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Diagnosed with Complex Trauma and a Dissociative Disorder, Emma and her system share what they learn along the way about complex trauma, dissociation (CPTSD, OSDD, DID, Dissociative Identity Disorder (Multiple Personality), etc.), and mental health. Educational, supportive, inclusive, and inspiring, System Speak documents her healing journey through the best and worst of life in recovery through insights, conversations, and collaborations.
Over:
Speaker 2:Welcome to the System Speak Podcast, a podcast about Dissociative Identity Disorder. If you are new to the podcast, we recommend starting at the beginning episodes and listen in order to hear our story and what we have learned through this endeavor. Current episodes may be more applicable to longtime listeners and are likely to contain more advanced topics, emotional or other triggering content, and or reference earlier episodes that provide more context to what we are currently learning and experiencing. As always, please care for yourself during and after listening to the podcast. Thank you.
Speaker 2:Hello. We have a special guest today. I'm interviewing Doctor. Colin A. Ross, who completed his medical school at the University of Alberta and his psychiatry training at the University of Manitoba in Canada.
Speaker 2:He is a past president of the International Society for the Study of Trauma and Dissociation and is the author of over two twenty papers and 30 books. He has spoken widely throughout North America and Europe, and in China, Malaysia, Australia, and New Zealand. He has been a keynote speaker at many different conferences and has reviewed for over 30 different professional journals. Doctor. Ross is the director of a hospital based trauma programs in Denton, Texas Torrance, California, and Grand Rapids, Michigan.
Speaker 2:He provides weekly cognitive therapy groups at all three locations, in person Texas and by video conference in Michigan and California. He has been running a hospital trauma program in the Dallas area since 1991. Doctor. Ras's books cover a wide range of topics. His clinical books focus on trauma and dissociation and include Dissociative Diagnosis, Clinical Features, and Treatment of Multiple Personality (nineteen ninety seven), Innovations in Diagnosis and Treatment thousand and four, The A Solution to the Problem of Comorbidity in Psychiatry, two thousand and seven, Trauma A Treatment Approach for Trauma Dissociation and Complex Morbidity, 02/2009, A Proposed Modification of the Theory, 2013, and Treatment of Dissociative Techniques and Strategies for Stabilization, published in 2018.
Speaker 2:Doctor. Ross has published a series of treatment outcome studies in peer reviewed journals, which provide evidence for the effectiveness of trauma model therapy. Many of his papers involve large series of cases with original research data and statistical analyses, including a paper entitled Trauma and Dissociation in China in the American Journal of Psychiatry. Besides his clinical psychiatry interests, Doctor. Ross has published papers and books on cancer and human energy fields, as well as literary works including essays, fiction, poetry, and screenplays.
Speaker 2:He has several different hobbies including travel. I actually first found Doctor. Ross in the cancer articles when I was looking for information after my parents were diagnosed and then my own diagnosis. That's not what we're talking about today, but what I appreciated at the time was his perspective was so different than the politics and culture of money based medicine, as opposed to science based medicine, and it really impacted me. So when I discovered that he was also one of the early leading experts in the field of dissociation and trauma, I was really surprised and found the same thing, that he holds a unique perspective that can be a bit mind boggling compared to what everyone else says when they are so easily dismissive of dissociative disorders.
Speaker 2:And yet his research has held out hope not only to understand dissociation, but to confirm that it exists and that it's far more common than most people think. Because of time constraints for the podcast, I want to skip the story of how he learned about dissociation in his early career, but it's a really good story. And so I'll include a link to one of his videos in the blog. So let me welcome Doctor. Colin Ross, and let's start with just defining dissociation.
Speaker 2:I know that some of what you have taught in the past is that part of the confusion about what dissociation is, is that there are actually four definitions to dissociation, and people often aren't even sure what they're talking about.
Speaker 1:Well, I I go over that in my workshops and my writings, and there's at least four definitions of the word dissociation. And so that does cause confusion because there's crosstalk because people mean one meaning or another meaning or another meaning. So the first meaning is it's just a general systems term, and it's really just the same thing as disconnection. So if two things are dissociated, dissociated, they're out of relationship with each other. They're not interacting.
Speaker 1:They're disconnected from each other. If two things are associated, they're linked together, interacting, connected. So dissociation is the opposite of association and basically means the same thing as connected or connection. And this can be true anywhere in the universe. So there's dissociation constants in physical chemistry, for instance.
Speaker 1:Any two things can be dissociated from each other. So it's a very general term. The second meaning of dissociation is it's a technical term in cognitive psychology, experimental psychology, and it's been used for thirty years or so now at least. And so there will be a disconnection between, say, procedural memory and declarative memory. Declarative memory is more or less like explicit conscious memory.
