Latest / System Speak: Complex Trauma and Dissociation / Guest: Fran Waters

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Guest: Fran Waters · System Speak: Complex Trauma and Dissociation

• 0:08
  Speaker 1: Over:
• 0:11
  Speaker 2: Welcome to the System Speak Podcast, a podcast about Dissociative Identity Disorder. If you are new to the podcast, we recommend starting at the beginning episodes and listen in order to hear our story and what we have learned through this endeavor. Current episodes may be more applicable to long time listeners and are likely to contain more advanced topics, emotional or other triggering content, and or reference earlier episodes that provide more context to what we are currently learning and experiencing. As always, please care for yourself during and after listening to the podcast. Thank you.
• 1:04
  Our guest today is Fran Watters, an internationally recognized trainer and consultant in the field of childhood trauma, abuse, and dissociation. As an invited presenter, she has conducted extensive training programs nationally and internationally, ranging from a day to five days in Europe, Africa, Australia, South America, and North America on a variety of related topics. She is the author of Healing the Diagnosing and Treating Youth with Dissociation and past president of the International Society for the Study of Dissociation. She is a fellow of the ISSTD and received ISSTD's Presidential Award and Cornelia Wilbert Award, the Media Award from American Professional Society on Abuse of Children for her three part DVD on Trauma and Dissociation of Children, and the William Friedrich Memorial Child Sexual Abuse Research, Assessment, and or Treatment Award from Institute on Violence, Abuse, and Trauma. She maintains a private practice in Minnesota.
• 2:13
  Welcome, Fram Waters.
• 2:16
  Speaker 1: Very excited to be able to do this and, I can talk more about that when we get started.
• 2:23
  Speaker 2: I'm very excited to have you actually and I think the work that you're doing is really important and I am very honored that you are here to share that with so many people so that they can know more about what you're doing. Why don't we just start a little bit with an introduction? Can you wanna tell us a little bit about yourself?
• 2:42
  Speaker 1: Yes. My name is Fran Waters, and I am a psychotherapist with a degree in social work. And I practice in a rural community of Marquette, Michigan, up in the Upper Peninsula on Lake Superior. So I have been specializing in child abuse ever since my undergraduate degree. So I've been at it for a good forty five plus years and began to back in 1980 recognize at that point after I got my degree and my master's in social work, sexual abuse.
• 3:27
  That was a time when there was a lot of information on that. And then interestingly enough, I went to a in service at the local mental health center in mid-80s that was by Doctor. Lou Kunhoff. She was a psychiatrist at our clinic. And she, I think, had gone to one of the early international conferences on dissociation.
• 4:00
  At that time, I think it was called the International Society for the Study of Multiple Personalities and Dissociative Disorders. And I was curious about this in service since I was specializing in trauma and sexual abuse of children. I was getting a lot of referrals from around the communities and through the justice system and the CPS. So I was having a lot of these cases. So I thought, well, it'd be worthwhile to go and hear what she had to say.
• 4:35
  And she was talking about dissociative identity disorder. And I thought, well, I've maybe seen one in my lifetime. I really thought it was very rare. And so interesting after that, it was maybe a few months later, this eight year old girl that I've been treating for a year and a half, knew my office, knew me, you know, in the clinic multiple times with her adopted parents, a horrible, horrible childhood trauma history. So she came into my office and she's looking around at my bookshelves and things on my walls and she's very curious and saying, Oh, what's that?
• 5:26
  Oh, look at that. Oh, that's cool. That's neat. And I'm looking at her thinking, Oh my gosh, she doesn't know. She's been in my office for, I don't know, 50 times probably in a year and a half.
• 5:43
  And what the psychiatrist had said at this little very small in service at the clinic, there must have been maybe, I don't know, 10 of us that attended, it just clicked, this child may have dissociation because she has amnesia. And so that was the beginning of my exploring what was going on with this child and the field of dissociation in children. And then I began to attend the conferences at the International Society for the Study of Trauma and Dissociation, which is what it is called now. And joined up with a few other child therapists at that time, Joyce Silberg and Madge Bray. Madge Bray was in England and running a residential program and really treating dissociative kids at the time.
