When Dissociating Isn’t Enough
A wise and more experienced colleague said to me once, “You can’t expect someone to just stop dissociating and do something else more beneficial for their wellbeing when they don’t feel safe enough to stop dissociating. They need to find safety first within that dissociated state to come out of it.” Essentially, somebody who relies on soothing and safety within a dissociated ego state has nowhere else to go-inside the mind/body or outside that is adequately safe or soothing enough to regulate the nervous system.
Safety First
A wise and more experienced colleague said to me once, “You can’t expect someone to just stop dissociating and do something else more beneficial for their wellbeing when they don’t feel safe enough to stop dissociating. They need to find safety first within that dissociated state to come out of it.” Essentially, somebody who relies on soothing and safety within a dissociated ego state has nowhere else to go-inside the mind/body or outside that is adequately safe or soothing enough to regulate the nervous system. The original threat of danger may have passed years ago, yet the motivation to continue dissociating can remain undeniably strong with a widening set of threat triggers over time. This unfortunate situation is the catch-22 many traumatized people face.
High Stakes
One of my newer clients, Loida, is repeatedly caught in this conundrum during our outpatient sessions. She is barely hovering inside the appropriateness of an outpatient level of care and is just a suicidal plan or pill overdose away from her sixth stint in residential treatment in her young adult life. Loida’s parents have vowed to kick her out of the family home if she overdoses one more time, so the stakes are high for her newest outpatient treatment efforts (this time with me).
“DBT therapists have told me to take a cold shower, or hold ice cubes when I begin to dissociate. That’s awful, and my pain feels invalidated. My little girl inside needs attention and comfort. Late at night when I’m alone in my room I cry for hours, and I feel so alone and desperate. I don’t even know why I feel this way!”
Loida hadn’t allowed herself to remember yet about any kind of abuse. I tried seeing whether she had a collaborative relationship with her little girl way of being, “Can you go inside now and see if you sense her, maybe look into her eyes?”
“I hate her and she hates me. And I want to kill her and she wants to kill me. And there’s no relief and I get confused and I dunno and I dunno are you safe? Are you gonna be mean? Are you gonna are you gonna are you gonna leave me too like the five other therapists have? ….” Loida’s speech tone began to trail off as the other way of being Loida became evident. I knew then where our work had to start.
Could I Even Handle This?
This is an excerpt from my first session with Loida as she was enacting for me her trauma story which she didn’t even know about yet in a narrative fashion, just being able to recount spontaneously in a very regressed, nearly collapsed child ego state. Marshalling my nearly quarter century of clinical experience, I wondered to myself whether I could even handle her presentation after just 15 minutes into the intake session. My efforts at helping her to ground in her five senses were met with prolonged blank stares and uncontrollable crying jags. I was in the presence of a severely traumatized and dissociated individual who could find no safety in her present dissociated state.
Starting in the second session, her child ego state began usurping session time with more unstable emotionality, a paucity of speech that was almost inaudible, balling up on my blue pleather couch clutching throw pillows to cover her face.
“I’m here. I’m listening, and I sense your pain. I’m Christine, your helper. Can I ask adult Loida to talk to me please?”
Crying, lots of loud crying came in response to my request. Then the words with an outstretched arm from beneath the pillow fort, “I need a hug. I need a hug. I need a hug. I need a hug. I need a hug….”
A Rocky Road
Here was my opportunity to help her, not by hugging her but by using my voice presence to meet her in her desperate and dissociated way of being herself in that moment. I was still unsure whether her presentation was descriptive of Dissociative Identity Disorder (DID) or Other Specified Dissociative Disorder (OSDD), but I did know one thing for certain. If I gave into becoming her substitute caretaker by giving her a hug, this kindness would not be therapeutic. I would be colluding with her dissociated state that has avoided learning how to trust the adult version of herself inside for soothing and comfort. But there was another complication. The Loida who engages with adult daily life had a personality adaptation that was highly unstable too, Borderline Personality Disorder (BPD).
How does a therapist stay empathic to a relationally traumatized client like Loida and still deliver the standard of care ethically? Understandably, Loida needs a felt sense of caring and safety with me. She certainly does not feel that within herself.
It’s been a rocky road experience for both of us, Loida and me. Carefully negotiating the therapeutic relationship within the treatment frame has kept her out of a higher level of care (residential) so far, and is also what she struggles so mightily with session after session. Heels dug in, Loida’s little girl ego state desperately wants caretaking in the form of hugs, assisting her out of my office while she’s mostly collapsed into a dissociative state. She relies heavily on me and hates me simultaneously for seeing what she needs and not giving it to her in the way she demands it. I am staying the course to help her tolerate her wildly uncomfortable feelings while living in an adult body that must play by the rules of adult life. My gut tugs at me from time to time, “But am I being mean when my clinical judgment is to refrain from touching her in any way?”
“I promise I won’t see you as a man who’s scary if you give me hugs at the end of sessions. My other therapist gave me hugs as part of a reward system. That was mean, but it’s better than nothing at all!”
“I’m committed to helping you find safety and soothing in whatever way you experience yourself….without my hugs, Loida. I’ll help you find safety within yourself…as long as it takes. We’ll do this together, me and you.”
The Right Approach
It takes a specialized treatment approach to serve clients as traumatized as Loida is, and it can be tedious for both in the treatment dyad. The standard of care for highly traumatized clients means much more than simply a “trauma informed approach.” If you would like more information about this topic and how to find a therapist trained to help with complex trauma and dissociation, visit ISST-D.org. The International Society for the Study of Trauma and Dissociation (ISST-D) has excellent resources for the public to understand complex trauma via podcasts and a national therapist directory. They also have a professional program that trains therapists how to specialize in the treatment of complex trauma and dissociation; I highly recommend it!
Insecure Attachment Isn't Bad-Secure Attachment Isn't Good
It was a great relationship with my mother. Sounds counter-intuitive, right? I can’t tell you how many times I’ve raised eyebrows with that provocative sounding statement in my psychotherapy office whilst sitting across from a new client.
It Was A Great Relationship With My Mother
Sounds counter-intuitive, right? I can’t tell you how many times I’ve raised eyebrows with that provocative sounding statement in my psychotherapy office whilst sitting across from a new client. Jeremy (age 58), a sports writer, came in for treatment due to a low-grade depression that he couldn’t “shake off for years now.” Here’s the story of how his eyebrow raise occurred at this notion.
“My relationship with my mom when I was a kid? It was, she was, she was great with me. She was a great mother.”
“Ok. Help me understand that. Can you bring up a memory of your early childhood relationship with her being a great mother? Any example of that any time between the ages of five through twelve years old will work.”
“Um…uh…(5 seconds)…well she was just great, she used to cook these full-on meals for us. Dinner was always on the table right at six o’clock. On the button at 6 in fact…. (3 seconds) Mom used to get upset [laughs lightly] when anyone was late for dinner. This one time my dad was about a half-hour late. He plopped down at the table, served himself some mashed potatoes. Before he could even set a meatloaf slice onto his dinner plate, my mom snatched up his plate, went over to the sink and slammed it down without saying a word. [Huh]”
I went on to ask Jeremy for four more adjectives that describe his childhood relationship with his mother, each followed up by my request to provide a specific example from early childhood regarding each adjective. Jeremy produced the following, “wonderful, sweet, and happy.” He didn’t come up with another adjective, and remarked that that was already enough. Regarding his relationship with his father, he offered, “regular, good, and sports like stuff.” He couldn’t give me a fourth or fifth adjective regarding his relationship with his dad. I continued our intake meeting asking him the balance of questions from the Adult Attachment Interview (AAI)- (George, Kaplan, & Main, 1996).