Speaker 1:Procedural memory is like implicit or unconscious memory. And you there's tons, like thousands of experiments showing in many different experimental models that you can have information stored in procedural memory. It's not available to conscious memory, but it's affecting behavior and output. And so this is just a fact in cognitive psychology. You have a dissociation between memory systems, the conscious system, the unconscious system.
Speaker 1:Third meaning of dissociation is phenomenological meaning. That is dissociation is the symptoms of dissociation. It's so how do you define dissociation? Well, it's the items in the measures of dissociation or in the diagnostic criteria in the DSM five. So dissociation is example, one two three four five.
Speaker 1:It's just symptoms, which is also true of, say, panic disorder. What is panic disorder? Well, panic disorder is when you have this, this, this, this, and this. What is depression? It's this list of symptoms, and so it's just symptoms that people report.
Speaker 1:It's no different, no more mysterious than any other set of symptoms in the DSM. And then the fourth meaning, which brings in a lot of the confusion, is it's a theoretical defense mechanism. So it's not something you can observe or weigh or measure. Dissociation is a process or a defense mechanism going on in your mind. And so there's people who, first of all, aren't clear on these different meanings, and they'll say, don't believe in dissociation.
Speaker 1:They're not saying that they don't believe in the general idea of disconnection. They're not saying they don't believe that there are measures of dissociation that have listed symptoms. They're saying most of the time, they don't believe in this internal process defense mechanism of dissociation. So you can not believe in the internal defense mechanism, meaning of dissociation, and completely believe in the other three meanings. So it's not like all all or none.
Speaker 2:Oh, wow. What it what is it that you've spoken about, the horizontal and the vertical splitting?
Speaker 1:Okay. So that's a good good thing to get into next because part of the confusion is and the controversy is there's no such thing as repressed memories. There's no such thing repression is the same thing as dissociation. So skeptics or critics will say, well, there's no evidence for repression. It's just a bunch of bogus Freudian theory.
Speaker 1:Dissociation's the same thing. There's no evidence for that either. So the whole thing is bogus and unscientific.
Speaker 2:Wow. So
Speaker 1:meanwhile, they're ignoring the fact that there's a huge literature on measuring dissociation, questionnaires for it, diagnostic criteria for it that follow all the same rules as the regular DSM five. But so why is it not true that even at the level of a defense mechanism, dissociation and repression are the same thing? And the there's this very handy little diagram to use to explain that, which was first invented by a guy who was writing in the the late seventies, Ernest Hilgaard. He he had a book called Theory, and he had this little diagram. So he says that repression is based on horizontal splitting, so that's a horizontal line in your mind, and dissociation is vertical splitting, so it's a vertical line in your mind.
Speaker 1:So this is just a metaphor or diagram. But in Freudian theory, there's two subtypes of repression. So it's also important to be clear what does Freud mean by the word repression.
Speaker 2:Right.
Speaker 1:So there's primal repression, which has absolutely nothing to do with memories, events, trauma, abuse, or anything else. In primal repression, you have id impulses, urges, drives that are emerging into the ego consciousness. The ego's got some sort of conflict or phobia of them, so they get pushed back down into the unconscious before they even really fully emerge into conscious awareness. So that's just impulses, drives, instincts, and so on. Nothing to do with experience, nothing to do with trauma, nothing to do with memory.
Speaker 1:The second meaning is repression proper, and these are terms that Freud just defined in his essays on repression.
Speaker 2:Okay.
Speaker 1:In repression proper, you have material in your ego, in your conscious mind, and it has to do with things that have happened. And you have conflict about it or you don't wanna deal with it, so you push it down through this horizontal barrier in your mind into your unconscious. So it was up top in the ego. Now it's down below in the id, and when it's down in the id, then it's subject to all kinds of primary process, dream mechanisms, fantasy, all these things that the unconscious mind does, and it can get distorted.
Speaker 2:Wow.
Speaker 1:That's that's Freudian theory. So what is dissociation? If we use dissociative identity disorder as the main example. In dissociation, nothing is pushed down from the conscious mind into the unconscious mind. There's no horizontal splitting.
Speaker 1:Things are pushed from one compartment in the ego into another compartment in the ego across a vertical split, and the the point there is that these things are not buried in the unconscious. They're not getting all mixed up with dreams, and when you recover a memory in somebody with dissociative identity disorder, all you're doing is removing the horizontal barrier between one alter personality and the other alter personality. So for, say, the eight year old alter personality that remembers sexual abuse by dad, that eight year old ultra personality has always remembered that information. It's always been in the conscious mind. It's just in one compartment and not in the out front adult compartment.
Speaker 1:So it's a it's a completely different process.
Speaker 2:So it's not that a memory is falsified or recovered so much as access is gained to where it already was and still present.
Speaker 1:Right. And it was in the conscious mind
Speaker 2:Okay.
