar isolated childhood space, Initially withdrawing from most of my friends and soon from my family as well. And of course, that put me at enormous risk. Kate worked hard to keep me connected. She told me to walk into my children's bedrooms when they weren't home.
• 22:13
  To look through photo albums and keep family photos in the wallet and in the car. I needed to be drawn out of my isolation repeatedly. She urged me to get out of the house to join a gym and get some exercise to take the dog for a walk. I tried, but, you know, sometimes those suggestions felt absurd. When I was at my lowest ebb and needed most to do that, I couldn't at all.
• 22:34
  Despite seeing Kate three, four, sometimes five times a week with phone calls in between, my mood plummeted further. A psychiatrist prescribed antidepressants, which I took begrudgingly. I still didn't want to admit that I was unwell, or worse, still needy. At first, the medication took the edge off my mood, but as suicidal thoughts filled my days, trips to the gap, a local cliff face with a deadly drop became a daily occurrence. I didn't tell Kate about this for weeks, but when I did, Kate was calm and urged me to call her whenever I needed to.
• 23:04
  That battle with suicide raged on and off for years. I really didn't want to die. I just wanted to end my pain, which was excruciating. On several occasions, Kate and I talked about hospitalization, but we ruled it out as my relationship with her was fundamental to my survival. On a few occasions, Kate urged me to sign a contract, which I did.
• 23:25
  I don't know what how or why it worked. I really resented it being coerced to do it, but I always complied. As time progressed, I learned to keep Kate's presence in my mind outside of my sessions. Yet with the slightest perceived inconsistency, I would doubt her all over again. Meanwhile, the flashbacks continued with a vengeance, and I became overtly dissociative in my everyday life, but especially around and during my therapy.
• 23:52
  I covered it with my kids pretending that I was kidding around. But for the first time, I realized that I had undoubtedly dissociated from early childhood, and now more often than not. I would dissociate more as each appointment approached and arrived for the session completely spaced out. And when Kate asked me in, I couldn't get up. She'd find me in the waiting room unable to move and sometimes have to lean me by the hand into her consulting room.
• 24:19
  By now, my memories were returning thick and fast, no longer with my husband, but from my dissociated state in the safety of Kate's office. And so Kate patiently observed the outpouring of horror I relived in her presence, and sat with me holding the feelings and the experience in the room. In these sessions, I would be completely subsumed in the past, writhing and contorting in terror in my chair in her room. Twenty minutes before the end of each session, she would offer me a glass of water. I often couldn't find the cup in her hand.
• 24:50
  She'd need to guide my fingers to hold it. But as the water trickled down the throat, the sensory input usually pulled me back through the dissociative cloud to the present. And from there, we could reflect on some of what I had what we'd relived together. The material was terrifying and emerged in disarticulated fragments without chronology or context. But Kate would sit me as sit with me as I struggled to accept what had played out.
• 25:15
  Together, we would question, examine, reflect and process. At the end of each session, I would be finished, immobilized and struggle to move. I sometimes couldn't believe that she could throw me out in that state. My trauma was so raw and my suffering so acute. But my session had finished and the next patient was waiting.
• 25:34
  I'd occasionally have to sit in another room before I was safe to be able to leave. Or I'd work to find my feet and place them on the floor, one foot in front of another, to walk up her drive back to my car. I'd struggle into the car, tip the seat back, and pass out. When I came to, I'd drive home to rejoin my life in the present. I experienced a range of dissociative phenomena, strange out of body experiences with parts of myself disappearing, my mind not feeling like my own, and myself or the world around me feeling unreal.
• 26:07
  Most terrifying and confusing of all was the day in which one of my parts spoke out aloud for the first time. Over time, different disavowed child parts came to therapy. Some only fragments, others holding a single horror, others more formed, but all playing a pivotal role in my survival. And each of them would find their voice and speak, while the adult part of me and Kate would listen in disbelief. I'd typically begin those sessions dissociated as in previous years.
• 26:33
  Slip further away and then speaking in a child's voice. And the child would use children's language and concepts. Sometimes different parts spoken, they would converse with one another, with Kate or with my adult self. My mouth would switch between different voices. I never knew what to expect until the words came out.