As it turns out, Jeremy’s AAI responses were descriptive of an Insecure Dismissive attachment. His remembrance of early childhood with mother and father was at times, idealized and nonspecific, and at other times bore out contradictory examples compared to his overall positive impressions; we see this evidence above describing his “great relationship” with mother at the dinner table scene. He’s had to encode the meaning of clearly negative parental experiences in a way that made sense for him to get along in his family of origin and maintain a sense of safety and security throughout childhood.
Looking Beyond Face Value
It’s characteristic of Insecure Dismissive attached adults to idealize their childhood while at the same time downplaying the importance of close relationships because from an early age self-sufficiency was positively reinforced and dependency/vulnerability was not. These latter states are typically met with parental rejection in an Insecure Dismissive parent. Research bears out that there’s approximately a 75% concordance rate between parent and child attachment strategy (Bakermans-Kranenburg & van IJzendoorn, 2009). Presently, Jeremy does not place high value on close relationships, he is mostly detached from his feelings not finding any practical benefit in emotional literacy, and he rejects vulnerability as “weak.” Instead, he places a high premium on material achievement, self-sufficiency, and connections with others instrumentally through activities and to benefit his own purposes. This may sound like Jeremy is rather heartless, but he’s not. This way of being with himself and the world is an adaptation that worked up to a certain point.
“When was the first time in your life that you remember feeling really down, and nothing helped?” [I was taking a history of Jeremy’s symptom of depression and had already worked out with him some contributory factors.]
“My chocolate Lab died when I was 10 right in front of me. She was run over in the street out in front of our house.”
“Who was there with you? How did your parents handle it?”
“My dad was at work, so my mom took Springy to the vet. They put her down, and she never came home. That’s one of the only times my mom didn’t smack me for having tears. I guess she felt sorry for me cause she just told me to go to my room to cry.” [Not surprising, Jeremy had a string of memories into adulthood wherein loss and rejection affected his sense of safety and security in the world and which contributed to the development of his low-grade depression.]
It’s All In The Early Conditioning, And No One’s To Blame
In reflecting on what I learned about his early background, it appears that Jeremy was conditioned from very early on to back away from valuing and realizing his vulnerability and natural dependency needs. There was not enough parental modeling of making appropriate sense of negative experiences within his nuclear family home. He didn’t grow up in an atmosphere of being cherished for just being a kid, but instead had to “earn” his acceptance and accolades. This mixture of attachment experiences over the course of thousands of instances in his childhood developed into an Insecure Dismissing attachment strategy by the time Jeremy was a young adult.
“Hold on. [I softly smiled pointing up one lonely finger] I’m not blaming your parents here for your developing depression, Jeremy. Quite the contrary, so please hear me out.”
What I then said to Jeremy resonated. I explained how I saw it--that he was raised by his parents to survive and adapt well in today’s world, and to be a good person too. Which he is! I let Jeremy know everyone’s early life creates the default setting for how to be with themselves, how to be in the world and with others, and what to expect for themselves the future. It’s only when a person’s sense of safety and security are at issue that their default settings of how to handle life may fail them, and out of that challenge, symptoms can develop—like depression for instance.
And BTW-No One Is Immune To Mental Illness
If Jeremy had developed a Secure attachment strategy from his early childhood relationship experiences with his mom and dad, that would not have made him immune to developing a symptom like depression. While there is research showing greater emotional resiliency for those with a Secure attachment strategy (Mikulincer & Shaver, 2016), this is no magic bullet to protect against mental illness. Having greater emotional resiliency is like having large shock absorbers for adverse life experiences; the ride through life isn’t as bumpy and jarring over the long haul.
“I was raised to respect my parents, and I think they did a great job with me and my brother. I can’t get my head around thinking that they messed me up.”
“They didn’t. There’s no blame, not for them, not for you either. You’ve been depressed for a while now and you’ve gotten by without taking meds. I know it took a lot for you to come see me, and here I am asking you to go inside yourself to figure it out and find the answers. Your depression is real, and I’m gonna help you get better. We do, however, need to go against the way you were raised a little bit to retool some ways of relating to yourself and your life experiences, so your natural healing capacity can be unblocked. It will never be a requirement to think of how you were raised as bad, or that another way of being raised would have been better.” [That’s when Jeremy raised his rather bushy left eyebrow and leaned in toward me from my office’s blue pleather couch.]
Anyone who comes to therapy with mental health challenges will need to get themselves to the point of realizing and working through the origins of these challenges, reintegrate adverse life experiences from which they made dysfunctional meaning out of them, and put the past in a perspective that benefits who they intend to become. Everyone has an attachment strategy that was formed early on within the context of the nuclear family. Whether it be insecure or secure, it’s simply a way to understand a person’s characteristic ways of relating, and there’s nothing good or bad about it.
References
Bakermans-Kranenburg, M.J., & van IJzendoorn, M.H. (2009). The first 10,000 Adult Attachment Interviews: distributions of adult attachment representations in clinical and non-clinical groups. Attachment & Human Development, 11(3), 223-263.
George, C., Kaplan, N., & Main, M. (1996). Adult Attachment Interview. Unpublished manuscript, Department of Psychology, University of California, Berkeley (third edition).
Mikulincer, M. & Shaver, P.R. (2016). Adult attachment and emotion regulation (ch. 24, pp. 507-533), In J. Cassidy and P.R. Shaver (Eds.) Handbook of Attachment: Theory, Research, and Clinical Applications (3rd ed.). New York: Guilford.
The Compassionate Codependent
Compassion and Codependency make strange bedfellows. Indeed they do. Truly this combination is a one-sided marriage, and the two together effectively maintain an insecure balance. If you are acquainted with a compassionate codependent, your mindful patience can go a long way toward holding space for them. Simple common sense tells us that compassion and codependency are a bad mix in intimate relationship, yet some continue to play out codependent relationships of this sort even when they know it hurts them.
Compassion and Codependency make Strange Bedfellows
Indeed they do. Truly this combination is a one-sided marriage, and the two together effectively maintain an insecure balance. If you are acquainted with a compassionate codependent, your mindful patience can go a long way toward holding space for them. Simple common sense tells us that compassion and codependency are a bad mix in intimate relationship, yet some continue to play out codependent relationships of this sort even when they know it hurts them.
Charlese sees herself as being a giver. She continually over-gives to Donald knowing that it hurts her. Softly spoken with kindness in her eyes, “I really don’t expect him to reciprocate anymore. He can’t. And it feels right to be compassionate to him because I know what a hard life he’s had.” Charlese has been with Donald, cheated on for years now. Her partner drops hints that Charlese’s maturing face “could easily look younger with some work.” There are angry, emotionally abusive outbursts when Charlese doesn’t have frequent orgasms that are expected--and the proof Donald absolutely needs in order to be reassured of Charlese’s devoted love. She has to be careful not to invoke his out-of-control jealousy; they have had to replace several TV sets over the years after Donald throws his phone or a coffee cup at the screen. And Charlese repeatedly accepts this poor treatment by her partner. Sure, she protests sometimes, but Charlese does not deliver behavior-correcting consequences for non-negotiable behaviors and cutting assessments of her looks and character. Instead, Charlese has settled into a pattern of resignation from the steady diet of conscious undermining by her partner. Perhaps you are thinking that Charlese should just leave the relationship, or maybe grow some backbone? Do you know someone like Charlese?
No Clear Off Ramp on this Highway
The well-worn highways of Charlese’s codependent mindset have no obvious exit ramp that she can discern. She can barely connect with the misery of being stuck in a one-down relationship, so she makes the best of her day-to-day, minimizing her pain and idealizing her partner. Well before she met Donald, Charlese was thoroughly conditioned in her family of origin to depend on this kind of insecure attachment. Looking to Donald for cues on “how to be” in intimate relationship is a skill set that was fully developed by the time she became a young adult. The default setting is an intergenerational attachment pattern that gets played out for all of us, whether it be secure or otherwise. Charlese’s self-image of being a compassionate person was rewarded for her early on in life, so it stuck. She was also socialized from young childhood onward to ignore threat cues, to devalue and cut-off awareness of righteous anger, to put others’ needs (especially her parents’) before her own, and to substitute and root in shame in the place of healthy guilt (which is solely meant to correct poor behavior). What securely attached people don’t put up with for very long in a narcissistically oriented and/or abusive partner, Charlese recognizes as a challenge for her character to overcome. “I can change,” she thinks. She doesn’t allow herself to consider seriously that she deserves better treatment.