Speaker 1:All all along. But all I'm the point I'm making is that repression is not the same thing as dissociation. So if you blow off repression and say it's not real, there's no science for it, that tells us nothing about the scientific status of dissociation because they're not the same thing.
Speaker 2:Okay.
Speaker 1:And then the other curious twist on the history is a lot of the hostile skeptics will say, well, it's all a bunch of bogus Freudian theory, and, you know, we don't believe in Freud anymore. We're scientists. We're in the 20 century now. And so therefore, we don't believe in all this recovered memory stuff. We think that these are all false memories.
Speaker 1:But problem is, if you go back to actual Freud and his actual writings, in his 1895 book called Studies on Hysteria with Joseph Breuer, he describes a whole series of women who clearly have partial or full dissociative identity disorder. They have all kinds of symptoms, and he attributes those symptoms to childhood sexual abuse that he thinks actually happened. So this is the seduction theory of hysteria. Back then, hysteria did mean what it means today. Right.
Speaker 1:Back back then, hysteria meant basically a combination of post traumatic stress disorder, dissociative disorders, borderline personality disorder, psychosomatic symptoms. So all these symptoms, he thought, were directly causally related to sexual abuse in childhood that actually happened, and he describes this in great detail and talks about double consciousness and amnesia for things, etc. Then in 1897, in his letter to Wilhelm Fleisch, he repudiated the seduction theory. He decided that all this abuse never happened, and the abuse was being reported to him by father daughters of his Jewish friends, neighbors, and colleagues in a small section of Vienna. So it was very uncomfortable for him.
Speaker 1:So when Freud assumed that the memories are accurate and really did happen, by and large, they're not perfectly accurate, then he had basically a dissociation theory. When he decided that these were false memories, now he had a puzzle. Why are all these hysterical women coming into therapy with all these false memories of sexual abuse that never happened? In order to solve that puzzle for himself, he developed repression theory. So repression theory is designed and developed for when the memories are false.
Speaker 1:So the the skeptics today have it completely backwards. If you follow a repression theory, you agree with it, and you base your treatment on it, you're going to say that the memories are false. So the whole thing's very mixed up.
Speaker 2:Wow. Tell me about structural dissociation and OSDD and these changes. What's happened there?
Speaker 1:Okay. Well, structural dissociation is a theory, and there's a book called The Haunted Self in which the authors, Ono Vanderhardt, Ehlers Nayenhouse, and Kathy Steele, write at great length about this model and the treatment that follows from it and so on. And then they also have published a series of papers, and they do lots of speaking about it. And I've written commentaries on that and a short book about it, and so I'm very familiar with it. In one way, structural dissociation is nothing new.
Speaker 1:It's just a a restatement of the theories of Pierre Jainet from the late nineteenth century, But in another way, it is something new because these authors have really fleshed it out in full, added a lot of detail, talked a lot about treatment. The basic idea is that something traumatic happens, and it's too overwhelming. It's too much. So your mind just kinda pushes it over to the side, walls it off, and you either don't remember the information at all, which would be full dissociation, or you kinda remember the information, but the feelings aren't there. It's just emotionless information.
Speaker 1:So that's that's dissociation. In structural dissociation, there has to be formation of a natural separate ego state alter personality or identity. So the memories, the feelings, the conflicts are held in a split off section of your psyche that may have in full DID, it may have a name and age, different hair color, all kinds of personal attributes. That's full dissociative identity disorder. In what used to be DDNOS, dissociative disorder not otherwise specified in DSM four, which is now other specified dissociative disorder in DSM five because they changed the names Mhmm.
Speaker 1:Which they did for all the sections, anxiety, depression, and so
Speaker 2:on. Right.
Speaker 1:In OSDD, I always just explain to people is it's the same thing as DID, but only half or three quarters as much. So you have a separate split off, dissociated off section of your psyche. It's holding thoughts, feelings, memories, but it maybe doesn't have a specific name or a different age, or it just stays internal. It doesn't come out to the surface, and you don't see the person switch to another character. So it's it's the same thing, but just not as much.
Speaker 1:In structural dissociation theory, there's got to be some sort of dissociated internal state with its own subjective sense of a separate identity. Okay. And so that's just what DID has always been. It's always been described that way. It's nothing new.
Speaker 1:These authors have just come up with some tying it into animal defense mechanisms like fight, flight, and freeze, elaborating on it, and describing the treatment interventions in more detail, and some research that follows from it as well.
Speaker 2:Okay.
Speaker 1:So that that's basically what structural dissociation is.
Speaker 2:So is there a little bit of a spectrum between OSDD all the way to I DID? Or
Speaker 1:Yeah. It's everything in mental health is on a spectrum, basically. So you've got one person who's never drinks at all. You got another person who has, you know, the odd glass of wine maybe a couple times a month, then somebody who has a glass of wine most nights of the week, but not every day. And then next person drinks a couple of beer, sometimes two, three, four beers during the week, and then on the weekend has maybe six beers on Saturday or six beers on Sunday.