• 6:39
  She's not doing that currently. And then Joyce Oberg, who's well known, has written a book as well. And so we all collaborated. And then from that point on, I've been doing training and then serving in leadership positions at the International Society for the Study of Trauma and Dissociation. And so that was the beginning.
• 7:03
  And that was toward the about '86 or '87. And then I recognized so many children at the clinic with horrible backgrounds that had dissociation that I probably would not known what to do about it if I hadn't gotten that in service. And I should mention that when I first got this child, when I first recognized this child that had been in my office for a year and a half previously, I looked around the country and I was able to find somebody close to Michigan in Westcott, and Doctor. Roger McKinley and his associate, Ann Bailey, who had been treating adult to social clients, and they actually mentored me in my early career. And then I began to more and more collaborate with the other professionals that I've mentioned.
• 7:56
  So that was how I kind of fortuitously got involved in the field. By just simply going to this workshop, this in service, and then recognizing shortly after that, there was a child that had significant dissociation and indeed she did have DID.
• 8:15
  Speaker 2: There are so many things I love about your story, but two things specifically. One, you're such an example of how simple it is to just go get training and be informed and start helping and two, that because you're working with children and educating people about working with children and advocating for children. There are so many survivors out there that could have had help much younger and much earlier in their lives and it would have saved them from so many struggles and experiences they went through later because they didn't yet understand what's going on. I just really think what you're doing is so very powerful.
• 9:02
  Speaker 1: Well, I totally agree with you. It is so much easier to treat children than who haven't developed ongoing reliance on dissociative mechanisms and states that they have developed as they go through their developmental stages, which actually becomes very disrupted because of their trauma and dissociation. It is treatable. It is treatable and it's a passion of mine because I see so many children and adolescents that have come to me that have not been their dissociation recognized, even not their trauma recognized. And they've had a lot of failed treatment episodes, a lot of different diagnoses, a lot of different medications.
• 10:00
  They're feeling very despondent. They feel so inadequate. Parents have many of them given up on them. They've had disruptive placements. And it's a very demoralizing process for them when it really is not their fault.
• 10:20
  It is the fault of the system, of the therapeutic system, of recognizing what dissociation is and getting understanding and more information about that. So, I can't tell you how many hundreds and hundreds and hundreds of children I've treated that have come to me and felt this sense of hope again, that had been diagnosed with no attention deficit hyperactivity because they were in their own world, they were zoning out, had been diagnosed with bipolar or now it's disruptive, dysregulated mood disorder. They've been diagnosed because of their extreme mood switches that are really related to different self states that hold a lot of the trauma and emotions, that hold the behaviors and memories. And so many of these kids have been so misdiagnosed and when they do report voices in their head, the professionals are not able to distinguish between psychotic or schizophrenia and a dissociative state and will then diagnose these kids with schizophrenia or psychosis and put them on medication. And the origin of their disruptive behavior, their mood changes is really not addressed.
• 12:01
  So, I am, you know, I've written my book, Healing the Diagnosis and Treatment of Youth with Dissociation in the hopes that I would awaken the community of mental health professionals. And it seems to be working. You know, I'm getting a lot of calls from the mental health professionals and wanting collaboration. And I've actually gotten a large number of parents from around the country that have called me wanting to come in for some intensive therapy with her kids because it's finally, is all making sense to them about this confusing presentation that these kids will have that do have dissociation.
• 12:48
  Speaker 2: I wanna go back to something you said earlier about the reliance on dissociation. That really phrases it in a way I hadn't thought about before, and I think it's important. So if you could explain a little bit about that a little more, and then also your perspective on how you explain dissociation to parents or to children as well.
• 13:15
  Speaker 1: Okay. Well, in most extreme cases, parts of the South that contain these horrific injuries that are happening to the child. And it's not only interpersonal violence, it can also be, you know, very painful medical, intrusive things that they incur, painful medical hospitalizations, injuries. It can be from the war, exposure to domestic violence, when a child is simply overwhelmed. And then what happens is that they lose a part of their history, a part of who they are, because it's all put into what I call dissociative boxes, where they have amnesia to what is transpire, and then it can affect their development.
