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Trauma, Attachment, Dissociation & EMDR – Inspiration Series 2.0 Webinar

Colin A. Ross, M.D. joins us to discuss trauma attachment dissociation and EMDR. See the full video and transcript below:

Trauma, Attachment, Dissociation & EMDR

Hello everyone! Thank you so much for joining us today – our second inspiration series and our second presentation in that series and our second presentation from Dr. Colin Ross

So thank you so much for spending part of your afternoon with us today and what better topic than trauma attachment dissociation and EMDR.

Now the world for all of us has changed drastically over the last week with George Floyd and just what we’ve seen and what we’ve experienced. I’m here in Chicago and I can tell you it was very traumatic this week and I’m sure wherever you are whether it’s Illinois or we have someone from the UK, I’m sure you felt some sort of trauma or disassociation. So, we’re so glad that Dr. Colin Ross is joining us today to talk about that. So timely, and so important, and so relevant

Just want to show some of our heroes here. Internal heroes from our nursing department in the upper left to our Springfield facility in the upper right. Our in-house sign that the employees did for the other employees and the bottom right, this is a new picture, Sandra Beecher who is our outreach coordinator. You know this is how she is about supporting people. Today when she’s calling on hospitals, or therapists, case managers, other treatment providers, you know it’s a new world how we have to go into the world and dress up and show up and also protect others as we protect ourselves.

So a shout out to our staff, to our outreach team that are there. They help the therapists, physicians, psych techs. Everybody who’s supporting people in substance abuse disorder and mental health treatment and to you our viewers today, you know it’s so, so important the work that you do, the role that you play now more than ever.

There was some statistics released today in Chicago, not great statistics, that basically shows that there’s been since January, January through April, a 72 percent increase in EMS visits due to overdoses. Not only that but since January through April there have been an increase of 3 percent in overdose deaths. So you know, we’ve been talking on these webinars about death of despair, which is the terminology given to this virus to those who are not dying from the virus bu

dying because of the virus, the secondary effects. We’re seeing this in Chicago. I’m sure it’s taking place all over the country. You know it’s estimated that over 75,000 people will die as a result of this. So, the work that you do, the role that you play, is hugely, hugely important. Thank you for the risk you take and for that.

I just want to mention a few things about our controls for some of you who are new to webinar. You know some people use zoom, we use webinar. You have a control panel and there is an arrow that looks orange here, but I think it’s right on your control panel. You can press that and the controls will disappear. We will be asking questions or we will be having you ask questions for Dr. Ross in the presentation. So at the end of the presentation, we will answer those questions for you. Just please, you know, type them in the question area and then we will ask them at the end. If for some reason you are having some audio issues, you can see the number there the toll-free number you can call in and listen to it that way if it’s not working on your computer.

Some of you are here for CEs. You get 1.5 CEs for the presentation. We will send you an evaluation. At the end of the presentation, we will send you an evaluation. A special thank you to our sponsors at Higher Side Institute, which is one of the premier providers for a behavioral health education in-person and webinars.

The Gateway Foundation, which I am most closely associated with, I am the marketing officer for Gateway. We have 14 programs throughout the state of Illinois and Dover, as well we use nine evidence-based practices as our core curriculum. We offer trauma-informed care seeking safety. One of our programs, which is a woman in trauma program called her story, first EMDR which Dr. Ross will be talking about today. We are open, we are providing services: inpatient detox, a residential outpatient, and virtual programming as well as an in-person outpatient program obviously

Thank you to Dr. Ross for being here and his Ross Institute, which he founded in 1995 to help people and organizations develop trauma models of psychopathology. Very excited to have Dr. Ross here, somebody who I’ve known over the years. Gosh, probably now about 15 years. Colin, so glad that you joined us. He is an internationally renowned clinician researcher, author, lecturer in the field of dissociation and trauma related disorders. He’s appeared in numerous television documentaries, he’s published essays, aphorisms, poetry, short stories and screenplays. I don’t think there’s anybody on this who’s joined us to date who is in this field that hasn’t picked up one of Dr. Ross’s 32 books. He is a true thought leader in the field of trauma related disorders and has a passion for helping people.

I know that was a long introduction, but welcome back to Colin Ross. How are you? I’m good, thank you. So,  now there’s a little thing where you pass the baton to me right? Yes, I will be giving you control. I love being in control, it’s always good. We’ll share and again, thank yo

for being here, Colin. You know, I know it’s a crazy week and you’re calling in from Austin, Texas and we’re so glad that, you know, you’re spending time with us today and and are with us, especially during this time. So, we appreciate that you’re here with us

I’m going to change over to you. You should see something on your screen pop up. I will disappear once you take control and leave you in the good hands of Colin Ross. All right, here we can see you, we’re good, okay. So, this is, I guess that means I have to start presenting now. So, this is what I’m gonna talk about as he said trauma attachment dissociation in the EMDR

I’m not going to talk about how to do an EMDR. Although I’ve taken a full EMDR training, published in their Journal, spoken at their conference, and I’m speaking at their fall conference, which is now a virtual conference. So I’m very Pro EMDR and I’ll explain a little bit why, but mostly I’ll talk about trauma attachment dissociation trauma

Education essentials is my daughter and I, who’s a psychiatrist in Toronto, we provide webinars and pre-recorded courses and we have a lot of really good trauma expert speakers. So, you can check  that out and if you go there you can sign up for the free newsletter, which my daughter writes every month, and she always has a review of some trauma related book. Writes some very nice reviews and there’s some handouts and practical things that you can get for free there as well my contact information in case you want to email for any reason. Like to ask me what the heck I was talking about.

Just two of my books: Trauma Model Therapy and Treatment of Dissociative Identity Disorder, if you’re gonna buy any one of my books, I’d start with Trauma Model Therapy. It’s the general model for trauma and all kinds of different mental health problems, addictions, etc. and I’ll talk about that.

Just starting in a little bit here, well, that was a short little bit. So, Trauma Model Therapy is evidence-based in the sense that there’s, I think I’ve got eight published studies now, which take the form of a whole bunch of standardized measures like Beck Depression Inventory and so on. Structured interviews at admission then a discharge from my hospital based trauma program and then three, six, ten months to a year follow-up in different studies and repeating all thes

standardized measures and showing like, really significant big drops in score. Just in the inpatient partial hospital phase, then everybody goes back to their outpatient providers who were the referral sources

The reduction, like, almost 50% drop in depression, hopelessness, suicide scores in the inpatient partial hospitalization three weeks or so and then back to the outpatient therapist Those are sustained and overtime drop even further, so it’s not randomized controlled trials because we’re talking long term psychotherapy. So,  you can’t say to somebody would you mind being on a waiting list for five years, but it is perspective. It’s what’s called level two evidence by the US Public Health Service

Level one is randomized control trials. Level two is called cohort studies, it can be of anything. So, you have a whole bunch of people who all have cancer of the liver. You provide such and such a treatment and you follow them forward in time to see how they do so that’s what we have and the core elements of Trauma Model Therapy, which is going to tie into now trauma. The attachment, the dissociation aspects the core elements of trauma model therapy are these and the two really really core elements are the problem of attachment of the perpetrator and the locus of control shift. I’ll touch on the others a little bit and we focus on these in my hospital based trauma program all the time, all the time, all the time.

The people who come to the program, which halfish it’s in the Dallas area, half sometimes more than half from outside the Dallas area and half or less than half from outside Texas. So, very motivated people, high levels of acuity, almost all intensely suicidal, 97 percent meet criteria for depression on structure interview. 95 percent a dissociative disorder ,80 percent PTSD, two-thirds panic disorder, two-thirds OCD, 60% substance use, that’s who will admit to it, 60 50 60 percent borderline personality disorder, 40% one of the somatoform the psychosomatic disorders 40 percent an eating disorder so lots and lots of problems from all across the board.

In this setting the really, the number one goal is to stabilize, to get the suicidal ideation down, the chaos, the hyper arousal down to a level that reasonably, safely the person can be discharged either back to outpatient or step-down to partial and then back to outpatient. But in order to do stabilization that everybody claims to do, we provide very active therapy. So, it’s 30 hours a week of groups and three individual therapy sessions a week inpatient, all designed with trauma model therapy. It’s so by doing this intensive work.

