July 13, 2015 • 50 mins
We interview Colin Ross.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:08):
Over:
Speaker 2 (00:11):
Welcome to the System Speak Podcast, a podcast about
Dissociative Identity Disorder.If you are new to the podcast,
we recommend starting at thebeginning episodes and listen in
order to hear our story and whatwe have learned through this
endeavor. Current episodes maybe more applicable to longtime
listeners and are likely tocontain more advanced topics,
(00:33):
emotional or other triggeringcontent, and or reference
earlier episodes that providemore context to what we are
currently learning andexperiencing. As always, please
care for yourself during andafter listening to the podcast.
Thank you.
(00:55):
Hello. We have a special guesttoday. I'm interviewing Doctor.
Colin A. Ross, who completed hismedical school at the University
of Alberta and his psychiatrytraining at the University of
Manitoba in Canada.
He is a past president of theInternational Society for the
Study of Trauma and Dissociationand is the author of over two
(01:18):
twenty papers and 30 books. Hehas spoken widely throughout
North America and Europe, and inChina, Malaysia, Australia, and
New Zealand. He has been akeynote speaker at many
different conferences and hasreviewed for over 30 different
professional journals. Doctor.Ross is the director of a
(01:38):
hospital based trauma programsin Denton, Texas Torrance,
California, and Grand Rapids,Michigan.
He provides weekly cognitivetherapy groups at all three
locations, in person Texas andby video conference in Michigan
and California. He has beenrunning a hospital trauma
program in the Dallas area since1991. Doctor. Ras's books cover
(02:03):
a wide range of topics. Hisclinical books focus on trauma
and dissociation and includeDissociative Diagnosis, Clinical
Features, and Treatment ofMultiple Personality (nineteen
ninety seven), Innovations inDiagnosis and Treatment thousand
and four, The A Solution to theProblem of Comorbidity in
(02:25):
Psychiatry, two thousand andseven, Trauma A Treatment
Approach for Trauma Dissociationand Complex Morbidity, 02/2009,
A Proposed Modification of theTheory, 2013, and Treatment of
Dissociative Techniques andStrategies for Stabilization,
(02:47):
published in 2018.
Doctor. Ross has published aseries of treatment outcome
studies in peer reviewedjournals, which provide evidence
for the effectiveness of traumamodel therapy. Many of his
papers involve large series ofcases with original research
data and statistical analyses,including a paper entitled
(03:07):
Trauma and Dissociation in Chinain the American Journal of
Psychiatry. Besides his clinicalpsychiatry interests, Doctor.
Ross has published papers andbooks on cancer and human energy
fields, as well as literaryworks including essays, fiction,
poetry, and screenplays.
He has several different hobbiesincluding travel. I actually
(03:27):
first found Doctor. Ross in thecancer articles when I was
looking for information after myparents were diagnosed and then
my own diagnosis. That's notwhat we're talking about today,
but what I appreciated at thetime was his perspective was so
different than the politics andculture of money based medicine,
as opposed to science basedmedicine, and it really impacted
(03:49):
me. So when I discovered that hewas also one of the early
leading experts in the field ofdissociation and trauma, I was
really surprised and found thesame thing, that he holds a
unique perspective that can be abit mind boggling compared to
what everyone else says whenthey are so easily dismissive of
dissociative disorders.
(04:10):
And yet his research has heldout hope not only to understand
dissociation, but to confirmthat it exists and that it's far
more common than most peoplethink. Because of time
constraints for the podcast, Iwant to skip the story of how he
learned about dissociation inhis early career, but it's a
really good story. And so I'llinclude a link to one of his
(04:32):
videos in the blog. So let mewelcome Doctor. Colin Ross, and
let's start with just definingdissociation.
I know that some of what youhave taught in the past is that
part of the confusion about whatdissociation is, is that there
are actually four definitions todissociation, and people often
(04:54):
aren't even sure what they'retalking about.
Speaker 1 (04:58):
Well, I I go over that in my workshops and my
writings, and there's at leastfour definitions of the word
dissociation. And so that doescause confusion because there's
crosstalk because people meanone meaning or another meaning
or another meaning. So the firstmeaning is it's just a general
systems term, and it's reallyjust the same thing as
(05:20):
disconnection. So if two thingsare dissociated, dissociated,
they're out of relationship witheach other. They're not
interacting.
They're disconnected from eachother. If two things are
associated, they're linkedtogether, interacting,
connected. So dissociation isthe opposite of association and
basically means the same thingas connected or connection. And
(05:42):
this can be true anywhere in theuniverse. So there's
dissociation constants inphysical chemistry, for
instance.
Any two things can bedissociated from each other. So
it's a very general term. Thesecond meaning of dissociation
is it's a technical term incognitive psychology,
experimental psychology, andit's been used for thirty years
(06:04):
or so now at least. And so therewill be a disconnection between,
say, procedural memory anddeclarative memory. Declarative
memory is more or less likeexplicit conscious memory.
Procedural memory is likeimplicit or unconscious memory.
And you there's tons, likethousands of experiments showing
(06:24):
in many different experimentalmodels that you can have
information stored in proceduralmemory. It's not available to
conscious memory, but it'saffecting behavior and output.
And so this is just a fact incognitive psychology. You have a
dissociation between memorysystems, the conscious system,
(06:45):
the unconscious system.
Third meaning of dissociation isphenomenological meaning. That
is dissociation is the symptomsof dissociation. It's so how do
you define dissociation? Well,it's the items in the measures
of dissociation or in thediagnostic criteria in the DSM
five. So dissociation isexample, one two three four
(07:10):
five.
It's just symptoms, which isalso true of, say, panic
disorder. What is panicdisorder? Well, panic disorder
is when you have this, this,this, this, and this. What is
depression? It's this list ofsymptoms, and so it's just
symptoms that people report.
It's no different, no moremysterious than any other set of
(07:31):
symptoms in the DSM. And thenthe fourth meaning, which brings
in a lot of the confusion, isit's a theoretical defense
mechanism. So it's not somethingyou can observe or weigh or
measure. Dissociation is aprocess or a defense mechanism
going on in your mind. And sothere's people who, first of
(07:53):
all, aren't clear on thesedifferent meanings, and they'll
say, don't believe indissociation.
They're not saying that theydon't believe in the general
idea of disconnection. They'renot saying they don't believe
that there are measures ofdissociation that have listed
symptoms. They're saying most ofthe time, they don't believe in
this internal process defensemechanism of dissociation. So
(08:17):
you can not believe in theinternal defense mechanism,
meaning of dissociation, andcompletely believe in the other
three meanings. So it's not likeall all or none.
Speaker 2 (08:31):
Oh, wow. What it what is it that you've spoken about,
the horizontal and the verticalsplitting?
Speaker 1 (08:37):
Okay. So that's a good good thing to get into next
because part of the confusion isand the controversy is there's
no such thing as repressedmemories. There's no such thing
repression is the same thing asdissociation. So skeptics or
critics will say, well, there'sno evidence for repression. It's
just a bunch of bogus Freudiantheory.
(09:00):
Dissociation's the same thing.There's no evidence for that
either. So the whole thing isbogus and unscientific.
Speaker 2 (09:07):
Wow. So
Speaker 1 (09:08):
meanwhile, they're ignoring the fact that there's a
huge literature on measuringdissociation, questionnaires for
it, diagnostic criteria for itthat follow all the same rules
as the regular DSM five. But sowhy is it not true that even at
the level of a defensemechanism, dissociation and
repression are the same thing?And the there's this very handy
(09:31):
little diagram to use to explainthat, which was first invented
by a guy who was writing in thethe late seventies, Ernest
Hilgaard. He he had a bookcalled Theory, and he had this
little diagram. So he says thatrepression is based on
horizontal splitting, so that'sa horizontal line in your mind,
(09:53):
and dissociation is verticalsplitting, so it's a vertical
line in your mind.
So this is just a metaphor ordiagram. But in Freudian theory,
there's two subtypes ofrepression. So it's also
important to be clear what doesFreud mean by the word
repression.
Speaker 2 (10:10):
Right.