Speaker 1:Then you got the person who drinks a bottle of whiskey every day for the last twenty years. So that's all on a spectrum, and there's no sharp cutoff point.
Speaker 2:That makes a lot of sense, and it kind of makes DID or dissociation in general sort of consistent with everything else rather than being such an outlier.
Speaker 1:Yeah. It's not an outlier in reality. It's just an outlier in people's false impressions about it.
Speaker 2:Why is that? What happened with that shift culturally in the clinical world when there was so much research and so many people trying to help or learn how to help, and then a whole group of people that just sort of said that's not a thing anymore?
Speaker 1:Well, I have some ideas and theories about that, but, basically, it's very puzzling to me. But jumping back to alcohol for a minute, so it's true that alcohol is on a spectrum, and there's no sharp cutoff. So when you're in kind of the gray zone in the middle of the continuum there, one psychiatrist or clinician might say, oh, this person has a drinking problem. And the next person might go, he drinks a little bit too much, but it's not really a drinking problem. I wouldn't say it's a substance use disorder.
Speaker 1:It is kinda getting near that. And the rate of agreement between different psychiatrists on who is an alcoholic and who is not in that kind of gray zone is gonna be very low. But if psychiatrists interview a hundred people who don't drink at all and a hundred people who've had a bottle of whiskey every day for the last twenty years, they'll have perfect agreement on who is an alcoholic and who isn't.
Speaker 2:So you're talking about concordance?
Speaker 1:Yeah. No inter rater agreement. So my point being that if we go back to DID, sure, dissociation's on a continuum. Everybody does it a little bit. Some people do it a little bit more and more and more and more.
Speaker 1:When you get all the way out to DID, there's clearly things going on that most people don't experience. So most people don't have the experience of they're at home making lunch, and next thing they know, it's 9PM at night. They're downtown. They're at a bar. They don't know how they got there.
Speaker 1:That's not an experience that, you know, most people have a little bit of the time. And similarly, people don't generally unless they have some neurological problem, they don't look in the mirror and not know who that is. But people with DID have these kind of experiences. So it's both a continuum and a discrete category. When you get out to the far end, it's just a different category.
Speaker 1:It's not the same as normal, and both things are true, which is also true of anxiety, depression, substance abuse, alcohol, whatever.
Speaker 2:Right.
Speaker 1:Do you mind if we jump back to the controversy and the disbelief?
Speaker 2:Oh, please. Please. Absolutely. Okay.
Speaker 1:So first of all, there's controversy and disbelief about a lot of things in the DSM. So there's a whole group of people who have their own organization, their own conference, their own journal, their own series of books, who are very skeptical that schizophrenia is a legitimate disorder, and they think that maybe we should change the name altogether. They are very skeptical about what causes it and so on. So there's and there's peep large group of people in our culture who think that psychiatry is just medicalizing everything, and depression isn't really a disorder. It's certainly not a disease.
Speaker 1:They're just exaggerating and making a big deal of normal sadness, normal reaction to life events. So there's plenty of controversy about everything in psychiatry and everything in the DSM five, but the controversy about DID is a little bigger and a little more intellectually violent.
Speaker 2:It's so intense.
Speaker 1:Yeah. Yeah. And it's not that people go, well, you know, I'm a little bit skeptical. I'm just not quite convinced. Psychiatrists have very energized, hostile, angry, belittling, dismissive attitudes.
Speaker 1:There's a lot of energy behind it. So why? So first of all, that intense energy to me is evidence that this is not just an intellectual question.
Speaker 2:Right. Right.
Speaker 1:Something big at stake personally. Like, this is touching on some kind of personal something. I don't know what that is necessarily, but now we get into my theories. Okay. So the first theory is not really theory.
Speaker 1:It's just a fact. A lot of people who are highly skeptical about DID don't even read the literature. They're not familiar with the scientific literature on DID, so they're just speaking really out of ignorance.
Speaker 2:Right.
Speaker 1:So that's problem number one. Problem number two is they have all these misconceptions. Like, if you people who diagnose DID think that there's literally separate people in there, and one person's not responsible legally for what the other person does, which is not true at all.
Speaker 2:Right.
Speaker 1:They think that if you have DID, you can get away with all kinds of stuff because you couldn't help it because somebody else did it, not true at all.
Speaker 2:So I'm not responsible for the system as a whole.
Speaker 1:Yeah. But we I and a lot of people in the field hold the person as a whole responsible for the behavior of all the parts in just the same way that we would any person without DID.
Speaker 2:Okay.