An empathic, compassionate “giver” is a perfect, neurotic partner for someone who has limited or no ability to recognize power and control within oneself as the true and appropriate measure of personal power. Similar lesson, different side of the coin for the other partner in the codependent relationship—instead of taking care of oneself to ensure mindful integrity, taking care of the partner’s needs, wants, desires are given primary focus to provide the “hope” of internal stability and self-integrity. Being continually downgraded as unequal in the partnership is passed over, unacknowledged as a legitimate gripe that necessitates clear consequences for the behavior of the other partner.
The Difficult Solution
How to begin to connect intimately, with mindful integrity, for the currently codependent partner? First, that prospect would be all about embracing the disillusionment that clarity offers, a disillusionment that requires a wider window of embodied emotional tolerance than was present before. Taking in and acting on new information about healthy interpersonal boundaries, self-integrity, and yes, saying no to the breach of these boundaries and anything that compromises integrity of oneself or one’s partner are essential skills. This kind of change can be very scary because when one person in a system changes, the system itself naturally changes. Codependent partners do often break up when one person in the intimate partnership starts thinking and behaving in ways that threaten the usual, unhealthy expression of power and control within the relationship. When unresolved abandonment issues are at play too, this is a powerful blockade against the expression of healthy mutual interdependence! In order to avoid the emergence of core abandonment issues, the codependent partner often would rather remain muted within the problematic relationship as the solution to avoid being abandoned. It’s a difficult situation to work with for sure, especially if the change agent (for us, Charlese) has little to no support for the healthier pattern to take hold. This is where mindful patience for the persons in this transformation process goes a long way.
If someone in a codependent relationship looking for change cannot afford it or does not want psychotherapy, becoming a healthy intimate partner is still a doable prospect. Educating oneself is a necessary first step. Having healthy emotional support is pivotal to kick start one’s progress, and surrounding oneself with positive influences is a great start. There are 12-step programs for addressing codependency. Google search Codependents Anonymous in your geographical area. I like to recommend to my psychotherapy clients two tried and true books to facilitate this process of change. The Mindful Path to Self-compassion, by Christopher Germer, Ph.D., includes a bevy of practices and activities at the end of each chapter, and the classic Codependent No More-How to Stop Controlling Others and Start Caring for Yourself, by Melody Beattie, has sold more than five million copies for a very good reason.
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A "Trauma Story" Told by a Very Young Child
Yesterday was a cloudless Summer day in Southern California, and I was done early with my clinical hours. COVID-19 hit and everything has been on shutdown since mid-March. It’s now mid-September, and I’ve been feeling the need for some sun to drink into my skin. I drove over to the local pool (that is now re-opened, yay!) and lay down on the warmed and water splotched, brown concrete deck. Immediately I was alerted to a distressed toddler in the pool who was, in fact, with a swim instructor protesting into a water safe swim lesson.
S.O.S
Yesterday was a cloudless Summer day in Southern California, and I was done early with my clinical hours. COVID-19 hit and everything has been on shutdown since mid-March. It’s now mid-September, and I’ve been feeling the need for some sun to drink into my skin. I drove over to the local pool (that is now re-opened, yay!) and lay down on the warmed and water splotched, beige concrete deck. Immediately I was alerted to a distressed toddler in the pool who was, in fact, with a swim instructor protesting into a water safe swim lesson. As the minutes sludged on, I found myself on the edge of my bandwidth of tolerance. This toddler was in distress. Instead of acting on my strong urge to leave the pool deck (and relieve my own viscerally triggered memory of being a tiny girl forced into a swim lesson that I wasn’t ready to experience), I stayed anyhow and breathed through my own triggering moments for the next twenty minutes. I wanted to really understand this child’s distress process, and to be frank, my own as well.
No matter the constant protests of, “Towel!”, “Dada!”, “Hug!” and visceral sounds of the attachment cry that only a baby can produce, the swim instructor in her sun-worn, wide-brimmed straw hat remained calm and collected. She made constant, reassuring eye contact with the toddler and used encouraging, simple words with him. She stayed physically connected and responsive to this young boy. Apparently the instructor’s aim was to teach him to roll over onto his back and float after she induced a brief underwater submerge by letting go of him while gently pushing forward her arms. Upon his little head bobbing to the surface, she then guided him to the edge of the pool, and he would pull himself out onto the pool deck. He went through this trial over and over, all the while crying out with “Towel!”, “Hug!”. This was a real survivor reality show - moment, after moment, after agonizing moment! And just like on TV, I knew all would be well in the end. Despite my headspace knowing the outcome, in those excruciating twenty minutes I struggled to stay present, calling on all my robustness to tolerate my own emotional distress in this desperate boy’s calls to survive those moments, the moments that reverberated through my whole body and being. I can only imagine what it was like for him…
Happy Hour
At last, the swim instructor’s voice gave a lilt that implied the lesson was over. Three o’clock, a brand new definition of Happy Hour for me. When the toddler’s father approached the edge of the pool deck, the swim teacher made a polished water-airlift-hand-off of the boy to his dad, and suddenly the protestations muffled into a whimper, then ceased all together as a plush, wide-striped blue and white towel securely bound the little one’s big and raw emotions. Now there were just two little feet and a towhead on the other end. In silence, his father swooped up this little burrito. Teacher gave a pleasant recap of the swim safety lesson while dad agreeingly smiled and nodded. I couldn’t see the boy’s face anymore because he had buried it next to the safety of his dad’s chest and armpit. Finally! My nerves were beginning to calm down a bit. But I was wondering (with a slight dose of worry attached) whether the boy was experiencing a dissociative rebound, or was calmly resting in his father’s arms…
A few minutes later, after father had gathered up his little man, I found myself joined by the swim teacher who has taking a break dangling her shins over the edge of the pool deck (6 ft. apart!) by me. I took this unexpected opportunity to tell her how grateful I felt that someone like her had such importance in the lives of people. Water safety is so crucial for little ones. She returned, “It must’ve been hard to watch because he was having such a difficult time today, but I’m actually used to it.” Searching her hazel eyes I believed her. “With the three-year-olds and older, I can reason with them easier,” she easily imparted. What she told me next put everything into context.
The Trauma Story
“This little guy fell into a pool. That’s why his mom brings him. It’s been a few weeks now…Tuesdays and Thursdays. He usually calms down after a minute or so, but today his dad brought him.” Now I was piecing things together. “The first few times his mom brought him, he’d say ‘Fall! Fall!’ repeatedly throughout the lesson, but he doesn’t do that really anymore.” Matter-of-fact-like she offered, “He only speaks one word at a time.” Before my filter could kick in, I shared back with her, “That makes sense…” I qualified my previous comment that unintentionally blurted out as if I was still thinking to myself. “I’m a psychologist.” I didn’t know how she’d take that in the context of our impromptu conversation, but in that moment I decided to move forward anyway. “In his own way, he must have been telling you his trauma story, just like I think he was doing today.”
Turning Off Alarm Systems
At the risk of her taking it defensively, I first complimented her on being so welcoming and calm in the face of this boy’s abject terror. “I admire how you were able to be so even-keeled just then. This boy truly couldn’t calm down. I think he needed something really important to happen first. Would it be alright if I gave you a tip?”