Speaker 1 (10:11):
So there's primal repression, which has absolutely
nothing to do with memories,events, trauma, abuse, or
anything else. In primalrepression, you have id
impulses, urges, drives that areemerging into the ego
consciousness. The ego's gotsome sort of conflict or phobia
of them, so they get pushed backdown into the unconscious before
(10:35):
they even really fully emergeinto conscious awareness. So
that's just impulses, drives,instincts, and so on. Nothing to
do with experience, nothing todo with trauma, nothing to do
with memory.
The second meaning is repressionproper, and these are terms that
Freud just defined in his essayson repression.
Speaker 2 (10:55):
Okay.
Speaker 1 (10:55):
In repression proper, you have material in your ego,
in your conscious mind, and ithas to do with things that have
happened. And you have conflictabout it or you don't wanna deal
with it, so you push it downthrough this horizontal barrier
in your mind into yourunconscious. So it was up top in
(11:16):
the ego. Now it's down below inthe id, and when it's down in
the id, then it's subject to allkinds of primary process, dream
mechanisms, fantasy, all thesethings that the unconscious mind
does, and it can get distorted.
Speaker 2 (11:33):
Wow.
Speaker 1 (11:34):
That's that's Freudian theory. So what is
dissociation? If we usedissociative identity disorder
as the main example. Indissociation, nothing is pushed
down from the conscious mindinto the unconscious mind.
There's no horizontal splitting.
Things are pushed from onecompartment in the ego into
(11:57):
another compartment in the egoacross a vertical split, and the
the point there is that thesethings are not buried in the
unconscious. They're not gettingall mixed up with dreams, and
when you recover a memory insomebody with dissociative
identity disorder, all you'redoing is removing the horizontal
(12:19):
barrier between one alterpersonality and the other alter
personality. So for, say, theeight year old alter personality
that remembers sexual abuse bydad, that eight year old ultra
personality has alwaysremembered that information.
It's always been in theconscious mind. It's just in one
compartment and not in the outfront adult compartment.
(12:40):
So it's a it's a completelydifferent process.
Speaker 2 (12:43):
So it's not that a memory is falsified or recovered
so much as access is gained towhere it already was and still
present.
Speaker 1 (12:52):
Right. And it was in the conscious mind
Speaker 2 (12:55):
Okay.
Speaker 1 (12:55):
All all along. But all I'm the point I'm making is
that repression is not the samething as dissociation. So if you
blow off repression and say it'snot real, there's no science for
it, that tells us nothing aboutthe scientific status of
dissociation because they're notthe same thing.
Speaker 2 (13:14):
Okay.
Speaker 1 (13:14):
And then the other curious twist on the history is
a lot of the hostile skepticswill say, well, it's all a bunch
of bogus Freudian theory, and,you know, we don't believe in
Freud anymore. We're scientists.We're in the 20 century now. And
so therefore, we don't believein all this recovered memory
stuff. We think that these areall false memories.
(13:36):
But problem is, if you go backto actual Freud and his actual
writings, in his 1895 bookcalled Studies on Hysteria with
Joseph Breuer, he describes awhole series of women who
clearly have partial or fulldissociative identity disorder.
They have all kinds of symptoms,and he attributes those symptoms
(13:59):
to childhood sexual abuse thathe thinks actually happened. So
this is the seduction theory ofhysteria. Back then, hysteria
did mean what it means today.Right.
Back back then, hysteria meantbasically a combination of post
traumatic stress disorder,dissociative disorders,
borderline personality disorder,psychosomatic symptoms. So all
(14:22):
these symptoms, he thought, weredirectly causally related to
sexual abuse in childhood thatactually happened, and he
describes this in great detailand talks about double
consciousness and amnesia forthings, etc. Then in 1897, in
his letter to Wilhelm Fleisch,he repudiated the seduction
(14:42):
theory. He decided that all thisabuse never happened, and the
abuse was being reported to himby father daughters of his
Jewish friends, neighbors, andcolleagues in a small section of
Vienna. So it was veryuncomfortable for him.
So when Freud assumed that thememories are accurate and really
(15:05):
did happen, by and large,they're not perfectly accurate,
then he had basically adissociation theory. When he
decided that these were falsememories, now he had a puzzle.
Why are all these hystericalwomen coming into therapy with
all these false memories ofsexual abuse that never
(15:25):
happened? In order to solve thatpuzzle for himself, he developed
repression theory. So repressiontheory is designed and developed
for when the memories are false.
So the the skeptics today haveit completely backwards. If you
follow a repression theory, youagree with it, and you base your
(15:46):
treatment on it, you're going tosay that the memories are false.
So the whole thing's very mixedup.
Speaker 2 (15:53):
Wow. Tell me about structural dissociation and OSDD
and these changes. What'shappened there?
Speaker 1 (16:01):
Okay. Well, structural dissociation is a
theory, and there's a bookcalled The Haunted Self in which
the authors, Ono Vanderhardt,Ehlers Nayenhouse, and Kathy
Steele, write at great lengthabout this model and the
treatment that follows from itand so on. And then they also
have published a series ofpapers, and they do lots of
(16:22):
speaking about it. And I'vewritten commentaries on that and
a short book about it, and soI'm very familiar with it. In
one way, structural dissociationis nothing new.
It's just a a restatement of thetheories of Pierre Jainet from
the late nineteenth century, Butin another way, it is something
new because these authors havereally fleshed it out in full,
(16:48):
added a lot of detail, talked alot about treatment. The basic
idea is that something traumatichappens, and it's too
overwhelming. It's too much. Soyour mind just kinda pushes it
over to the side, walls it off,and you either don't remember
the information at all, whichwould be full dissociation, or
(17:12):
you kinda remember theinformation, but the feelings
aren't there. It's justemotionless information.
So that's that's dissociation.In structural dissociation,
there has to be formation of anatural separate ego state alter
personality or identity. So thememories, the feelings, the
(17:33):
conflicts are held in a splitoff section of your psyche that
may have in full DID, it mayhave a name and age, different
hair color, all kinds ofpersonal attributes. That's full
dissociative identity disorder.In what used to be DDNOS,
dissociative disorder nototherwise specified in DSM four,
(17:56):
which is now other specifieddissociative disorder in DSM
five because they changed thenames Mhmm.
Which they did for all thesections, anxiety, depression,
and so
Speaker 2 (18:05):
on. Right.
Speaker 1 (18:06):
In OSDD, I always just explain to people is it's
the same thing as DID, but onlyhalf or three quarters as much.
So you have a separate splitoff, dissociated off section of
your psyche. It's holdingthoughts, feelings, memories,
but it maybe doesn't have aspecific name or a different
age, or it just stays internal.It doesn't come out to the
(18:29):
surface, and you don't see theperson switch to another
character. So it's it's the samething, but just not as much.
In structural dissociationtheory, there's got to be some
sort of dissociated internalstate with its own subjective
sense of a separate identity.Okay. And so that's just what
(18:51):
DID has always been. It's alwaysbeen described that way. It's
nothing new.
These authors have just come upwith some tying it into animal
defense mechanisms like fight,flight, and freeze, elaborating
on it, and describing thetreatment interventions in more
detail, and some research thatfollows from it as well.
Speaker 2 (19:12):
Okay.
Speaker 1 (19:12):
So that that's basically what structural
dissociation is.
Speaker 2 (19:15):
So is there a little bit of a spectrum between OSDD
all the way to I DID? Or
Speaker 1 (19:22):
Yeah. It's everything in mental health is on a
spectrum, basically. So you'vegot one person who's never
drinks at all. You got anotherperson who has, you know, the
odd glass of wine maybe a coupletimes a month, then somebody who
has a glass of wine most nightsof the week, but not every day.
And then next person drinks acouple of beer, sometimes two,
(19:44):
three, four beers during theweek, and then on the weekend
has maybe six beers on Saturdayor six beers on Sunday.
Then you got the person whodrinks a bottle of whiskey every
day for the last twenty years.So that's all on a spectrum, and
there's no sharp cutoff point.
Speaker 2 (20:02):
That makes a lot of sense, and it kind of makes DID
or dissociation in general sortof consistent with everything
else rather than being such anoutlier.