• 14:26
  You know, I look at the timing of when children were traumatized, and look at what happened during that process that normally would help them achieve a certain developmental milestone. And so, they really are deprived of the feeling of safety to be challenged to go through certain developmental stages and to develop the health of the sense of self. So, they then form a pattern of relying on dissociation when they're under a a certain amount of stress. And, you know, feelings of anxiety get associated with that original state of anxiety and fear, even though it may not be at the degree of that feeling of terror, but they may feel that threat and then they begin to rely on dissociation from that point on to cope with stress, to cope with a sense of feeling overwhelmed a bit, even when the environment is not threatening in the current environment from the past environment. But they associate a threat If, for example, they're at school and a teacher is disgruntled because the classroom is out of control and a teacher raises his or her voice and sounds very loud and stern, that can trigger the child then to dissociate because of the early experience of being screamed bad and told, sworn out and said bad things about them, that they will then go to that reliance on dissociation.
• 16:20
  And one of the things that I did not realize when I began to work with these children is that the younger they are, the more likely they are to dissociate because they don't have the defenses to manage the fears, the anxieties. More vulnerable and Ruth Perry has talked about that in his work. And that was a very important thing for me to remember because I just thought, well, when they get to be, you know, older, my first case was around age elbows and, you know, even at the mental health center, I was recognizing younger children. I am now in my private practice and have been for, I think it's been about twenty seven years in my private practice. So I've been around quite a while, but I just want to bring up a case that might illustrate my point about how easy it is to misinterpret children's behavior.
• 17:28
  And you might think that they are exhibiting regressed behavior when they act much younger. I remember doing the evaluation for the court of a little girl that was three. She had then sexually abused a year and a half by her biological father, and then mother's boyfriend had sexually abused her at three and I became involved with her at three. And I wrote this elaborate court report explaining about her trauma history. She was in a foster home and had been in there for about eight months.
• 18:01
  And so she was in the psychotherapy room with me and she was crawling around, that's why I work in the health center. She was crawling around and she was using a lot of beta talk And I thought, oh, well, that's kind of interesting. She was a very well coordinated girl. She could walk well. She was articulate.
• 18:23
  She knew the names of things, but she did not know the names of these toys that she'd seen and played with multiple times in the play therapy room. And all of a sudden in her baby Tuck, she's, you know, crawling out of all fours and she raises her arms and says, Potty, potty. And so I thought, okay, she just wanted me to carry her to the bathroom. And she's a small little girl, so I lifted her up and put her in my arms and we went to the waiting room and I stopped at the lounge where the foster mother was sitting. And I said, Oh, we're on our way to the bathroom.
• 19:00
  And she looked at her foster mother in total fear, total fear. She grabbed around my neck and turned away from her foster mother. Did not know her. She had been with that home, like I said, about eight months. She'd come to line, I think this was in February or so maybe it wasn't quite a month, but it was quite a long time.
• 19:25
  And I recognized at that point, this was not the three year old. This was a little year and a half old child, probably the toddler that was separated at the time of the sexual abuse by her biological father. And I went back to my court report, and in it I described regressed behavior. So, here I am, I've been working with Dissociative Kids for a few years and I thought she had regressed behavior. That's the way we used to look at it.
• 20:07
  When in essence, it was actually a dissociative part. So I thought that was something that is important, I think, for us clinicians to recognize with trauma history, we really need to evaluate more about dissociation and what the child's experiencing internally, what we're seeing, and know how to evaluate just the child's behavior in the right context so the child can get the proper treatment then, because otherwise the child will continue to exhibit these symptoms and will not improve. So, that's one of the many stories that I have.
• 20:57
  Speaker 2: That's an amazing example. I just I'm thinking I'm just thinking of how often that must happen and people aren't even aware of it.
