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Episode 6: Healing from Trauma with Johanna Dobrich
137 Plays4 years ago
Johanna Dobrich talks to us about dissociation, disabled siblings, and how to navigate complicated family dynamics and challenging life experiences.
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Transcript
Introduction to Contradictions and Podcast Overview
00:00:05
Speaker
The toleration of contradiction is health. Thank you for joining us on doorknob comments, a podcast that we created to discuss all things involving mental health. We take the view that psychiatry is not just about the absence of illness, but rather the positive qualities, presence of health and strong relationships and all the wonderful things that make life worth
Guests and Focus on DID
00:00:24
Speaker
living.
00:00:24
Speaker
I'm Dr. Farah White. And I'm Dr. Grant Brenner. Here with our guest Johanna Dobrich, a licensed clinical social worker and psychoanalyst. Thanks so much for being here today. We wanted to bring you here to talk a little bit about your work in trauma and with DID.
00:00:40
Speaker
Right. So for listeners, DID means dissociative identity disorder. That used to be what's called multiple personality disorder. And I think while probably the public understanding is a little bit better, it's typically been pretty sensationalized.
Media Portrayal of DID
00:00:55
Speaker
One thing I've noticed that I was curious what your thoughts were, Johanna.
00:00:59
Speaker
There's been a resurgence of depictions of people with dissociative identity disorder in the media, things shows like Mr. Robot on Netflix, movies like Split, Fight Club. I'm curious what you think that means for our culture, kind of, or, you know, something along those lines.
00:01:17
Speaker
Right. I'm of split minds about this because I think getting attention to the prevalence of dissociation and dissociative disorders and DID in particular is really important. But because DID is often represented in a sensationalized way, the quality of the depiction really matters. And sometimes I think less is more, not more is better in that regard. The films that you mentioned all
00:01:45
Speaker
pretty much highlight some of the sensational aspects to the exclusion of more ordinary presentations, which are far less dramatic, though they can wreck sort of internal havoc on individuals' lives.
Misconceptions and Accurate Depictions of DID
00:01:57
Speaker
They're not going to be something someone walking down the street might take note of. The show Unbelievable on Netflix is the exception. I don't know if you guys saw that.
00:02:06
Speaker
I have to say I was really impressed with the show because instead of showing what DID looks like from the outside, the lead character just embodies the subjective experience. And there's no sort of like meta description of it. You just watch her say in an interrogation room, literally shifting states and the police officers doing the interview clearly not
00:02:27
Speaker
at that time knowledgeable about dissociation, calling her a liar or saying, that can't be true. You just said this. And the blankness and the confusion and the way the film is able to depict how she goes away in her mind is really well done. But that's an exception. I think for the rule, there's people can walk away thinking that people with dissociative identity disorder are homicidal, crazy, and out to hurt others, which is not the case.
00:02:51
Speaker
you know, definitely there's a kind of a law and order, you know, element to it. And there's a perception that people with trauma in general kind of have have superpowers, you know, that which is often depicted in the shows, but also sometimes because people with with conditions like this will be capable of doing a lot of work in a short period of time in a dissociative state, which to people who don't know what's going on can look, you know, quite different from what it's like on the inside. Right, right.
00:03:21
Speaker
which is really very inconsistent. And as you said, often kind of misjudging what behavior means. So not everyone who behaves in a contradictory manner, for example, is a hypocrite, or a liar, or being manipulative.
00:03:35
Speaker
Right. In fact, that's one of the harder, I think one of the harder experiences of having DID as an adult. The patients will be called by loved ones and family members liars or, you know, out to try to confuse or torment their loved ones when that is, that's not the subjective experience. Although the partners may not have any other way of understanding why one thing that was true yesterday is no longer true today or held within memory maybe.
00:04:01
Speaker
Well, I think that makes me, and I'm curious what you think Farah, psychoanalytically, at least traditionally, like people might ascribe destructive, self-destructive behaviors or relationship interfering behaviors as being masochistic, to some extent unconsciously on purpose.
00:04:18
Speaker
Whereas with trauma and dissociative disorders are often a consequence of early trauma that prevents a coherent sense of self from developing, the self-destructive or relationship interfering or work interfering behaviors, they're not on purpose and they're not wanted. And so calling it masochism is a big misunderstanding.
00:04:38
Speaker
Right.