Speaker 1 (20:12):
Yeah. It's not an outlier in reality. It's just an
outlier in people's falseimpressions about it.
Speaker 2 (20:19):
Why is that? What happened with that shift
culturally in the clinical worldwhen there was so much research
and so many people trying tohelp or learn how to help, and
then a whole group of peoplethat just sort of said that's
not a thing anymore?
Speaker 1 (20:34):
Well, I have some ideas and theories about that,
but, basically, it's verypuzzling to me. But jumping back
to alcohol for a minute, so it'strue that alcohol is on a
spectrum, and there's no sharpcutoff. So when you're in kind
of the gray zone in the middleof the continuum there, one
psychiatrist or clinician mightsay, oh, this person has a
drinking problem. And the nextperson might go, he drinks a
(20:58):
little bit too much, but it'snot really a drinking problem. I
wouldn't say it's a substanceuse disorder.
It is kinda getting near that.And the rate of agreement
between different psychiatristson who is an alcoholic and who
is not in that kind of gray zoneis gonna be very low. But if
psychiatrists interview ahundred people who don't drink
at all and a hundred peoplewho've had a bottle of whiskey
(21:20):
every day for the last twentyyears, they'll have perfect
agreement on who is an alcoholicand who isn't.
Speaker 2 (21:26):
So you're talking about concordance?
Speaker 1 (21:28):
Yeah. No inter rater agreement. So my point being
that if we go back to DID, sure,dissociation's on a continuum.
Everybody does it a little bit.Some people do it a little bit
more and more and more and more.
When you get all the way out toDID, there's clearly things
going on that most people don'texperience. So most people don't
(21:50):
have the experience of they'reat home making lunch, and next
thing they know, it's 9PM atnight. They're downtown. They're
at a bar. They don't know howthey got there.
That's not an experience that,you know, most people have a
little bit of the time. Andsimilarly, people don't
generally unless they have someneurological problem, they don't
(22:11):
look in the mirror and not knowwho that is. But people with DID
have these kind of experiences.So it's both a continuum and a
discrete category. When you getout to the far end, it's just a
different category.
It's not the same as normal, andboth things are true, which is
also true of anxiety,depression, substance abuse,
(22:32):
alcohol, whatever.
Speaker 2 (22:34):
Right.
Speaker 1 (22:35):
Do you mind if we jump back to the controversy and
the disbelief?
Speaker 2 (22:38):
Oh, please. Please. Absolutely. Okay.
Speaker 1 (22:41):
So first of all, there's controversy and
disbelief about a lot of thingsin the DSM. So there's a whole
group of people who have theirown organization, their own
conference, their own journal,their own series of books, who
are very skeptical thatschizophrenia is a legitimate
disorder, and they think thatmaybe we should change the name
(23:02):
altogether. They are veryskeptical about what causes it
and so on. So there's andthere's peep large group of
people in our culture who thinkthat psychiatry is just
medicalizing everything, anddepression isn't really a
disorder. It's certainly not adisease.
They're just exaggerating andmaking a big deal of normal
(23:23):
sadness, normal reaction to lifeevents. So there's plenty of
controversy about everything inpsychiatry and everything in the
DSM five, but the controversyabout DID is a little bigger and
a little more intellectuallyviolent.
Speaker 2 (23:40):
It's so intense.
Speaker 1 (23:42):
Yeah. Yeah. And it's not that people go, well, you
know, I'm a little bitskeptical. I'm just not quite
convinced. Psychiatrists havevery energized, hostile, angry,
belittling, dismissiveattitudes.
There's a lot of energy behindit. So why? So first of all,
that intense energy to me isevidence that this is not just
(24:04):
an intellectual question.
Speaker 2 (24:06):
Right. Right.
Speaker 1 (24:07):
Something big at stake personally. Like, this is
touching on some kind ofpersonal something. I don't know
what that is necessarily, butnow we get into my theories.
Okay. So the first theory is notreally theory.
It's just a fact. A lot ofpeople who are highly skeptical
about DID don't even read theliterature. They're not familiar
(24:30):
with the scientific literatureon DID, so they're just speaking
really out of ignorance.
Speaker 2 (24:35):
Right.
Speaker 1 (24:36):
So that's problem number one. Problem number two
is they have all thesemisconceptions. Like, if you
people who diagnose DID thinkthat there's literally separate
people in there, and oneperson's not responsible legally
for what the other person does,which is not true at all.
Speaker 2 (24:53):
Right.
Speaker 1 (24:54):
They think that if you have DID, you can get away
with all kinds of stuff becauseyou couldn't help it because
somebody else did it, not trueat all.
Speaker 2 (25:03):
So I'm not responsible for the system as a
whole.
Speaker 1 (25:06):
Yeah. But we I and a lot of people in the field hold
the person as a wholeresponsible for the behavior of
all the parts in just the sameway that we would any person
without DID.
Speaker 2 (25:17):
Okay.
Speaker 1 (25:18):
So so DID doesn't necessarily lead the diagnosis
diagnosis doesn't lead to, oh,you can get away with anything.
That's just a misconception. Thenext thing that's contributing
is DID is very strongly tiedinto childhood abuse, including
sexual abuse, physical abuse,emotional abuse, neglect, and so
on. So that makes it a very hotbutton topic just by itself,
(25:45):
because if the topic is someneutral thing about, you know,
what is the function of somecertain part of the brain in
obsessive compulsive disorder,nobody gets that hot about it
except maybe a few academics.
Speaker 2 (25:59):
Right.
Speaker 1 (25:59):
But if the if the subject is child sexual abuse
and people accusing theirfathers of incest, all of a
sudden, there's a lot of energy,a lot of controversy, and a lot
of angry people, which which isnot too hard to find on the
Internet.
Speaker 2 (26:12):
Right.
Speaker 1 (26:12):
So it's just a very charged topic, and DID is really
connected into that charge. Sowhy would people get so upset
about that topic? Well, I thinkthere's several explanations
there. Besides the fact thatthey're just generally
uncomfortable with it and don'twanna think about it and don't
wanna deal with it, there'sgonna be there's no reason to
(26:35):
think that the rates ofchildhood sexual abuse are lower
in psychiatrists, psychologists,social workers, counselors than
the general population. Ifanything, it's likely to be
higher because sexual abusepeople might want to go into
those fields to try and figurethemselves out or to help other
people.
So the rates of childhood sexualabuse are not gonna be, you
(26:57):
know, less than the generalpopulation, which is I know
we're talking fairly seriousabuse, not just one touch. Five
percent in boys, fifteen percentin girls is kind of the basic
ballpark. So, therefore, there'sno reason to think that less
than five, ten percent ofpsychiatrists, psychologists,
social workers themselves weresexually abused as children. So
(27:20):
they're gonna have a lot ofreaction to these topics. And if
they don't wanna think about,feel, or know their own abuse,
they're gonna discredit DID.
And especially if they'reworried that there may be even
more abuse buried inside themthat they don't know about yet,
they're gonna wanna discreditrecovered memories dissociation.
Then the other set of peoplewould be people who themselves
(27:44):
are perpetrators of physicalabuse, sexual abuse, emotional
abuse of adults and children.They're not gonna want anybody
blowing the lid on that. And weknow that there's, you know,
pedophiles in the Catholicchurch. We know there's lots of
them.
We know that there's beenpedophiles in the Boy Scouts,
football coaches, gymnasticscoaches for the Olympics team.
(28:07):
So there's pedophiles all overthe place. There's no reason
again that there's not gonna bepedophiles in psychiatry,
psychology, social work. So ifyou are, in fact, a pedophile or
perpetrator of domesticviolence, you wanna put the lid
on all that, and one way to putthe lid on is to discredit DID.
Speaker 2 (28:28):
Both of those choices are really frightening.
Speaker 1 (28:31):
Well, yeah.
Speaker 2 (28:32):
Right.