• 21:09
  Speaker 1: It's very, very, very common, unfortunately, that people are not aware of it. And I wrote a case study in my book about a beautiful example of what a child told me about her inside voice, which is one of the characteristics of dissociation is auditory visual hallucinations that are often misconstrued as psychosis. This was an interesting case where I had been treating her for about a year and a half for PTSD, and she had been very badly abused by her step brother, whom she spent time with when visiting her father during the holidays and summer vacations, physically and emotionally abused, and very punitive behaviors toward her. And she was playing with her older male cousins, and it triggered a memory of what happened to her with her stepbrother. And suddenly, she became extremely oppositional.
• 22:26
  She would cry for hours on end, refusing to get dressed for school. She had this big conflict of wanting to wear pants to school, she was entering kindergarten, or wanting to wear a dress. She was sleepwalking, she was having nightmares. She would have this extreme mood and behavior switches. One minute she wanted or like something and the next minute she didn't.
• 22:54
  So there was this terrible change in her. And so when she came in, she told me that she had heard a voice. And I asked her to tell me what the voice was like. And she said, It's Charlie. And that was the name of the stepbrother.
• 23:18
  And I'm changing the names here, of course, but Charlie was the name. And I said, well, I had a bunch of puppets. And I said, well, you know, why don't you pick out a puppet that would represent Charlie and I'll pick out a puppet that I would hold on to. And then she picked out the puppet that was the alien. And what was so interesting is she said, it's all Charlie's fault.
• 23:45
  And I was asking about her behavior and she said it's all Charlie's fault and she was pounding the alien puppets head with her free hand. And I said, well, what do you mean it's all his fault? And she said, that means Charlie makes me do bad things. And I asked her, you know, what kind of bad things? And she said, I can't remember.
• 24:11
  And I repeated what she said. You know, he makes you do bad things, but you just can't remember what's going on. And she said, Yes. And I said, Well, what happens next? She said, I don't know, but one thing is he gets louder, louder and louder and then he shoves out.
• 24:34
  And she's stretching her head up. She's kind of checking that how he could shove out of her head. And I said, what happens next? And she says, he gets louder and louder and then my mind walks away and he's in my mind. And then I said, Your mind walks away, he's in your mind?
• 24:56
  And she says, that the nice? But what happens next? And she said, I don't know. So I thought that was the most eloquent expression from a preschooler that I'd ever heard of dissociation. That was really something.
• 25:13
  And yeah, I recorded it. I was fortunate that I had recorded the session. Sometimes I will record some of those sessions. And then we were able to work with the truckerly boys. Wickley, within that session, I said, you know, I wonder if he's picking some really bad things for you.
• 25:37
  And she checked inside and she had a little puppet that was a little girl puppet that was talking with the mouth moving up to her head, talking to the Charlie boys. She said, yes, he had taken bad stuff. And we asked her, well, do you think we could thank him for taking the bad stuff? And she did. And within thirty minutes, this was a thirty minute session, he thanked her for appreciating him and thanked me for appreciating him for what he took.
• 26:10
  And he was willing to work with her for not doing bad stuff. And she was going to help him learn how to express his anger in an okay way. And that was the beginning of the resolving the misbehaviors that she was exhibiting. It was quite a simple intervention in many ways, but it was very profound. The amnesia for her, she's taking things, taking things that she didn't remember taking and doing things that she didn't remember doing.
• 26:48
  All of that was over with. He was now more working in partnership, actually then thereafter had integrated. So that was sort of an example of the simplicity in many ways of doing this work. Now, on this case, wasn't having any more business with the father until he set up circumstances where he actually separated from wife, that wasn't what he had decided to do. But she maintained, she was maintained in a safe environment, which is a really critical factor.
• 27:31
  So there was a tremendous felt relief that she had because there was a way to help this part of her and there was no more of this internal conflict going on. That's amazing. Well, it is amazing, but in many ways, Emma, it's also simple. And if you understand from a perspective of collaboration and cooperation in a good therapy setting or in a family setting, you resolve these conflicts by helping one another out. If you can conceptualize it as that, and that use principles of respecting all parts of the self like you would respect family members, respect everybody in a group therapy setting, work out your conflicts in a healthy way, contract for safe ways of expressing them.