Speaker 1:So so DID doesn't necessarily lead the diagnosis diagnosis doesn't lead to, oh, you can get away with anything. That's just a misconception. The next thing that's contributing is DID is very strongly tied into childhood abuse, including sexual abuse, physical abuse, emotional abuse, neglect, and so on. So that makes it a very hot button topic just by itself, because if the topic is some neutral thing about, you know, what is the function of some certain part of the brain in obsessive compulsive disorder, nobody gets that hot about it except maybe a few academics.
Speaker 2:Right.
Speaker 1:But if the if the subject is child sexual abuse and people accusing their fathers of incest, all of a sudden, there's a lot of energy, a lot of controversy, and a lot of angry people, which which is not too hard to find on the Internet.
Speaker 2:Right.
Speaker 1:So it's just a very charged topic, and DID is really connected into that charge. So why would people get so upset about that topic? Well, I think there's several explanations there. Besides the fact that they're just generally uncomfortable with it and don't wanna think about it and don't wanna deal with it, there's gonna be there's no reason to think that the rates of childhood sexual abuse are lower in psychiatrists, psychologists, social workers, counselors than the general population. If anything, it's likely to be higher because sexual abuse people might want to go into those fields to try and figure themselves out or to help other people.
Speaker 1:So the rates of childhood sexual abuse are not gonna be, you know, less than the general population, which is I know we're talking fairly serious abuse, not just one touch. Five percent in boys, fifteen percent in girls is kind of the basic ballpark. So, therefore, there's no reason to think that less than five, ten percent of psychiatrists, psychologists, social workers themselves were sexually abused as children. So they're gonna have a lot of reaction to these topics. And if they don't wanna think about, feel, or know their own abuse, they're gonna discredit DID.
Speaker 1:And especially if they're worried that there may be even more abuse buried inside them that they don't know about yet, they're gonna wanna discredit recovered memories dissociation. Then the other set of people would be people who themselves are perpetrators of physical abuse, sexual abuse, emotional abuse of adults and children. They're not gonna want anybody blowing the lid on that. And we know that there's, you know, pedophiles in the Catholic church. We know there's lots of them.
Speaker 1:We know that there's been pedophiles in the Boy Scouts, football coaches, gymnastics coaches for the Olympics team. So there's pedophiles all over the place. There's no reason again that there's not gonna be pedophiles in psychiatry, psychology, social work. So if you are, in fact, a pedophile or perpetrator of domestic violence, you wanna put the lid on all that, and one way to put the lid on is to discredit DID.
Speaker 2:Both of those choices are really frightening.
Speaker 1:Well, yeah.
Speaker 2:Right.
Speaker 1:And so then another this will sound a little bit fantastic unless we went into it for a couple hours, but it's it's an objective documented fact that two of the original board members, professional advisory board members of the False Memory Syndrome Foundation were Martin Orne and Jolly West, two famous psychiatrists, and they were part of the organization that was spearheading trying to completely suppress multiple personality disorder, now DID, discredited, discredited recovered memories. What what might have been their motivations? Well, absolutely documented for a fact, both of those guys were top secret cleared contractors on MKUltra, and we're contracting with the CIA on how to study, create, and understand dissociation to multiple personalities, and we're part of the mentoring candidate candidate programs in the CIA. That's just a fact. Wow.
Speaker 1:So so then there's gonna that's gonna be another motive to try and cover up all this stuff because what if somebody is spilling the beans in some civilian therapy? So there's gonna be and then there's another another set of motives is just hardcore biological people who think that what happens to you, like abuse, doesn't have anything to do with anything. It's all genes and chemicals in your brain, and so we have to discredit anybody who's coming forward saying no. These serious mental disorders are coming from what happens in the environment. They're not coming from your genes, and they're not coming from eating the wrong flavor of Jell O.
Speaker 1:They're coming from serious stuff like sexual abuse. And then the final one I would say is the literature on dissociative identity disorder, there's we have multiple studies from multiple different countries showing that DID is affecting in the ballpark of one percent of the general population, and that includes a lot of much milder cases than we see clinically. Just like if schizophrenia affects one percent of the population, which is the basic statistic, that doesn't include cases that are as severe as you'll see in the state mental hospital. It includes those plus a lot of much minor versions of schizophrenia. Same for DID.
Speaker 2:You've talked about what you found in China and the that study where there's not any cultural pieces where people could have gotten it or got the idea from it for through social media or films or anything like that because those pieces aren't there in the culture.
Speaker 1:Exactly. Yeah. That was I did multiple visits to Shanghai Mental Health Center, and the the Chinese team, we translated the standardized interviews. Chinese team did many, many interviews. And then me and my colleague went over there and did interviews of some of the people with a Chinese translator.