So if you’re there for three weeks and you’re getting 30 hours of group, three hours of individual you’re getting close to a hundred hours of therapy structured, planned, intensive therapy in your stay. Plus you’ve got homework assignments and then you’ve got the healing power of the milieu and the interaction with all the other people. So that’s a lot of therapeutic input in a short period of time

And as I said, two of the core things that we talk about are attachment to the perpetrator and the locus of control shift. So, I’m gonna go through these one by one and then kind of weave them into dissociation trauma and EMDR a little bit all into some sort of quilt that looks not totally chaotic.

But before I go into all of that what the heck is dissociation anyway so it’s always good to know what you’re talking about, and the problem with the word dissociation is there’s at least four different meanings in the literature. So there can be a lot of talking at cross-purposes.

So, one person is talking about dissociation they mean this meaning, but the other person who’s listening thinks they mean that meaning, so they reply concerning this meaning. It’s just a big scrambled mess. so it’s good to have these definitions and these are definitions that have been in the literature for a long time, I didn’t just make them up.

So the first is dissociation is a general systems term. Dissociation is the opposite of association. So anywhere in the universe, in any system or subsystem, two things can either be associated, that is they’re connected, interacting, linked together or they’re dissociated, their outer relationship, they’re not interacting and so there’s dissociation constants and physical chemistry for instance. So dissociation in this general just english-language sense is basically the same thing as disconnection. So when you’re dissociated from yourself, you’re disconnected from yourself, which can be from your identity, from your feelings, from your motor, or your sensory functions, your memories, all kinds of bits and pieces and combinations of different parts yourself can be disconnected, dissociated from each other

Second is it’s a technical term in cognitive psychology and this is going back 40-plus years now. The experimental, Cognitive Psychology people, University Based publishing journals have talked about dissociation in memory. So we know the memory is composed of two major subsystems, which is conscious/unconscious. A declarative procedural explicit implicit memory, which roughly more or less mean the same thing and you can have information that’s stored is your procedural unconscious mind doesn’t have direct conscious access to it, but it’s affecting your verbal behavior, verbal output and your behavior in a measurable way in an experiment

This is a completely proven fact in cognitive psychology and it’s part of normal psychology, so of course, what we don’t do is drop somebody out of an airplane without a parachute and then dive down and rescue them just before they hit the ground and then ask them how they felt. So in University, College experiments usually with undergraduates the intervention is very small and very mild, but it illustrates how the system operates.

So a typical experiment is you the students come in, you get course credit, come into the lab and you memorize a list of word pairs and there’s say 20 of them. Then you work on that for however long and then you’re asked to repeat them and you were able to repeat 18 out of 20. You come back to the lab in two weeks, can you write down the list of word pairs? You’re able to remember and write down 12. So you’ve developed amnesia or in this example, six of the items that you could remember and repeat two weeks ago and eight of the items that you originall

read. So you’ve got quotes and amnesia, the information is dissociated. It’s stored in your procedural unconscious mind.

Well how do we know that it’s stored there? Well, we do different kinds of probes and there’s a million different experimental setups, but in this setup they’re called homophonic word pairs. In this experiment meaning, words that are spelled this differently have different meanings, but sound the same.

So one of the pairs is reed / read. So the person doesn’t write that word pair down two weeks later, they have forgotten it. But then what the experimenter does is assess to the student, what’s the name of a tall thin plant that grows in marshes? Please write that down

So it’s a reed. So there’s the experimental group at the word list they’ve memorized, that they have amnesia for reed / read, they mistakenly misspelled the name of the plant as read more often than the control group who also memorize 20 word pairs but it didn’t include reed / read. So again it’s the tiniest little thing, but it illustrates the principle that you can have a rea

experience of something was actually, there it’s actually stored in your unconscious mind. You actually don’t remember it, but it’s in there and it’s affecting your behavior in your verbal output. So this is a dissociation between conscious/unconscious procedural declarative memory lockdown proven by zillion experiments in cognitive psychology with all kinds of differen


Third meaning of dissociation, phenomenological meaning. So this just means symptoms. So what is dissociation? Dissociation is the symptoms of dissociation that are in measures of dissociation structured interviews, the diagnostic criteria. So what is a panic attack? A panic attack is the list of symptoms in DSM and this is true of all forms of psychopathology. It’s self reported symptoms. What’s going on, where do you feel, what do you think, what do you know, what’s going on inside. So that’s the phenomenological meaning of dissociation. No different from anxiety, depression, eating disorders, any form of psychopathology and in the field. We’ve got as solid, strong high-level statistics about this as any other form of psychopathology. So there’s nothing mysterious about any of these three terms

Now we get to the fourth one. It’s a postulated defense mechanism meaning, it’s a theory about what’s going on in your mind. It’s not something you can photograph, scan, four-way measure it, it’s not objective and here’s where the confusion comes in. Because people who are hostile to the dissociative disorders for the last thirty years have been attacking the dissociative disorders and recovered memory and repressed memory and they’ve been saying consistently that dissociation, there’s no scientific proof of repression or recovered memories and repression and dissociation of the same thing. Since repression and dissociation are the same thing and there’s no scientific proof of repression, that means that there’s no scientific proof of dissociation, which means it’s totally unscientific, which means it’s bogus.

So there are several problems here. Okay, there’s no evidence for recovered memory, it’s some sort of outside the range of normal psychology. It doesn’t sometimes, the hostile experts say it violates the laws of memory as if they’ve got memory completely mapped out. Okay, so tell me the name of a famous movie star who was the lead actor in the Mad Max series whose first name begins with ME. Okay, so everybody knows Mel Gibson but nobody except some super fans, nobody, I think, was thinking about Mel Gibson before I said that.

So what happened there? I provided a stimulus into your mind, a probe and you that set in motion a chain of associations of Hollywood actors. Okay, famous actor, we’re now we’ve opened that box. Mad Max movies, okay we’ve opened that box. Oh lead actor we’ve opened that box, Mel Gibson. So it’s a chain of associations that got triggered by my implanted a suggestion in your mind and you recovered the memory of Mel Gibson, which was not in your conscious mind. It was accurately stored in your procedural memory. So recovering memories happens like a bazillion times a day to everybody all the time.

If we had all the information that’s in or stored in our minds and our conscious minds all the time would be overwhelmed and frozen. So retrieving memories from storage completely everyday, normal psychology happens all the time. Why would anybody not believe in that?

So the debate then is how big a memory can you be unable to retrieve and how much retrieval effort can you put in and still not be able to remember. So that’s what the debates really about but that there’s a dissociation within memory and that real memories of real events are accurately stored and sometimes it can be hard to recover them, but what is it that’s out of the ordinary about this? It’s completely common sense.

There’s also a huge literature on what’s called spontaneous recall and cued recall. Spontaneous recall is just, oh yeah, yeah, I remember Mel Gibson, but you didn’t really spontaneously remember Mel Gibson. That was actually an example of cued recall. They gave you a recall cue. Without the cue, you wouldn’t have remembered and so there’s again, bazillion experiments all kinds of different paradigms showing that somebody can be unable to remember something and then you give them a cue and through repeated recall effort they’re able to pull it up and remember it consciously. You know that it’s something that was in the experiment two weeks ago so you know it’s an accurate memory. So cued recall equals recovering a memory.

So really, the debate is just about repression. It’s about the mechanism and the attack is from the skeptics about dissociation. Extreme skeptics, not reasonable sceptics, the attack is it’s all bogus Freudian Theory, its repression theory. Dissociations are the same thing as repression and there’s no proof for it; it’s outside ordinary psychology. When actually, it’s everyday common sense, but that crazy Freud guy, you know, we don’t believe in him anymore. We’re scientists here. So what’s the matter with that? Well there’s several things and we’re gonna jump into a primal repression, repression proper here in a second. And sorry it’s kind of belaboring the definitions here, but this is an important background for understanding the whole message today.

So a history of Freud, real brief. In 1895, Freud and Breuer or Breuer and Freud actually published a book called Studies on Hysteria and it had a sort of intro theory section and a whole bunch of case examples. The case examples were in DSM-5 terms. There are women, adult women with mixtures of PTSD somatoform symptoms, borderline symptoms, dissociative symptoms, and they had childhood sexual abuse. And according to Freud and Breuer, the childhood sexual abuse really happened and the symptoms were directly related to and connected to that unresolved childhood trauma. And they talked about dissociation, they talked about double consciousness, split personality, multiple personality in the case examples.