• 28:31
  That makes an amazing difference with these children because if a child is preoccupied with all these abuses and these different states with different attitudes, feelings and wishes, it's very difficult for a child to have relationships with others. And I'll just say a little bit about that because there's a lot about reactive attachment disorder, attachment disturbances. And like a lot of the kids that I see don't fit the criteria for a particular attachment diagnosis. There's the disinhibited diagnosis, there's the reactive attachment diagnosis. Disinhibited, the child will go to just about anybody and the reactive attachment disorder is a secure attachment and doesn't want to separate from the parent.
• 29:36
  But these kids with association can switch back and forth rapidly from one attachment preference to another, from being afraid of the parent, to angry at the parent, to not wanting to separate from the parent. And that actually is, when you look at these traumatized, because there are different states that have different qualities of attachment or some may not even know who the people are that are living with them in the environment. So, it's a very complex situation, but if you understand about the child's vulnerability and overwhelming fear of losing oneself, then you can begin to understand how the child has to compartmentalize those experiences into different emotions, behaviors, and sometimes into different parts of the self.
• 30:41
  Speaker 2: So it's not just that, it's more simple because not as much time has passed, but literally sorting out these developmental tasks and process so that they can have healing while still developing so it doesn't get like exponentially complicated as they get older.
• 31:04
  Speaker 1: Yes, that's right. It does require specialized treatment. Positive behavioral therapy is fine to a certain extent, but it's not effective with social determinants, you incorporate the parts of the therapy. And also, when you look at cognitive behavior therapy, the child's brain is actually affected by the trauma and we know that the higher parts of the brain are not functioning well and yet if we expect children to talk about the trauma or explain it and be able to use words and be able to synthesize it or give a chronology of what's going on. A child simply doesn't have the brain capacity to be able to do that.
• 32:02
  And a lot of the new research is looking at the body holding the trauma and the body keeps the score. That's a Bana Cook's book. And we recognize that we really need to do a bottom up and top down therapy with these kids. We need to get their bodies involved in the healing process and help them be able to express what's happening somatically because the trauma is actually laid down somatically. The sights, the smells, the touch, and the higher parts of the brain are really deactivated at the time of trauma.
• 32:45
  It's just not able to function. So we really have to learn how to reach the child through a different modality that incorporates bodywork and play therapy and EMDR. And there's a new one that I've been certified in, it's called Havening, and that's been very effective with children and adults as well. So, we always have to look at how the child has processed the therapy or the trauma and what is going on internally with the child, because that will affect the child's responses externally to the environment. And we have to know what is going on in the environment that would trigger the child.
• 33:42
  We are all investigators and I like children to see themselves as curious investigators. Together we work on sorting out what was the trigger, for example, that caused them to have a certain behavior, what was going on internally with them. I remember, Emma, that you did ask me, how do I explain dissociation to children and parents? And I would be glad to address that at this time, if you'd like. Oh, yes, please.
• 34:16
  What I say to kids is pretty much what I've already said, and that is that they had no way of escaping. They were very creative to be able to find a way to escape and to box off different feelings, memories, and behaviors, and things that were just too much for them to take. And that that really showed a lot of strength to be able to do that. And I let them know that it's that strength and that creativity that they can use to help them heal all those things that they put into the dissociative boxes, for example. I also will say it's like when the house gets overloaded with all the appliances running at the same time and there's an electric shortage and the lights go out, I say, well, that's like what happens to us when we get overloaded, our lights go out and we freeze and we don't remember things.
• 35:22
  So it's something that we humans do and animals do that too. And even our houses don't do that, when the surge battery system is not working, it gets overloaded. So I do explain that to them. And I also use that analogy with parents and I tell the parents that they play a major role in the healing of their children, That they need to provide a very safe environment for them, and safe means psychologically as well as physically safe, and that they become the co regulators of the children. And I say, what I mean by that is how you handle your emotions will help the children regulate their emotions.
