Our guest, Dr. Nicole Black, shares the "Dissociative Experiences Cards" she has created for use with clients.
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.
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Speaker 2:Doctor. Nicole Black has over twelve years of experience in the mental health field working with individuals of all ages and backgrounds. For seven of these years, she worked in various settings including residential treatment, an emergency assessment shelter, as crisis worker, and as a therapist for sexual abuse survivors. She has been licensed as an LPC and worked in private practice for five years. Doctor.
Speaker 2:Black is certified in trauma focused cognitive behavioral therapy and is certified in EMDR. She's also an EMDR consultant in training. She's a registered play therapist and has experience working with children as young as two and a half. Doctor. Black's practice focuses heavily on working with child and adult survivors of abuse and trauma.
Speaker 2:While Doctor. Black's practice focuses heavily on trauma, she has clinical experience treating a wide variety of mental health conditions. Doctor. Black completed her master in counseling from Texas Tech University in 2012 and has been licensed since 2015. She has extensive experience in the field of crisis intervention.
Speaker 2:She completed her doctorate in Counselor Education and Leadership from Texas Tech in 2017. Doctor. Black combines elements of talk therapy and evidence based therapy to help clients develop specific skills and make noticeable changes in therapy. Her approach focuses on understanding what has happened to the individual, not what is wrong with the individual. She has provided expert testimony in child sexual abuse cases and custody cases.
Speaker 2:She has conducted trainings on abuse across the country. Welcome Doctor. Nicole Black.
Speaker 3:Okay, my name is Nicole Black and I'm a licensed professional counselor and licensed chemical dependency counselor and redshirt play therapist. I work in private practice in Lubbock, Texas.
Speaker 1:How did you get involved in helping people with trauma and dissociation?
Speaker 3:So I've always known that I wanted to work with trauma, and I've worked with that in various areas. I've worked with kids in foster care and I worked as a crisis worker and I worked at the Children's Advocacy Center, working with kids that have experienced different types of abuse. But when I was began working in private practice, I had a client that I had worked with previously as a child that came back as an adult. And they were talking with me in session and got distressed, and they suddenly had a sudden shift in their behavior and in their demeanor. And I knew this client had had some dissociation, but I realized that they had switched.
Speaker 3:And that that is when I realized that this client had DID. And being in West Texas, we were kind of taught in school that DID and dissociative disorders are extremely rare, and you'll never really probably ever see one in your career. And if you do, it's like this surprise hidden jewel. And then I started trying to read more and understand more and kind of found that ISSTD and started going to as many workshops and buying all the books and trying to figure out how to help my client. And then I quickly realized after I went to EMDR training and learned how to do some dissociative assessments that a lot of my clients turned out to have dissociation, and it wasn't rare.
Speaker 3:And now I have several clients in my caseload that have DID or some other dissociative disorder or dissociation with PTSD, things like that. And so I have been working quite a bit with it actually, and I enjoy it so much. And I feel so bad for that client because they came back to therapy for different points of their life. But I surely looked stupid when I was talking to that client the first time that I realized that they had, parts, and I just had the dumbest look on my face, I'm sure. And so I just felt so bad for them for not knowing.
Speaker 3:I wish that my younger self knew more, and I wish somebody had been there to kind of guide me through it. But there was really nobody in the community that I could go to to help me out. So I had to seek consultation out of my community and, try to become that therapist. So
Speaker 1:I love what you shared just now because it's so vulnerable and there's such a cultural humility to it of the learning process of how to work with trauma and dissociation. How do you offer yourself from the past that same compassion that you're teaching your clients to do?
Speaker 3:I have Anna Gomez's and Kathy Steele's voice in my mind. And I know that you've listened to Kathy Steele before, and she talks about how she's worked with dissociative disorders for, you know, thirty plus years. And there are times that she doesn't know if a client has DDNOS or full DID. And so if Kathy still doesn't know, then I have permission to not know things. And then Anna Gomez talks has talked in her training about when she had her first DID client that didn't know she didn't know, and she didn't know what to do, and she had to go get consultation outside of her community because there was nobody else for her to to learn.
