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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 a podcast about Dissociative Identity Disorder. If you are new to the podcast, we recommend starting at the beginning episodes and listen in order to hear our story and what we have learned through this endeavor. Current episodes may be more applicable to long time listeners and are likely to contain more advanced topics, emotional or other triggering content, and or reference earlier episodes that provide more context to what we are currently learning and experiencing. As always, please care for yourself during and after listening to the podcast. Thank you.
Speaker 1:Okay, for Friday of conference, I spent the entire day in Tyson Bailey's Suicidal Ideation and Behavior presentation. I loved his title. He called it Inviting Death to Trauma Responsive Care for Assessing Suicidal Ideation and Behavior. It was so good. I liked that it was a relational presentation and, centered the therapeutic relationship rather than centering behaviors and interpreting behaviors.
Speaker 1:I think that's really a huge part of empowering clients when we are not labeling them, when we are not assuming what is going on, and when we're not assuming we ourselves have not struggled with similar things. So he offered some good resources, including the CAMS Collaborative Assessment and Management of Suicide by Jobes from 2016. He also referenced the book Rethinking Suicide by Craig Bren and talked really about how we cannot lean into relationships when we're terrified because avoidance is withdraw for safety. I love that he clarified that, that we cannot connect when we don't feel safe, but when we do feel safe, we can connect. So not being able to connect tells us that we're not safe or we're not feeling safe.
Speaker 1:So when we're working with folks who experience any kind of suicidality, even if it's ideation, it's really important that they're feeling safe, that we support them and being able to talk about these things without just being afraid about what will happen if they do. And also important that we're not shaming our clients. He talked about Patricia DeJong, which I love that he included her, and our need to be understood cannot be met is really the root of the shame, except also when we are understanding and when we are working with our clients instead of doing to them or doing for them, then we do understand or can understand more. So it's really put it in the framework, the whole training and the framework of relational liberation, feminist psychology. And it's one of the things I appreciate about his work.
Speaker 1:He was trained by Laura Brown. And so really this was an excellent training. I highly recommend if you missed it in person, if they have it in CFAST, I really hope that they do. It's definitely worth seeing. So even though the whole day was about suicide, he really was talking about how we can't just reclaim safety if we've never had it.
Speaker 1:And safety isn't just an out there resource. We can't work hard enough to get safety. It has to come relationally. So as therapists, that comes through not just cultural competence, where we understand cultural differences and gaps, but also cultural humility, where we learn from those we work with, reserve our judgment and actively bridge those divides. That's what leads a therapeutic alliance where we can move between graduated exposure and flooding and help with titration containing and processing all the things.
Speaker 1:Right? So I really want to, I really just want to emphasize other than the actual trainings about suicidality. I loved the framework which he was teaching from, the framework from which he works with his clients. And my favorite thing he said the whole entire day was that I don't treat symptoms. I treat humans.
Speaker 1:That was my favorite thing. The other thing I think he really contributed that's super important is he talked about explicit memory and implicit memory, which I understand. And I know we even talk about it sometimes in the community, both with communication and with memory. But when we're talking about explicit memory, we are recognizing that as a memory, as something in the past. Like I can remember what I had for breakfast this morning.
Speaker 1:That is explicit memory, but implicit memory comes to us as experiences. So it's not actually conscious and it's also not even unconscious or nonconscious. Like it can't be recalled as a memory. It's just so brain based and physiological that we do remember in a way that's like our body remembering. So like walking, I don't remember when I learned to walk.
Speaker 1:I don't think about walking. I just can walk. Well, most days. I did run into a door this morning, but that's a different story. So talking about how with chronic suicidality or because of chronic trauma, then that chronic suicidality can actually become implicit memory that is invading now time, where in now time, it may not actually be a thing, but because of implicit memory, we experience it as a thing.
Speaker 1:And I love that he had this and contributed this to the field because I never heard anyone talk about this before. And I really, really appreciated how even suicidality can be part of memory time and also how we can tend to that and be relieved from that the more we're able to recognize now time. He also really emphasized that not only do we need to look at risk factors with our clients, but we also need to look at protective factors. And in this section of his talk, I really appreciated that he referenced not making assumptions about what is a protective factor, because for example, in most assessments, it will list spirituality or religion as a protective factor. But for those of us with religious trauma, that can actually be a risk factor instead of a protective factor.
Speaker 1:He also talked about how important autonomy is and how clients will ultimately survive by their own agency and autonomy, not because of anything we do. And so self efficacy is a better focus than rescuing them. Even when they choose to quit therapy, we still have to respect their autonomy and let them quit therapy. People will return to therapy or different therapy if and when they're ready, but we cannot choose for them or force them to either engage in therapy or to choose healing in the ways that we think healing means for them. So he covered all of the required suicidality things and all of us that our clinicians are required to go through that every year.