• 26:52
  I didn't know it then. But to cope with my trauma, I'd compartmentalized and created different parts or self states. Many of them children. Kate engaged with each of the parts in an age appropriate way, helping them each to feel safe and begin to trust her. Over many months, all of them introduced themselves.
• 27:09
  Some were suspicious. Others were very angry and very hurt. It took a long time for them to accept one another and for me to accept them all. The process was fraught with resentments and abject terror. I particularly struggled to accept the parts which had held the worst of the abuse, those of which I was most ashamed and which the other parts blamed.
• 27:30
  Those parts felt bad and dirty to the others and to me. I rejected them harshly and cruelly, but Kate modeled acceptance and her understanding of them and their roles. I endeavored time and again to get rid of the bad parts, and my feelings of shame pushed me to the gap again and again. Kate encouraged me to put my arms around the hurt, scared and shameful parts, which I initially abhorred and resisted. But over time, I started to accept the different parts of me.
• 27:57
  And over time, the fragmented turbulent we became a more peaceful, resolving me. I can now reflect on my struggle to reach that point. During that time, I really was a we and often experienced a marketplace in my head. It was exhausting and often came with disabling eye pain and headaches. During this time, I had now, in retrospect, many ludicrous conversations with Kate.
• 28:23
  For example, I'd tell her to keep the dirty parts over the weekend, especially a part called Growley, despite this being a part of me. Growley had done the most terrible things of all, and I hated him. The internal battle to accept Growley raged for months. Accepting Growley meant accepting a part of me which had perpetrated despicable acts. And it meant absorbing the pain and guilt of being growling.
• 28:46
  Dissociating growling in the other parts that allowed me to externalize those negative feelings and behaviors. But in doing so, I'd lost so many parts of myself. And not only my memory for bad things, but my capacity for joy too. Peg did never draw any conclusions before I reached them myself. She remained open to whoever and whatever I brought to therapy, and I took my cues from her.
• 29:07
  But I was hypersensitive to every nuance of her words. And by now, even when I was deeply dissociated, I remained aware of her presence and demeanor. She listened and she heard. Most importantly, she acknowledged and validated my experiences. But any small attempt to hurry me along and any perceived impatience would send me into a deeper dissociative state.
• 29:30
  I and the material needed to set the pace of therapy, not Kate. Not to say that Kate didn't ever challenge me. Some of my thinking absolutely needed challenging. Thinking like my assertion that my suicide would only make my children a little sad. That I could throw one part of me growly over the gap and the rest of us would live on.
• 29:50
  That as a young terrified child, I could have stopped a group of adults from abusing me. Greater logic to my thought process also helped me manage my emotions better. And eventually, the highs and lows became less turbulent. And my battle with suicide and depression subsided. I think my shame was a very, very big obstacle, and dealing with it took a long time.
• 30:12
  I blamed myself harshly for my abuse, and judged the child me for being abused. Kate challenged me to think of my own children, especially my two youngest daughters, and whether they could have stopped powerful adults abusing me, abusing them. Or look at young children at the age at which I abused I was abused, that I should stop judging myself with my adult mind and show compassion for my child self to forgive myself and believe that I wasn't to blame, that I wasn't worthless and and bad after all. My history is very complex, and I had a driving need to know. That meant exploring it repeatedly from many angles.
• 30:51
  But ultimately, I had to accept that I would never know and understand certain aspects of it or make sense of them, and never really be able to explain why. But, you know, I'm glad to say that I have reached a place in which I can sit back from my story and see it as part of my life's journey, not all of it, but also part of a much larger collective. I was lucky in a way. I found a way to therapy to feel safe, to build a strong relationship of trust, and find a voice which was respected. I spoke in therapy and I also wrote.
• 31:27
  Writing started as a private purge, a way of getting the trauma out and onto the page. Later, I chronicled my history and eventually wrote a book. This was a process of integration for myself, alongside weaving it into a semi digestible narrative. That voice, of course, has grown stronger and moved from therapy into social settings, and now through my book interviews and my work into the public domain. And I think like many survivors, I've sought to find meaning in what happened to me and to become an advocate, which is one of my key roles with Blue Knot Foundation.