I thought to myself, “Oh God. Maybe I’d just ruined the moment between us.” “Maybe his distress cries needed your validation [aka therapist-speak: mentalization] first before he could calm himself through your being close to him, holding him in the pool.”
We went on exchanging conversation about her experiences as a swim instructor and my understanding of how kids reveal their traumas. “Really?” She raised her eyebrows. “Yeah. Whatever he brings you in terms of his trauma retelling, you can accept it in the moment verbally and with your presence too, and then with good timing redirect his attention to being reassured— as much as he needs it, moment by moment. Like if he says ‘Fall!’, you can let him know, ‘Yes, you fell into a pool. That was really hard…’ Then take a moment to look into his eyes and acknowledge his way of communication. And then… let him know ‘You’re safe now here with me. I’ve got you!’ If he doesn’t mention the fall but is stressing really hard like today, you can say something like ‘I see you. I hear you. It’s sooo not easy for you right now, and I’m here with you. You’re safe now.’”
I sensed she wanted to hear more, so we continued, “That kind of in-the-moment validation will do a lot to turn off his alarm system because he’s got your great and calm presence, with your reassurances over the span of the whole swim lesson.” Of course because I couldn’t help myself, I went all out. “I feel like letting you know that you’re a kind of trauma therapist yourself for ones like this little boy today!” She brimmed. I was happy too that I took the chance to share in this unexpected exchange with her.
Attachment
“Attachment is where it all happens. The good. The bad. And the ugly,” Ed Tronick, author of the Still Face experiment said. When we help very young children make sense of their experience, when we are able to quickly and responsively repair attachment disruptions, and when we provide a good enough constancy of rapport, children can grow up to be securely attached and robust, even in the face of traumas.
The good news is that “the bar” is actually set pretty low. Attachment theory, notably via Donald Winnicott’s writings, imparts the notion that the standard for secure attachment development is set at about 1/3 of the time (or more) for caregiver-child interactions—and I add here this proportion assumes the absence of emotional, physical, and/or sexual abuse. Wow! It turns out that the human condition is inherently robust. This idea is confirmed by The Adult Attachment Interview (AAI) data that indicate in the world populous, approximately 55-60% of adults are securely attached.
Bottom line is: as adults in a position to influence the lives of children, we can all be inoculators against the effects of big and little traumas. We can all intentionally be the promoters of secure attachment and a protective factor against the development of PTSD and other trauma-related conditions in children. The attachment cry is the human condition’s way of communicating, “I need help!,” and validating this unique communication is just as important as being soothing and calm in any little one’s distress.
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Anticipating Life After Integration
People are able to integrate their dissociated personalities that have been separate for a very long time behind an amnestic curtain. And true, it takes many years in psychotherapy with a skilled clinician for this process to complete itself thoroughly. This being stated, not all persons with Dissociative Identity Disorder (DID) will move forward after long-term treatment with a single, unified personality. That is their choice in the event that integration of solidified ego states (aka-alter personalities) does not ever spontaneously occur.
It Is Possible
Truth. It does happen! People are able to integrate their dissociated personalities that have been separate for a very long time behind an amnestic curtain. And true, it takes many years in psychotherapy with a skilled clinician for this process to complete itself thoroughly. This being stated, not all persons with Dissociative Identity Disorder (DID) will move forward after long-term treatment with a single, unified personality. That is their choice in the event that integration of solidified ego states (aka-alter personalities) does not ever spontaneously occur. Sometimes a person’s internal system will opt for co-consciousness with a sense of respectful agency for internal personalities. People living without multiplicity (roughly 99% of the general population) may have understandable trouble with this notion. And surely for persons living with internal multiplicity, the concept of integration can be scary.
Passing The Vibe Test
My first DID client, Darlene**, was a surprise to me, as is the case for most clinicians not steeped well enough in graduate school courses and supervised professional experience in the treatment of the dissociative disorders. Darlene was a physician in her late 40s who knew she was a multiple when she arrived self-referred to my private practice. She had stopped therapy for several years after moving to a different city post-residency. Right away after Darlene’s intake appointment, I began seeking consultation with a DID expert and sought further educational experiences regarding complex trauma and dissociation to continue to treat her in my private practice.
It was initially very difficult work for me to keep my countertransference in check; often I privately found myself feeling both sad and enraged while thinking about the injustices she had experienced as a child. As Darlene unpacked her life history to me, I learned that her alcoholic father used her for sex from the ages of three through thirteen, and then… “he lost interest in me.” Darlene’s mother knew all along and did nothing to protect her. Living in a chaotic household also rife with domestic violence and poverty, Darlene made it out of impoverishment by earning an academic college scholarship and doing quite well in her studies. She paid her way through medical school by prostituting her body. Being a sex worker was the job of one of her alters inside. During her college years, another alter personality would go to bars occasionally and pick fist fights with men after they came on to her. By the time Darlene had entered into treatment with me, she had made peace somewhat with the different ways of being herself inside, but she had no access to consciously embodying the vulnerable feelings she and I made note of early on. The streaming tears running down her straight face… she would cry and not know where the tears came from, who inside was crying, or even what crying tears felt like emotionally.
It seemed as though Darlene had invested much self-esteem in her disaffected presentation and high career accomplishments. Even though I had tried to help her understand it wasn’t necessary to recount her early life troubles at the onset of therapy, she soldiered through telling me about her shocking history. Thankfully I passed the vibe test as her new helper because I didn’t appear to be easily rattled as she later told me. I was actually surprised that confronting her trauma so early on in treatment via the history taking process didn’t derail or destabilize Darlene’s adaptation to daily life, but it was clear to me the price she (the one out front) paid for consciously knowing much of her story.
For many years we worked together in therapy to understand how and why she had come to live dissociated inside and function under such overwhelmingly stressful circumstances beginning as a toddler. Developing internal multiplicity was how “her body-mind’s wisdom” survived and adapted thereafter. We worked together over time to understand the alliances and divisiveness amongst and between her alter personalities, respectively, to create a more peaceful and collaborative internal system, updated for the current life circumstances. We worked through Darlene’s disgust toward some of her alters, and their corresponding mistrust and rage toward Darlene too. When the time was right, we intermittently addressed her traumatic wounding, so that she could know and understand her felt sense of pain, release it, and come to a new understanding of its meaning in the context of whom she intended to become for all of her selves. It certainly was not a linear process. We needed to toggle between trauma confrontation, and containment of her internal discomfort coupled with building emotional tolerance and other skills building for years.
Creating Heart Space For A New Normal
Toward the end of her therapy (a period of more than a year or so), we began discussing what life would be like after integration of her system of personalities. In Darlene’s case, all of her alters integrated before the last year of therapy, save for two of them. She retained co-consciousness with a sense of personal agency with these two. The first one she created initially for the purpose of functioning optimally at work when there was an emergency, and the other alter personality would come forward for running marathons and training. It’s quite interesting that her system thought it best to retain these two personalities as separate and distinct, the only ones created outside of experiencing clear defensive threat. During our many discussions about life after integration, we talked about how Darlene would use her time/energy management because there came to be an emerging massive internal silence and solitude--which was a very big change. I held space for Darlene as she mourned the loss of many alters, and she decided to make meaning of these changes by feeling into a sense of them in her heart space. They had not been banished, “killed off” or died; their functions were now to support the body in a different way, a way that felt right for her. In one of our later sessions Darlene remarked, “I don’t have multiple personality disorder anymore. I’m a family of three loved ones inside now.”