Understanding Self-Injury and Affect Regulation in DID
00:04:39
Speaker
The neuroscientific perspective is that those behaviors are for affect regulation. Paradoxically, that self-injury, self-harm is actually a way of the person's internal system rerouting itself. Although I agree with you that psychoanalytic classical or older versions of psychoanalytic perspectives might say,
00:04:59
Speaker
This is a communication to the therapist of dissociated anger and it's messages for the therapist when really in a dissociated system, it's an internal message, right? We've crossed thresholds. The only way we know how to come back is through something that creates like a hypnotic quality, which is what a lot of self-injury does for patients with dissociative
Dobrich's Background and Trauma Therapy Approaches
00:05:18
Speaker
disorders.
00:05:18
Speaker
I'd like to shift gears a little bit and just if that's okay and just hear more about kind of how and when you got interested. I know that you've recently done a bit more training and incorporated some other modalities aside from analysis into your practice. You know, what makes someone interested in trauma? And it's sort of like, well, I don't think you choose trauma. Trauma chooses you. So most therapists, and I'll speak for myself because I can really only speak for myself.
00:05:45
Speaker
have some of their own direct lived experience with trauma, and it's something that contributes to, you could say psychoanalytically, the repetition compulsion and the desire to work something through. Early life experience for me with loss and medical illness in the family definitely informed my interest in dissociative process. You know, brought me to a sense of how important it is to have that understood as like a tool that kids may use, but
00:06:11
Speaker
outgrows its usefulness. And as far as training, I think that with trauma, it's really important that you get a salad bar experience and not delve singularly into one thing. I seem to draw support from the trauma literature, the psychoanalytic literature, and sometimes even the basic social clinical social work skills, direct practice, meaning the person where they're at literature. And you make a hybrid for yourself and you don't stop reading and learning.
00:06:37
Speaker
So would you say that it's sort of come together organically? Or would you say that there's something a little bit different, that the hybrid looks different in every case? Like at the heart of healing is a kind of witnessing, right? And when you witness someone, you can't witness someone the same way or be yourself the same way, like every time. So in a sense, each encounter calls for a different kind of involvement. But having certain scaffolding in your mind in terms of understanding
00:07:02
Speaker
for example, dissociative phenomenon. You can't treat trauma if you don't get that. You can't CBT it away. You can't talk someone into a different place.
Exploring EMDR in Trauma Therapy
00:07:11
Speaker
Or medicate someone into a different place. Yeah. Somewhere along the way, though, I did get really interested in thinking about how talking had its limits. And that's what led me to train in EMDR.
00:07:23
Speaker
I would like to hear a little bit more about EMDR. I should say I can't really be a full spokesperson as I recently completed the training, so it wouldn't be appropriate for me to be the expert on it. But I will say that what drew me to it is that with dissociation, you've absented yourself from fully experiencing what's happened to you in one form or another in one way or another. In order to encounter it, I think you need
00:07:47
Speaker
There are certain things the environment needs to provide. So a good therapeutic situation, the therapist will witness it with you. Sometimes because it involves the whole body and the central nervous system, there are processes that are happening beyond your control that interfere with your ability to create a narrative that you can tell a therapist that a therapist can see and hear and respond to. So my like rogue and newish understanding of EMDR is that it
00:08:12
Speaker
It offers a way for a person to access discordant parts of the experience through specific protocol, particularly the bilateral stimulation, that bypass some of the obstacles you would encounter by trying to just talk about it directly.
00:08:28
Speaker
Right. So what would that mean if a patient came in and they said, they said, you know, when I was 11 years old, this horrible thing happened and you, you know, you evaluate them and you know, they have had some traumatic experience. They're having some dissociative symptoms, having some difficulty in a relationship. What would that look like from the patient point of view? What would you actually do? What would, what would a standard EMDR thing be? Is there a particular example of a common trauma you want to use or?
00:08:55
Speaker
There's protocol for every kind of trauma. The EMDR community has blossomed into its whole own entity because I'm figuring out how to incorporate it in what I already consider a psychoanalytic approach. The way I would approach it in someone that really is fully identified as primarily an EMDR therapist is different.
00:09:14
Speaker
An EMDR therapist would approach that patient by getting a trauma history and doing something called resourcing, which is building up inner tools to use to help regulate affect during the actual desensitizing and processing. So that means what, though, the actual desensitizing and processing would mean? What? They would talk about their trauma? They would remember it? No, no, no.