Speaker 3:And so I have kind of the things that I picked up in their trainings that I've kind of internalized for myself that if they don't know something, it's okay. It's okay for me to not know. And, you know, in these different trainings and on different forums and things like that, people talk about, we just don't know sometimes. The client doesn't know. We don't know, and that's okay.
Speaker 3:And so I I try to keep that in the forefront of my mind that it's okay for me to not know right now, which is hard for me because I like to know things. I like to read and have the answer and go discover what to do next. So it's something to continuously balance and just try to keep in my mind that it's okay.
Speaker 1:I love this perspective of being able to sit with not having all the answers yet, and yet you are also compassionate enough and dedicated enough both to your field and to your clients to go find consultation, to go find answers, to go do that work, to improve and to learn and to progress in those ways. And I think that is such a different experience with clients or with clients with their therapists who do that than those who just shut it down and don't try or those who dismiss it altogether. As well as even those who pretend they know when they don't. And so I think that's a very authentic thing and a very healing thing that you've done. Good for you.
Speaker 3:Well, thanks. I've had to learn it. I did not come out of my master's or doctoral program like that. And I think that's the that's a big shift in moving from, like, a cognitive behavioral perspective to EMDR. And EMDR promotes curiosity, and and and basic DID work promotes that curiosity.
Speaker 3:And EMDR, honestly, opened up a huge paradigm shift of of so many things. And I thought I knew a whole bunch of stuff when I went in and I knew things. But EMDR showed me, well, you there's a whole bunch you didn't know about. And look, your clients have been under your nose this entire time and you didn't know about it. But now you can.
Speaker 3:This is the next thing and there's not necessarily one particular right therapy. It's lots of different therapies and pulling from all of them to give what's best for that particular client. So it it's definitely you know, in in Texas, you have to be a therapist for five years to an LPC for five years before you can be a supervisor. And I remember being in my PhD program and thinking, that's, I mean, that's a whole long time because it used to be three years. And I think they moved it to five years to give you long enough time to realize that you don't know everything.
Speaker 3:And enough time for you to get out into the field and realize, oh, they didn't teach me nearly all the things that I need to know. You know, you have to get in there with a client and learn from them. So it's definitely been a shift of perspective over time.
Speaker 1:You've been on quite the journey, and now you have sent me a present, and that's what we're gonna talk about today. This this let me describe for the listeners what I'm looking at. I have a small box like would be for a card game, and it kind of is a card game except not a game, but it is, and we'll talk about it. But it's kind of like I don't know. What would you say?
Speaker 1:An indigo color with a thought cloud on the top, on the lid, and it's called dissociative experiences cards. Tell me, before we talk about the cards themselves, how tell me how you got this idea or where this came from.
Speaker 3:So I work with all ages, and I had a a kiddo that I was reading Anna Gomez's book with this kiddo and the book is called All of the Colors of Me and it introduced this con the concept of dissociative symptoms and parts or voices and things like that. And I wanted to to begin to help this kiddo notice the dissociative symptoms that they were experiencing because this particular client was, they were it was reported that they were sleepwalking, but they weren't actually sleepwalking. They were switching, and the client had amnesia for what was going on. So there was not a lot of awareness for this client, and I wanted to help build that awareness so that the the kiddo could understand when they were possibly gonna have some switching or dissociation and help to catch and notice those symptoms so that then we can introduce different ways to regulate or to ground and to help the parents understand when that was gonna be coming up and to give the kiddos some resources so that we could do work, for things that were coming later in therapy. And it also came secondary to working with adult clients that have had never been diagnosed with a dissociative disorder.
Speaker 3:And they were trying to explain their experiences to me when we were doing the dissociative experience to scale or other assessments and exploring symptoms. And they would ask me, you know, things like, am I explaining that right? Or does that make sense? Or does does that seem crazy to you? And I'm I would say, no.
Speaker 3:No. No. No. And I would I would try to explain to them in my words to just normalize that experience about, you know, does it feel like you're in the back of your head, or does it feel like you're kind of floaty feeling, or does it feel like there's something inside of you that's trying to take over the controls and and make things happen? And just using different language to kind of normalize the experience so that they would relax and feel comfortable sharing what they were experiencing to know that I understood what they were saying and they didn't have to spend so much time overexplaining to make sure that I was comprehending how they were experiencing things and to know that other people experience this.