There’s obvious switching from one identity to another. The person can speak English, now they can only speak French. They can remember this session yesterday. Now, they don’t remember that everything, met you before. So very, very clear complex dissociation, that was 1895.  So, this was the seduction theory of psychopathology

So calling this, calling criminal pedophile child rape a seduction is already a bit whitewash, but the theory was that, that abuse really happened then in 1897. In a letter to his really weird friend Vilhelm Fleiss, who was an ENT surgeon, Freud repudiated this seductio

theory. He decided that the sexual abuse never actually happened. It was “false memories” so now he’s got a puzzle because he’s Freud, the genius. He’s got to figure out a why are all thes

Women are hysterical.

Back then hysteria meant PTSD, a dissociation somatoform symptoms. It didn’t mean being hysterical like it does now. It wasn’t a put-down. Why are these women presenting wit

hysterical symptoms and false memories have been sexually abused which never actually took place? So he’s thinking away, thinking away. So by 1917, he wrote an essay on repression. So, Freud repudiated the seduction theory and along with it got rid of dissociation. So he assumed that when the abuse is real, no memories are perfect. It’s not perfectly remembered, but by and large the remember memories are most of the time substantially accurate and the primary defense is dissociation.

He got rid of the reality of the memories and he got rid of dissociation and then he created repression theory. So a repression theory applies when the memories are assumed to be false, which I’ll circle back to in a second, and then he subdivided it into a primal repression and repression proper.

Primal repression is when you have impulses and drive things in your unconscious and they’re either starting to emerge into your conscious mind or they’re sort of in your pre-conscious. They’re coming up and you can’t deal with them, they’re too much. You have conflict, so you push them back down. That’s repression proper, which has nothing to do with outside experience, memories, trauma at all

Then there’s repression proper. So primal repression couldn’t possibly have anything to do with dissociation of trauma. Repression proper is when you do have conscious memories of outside events, thoughts, feelings. It’s too much, you have too much conflict and you push them down into your unconscious mind. So in the one, nothing was ever in your conscious mind. In repression proper, it was. It gets pushed down.

So what’s the difference in terms of a model of defense mechanisms? What’s the difference between repression and dissociation? It’s actually a very simple model. So it’s a metaphor. It’s a diagram horizontal splitting and vertical splitting, which is a guy named Ernest Hilgard, who developed a neo dissociation theory and published a book about that in the late 70s. It’s the best little diagram model I’ve ever seen Repression is based on horizontal splitting, remember it’s a metaphor. There’s a wall in your mind that’s horizontal you’ve repressed the stuff from your conscious mind down into you

unconscious mind. Vertical splitting equals dissociation. When you dissociate something you don’t push it down into your unconscious mind, you push it over into another compartment in your ego, your conscious mind. So it’s never out of conscious awareness. It’s never pushed down into the unconscious where it’s subject to dreams fantasy primary process, etc.

And this is what we see in dissociative identity disorder. We don’t ever see repressed memories or recovered memories from the perspective of the whole person or from the perspective of the alter personality, who’s always remembered the trauma. What we have is this compartment of the conscious mind, the host personality, the old front person and the memories, the feelings, the cognitions, the whole package is pushed over through the vertical split into another compartment, an alter personality

But from the perspective of that alter personality, these memories have never been lost, repressed, dissociated, they’ve always been there. So there’s no forgetting and there’s no recovering of memory from the perspective of the alter personality. Completely different picture from repression theory and then the whole treatment doesn’t involve digging down to the unconscious mind and doing 30 sessions of cycle and all 30,000 sessions of psychoanalysis

You just have to make friends with the other part of the mind. Communicate with that part of the mind and the memories are right there.And so you can get to work on them.

So the extreme skeptics about dissociation, one of their attacks is repression theory is bogus. It’s just a bunch of Freud. We don’t believe in Freud. He was a nutcase. Well hold on, hold on guys. Here, like how about if you actually read Freud, when you actually read Freud what you learn is that repression theory applies when the memories are assumed to be false. You’re saying that the memories are false and you have to dismantle and discredit repression theory. Because the repression therapists think that it really did happen and they’re always recovering repressed memories, it’s just a giant mix up. So sorry to belabor those points a bit. Let’s go backwards now. So this is like a time travel presentation we’re going backwards in time to the previous slide.

So the problem of attachment of the perpetrator. Now we’re going to be talking about dissociation in the general system sense and a little bit in the phenomenological sense so you can see that if you’re talking about dissociation as a symptom and then you’re getting attacked by somebody who doesn’t believe in dissociation as a defense mechanism. It’s all at cross-purposes.

There are repression based theories of every diagnosis in the DSM and Freudian theories to explain every diagnosis in the DSM. The dissociative disorders don’t depend on repression theory any more than any other diagnosis in the book and you’ll see that the word dissociation is in DSM-5. But the word repression isn’t there at all. There’s no section of repression disorders. so it really is not the same thing as repression

The problem of attachments perpetrator, so the idea here is that we’re working with mammals and if you’re a human mammal and you live on a third rock from the Sun there’s a really good chance you’ve been exposed to a bunch of trauma. And we’ve at least surely been experience

to lots of trauma in the last week, sitting on top of the trauma of the last few months, sitting on top of all the other trauma of life. So we’re not exactly in a low trauma sort of status right now, but what I’m talking about now is really childhood trauma.

If you are a mammal and you’re born and your goal is survival, which is true of all organisms in order to survive, you must attach to an adult caretaker. So this is not about your gender, your culture, your race, your IQ, your personality style, it’s the biology of mammalian attachment. It’s not an option, it’s not a choice. It’s built into your DNA and it just happens. You bond, connect, attach, need and need to be loved and cared, taken care of by an adult caretaker. Not an option, not a choice, everybody.

And so in a halfway okay family, it just rules out. Okay, you end up with unconditional positive regard from your parents because they read some psychotherapy texts that promote that and they’re fans of Carl Rogers or if they haven’t read those text books, they have unconditional love for you plus conditional love because they’re proud when you do a good job. So you develop secure attachment, good self esteem, and the world is a reasonably safe place. You can take risks because you always have a safe home base to come back to.

So in our trauma programs, we’d never ever, ever, ever, ever, ever see a person from a family like that because that’s not what our program is about. And I would say in the mental health field no matter where you work, what kind of therapy model you use, what the main set of diagnoses you focus on are you’re dealing with trauma survivors 80 plus percent of the time. So the Trauma Model Therapy is just mental health therapy and people who don’t have severe trauma and just having whatever kind of brain illness, to me that’s a small subgroup the subspecialty within psychiatry. Trauma Model Therapy is general psychiatry, according to the author of the book who I agree with.

So the problem of attachment to the perpetrator, the people who come into our programs had big, big, big levels of childhood trauma in all kinds of different combinations. Physical abuse, sexual abuse, verbal, emotional abuse, family violence, emotional neglect, physical neglect just general crazy-making family dynamics all across the board. Chaos, loss of parents and caretakers through death, divorce, imprisonment. Being so depressed you don’t get out of bed being so stoned. So all different types of trauma that’s just inside the family.Then we get the bullying at school. Molestation by the coach in high school, the rape at the frat house, the first abusive husband, the second abusive husband, on and on and on it goes.

So this little mammal has a problem. They’re biologically programmed to attach to their primary caretakers, but just like touching a hot stove and pulling away there’s all these built-in reflexes from psychological trauma. I hate you. I’m afraid of you. I’m shutting down. I’m out of there. I’m done with this. But you can’t go into shutdown, I’m out of here mode because you’re just a little kid and you’ll literally die if you don’t have an adult caretaker.

So now you’ve got what I call a mode A, mode B. Mode A is I’m okay, you’re okay bond, connect, attach. Mode B is you’re not okay, I’m not okay and I’m out of here. But you got to get back into mode A because you’re depending on your caretakers for survival. So this is this core dissociation, disconnection, split, fragment, fracture, divide there’s all these different terms and a lot of these terms are loaded up with all kinds of theory and there’s all kinds of academic warfare about it all.