• 36:20
  If you present yourself in a very calm way and that will help your child come down when your child is escalating. And that I want to work with you as partners and providing strategies that you can do at home and with younger children, if possible, and the parents are supportive and able to be involved in the therapy sessions, I do invite them to be a part of the therapy sessions if children aren't comfortable with that. Otherwise, I'll provide a lot of collateral contact with them and describing and getting information from them about what's happening with their children at home and what they can do with their child that would help them decrease their dissociation and help them become more integrated.
• 37:15
  Speaker 2: What would you say would be some of those things that they could do with children at home for parents who have children that dissociate?
• 37:23
  Speaker 1: I would say to talk to them in a calm way. So let them know that you care about them, that you understand that something is going on with them right now and you would like all parts of them to listen and look and see where they're at. They're in a safe environment, hopefully. I've developed what we call the six Ls. And when I tell parents and children about the six Ls, I want all parts of the South to look through the child's eyes, to listen through the child's ears, to learn according to the mind they had with the child's mind and to love themselves and the good people in their lives and to live and laugh.
• 38:21
  So as I'm saying this, I will be pointing to the eyes and the ears and the head and the heart and then live and laugh. I'll just extend my arms and hands and just laugh and say, live and laugh and enjoy the things that you enjoy doing. So that is a very important integrative technique. And so the parents can remind the children of the seven L's, six L's, excuse me. And then I teach the parents and the children some other stabilization techniques, deep breathing, tapping their shoulders, to feel their body and their knees, giving themselves a butterfly hug where they cross their arms and tap their shoulders.
• 39:19
  Drawing a picture of what's disturbing them, finding a safe place in their house to calm down with music, art supplies, weighted blankets, finding physical activities that they can do to express their anger in a safe way. Those are some of the things I do. Music can be very helpful if they have a particular type of music they like to listen to that can help them either distract them or to calm them down. So, are a few of the techniques. Think what is important to make it effective is that we make sure that we engage the child's internal life in the discussion of what just happened and what affected the change in the child's behavior or mood.
• 40:21
  And the child and the parents work with that part and reassure that part of safety and love, that the parents love all of the child, all parts of the child, even the angry parts. And that they're there to understand and to see all parts of the child. It's really important.
• 40:46
  Speaker 2: Where could clinicians find your book? And what else do they need to know about how to get more training to help with children?
• 40:56
  Speaker 1: Well, there my book is is on Amazon and it's available. The International Society for the Study of Trauma Dissociation, that's having a workshop shortly. I and Joy Silbergh are doing a couple of workshops together. One is I'm working with resistant children and another one is on comorbidity. And then I do have a website and I've got some training coming up in the fall in Canada.
• 41:30
  And it looks like there's another one, one end of Canada from the other, I'll be doing some training. So I do have a website, it's waterscounselingandtraining.com. I don't always update my website as well as I should, but it is, there are some things there about my training. So yeah, I think that the ISSTD does have some things on there for parents and teachers. And I'm in charge of the ISSTD psychotherapy training program.
• 42:16
  And we are revising our program, but we will be starting a comprehensive course that we have taught many years, but we'll be redesigning it and starting it in the fall in October. And there'll be information about that at ISSCD's website. So, I know that there many societies that are really promoting the training on dissociation. MDRIA is, which I'm very glad about. So it's out there, but I think my website and ISSTD's website are good places to look at for resources.
• 43:17
  Speaker 2: Is there anything else that you wanted to share about trauma and dissociation with children?
• 43:23
  Speaker 1: I would like to share an important research that was done that I think highlights more of the prevalence of dissociation in children than we realize is existing. And this was a research done by Cassandra Kissel. She is with Northwestern University and she was looking at some clinically significant rates of dissociation in the child welfare system in Chicago, and all of Illinois rather, the Illinois child welfare system. And she looked at like almost 21,000 children and used a variety of measurements And found that the children in residential placement had an average of seven point nine percentile of clinically significant dissociation. And what was interesting, the kids from four to six years old had thirteen point six percent rate of dissociation.