• 31:59
  Speaker 1: That was amazing. Thank
• 32:01
  Speaker 2: you.
• 32:02
  Speaker 1: I don't just mean well presented or amazing as in a good job of telling a story, but it was just so touching, the pieces that you shared, not just of your own story, struggling with the process of dissociation and healing and coping, but even the vulnerable pieces of how hard it is just to get into therapy and how hard it is to stay in therapy, much less actually engage in the process.
• 32:30
  Speaker 2: Yes. And of course, you know, I do feel privileged because I was able to find a therapist who was skilled and although, you know, at sometimes in the process I had a sense that, you know, she was struggling but she was obviously always able to go to supervision and find what she needed to really hold me in that space. And I just know that so many people are unable to do that. And of course therapy is not the for everyone either. There are many, many ways to healing.
• 33:04
  But I was privileged in that I could do that and I could stay in it for the long haul and have someone who despite all my challenges and challenging her so often, was able to just hold that and be there and walk alongside me.
• 33:20
  Speaker 1: That's so beautiful. It's beautiful. And and I appreciate the inclusivity of it as well that it is a privilege when we're able to find a good therapist and have the resources to be able to continue going and all of those layers that are so hard for so many. And then also acknowledging that there are so many different aspects to healing.
• 33:46
  Speaker 2: Yeah. That's right. And we're all, you know, we're all unique. So there are as many paths to healing as there are there as there are human beings.
• 33:56
  Speaker 1: What else do we need to know, do listeners, both survivors and clinicians need to know about Blue Knot?
• 34:03
  Speaker 2: Blue Knot is a small charity in Australia. And we've really struggled to claim a space around complex trauma. Because we realise that there's such a misunderstanding about what trauma really is. And when people think of trauma, they usually think of a single incident. A flood, a fire, we've had a lot of bushfires lately.
• 34:34
  And not to minimise the impact of that. Or an accident or an assault as an adult. The equivalence with PTSD. And again, profound impacts often. But there's a real lack of understanding about the difference between that and complex trauma.
• 34:54
  And how complex trauma affects the very core sense of yourself, your identity, your ability to have relationships with yourself, which of course is the most critical relationship of all, with others and with the world. And you know, how you struggle with strong emotions and just an understanding also of differences in the levels of arousal people struggle with, the physiological responses which just make so much sense, but which is not understood and which is judged. And the behaviors that are generated by them are really often judged and responded to so punitively. So a lot of this is a lot of what we do is to really try and educate and invoke understanding in everywhere where people engage with human beings. We're not saying that everyone has experienced trauma, but we all have experienced different life experiences along the way.
• 35:57
  And they all impact the way we respond or react or are triggered or don't engage with services or do engage with services. And so it's about understanding It's a human lens that we're trying to invoke. I mean, word trauma informed has become a bit of a buzzword, and buzzwords tend to lose their meaning over time. But what we have tried to do, along with other partner organisations, is explain that being trauma informed is about putting the humanity back into services and service responses. And treating people as we all want to be treated, with respect, with human dignity.
• 36:45
  We all want to feel safe. We all want to be able to trust. But understanding that with complex trauma, many people have never felt safe. And that's such an alien experience and it can take so long. So not to take people's reactions personally, but to understand that what has happened to them along life's journey has meant that for them it is really, really hard to trust.
• 37:14
  They have been betrayed often repeatedly. They haven't had a safe space. They often haven't had any choices in their life. And they've often been repeatedly disempowered. I was really quite shocked myself in my mid forties when, you know, still in therapy.
• 37:32
  I was asked what I liked. What were my choices? And I really struggled, because I don't think I'd ever known that I was allowed to make my own choices. And I really struggled to identify what my real feelings were, because, again, they hadn't been validated or mirrored, reflected back to me. And that's a real struggle for so many people who've experienced repeated interpersonal trauma.