00:09:38
Speaker
specific protocol where archaic beliefs about the self, negative beliefs about the self that are irrational, that are associated with the memory, such as with early parent loss, a kid could feel that they're culpable for that even though it's irrational.
00:09:54
Speaker
the protocol sets it up so that you activate both the left and the right brain. So you get the affect system going and you get the thoughts going associated with the trauma. And then the point of desensitizing is that you use the stimulation to have them experience, recall, see where their own intrinsic healing system takes them. So it's a process of association. It bypasses dissociation because it
00:10:20
Speaker
it works in such a way that it gets you to just put things together that you'd never put together before. So I can give you an example of this because when you ask a patient about a trauma, they'll typically tell you in either a flat affect way or a disembodied way, the event, right? When you do EMDR, what's really interesting is that even though parts of that dissociative experience can enter into the processing part, I've so far experienced learning details I've never heard before when I've just asked outright about an event.
00:10:49
Speaker
And the details that are omitted are actually the protective factors. It's so interesting. All of a sudden, someone's at the parent's funeral, at the casket, et cetera, et cetera. And then they have a memory of someone holding their hand, or they have a memory of what they did right after, or they have a memory of how a teacher at school did blah, blah, blah. And these protective features are not in the consciousness of the person when they come in to talk about the trauma.
00:11:12
Speaker
That, to me, is a really amazing and cool gift of EMDR. And it's not that necessarily negates or takes away the trauma, but it allows it to become integrated in a way that's stored somewhere else that's not sequestered often as harmful because adaptive features get recognized. Basically, the main idea is that beliefs about the self are changed. So whatever that negative belief is is ultimately through a successful EMDR processing rework to something more adaptive, like it wasn't my fault, or I did the best I could,
00:11:41
Speaker
But just to get back to what you said, Grant, because I do want to say I don't do that. If someone comes in and tells me they have a trauma, I'm not like setting a protocol. Because I still very much believe in relational healing and witnessing. And I think that my relationship with the patient and the degree to which we're connected is going to be a part of that. With someone that's dissociated, you really want to go super slow. You don't want to go right into trauma processing. There's a reason they're dissociated. So I do a lot of relationship building and get them
00:12:10
Speaker
gradually to become conscious of their dissociation, and I might do EMDR months or years into the treatment. Right. That's fairly standard with a phase-based approach, meaning that you start with safety, and then you work your way toward what's more difficult processing traumatic memories in the middle phase of therapy. My question was kind of like, what's the difference between EMDR and trauma-focused cognitive behavioral therapy?
00:12:35
Speaker
because the evidence is that they're equally effective for trauma. And what interests people with EMDR, it's more popular than trauma-focused CBT. It's sort of caught the public interest recently. There's people who report that EMDR sort of will almost miraculously cure them. And there's a message that the bilateral component does something different. And so far, I haven't seen any sort of scientific evidence
00:13:01
Speaker
that it is better than trauma-focused CBT. I'm just curious since you did the training and for listeners whether there's fundamentally any difference. I do think that the bilateral sounds like a little wonky and like how could it make a huge difference, but experientially I will tell you it does.
00:13:18
Speaker
It absolutely does. Part of the training requires that you experience EMDR yourself. I was skeptical. Like, why would tracking with my eyes mean that I would reach somewhere that I haven't gotten just on my own accord? And I did. And I don't know why it works. I mean, Frances Shapiro, who was walking in the woods and developed the technique and noticed that
00:13:37
Speaker
because she was walking in the woods had to avert her gaze bilaterally. This was discovered by accident. She was thinking about something distressing, walking in the woods while doing that. And she realized that lessened some of the capacity to want to not think about it. So she was able to stay with it longer. So something about the bilateral stimulation creates an associational chain. It's like on a highway. It's just going so fast. Like it's like whatever sort of sensor experience you'd have at stopping a thought that you wouldn't even know, but just unconsciously would be happening is interrupted.
00:14:07
Speaker
So, that potency I don't think is recreated in the stage therapy of trauma that focus CBT because there isn't something to help with the associational process in this way. And I don't think that they're activating, they're not activating left brain, right brain, right? Intentionally they're not creating protocol to use both parts of experience, are they? I'm less familiar with it.
00:14:30
Speaker
No, I don't think that's an explicit part of that. Yeah. The stimulation right, left, right, left is somehow supposed to help with integration across the two halves of the brain. Right. Like across the corpus callosum. Yeah. When I've worked with people who are spontaneously processing trauma, they will often look up as people do when they imagine things and look back and forth. That's right. It happens organically. That's right.
