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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, we have had an epic adventure after missing ISSTD Annual Conference last year because we were moving and then and so this year to get to be back at Annual Conference has been amazing. It has been so good to see my friends in person, so good to have the rest and the coziness of the space, the excitement of all the learning and the reunions of all the friendships. It has been so good. And also, it has been quite the adventure. It was raining really hard all the way here.
Speaker 1:We left super early to beat the traffic in the city, but we got settled in with no drama at all. My colleagues who are also on staff with ISSTD met me at the door literally to welcome me, it was easy to get parked and unloaded and checked in, getting settled in our room, and we had sack lunches already ready. So, it was just the easiest transition. I can't even say. I was worried that we would have to wait until later check-in time.
Speaker 1:And I had planned some backup options, but it was raining so hard that was not gonna work. But we got into our room just lovely and it has been gorgeous ever since. We still got to play in Portland and we got to see the cherry trees at the waterfront. We got to see the food truck pod and it has just been so much fun. I also finally got a run through of my presentation and got it recorded for the podcast, so that will come up later.
Speaker 1:I don't present until Saturday, but I'll put it at the end of our ISSTD Recaps, which I have permission to continue doing. So I have not recorded episodes this year except one about the flood and that one at the skate park when I was trying, but I have been so sick all year with this pneumonia. Those of you in the community have heard me hacking and seen me so sick. It has been months of being super, super sick, and I basically have just slept through the last three months. It has been so intensely awful being sick, but I think that, I am breathing, I am here, and I did the run through, so if I've got cough drops and enough water, I think I can get through my presentation.
Speaker 1:I had ISSTD on alert that I might not be able to do it, but here we are. And it feels good to finally be recording as well. My presentation is four whole hours, and so getting through that for the final run through and timing everything and making sure it was on point, I'm so grateful y'all were so patient, those of you who were there to listen. And then that afternoon I got to rest. I needed the rest because my body is still bouncing back and has not been happy about being sick.
Speaker 1:Every muscle in my body hurts from coughing, and the coughing even broke a tooth. It's been a whole thing y'all. It's been a whole thing. But by Wednesday night, our local friends were meeting up, our students and colleagues were arriving, we got to try out the restaurants downstairs. It was just so good to be reunited with my people and really book into the last year of all the things we have learned, all the growth we have done, and just coming full circle back to being at conference again.
Speaker 1:We missed it so much last year. I got permission to skip the board and staff dinner and just hung out with my friends and family. Some of these people I only get to see in person here, and so it felt so good to be with them. I was so nourished by our time together and our good conversations. It just filled me up.
Speaker 1:It was amazing. I have missed these people for two years. So by this morning, when pre conference was starting, it's extra sessions not everyone comes to, they call it pre conference, but really it just feels like part of the conference. I woke on time slowly and gently after really good sleep, seeing everybody last night just filled me up. And so I slept so well.
Speaker 1:I woke up ready to go and that felt good. I got my breakfast. I got to my session early to be all settled with my interpreter and it was perfect. Like I am so grateful that everything went so smoothly. So the morning session that I did was the Human Rights Complex Trauma and Dissociation Forensic Documentation of Persecution session.
Speaker 1:It was perfect and exactly what I hoped it would be. Kim Varanowski from McLean Hospital was presenting and it was so good to get familiar with her work. She talked about how important it is to ground our work in literature and to be citing it, and about how hard it is to be tracking policy changes, which we've talked about as a nonprofit, and so having more resources to help with that was super amazing. She said there are 117,300,000 forced displacement people because of persecution, conflict, violence, human rights violations. And then we talked about what torture was.
Speaker 1:And she really just gave a broad view of psych assessments with medical legal affidavits and how to get involved in the social justice of where this is really need people are really needing support with this right now. So as part of that, we got into language about interpersonal violence. We got into language about state violence and how all of this has the focus of disintegrating the personality, the sense of self and sense of belonging, the sense of being. And then she went into more specifics and more in-depth about different forms of torture, gender based violence, the power and control wheel from interpersonal violence, which I'm talking about with ISSTD in May, and then also trafficking, which specifically includes, as Michael Salter says, the crossing of lines. So for it to count as trafficking, it has to include crossing state lines or international boundaries.
Speaker 1:And then she also talked about forced or coerced sterilization and how that's battery and different examples of that happening, and then forced migration, and that 67,800,000 people are internally displaced. And then really for the second half, it was all about the asylum process. There are 2,339,682 people in The U. S. Waiting for a hearing.