Speaker 1 (28:33):
And so then another this will sound a little bit
fantastic unless we went into itfor a couple hours, but it's
it's an objective documentedfact that two of the original
board members, professionaladvisory board members of the
False Memory Syndrome Foundationwere Martin Orne and Jolly West,
two famous psychiatrists, andthey were part of the
(28:56):
organization that wasspearheading trying to
completely suppress multiplepersonality disorder, now DID,
discredited, discreditedrecovered memories. What what
might have been theirmotivations? Well, absolutely
documented for a fact, both ofthose guys were top secret
cleared contractors on MKUltra,and we're contracting with the
(29:19):
CIA on how to study, create, andunderstand dissociation to
multiple personalities, andwe're part of the mentoring
candidate candidate programs inthe CIA. That's just a fact.
Wow.
So so then there's gonna that'sgonna be another motive to try
and cover up all this stuffbecause what if somebody is
(29:40):
spilling the beans in somecivilian therapy? So there's
gonna be and then there'sanother another set of motives
is just hardcore biologicalpeople who think that what
happens to you, like abuse,doesn't have anything to do with
anything. It's all genes andchemicals in your brain, and so
we have to discredit anybodywho's coming forward saying no.
(30:02):
These serious mental disordersare coming from what happens in
the environment. They're notcoming from your genes, and
they're not coming from eatingthe wrong flavor of Jell O.
They're coming from seriousstuff like sexual abuse. And
then the final one I would sayis the literature on
dissociative identity disorder,there's we have multiple studies
(30:24):
from multiple differentcountries showing that DID is
affecting in the ballpark of onepercent of the general
population, and that includes alot of much milder cases than we
see clinically. Just like ifschizophrenia affects one
percent of the population, whichis the basic statistic, that
doesn't include cases that areas severe as you'll see in the
(30:47):
state mental hospital. Itincludes those plus a lot of
much minor versions ofschizophrenia. Same for DID.
Speaker 2 (30:54):
You've talked about what you found in China and the
that study where there's not anycultural pieces where people
could have gotten it or got theidea from it for through social
media or films or anything likethat because those pieces aren't
there in the culture.
Speaker 1 (31:13):
Exactly. Yeah. That was I did multiple visits to
Shanghai Mental Health Center,and the the Chinese team, we
translated the standardizedinterviews. Chinese team did
many, many interviews. And thenme and my colleague went over
there and did interviews of someof the people with a Chinese
translator.
(31:33):
It was quite easy to find casesof clear classical American
style DID, which is prettystrong evidence. It's not just,
you know, some kind of fadthat's going on in The United
States. Wow. And so and theother final point I was gonna
make is, so if it is true thatDID affects maybe about ballpark
(31:55):
four percent of general adultpsychiatric inpatients all
around the world, so that's oneout of twenty five inpatients on
psychiatric units all around TheUnited States, Canada, Europe.
If that's a fact, which is thenumber that's in the literature,
this means that all thesepsychiatrists who don't think
about it, don't believe in it,or hostile to it, are missing an
(32:17):
awful lot of diagnoses andfailing to provide the right
treatment day in and day out ona large scale.
So that means that they're notall that competent, and they're
not all that helpful. Andthey're not gonna want to know
that or admit to that, so theyhave to discredit DID.
Speaker 2 (32:35):
Wow. That makes a lot of sense. Good. So what about
tell me about the trauma model.
Speaker 1 (32:44):
Okay. So the trauma model is is in the title of one
of my books, and the traumamodel is a general scientific
model of the mental health fieldand what's the role of trauma
all across the DSM system. Andit's very detailed, and it's
based on the researchliterature, on my thinking, on
(33:06):
clinical experience, and I Iprovide a whole long list of
specific research predictions.For instance, if you do this
research, trauma model predicts,you'll find this. Regular
psychiatry would predict, you'llfind that.
So it's set up so it's not justa belief or a theory or opinion.
It's actually a testablescientific model. And I could
(33:27):
give you a couple examples ifyou want. But Sure. The basic
basic basic idea is that traumais a big deal in the mental
health field, and it's a majorcontributor to a large
percentage of mental healthproblems.
There's also people who haveserious mental health problems
who didn't have trauma. So it'snot an all or nothing thing.
Speaker 2 (33:44):
Right.
Speaker 1 (33:45):
It's it's not just a little sub area or just PTSD all
across the board. And this isnow acknowledged in DSM five,
all across DSM five. Most of thesections, it says that childhood
trauma, including sexual abuse,is a serious risk factor for
whichever section we're in. Wow.So that so that's the trauma
model.
(34:07):
So it's not specific to DID.Trauma model therapy is the
therapy method that kinda sitson top of the trauma model, and
it's also useful for manydifferent diagnoses, not just
DID. Because people with DIDhave all kinds of other problems
besides their DID. Theyfrequently are depressed.
They're anxious.
(34:27):
They have substance abuseproblems. They have PTSD. They
have all kinds of things, all ofwhich have to be treated. And
what's, I'd say, what's new anddifferent about the trauma model
therapy is the way I've kind ofintegrated together into a
(34:48):
single approach attachmentconflicts that come from trauma
when you're people who you lovewho are your caretakers are also
the people you hate who areabusing you. The self there's a
whole way of thinking about theself blame that's almost
universal in trauma survivors.
I call that the locus of controlshift, and it comes from normal
(35:09):
childhood thinking where youthink that you're causing
everything that's going on. SoI'm I'm tying all the self
blame, self hatred, selfpunishment into normal childhood
psychology, psychology, andthat's the way kids think
Speaker 2 (35:22):
about Oh, I had not connected that piece. Like, I'm
thinking of, like, Patricia DeJong and some of the shame based
stuff. I have not connected itto the child actual perspective.
Speaker 1 (35:33):
It's also very similar to moral injury and
combat PTSD.
Speaker 2 (35:38):
Right.
Speaker 1 (35:40):
And then I've I've tied in subsystems principles.
The problem is not the problem.That is the presenting symptom
or behavior is usually some sortof unhealthy attempt to solve
some problem in the background,cope with their feelings, cope
with the situation. So you haveto try and understand the
problem in the background, helpthe person to regulate their
(36:01):
feelings, cope with life better,and then they can kinda let go
of the presenting symptom oraddiction or behavior. Then
there's sort of an addictioncomponent I've blended in.
There's a very well defined andstructured component. And then
the victim rescue or perpetratortriangle, I use that as a a way
(36:22):
of talking about what's goingon. So I've taken elements from
here, there, and everywhere,some of which are somewhat
original, especially locuscontrol shift, but it's just the
way they're all tied together ina kind of seamless, flexible
model. And trauma model therapyis not just, you know, this
little silo here, and then overthere you have that silo, which
(36:44):
is cognitive therapy, and overthere you have EMDR. Trauma
model therapy is very open.
The more tools in the toolbox,the better.
Speaker 2 (36:53):
Oh, wow.
Speaker 1 (36:54):
So it's not like an exclusive little empire of its
own at all. And when I talk totherapists about it, which I do
a lot, who are not talking aboutDID in particular, I just they
all say, this makes so muchsense. I really like this. This
is useful. This is helpful.
(37:14):
And I also have six or seventreatment outcome studies
providing data showing that it'seffective at what's called level
two evidence. So it's actuallyan evidence based therapy.
Speaker 2 (37:27):
Oh, that's great. Tell me just since I since I
have you specifically, tell methat piece that's unique to you
about the locus control shift.What was it?
Speaker 1 (37:36):
Locus of control shift.
Speaker 2 (37:38):
Tell me more about that.
Speaker 1 (37:40):
Okay. So locus of control is just there's a big
literature on that. It's asocial psychology literature.
And the locus of control somepeople have an external locus
control, which is they feel likethe outside world controls them
and is kicking them around allthe time. Some people have an
internal locus of control, whichthey feel like they're in charge
and they're making thingshappen, and then healthy people
(38:02):
have kind of a flexible fluidshift back and forth.
So I just borrowed that term,locus of control. And my
thinking is that the locus ofcontrol shift happens
automatically for abused kids.The locus control being where is
the control point? It's reallyin the adults. But because of
the way the child minds work,the control point gets shifted
(38:26):
inside the kid.
Because kids experience life asI'm at the center of the world.