00:14:55
Speaker
Yeah, so I'm open to the possibility. I would just like to see, you know, an FMRI study or something like that. You know, brain science. But you're saying subjectively, having done the training, something different happened and you made connections that you hadn't made previously. And you're still trying to think about how to fit it in with sort of your more traditional insight oriented therapy.
00:15:17
Speaker
Right.
Therapist Preparedness for Trauma Work
00:15:18
Speaker
And so much of that is just really a question, well, a few questions. One of timing and readiness, which is always a question when you're working with trauma, is this person able to incorporate and tolerate what's going to come up, which is what's required of being able to desensitize a memory, or would it be so disruptive to do that or too disruptive to do that, or do we need to break it into pieces to do it, etc.
00:15:42
Speaker
The other thing EMDR does is it really draws attention to the body. Part of the processing and part of the protocol involves scanning and noticing what's happening in the body, and I don't know that trauma-focused CBT does that as much either. I think it's more about what's in the mind, right? I believe that embodied experience would be a part of it.
00:16:03
Speaker
That's more of like a technical question. I think it's really hard to do any kind of trauma-oriented therapy if you're not covering all the different types of experiences that people have. But I think it would be common for therapists to kind of forget about the body. Right.
00:16:18
Speaker
I always make a point of kind of thinking about bodily experience and that's where sort of trans, counter transference and transference can come in handy because you notice things in your own body. And when you're talking about people, patients being ready to deal with trauma, it's also
00:16:35
Speaker
I think especially for less experienced therapists is the therapist ready for the trauma and a lot of times the blind spots that come up in therapy are because both people are quote unquote unconsciously colluding to avoid difficult topics or you know that sort of thing. It's also not unusual for therapists to get better as therapists over time when they've dealt with their own stuff because now there's a whole topic you can talk about.
00:17:00
Speaker
Right. There's also that experiential repertoire that you know what's on the other side. So the risk is not unknown. Right. What therapists call like a coherent narrative. So if you've dealt with your own body stuff, then you're more likely to be able to help patients with it, which also can be a source of guilt for less experienced therapists.
00:17:19
Speaker
Right, right.
Sibling Experiences and Family Dynamics in Therapy
00:17:20
Speaker
I'm writing this book about the experience of being a survivor sibling and part of what I'm... What does that mean, a survivor sibling? Oh, thanks. Yeah, sorry. So I've interviewed psychoanalysts who grew up alongside a medically complex sibling and I'm looking at sort of early developmental narratives and experiences with that kind of survivorship, psychic survivorship is what I mean really.
00:17:41
Speaker
Do you mean people who have a sibling who had a medical condition or a developmental disability? Yes, the condition had to be present from early on, if not right away in the life cycle and have persisting, debilitating features, medical, psychological, physical.
00:17:57
Speaker
So one of the experiences I had early on as in my teens in analysis was, you know, I was seeing maybe, I guess it was a Freudian analyst in training, and I would sometimes get this body sensation that I was cut off at the knees. And I couldn't really even put it to words, and I think the few times I tried to, it wasn't material somehow. Like, you know, this analysis hadn't conceived of using the body or understanding the body or embodiment yet.
00:18:23
Speaker
I heard that metaphorically, being cut off of the knees. Exactly. You know, it's a metaphor. Well, my brother's in a wheelchair and I don't think I had any other way of bringing that experience in, so my body did for me.
00:18:35
Speaker
Well, a lot of times survivors in situations like this, you know, they will feel guilt also, right? And a variety of complex feelings. So where are you in the process of writing the book? It must be an incredible experience to put that into words. It is, it is. I found EMDR in that process.
00:18:54
Speaker
Do you flip back and forth in the pages? I know there's a funny thing with the MDR because it does have an aura around it where it's not fully accepted and yet it has this allure for people so it'll mean to be disparaging. What have you found in writing though?
00:19:14
Speaker
Experientially, it was really, really hard. I thought I could write about history and it be in history. And I wasn't prepared for re-encountering it in the writing. And I should say that the idea for the book came to me because I was sleep training my infant son at the time when he would wake up in the middle of the night crying. I had a very particular kind of traumatic experience. Part of my early years, my brother would have life-threatening seizures mostly overnight when I was zero to six.