To me, they’re mostly metaphors. So you have to dissociate, you can’t afford to see, not feel the whole picture all at once in order to protect your attachment systems, not to protect your personal feelings so much. In order to protect your attachment systems to create the illusion that mom and dad are ok so you can attach, so you do have caretakers, so you can survive you have to put the bad stuff a little bit out of sight, out of mind over there, denied, pushed away, back-burnered, dissociated.

So dissociation is kind of the fundamental solution to the problem attachment to the perpetrator. But the whole thing is just totally overwhelming emotionally. You can’t figure it out cognitively, you’re just a little kid and you end up with this mode A mode B – mode B back and forth. I hate you, don’t leave me. You want to push the perpetrator away so you can be safe. As you push the perpetrator away, oh no I’m safe. Oh my god my caretaker is too far away. I better pull the caretaker back in.  Local caretakers are getting closer. Okay, now I’m safe. Okay, I’ve got the caretaker here, close. Oh my god, the caretaker’s the perpetrator, push him away. you just end up in the border line dance. I hate you, don’t leave me.

So to me, the core dynamic of borderline personality disorder, this push-pull approach avoid, push them away, reel them back in and you can reel them back in with being a sexual object, being flirtatious, being a good wife, being a good cook, or if you’re a guy, it’s not gender specific at all. So there’s all these maladaptive behavioral strategies designed to make sure the caretaker is close enough, which completely conflicts with making sure the perpetrator is far enough away because it’s the same person. It’s just overwhelming, crazy, making you can’t figure it out. So all you can do is dissociate.

So this is why to me dissociation in the general sense is the most fundamental defense mechanism and almost all defense mechanisms involve disconnects, disassociation in some fashion. So you don’t know it all, feel it all. Doubt aside, it’s projected onto this other person. It’s somewhere else. You don’t have to feel it and know it.

So that’s the problem of attachment to the perpetrator. People come into the program, now they can’t act out, they don’t have to cook dinner, they don’t have to take care of their kids, they don’t have to go to work. There’s all these annoying people who claim to be therapists, who are saying things like be mindful, introspect, do your homework. So you’re kind of stuck with being mindful, feeling it, knowing it, doing an inventory of it and it starts to sink in. Wait a minute, I love the people who hurt me. I was hurt by the people that I loved. Both things were true and I felt both sets of feelings. It was overwhelming. It was impossible and how did I feel bottom line? Small, scared, sad, lost and lonely

So the bottom line, underneath all the behaviors, all the defenses, all the addictions, all the acting out is small, scared, sad, lost, lonely. Which in DID, would be a fully-formed child alter personality and I commonly talked to alter personalities who tell me the current year is 1992 or 83 so they’re literally cognitively stuck in the past. They don’t even know it’s 2020. In partial DID, which is another specified dissociative disorder, the ego states not going to be so fully formed. May not have a separate name or age, but it’s kind of distinct and when it surfaces it really is like another person here.

But they may not have a separate name or a specific age and then that just shades down into, yeah there’s kind of an inner child there who’s kind of separate but not really formed but it’s not exactly me. I could feel her in there. So it’s on a spectrum from no inner child is just a metaphor to sort of a slightly dissociated ego state that’s not really formed that’s holding some feelings to an ego state that has a separate sense of identity that doesn’t come to the surface. There’s no switching, there’s no amnesia to one where they’re switching but not so much amnesia to full DID. So it’s a spectrum.

So everybody has the wounded inner child in our program and everybody’s got that child dissociation and what we want to do is work on reconnecting, which nobody in the right mind wants to do it because who wants to reconnect to that wounded child and feel all those feelings? Nobody.

So everybody is resistant and to me, being resistant to therapy equals being street smart. So we’re always pacing, pacing, pacing not pushing in too hard, too fast and not just EMDR all kinds of different therapy practices. But in terms of EMDR, which remember I’m very pro, it’s incredibly valuable. And EMDR for those who aren’t totally familiar with it, everybody thinks the EMDR means this.

EMDR is actually a comprehensive trauma dissociation model, which I’ll explain a bit, but the problem that we see in terms of people getting overwhelmed and triggered and having to come in-patient from an EMDR practice it’s always the same thing diving in TOO hard too fast. Follow my fingers, think about the memory. The memory comes up, you’re overwhelmed. You’re flooded, you regress. There’s more conflict to get suicidal. You come in so the fix is always slow.

The outpatient therapy down. This doesn’t mean stop doing a EMDR because the EMDR actually is a comprehensive trauma model divided into stages. The first three stages, called history preparation assessment, are all about stabilisation, preparation before you start doing any of this stuff. This is the middle phase of therapy. So it’s not that you need to stop doing EMDR, it’s that you’re not doing the history preparation assessment phases thoroughly enough. You’re actually violating the procedures and rules of correct EMDR.

But what is EMDR just in general? It’s based on what’s called the adaptive information processing model, which I kind of like and I kind of agree with,  but I also kind of think it’s not that big a deal. It’s more kind of common sense, but then most of the mental health field doesn’t take this into account and the basic basic sort of benefit to the therapists is the therapist doesn’t have to do all the work. You really, it’s just like surgery.

So the surgeon does whatever procedure. Stitch the person up and then they don’t have to like get a little microprobe and push the white blood cells around and the fibroblasts and they just let the wound heal itself. They do what they need to do and then the body takes over the healing process and does it naturally. It’s basically the same idea here.

It’s a trauma dissociation model because you’ve got disconnected little engines, which are dissociated feelings, thoughts, memories, little packets of trauma and they’re intruding and erupting in and causing flashbacks and what you want to do is target those when you’re adequately prepared. Do the bilateral stimulation, which can be fingers, tapping sounds and then mysteriously the healing power of the brain just kind of takes over. And what you do is you have these maladaptive networks, which are little packets of trauma, and when you open them up through the process of bilateral stimulation they kind of hook themselves into the healthy circuits in the brain. The energy gets dissipated. The normal healthy energy kind of flows in.

This is all a metaphor and the therapist doesn’t have to do anything. So the brain just does the healing. What you’ve done is you’ve reversed the dissociation. You’re reintegrating and reconnecting the trauma memory with the healthy aspects of the brain so that’s just the energy just kind of diffuses out into the brain as a whole and goes out into the universe so to speak.

So EMDR, I believe, is fundamentally a trauma dissociation model and the technique is incredibly useful but preparation, preparation, preparation, preparation.

I’ll talk a little bit about locus control shift, which is the other core aspect of trauma model therapy and this is a little bit like attachment of the perpetrator in that it’s not about culture, race, IQ, gender, it’s just how kids think. so it’s not about mammals in general it’s about Piaget developmental psychology, how kids think, not that dogs and cats can’t think. So I’m not a species chauvinist, I think that cats are like amazingly thoughtful animals.

But setting that aside, when you’re in a big trauma family how does your mind process the information? The same way all kids process all information down at three, four, five, six, seven sensorimotor concrete operational stages. I’m at the center of the world, the world revolves around me. I’ve got this magical power to make things happen so that’s the mind of the magical child. So the child automatically shifts the locus of control, the control point, from inside the adults where it really is to inside yourself. I’m bad, I’m causing it. I deserve it, it’s my fault.

And I came to this little model by listening to survivors coming into the program over and over and over saying with complete certainty, “I’m bad. I caused it. I deserve it.” I’m this, I’m that. I deserve what’s going on now. Or they might have a little veneer of political correctness and they said, “I know it’s not really true, but in my heart I don’t believe that. In my heart, I know I’m bad.” So this is the locus of control shift. It’s the self blame, self hatred from which comes the self punishment. Which then is all kinds of self abusive behavior, unhealthy behaviors, tolerating unhealthy treatment from others because that’s all you deserve anyway. Nobody else would want you. Nobody else would ever attach to you because you’re such a bad little child.

Why do people hold onto this belief so hard for so long? Because it’s been way engrained over and over and over and over by all the things, all these perpetrators and family members, and schoolmates said and the coach and the husband and the second husband. It’s also been reinforced, engrained by your own self-talk, your negative self-talk, your negative core beliefs, your cognitive schema. I’m bad, I’m bad. I caused it. I deserved it. I’m unworthy. They’d be better off if I just killed myself. They are husband and kids, relatives, family, friends or just the planet. So the person actually believes they’re kind of like a toxic waste dump and they’d be doing the planet a favor to rid this planet of this toxicity and it’s like really deep, it’s really intense self-hatred.