• 38:04
  So, you know, we have a long way to go in our society, certainly, with an understanding of this. What we have had in in Australia quite recently is is a number of royal commissions. And, you know, royal commissions can come and go, but these appear to have not only been very meaningful, but to have really started to change the conversation in this country. So we've had a child abuse royal commission, one into the aged care sector and now one into disability. As well as a number of inquiries into domestic and family violence.
• 38:42
  And what it is doing is creating more understanding and a healthier conversation around what violence and abuse and neglect at different times in people's life's journey can impact. And why some adults just struggle to get to first base. It's about understanding why some people can't get a job, can't get to the shops to buy the groceries they need, may not have the money or the capacity to manage the small wealthier payment they receive. We're very quick to judge as human beings. This is about tolerance and understanding.
• 39:33
  Speaker 1: I don't even have words. That's I love so much what you're doing and what Blue Knot is doing and the new guidelines, which we'll talk about in a minute. But that's one of the reasons I wanted to have you on the podcast because I so want people to see and know what you're doing and help support what you are doing and spread word about what you're doing. Because I think it's not just significant work that you're doing, but you're doing it so differently and so beautifully and with such compassion and attunement to the person as a person and to people as people, not just a diagnosis.
• 40:13
  Speaker 2: Yeah. I mean, we we recently I mean, a couple of times this year, we've had a few clinicians over from from Britain who have developed a framework called the Power Threaten Meaning Framework. I don't know if you've come across it. Which is a framework which offers an alternative to the diagnostic model of mental distress. And what it does is bring together a whole lot of research, which builds on the trauma informed paradigm and just looks at what we all need in our lives in terms of the ability to a narrative of what's happened to us, to help us make sense of mental distress and to depathologize the medical model and find other ways of reflecting on people's difficulties.
• 41:09
  It's really quite Yeah. It's really quite an inspiring, powerful framework. It was developed by people with lived experience, as well as clinicians under the auspice of the British Psychological Society, and it's really worth taking a look at.
• 41:25
  Speaker 1: I think that's a powerful thing, and that's another thing that survivors as a community have been asking for, is to be involved and have a voice in what's Yeah. Being done to them.
• 41:36
  Speaker 2: Yeah. Exactly.
• 41:37
  Speaker 1: In the name
• 41:37
  Speaker 2: of treatment. Yeah. Exactly. Well, absolutely. You know?
• 41:42
  I mean, it's just sort of ludicrous to think that, you know, the person who's, you know, lived the experience and is struggling with its impact doesn't have a say in what happens to them. It just makes no sense at all.
• 41:55
  Speaker 1: Right. Right. Yeah. How do you, from your perspective or Blue Knot, how do you all explain dissociation when you're educating and advocating?
• 42:06
  Speaker 2: Look, I mean, dissociation is is a very complex area, and it's one in which we're going to release a new publication in the new year. But certainly there's a lot to say that dissociation is probably much more of a factor in a whole lot of mental health diagnosis than just things that are called dissociative disorders. And certainly, for me, in my experience, I really struggle with the fact that people don't understand this is a defense mechanism that is really so ingenious that when you have a child who's experiencing the sorts of repeated traumas and horrors that no child should ever experience, that the mind brilliantly divides that trauma up into bite sized chunks and keeps them all separate so they won't overwhelm the mind and cause psychic breakdown. It actually just it's ingenious and it deserves to be celebrated rather than questioned. And so, look, I'm in the new publication in the new year, and I believe you're going to be talking to Pam Stavropoulos down the track, our head of research.
• 43:34
  And she can really talk to the research around this. But from my perspective, it's about understanding that dissociation is a normal phenomenon. And in the presence of trauma, of course, it is seen as pathological. But but I certainly see it as an incredible coping strategy and way of surviving. And for me, you know, it actually helped to protect me, to enable me to study medicine and be successful in that very contained compartmentalised way, while there was this wealth of traumatic material that was sectioned off, until really I was in a safe space where I could begin to examine it.
• 44:31
  And and it was able to be revealed over time and processed and understood.