Speaker 1:And also I really loved how he used that relational feminist liberation kind of perspective to filter how we're assessing and how we are treating suicidality. It is absolutely worth seeing if you ever get the chance or if it goes into the CFAS library. On Saturday morning, I was assigned to the registration desk. I would like to point out how this is a terrible idea. I feel like I've learned this lesson in years past, but I must have forgotten not explicit memory.
Speaker 1:And so I signed up again, but it's not a good idea to put the deaf girl in charge of registration because people are coming up and giving me their names and wanting their badges to get checked into the conference, but I can't hear their names. I can't understand their names. And so it's like, oh, I'm sorry, what did you say? What was that? Can you say that one more time?
Speaker 1:How do you spell that? However, I got assigned with some pretty other cool volunteers and it was super fun to get to know them. One, I already knew a little bit, but got to know more and we had a good time. And so even though it was early in the morning after the pre conference had already been going for two days, that first day of the actual conference, it was a pretty fun start to the day, actually. The first session of the actual conference that Saturday morning was actually Melissa Kaufman from McLean.
Speaker 1:And that presentation was incredible. I don't think a recap could even do it justice, but talking about the intersection of lived experience and science, we got to hear about the background, professional work and training and all of those things, and a classic Lowenstein story, which made everybody laugh because we all know Lowenstein. And then also about the coming out process as someone with a dissociative disorder and more about what the LEAP program is like. And I know we had someone from LEAP come on the podcast and it was super fun to get to know her and she shared so much about that. So I just wanna honor that voice and let her speak for herself.
Speaker 1:But the fact that that then ultimately intertwined with the New York Times interview with the article that's just recently coming out, I can put it in the show notes. I was also interviewed for that and in the article. And I did not know when I was interviewing for it that it was going to be about Melissa Kaufman. And to come full circle and experience that coming out, the hope that the article really held for healing and focusing on the healing of it. I love the article so much for those reasons.
Speaker 1:And then she also addressed specifically being a clinician with lived experience. And really what I thought was most important that she said about this is that I'm a good therapist because of my training and supervision. I understand the language of survivors because of lived experience. This really landed well with me because it's actually also congruent with what I've experienced as a therapist who's deaf. I didn't even before I got my cochlear implants, I lived in a state where I was the only deaf therapist for a while, so I would get all these referrals from all over the state.
Speaker 1:And this was before we had telehealth. And one thing that I really experienced was how it sort of got me pigeonholed into the therapist for this because of my identity, which is not actually what I ever wanted or tried to do. It was more like, I just wanted to be a good therapist. I didn't wanna be a deaf therapist. So it's one of the reasons that ultimately I moved from that state was because I really just wanted to be a good therapist.
Speaker 1:It also was one of the reasons I ended up choosing cochlear implants for more access to more independence, to more access to choices. And that was a tricksy thing for me because the cochlear implants is really a controversial thing in the deaf community, but I was getting so stigmatized anyway, that I really, it feels like one of those differentiation moments where I really had to push back because people were not understanding me or who I was. And I had to hold my own and differentiate myself for who I wanted to be rather than who people were telling me I was. And so it was a really significant piece in my own career development or professional development. And so I had not until this talk really considered the parallels between that and lived experience.
Speaker 1:And I appreciate that because I want to be a good clinician regardless of my lived experience. And also I think it is lived experience that helps us understand more, more quickly. But any of my assessment or treatment or diagnosing or formulation or clinical skills comes from training and supervision and experience and consultation. It's not because I have lived experience. The lived experience helps with understanding and perspective, but even that needs consultation and to stay in therapy and supervision and consultations, because I don't wanna interfere with it either, which I actually talked more about in my talk.
Speaker 1:You'll hear later of how transference and countertransference can really work together and be information that's super helpful. After Doctor. Kaufman's talk, I actually missed the panel with Jennifer Gomez. I wanted to see Jennifer Gomez. That was part of the panel, but I ended up missing the whole entire panel because I needed to practice my slides for the afternoon.
Speaker 1:And then in the afternoon, I did my presentation all afternoon. You will hear that next week. I met so many different people. And also by the time I got upstairs, I was so tired that I didn't even go to the awards dinner or the evening activities I had scheduled to meet with a couple of people. I just went to bed and I slept for twelve hours.