So why do people hold on so hard? Because it’s been reinforced so much it becomes a habit, but it also confers an illusion of power control and mastery. That’s what’s so addictive and quot

seductive about it. I’m not powerless, helpless, trapped, overwhelmed. I know what the problem is. I’ve got all the badness contained inside myself. If I decide to be a good little girl, took me a while to figure out how to do that, but when I decide to be a good little girl mom and dad will see that. They’ll forgive me and all abuse will stop.

So we want to reverse the locus control shift so we do a bunch of cognitive therapy cycle education processing experiential work. Oh okay, okay, I’m starting to get it. So you’re telling me that I deserve to be loved, taken care of, treated well just like every other child ever born and it didn’t happen, which was horrible, but it wasn’t my fault. I didn’t cause it. It’s not what I deserved. No, I guess it was them. I guess they were really messed up. I guess I never had the mom and dad I really wanted. How did I feel? Small, scared, sad, lost, lonely, overwhelming amount of grief there

And so again, nobody in the right mind wants to feel all that so you hold on to the badness of the self to hold on to the illusion that you’ve got control. You’re in charge. So that’s the locus control shift. Problem is not the problem, it’s just the idea that presenting behavior symptom diagnosis from this perspective is always a solution to some problem in the background so it’s your basic Family Systems Theory.

Family comes in, they know the kids have the problem, they want the problem fixed, but the family therapist goes, ah this behavior by the kid is serving some function in the family system. It’s solving some problem in the background and then from that can follow a very different intervention. Because if you’re not thinking systemically, you’re just thinking the problem is the problem. Then you take the problem equals the kid and put them on the assembly line and give them therapy or medication and the parents just have to drive them to the appointments.

But if you’re thinking systemically you could come up with the earth-shattering conclusion that sometimes it’s not the kid who is the problem, it’s the parents. And then the intervention can be couple therapy and the kid doesn’t even have to come so, it’s not just a theory. It leads to a whole different way of approaching things and so within this model and within my mind, the belief is that all these different DSM diagnosis. Not a hundred percent of the time, but a huge percentage of the time the problem is not the problem. The symptoms, the behavior, the diagnosis I want to know how do they fit in this person’s life story? How are they all part of some kind of survival strategy? They’re not healthy, but how do they make sense? How are they a desperate attempt to survive when you’ve been in a family where you got all these trauma feelings ramped up here and your coping strategies are way down in the basement because nobody had healthy coping strategies? Nobody modeled them. You never learn them or practice them. So you got this huge gap between your hyper arousal level and your coping strategies.

So you got to enlist some desperate measures to bring the feelings down. Be able to get through the day and the desperate measures can include drugs, alcohol, cutting, depending on the abusive boyfriend or girlfriend, a million different things. One might come back to some of the others, but I’m going to jump slides here. I covered part of that so these slides are just sort of reminders to me in case I forget what on earth I’m talking about all together here.

So I talked about adaptive information processing. So the targets, I’ll go over this quickly, but I kind of explained it. So in the EMDR, they’re talking about targets all the time. So what’s going to be the target here? And often it’s a particular memory. So if somebody was in a no big trauma history: they’re in a single car wreck, a single natural disaster, a single assault it’s definitely traumatic but you’re just focusing on that one event.

And so basically you agree the person is just going to think about the picture. Feel the feelings of, and follow my fingers, hold on to that. Follow my fingers. And somehow, through the mystery of the mind and there’s models and theories about it, but nobody really knows what on earth what it does. It somehow gets the hemispheres talking and sends signals across the corpus callosum and somehow integrates things.

So the target can be a specific trauma memory, that’s the classical picture, but you can also target a cognition, a belief, a feeling, and another element of EMDR is the body scan. So now this is really tying into the biology of the mammalian, biology of trauma and attachment and so what do we know?

Well, we know that animals have got three basic defense systems. So when you threaten, corner, threatened, corner a mammal, one response you can get is fight. And if it’s a grizzly bear that you’re trying to pick on, there’s a pretty good chance you’re gonna get a fight coming back. If it’s a deer or gazelle you’re gonna get flight because it’s gonna run away and you can’t run quite as fast so that works. If it’s an opossum gonna roll up, go into freeze mode and that’s a smart survival strategy because the predator goes, fends off stupid dead animal and leaves.

I just watched a week or so ago one of these amazing Facebook videos that pops up and it’s a leopard and it’s some sort of gazelle type in Africa. I can verify I even knew the name, but it’s a gazelle. The one with the kind of curly antlers. And the leopard catches, sits on top of it and it’s like in freeze mode to the max. Motionless, not blinking, nothing and 100% guaranteed death, but then some baboons come walking up and start like harassing this cheetah. Cheetah kind of looks up, gazelle doesn’t move or twitch back on it, it’s not actually biting into it but just about to and then finally the baboons just cause too much hassle. So the cheetah gets up and runs away and then for a couple of minutes you see the gazelle motionless.

You can’t even see it breathing. You think what I wonder if it’s dead. Maybe it’s bleeding like around the corner and then you start to see just a little bit of motion in the abdomen from the breathing and then again and then we’re in hyperventilation mode. but otherwise calm, no motor movement at all. Then all of a sudden, it kind of sits up and then it starts this violent shaking that goes on for a while and you can just see it shaking itself off. Then it gets up and runs away.

So freeze, fight, flight and freeze and freeze you can either have separate categories or put it all within freeze. So there’s just like catatonic freeze, there’s collapse but it’s all parasympathetic dominant. Whereas fight/flight are sympathetic dominant. So we know and we teach this all the time on trauma programs. You’re a mammal. You’re cornered, threatened, cornered, threatened, cornered, threatened, this is just the biology of being a mammal.

Why did you love the person who’s hurting you? Because you’re a mammal, it’s a mammalian attachment. So we’re teaching, normalizing, teaching, normalizing. Why do you have anger in you? Because you’re evil? Because you’re bad? Because you’re a bad child? No, because you’re a mammal.

Your fight system got activated over and over and over. You couldn’t get angry and attack your perpetrators because you’re just a little kid. And if you tried that, you’d get it even worse. So you learned in general, that anger equals rage is evil. The horrible toxic you learned that your own anger is bad evil because it gets you in trouble so you didn’t exactly come out with healthy cognitions about anger. And you had to stuff it, but it’s leaking out this way and that way and you’re turning it on yourself blaming.

Remember we talked in a trauma education group about the locus control shift. That’s turning the anger on yourself and so what we want to do then? First of all, we teach the biology of trauma, we normalize it. You’re not evil because you have anger. In fact, anger is the best antidepressant on the market. I get to say this because I’m a psychiatrist. Just think about it for a second. Can you be deep, deep, deep in stage four sleep and working a math problem at the same time? Sometimes it can’t be working a math problem when you’re wide awake but deep, deep stage four sleep. We’re out and working on a math problem, our incompatible states.

If you’re in one, you’re not in the other. Being really, really depressed, low on energy, hopeless and being really, really mad, they’re just incompatible states. So what happens to your depression? It’s almost everybody’s had lots of depression because they had very depressing things happen to them.

What happens to your depression when you get really, really mad? When you just explode? Hmm, depression is gone, right? So you got more energy. Anger is rocket fuel for life. You got more energy, better boundaries, better service, better self-care. You’re not going to take this from nobody. So the idea here is if you can get in touch with your anger practice, we’re going to. We have experienced all groups who are practicing getting angry or learning self regulation skills. You’re gonna find your better boundaries, better service, less self hatred, less self blame, less depression, it’s all wonderful. Your anger is your best friend. I’d be very concerned if you didn’t have enough anger.

And so where’s your anger stored? So we’re going to get a body scan now. So we, which is a variation on mindfulness. But you do a specific like mental inventory. What’s going on in your feet? What’s going on in your thighs? What’s going on in your abdomen? What’s going on in your chest? What’s going on in your neck? What’s going on at your hands? Where is the anger located?