00:19:43
Speaker
And so I had this reaction to hearing my sons crying that I couldn't understand because I was like, he's a baby. He's supposed to cry. He probably wants milk. But like my whole body would tense up and I would just like, I kind of had this phrase in my head. It was just like, no, no, no. And then I would really kind of quickly come to. So I didn't lose too much time in that place. But I was like, wow, the potency of those early years are even here now. And so that got me thinking, I can't be alone if I'm
00:20:12
Speaker
other survivor siblings must have this encounter, and I wanted to hear from others. I definitely knew that it was some part of the driving force between my desire to become a therapist, so I decided to make use of that intrusive experience and examine it.
00:20:30
Speaker
So when you write about it, what do you want readers to understand and what have you written about that? Have you written that section yet? Yeah, that's the preface. I guess I want people to understand that it's never too late to process whatever's happened to you and that going to
00:20:48
Speaker
therapy and making space for yourself and your experience is really worth it. In the field in general, I want us as therapists to think about the impact of, um, you know, medical issues in the family, but sibling experience in particular, I mean, there is literature and I'm also interested in this topicly, uh, narratively as well of early parent loss, but there's not that much about sibling and sibling encounters, especially around loss. What is present is, is around envy competition and the assumption of evenness and
00:21:18
Speaker
capacity. I think there's one book that was written a decade or two ago. Yes. Called the other one. The normal one. So your book sounds like a follow-up or not a follow-up but your take on it which I'm sure has a lot of unique elements to offer. That's right.
00:21:36
Speaker
Yeah, I wouldn't say it's a follow-up. Jeannie Shafer wrote that book, and she interviews siblings with difficult sibling relationships in general. So it's not focused on medically complex issues in the family. Oh, that's interesting. I didn't know that. Yeah, so you could have a really difficult, strained relationship with a sibling or a brother with cerebral palsy and be in the book. And my book really is focusing on a very particular sect of survivorship.
00:22:06
Speaker
Andrew Solomon has an interesting book. Have you, you know, Far From the Tree? I sure do. Which is mainly about parents with children with differences. Right. And, you know, for a lot of parents, I think, at least the ones who respond with resilience, you know, having a child with a significant challenge can be an incredible growth experience, as well as, you know, a process of grief.
Integrating Adversity and Dissociation in Identity
00:22:29
Speaker
Of course, you imagine your children will be different than they are under the best of circumstances.
00:22:36
Speaker
siblings with difficulties like that, you don't have that imperative to be there for them as a parent. And it can kind of become a defining feature of your life as an adolescent, for example, because you're the kid who has that sibling, or you're the kid who has that secret, or whatever it is. And it makes me curious about how you approach the question of identity.
00:23:02
Speaker
because I think anyone who grows up with adversity has to integrate it into their identity in order to be full and authentic human beings. That's right. And that's where a dissociative process plays a part because actually one of the pathways to relatedness among, you know, a survivor sibling and a disabled sibling is kind of like parenting or caretaking. It's one of the only pathways since language and other areas.
00:23:24
Speaker
are often unshared. It creates real complications in terms of the psychic structure of the survivor. They're a sibling, but they don't have all the privileges of being a sibling, but they have the responsibilities of more than a sibling. What do you mean by psychic structure?
00:23:40
Speaker
like how they negotiate a sense of themselves in their relationships in their inner world. Then psychic structures would determine how a person responds in different situations and particularly if they don't understand what's going on mentally, they're likely to say repeat patterns that aren't optimal.
00:24:00
Speaker
Sure. That's right, Grant. But I would say it's sort of like a perceptual apparatus. And most survivors of any kind, survivors in general, by definition, develop a dissociative perceptual apparatus. Like the lens. The lens. Where they're able to notice and experience certain parts of themselves and others and where they have to omit and disidentify or not notice or not absorb other aspects. And that will infiltrate all relatedness beyond the original situation that elicits it.
00:24:27
Speaker
I want to ask if you have an example of that. If I grew up with a disabled sibling, then what would I see in people close to me and what would I miss? I'm very careful in this book to not say, if you have this, this will happen. Not too prescriptive. Yeah, because I think that there's more than one way to survive. There is more than one way to survive. What often happens, or maybe this may be an example I can give, is that one doesn't notice their own disabled selves or their own limitations because there's such pressure on
00:24:56
Speaker
identifying with ability and performance. And there isn't a space to work out struggle, maybe with parents. Parents have to work out struggle with the disabled child. So, you know, so what does that look like? Well, it might look like a therapist who has trouble confronting or addressing or dealing with patients who present in challenging ways. They might absorb responsibility or disavow feeling a sense of difficulty doing the work.