• 44:43
  But what was curious that we have found is that when these kids came into the Illinois Child Labour System, the workers were given the information to rate these kids and they rated them very low for dissociation compared to those in the residential placements. So there's really a lack of understanding about what dissociation looks like, how to inquire about it among the workers that are actually dealing totally with abused kids. And that is a big concern of mine. I was the executive producer of the International Society for the Study of Trauma Dissociation's three part DVD set that was geared at protective service workers and forensic evaluators and lawyers, and had convened national figures to come and speak as part of this DVD training. So we had people from the National Child Advocacy Center that does training for CPS workers.
• 46:11
  We had prominent lawyers in the field that specialize in legal matters and child abuse, and then a number of us professionals. And that DVD set is available at ISSTD store on the website. So I think that there are people that are having direct contact with children and are not evaluating the children from the lens of trauma and dissociation and not knowing that their behavior could be a sign of dissociation. A lot of these kids have disrupted behaviors and they're looked at as oppositional defiant disorder or conduct disorder. And they'll deny that they did these certain things.
• 47:08
  Just like the kids I've described today, the little girl that did not know she did these things because Charlie took over had a lot of denial of her behavior. And so these kids are looked at as liars, looked at as being, you know, oppositional when they really don't know. They don't really know that they have done these things. They have significant amnesia. And, you know, that misunderstanding of what trauma does and the not exploring the possibility of amnesia and dissociation really hurts a child because a child then is totally misunderstood.
• 47:56
  And it just increases a child's poor sense of self. So, I really encourage therapists and those who have contact with children who've been abused to please get training. Just thought I'd mention one other thing, Emma. I developed a new checklist called CIT DY. It is on my website.
• 48:31
  It stands for a checklist on checklist of indicators of trauma and dissociation in youth. And it's a comprehensive checklist that guides the assessment process. It has the things in here that I've just talked about. For example, it has in there how many treatment episodes has the child received? It is a parent or therapist checklist.
• 49:03
  How many treatment episodes has the child received? How many placements has the child been in residential, juvenile justice, family, familial placements group homes, and at what ages? How many diagnosis has a child received and what were they? And what were the medications? If they were on medications, what were they and at what ages?
• 49:32
  And then along with that, I have a checklist of a comprehensive developmentally sensitive checklist on trauma beginning pre birth. Was it the mother using alcohol during that time? Was the mother having mental illness and depression? So I'm really looking at pre birth trauma all the way up to 18 years old, this checklist. And then I have a rating system for dissociative symptoms.
• 50:11
  So I'm in the process of getting a formal research program set up so I can collect data. And I'm starting to collect data from the cases that I've worked on colleagues that have consulted with me are sending me cases to begin to look at that information and correlate it. But what I've seen is these kids have had failed treatment episodes, have had multiple disrupted placements. They've been in and out of their
• 51:02
  placements. Biological homes multiple times, in and out of relatives homes multiple times. In adoptive homes that were disrupted and were on many medications, had many different diagnoses, were in the hospital multiple times and in the end they had dissociation. And the parents are really rating these kids with significant dissociation that have that kind of profile. So I'm really excited to get a research project going on this and I'm exploring possibilities currently. And I'm hopeful that this comprehensive checklist will help connect the dots on what oftentimes is missed with kids and that is they're rotating in and out of treatment placements, hospitalizations are rotating from one home to the other, and they have a significant trauma history and dissociation.
• 52:05
  Speaker 2: I really know so many survivors who have profiles like that and who were in and out of so many placements both clinically and for foster care or other placements and I just think the work that you're doing is so, so important. Thank you for talking to us.
• 52:26
  Speaker 1: Thank you very much, Emma. It was a real pleasure. And I'm just hopeful that other people can learn and understand about these children and really help them because they feel so relieved to be understood. And parents are so relieved to understand their children that there is help and these children do get better and they can have very healthy relationships with their parents and family members and do well in school.
• 52:57
  Speaker 2: Thank you so much.
• 52:59
  Speaker 1: You're welcome, Emma. Thank you.
• 53:18
  Speaker 2: Thank you for listening. Your support of the podcast, the workbooks, and the community means so much to us as we try to create something together that's never been done before, not like this. Connection brings healing, and you can join us on the community at www.systemsbeat.com. We'll see you there.