I’ve never had somebody tell me all my anger is stored in my left pinky finger. So it’s normally in your abdomen. Sometimes it can be in your chest. As well as what color is it? Nobody ever says my anger is pink. Everybody says their anger is, almost all the time black or red.

So there’s this ball of black anger in your stomach. Okay, if you were writing a letter to your anger, so we’re a little bit out of EMDR now, what would you want to say to your anger? Instead of your toxic, “I hate you, go away”. Okay, so I might want to say, “you’re normal, I love you. I’m glad you’re on board. Thanks for holding all that anger for me.

If it’s a DID case you’re talking to, the angry part, if it’s not a dissociative disorder it’s a metaphorical letter to yourself exercise where you’re normalizing, accepting, making the way to blame from all, all the anger that’s stored in your body. And you’ve done enough body scan and you know where it is. So how about if you just let some of that come up?

So point being here back, to target that energy in the body pain, anger, anxiety, sadness in your heart, pressure, tiredness any of these things can be targets for bilateral stimulation. And the whole goal, I believe, of EMDR therapy is reattachment to the dissociated aspects of oneself integration of dissociated aspects of the self.

So it’s EMDR trauma, dissociation attachment, and attachment to the self are all completely intertwined and not really separate categories. So I would show this slide, except for the fact we still have a little bit more time so before we get to that slide we’re going to look back in time again.

What are some other elements of trauma model therapy? We just say no to drugs is the addictions part of this model. So you can be addicted to drugs and alcohol, obviously, but from this perspective you can’t be addicted to anything. For instance, you can be addicted to the locus control shift and what you have to do is say no to the drugs. Which could be a whole array of things you’re addicted to

Physical substances, relationships, social roles, symptoms, there’s no end to the things you can be addicted to. Including negative beliefs about yourself and the locus control shift. So the idea here is I sometimes explain this by saying well, you know about the 12 steps, which most people know. I always say that there’s a neglected step, which is step 0.5. Step 0.5 is you can’t start working on your steps until you decide to, which actually in reality is part of step one, but I’m just making a point in order to start working on recovery.

Whether it’s 12 steps or whatever, EMDR, you’ve got to decide you’re gonna do it. You’ve got to make that for real commitment. We don’t have to, but if you want to go down the road of recovery and you want to work with me and this is how I know how to work. You’ve got to make this deep, deep commitment. You’re going to say, “No, for real. That’s not an instant cure, but that means you’re on it. You’re dedicated, you’re focused, and you’re going to get to work.

So that’s just saying no to drugs. Addiction is the opposite of desensitization. The idea here is that all addictions, literal, chemical or metaphorical are avoidance strategies that take you from here. Go over there, over there is anywhere except here. Here is bad feelings, bad memories, bad situations, bad relationships. Over here is stoned, wasted, thrill, distracted. Addiction is the opposite of desensitization.

Desensitization is when you say no to your drugs, turn around and systemically little step by step start dealing with what you’ve been avoiding. And we have experiential groups for that purpose. So this in our hands, which is anger management, group, art therapy, all kinds of experiential groups, the whole purpose is not just to feel your feelings. It’s to feel your feelings in a safe, contain structured environment as part of an exercise. Get the feelings up, which in one group will be anger, another group would be sadness, not group of fear.

If we have a grief group for instance. Okay good, so your limbic system is alive and well and running. Not so much that your cognition and your external cortex are shut down or offline. So if you’re getting too up there, we have grounding orientation. Move your feet, stop looking in a straight line, look around. Where are you? Rub your hands. Who do you see? What’s the date? What’s your name? Where are you? Why are you here?

Typical this kind of deescalation of ground skills, but we don’t want to numb out and shut down. So, you’re like, “oh I’m a very healthy person. Today we want the effect up and running intensely, but we also want you to be able to work on it cognitively. And so now what you gotta do is, in this control, contained, inpatient setting, figure out how to de-escalate and step out back down. So the purpose of the experiential groups is to get the feelings up and going so you can actually practice how to manage them without acting out without addictive, self-defeating, self-destructive behavior

So it’s like a sheltered workshop, real-life simulation practice, exercise. And I always say, how many people have learned how to ride a bike only by reading books? Nobody. You got to get on the bike and practice. So any skill you’ve got to practice, learn, practice, learn, practice, learn. Same thing here, you’re practicing getting angry without flying into destructive rage. Without just zooming out, shutting down. You gotta back out step by, step by, step. So that’s the self regulation and effect management, skill building, coping styles, coping strategies. The other purpose is out of desensitization. I got really angry. I backed out and settled down.

There’s so many weird people in this building. There’s like the piers and then there’s the therapists and they’re all saying, “Good work. We’re proud of you.” Like what’s with them? They’re proud of me because I got angry? So it’s a cognitive restructuring aha moment. So my anger is not evil, bad and horrible. And it’s not like when I was a little kid where it was a threat to my existence.

It actually is more manageable than I thought. I’ve got a little bit more skills than I thought. I had been cognitively desensitized. I’ve reframed. I’ve listened to the fight, flight, freeze lecture. Now I know I just need to practice and I’m better at it than I thought. Because I’m older and bigger. I’ve got these tools in my toolbox. So I don’t have to fully avoid it quite so intensely. So next time I can go into a little bit more practice backing out. So it’s desensitization combined with practicing managing your effort.

This is kind of our over approach and then the triangle we just talked about, victim, rescuer, perpetrator. This is victim behavior. So we have actual, written handouts we talk about in educational groups. We talk about it in therapy groups. This is victim behavior. What is it doing for you to take the victim role? So the problem is not the problem. What problem are you solving for yourself? What’s the upside of this strategy? What’s the downside? How did you get into this strategy? Oh, that’s perpetrator behavior. Okay so what is it doing for you to be in the perpetrator role? So that’s just like micro skim over that.

So here’s a quick mini case example and some rude person whose first name is Keith is going to interrupt me in five or ten minutes. Maybe if there’s some questions, but if not I’ll just keep on going. There are some questions. Yes, oh okay. Should we start with questions now or do you want to hold them for a minute? Yeah, we have four more questions so far and they’re pretty involved. Ok, so let’s start with the questions because I was gonna do a case example, but I can weave that into my answers.

Ok, so this question comes from Michelle Joette from the UK. Oh she’s emailed me and told me that she’s gonna be listening. Awesome, well here’s her first question. When the host personality in DID begins to spontaneously recover traumatic memories, where do they emanate from if there’s a vertical split between the host personality and the alters? Thereby creating amnesia of the memories for the host personality?

Well, so hello Michelle. I don’t know, you should ask somebody else. Next question. So, I kind of answered the question already and you kind of answered it in your question already. I mean the memories come from where they’re stored, which is in the altars. So then it’s not really so much where do they come from and it’s not all memory even in somebody with the DID. Not all memories are held by altars. Some are just kind of over, they’re stuffed somewhere, but not in a compartment that has a name and age. But in DID, most of the time, there’s a child or sometimes adolescent alter who’s holding the feelings, the body, memories, the cognitive information in the whole package.

Or the package can be split into different personalities. Some are having body memories. Some don’t remember the events. Others remember the events, but have no emotions. There’s a lot of different combinations, but basically the puzzle is not where are they coming from? It’s why are they coming now and how can I go about regulating this? So it’s good news that you’re having say, it’s flashbacks, which is the typical way that memories come back.

So you’re having flashbacks. That’s great. That means you’re moving forward in therapy. Nobody ever goes, “Yeah, I just love having flashbacks.” So it is progress, but it’s also painful and overwhelming. So the problem here is pacing. So what we need to do is find out who’s holding those memories and then we’ll be able to talk to that person either directly or indirectly or we may assign another part who’s a caretaker of the children on the inside.

What year do they think it is? Well if there are four, they may not know what year it is at all, but if they’re 8 or 10, and they may tell you it’s like, if you’re 40 they’ll tell you some year 30 plus years ago. So they’re like I said, they’re cognitively stuck in the past so then you want to create a safe place for them on the inside. Like somebody is going to be a caretaker you want to make sure the safe place has got a bed and some stuffed animals and maybe some books to read at bedtime and there’s enough light in there scary people are not coming in on the inside. And that’s just soothing and calming.