Speaker 1:It was quite easy to find cases of clear classical American style DID, which is pretty strong evidence. It's not just, you know, some kind of fad that's going on in The United States. Wow. And so and the other final point I was gonna make is, so if it is true that DID affects maybe about ballpark four percent of general adult psychiatric inpatients all around the world, so that's one out of twenty five inpatients on psychiatric units all around The United States, Canada, Europe. If that's a fact, which is the number that's in the literature, this means that all these psychiatrists who don't think about it, don't believe in it, or hostile to it, are missing an awful lot of diagnoses and failing to provide the right treatment day in and day out on a large scale.
Speaker 1:So that means that they're not all that competent, and they're not all that helpful. And they're not gonna want to know that or admit to that, so they have to discredit DID.
Speaker 2:Wow. That makes a lot of sense. Good. So what about tell me about the trauma model.
Speaker 1:Okay. So the trauma model is is in the title of one of my books, and the trauma model is a general scientific model of the mental health field and what's the role of trauma all across the DSM system. And it's very detailed, and it's based on the research literature, on my thinking, on clinical experience, and I I provide a whole long list of specific research predictions. For instance, if you do this research, trauma model predicts, you'll find this. Regular psychiatry would predict, you'll find that.
Speaker 1:So it's set up so it's not just a belief or a theory or opinion. It's actually a testable scientific model. And I could give you a couple examples if you want. But Sure. The basic basic basic idea is that trauma is a big deal in the mental health field, and it's a major contributor to a large percentage of mental health problems.
Speaker 1:There's also people who have serious mental health problems who didn't have trauma. So it's not an all or nothing thing.
Speaker 2:Right.
Speaker 1:It's it's not just a little sub area or just PTSD all across the board. And this is now acknowledged in DSM five, all across DSM five. Most of the sections, it says that childhood trauma, including sexual abuse, is a serious risk factor for whichever section we're in. Wow. So that so that's the trauma model.
Speaker 1:So it's not specific to DID. Trauma model therapy is the therapy method that kinda sits on top of the trauma model, and it's also useful for many different diagnoses, not just DID. Because people with DID have all kinds of other problems besides their DID. They frequently are depressed. They're anxious.
Speaker 1:They have substance abuse problems. They have PTSD. They have all kinds of things, all of which have to be treated. And what's, I'd say, what's new and different about the trauma model therapy is the way I've kind of integrated together into a single approach attachment conflicts that come from trauma when you're people who you love who are your caretakers are also the people you hate who are abusing you. The self there's a whole way of thinking about the self blame that's almost universal in trauma survivors.
Speaker 1:I call that the locus of control shift, and it comes from normal childhood thinking where you think that you're causing everything that's going on. So I'm I'm tying all the self blame, self hatred, self punishment into normal childhood psychology, psychology, and that's the way kids think
Speaker 2:about Oh, I had not connected that piece. Like, I'm thinking of, like, Patricia De Jong and some of the shame based stuff. I have not connected it to the child actual perspective.
Speaker 1:It's also very similar to moral injury and combat PTSD.
Speaker 2:Right.
Speaker 1:And then I've I've tied in subsystems principles. The problem is not the problem. That is the presenting symptom or behavior is usually some sort of unhealthy attempt to solve some problem in the background, cope with their feelings, cope with the situation. So you have to try and understand the problem in the background, help the person to regulate their feelings, cope with life better, and then they can kinda let go of the presenting symptom or addiction or behavior. Then there's sort of an addiction component I've blended in.
Speaker 1:There's a very well defined and structured component. And then the victim rescue or perpetrator triangle, I use that as a a way of talking about what's going on. So I've taken elements from here, there, and everywhere, some of which are somewhat original, especially locus control shift, but it's just the way they're all tied together in a kind of seamless, flexible model. And trauma model therapy is not just, you know, this little silo here, and then over there you have that silo, which is cognitive therapy, and over there you have EMDR. Trauma model therapy is very open.
Speaker 1:The more tools in the toolbox, the better.
Speaker 2:Oh, wow.
Speaker 1:So it's not like an exclusive little empire of its own at all. And when I talk to therapists about it, which I do a lot, who are not talking about DID in particular, I just they all say, this makes so much sense. I really like this. This is useful. This is helpful.
Speaker 1:And I also have six or seven treatment outcome studies providing data showing that it's effective at what's called level two evidence. So it's actually an evidence based therapy.
Speaker 2:Oh, that's great. Tell me just since I since I have you specifically, tell me that piece that's unique to you about the locus control shift. What was it?
Speaker 1:Locus of control shift.
Speaker 2:Tell me more about that.
Speaker 1:Okay. So locus of control is just there's a big literature on that. It's a social psychology literature. And the locus of control some people have an external locus control, which is they feel like the outside world controls them and is kicking them around all the time. Some people have an internal locus of control, which they feel like they're in charge and they're making things happen, and then healthy people have kind of a flexible fluid shift back and forth.