Speaker 1:About ten seventy five of those will be granted, 4,786 were just removed, and then up to 8,843, I think these were numbers from February, self deported primarily to avoid being sent to a place they didn't want to return to or the place that was not actually their home country. And so talking about how they have to prove past persecution protected ground, the state being unable or unwilling to help address the control issues, and internal relocation being unreasonable or unsafe. So like, last year when we left a state with one kind of politics to a state that better supports the safety of our family, and then they also have to prove there's no bar to their eligibility. So then we went through the actual application, including form five eighty nine, the written declaration, which has to be done in first person, the supporting documents and country conditions report. So it was so, so helpful.
Speaker 1:I already knew about the Istanbul Protocol Guideline, guidelines from work that I've done before, but this was really, really walking through the affidavit paperwork. We talked about trauma informed interviewing and ways to show in the paperwork the impact of state violence on people's ability to share their own stories, as well as resilience factors so that it's not just only focused on a diagnosis and how different countries, cultures, and languages talk about PTSD kinds of symptoms in ways that use different language than we do. So like from Cambodia, they use a phrase that means broken courage, or in Peru, they use a phrase that means sorrow and sadness. And in Punjabi, they use a phrase about a sinking heart. There were just all these different examples that were very, very emotional.
Speaker 1:She said there's currently over 68,000 people in detention centers, and part of what these affidavits can do is help the people in detention centers get humanitarian parole. And so there are some people who have the spoons or capacity to actually go to the detention center and do evaluations. Others support them. Others can write reports. Others can do telehealth reports.
Speaker 1:Others can do it as chart reviews. There's different ways to do it, but how there's a huge need right now for clinicians to help folks in detention centers and help folks in the asylum process. So we walked all the way through the affidavit training, and I will save you the details of that, but it was super helpful to see. I've had to do court reports before, and I've had to do testifying before, but to have this specific population and the current need of social justice in our country, to have the experience and knowledge to be able to know how to apply those skills to that setting really was so, so important. After that, there was a nice long lunch break.
Speaker 1:I hung out with my family. It was chaos and loud. We also went outside for a while, and I got a nap. Like, they give us a nice long lunch break, which I appreciated, to be honest. In the afternoon, I got to see Lou Hines again.
Speaker 1:I love those presentations. This one was called Translucents, Transparency, and Psychodynamic Therapy with Trans Clients. Super fun. They talked about attachment theory, psychodynamic treatment, trans 101 kinds of stuff, and psychodynamic with trans folks specifically. So they talked about translucence meaning semi transparent, where there's a sense of what's going on internally, but with therapy, we sort of offer more light to bring out those shadows to see what else is going on.
Speaker 1:And not everyone stays for that, especially, again, like we were just talking about in in my presentation, the the unfortunate experience of people quitting right before a developmental breakthrough. They talked about transparency, letting more and more light in to bring more clarity as we go through those developmental breakthroughs and through the therapeutic process, and then ultimately transformation where we're being seen and witnessed. And for us clinicians that we are seeing and witnessing. So then they gave a great history about attachment. I loved hearing this from their perspective and the way they broke it down.
Speaker 1:In 1958 with Bolby, how all humans have a biological requirement for survival to form a soothing protective bond with a caregiver within the first six months. So the caregiver becomes that surrogate nervous system to bring the soothing and to bring the regulating, and then we can learn to do it ourselves after that practice with our caregiver. So how, if we don't have that, we don't get that experience. And literally it doesn't develop in our nervous system. And then in 1969, he finally talked about attachment systems specifically and meant it as a disposition in the infant that keeps them oriented toward closeness with the caregiver.
Speaker 1:So what he's ultimately talking about is proximity. We didn't have that word yet, but that's where he was going. So then attachment behaviors are the specific observable actions the infant uses to achieve that proximity, especially when distressed or alarmed. So how the caregiver responds determines the course of their attachment strategies as they grow up or enter into relationships in adulthood. We've talked about that on the podcast before, where when folks were not receiving care, they may have to seek it out and use those anxious or approach strategies, and then that can become very, very controlling because they're having to demand it or ask it.
Speaker 1:And then how those folks who had to avoid harm may struggle to stay present in the relationship and tolerate the relationship, especially if that gets mixed so that the relationship itself is becoming a disorganized attachment ultimately together externally instead of people internally rescuing their own babies, right? So then they talked about Ainsworth and how they finally came up with the secure versus insecure attachment via the Studies with Strange Situations. And then it was Mary Main as a postdoc person under Ainsworth who talked about disorganized attachment in the context of absence of coherent strategy. And what we know from Ana Gomez is that absence of coherent response from the caregivers. So it's not the children or the attachment strategy is disorganized, it's that the care was disorganized.