Speaker 1:And also I was so much better even than when I had rehearsed my talk the few days before and I was very much relieved because I've been so sick this year with pneumonia since the holidays. And so I was able to get through my talk. I was able to breathe. I did have to almost lay down on the break, but I got through it. I had water.
Speaker 1:I had cough drops. We got through it. So I did okay. This morning is Sunday morning now. And this morning I went to an incredible, one of my new favorite talks that was just profound.
Speaker 1:And I have so much to say about it. I feel like it could be its own 10 episodes if it were not just a recap, but it was called Trauma Bond to Trauma Coerced Attachment. And they were talking about how trauma bonding and trauma coerced attachment is more than just identifying with the abuser. So first they talked about trauma bonding theory and how it's that intense emotional attachment that develops in relationships marked by abuse and how it's an adaptive survival response and how originally the research on this came from prisoners of war and then also hostages. And then finally later after Herman's work, Judith Herman, then we talked about childhood sexual abuse and interpersonal violence.
Speaker 1:And now it's being added to the research on cults and the research on trafficking. So they went all the way back to 1924 when Freud started talking about masochism as that unconscious ensuring a punishment. So again, not consciously or intentionally, but holding ourselves hostage in a way that we're not actually complicit to the abuse because we're not consenting to abuse, right? But it feels like it because we are so used maybe because of specific trauma and deprivation, maybe because of infanticidal attachment, maybe because of all these different reasons where we are used to being the bad one. And it is almost like a relief to be punished.
Speaker 1:So that was really icky to hear. I felt nauseated. 1933 with forensic identifying with the aggressor. That's when we got that language started. Now we would talk about that as appeasement or as fawning.
Speaker 1:And then 1981 with Dutton and Painter, and finally talking about trauma bonding, which really is the flip side of betrayal trauma, where we're having to maintain the attachment with the caregiver to survive, even though also it's the caregiver who's harming us. Then the DSM-five back in 2013 talked about OSDD, identity disturbance. This piece was fascinating, but we're gonna come back to it in just a minute. And then 15, taking that OSDD piece we're about to talk about, they took it and are calling it trauma coerced attachment and calling it TCA. And that being operationalized, this is what they published in 2023, TCA being operationalized as what is happening in OSDD.
Speaker 1:So first, let me come back to TCA. Why this is so specific is number one, it captures the role of the abuser rather than blaming the victim. So one thing that happens is when there are victims of interpersonal violence, we talked about this with Laura Brown's book. We talked about this with Doctor. Teuma.
Speaker 1:When there are victims of interpersonal violence, they get blamed for their responses to what they were enduring. So like blaming, they compared it to blaming a soldier for getting PTSD. It's the environment what's happening. It's the environment that's the problem. It's what they're experiencing that is traumatic and their responses to that environment and those experiences and relationship are responses to the trauma and deprivation.
Speaker 1:And number two, the lack of reciprocity because there's a power imbalance. So someone else has more privilege. Someone else has more access to money. Someone else has more access to stability like housing or other supportive relationships. And because it is coercion, it is not consent.
Speaker 1:So then someone is being compliant to what is being asked of them, which is not the same as building a relationship. And then number three, not an attachment disorder, meaning it goes away when the environment changes. So when like avoidance, because we're being harmed is getting weaponized, we're not actually avoidant outside of that relationship before that relationship and after that relationship, we may be profoundly available, but within the relationship, we are being harmed, we are withdrawing further and further, not even because of attachment styles, but because of freeze responses, because we're continuing to be harmed. We're going further and further into the turtle shell. So here's what they pointed out that I thought was really interesting in the DSM-five TR when it's talking about OSDD, it says individuals who have been subjected to intense coercive persuasion may present with prolonged changes in or conscious questioning of their identity.
Speaker 1:So they pointed out that in this description, also goes on to name cults specifically, but it omits traffickers and domestic abusers. So what they were saying is that when we look at that intense coercive persuasion, so like in my notes, I circled that word, they're talking about forceful and severe. And when we look at prolonged, so I circled that word, we're talking about continuous and how this fits the interpersonal violence profile, even though it's not specified specifically. So with criterion A that extended and prolonged, this is what happens with prolonged experiences of interpersonal violence because that violence echoes even when they're not around. And so they talked about the coming and going of an abuser than an abuser because they're not actually committed to the relationship.
Speaker 1:There's this coming and going experience where they're coming and leaving and coming and leaving. And also when they leave, you still have the echo of them. And so the times they're not there, you still have to follow the same rules or still follow the same expectations. So you're not actually free to do your own thing or live your own life while they're not there. And then how also it happens in both private and public spaces.