Speaker 1:So I just borrowed that term, locus of control. And my thinking is that the locus of control shift happens automatically for abused kids. The locus control being where is the control point? It's really in the adults. But because of the way the child minds work, the control point gets shifted inside the kid.
Speaker 1:Because kids experience life as I'm at the center of the world. Everything revolves around me, and I've got this magical power to make things happen. That's just the way kids think.
Speaker 2:Right. Right. Just developmentally. Right. Okay.
Speaker 1:So when there's a whole bunch of abuse and mental death going on, automatically conclude it's my fault. It's happening because I'm bad. I deserve it. I'm no good. I'm this.
Speaker 1:I'm that. And so it makes the self blame, the self hatred, the self punishment, all this unhealthy behavior understandable, and it makes it be more like the person who gets hit by the drunk driver comes into the ER with a broken leg, and their femur is sticking out through the skin of their thigh. Well, the doctor goes, well, that's abnormal. That's pathological. But the doctor doesn't go, this is a pathological person, or what's genetically wrong with this person?
Speaker 1:The doctor says, well, they just got hit by a drunk driver. This is abnormal.
Speaker 2:Oh, wow.
Speaker 1:If you've been through that kind of trauma. And so the the model is constantly making this point that you're angry. Why? When you threaten and corner a mammal over and over and over and over, you're gonna activate its fight system. Your anger is normal, natural.
Speaker 1:It comes from being threatened over and over as a kid. Now how you handle it is not maybe the healthiest. We need to work on that. And the fact that you hate yourself and blame yourself, that's just the way it is with kids who get abused. And so it it destigmatizes it.
Speaker 1:It takes away a lot of the shame, and now we can get to work on it.
Speaker 2:So it really it normalizes it, not that what happened was okay, but that the response to what happened is okay.
Speaker 1:Right. Wow. Exactly the same as getting hit by a drunk driver is not okay, but having a broken leg as a result can be completely normal. And nobody goes, what's what's up with you? How come you got this broken leg?
Speaker 1:People just don't have those attitudes.
Speaker 2:So not what is wrong with you, but a consequence of what happened to you?
Speaker 1:Yeah. That's the motto.
Speaker 2:Wow. The
Speaker 1:motto that dominates the mental health field is what's wrong with you. But in this perspective, the motto is not what's wrong with you, what happened to you.
Speaker 2:That's a huge shift.
Speaker 1:But I've just, you know, taken that and blended it into this very well organized model. And the the therapy has very defined tasks, steps, procedures, strategies. It's not just kinda vaguely floating around.
Speaker 2:So it's structured between the therapist and the client?
Speaker 1:Yeah.
Speaker 2:Or you mean, like, in a workbook format?
Speaker 1:We have some workbook book aspects, so a bit of both.
Speaker 2:Oh, okay.
Speaker 1:Mostly not in the in the work port workbook fashion. It's more okay. So we have to work on this. We have to work on that. We have to work on this.
Speaker 1:We have to solve this. We have to solve this. We have to solve this. The strategies and the techniques and the tasks are well defined, and here are some things you can do for this. Here are some things you can do for that.
Speaker 1:So it's just like an example would be somebody who's kinda spacing out, getting too anxious, losing track of where they are, getting disoriented because there's too much PTSD up and running. So there's a whole bunch of grounding skills, which are not unique to this model, but this is an example of you don't just talk about it forever. So there's specific things to do. Okay. Work on your breathing.
Speaker 1:Focus on your breathing. Slow your breathing down. Shuffle your feet. Look around. Don't be just having a fixed stare.
Speaker 1:Where are you right now? What's your name? What year is it? Who am I? Why are we here?
Speaker 1:You're safe now. It could be like squeeze a ball. Talk to yourself internally. Remind yourself. So there's a whole set of strategies that can be used to help the person get grounded, and that's throughout this therapy, there's all kinds of strategies and tasks for all kinds of different things.
Speaker 2:So in your approach, is it more important for the clinician to establish sort of, I guess, safety and tolerance skills and things like that before more talking about it, or it kind of goes hand in hand through the process?
Speaker 1:A bit of both. So in all different forms of trauma therapy, there's basically three phases. There's phase one, two, three. Phase one is getting these grounding skills, accepting the diagnosis, accepting the treatment plan. And if the person's being beat up by their husband every day, well, you have to work on that before you start working about childhood trauma.
Speaker 1:So it's stabilization, grounding, being motivated, making sure there's not too much other chaos going on in your life. And then we get into the sort of memory processing, talking about the trauma, accepting the feelings. And then the third phase is more resolution, consolidation, integration, and learning how to cope with life just as person in general. So trauma model therapy follows those three kind of stages, but that's just a sort of a teaching point. In reality, you do some stage one, then three, then two, then up to three, back to one.
Speaker 1:Oh, more one, up to two.