Speaker 1:The child doesn't know which parent they're going to get or which care they're going to get or which response they're going to get from the caregiver, which again brings it back to relationships that when the external stuff is being reenacted as trauma instead of secure attachment and rescuing our own babies, then that gets acted out and can be really distressing for both people. So we talked about several concepts. They talked about attunement. I've always said attunement as our emotional needs being noticed, reflected, and met. I love how Lou Himes phrased it, being aware and responding to the inner world of the other.
Speaker 1:And so that, again, taking that back relationally, if we have someone whose approach strategy is controlling and so the avoidant strategy, trying not to be harmed, has to back off, then that anxious strategy then becomes a self fulfilling prophecy where what their inner world is needing is connection, but with the pulling back of the avoidance, it will feel like abandonment. And for the avoidant one, then the intrusion and the controlling feels like additional harm. And so really all of that is true at the same time. Doctor. Himes talked about the mirroring, how matching the nonverbal communication of another, and we went into mirror neurons with tone and breathing and energy.
Speaker 1:And then the authentic self versus the false self. With the authentic self being that unique gestalt or whole of a person, We talk about it in terms of inclusion, including all of us. This is union concepts, but including the conscious and the unconscious parts, the physical and the mental characteristics, and also capacities and experiences going all the way back to in utero even. And then that false self, it's not about lying. It's not about not having, It's not about being bad or false.
Speaker 1:I know there's sort of that moral tone, the way we use the word in language today, but originally with Jung, that false self was about the defensive facade which hides the authentic self from abuse and neglect. So it was like a protector, not a false self as in lying, but a false self as in protecting what is good and real and trying to hide it so it's not invaded. So then that also gets acted out relationally, where if we're not feeling safe and having to withdraw, or we're not receiving care and feeling deprived and so have to seek it out, Either way, then we are not acting like ourselves, which obviously would be distressing to our partners. So someone with anxious or approach strategy is not someone who wants to be controlling or abusive. Someone who is using avoidant strategies to avoid harm does not want to isolate or abandon their partner.
Speaker 1:And so then it becomes reenactment until we tend to it. They went into porgis and what we know about polyvagal with attuned caregivers being able to share their regulated states as anchors and developing that capacity and flexibility to shift between physiological states, which is like the opposite of dissociation. But being able to do that or learning how to do that builds emotional resilience. So appropriate empathic attunement leads to the development of self and a regulated nervous system. Emotional neglect, abuse, or harmful attitudes towards marginalized populations leads to chronically dysregulated nervous systems and more of that false self, which now we talk about so often in terms of masking.
Speaker 1:They also shared this quote from Fraser about how faulty mirroring during periods of identity construction because the trans self is invisible to the outside world. And Doctor. Himes added that it's also invisible to the inside world because it's not even safe enough to see it ourselves. So then in hostile cultural or familial context or in reenacting relationships, that true or real self of a person most likely either gets repressed or rejected or hidden until it is time or safe enough for that to come forward again. So it's part of why we get disoriented.
Speaker 1:Chuck Benin Casa talks about it as trauma coming between us and our values, how we literally don't feel like ourselves. People who care about us may even feel like you're not yourself. Like, I know this isn't who you want to be, or I know this isn't how you're trying to show up, and also it's happening. They also talked about how not all trans folks experience dysphoria. And then they shared this story about a child that maybe is AFAB, but is identifying as male, but still a child, so no consent, no voice, no choice.
Speaker 1:And so having to respond to a parent giving them makeup or part of those socialization kinds of things, and how that really becomes a betrayal trauma, because they have to deal with that and maintain the attachment. They talked about disorganized attachment being rooted in distrust of parent because parents are causing fear or the child doesn't know if the needs will be met or the child doesn't know what to expect and so there's no consistent way of trying to engage and that anything that points that out surfaces shame or anything that points out the violation of those early childhood social contracts brings out shame. Or when fawning gets acted out, there's also this simultaneous shame that's happening. So there's a quote from Ruth Blizzard about the child being caught between the devil of abuse and the deep blue sea of abandonment. So then when Doctor.
Speaker 1:Himes talked about psychodynamic theory and brought up, like started with Freud, of course, and the neurobiology in its infancy, and talked about consciousness, about what's above water, the smallest amount, what's easiest to access. Preconscious is easily surface therapy, can help us see it and help us be with it. It can be cathartic. We can move through it, but unconsciousness has the vast majority of human experience, the largest parts of our experience, and it's not processable. It is repeatable, which is not cathartic, which is why things like interpersonal violence is contraindicated for couples therapy, or because, or how with reenactments, it is sometimes right to run or right to leave or need to pause or stop and reestablish safety in any kind of ship because it's not going to process while it is repeating.