Everything revolves around me,and I've got this magical power
to make things happen. That'sjust the way kids think.
Speaker 2 (38:38):
Right. Right. Just developmentally. Right. Okay.
Speaker 1 (38:41):
So when there's a whole bunch of abuse and mental
death going on, automaticallyconclude it's my fault. It's
happening because I'm bad. Ideserve it. I'm no good. I'm
this.
I'm that. And so it makes theself blame, the self hatred, the
self punishment, all thisunhealthy behavior
understandable, and it makes itbe more like the person who gets
(39:03):
hit by the drunk driver comesinto the ER with a broken leg,
and their femur is sticking outthrough the skin of their thigh.
Well, the doctor goes, well,that's abnormal. That's
pathological. But the doctordoesn't go, this is a
pathological person, or what'sgenetically wrong with this
(39:23):
person?
The doctor says, well, they justgot hit by a drunk driver. This
is abnormal.
Speaker 2 (39:28):
Oh, wow.
Speaker 1 (39:29):
If you've been through that kind of trauma. And
so the the model is constantlymaking this point that you're
angry. Why? When you threatenand corner a mammal over and
over and over and over, you'regonna activate its fight system.
Your anger is normal, natural.
It comes from being threatenedover and over as a kid. Now how
(39:51):
you handle it is not maybe thehealthiest. We need to work on
that. And the fact that you hateyourself and blame yourself,
that's just the way it is withkids who get abused. And so it
it destigmatizes it.
It takes away a lot of theshame, and now we can get to
work on it.
Speaker 2 (40:09):
So it really it normalizes it, not that what
happened was okay, but that theresponse to what happened is
okay.
Speaker 1 (40:17):
Right. Wow. Exactly the same as getting hit by a
drunk driver is not okay, buthaving a broken leg as a result
can be completely normal. Andnobody goes, what's what's up
with you? How come you got thisbroken leg?
People just don't have thoseattitudes.
Speaker 2 (40:34):
So not what is wrong with you, but a consequence of
what happened to you?
Speaker 1 (40:40):
Yeah. That's the motto.
Speaker 2 (40:42):
Wow. The
Speaker 1 (40:42):
motto that dominates the mental health field is
what's wrong with you. But inthis perspective, the motto is
not what's wrong with you, whathappened to you.
Speaker 2 (40:52):
That's a huge shift.
Speaker 1 (40:54):
But I've just, you know, taken that and blended it
into this very well organizedmodel. And the the therapy has
very defined tasks, steps,procedures, strategies. It's not
just kinda vaguely floatingaround.
Speaker 2 (41:11):
So it's structured between the therapist and the
client?
Speaker 1 (41:15):
Yeah.
Speaker 2 (41:16):
Or you mean, like, in a workbook format?
Speaker 1 (41:19):
We have some workbook book aspects, so a bit of both.
Speaker 2 (41:24):
Oh, okay.
Speaker 1 (41:25):
Mostly not in the in the work port workbook fashion.
It's more okay. So we have towork on this. We have to work on
that. We have to work on this.
We have to solve this. We haveto solve this. We have to solve
this. The strategies and thetechniques and the tasks are
well defined, and here are somethings you can do for this. Here
are some things you can do forthat.
So it's just like an examplewould be somebody who's kinda
(41:50):
spacing out, getting tooanxious, losing track of where
they are, getting disorientedbecause there's too much PTSD up
and running. So there's a wholebunch of grounding skills, which
are not unique to this model,but this is an example of you
don't just talk about itforever. So there's specific
things to do. Okay. Work on yourbreathing.
(42:10):
Focus on your breathing. Slowyour breathing down. Shuffle
your feet. Look around. Don't bejust having a fixed stare.
Where are you right now? What'syour name? What year is it? Who
am I? Why are we here?
You're safe now. It could belike squeeze a ball. Talk to
(42:33):
yourself internally. Remindyourself. So there's a whole set
of strategies that can be usedto help the person get grounded,
and that's throughout thistherapy, there's all kinds of
strategies and tasks for allkinds of different things.
Speaker 2 (42:46):
So in your approach, is it more important for the
clinician to establish sort of,I guess, safety and tolerance
skills and things like thatbefore more talking about it, or
it kind of goes hand in handthrough the process?
Speaker 1 (43:04):
A bit of both. So in all different forms of trauma
therapy, there's basically threephases. There's phase one, two,
three. Phase one is gettingthese grounding skills,
accepting the diagnosis,accepting the treatment plan.
And if the person's being beatup by their husband every day,
well, you have to work on thatbefore you start working about
(43:25):
childhood trauma.
So it's stabilization,grounding, being motivated,
making sure there's not too muchother chaos going on in your
life. And then we get into thesort of memory processing,
talking about the trauma,accepting the feelings. And then
the third phase is moreresolution, consolidation,
(43:47):
integration, and learning how tocope with life just as person in
general. So trauma model therapyfollows those three kind of
stages, but that's just a sortof a teaching point. In reality,
you do some stage one, thenthree, then two, then up to
three, back to one.
Oh, more one, up to two.
Speaker 2 (44:08):
That's just the way
Speaker 1 (44:09):
it goes.
Speaker 2 (44:10):
Right.
Speaker 1 (44:11):
But the but, clinically, we do see like, in
my hospital programs, we seepeople admitted who are way
overwhelmed, flooded, too manyflashbacks, too much
hyperarousal because somethinghorrible happened in life, but
also not rarely because thetherapist dove in too fast to
memories, memories, memories,memories. So it's very important
(44:34):
to keep the pace slow enough,but not so slow that it takes
forever. So pacing andcontainment are big themes in
the therapy. And for anytherapy, it doesn't matter what
kind, the literature isoverwhelmingly conclusive, and
basically all expert therapistsagree that a huge part of any
(44:56):
therapy, no matter what yourtheories and no matter what your
techniques, huge part ispositive therapeutic
relationship, good work ethic,the therapist being generally
interested and concerned aboutthe person, realizing they have
a serious problem, knowing whatthey're doing, just the
attitude, just the energy, thevibe, that's a huge part of the
(45:19):
healing no matter what specifictechniques the therapist uses.
Speaker 2 (45:24):
Is that just part of a general attunement kind of
process beyond just rapport, butjust being
Speaker 1 (45:30):
It's it's it's not it's not casual like you just
you're at a bar one night andyou chat with somebody and you
get along well and you never seethem again. It's the same basic
thing, but it's more structuredand it lasts for a long time.
Any other therapist has to bevery attuned, empathic, but not,
like, swallowed up by theperson's problems, obviously.
Speaker 2 (45:51):
Right. And what about for the other perspective from
the client's perspective,knowing how to find a therapist
like that or what like, aboutyour program, those sorts of
things.
Speaker 1 (46:05):
Well, that's kind of a hit and miss process.
Unfortunately, like everybodyelse on the planet, therapists
range from well, sometimesgrossly unethical and need their
licenses taken away. But, youknow, not very competent, not
very effective, not veryhelpful, medium helpful, or,
(46:25):
like, really, really helpful.And so finding out in advance
which one's which is a bigchallenge for clients,
consumers. But generallyspeaking, somebody who's got a
good reputation in the field,somebody who's active in their
professional associations,word-of-mouth, other people have
(46:46):
had good experience with thatperson, or you're referred to
them by an expert in the field.
Those are, you know, goodstarting points. In terms of so
I don't have an outpatientpractice. Don't do
consultations, but I do havehospital based programs. So if
you're looking for inpatienttreatment, then you either go to
(47:07):
my website, the Ross Institute,or you can go to u b h Denton
University Behavioral HealthDenton, u b h Denton, d e n t o
n, dot com. And there's a traumaprogram there, and there's phone
numbers, and you can call in andfind out how program operates
and get your insurance checkedout and so on.
And, also, we have a network oftherapists that we can refer to.
Speaker 2 (47:32):
You mean outside of the Dallas area? Or Yep. Oh,
wow.
Speaker 1 (47:38):
I mean, we don't have therapists, like, in every town
in the country, but we know andare aware of quite a few
therapists and can search andfind people to suggest.