Speaker 3:And we can work on this and it's it's normal and here's what's happening and those types of things to kind of have that normality and and a a picture to kind of represent things. So when I was working with my kiddo before, we would go through Anna Gomez's book, and I would tell the kiddo whenever they saw something that the book was describing that they noticed that they experienced to just let me know that. And then I had these little index cards or post it note type cards, and we would draw what that kid was experiencing. And I laminated them, and I would send them home with the kid. And I made like a deck of of cards that the child could go through at the end of the day and reflect when they were having these symptoms or they could express to their parents when those symptoms were coming up if the parents were accidentally triggering them.
Speaker 3:And and then they could use resources to help them ground and kind of come back into their and into their body and regulate. And so we developed, you know, this deck of cards with stick figures because, you know, I can't draw, and the kiddo would just draw their experience. Then we would draw a deck of cards for their resources with their coping skills, whether they're calm, safe place since I come from an EMDR perspective. And it just dawned on me one day to find somebody who could draw better than me and have all of these experiences illustrated in a way that was beautiful and really brought to life the essence of what that person was experiencing. And so I found a local artist who is phenomenal and sat down and and described to her, what that was what that was like for somebody, like, what what that might feel like inside for them.
Speaker 3:And that's how this all started.
Speaker 1:And when you're talking about dissociative experiences, are you talking specifically about the examples from the dissociative experiences scale or just in general that you have found with your clients?
Speaker 3:So both. So some of these cards were pulled from the the desk, and some were pulled from the mid. And then some of them were added in based off of what I knew to be very common for clients. So there's a card in the deck that says, I feel as if I'm floating. And I don't believe that that's on the desk or the mid, but it's very common for my for my clients to have an experience of when they start dissociating that they feel like they're floating.
Speaker 3:And I would use that language a lot and the clients would say, Yeah. Yeah. How did you know that? And I would say yeah I have a lot of clients that feel that way and it it's one of the quickest ones that a lot of my clients experience and so I find that card to be really helpful because if it's coming up in a session they can let me know, and then we can work to ground or work to regulate and do whatever we need to do or pace the work or things like that. So it's it's kind of comprised from the desk and the and the mid.
Speaker 3:And then also just the experiences that were frequently reported by several of my my clients at different times.
Speaker 1:So on the back of the box or the bottom of the box, I guess, it says dissociative experience cards. This box contains two sets of cards with 25 unique pictures in each set. The first set shows realistic depictions of dissociative experiences. The second set shows symbolic depictions. So the example you just gave of I feel as if I'm floating, it shows the pictures of this on the bottom of the box.
Speaker 1:And the first one is a person who the artist has drawn so it looks like that they feel like they're floating. And so you see the actual person because it's the realistic depiction. But then the second card that says, I feel as if I'm floating has, like, a balloon going up into the sky.
Speaker 3:And that was a that was one of those typos that we I'm fixing on this last run, and I I was able to go ahead and order the the set of cards for the to prepare them for sale. There's actually gonna be 27 different cards with in each deck. And so, yes, there there is a card that shows a realistic depiction, and it shows, you know, human beings from the perspective of inside the mind. There are some that are portrayed from inside the mind of the individual or there are some that are portrayed that show what it would feel like on the outside for that person. And it's kind of hard to explain that verbally, but when I was when I was working on all these cards, I began to show some of the illustrations to my clients, and I learned very quickly that some of my clients were getting triggered.
Speaker 3:And it was triggering the the symptoms. It was it was kind of causing those symptoms to come up, and then we would work to ground. And I didn't I didn't think that these cards would be triggering myself, but I don't have a dissociative symptoms. And so that was a real quick learning experience for me. And then I quickly decided that I needed to have something that was a little bit more distance.
Speaker 3:And so that's kind of where I drew on my experience being a play therapist and and doing sanitary therapy and those types of things that when it's too direct and it's too too personal to distance it a little bit. And so there are these symbolic cards that have different representations of things. So if you look at the deck inside, the first card that I came up with
Speaker 1:Oh, the first one that I have says, what is grounding and about grounding?