00:25:22
Speaker
Perfectionism. They also might be more compassionate. It all depends on how much they've worked out the dissociative stuff. That's really the premise of the book. You'd want to watch out for being overly compassionate. Right. That's as defensive as being not compassionate. It's somewhere in the middle.
00:25:38
Speaker
We're all therapists here, so we know there's a risk of being a compulsive caregiver. That's right. You want to remain curious about what motivates your caretaking and also recognize that there's not a lot of help for discordant feelings around the family circumstance. So what do you do as an adult with your discordant feelings?
00:25:58
Speaker
You mean something like in the family growing up, if you were the kid who didn't have the disability, for example, and you had a problem in school with a test, you might just keep it to yourself. And solve it on your own. Yeah. You don't feel like you deserve to get attention and the bandwidth might not be there. I know that doesn't apply to everyone. Right.
00:26:17
Speaker
That might be one way that it comes up. On one hand, you can feel proud that you don't have these problems, and lucky maybe, and afraid that something bad will happen. You might not be aware of it fully. But on the other hand, you may not be able to get the attention you need. That's right. And then you don't feel like you deserve to feel resentful. Right, right. And you're not allowed to express negative feelings, and then therapy.
00:26:38
Speaker
Like, yeah, but I would put them in self-state language and say part of the self might feel lucky. A part of the self might feel actually like really unlucky because they have to always feel lucky. A part of the self might have no way of using their aggression, which was a pretty consistent theme. Aggression feels deadly. There's actual limitations. So what are you supposed to do with that? That could overlap with other experiences like with a parental. It gets very frightening, I think.
00:27:03
Speaker
Yeah, I mean one of my biggest fears though is that it could be misheard as blaming or assigning, yeah, assigning blame to parents in the situation as if there's other ways of going through it. I mean, parents have their own dissociative process to work out around this development. So I'm trying to be really careful of
00:27:21
Speaker
telling a story or telling the stories of what might or could happen, but not really singling anyone or anything out. It's just an ambiguous loss that complicates the family narrative and has consequences on everyone's psychic structure. People look for a scapegoat. I remember I came up with a joke a few years ago about therapy, which was after years of successful therapy, I finally stopped blaming my parents for everything that happened to me as a kid. Now I blame my grandparents.
00:27:53
Speaker
There's no first cause, then it kind of becomes theological. This is really fascinating and enlightening and I'm thrilled that you're writing a book about it because I myself have a great interest in family dynamics. I find that it does not come up nearly enough. Right.
00:28:10
Speaker
Yeah, I mean, it's sort of, it is like a new frontier, siblings. I mean, it shouldn't be, they've been around forever, but it kind of is, you know? Especially when we talk about attachment and like the caregiving system, like the presence or absence of others, it has a huge effect on attachment. It's kind of like we have to account for this, you know?
00:28:29
Speaker
Traditionally, people have focused on the parents. Though in relational psychoanalysis, there's been a lot of attention to systems and family systems, but it tends to focus on parental relationships. And people have funny ideas about siblings. They're aware of things you said earlier, like competition. There's an idea that the older sibling has more responsibility, the middle sibling gets
00:28:52
Speaker
forgotten, the youngest sibling has all the freedom, then there's cultural differences, you know, there's a lot of ideas about that. And then parents will say things. I was actually speaking to not a patient, but someone else today who said, well, you know, the oldest, my oldest child, when they learned to drive, we were terrified. And then the other two, we just got numb.
00:29:13
Speaker
Right. And it says something because how do you think about stuff that is really troubling? I mean, and we're facing this problem sort of collectively because, you know, not to get too global, but, you know, there's scary stuff in the news and there's climate change and the world, you know, we don't know what's going to happen. And if you disengage from disturbing ideas, you can't deal with them well. Yeah.
00:29:40
Speaker
That's dissociation. Right. It's great when you're a kid and you can tune out, but when you grow up, you have to pay your bills and, you know, keep everyone safe. Well, and let's face it, those kids that tune out actually would rather have an involved and attuned caregiver. So it's maybe life-saving, but nobody chooses dissociation. I think that's the bottom line.