The plan going forward included a new definition of self-care without loads of internal energy spent on dealing with the dynamics of internal victim, rescuer, and perpetrator. Darlene was taking the risk to make new friends and develop new interests. For the first time in her life she was able to feel soothed by physical touch from a massage therapist. These kinds of endeavors met the challenge of the new and voluminous space that she acknowledged inside her. There were no more warring voices or crying from inside to manage. Darlene no longer had the adrenaline rush from flashbacks, or the spacey high from endorphins dumped into her system from dissociating—she worked hard in her therapy to leave those automatic, reliable escapes behind her. She was able to let go of hooking in to key drama-inducing people. Saving it for one of our last regular sessions, Darlene told me she was worried that I would suggest she stop running long distance and training for marathons due to the endorphins her body was gifted after long runs. We had a big, hearty laugh together over that one as I grinned, “Hell no! Keep on running the marathons, Darlene. You’ve earned those endorphins fair-n-square each time you intentionally push through together!”
Where To Turn For More Information
I feel fortunate to have assisted Darlene and her others inside on their journey in therapy, and I will always hold a special place in my heart for them. I also hold deep respect for all persons who find a way to overcome overwhelming obstacles to embody their own mental health. If you would like information about the understanding and treatment of complex trauma and dissociation, please visit the International Society for the Study of Trauma and Dissociation (ISST-D) website by clicking the button below.
**Note: Disguised identity information of my actual client has been used.
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Breaking the Rules—The Original Bonding Contract
It’s been said that perspective is everything. But really how does a person get a perspective in the first place? It’s locked and loaded, hardwired actually. By the time we’re six years old, humans show an emerging capacity to think about things in relation to the self and the outside world. When an infant has a secure home atmosphere where caregiver(s) are attending sensitively *enough* to their needs, fostering playful moments, providing a sense of security, protection and helping them make sense of their daily experience-this all is optimal for healthy development. It sets the stage for self-reflection capacity, a balanced adult viewpoint toward childhood caregiver(s) and experiences, and positive adaptation to life. Great! Attachment research puts these persons at around 50% of the general population around the world.
Perspective Is Hardwired
It’s been said that perspective is everything. But really how does a person get a perspective in the first place? It’s locked and loaded, hardwired actually. By the time we’re six years old, humans show an emerging capacity to think about things in relation to the self and the outside world. When an infant has a secure home atmosphere where caregiver(s) are attending sensitively *enough* to their needs, fostering playful moments, providing a sense of security, protection and helping them make sense of their daily experience-this all is optimal for healthy development. It sets the stage for self-reflection capacity, a balanced adult viewpoint toward childhood caregiver(s) and experiences, and positive adaptation to life. Great! Attachment research puts these persons at around 50% of the general population around the world.
Derailed Perspective
When caregivers, for whatever reasons, don’t provide an optimal early atmosphere, what then? Here are some possible scenarios. Perhaps the main caregiver(s) habitually place their own needs above the child’s. Maybe there was a major illness, and the parent was unavailable to the child for a critical period of time. Or say the caregiver was suffering from the effects of their own past trauma, so they were occupied mentally and emotionally with that throughout their child’s formative years. Maybe the early childhood atmosphere was chaotic and/or violent, with the child being exposed to abuse and/or being abused. There are many ways a child can be derailed into adaptations (s)he needs to make in order to survive the best they can.
Mirror Mirror, On The Wall
Michael, one of my Millennial therapy clients, came to me as his marriage was falling apart after just two years, and he claimed he was “just fine” with his wife—except that she was “changing the rules.” Michael’s wife complained to him that she was sick of his withholding feelings and, according to her, their “soulless” sex. He also wouldn’t talk meaningfully about their marital relationship. Michael said with a slow, even deeper tone, “I’d rather die than do that” rolling his eyes within a crescent moon. His cocked-forward presence on the edge of my pleather couch wreaked, “Fix it for me, doc!” It was clear Michael needed to self-reflect and adapt if he was going to save his marriage. And so it went forward. Willing to even come to therapy to save his marriage, I was asking him to take a curious, friendly look inside; this was tantamount to mutiny as evidenced by his response to my next intake question.
I point blank asked Michael why he thought his marriage was failing. “She knew who she was marrying. I’ve never been a big talker about feelings anyway. [several seconds passed as he stared into space] I guess I’m the strong, silent type. And by the way, I think I’ve always been pretty good for her in bed! She gets off nearly every time.” He didn’t answer my question as asked. This was not a surprise.
Adaptation Is Everything
The way Michael and we all adapt to upbringing is to maximize the easiest way to get needs met from parents. For him, the rules of bonding meant he shouldn’t show his vulnerability or organically talk about his feelings. That was not positively reinforced and was most reliably rejected. I discerned that Michael got hugs sure enough, but not because he needed them. His parents provided well for his material needs, safety and security, but were quite rejecting of his inherent value on the whole. There was pressure for him to achieve, be strong, and excel in sports in order to gain reassurance and approval. “My parents were wonderful, ” as he bared a toothy smile, yet he was unable to back up this assertion with even one specific childhood memory. I asked him similar follow-up questions about his wonderful childhood experience, but he was psychologically blocked from remembering any specific evidence for his original assertion. Instead, he offered vague memories of mom cooking; this is what we term “instrumental caring.”
Why did he respond to me in this fashion? To self-reflect on the actual experiences of his childhood meant Michael would have to make sense of and emotionally digest the conditioning by his parents, including the moments of rejection. He didn’t yet have that skill set or capacity to tolerate that kind of discomfort with an embodied knowing. Subconsciously, Michael sensed going inside like that was taboo. I believe he had an avoidant attachment as his adaptation in early childhood which he also has kept and guarded all these years.
When infants/children get the message over time that noticing their vulnerable feelings does no good to get their needs met, they generally deactivate awareness of feelings because it makes life much harder to get needs met! By the time Michael had gotten romantically involved with his future spouse, he had a lot of practice and was an expert at cognitively shutting off from realizations of vulnerability, not valuing or noticing or naming (especially) vulnerable feeling states.
As the saying goes, “Old habits die hard.” Even if there’s a stiff price to pay (e.g., Michael’s marriage), change is often resisted because the default modus operandi is really difficult and viscerally threatening to give up. The innate fear of abandonment for violating the original bonding contract with parents (Michael’s scenario: minimize vulnerability, don’t talk about or notice vulnerable feeling states, be strong and don’t need others, etc.) is kicked up loudly. In Michael’s early childhood, feelings needed to stay repressed to keep parents in proximity for safety, security and survival. When he showed up to my office, the same bonding contract was still valid.
Flip The Switch
A deep, subconscious survival threat becomes activated if the rules for bonding change like the way Michael’s wife wanted them to in order for her to stay in the marriage. My job was to help him identify for himself the original bonding contract with his parents, and to help him see that he’s now free *and safe* to retool his bonding patterns. It’s a positive proposition after all! The weighty paradox facing him was that to change was really threatening to his subconscious sense of survival, but to not change was threatening the survival of his marriage.
People are allowed to change their interior landscape, and it doesn’t necessarily take the assistance of a therapist to do that either. The alchemy of a positive, ongoing relationship with another safe, secure human can afford meaningful interior change. A self-reflective capacity and ability to work with embodied feeling states can certainly develop organically through relationship. Often times it’s a school teacher who is attuned to a child, a foster parent who provides a corrective emotional experience, or even a spouse who is able to stay the course in an atmosphere of compassion. Michael has me to help him now. I don’t know if his marriage will last, and I won’t promise him that it will last if he does his internal work. What I can promise him is that by breaking the rules of his original bonding and learning how to feel into a different way of being, he has the best chances of both personal evolution and a better marriage relationship.
Bottom line: break the rules of original bonding for a better life if you want!
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Triggering During the COVID-19 Outbreak: People with Complex PTSD
With COVID-19 cases escalating, I see both obvious and subconsciously concealed similarity to threats and danger from past trauma; this all gets understandably triggered in a person’s complex PTSD. What can people who suffer from complex PTSD do to mitigate the sometimes sudden and intense triggering these days?
March 17, 2020
Governor of the State of California, Gavin Newsom issues a “stay in place” mandate until April 17, 2020, for all of California except for essential activities and services such as food take out and delivery, grocery store shopping, obtaining essential healthcare services, mail delivery, going to laundromats, etc.