If you can help bring them to 2020, either by just having somebody bring them or if they’re more like 12 or 14, you can start talking through to them and saying — this is like a micro compressed version of a whole bunch of therapy — look out through her eyes, look at that hand. Is that a five-year-old girl or an eight-year-old girl’s hand or a 12 year old boy’s hand? No.Look at the feet. Whose shoes are those? Those are hers. How did her shoes get on your feet? I don’t know.

Well, and then I’ll explain about the inside world versus the outside world. In the outside world, see there’s the floor. There’s a ceiling. There’s your hands, your feet in the outside world. I’m going to tell you something that’s gonna be kind of crazy, you’re not going to believe. The year is not 1992 or 82, the year is 2020.

That’s what’s true in the outside world, but then there’s the inside world. In the inside world, you can, you’ve got your own separate body. Your own separate name and age, that’s real and true in the inside world. ubt here in the outside world, you and all the other parts live inside the same body.

What year was she born? Oh, she was born in 1980. And what year is it not always? Do the arithmetic. Okay, so then according to my arithmetic, I predict the person is either 39 or 4 now. Okay and how old are you? I’m eight And how old is she? Oh she’s eight, too. Okay, so that makes sense you were born in 1980 and you’re eight years old now and she’s eight years old, too.

But take a look at those hands, again. Those are not eight year old girl’s hands. Sometimes the alter hallucinates eight year old hands on top of the physical hands. So, it doesn’t work, but usually not. So in the outside world when I’m talking to her, you’re listening through her ears, you’re looking out through her eyes.

How many fingers am I holding up? Three. How many now? One. So the part is answering inside the person’s head and  the host is telling me the answers, okay. Do what I want you to do is check it out for yourself, especially outside the hospital. And so there’s a whole bunch of teaching strategies.

We’ll bring the person to 2020 and then I’ll explain the reason I want you to come to 2020  is, assuming this is true, sometimes you’re in a relationship that’s not really good, but most of the time life is a lot calmer and safer in 2020. Then it was in 1988. And if you come to 2020, first of all it’s just good to know what you’re, you’re in. Otherwise, how can you deal with life? But you’ll feel calmer and safer. You’ll have somebody on the inside taking care of you. You’ll have a safe place you can go to.

So then, I want to know why you have been sending her these flashbacks. Sometimes, the problem is what I call host resistance, which is the host has been ignoring and not wanting to talk to the alters and they’re just trying to get her attention by throwing flashbacks out. Sometimes it’s something going on in the present that’s just triggering the human being and the children are getting triggered and that’s all flooding up

So, you have to take care of the outside stuff, but a lot of the time there can be a, like, a small trigger, but it’s not a big trauma in the present. It’s only a trigger because it reminds you of the past. So that’s like the Vietnam vet or the now though the Iraq Afghanistan vet who’s in the backyard cooking hamburger or the helicopter flies over, he’s back in a flashback. That helicopter’s just a civilian helicopter. It’s not a threat in the present, but it’s a trigger for obvious reasons.

So sometimes you’ve got a lot of triggering going on without actual big present day trauma. So you have to figure that out. Bring them to 2020, and realize they live in a big body now. And by the way, who is this Susan person anyway? She’s who’s grown up. I don’t know, I think she’s like a neighbor or something. She’s around a lot. Does she have a dog? Oh yeah, she has Tex. Then we’re in Texas here. So Tex the dog, ah, so text doesn’t live at your house with mom and dad in 1988, right? He lives in her house. So, if you could come to 2020, you could play with text anytime you want. So I’m basically starting to sell a person that is coming to 2020.

So the problem is not the problem, the problem is not the flashbacks. The question is what problem is being solved by having the flashbacks? Well the problem of the host is ignoring them. The problem of nobody’s paying attention. The problem is the abuse happened yesterday and it’s going to happen tomorrow because I’m only eight years old and it’s 1988 right now. So the flashbacks, like anxiety in general, are an alarm signal. They’re a danger signal. What is the danger? What do we need to do about that?

Michelle’s going, “oh I should never have asked the question. I didn’t want that long answer.” Well Michelle has another question, but we’ll skip over that one and ask a couple others and then come back. Okay, Michelle.

So our next question comes from Tanya Sha. Thoughts on teasing out  DID versus complex trauma? I wonder how to approach disassociation with complex trauma cases, childhood, combat, romantic betrayal, etc. versus a dissociative disorder.

Okay, so each of these is a workshop, half-day workshop in its own right, but excellent question. So it’s not an either/or thing. Complex PTSD, by the way, is a category in ICD-11 but not in DSM-5. The dissociative subtype of PTSD is a category in DSM-5, but won’t be in ICD-11. So, so much for an integrated world.

But complex PTSD is what we see all the time and it was, the term was invented by Judith Herman all like decades ago. And it’s basically the idea that PTSD that you see in DSM-3 and 4 is only a little slice of the whole pie of PTSD and the rest of the pie is not comorbidity or other disorders. It’s all part of the big picture and when you have complex severe trauma, you’re going to have depression, anxiety, substance abuse, borderline eating disorder, all kinds of stuff going on.

You’re going to have this disorganized attachment, which I actually see is a very clever chess game where you can’t have consistent attachment to your parents because they’re coming at you with disorganized attachment. Sometimes, they’re okay if they’re doing an easy job. Sometimes they’re absent. Sometimes they’re perpetrating on you or perpetrating on each other. So you’re trying to play this chess game of matching your attachment style to what the caretaker perpetrator is doing with you. So it looks disorganized, but it’s actually like chaos theory if you look closely there’s actually a pattern there.

So complex PTSD includes attachment problems all the time and so it’s not either/or. Everybody with DID basically has complex PTSD. Not every, everybody but on this inner child spectrum I would say, almost everybody with complex PTSD is out there on this inner child spectrum. Where you’re — it’s not just a metaphor anymore. There’s some dissociated ego state.

It’s just a question of how separate, how distinct, can you visualize them internally? Can you hear the little girl crying? We’re more just feelings or do you actually talk to the little girl? Or does the little girl sometimes come out and talk to the therapist. So I explained that spectrum, I asked the person where they are and then I explained it doesn’t really matter.

So we get too hung up on diagnosis. Complex PTSD there’s almost always going to be in structural dissociation theory, which is a full theory, there’s going to be an emotional personality, a wounded child that has its own separate sense of identity. That’s disconnected and it doesn’t matter where you are on that spectrum in a sense because you have to change the self-talk.

You have to love and accept and validate the inner child. You have to soothe them, which equals soothing yourself. You have to spend time with them, write them a letter, sing them a song, there’s a whole bunch of therapy exercises that are always good. No matter whether you’re halfway, ¾, or all the way out that spectrum. But it’s handy to know if somebody has the DID.

So there’s a study, I always forget, it’s 92 or 98 studies in college students. So there’s now 90 plus  separate studies of a level of dissociation and dissociative disorders in college students. So this is not little small literature. I add all those studies together from around the world, 11% of college students have some kind of dissociative disorder and about 1% DID on a standardized structure interview.

For the general population, it’s about the same. As general adult psychiatric inpatients, we’ve got around about 10 studies in six plus different languages and countries, you average it together, 16ish percent of general adult psychiatric inpatients have a previously undiagnosed dissociative disorder. Three and a half to four percent previously undiagnosed DID. So it’s a common everyday thing whenever you’re dealing with somewhat complex, fairly complex or really complex PTSD. You’ve probably got the dissociative subtype of PTSD going along and probably got partial at least DID going along. So it’s like, all the time.

We have a couple more questions. Okay. And Tanya has another, but we’ll skip over that and go to the next couple people and then if we have time to go back to Tanya and Michelle.

So from Peter Lorenzo, thank you for this presentation. I do a lot of inner child work with my patients in recovery. I help them heal their old core beliefs such as self-loathing. A lot of them understandably struggle with practicing this and overwhelmed by the changes they’re trying to make. What specifically do you give patients as coping skills and homework in practicing this?

Another excellent question. So number one thing is pacing all the time. If they’re too overwhelmed it’s too much. I always want to go, instead of going, what’s wrong with the stupid patient? I want to go wait a minute. What’s wrong with me and my therapy approach? Maybe I’m going too fast. Maybe we need to slow down, but then the discussion is always if you slow down too much therapy is going to take 200 years and I’m gonna retire before that.