00:30:00
Speaker
Well, the choice, if there is an element of choice, it's in the context of not having other choices. This is kind of a default. I know people who have consciously chosen dissociation, it's because you don't have a secure attachment figure, or you can't access them if you happen to be very dismissive.
Intergenerational Trauma and Dissociation Dialogue
00:30:18
Speaker
Really, that's what I mean, right? Nobody chooses an insecure or disorganized environment.
00:30:22
Speaker
You don't choose your parents. You don't choose your family. You don't choose where you're born. Well, we could pass it past parents. You don't choose your legacy, the inheritance of unconscious stuff from all the generations. You know, a lot of trauma patients actually are carrying the trauma of their parents or their parents' parents and not their own. And they have no idea why they're so depressed or why life feels one dimensional or why relationships always go awry at point X.
00:30:45
Speaker
Yeah, even epigenetically, that you can be carrying genetic effects from your ancestors. And a lot of clinicians aren't trained to ask about the family history. You develop a sense of it. And also, when people come from certain places, you know that where their families came from, there was war. And so you kind of know objectively to ask about it historically. Like you're saying, it's pretty much ubiquitous. Anyone who came to America in the last couple hundred years came from somewhere
00:31:12
Speaker
But also maybe it could be dissociation inherited genetically, right? An example of that, that we reference it as loss or that thing, that being the inheritance.
00:31:21
Speaker
It's tricky the way language is used and it's really interesting because there's polite ways of talking and then there's impolite. Some people, they think that it's good to be honest all the time, quote, unquote, honest. I always try to cure that quickly. You cure that, yeah. And there's different self states, right? Like you're saying, part of me wants to be really candid and part of me wants to be more diplomatic.
00:31:44
Speaker
the categories we put people in can both empower them and also silence them. So if you tell someone how sweet they are or it makes me think of sexism like, you know, you're so sweet, you know, why don't you smile more or you're being, you know, the pejorative term that people use to describe women who are assertive.
00:32:03
Speaker
Elizabeth Wurtzel just passed this week and one of her books is by that name. Melanie Klein's daughter was giving a talk about her work with borderline patients that I read recently for a talk in preparing and the all-male analytic audience at the end said, wow, that was so sweet. Your sympathetic nature just elicits a nice positive transference.
00:32:29
Speaker
Right, right. And she would be thrilled, I'm sure, to be referred to as Melanie Klein's daughter. Is that her birth certificate? Just put Melanie Klein's daughter down for her name. All right, truth be told, I'm dyslexic and I have trouble pronouncing names. Melitta is her first name. I'm not going to try to say her last name. It starts with an S.
00:32:54
Speaker
Oh yeah, I don't know her name anyway, but it's an interesting thing. Is that like a repetition of something, an enactment, or okay, I can't remember her name. Well, I think it's actually me just not wanting to feel ashamed at mispronouncing it, imagining someone knows how to say it right if I say it wrong. But it is also interesting that I would use a phallic representation of her mother to introduce her. So I don't know, maybe there's both stuff there happening.
00:33:22
Speaker
I usually just say it wrong. You know the word quixotic from Don Quixote? I usually say chaotic, which no one gets. Right. I'm fortunate that I have a partner who can translate my mispronunciations rather easily. What do you guys think about trauma? Where are you in your journey in treating trauma?
00:33:45
Speaker
I think for a long time I hid behind the fact that I was pretty new to practice and that I had started with people relatively recently. So as I'm moving through into that second phase with patients, I see more and more coming up. I feel my own awareness kind of growing, but still looking for the tools and the scaffolding. One thing that was really interesting was taking
00:34:10
Speaker
A course in analytic course and development. Right. Because if something felt very adolescent to me or if I wasn't able to put my finger on it, you know, there was something that happened during latency. And now, I don't know, I think I look at things a little bit differently, but I don't feel totally equipped. And that's probably why I work so closely with you.
00:34:33
Speaker
But I think the day you feel totally equipped to deal with trauma, you are no longer dealing with trauma because that's not, I mean, no matter where you are on the journey, that attitude is one, defensively excluding what is not known. You can't possibly know it all. And I think you're right. It's really important to have a good grasp on what should happen, developmentally in life, to know that
00:34:56
Speaker
to know what to look for when it hasn't. I mean, so much of lowercase relational developmental trauma is the absence of something happening that might have been profitable. That's the Winnicott quote, I think. Yeah, right? So it's not these big moments of terror. It's chronic misatonement or chronic shame. Chronic emotional neglect.