Speaker 1:So because the relationship really is not a relationship, but it's an exploitation of attachment And they're using it for them to meet their needs of control or whatever is going on with them that then it bleeds into public spaces as well. And we can talk about that in a minute, but that is part of the prolonged. And they gave the story about a rainstorm that it's like your roof is leaking. So even when the storm is over, there's still water dripping in, or if they're gone, there's still puddles around. And so that prolonged exposure and the prolonged changes continues to impact our understanding of identity.
Speaker 1:So then with coercive control specifically, that coercive persuasion happens with ongoing abuse tactics, gaslighting that gets justified so that your experience of yourself is manipulated. And then that's where that confusion starts to come in, which Chuckman and Casa talked about your values being violated. Because you're not getting to be yourself and how there's been physical and sexual abuse that comes into that. And then isolation from friends and family and community and professional identity, where they sort of invade those areas of your life and then try to take them over or isolate you from them so you don't have access to your senses of support. And so that adds to the confusion.
Speaker 1:And then also the surveillance, which we know are things like tracking your phone, recording, having other people watch you, having other people report on you. And that can be true, whether it's interpersonal violence or whether it's something like a cult experience or institutional betrayal, like church or religious trauma. And then with that, the micro regulation of where you're having to report where you are, or you're having to wear certain things or not wear certain things or all these different ways that they are regulating you and you are having to appease them and regulating them through compliance. And that is part of what drives them because they can't actually regulate themselves. And then two, the other piece of using OSDD as a TCA diagnosis is the identity disturbance.
Speaker 1:Is the more that isolation increases, the worlds begin to split even externally. So because you don't have access to those mirror neurons and you don't have access to the mirrors and community and support you usually have, then we have these experiences of literally having to shift identities to try to maintain the compliance with the abuser and dissociate from who we were before the abuser or who we were in process of becoming developmentally. So then that also starts to shift or increase dissociation between our thinking and our sensory and our emotions. So that's part of why we get confused because literally the trauma and deprivation itself has come between us and our values. So then as we're surviving in an oppressive life threatening environment, he said that our reality testing otherwise would be intact, But now we feel confused about what reality actually is because someone else is telling us what reality is.
Speaker 1:Someone else is telling us who we are. Someone else is telling us when we can be with our friends or not be with our friends or scheduling us or tracking our scheduling us. So while we normally could function fine at work, even if we have a trauma history, for example, in a world dominated by our abuser, again, whether that's interpersonal violence or in an institutional kind of harm, that fear gets overlapped with love because as it escalates, we increase our fragmentation. So TCA isn't just PTSD or anxiety or an attachment disorder. It's literally an identity disturbance, which puts it under OSDD.
Speaker 1:So to think of these responses as an OSDD expression and to realize even if someone does not have DID or even if they do, part of them could also be having OSDD specifically because of TCA. So then they talked about coercive control specifically and how that begins with a forced or fraudulent connection. So for example, in a religious trauma, the reasons that are appropriated or used to get them into the group or get them into the church or with interpersonal violence, the telling one story about how you met, but it actually being a different story or with trafficking. He talked about research where it only takes two days from an initial text to agreeing to sell yourself for sex because the traffickers are so trained into, working that coercive model so quickly. It really can only take two days.
Speaker 1:So then the next phase being isolation and intimidation and manipulation, And that that is part of violence, not just physical or sexual abuse, although that also gets used, but that isolating from community and intimidating them or manipulating them as part of it. And then in response to those violent experiences, flight or fight actually fails because we can't leave the abuser and we can't win the fight against the abuser. So that leads to that feeling stuck, via entrapment of trauma as Courtau and Ford talk about. And that means the only choice that people have is appeasement, which is placating them, adopting their worldview and changing who we are to align with what they are telling us to try to please them enough that there is more space between those violent episodes of them being upset with us or telling us how bad we are or harming us in those emotionally manipulative ways. And then the next being exploiting that attachment need because confronting the abuser is impossible.
Speaker 1:So the blame and the badness of the experience turns inward. That's violence directed towards ourselves when we can't confront the abuser. Because we turn that inward, that increases dissociation, which adds identity fragments and splitting the realities to be able to maintain the relationship in a betrayal trauma kind of way. So that builds this self reinforcing loop, which is why it is so hard to leave interpersonal violence, why it's so hard to get away from cults, and why it's so hard for those who have been trafficked to be able to leave the situations they've been in. This was a group of three people presenting, and so there were sort of three different sections.
Speaker 1:And one of the other things that I was just amazed by is how they define the love bombing. They said that it's not just about oh you're the perfect one. It is about the match is perfect, that this match feels better than anything else. This match is what is most regulating. It is you that sees me better than anyone.