Week One
In my small corner of the world where I sit in my California psychotherapy office, still most of my clients have elected to come in for their regular therapy sessions. At initial check-in, some of my clients have been a bit rattled, but still doing alright. With dedication I have disinfected my sky blue pleather couch between sessions and offered Crabtree & Evelyn hand sanitizer before and after each meeting. I’m told my new ritual has had an effect of reassurance and caring.
Week Two Of The COVID-19 Mandate
My clients dealing with complex PTSD are mostly feeling pretty isolated and more triggered by the COVID-19 pandemic. Themes of isolation, helplessness, doom, lack of personal agency, and escalating anxiety are central. I look across my carved wood coffee table into red-faced countenances, forward-rounding shoulders, words of irritable disbelief about human nature, and eye sockets sometimes quickly tearing up at check-in.
Mitigating Triggers
With COVID-19 cases escalating, I see both obvious and subconsciously concealed similarity to threats and danger from past trauma; this all gets understandably triggered in a person’s complex PTSD.
What can people who suffer from complex PTSD do to mitigate the sometimes sudden and intense triggering these days?
I realize this blog may be bordering on therapeutic advice; however, I am simply trying to promote mental health and awareness in a time of crisis. People who may not have access to a therapist and who have histories of early, ongoing caregiver neglect, physical abuse, emotional abuse, and/or sexual victimization need to know it’s really understandable that they experience elevated triggering in these unprecedented times.
Nonetheless, here are my thoughts.
1. Calm down the nervous system first.
Common knowledge is that a heart rate below 94 beats per minute maximizes access to higher brain functionality in the cerebrum versus absorption into the emotional brain’s reasoning and strong influence. Diaphragmatic breathing or any sustained controlled breathing techniques will do a relatively quick reset for the nervous system to set itself at a lower idle. This opens up greater conscious brain capacity to adapt to the situation at hand.
2. Hold in mind and sustain the most adult perspective (that is connected to the grounded reality of present life).
Allow the five senses to perceive the moment’s reality: name things of a similar color in the room, register different sounds heard in the room, make saliva in the mouth, plant feet into the floor with arms hugging the torso (repeat several times), notice any scents or have pleasant soap to smell.
3. Thank what is inside the mind and body communicating a sense of threat and danger.
Express gratitude for the ongoing attention and care promoting survival that has persisted all these years. Be non-judgmental, friendly and curious about the messages offered in whatever form they appear--as much as possible.
4. Help what’s inside to know the difference between what’s past and what is now true in terms of the adult self’s:
ability to protect what happens to the body, where the body is now in point of fact, and how much the adult perspective can help bring what’s inside up to current knowledge with the times. Allow what’s inside to communicate their different reality perspective, fears, way of protecting the body, etc. Remember to be curious and friendly to the messages received from within.
5. Be gentle with what’s inside please.
Through your adult perspective, offer calm and certain reassurance that the body will be protected and cared for; after all, that’s the job of the adult self. What’s triggered inside has successfully accomplished the job of sounding the alarm. Now it can be time to rest inside new understandings.
Get Help If Needed
If you yourself are experiencing triggering due to COVID-19 fallout and are in imminent danger of harming yourself or others, please call 9-1-1. And if you have been struggling with complex PTSD, the mitigation of triggers suggested in this blog merely serve as a starting point to deal with the situation at hand. Please consider getting professional help to alleviate your symptoms and struggles related to complex PTSD.
The International Society for the Study of Trauma and Dissociation has as therapist referral link for you.
Be well, and please take all necessary precautions to keep your body as safe and protected as possible in these times of the COVID-19 spread amongst our global population. Your care and attention to this matter really makes a difference!
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Trauma Bonding and Dissociative Coping
The International Society for the Study of Trauma and Dissociation (ISST-D) has standard of treatment guidelines and therapist referral sources that are publicly available at www.isst-d.org. If you know someone who is in an abusive home atmosphere, please give them information about how they can seek help. If it is a child, please contact a mandated reporter of abuse, such as a school official.
Tu Te Calme!
I had never witnessed anything like this scene before, yet I’ve heard similar (and more severe) first-hand accounts of this nature when people make their way into therapy. One of those moments I’ll never forget--apparently helpless to do anything but affront the blatant abuses with my burning stare, I almost immediately regretted my inaction.
Last week I was traveling in Costa Rica and had visited its most popular national park near the town of Manuel Antonio. I was next in line to enter the two-stall women’s restroom that had an open entryway. There was a young girl probably five or six who suddenly made a loud fuss aimed at her mother who was next to the washbasin.
The mother’s was jarringly louder and shriek-like than the young girl’s protests, “Tu te calme! Tu te calme!” pinballed in the pink cement interior as she boxed the little girl’s ears—twice! Shockingly, it seemed I was witnessing a well-practiced motion. The woman glanced out at me before asserting her right hand along her side, and the brown-pig-tailed girl silently obliged her little fingers into her mother’s stronghold. Just as suddenly as she had protested near the washbasin, this small girl had been screamed at to be calm while she was being physically and emotionally abused! Within one second after her ear-boxing, this little one adjusted herself into a slight smile with glazed-over eyes as she walked out of the restroom in a kind of lock step with her mother. Something tells me that this sort of mother-daughter exchange had happened many times before with them.
Then an older girl with a dour face, maybe nine or ten, peered out of the restroom’s threshold with furrowed brow spying on her mother and sister (I assume) who absorbed into the nearby sea of tourists exiting the national park. As she lost sight of them within a couple of seconds, the taller sister flashed a panicked face, began running after the pair, and caught up with them just outside the entrance. With jerky and erratic motions, the mother’s left arm seemed to signal her older daughter to scramble toward the right side of her younger sister’s back. And then they were lost.
Trauma and Dissociation
I was really jolted out of my vacation mode having witnessed this abusive scene because who expects to see something like this in public on a beautiful day? I had the urge to confront the mother, but I held myself back. I don’t speak French. Who would I report the abuse to anyway? And if I had done something, anything to let these sisters know that there was an adult who would stand up for them, I could have been placing the girls in much greater jeopardy later when the mother was free from public view. I hate to imagine what happens to those girls in private with their mother.
What I saw unfolding before my eyes with these sisters likely was a desperate coping pattern, the need to attach to their mother at any cost. These girls developmentally do not have the capacity to make sense of their traumatic experience, and they do not have the choice to physically disengage and find safety from their abusive world. There is no perspective yet to put abuse into an appropriate context for their lives, no appropriate assignment of responsibility for the abuse (rightfully resting with the mother).
When the source of care and comfort is also the abuser, this makes for disorganized attachment to the caretaker that mirrors the chaotic behaviors and other unhealthy communications from the caretaker-abuser. Unfortunately, children naturally resort to desperate coping measures in these circumstances by dissociating from their traumatic experience because they cannot psychologically or emotionally handle them, and they cannot physically leave.
Dissociative Identity Disorder
In abusive home atmospheres, children cannot integrate their different ways of being in the abusive milieu into their consciousness. When abuse is severe, begins before the age of five years and is ongoing throughout childhood, dissociative coping often can develop into Dissociative Identity Disorder (DID). Lesser forms of dissociation do not organize a fragmented personality structure around dissociative coping and can be seen in milder forms, such as derealization of the environment, or depersonalization of the body when stressed or triggered. Usually these lesser forms of dissociation are correlated with less severe trauma histories.
While the story of these two unfortunate girls is all too similar to abuse around the world, there is help and treatment for those suffering from current trauma and/or past abuse. Many people do not find relief through treatment until they are adults, and children who are removed from their abusive home environments also incur the pain of longing for their abusive caretakers due to trauma bonding.