Speaker 3:Yes. So there's I put that on there to on the on the top. So I I try to be very strategic in setting up the deck. There's the the instruction booklet that kind of gives that warning that some of these cards can be triggering for individuals and you can alternate. And it doesn't really correlate with, you know, how much trauma that person has or anything.
Speaker 3:It may be more likely that the triggering is it's just that they identify deeply with that experience that they're seeing and so then it starts to kind of stimulate that dissociative symptom, or it could be that that person has kind of a phobia of dissociation or dissociative symptoms or they're kind of phobic of parts. And so then that's hard for them to think about or to look at. And so then you need to just distance it a little bit. But the first card that I have the artist draw was the one that says, I feel as if I'm in the back of my head and I can't control my body or actions. And so in this depiction, there is a person that's behind an eyeball.
Speaker 3:They're they're in the back of their head, and they're trying to control the control panel. And as you look through the eye, you see that that person is, you know, having a disagreement or an argument with somebody else. And it it shows a representation of kinda being in the back of your your mind, and you want to control your body, but you can't quite make your body do the things that you want it to do and and having that experience. And so that that was hard for some people to look at. So then I developed the second deck of cards, and that one has a little controller for a video game.
Speaker 3:And so there's a nice little symbolic representation of what that experience might be like, but it's not so triggering. And so these these cards can be used in different ways. You know, maybe the client knows very well what that experience looks like and they don't need to see the realistic card. They can just use the symbolic card but maybe they have a parent in their life or a partner or a therapist that is new to working with dissociative symptoms who doesn't quite understand what that would feel like for a person, they have a hard time understanding how that experience would feel or it seems bizarre to them or foreign. And so I love these realistic cards because they can be used to to kind of teach individuals that don't know about that experience what that could feel like in a in a literal way for somebody.
Speaker 3:And that's what some of my clients have begun using this for. They will use the symbolic cards for themself, and they will they will show the realistic card to family so they can be more empathetic and understanding for what they're experiencing and then help them to use their resources or to ground or things like that. And then the other thing that I like to use a realistic cards for is when I'm doing assessment and exploring symptoms with clients and they're trying to explain what that feeling is like, then I can go for the card, and I can say, does it feel like this? And then they can say, yeah. Yeah.
Speaker 3:It feels just like that. Man. And then I have a a therapist friend that I gave this to, and she's been using them with clients. And a a lot of clients have expressed relief that there are cards out there that show these different symptoms and feelings and that they're not the only one who's experienced them. And that there's something that names that that it that explains that and that there's something that you can do to kind of help it or resource it or just to know that it's not atypical to have these experiences.
Speaker 3:So they've been really neat to see different ways to use them.
Speaker 1:That's amazing. And I like that other than the instruction booklet, that the first thing that you see is about grounding and then five four three two one, that name things you can see and touch and hear and smell and taste. And then on the back of that card, it explains what grounding is and gives different ideas as well. And so I think that's pretty neat for opening with that, for making sure that before you do this activity, here is a backup plan if you need it. Here's how to keep yourself safe while you do it.
Speaker 1:I love that you included that. Then the next card is another one, and on one side, it's a it's yellow and says warning. And on one side, it's red and says stop. Can you tell me about that?
Speaker 3:Yes. So I had a client that I was working with these cards with, and this client has a part that will act kind of as a gatekeeper. And so if we went too far or if we cross a line or if we pushed a little bit too much or, you know, did anything like that in therapy, then this gatekeeper part would shut things down. And I wanted to be very respectful of that so that we were not overstepping or stretching past what we needed to do. And I said, what if you have, like, a stop sign or some way to to kind of signal me?
Speaker 3:And they signaled me with a word, but I didn't catch it immediately because I thought they were just talking. And I said, okay. Let's let's get, like, a stop sign. And so I actually went into my playroom and got a red piece of cardstock and cut off the shape of the card. And if we got too much, too high, or too, you know, push too much in therapy, then they could hold up that red piece of card.
Speaker 3:And I thought, okay. I need to make an actual card for this. So on one side, it says stop. That's your hard no. We don't need to do anymore.