Speaker 2:That's just the way
Speaker 1:it goes.
Speaker 2:Right.
Speaker 1:But the but, clinically, we do see like, in my hospital programs, we see people admitted who are way overwhelmed, flooded, too many flashbacks, too much hyperarousal because something horrible happened in life, but also not rarely because the therapist dove in too fast to memories, memories, memories, memories. So it's very important to keep the pace slow enough, but not so slow that it takes forever. So pacing and containment are big themes in the therapy. And for any therapy, it doesn't matter what kind, the literature is overwhelmingly conclusive, and basically all expert therapists agree that a huge part of any therapy, no matter what your theories and no matter what your techniques, huge part is positive therapeutic relationship, good work ethic, the therapist being generally interested and concerned about the person, realizing they have a serious problem, knowing what they're doing, just the attitude, just the energy, the vibe, that's a huge part of the healing no matter what specific techniques the therapist uses.
Speaker 2:Is that just part of a general attunement kind of process beyond just rapport, but just being
Speaker 1:It's it's it's not it's not casual like you just you're at a bar one night and you chat with somebody and you get along well and you never see them again. It's the same basic thing, but it's more structured and it lasts for a long time. Any other therapist has to be very attuned, empathic, but not, like, swallowed up by the person's problems, obviously.
Speaker 2:Right. And what about for the other perspective from the client's perspective, knowing how to find a therapist like that or what like, about your program, those sorts of things.
Speaker 1:Well, that's kind of a hit and miss process. Unfortunately, like everybody else on the planet, therapists range from well, sometimes grossly unethical and need their licenses taken away. But, you know, not very competent, not very effective, not very helpful, medium helpful, or, like, really, really helpful. And so finding out in advance which one's which is a big challenge for clients, consumers. But generally speaking, somebody who's got a good reputation in the field, somebody who's active in their professional associations, word-of-mouth, other people have had good experience with that person, or you're referred to them by an expert in the field.
Speaker 1:Those are, you know, good starting points. In terms of so I don't have an outpatient practice. Don't do consultations, but I do have hospital based programs. So if you're looking for inpatient treatment, then you either go to my website, the Ross Institute, or you can go to u b h Denton University Behavioral Health Denton, u b h Denton, d e n t o n, dot com. And there's a trauma program there, and there's phone numbers, and you can call in and find out how program operates and get your insurance checked out and so on.
Speaker 1:And, also, we have a network of therapists that we can refer to.
Speaker 2:You mean outside of the Dallas area? Or Yep. Oh, wow.
Speaker 1:I mean, we don't have therapists, like, in every town in the country, but we know and are aware of quite a few therapists and can search and find people to suggest.
Speaker 2:How do clinicians become involved with that or participate with that or connect with others who are doing quality of work and not the creepy people who are doing such a bad job?
Speaker 1:Yeah. Well, that's also a challenge. But, basically, if you're an eating disorders person, well, then you're gonna read journals about eating disorders, read books about eating disorders, go to conferences about eating disorders, and belong to a professional association focused on eating disorders. Same thing for dissociative disorders. There's the International Society for the Study of Trauma and Dissociation, which is I s s hyphen isst-d.org.
Speaker 1:And so you could go there. There's a journal. You get into the literature, read the leading books, go to conferences. There's webinars.
Speaker 2:Their conference is gonna be in New York next. Right?
Speaker 1:Right. New York in March. And they have regional conferences scattered around and webinars.
Speaker 2:Oh, okay.
Speaker 1:And there's also a find a therapist tab, whereas you can just go to the website. You don't have to join the organization. And you can do find a therapist and search in this state or this town who is the therapist who knows about dissociative disorders. And sometimes there won't be one. Sometimes there'll be one three hundred miles away.
Speaker 2:Right.
Speaker 1:Right. And then I also have a series of webinars. My daughter and I. My daughter's a psychiatrist in Toronto, and we have a webinar series. We're just about to do the twelfth month.
Speaker 1:We'll finish our first full year in in January.
Speaker 2:Wow.
Speaker 1:It's TraumaEducationEssentials.com. So it's TraumaEdEssentials.com is the website.
Speaker 2:Okay.
Speaker 1:And you can go there. Check it out. Also, you can sign up for the newsletter, which is free, which is monthly written by my daughter. It's usually got a good book review or a nice article, sometimes practical tips for therapy announcements, and so on. So we have really good speakers.
Speaker 1:In January is John Breyer for three hours. He's, you know, one of the handful top experts on PTSD and trauma and a very engaging speaker, very practical, easy to follow.
Speaker 2:That was really helpful. Thank you so much.
Speaker 1:No. You're welcome. Very nice talking to you. Thanks for asking.
Speaker 2:Sure. Thank you for listening. Your support really helps us feel less alone while we sort through all of this and learn together.