Speaker 1:And really that is what turns into that I exist because you see me and that is becomes part of the love bombing. So the love bombing isn't even about how much we feel loved in those moments when they're rewarding us, whatever their style of reward looks like. The love bombing is about acknowledging our existence because we are seen. They will say, I can see you and understand you more than anyone else can see or understand you. And so what is being exploited is actually the deprivation rather than it being childhood trauma that's reenacting.
Speaker 1:And so it's one more reason we can't blame the victims. So then with TCA, which is that trauma coerced attachment, the first piece is the powerful coerced affiliation, which manifests as dependency on the abuser. So they talked about how the abuser will give money, but then you have to pay it back. So you're dependent on them. Even though if you were just on your own, you would just budget differently or giving you clothing or gifting, housing, or different things to keep an illusion of sustaining and supporting you while actually it's keeping you indebted to them.
Speaker 1:But then the feelings of love and gratitude and respect are what they exploit to make you loyal towards them. And then two, the shift in world view and self view becomes that identity disturbance where the outcome becomes behaviors of minimizing the abuse, blaming yourself, and then even defending or protecting the abuser. So in talking through the process of coercive control, they talked about the romantic idealization and how that increases the rapid escalation of violence. So whatever style or kind of violence is happening, starts out with like 90% of love bombing and just 10% of the violence. But by the end of things, those have actually reversed where it is 90% violence happening and only 10% good moments, which really becomes the euphoric recall that we've talked about before on the podcast.
Speaker 1:And then again, isolation, cutting people off from their families, friends, and even employment. And with surveillance and microaggressions where they're being monitored, they're being controlled, their social contacts are controlled, their schedule is controlled. And then the intimidation through physical and nonphysical ways, including differences in privilege. So those in marginalized groups being less privileged than those who are not. And then manipulation with intermittent reward and punishment.
Speaker 1:So this experience of going back and forth between being in trouble and being good and being in trouble and being good and being in trouble, and how is this binary whiplash that happens? It feels like a roller coaster. That is an awful, awful experience. And then the gaslighting of that, where it's put back on you, that you're being held accountable or that you're in trouble because of something you did, or that they're just trying to make things work out and you have to talk about the things to work them out. So these kinds of things being weaponized, and it's an attack on competence and perception of reality.
Speaker 1:So that the experience then becomes that you never know when you're going to be hit or raped or given presence. And that can also be a parallel to childhood experiences. So to treat this or help this, we have to replace the coercive attachment with safe connections. So again, that goes back to what we learned from Chuck Benen Casa, that safety is not the absence of danger, but the presence of community. We have to not shame them because it's not their fault that this has happened.
Speaker 1:And we don't have to overestimate the volition because compliance is not the same as consent. And then we cannot mistake this as attachment style or attachment behaviors even because it's not informed consent or true safety when people don't have a choice. The hardest part of healing then is that collapse of idealization. When you realized you've been betrayed and that it never was loved, you were just used and exploited to meet their needs and the grief that follows, psychological reactions, the identity crisis, and the high risk for self harm and suicidality. That this is also a high risk time.
Speaker 1:This was interesting. He talked about it. He said this is also a high risk time where people turn against their support system. So because they have been isolated from employment, they may struggle to reengage with the same community or employment that they had before. This is also the time they may harass or stalk the therapist.
Speaker 1:It may be the time they express anger at family or close friends. And it may also be when they try to recruit others to take their side, all to get the focus off their own pain and trauma. And so going slowly, being safe, stabilization, all of those things being so important. The only other piece that I would add is that he talked, he never, they never, any of them ever said euphoric recall, but they referenced it. And one of the examples they gave is someone saying he held me in my arms or she looked me in the eyes and them pointing out that they also did that when they were being abused.
Speaker 1:But that part is dissociated. So that's part of why it's such an extreme imbalance and so hard to shake off because the only way to see it clearly is to also see the hard things that happened. But it was really, really good, really, really powerful. And I'm really glad that I heard it, not just for me personally, but also because I'm getting ready to present on coercive control for ISSTD in a couple months. And so this was helpful to hear some of these things validated both professionally that we have a way to tie it to OSDD and to hear that explained.
Speaker 1:And then also for me personally, just with everything I've been talking about since 2022, whether it's my own personal history or the religious trauma pieces, this was just a really, maybe thus far, the most painful session for me to attend personally.
Speaker 2:Thank you so much for listening to us and for all of your support for the podcast, our books, and them being donated to survivors and the community. It means so much to us as we try to create something that's never been done before, not like this. Connection brings healing, and healing brings hope.