Speaker 3:And then you've got your warning. So that if things are becoming too much, too overstimulating with clients that have PNESs or, you know, pseudoseizures, those types of things, we're working very much on noticing when we need to stop, when we need to down. Because if we don't, then it could trigger something else. It could trigger a pseudoseizure. And so helping the client to have that control and helping them to notice when they're reaching their threshold and they need to we need to pace the work and those types of things.
Speaker 3:Or if you're working at home with a family member or something like that or a parent, then this is good for them too because they don't they don't know. Nobody knows like the client knows. And then this will help kind of communicate that so that there's no missed signals or anything.
Speaker 1:Now, again, I'm sorry for going back to this. I just wanna describe them so well since it's a podcast, you know. You're can't see what I'm seeing. And so the next thing in the box are the two decks of cards. And the ones with the pictures of people are black on the back, and the ones with pictures of symbols are blue on the back.
Speaker 1:And they are about twice this size as a regular playing card. And so to me, as far as size, they make me think of, like, in America anyway, like, the old made cards or go fish or something.
Speaker 3:Yeah.
Speaker 1:As far as
Speaker 3:Yes.
Speaker 1:Size of playing cards. Right? So they fit in my hand. I can hold them. They're about the size of my hand, actually, And so they're pretty neat.
Speaker 1:The other thing I wanna say that I noticed immediately that I think is a really good thing is that I see lots of different kind of people. So there's not it's not just full of girls. There are also boys. There are people that you don't know what gender they are. There are different skin tones and different hairstyles, and there's a lot of diversity as far as the presentation of the people on the cards, and that's something I appreciate as well.
Speaker 3:Yeah. I have to give props to the artist. I she did a just a tremendous job, and she used people of color, and I said, yes. Let's do more of that because I I always feel sad when I look in these children's books, and I have a client that is a person of color. And, you know, I'm I'm white, so I relate to that experience.
Speaker 3:But I'm aware that not everybody else has that experience, and it's nice to see people that resemble yourself when you're looking at these different books or cards or things like that. So and the cards are about three and a half by five and a half. So they are good size, which I enjoy because you can see just a nice representation of of the artwork, and they're good for all ages to kind of get a hold of that and go through it. They're not tiny little cards and difficult for children to handle or to kind of manipulate in their hands. So and I I colored the the backs different colors so that if they were highly triggering or anything like that, you can easily flip them over and you can separate your decks.
Speaker 3:So I wanted them to be very clear of which one they belong to.
Speaker 1:That makes sense. I wanna go back to what you said just a minute ago about the diversity of people represented in the cards because I think that that is so, so important and it's often forgotten. And I have children with differing abilities and differing challenges in our family, outside children. And one of the things that we struggled as as we realized we were going to be adopting them and they had these challenges, we wanted to find books and things that reflected them, and it was impossibly difficult. And ultimately, that's why we wrote the series of children's books that we did with different medical issues and different developmental disorders and things because we wanted them to have a book that reflected them.
Speaker 1:And so we had to write our own because there wasn't anything. And the same thing with our daughters with brown skin. We have to actively seek out books and toys that reflect them and their skin tone and not just books about black people or books about people with brown skin, but books by black people or with brown skin or artists who have done that. And it can be so, so difficult. And so to just be mailed this package from you to us and to open it and see that already there, I think is such a powerful experience.
Speaker 1:Like, I I would have no problem handing this deck of cards to my daughters and saying, look at all these different people and the different experiences and them being able to flip through the pack of cards and see people reflected like them. And I just I wanna verbalize that. I know that's not why you're here to talk about, but I wanna appreciate that and I wanna honor that because it really is so, so important. And I I think that's really well done.
Speaker 3:Yeah. I mean, I have to give props to the artist because she I just told her yes, you know, the diversity and the people and things like that. And she even she chose different hairstyles for the the people of color. And so there's, like, several black girls or black women in these different depictions, and they have different hairstyles that are diverse and beautiful and are not just what one person may expect. And and like you said, there are people that are depicted that you're not quite sure if they have a certain gender expression.
Speaker 3:So I I think she did such a a tremendous job. And I have to give props to the artist because I was writing paragraphs of trying to explain. I would write her an email and I would say, this is what I envision in my mind when my clients tell me about this symptom and here's how I want you to portray it. And, she would give me a sketch back, and I would say, that's perfect. Or if we needed to make a change, you know, let's let's change his facial expression or let's that's not quite right.