What You Can Do
The International Society for the Study of Trauma and Dissociation (ISST-D) has standard of treatment guidelines and therapist referral sources that are publicly available at www.isst-d.org. If you know someone who is in an abusive home atmosphere, please give them information about how they can seek help. If it is a child, please contact a mandated reporter of abuse, such as a school official. Thank you for reading my blog and thereby raising awareness on the phenomena of trauma and dissociation.
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Are The Memory Wars Over Yet?
The human condition automatically (read: without conscious direction) processes and stores traumatic experience as it’s happening in a different part of the brain as compared to non-traumatic experience (van der Kolk & van der Hart, 2019).
Don’t Shoot The Messenger
Just last week, I was looking into new general liability insurance for my private practice location—so I had to answer some questions about my therapy activities. “This is routine enough,” I thought. That is, until it came to one particular question: “Do you engage in repressed memory recovery therapy?” I literally heard myself utter softly, “The f*#k?!” I am a psychologist specializing in the treatment of complex trauma and dissociative disorders, and therefore I responded ethically and resolutely with “No.” I asked myself where was this insurance underwriter’s wording of such a question coming from? I knew that the question was just another shopworn strategy to blame victims of abuse and to shoot the messenger (read: therapist) in the process. There’s good reason for the insurance industry to mistakenly believe that there is such a thing as repressed memory recovery therapy. To appreciate the insurance underwriter’s position, I had to understand the history of victim and therapist blaming in this context before reverse engineering the misguided reasoning behind it; enter the Memory Wars.
The False Memory Syndrome Foundation Emerges
Here’s the short version of quite a sad and seminal story that gave birth to the False Memory Syndrome Foundation in 1989 and the national aftermath of the Memory Wars. Peter and Pamela Freyd were non-biologically related adoptive siblings who developed a romantic relationship and later married each other. They had a baby together named Jennifer Freyd. When Jennifer entered psychotherapy in graduate school and began to recall memories of incest from her father during childhood, she confronted her parents. Their response to her was to form the False Memory Syndrome Foundation (FMSF), and “out” her in the public literature and newspapers while she was still a graduate student.
Since 1989 there has been a campaign by the FMSF to smear victims of abuse who did not recall until adulthood psychotherapy their trauma at the hands of the guardians entrusted with their protection and care. The nationwide campaign of the FMSF gathered much steam in the years following its inception from accused molesters and other alleged abusers intending to shift blame away from themselves and onto the victims—and their therapists—who, it has been assumed, plant false memories of childhood abuse. The FMSF has conveniently explained all alleged abuse discovered during the psychotherapy process as being an iatrogenic problem. FMSF’s assumption: If the childhood abuse were indeed real, why wouldn’t memory for something so horrible stick with people throughout their whole lives?
And the Misinformation Continues
Surprisingly, numerous academicians have joined the battle call on the side of FMSF as reflected in a recent article following the trend of reports of recovered memories of abuse in therapy (Patihis & Pendergrast, 2019). As a result of the Memory Wars, countless families have been split apart in bitter battle. Abuse victims have born the second quiver of arrows by being dismissed and vilified for their delayed disclosures of abuse. And therapists have seen their careers shattered from lawsuits and licensing board investigations launched by enraged family members who want revenge for “implantation of false memories of abuse.” In their empirical article, Patihis and Pendergrast (2019) reported that “therapists discussing the possibility of repressed memories of abuse were 20 times more likely to report recovered abuse memories than those who did not.” (p. 3) The prevailing point of view of the FMSF proponents is that “a belief in repressed memories” by therapists “creates” memories of childhood abuse; however, this notion is so misinformed, and here’s why.
Traumatic vs. Non-traumatic Memory Retrieval
The human condition automatically (read: without conscious direction) processes and stores traumatic experience as it’s happening in a different part of the brain as compared to non-traumatic experience (van der Kolk & van der Hart, 2019). For the highest survival value for the future, traumatic experience is recorded in sensory fragments without the fluid awareness of “storyline,” i.e., in the brain’s right hemisphere—mostly cordoned off from access by the brain’s left hemisphere where narrative memory (read: the integrated memory of experiences on the levels of sensation, emotion, thought and action sequence) is housed. Admittedly, this explanation is a super rough sketch here for a blog post, but it helps us to understand why many victims of childhood abuse have no clear awareness of their traumatic history until they get into therapy. At this point, the brain begins to search itself and make important connections between the left and right hemispheres. Over a natural process in therapy, previously existing mental schemas are invoked by trauma victims in a safe, skilled atmosphere eventually affording them to make meaning of sensory fragments, intrusive and disconnected mental images, etc.
The FMSF actually disbanded on December 31, 2019, without explanation. But given the fervor of its proponents, it will serve the mental health community to be aware of the misguided arguments the FMSF have used—just in case it pops up again under a different name. It will also serve the mental health community to know and be able to explain the difference between traumatic and non-traumatic memory capabilities since this is well known in psycho-neuro traumatology circles now. Knowledge is power. Let’s use this knowledge to raise awareness and stop blaming victims and their therapists.
References
Patihis, L. & Pendergrast, M.H. (2019). Reports of recovered memories of abuse in therapy in a large age-representative U.S. national sample: Therapy type and decade comparisons. Clinical Psychological Science, 7(1),3-21.
van der Kolk, B.A., & van der Hart, O. (2019). American imago, 1991 the intrusive past: The processing of ordinary and traumatic memories. Retrieved from www.researchgate.net/publication/338104134 on December 24, 2019.
What’s at the Heart of Trauma Resolution
Skilled therapeutic intervention is key to resolving trauma, and fortunately there is not just one method or modality to accomplish resolution of traumatic experiences! At the heart of mental/emotional trauma resolution is therapeutic memory reconsolidation as articulated by Bruce Ecker’s (2018) methodology literature review.
When is it trauma?
So many of us have brushed aside the notion of being traumatized because our self-image, our self-talk, our reliable defensive stance in life don’t allow us to reflect inside. “It was my fault. I shouldn’t have been dressed that way. Maybe then they wouldn’t have followed me outta that bar and beaten me up…” is what I heard one new client referred by the Victim Witness Assistance Program tell me when speaking about their most recent hate crime.
My client didn’t consider themself a victim, and they were proud of that. I respected their personal experience of the beating, and I knew their take on it was protective for them. My understanding of their beating (which I didn’t share with them at intake) was that they had likely dissociated from the vulnerable feelings and sensations that were a part of the beating in that dark parking lot. While this client presented a more obvious story of trauma that therapy could, and would resolve, other traumas are less obvious…yet just as devastating to the mind-body psyche.
Interestingly, conscious awareness at the time of traumatic experience is not a prerequisite for people to [subconsciously] register experience as traumatic. At clinical intake, the psychotherapist may hear, “My childhood? Mine was just great. Wonderful parents! Funny thing though…I don’t remember anything specific about it now that you ask.” Only many sessions later may the therapist begin to discover the client’s abusive/neglectful childhood if there is one. This kind of dissociative process happens automatically as a built-in survival mechanism attendant to the human condition. Why? -----because we are built to cordon off that which we cannot metabolize consciously. And kids are especially susceptible to dissociating when life gets to be too taxing for their burgeoning personal psychology in the midst of abuse and/or repeated experiences of emotional neglect.
My client who had been beaten up did not begin to consciously register their trauma until they sensed it was safe enough with me to explore this possibility within a paced, therapeutically shared internal journey. Resolution of trauma came quite slowly. After careful clinical interviewing, it became apparent to me that this client had Dissociative Identity Disorder (DID), and we worked through a serious history of early trauma extending up to the present at age 21 years. Their trauma healing process took a handful of years altogether in therapy with me.
When does the trauma response cease to be triggered?