• 44:36
  Speaker 1: A trauma team that I worked with in Israel actually phrased in, obviously, Israel in that area of the world knows trauma in their own way. But they said they would use the phrase about how it's such response to abnormal situations.
• 44:54
  Speaker 2: Exactly. Exactly. It's about normalizing it. Exactly.
• 44:59
  Speaker 1: What makes the blue knot guidelines what makes them different?
• 45:03
  Speaker 2: So in the 02/2019 guidelines, really look at the last seven years of research. And they look at practice based research and new evidence. There have been quite a few developments. Further to the discussion about dissociation in this country, there was a pivotal legal case earlier this year in which a woman called Jenny Haynes took her father to court on the basis of a number of her self states providing testimony in court. And so that was the very first time someone with dissociative identity disorder and her parts actually meant that the perpetrator received a conviction of, I think it was forty five years.
• 45:59
  So it shows that change is afoot. And to actually think that happened in a mainstream court in the state of New South Wales and Australia was really quite incredible. So that's certainly one of the things that has changed. I mean, the other thing that is you know, major thing that has changed is that the ICD 11 has announced that there will be a formal diagnosis of complex PTSD for the first time. And that makes recognition and appropriate treatment of complex trauma much more likely.
• 46:35
  And that's going to come into effect in January 2022. As I said before, there are lots of inquiries that are really changing the societal perception here of complex trauma and what it means. Just more tolerance about the long term impacts that it has. Of course, we know that it's a changing treatment landscape and one that's much needed. With studies, it's found that current treatments are ineffective for between twenty five to fifty percent of people in clinical trials.
• 47:09
  And most of those trials are for people with single incident PTSD. And that's because people with comorbidities, which often by definition of people with complex trauma, are excluded. What that does is really limit the service system in terms of the number of sessions, the type of therapies, and a focus really on relieving symptoms, rather than looking at the whole person, and a real depth of healing. And also, of course, what's changed is a much greater focus on an understanding of the body, and the importance of working with the body and physiological responses, and and needing to calm what is an overactive nervous system, before you can really start to look at processing. The whole idea of working from a CBT approach with thoughts and reflections when the prefrontal cortex is offline just isn't very logical.
• 48:20
  And of course, there's much greater understanding, as I said, about dissociation and its implications. And the people really dissociate to protect against the challenges of interpersonal contact, where previously they've been harmed. I mean, just makes so much sense. But many therapists are just not trained to detect it, and to understand it, and often don't acknowledge it in everyday presentations, let alone in complex trauma and structural dissociation. And I suppose the other major change also is and I don't know if this is happening in The States.
• 49:03
  I mean, it came originally from The States as the whole sort of trauma informed change process. And certainly, we're seeing that trauma informed care is being taken up in this country, still sporadically. But governments are also starting to introduce it through mental health units and EDs. It was a big part of the report for the Royal Commission into Institutional Responses to Child Sexual Abuse. So there is much greater trauma awareness.
• 49:40
  Still not so much complex trauma awareness, but we are seeing shifts. And I suppose we just we wanted to reflect those shifts, just really re examine the new research into neuroscience and the neurobiology of attachment, into working with the right brain, sensory motor approaches, new treatments. I mean, there's just so much. And we just felt the time was the time was here to to do that.
• 50:13
  Speaker 1: When I read through the document, I I read through it to to see if I wanted to endorse it or not. And as I read through it, I was just in awe of what a completely different document it felt like than the old guidelines that are used so often because it's what it's still there. So to have the honor endorsing that and to be able to share your story and what Blue Knot is doing and these new guidelines is just been such a powerful experience to be a part of. And I'm so grateful because we have, as a community, asked and asked and asked for this, and you all put this into a document and just handled handed it out so beautifully. I'm just amazed.
• 51:13
  Speaker 2: Look, you know, a lot of credit has to go to to Pam who, you know, has done the you know, she worked for eighteen months on the on the research base of this. And she has an incredible ability to to filter and distill and to articulate. And it's obviously fantastic for me to be able to work with her and to form them into into the guidelines that you've read. But I I really appreciate your time. And thank you for your feedback.