Speaker 3:You know, let's do this differently. And then I would I would get a color version of the sketch, and I would take it to my clients and say, is this an accurate depiction of what you would experience? And just get that feedback from them of of what was right, or what kind of was different from their experience. And and not everyone's experience is the same. And so the cards, instructions talk about that as well.
Speaker 3:So not everyone's going to fit into these depictions but they're a good starting place for recognizing and being noticed of what experience that person has And then the the client can go from there explaining how their experience is unique. There's a lot of versatility with it.
Speaker 1:I love it. They're the the the people are not binary people. The colors are not just one skin tone. The hairstyles and the the presentation of the people and the different facial expressions. I really, really love that about it.
Speaker 1:The other thing or the next thing that I notice is that it's almost, I don't wanna speak for the artist, but it's almost a kind of sketch watercolor kind of presentation so that the cards themselves, sort of the background colors, are very soft to look at. It is not a bold, jarring experience to look at them as far as the artwork. And then the primary, instead of being busy in the background, the primary focus of each card is the sketch of that description. And they're they're in color, and they're bright, but in a soft way, and I appreciate that. It feels more gentle somehow.
Speaker 3:Yeah. And I I really I was really purposeful when working with the artist kind of explaining the importance. And I would sit down and type an email to her about, okay. With this card, we're really gonna have to deliver it in a a very purposeful way because this certain depiction will probably be very triggering for people. And so we're gonna have to deliver it in a way that is distanced appropriately and but catch catches the essence of what that would feel like for a person.
Speaker 3:And there's it's so fun. It was so fun for me to kind of put myself in the shoes of of people with dissociative symptoms and and try to understand and explore what that experience would be like for them. So there's a card in here that I'm looking at in front of me that says, I find evidence that some something has been done. I must be the one who did it, but I can't remember. And that's a hard experience to have.
Speaker 3:Like, when you come home and you realize that you've done something and you don't remember, and what did you do? You know? That and that's different for everybody, but I wanted to be very careful, and tactful, and how I portrayed it so that it was easy to look at that that depiction, not shaming in any kind of way, hopefully, but also captured the true essence of what that meant for somebody so that people also, I wanted to help clarify for other individuals how these dissociative symptoms are different from just normal everyday forgetting. You know? I forget that I switch the laundry over sometimes, but it doesn't mean that I have amnesia.
Speaker 3:But there are individuals that, you know, have that. And so trying to catch the essence of that so that also I could help people clarify when it was a dissociative symptom or maybe it was just normal everyday forgetfulness. Kind of going back to the the deaths and helping, tease out those symptoms that clients are reporting when they come in.
Speaker 1:This is so exciting. Thank you for sharing this resource.
Speaker 3:Yeah.
Speaker 1:Where can people get them? Can you tell about that?
Speaker 3:So I'm ordering the first set of the cards, and they should be available after March 15. And they will be available on my website, which is www.phoenixarisecounseling.com, or they'll be available on Etsy. And the Etsy's, shop name is Phoenix Arise Shop.
Speaker 1:Thank you so much for sharing with us. Is there anything else you wanted to share while we still have you?
Speaker 3:The last thing that I would say is that there will be that the PDF that is available for download. It's a a free PDF that they just have to go online and get it, and the the box has the information on it. But that PDF is a blank template for cards that match the same size as these cards so that if a person has a different experience that they wanna include, they can make their own card that shows their unique experience, and they can print that out on cardstock or print it out and draw it and laminate it, and they would have access to their own special set of cards that are unique to them.
Speaker 1:And that is also available at phoenixarisecounseling.com. Yes. Thank you so much for telling us about these and for letting us look at them. We'll also post pictures of them on the blog if that's okay.
Speaker 3:Yes, that works. Thank you so much for having me. It was a delight.
Speaker 1:Sure. Thank you so much.
Speaker 4:Thank you for joining us for System Speak, a podcast about dissociative identity disorder. This podcast is available on any podcast player and on systemspeak.org. If you would like to know more of our story, our memoir, If Tears Were Prayers, is now available at systemspeakbooks.com. Thank you for listening.