Skilled therapeutic intervention is key to resolving trauma, and fortunately there is not just one method or modality to accomplish resolution of traumatic experiences! At the heart of mental/emotional trauma resolution is therapeutic memory reconsolidation as articulated by Bruce Ecker’s (2018) methodology literature review. Healed trauma cannot be re-triggered. It’s permanently gone. Erasure of memory’s traumatic aspects connected to the declarative (aka, factual) and episodic recall is complete. This is fantastic news!
At present, there are ten different therapy modalities that have the backing of published scientific research explaining therapeutic memory reconsolidation. Check the list out here. These distinct therapies provide a framework for established best practices in the field of trauma psychology. The International Society for the Study of Trauma and Dissociation (ISST-D) has treatment guidelines for adults which can be found here, and for child treatment of trauma, the guidelines can be viewed here. Working within these guidelines leaves ample room for applying the various treatment modalities alluded to above. FYI, please look them up!
To be frank with you, in my early years of treating Complex PTSD and DID, I hardly knew how to recognize what the heart of the matter was with these clients! I definitely contributed to the well-known statistic of DID clients being in therapy for an average of seven years before being given an accurate diagnosis of DID. Fortunately, I found ISST-D via one of my mentors, and my confidence in working with traumatized clients has blossomed over the years. I now utilize the treatment modality of EMDR as a framework with nearly all of my clients, and it requires a specialized, advanced application with traumatized persons. If you are a client needing trauma-informed care, or if you are a psychotherapist treating trauma, aren’t we so fortunate as seekers and deliverers of therapy at the current time when trauma truly can be healed! Please share this blog with anyone you know who may benefit.
Ecker, B. (2018). Clinical translation of memory reconsolidation research: Therapeutic methodology for transformational change by erasing implicit emotional learnings driving symptom production. International Journal of Neuropsychotherapy, 6(1), 1–92. doi: 10.12744/ijnpt.2018.0001-0092
Instinct, Defense, and the Development of Complex Trauma
Pierre Janet (1859-1947) once wrote, “Traumas produce their disintegrating effects in proportion to their intensity, duration and repetition.” (1909) He was the first in a long line of clinician theorists who have attempted to explain what happens to the human condition as a result of enduring repeated, ongoing neglect and all manner of abuse.
Not All PTSD Is Created Equal
Pierre Janet (1859-1947) once wrote, “Traumas produce their disintegrating effects in proportion to their intensity, duration and repetition.” (1909) He was the first in a long line of clinician theorists who have attempted to explain what happens to the human condition as a result of enduring repeated, ongoing neglect and all manner of abuse. And though contemporary understandings have made PTSD a commonly recognized acronym, a majority of mental health professionals grapple with efficiently treating the complexity that PTSD often involves. Why? The simple answer is that not all PTSD is created equal. Here’s an illustration: Surviving the fallout from a fiery car crash (having previously enjoyed a trauma-free upbringing) is quite different from surviving the latest trauma of a fiery car crash given the backdrop of an abusive, neglectful and chaotic upbringing.
The roots of psychological disintegration that Pierre Janet so elegantly outlined for us come from an instinctual, desperate attempt to survive perceived threat. Humans (at any age) will do whatever is necessary to survive when escape from perceived threat is impossible. Infants cry instinctually in an attempt to get attention, so their physical survival is maximized. And when aggressors are much larger, the primacy of the fight instinct is abandoned for fleeing as the best way to cope. And when fleeing is not an option, what’s left is to submit and comply with the powerful other’s demands; submittal with analgesia (the body goes limp and internal endorphins are released) is the last survival strategy by instinct. These automatic survival processes are designed by nature to segregate traumatic experiences, especially severe and chronic ones. This process helps the survivor to most efficiently focus on daily life despite their trail of traumatic experiences.
The success of survival from chronic, perceived threat comes at the price of a disintegrated psyche via traumatic learning.
Traumatic learning is very difficult to undo because it holds strong survival value. Here’s an example: A child learns to wall off the realization that the parent who molests her late nights is the same parent smiling and making small talk at the breakfast table the next morning. This child cannot escape the molestations and must carry on a “normal” relationship with that parent. This girl who submits to and experiences the molestations may be remotely aware (or even unaware) of the one who makes small talk with her molester-parent at the breakfast table. This is but one possible effect of traumatic learning processes that are born out of an instinctually defensive purpose to survive.
How Do We Begin To Help Our Clients?
So where do we start as clinicians with treating such complex trauma? We start with gentle kindness, with friendly curiosity. We hold space for our clients’ confusion, their knowing and not knowing about what their past experience holds. And when the time is right, we reaffirm whatever the client had to do in order to survive was alright. That’s where we begin, and that’s where we stay as long as is necessary.
When we, as clinicians, understand these instinctually defensive roots of traumatic response, we can help our traumatized clients begin to stabilize their daily living and to build customized skill sets that address what is needed to eventually confront the realization of their traumas. Out of this process, our clients will eventually make sense of their trauma in terms of who they intend to become—not only as survivors, but also as thrivers.
Click the button below to learn more about how the treatment of PTSD can be achieved through EMDR Therapy.
Photo by Camila Quintero Franco on Unsplash
Thinking About Becoming EMDR Trained?
The EMDR Center of Southern California (ECSC) is accredited by EMDRIA, and we take pride in offering a comprehensive, state of the art EMDR Basic Training. Participants can rest assured they will be given all the knowledge, practice exercises and consultation re effective treatment of their actual clients. ECSC will help you take your clinical skills to the next level.
Thinking About Becoming EMDR Trained?
Some may think, “The learning curve seems so steep to be an EMDR Trained therapist from an EMDRIA accredited program! How is all this effort going to pay off anyway?”
Buyer Beware
First, what you need to know is that standards for training and best practices in EMDR Therapy are regulated by the EMDR International Association (EMDRIA). So please, Buyer Beware! Marketed widely in the United States are so-called EMDR Therapy trainings which are unaccredited and claim that clinicians can learn and easily apply EMDR Therapy after just two days! In fact, so many clinicians who have taken these non-accredited EMDR trainings have dropped using what they were taught out of frustration because their clients’ symptoms didn’t improve!
Since EMDR Therapy is a complete treatment paradigm with its effectiveness backed up by decades of solid research showing its reliability and validity, all EMDIRA-accredited trainings expose participants to the comprehensive method of EMDR Therapy. Here’s the clincher—not all EMDRIA-accredited Basic Trainings are the same. Many EMDRIA-accredited Basic Training programs do not offer consultation feedback on participants’ actual client cases within the classroom experience. Instead, this vital portion of Basic Training is outsourced and basically is a hidden, additional fee for participants who must guess at whether their Consultant will actually assist them effectively to learn the comprehensive EMDR Therapy! Yikes!
ECSC Is Here To Lend A Hand
The good news is that the EMDR Center of Southern California (ECSC) is accredited by EMDRIA, and we take pride in offering a comprehensive, state of the art EMDR Basic Training. Participants can rest assured they will be given all the knowledge, practice exercises and consultation re effective treatment of their actual clients. ECSC will help you take your clinical skills to the next level.
Our ECSC Participants Learn:
1) how to effectively assist their clients to reorganize their thoughts around traumatic experiences
2) how to let go of the emotional burden connected with the traumatic memories
3) how to embody new, more positive self-beliefs as a result of having effectively addressed traumatic memories.
As you have already probably been thinking, riding the learning curve of how to do EMDR Therapy effectively involves much effortful thought, paced and supervised practice exercises, and application to client populations with expert consultation. The learning atmosphere during EMDR Basic Training is crucial. At ECSC we have the most excellent staff. They are supportive and compassionate, patient, and encouraging of your learning style. Learning the comprehensive EMDR Therapy paradigm is undoubtably a worthwhile challenge, and within our learning environment that is maximized for your trajectory of excellence you will achieve your goal of mastery to become an EMDR Trained therapist!
If you are interested in signing up for our upcoming EMDR Basic Training, click below to read more about it and to register.