Speaker 2 (47:48):
How do clinicians become involved with that or
participate with that or connectwith others who are doing
quality of work and not thecreepy people who are doing such
a bad job?
Speaker 1 (48:03):
Yeah. Well, that's also a challenge. But,
basically, if you're an eatingdisorders person, well, then
you're gonna read journals abouteating disorders, read books
about eating disorders, go toconferences about eating
disorders, and belong to aprofessional association focused
on eating disorders. Same thingfor dissociative disorders.
There's the InternationalSociety for the Study of Trauma
(48:24):
and Dissociation, which is I s shyphen isst-d.org.
And so you could go there.There's a journal. You get into
the literature, read the leadingbooks, go to conferences.
There's webinars.
Speaker 2 (48:43):
Their conference is gonna be in New York next.
Right?
Speaker 1 (48:46):
Right. New York in March. And they have regional
conferences scattered around andwebinars.
Speaker 2 (48:51):
Oh, okay.
Speaker 1 (48:52):
And there's also a find a therapist tab, whereas
you can just go to the website.You don't have to join the
organization. And you can dofind a therapist and search in
this state or this town who isthe therapist who knows about
dissociative disorders. Andsometimes there won't be one.
Sometimes there'll be one threehundred miles away.
Speaker 2 (49:12):
Right.
Speaker 1 (49:13):
Right. And then I also have a series of webinars.
My daughter and I. My daughter'sa psychiatrist in Toronto, and
we have a webinar series. We'rejust about to do the twelfth
month.
We'll finish our first full yearin in January.
Speaker 2 (49:29):
Wow.
Speaker 1 (49:30):
It's TraumaEducationEssentials.com.
So it's TraumaEdEssentials.comis the website.
Speaker 2 (49:38):
Okay.
Speaker 1 (49:40):
And you can go there. Check it out. Also, you can sign
up for the newsletter, which isfree, which is monthly written
by my daughter. It's usually gota good book review or a nice
article, sometimes practicaltips for therapy announcements,
and so on. So we have reallygood speakers.
In January is John Breyer forthree hours. He's, you know, one
(50:03):
of the handful top experts onPTSD and trauma and a very
engaging speaker, verypractical, easy to follow.
Speaker 2 (50:11):
That was really helpful. Thank you so much.
Speaker 1 (50:13):
No. You're welcome. Very nice talking to you. Thanks
for asking.
Speaker 2 (50:15):
Sure. Thank you for listening. Your support really
helps us feel less alone whilewe sort through all of this and
learn together.
Over:
Speaker 2 (00:11):
Welcome to the System Speak Podcast, a podcast about
Dissociative Identity Disorder.If you are new to the podcast,
we recommend starting at thebeginning episodes and listen in
order to hear our story and whatwe have learned through this
endeavor. Current episodes maybe more applicable to longtime
listeners and are likely tocontain more advanced topics,
(00:33):
emotional or other triggeringcontent, and or reference
earlier episodes that providemore context to what we are
currently learning andexperiencing. As always, please
care for yourself during andafter listening to the podcast.
Thank you.
(00:55):
Hello. We have a special guesttoday. I'm interviewing Doctor.
Colin A. Ross, who completed hismedical school at the University
of Alberta and his psychiatrytraining at the University of
Manitoba in Canada.
He is a past president of theInternational Society for the
Study of Trauma and Dissociationand is the author of over two
(01:18):
twenty papers and 30 books. Hehas spoken widely throughout
North America and Europe, and inChina, Malaysia, Australia, and
New Zealand. He has been akeynote speaker at many
different conferences and hasreviewed for over 30 different
professional journals. Doctor.Ross is the director of a
(01:38):
hospital based trauma programsin Denton, Texas Torrance,
California, and Grand Rapids,Michigan.
He provides weekly cognitivetherapy groups at all three
locations, in person Texas andby video conference in Michigan
and California. He has beenrunning a hospital trauma
program in the Dallas area since1991. Doctor. Ras's books cover
(02:03):
a wide range of topics. Hisclinical books focus on trauma
and dissociation and includeDissociative Diagnosis, Clinical
Features, and Treatment ofMultiple Personality (nineteen
ninety seven), Innovations inDiagnosis and Treatment thousand
and four, The A Solution to theProblem of Comorbidity in
(02:25):
Psychiatry, two thousand andseven, Trauma A Treatment
Approach for Trauma Dissociationand Complex Morbidity, 02/2009,
A Proposed Modification of theTheory, 2013, and Treatment of
Dissociative Techniques andStrategies for Stabilization,
(02:47):
published in 2018.
Doctor. Ross has published aseries of treatment outcome
studies in peer reviewedjournals, which provide evidence
for the effectiveness of traumamodel therapy. Many of his
papers involve large series ofcases with original research
data and statistical analyses,including a paper entitled
(03:07):
Trauma and Dissociation in Chinain the American Journal of
Psychiatry. Besides his clinicalpsychiatry interests, Doctor.
Ross has published papers andbooks on cancer and human energy
fields, as well as literaryworks including essays, fiction,
poetry, and screenplays.
He has several different hobbiesincluding travel. I actually
(03:27):
first found Doctor. Ross in thecancer articles when I was
looking for information after myparents were diagnosed and then
my own diagnosis. That's notwhat we're talking about today,
but what I appreciated at thetime was his perspective was so
different than the politics andculture of money based medicine,
as opposed to science basedmedicine, and it really impacted
(03:49):
me. So when I discovered that hewas also one of the early
leading experts in the field ofdissociation and trauma, I was
really surprised and found thesame thing, that he holds a
unique perspective that can be abit mind boggling compared to
what everyone else says whenthey are so easily dismissive of
dissociative disorders.
(04:10):
And yet his research has heldout hope not only to understand
dissociation, but to confirmthat it exists and that it's far
more common than most peoplethink. Because of time
constraints for the podcast, Iwant to skip the story of how he
learned about dissociation inhis early career, but it's a
really good story. And so I'llinclude a link to one of his
(04:32):
videos in the blog. So let mewelcome Doctor. Colin Ross, and
let's start with just definingdissociation.
I know that some of what youhave taught in the past is that
part of the confusion about whatdissociation is, is that there
are actually four definitions todissociation, and people often
(04:54):
aren't even sure what they'retalking about.
Speaker 1 (04:58):
Well, I I go over that in my workshops and my
writings, and there's at leastfour definitions of the word
dissociation. And so that doescause confusion because there's
crosstalk because people meanone meaning or another meaning
or another meaning. So the firstmeaning is it's just a general
systems term, and it's reallyjust the same thing as
(05:20):
disconnection. So if two thingsare dissociated, dissociated,
they're out of relationship witheach other. They're not
interacting.
They're disconnected from eachother. If two things are
associated, they're linkedtogether, interacting,
connected. So dissociation isthe opposite of association and
basically means the same thingas connected or connection. And
(05:42):
this can be true anywhere in theuniverse. So there's
dissociation constants inphysical chemistry, for
instance.
Any two things can bedissociated from each other. So
it's a very general term. Thesecond meaning of dissociation
is it's a technical term incognitive psychology,
experimental psychology, andit's been used for thirty years
(06:04):
or so now at least. And so therewill be a disconnection between,
say, procedural memory anddeclarative memory. Declarative
memory is more or less likeexplicit conscious memory.
Procedural memory is likeimplicit or unconscious memory.
And you there's tons, likethousands of experiments showing
(06:24):
in many different experimentalmodels that you can have
information stored in proceduralmemory. It's not available to
conscious memory, but it'saffecting behavior and output.
And so this is just a fact incognitive psychology. You have a
dissociation between memorysystems, the conscious system,
(06:45):
the unconscious system.
Third meaning of dissociation isphenomenological meaning. That
is dissociation is the symptomsof dissociation. It's so how do
you define dissociation? Well,it's the items in the measures
of dissociation or in thediagnostic criteria in the DSM
five. So dissociation isexample, one two three four
(07:10):
five.
It's just symptoms, which isalso true of, say, panic
disorder. What is panicdisorder? Well, panic disorder
is when you have this, this,this, this, and this. What is
depression? It's this list ofsymptoms, and so it's just
symptoms that people report.