00:35:17
Speaker
Right. Or even in an infancy, not having someone help you mark transitions between states and not helping build a highway with lots of roads that intersect so that you can jump from hungry to angry to interested to bored to sleepy without feeling like you're a completely different person or you're a stranger unto yourself. Right. Well, being left alone by the tip, stereotypically the mother, the primary caregiver, when a kid has an experience which they can't make sense of and then the caregiver comes in and says,
00:35:46
Speaker
were hungry and now I fed you and now it's time for a nap. And so the person marking develops a sense of continuity over time of switching from one state to the next and through the language and embody the body contact with the mother, they develop a sense of self, which is more cohesive. That's right. That's right. And also a belief that they could be known.
00:36:12
Speaker
That's huge. I mean, how much do you hear in adult patients, this idea?
Therapeutic Techniques and Building Conflict Tolerance
00:36:17
Speaker
There are so many adult patients are dating a fantasized version of themselves and the other person because they haven't had this experience of being known. They don't know what it is to exist in the mind of the other person as they are, as they shift through states.
00:36:32
Speaker
One of the hot topics in therapy nowadays is along these lines is mentalization-based therapy, which really focuses on developing that kind of curious containment and imagining and speaking, symbolizing self-representations and the mind of the other person in the context of communicating together.
00:36:55
Speaker
And so that creates another like buzz phrase would be like an intersubjective way of relating. Totally. Where there's room for different perspectives and they don't have to clash and become conflictual and so something like contradiction is fine. It's health actually from a relational perspective as I understand it. Right. The toleration of contradiction is health. Right. With extreme dissociation you don't even have conflict because the person doesn't encounter the contradiction.
00:37:22
Speaker
They say it's ambiguous or ambivalent, pre-conflictual. That question about trauma and dissociation, I think it's really a big problem for our species because we're alluding to individuals coming from traumatic backgrounds and how that affects the family.
00:37:42
Speaker
As a people at a collective level, yeah, there's really not much room for negotiating conflict. Though I guess you could make a counter argument and you could say things could be way, way worse. No, I don't want to make that argument. I want to tell you I share that concern, but what I do to settle myself is think, well, the people I'm working with to help build a capacity to bear conflict are also voters.
00:38:06
Speaker
and civic citizens who may then be able to bring a more integrated sense of self and presence into our world polity, or else it's too depressing and frightening.
00:38:18
Speaker
What should people do? At the risk of sounding prescriptive, the first thing is do your own work. You have to have an experience of your own depth treatment working out whatever your history is. You can't really take someone somewhere or be brave enough to encourage them to go there if you haven't been there yourself. But I wouldn't stop at your own treatment. I would say that good supervision is critical because if you
00:38:43
Speaker
treat trauma, you're going to be engaged and enlisted in feeling and experiencing and encountering a lot of things and it can get really disorienting. So having a third space, if you want to use that metaphor of attachment, if the supervisor is like the parent to help mentalize and mark what may be happening is really organizing for the therapist who's devoted to doing trauma work. Third thing is community.
00:39:05
Speaker
Thank you guys are awesome. Thanks for having me. Hope we can get dinner after this. But there are also really great organizations, and I mean, I never say this, but thank God for the internet for this. You can talk to people at the International Study for the Treatment of Trauma and Dissociation. You can get on the Dissociative Disorders listserv. You can get on PODS has a listserv in the UK, so there's lots of communities.
00:39:29
Speaker
of like-minded or therapists committed to working with trauma that you can join and feel less alone in doing the work. Also, just never stop learning. I feel like I don't have any more room on my bookshelf, so I don't know what the plan is, but I can't stop buying books. I think it's really important because what we know changes and can change pretty quickly in this field, at least in trauma, not in psychoanalysis. That's a glacial piece. I agree.
Integrating Trauma for Resilience
00:39:56
Speaker
There's a lot of strength in getting through these things and it's important always to remember that trauma isn't the whole story. In fact, you get that strength and resilience when trauma becomes part of your story and it sort of stops being traumatic.
00:40:13
Speaker
Well, it stops also defining you as singularly the thing about you. As you said earlier, authenticity is where it's at. You get to be an authentic person. An integrated person. If you're a jerk, you can be a jerk and feel good about it. Not so ashamed. And then I would thank you so, so much for being here today. And I feel like this was, I mean, I learned a lot. I think listeners will too. Yes. Thank you very much. Thanks for having me.