Speaker 1:So they said, and I love this, it's maybe the most important thing I heard all day, that therapy is not symptom reduction. It's understanding what's popping up the symptoms, what is surfacing the stuff. That's what we need to look at is what is under all the stuff that's surfacing. And then with abuse and neglect, our first task in therapy as part of safety and stabilization is learning to bring into our awareness, especially with dissociation, what our mind is trying to let surface even before we have language to describe the actual experience. So to do that, we work within the therapeutic frame, which is about consistency, time and place, and knowing when our sessions are, clear expectations and policies, the boundaries and privacy, and those not being rigid.
Speaker 1:We'll talk about that more in a liberation framework. And then humanistic, where there's unconditional positive regard. And also how unconditional positive regard does not mean not limit setting of when I am not safe, I cannot help you. And how there are boundaries about that. With the relational approach then, the therapeutic reparative bond is home base and we have to own the self as the tool that's used by the client.
Speaker 1:It reveals patterns, metabolizes and processes the unspoken into language. There's that secure base where clients will ground into us and push off of us. Hopefully, they stay with us long enough to complete that process. And also, even when they don't, that's not anything lost because it's still their therapeutic work and it's just where they are developmentally. So when transference and countertransference are heating up, it means that attachment system is activated and they're actually going deeper.
Speaker 1:But it brings up the question of what happened to them when they were little, how they were treated, and how they respond to what they've been through. So do they stay and engage? Do they shut down and leave or quit therapy? Or do they act out, blame the therapist and harm others in the process instead of tending to themselves? Because it's easier to focus externally and blame other people for what's wrong rather than sitting with our own stuff.
Speaker 1:And then complimentary transference about when the therapist is in the role of what happened to them when they were little or can Gordon transference when the therapist experiences the client's experience. I talk about this more in my session, so I'll just leave that for now and we'll come back to it. So the therapist seeing all of this and bringing it into awareness is called interpretation. And what happens between us in any of our ships is really a reflection of memory time. But in therapy, those feelings and interactions and how it happened can be tended to.
Speaker 1:And also when it gets hard and people want to run from therapy or people want to act out and blame the therapist, we can say to them, We don't have to throw away all the progress you've made, and we don't have to throw away you or me. We only have to throw away what the wrong messages were you were given when you were little. We only have to throw away the idea of what harmed you because that was never true or real. So then enactment together about things surfacing, that's the commingling of client and therapist stuff, baggage, memory time, replaying in a vicious pattern. But the solution is that solid interpretation.
Speaker 1:The therapist seeing clearly what's going on and the client staying to work it out. But then the interject, they said, is when we swallow something whole. So like a message we were given when we were little and then just puke it out on people. And they talked about Michael Coy's presentation this morning, which is one I've seen before and talked about before on the podcast, and he's come on the podcast, but about chewing up baby bits and to feed to the baby bird. And so how we have to be in therapy ourselves as therapists to be able to follow that process full circle, and our clients need to stay to be able to go through it full circle.
Speaker 1:After that, we got more specific into trans care specifically, everything from sex being about biology and identity being about the mental experience into the whole evaluation and writing a letter process. And then, the updates from standards of care, the eighth edition is out now, so we got those updates. And then post social transitions, things about hormone criteria, surgery criteria, and, how we can sit with someone's experience of oppression or being harmed even when we don't agree that we are the ones doing it to them. When we can see clearly that it's in memory time, we don't actually have to personalize that the things that they are expressing are true because it's coming up surfacing from those relational wounds in memory time. It was so good, such a long day.
Speaker 1:I'm super excited to hang out with family and friends tonight. We all want Indian food because there was a wedding downstairs. So, all through lunch in the afternoon, we could all smell the food. And so, we're all doing Indian food tonight. I am glad we're getting to relax and play and learn and be back in our element.
Speaker 1:I had a great day. It has been easy and comfortable and safe and all the things, and I am just delighted to be back with my friends. And it fun this year to have the family. It has just been so good. I can't even tell you.
Speaker 1:And also, my body is weak and tired. So, I'm excited for Indian food tonight also because it's good nourishment for my body that's trying to heal still. So, I am grateful I will have some spices as medicine tonight and I'm very excited. Welcome back to conference, y'all.
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.