It's no different, no moremysterious than any other set of
(07:31):
symptoms in the DSM. And thenthe fourth meaning, which brings
in a lot of the confusion, isit's a theoretical defense
mechanism. So it's not somethingyou can observe or weigh or
measure. Dissociation is aprocess or a defense mechanism
going on in your mind. And sothere's people who, first of
(07:53):
all, aren't clear on thesedifferent meanings, and they'll
say, don't believe indissociation.
They're not saying that theydon't believe in the general
idea of disconnection. They'renot saying they don't believe
that there are measures ofdissociation that have listed
symptoms. They're saying most ofthe time, they don't believe in
this internal process defensemechanism of dissociation. So
(08:17):
you can not believe in theinternal defense mechanism,
meaning of dissociation, andcompletely believe in the other
three meanings. So it's not likeall all or none.
Speaker 2 (08:31):
Oh, wow. What it what is it that you've spoken about,
the horizontal and the verticalsplitting?
Speaker 1 (08:37):
Okay. So that's a good good thing to get into next
because part of the confusion isand the controversy is there's
no such thing as repressedmemories. There's no such thing
repression is the same thing asdissociation. So skeptics or
critics will say, well, there'sno evidence for repression. It's
just a bunch of bogus Freudiantheory.
(09:00):
Dissociation's the same thing.There's no evidence for that
either. So the whole thing isbogus and unscientific.
Speaker 2 (09:07):
Wow. So
Speaker 1 (09:08):
meanwhile, they're ignoring the fact that there's a
huge literature on measuringdissociation, questionnaires for
it, diagnostic criteria for itthat follow all the same rules
as the regular DSM five. But sowhy is it not true that even at
the level of a defensemechanism, dissociation and
repression are the same thing?And the there's this very handy
(09:31):
little diagram to use to explainthat, which was first invented
by a guy who was writing in thethe late seventies, Ernest
Hilgaard. He he had a bookcalled Theory, and he had this
little diagram. So he says thatrepression is based on
horizontal splitting, so that'sa horizontal line in your mind,
(09:53):
and dissociation is verticalsplitting, so it's a vertical
line in your mind.
So this is just a metaphor ordiagram. But in Freudian theory,
there's two subtypes ofrepression. So it's also
important to be clear what doesFreud mean by the word
repression.
Speaker 2 (10:10):
Right.
Speaker 1 (10:11):
So there's primal repression, which has absolutely
nothing to do with memories,events, trauma, abuse, or
anything else. In primalrepression, you have id
impulses, urges, drives that areemerging into the ego
consciousness. The ego's gotsome sort of conflict or phobia
of them, so they get pushed backdown into the unconscious before
(10:35):
they even really fully emergeinto conscious awareness. So
that's just impulses, drives,instincts, and so on. Nothing to
do with experience, nothing todo with trauma, nothing to do
with memory.
The second meaning is repressionproper, and these are terms that
Freud just defined in his essayson repression.
Speaker 2 (10:55):
Okay.
Speaker 1 (10:55):
In repression proper, you have material in your ego,
in your conscious mind, and ithas to do with things that have
happened. And you have conflictabout it or you don't wanna deal
with it, so you push it downthrough this horizontal barrier
in your mind into yourunconscious. So it was up top in
(11:16):
the ego. Now it's down below inthe id, and when it's down in
the id, then it's subject to allkinds of primary process, dream
mechanisms, fantasy, all thesethings that the unconscious mind
does, and it can get distorted.
Speaker 2 (11:33):
Wow.
Speaker 1 (11:34):
That's that's Freudian theory. So what is
dissociation? If we usedissociative identity disorder
as the main example. Indissociation, nothing is pushed
down from the conscious mindinto the unconscious mind.
There's no horizontal splitting.
Things are pushed from onecompartment in the ego into
(11:57):
another compartment in the egoacross a vertical split, and the
the point there is that thesethings are not buried in the
unconscious. They're not gettingall mixed up with dreams, and
when you recover a memory insomebody with dissociative
identity disorder, all you'redoing is removing the horizontal
(12:19):
barrier between one alterpersonality and the other alter
personality. So for, say, theeight year old alter personality
that remembers sexual abuse bydad, that eight year old ultra
personality has alwaysremembered that information.
It's always been in theconscious mind. It's just in one
compartment and not in the outfront adult compartment.
(12:40):
So it's a it's a completelydifferent process.
Speaker 2 (12:43):
So it's not that a memory is falsified or recovered
so much as access is gained towhere it already was and still
present.
Speaker 1 (12:52):
Right. And it was in the conscious mind
Speaker 2 (12:55):
Okay.
Speaker 1 (12:55):
All all along. But all I'm the point I'm making is
that repression is not the samething as dissociation. So if you
blow off repression and say it'snot real, there's no science for
it, that tells us nothing aboutthe scientific status of
dissociation because they're notthe same thing.
Speaker 2 (13:14):
Okay.
Speaker 1 (13:14):
And then the other curious twist on the history is
a lot of the hostile skepticswill say, well, it's all a bunch
of bogus Freudian theory, and,you know, we don't believe in
Freud anymore. We're scientists.We're in the 20 century now. And
so therefore, we don't believein all this recovered memory
stuff. We think that these areall false memories.
(13:36):
But problem is, if you go backto actual Freud and his actual
writings, in his 1895 bookcalled Studies on Hysteria with
Joseph Breuer, he describes awhole series of women who
clearly have partial or fulldissociative identity disorder.
They have all kinds of symptoms,and he attributes those symptoms
(13:59):
to childhood sexual abuse thathe thinks actually happened. So
this is the seduction theory ofhysteria. Back then, hysteria
did mean what it means today.Right.
Back back then, hysteria meantbasically a combination of post
traumatic stress disorder,dissociative disorders,
borderline personality disorder,psychosomatic symptoms. So all
(14:22):
these symptoms, he thought, weredirectly causally related to
sexual abuse in childhood thatactually happened, and he
describes this in great detailand talks about double
consciousness and amnesia forthings, etc. Then in 1897, in
his letter to Wilhelm Fleisch,he repudiated the seduction
(14:42):
theory. He decided that all thisabuse never happened, and the
abuse was being reported to himby father daughters of his
Jewish friends, neighbors, andcolleagues in a small section of
Vienna. So it was veryuncomfortable for him.
So when Freud assumed that thememories are accurate and really
(15:05):
did happen, by and large,they're not perfectly accurate,
then he had basically adissociation theory. When he
decided that these were falsememories, now he had a puzzle.
Why are all these hystericalwomen coming into therapy with
all these false memories ofsexual abuse that never
(15:25):
happened? In order to solve thatpuzzle for himself, he developed
repression theory. So repressiontheory is designed and developed
for when the memories are false.
So the the skeptics today haveit completely backwards. If you
follow a repression theory, youagree with it, and you base your
(15:46):
treatment on it, you're going tosay that the memories are false.
So the whole thing's very mixedup.
Speaker 2 (15:53):
Wow. Tell me about structural dissociation and OSDD
and these changes. What'shappened there?
Speaker 1 (16:01):
Okay. Well, structural dissociation is a
theory, and there's a bookcalled The Haunted Self in which
the authors, Ono Vanderhardt,Ehlers Nayenhouse, and Kathy
Steele, write at great lengthabout this model and the
treatment that follows from itand so on. And then they also
have published a series ofpapers, and they do lots of
(16:22):
speaking about it. And I'vewritten commentaries on that and
a short book about it, and soI'm very familiar with it. In
one way, structural dissociationis nothing new.
It's just a a restatement of thetheories of Pierre Jainet from
the late nineteenth century, Butin another way, it is something
new because these authors havereally fleshed it out in full,
(16:48):
added a lot of detail, talked alot about treatment. The basic
idea is that something traumatichappens, and it's too
overwhelming. It's too much. Soyour mind just kinda pushes it
over to the side, walls it off,and you either don't remember
the information at all, whichwould be full dissociation, or
(17:12):
you kinda remember theinformation, but the feelings
aren't there. It's justemotionless information.