• 51:49
  It's very generous. And, you know, and and for doing what you're doing. I mean, it's amazing. So very much appreciated.
• 51:57
  Speaker 1: I I absolutely mean it authentically. We started this year at the ISSTD conference, began an online counter conference with the survivor community, not against the ISSTD. I want to be very clear about that. Not that kind of counter, but at the same time, a simultaneous conference by survivors for survivors on the same topics.
• 52:26
  Speaker 2: Yeah. Fantastic.
• 52:27
  Speaker 1: And it was so amazing. But as part of that conference, I did a keynote that was a history of DID, so to speak, a sort of a timeline. And at the end was this section of I have did this survey and got almost 10,000 responses and the things that people were concerned about and the things people wanted to ask for change and what they wanted things to do better. Almost every single piece of that is in these new guidelines that
• 53:04
  Speaker 2: Oh, wow.
• 53:04
  Speaker 1: Blue Knot is doing. Wow. So I I absolutely that is not at all false praise. I absolutely from my heart, I'm so grateful for the work that Blue Knot is doing and that you and Pam have contributed and that so many have worked for. And I think I I don't wanna speak for Jenny Haynes at all.
• 53:28
  I I have talked to her. I've invited her to be on the podcast. Her team has not permitted it yet because of the ongoing legal issues. Yeah. But without it all without at all minimizing her courage to do what she has done, what they have done, I think it is also evidence that she was successful is evidence of these kinds of conversations and these kinds of changes and these kinds of shifts that you're talking about because it wouldn't have been possible without that.
• 53:59
  Speaker 2: Absolutely. I think they all go hand in hand. And I think there is a lot of change. And hopefully with this wave, it'll make a real difference to practice and ultimately, of course, to people's healing journeys and opportunities to actually find some of the life that everyone deserves.
• 54:27
  Speaker 1: Yes. Yes. Thank you so much. We will be talking to Pam about the research and the guidelines more specifically. Is there anything else you wanted to share yourself?
• 54:38
  Speaker 2: Just just, you know, congratulations on what you're doing and thank you again for your time. Really, really appreciate it.
• 54:45
  Speaker 1: Oh, that's so kind. I'm so grateful. Thank you for being on and talking with us today.
• 54:51
  Speaker 2: Pleasure. Well, what a what a commitment, but it's it's it's so well respected. And, you know, I mean, when I look through who you've had on on here, it's very impressive.
• 55:04
  Speaker 1: I've learned so much, and I had no idea it was gonna turn into this. But I am grateful it's been helpful to people.
• 55:10
  Speaker 2: Such a substantial contribution. Yeah.
• 55:12
  Speaker 1: Well, this is my very favorite part is are these connections that we're starting to make and younger people learning the history of these famous people and why they're famous and what they've contributed for or just normal conversations of what it's like to hear another survivor story in a healthy, healthy, healthy way and not just trauma dumping or the drama, you know, in a healthy expression.
• 55:40
  Speaker 2: Yeah. Not healthy. Yeah. Yeah. Not not helpful.
• 55:44
  Yeah. Absolutely. Yeah.
• 55:46
  Speaker 1: It's it's an amazing thing, and I think it adds to our resilience when we connect to each other.
• 55:52
  Speaker 2: Yeah. Of course. Absolutely. Absolutely. And, you know, just that need to have hope because for so long, hope doesn't exist.
• 56:01
  And and to to know that there is possibility. Very important.
• 56:06
  Speaker 1: Thank you so much. I very much enjoyed speaking with you today.
• 56:10
  Speaker 2: And likewise, Emma. Thanks. Thanks so much.
• 56:14
  Speaker 1: You can find out more about Australia's Blue Knot Foundation at www.bluenaut.org.au. A direct link to the 20 19 practice guidelines will be included on the blog. We are very excited to be sharing them. Thank you for joining us with System Speak, a podcast about dissociative identity disorder. You can listen to the podcast on Spotify, Google Play, and iTunes, or follow along on our website, www.systemspeak.org.
• 57:06
  Thanks for listening.