But if you go too fast, you end up getting destabilized regressing and then you gotta use unhealthy coping strategies. You’re further behind then if you went a little bit slower. So always discuss pacing. That’s the first intervention and slowing down is not being lazy or being resistant. It’s good self-care and self-management. So you have to watch out for the self blame thinking there. And then basically it’s just the same strategies and techniques that everybody uses all the time.

What self soothing things work for you? Having a bath, listening to music, going for a walk, playing with the dog? And then your grounding skills like moving your feet, your hands squeezy things, some familiar object that’s a safe object of yours. Don’t have the fix stare. Listen, remind yourself where you are general de-escalation self-talk.

So the purpose of trauma model therapy is to fill the toolbox with as many tools from as many different therapy approaches as possible. The model is really more organizational and figuring out like what are the things you need to target? What’s the logic? How’s this all fit together here?

I’m not sure if that answers that question or not. Yes, definitely. Um, we have a couple more. I don’t know how much time you have left, Colin. Do you have a few minutes past the hour? Well, sure, yeah. Okay, so I’ll just say a few things and then I’ll go back to the questions just so people want to log off and not finish the questions. Just a couple quick things.

You know, again just to reiterate and receive your CES you will be receiving an evaluation from us. Once you fill out the evaluation, you will get the certificate back emailed to you. And then next week, June 12th, we have Dr. Sunny Wheaton speaking on the eight ways to well-being. And then the following week, Dr. Allen Berger speaking on June 19th on creativity and counseling, integrating left and right brain hemispheres.

All right, next question from Tracy Trout. I have a question regarding DID. I am under the impression that when the host is in control, the altar is aware and conscious, but is not at the forefront, which would make the host and the altar conscious at the same time. However, when the altar is in control and at the forefront, the host loses time and is unaware of the alter’s actions. Does this mean the host is in unconsciousness during this time?

So that’s called one-way amnesia. So co-consciousness is the host and alter, when the host is out, alter is aware of what’s going on. Alter comes out, the host goes in the back and the host knows what’s going on. That’s full co-consciousness.  What you just described is one-way amnesia, which is the alternate. What’s going on when the host is out flipping them around? The host doesn’t know what’s going on, and so there’s different reports.

So you asked when the host comes back, you ask them, well where were you? What was going on? And usually they just went out, unconscious to sleep. Sometimes they went to another room inside or another location inside but basically they’re out of tune with the outside world. And then and then, which is protective. The whole purpose of the idea’s so you don’t know, remember everything all at once, which is great when you’re a kid. Not working quite so well and needs a little adjustment in the present day.

And so then I’ll often, this is the first time I’ve met the person, I’m working with them in a cognitive therapy group, which is basically a single session of therapy, everybody else is processing along, applying it to themselves and after some discussion, I’m talking through to the part or the parts in the background.

I’ve asked the part some questions. The part is listening. The part would be fine to talk with me and so then I’ll just say, Okay, Susan, out front. How about if we just practice. This is a skill like anything else. We’re not going to talk about anything heavy-duty. I just want you to go in the background and Susie will come out front, but instead of being asleep, I want you to make a conscious effort to be awake and listening. We’re not gonna talk about anything scary. Is that okay? Okay. So, Susie, would you mind coming out?

Sometimes it just doesn’t happen, but Susie comes out. Hi, Susie. Thanks for coming forward. Now, Mary, this is Dr. Ross. Remember you said that you’re gonna try and stay awake inside. You’re not gonna switch back then come out front. I want you to be awake inside and listening and just like when I was talking through to Susie, now I’m gonna talk through to you, and I want you to say to Susie that you’re awake and you’re listening if you are.

She said she’s there, okay, great. So this is co-consciousness this is a skill you can practice this. And so it’s a matter of making friends with all the parts, not letting amnesia bury us down so fast that you get completely flooded and overwhelmed practicing it, practicing it, step by step. Desensitization, that was my answer to that one.

Awesome, thank you. From Tonya Shaw, is there more formal trauma model therapy beyond purchasing the book manual? Yeah, I have trauma model therapy certification on my website. And so you could go to my website and it’s just short for Ross Institute, which is in the slides there. Does everybody have access to the slides after? Yes, I do and they will and then we have your information on the screen right now.

So, thanks a lot. So, yeah, you just go to my website and there’s under education, trauma model therapy certification. There’s a couple of books, a bunch of DVDs of role plays, some papers to read and then when you complete that you do a little multiple-choice exam, which is not very difficult and then we send you a certificate saying that you’ve completed the training. And you have to sign a waiver that I’m not responsible for anything you do basically. So that’s trauma model therapy certification. Awesome, and last question from Michelle, again. How effective is EMDR from multiple traumatic memories as in the case of DID and how does a recipient with severe dissociation stop disassociating from the memory in the treatment?

Okay, so that’s another big complicated, but good question. So, according to EMDR trainers or specialists, who understand and treat dissociative disorders this EMDR waving your fingers, tones tapping, you have to do tons of regular general DID therapy before you get to that. So there has to be reasonable communication, cooperation in the system, reasonable degree of co-consciousness, no giant crises going on in the present. Where you’re just overwhelmed and preoccupied

So it’s Maslow’s Hierarchy of Needs, if you’re homeless, dying of AIDS and being beaten up on the street all the time, probably not going to do EMDR about your childhood trauma right now, Which is just common sense, but therapists forget that. So when there’s enough history in preparation, you can again target anything. So you can target a belief, an emotion, a body, memory of body sensation. You can target an amnesia barrier. It doesn’t have to be a traumatic memory.

But if you’re gonna start targeting trauma memories like this, you might want to have all the kids be in their safe place to sleep. You might want to, not might, you would want to start with a relatively mild traumatic event just to practice and get the hang of the procedure and then you also would want to target whatever’s causing the most trouble right now.

So that was part of the question and what was the other part of the question. I’ll read it. How effective is the EMDR from multiple traumatic memories, as in the case of DID? And how does a recipient with severe dissociation stop dissociating from the memory in treatment?

Slightly smart-alec the answer, you don’t want to. Why would you want to stop dissociating from the memory in the sense that you have no dissociation, no amnesia? You’re totally overwhelmed and flooded and suicidal. So dissociation isn’t the problem. It’s the solution to the problem of overwhelming thoughts, feelings, memories. And you want to dismantle it a little bit by little bit.

so Richard Kluft talks about fractionated abreaction. Abreaction is reliving and processing the memories. Fractionated means a little bit at a time. So there’s strategies, like the inner screen technique where you have the mind or the alter do a screening, so to speak, by playing the memory on a screen. So you’re watching the event, but you’re not actually getting all the feelings. So that’s controlled, planned, staged dissociation. But you’re removing a little layer of the dissociation one layer at a time. So dissociation not is not the problem and it’s not a bad thing and you don’t want to dismantle it too fast.

And so you have to make, you have to say no to the drug of dissociation if you’re doing too much. Make a serious commitment to getting to know your parts, making friends with them, taking care of them, and thanking them for their contributions. So a lot of the work is got to do with making friends, building relationships opening up communication channels before you get to the trauma memories.

The trauma memories are stage two out of three of the work. There’s a lot of work to do before you get to that and write a criticism of EMDR. I’d say it tends to be like PTSD therapy, a little over-obsessed with the memories. The memories are only part of the whole package that needs attention.  There’s the physiology of it, there’s the cognitive errors, there’s current-day relationships. So easy it is on digging into the memories, but not so easy it is that you never get there.

So I’m not sure, I’m sure Michelle will have follow-up questions by email. Confident of that. She’s a very bright, amazing survivor in recovery. Well, thank you so much, Colin. Thank you for spending the time with us this afternoon for your presentation. Thank you everybody who has joined us on this Friday afternoon and we wish you peace in safety over the weekend and I look forward to having you back with us hopefully next week.

If there’s anything we, Gateway Foundation, can do for you please don’t hesitate to call us and you see on the screen Gateway Beacon Houses Higher Thought and Dr. Ross’s information. Thank you again so much for spending time with us, Colin. Thank you. Thank you to my team that helped put this together. All right, take care, everyone.

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