So that's that's dissociation.In structural dissociation,
there has to be formation of anatural separate ego state alter
personality or identity. So thememories, the feelings, the
(17:33):
conflicts are held in a splitoff section of your psyche that
may have in full DID, it mayhave a name and age, different
hair color, all kinds ofpersonal attributes. That's full
dissociative identity disorder.In what used to be DDNOS,
dissociative disorder nototherwise specified in DSM four,
(17:56):
which is now other specifieddissociative disorder in DSM
five because they changed thenames Mhmm.
Which they did for all thesections, anxiety, depression,
and so
Speaker 2 (18:05):
on. Right.
Speaker 1 (18:06):
In OSDD, I always just explain to people is it's
the same thing as DID, but onlyhalf or three quarters as much.
So you have a separate splitoff, dissociated off section of
your psyche. It's holdingthoughts, feelings, memories,
but it maybe doesn't have aspecific name or a different
age, or it just stays internal.It doesn't come out to the
(18:29):
surface, and you don't see theperson switch to another
character. So it's it's the samething, but just not as much.
In structural dissociationtheory, there's got to be some
sort of dissociated internalstate with its own subjective
sense of a separate identity.Okay. And so that's just what
(18:51):
DID has always been. It's alwaysbeen described that way. It's
nothing new.
These authors have just come upwith some tying it into animal
defense mechanisms like fight,flight, and freeze, elaborating
on it, and describing thetreatment interventions in more
detail, and some research thatfollows from it as well.
Speaker 2 (19:12):
Okay.
Speaker 1 (19:12):
So that that's basically what structural
dissociation is.
Speaker 2 (19:15):
So is there a little bit of a spectrum between OSDD
all the way to I DID? Or
Speaker 1 (19:22):
Yeah. It's everything in mental health is on a
spectrum, basically. So you'vegot one person who's never
drinks at all. You got anotherperson who has, you know, the
odd glass of wine maybe a coupletimes a month, then somebody who
has a glass of wine most nightsof the week, but not every day.
And then next person drinks acouple of beer, sometimes two,
(19:44):
three, four beers during theweek, and then on the weekend
has maybe six beers on Saturdayor six beers on Sunday.
Then you got the person whodrinks a bottle of whiskey every
day for the last twenty years.So that's all on a spectrum, and
there's no sharp cutoff point.
Speaker 2 (20:02):
That makes a lot of sense, and it kind of makes DID
or dissociation in general sortof consistent with everything
else rather than being such anoutlier.
Speaker 1 (20:12):
Yeah. It's not an outlier in reality. It's just an
outlier in people's falseimpressions about it.
Speaker 2 (20:19):
Why is that? What happened with that shift
culturally in the clinical worldwhen there was so much research
and so many people trying tohelp or learn how to help, and
then a whole group of peoplethat just sort of said that's
not a thing anymore?
Speaker 1 (20:34):
Well, I have some ideas and theories about that,
but, basically, it's verypuzzling to me. But jumping back
to alcohol for a minute, so it'strue that alcohol is on a
spectrum, and there's no sharpcutoff. So when you're in kind
of the gray zone in the middleof the continuum there, one
psychiatrist or clinician mightsay, oh, this person has a
drinking problem. And the nextperson might go, he drinks a
(20:58):
little bit too much, but it'snot really a drinking problem. I
wouldn't say it's a substanceuse disorder.
It is kinda getting near that.And the rate of agreement
between different psychiatristson who is an alcoholic and who
is not in that kind of gray zoneis gonna be very low. But if
psychiatrists interview ahundred people who don't drink
at all and a hundred peoplewho've had a bottle of whiskey
(21:20):
every day for the last twentyyears, they'll have perfect
agreement on who is an alcoholicand who isn't.
Speaker 2 (21:26):
So you're talking about concordance?
Speaker 1 (21:28):
Yeah. No inter rater agreement. So my point being
that if we go back to DID, sure,dissociation's on a continuum.
Everybody does it a little bit.Some people do it a little bit
more and more and more and more.
When you get all the way out toDID, there's clearly things
going on that most people don'texperience. So most people don't
(21:50):
have the experience of they'reat home making lunch, and next
thing they know, it's 9PM atnight. They're downtown. They're
at a bar. They don't know howthey got there.
That's not an experience that,you know, most people have a
little bit of the time. Andsimilarly, people don't
generally unless they have someneurological problem, they don't
(22:11):
look in the mirror and not knowwho that is. But people with DID
have these kind of experiences.So it's both a continuum and a
discrete category. When you getout to the far end, it's just a
different category.
It's not the same as normal, andboth things are true, which is
also true of anxiety,depression, substance abuse,
(22:32):
alcohol, whatever.
Speaker 2 (22:34):
Right.
Speaker 1 (22:35):
Do you mind if we jump back to the controversy and
the disbelief?
Speaker 2 (22:38):
Oh, please. Please. Absolutely. Okay.
Speaker 1 (22:41):
So first of all, there's controversy and
disbelief about a lot of thingsin the DSM. So there's a whole
group of people who have theirown organization, their own
conference, their own journal,their own series of books, who
are very skeptical thatschizophrenia is a legitimate
disorder, and they think thatmaybe we should change the name
(23:02):
altogether. They are veryskeptical about what causes it
and so on. So there's andthere's peep large group of
people in our culture who thinkthat psychiatry is just
medicalizing everything, anddepression isn't really a
disorder. It's certainly not adisease.
They're just exaggerating andmaking a big deal of normal
(23:23):
sadness, normal reaction to lifeevents. So there's plenty of
controversy about everything inpsychiatry and everything in the
DSM five, but the controversyabout DID is a little bigger and
a little more intellectuallyviolent.
Speaker 2 (23:40):
It's so intense.
Speaker 1 (23:42):
Yeah. Yeah. And it's not that people go, well, you
know, I'm a little bitskeptical. I'm just not quite
convinced. Psychiatrists havevery energized, hostile, angry,
belittling, dismissiveattitudes.
There's a lot of energy behindit. So why? So first of all,
that intense energy to me isevidence that this is not just
(24:04):
an intellectual question.
Speaker 2 (24:06):
Right. Right.
Speaker 1 (24:07):
Something big at stake personally. Like, this is
touching on some kind ofpersonal something. I don't know
what that is necessarily, butnow we get into my theories.
Okay. So the first theory is notreally theory.
It's just a fact. A lot ofpeople who are highly skeptical
about DID don't even read theliterature. They're not familiar
(24:30):
with the scientific literatureon DID, so they're just speaking
really out of ignorance.
Speaker 2 (24:35):
Right.
Speaker 1 (24:36):
So that's problem number one. Problem number two
is they have all thesemisconceptions. Like, if you
people who diagnose DID thinkthat there's literally separate
people in there, and oneperson's not responsible legally
for what the other person does,which is not true at all.
Speaker 2 (24:53):
Right.
Speaker 1 (24:54):
They think that if you have DID, you can get away
with all kinds of stuff becauseyou couldn't help it because
somebody else did it, not trueat all.
Speaker 2 (25:03):
So I'm not responsible for the system as a
whole.
Speaker 1 (25:06):
Yeah. But we I and a lot of people in the field hold
the person as a wholeresponsible for the behavior of
all the parts in just the sameway that we would any person
without DID.
Speaker 2 (25:17):
Okay.
Speaker 1 (25:18):
So so DID doesn't necessarily lead the diagnosis
diagnosis doesn't lead to, oh,you can get away with anything.
That's just a misconception. Thenext thing that's contributing
is DID is very strongly tiedinto childhood abuse, including
sexual abuse, physical abuse,emotional abuse, neglect, and so
on. So that makes it a very hotbutton topic just by itself,
(25:45):
because if the topic is someneutral thing about, you know,
what is the function of somecertain part of the brain in
obsessive compulsive disorder,nobody gets that hot about it
except maybe a few academics.
Speaker 2 (25:59):
Right.
Speaker 1 (25:59):
But if the if the subject is child sexual abuse
and people accusing theirfathers of incest, all of a
sudden, there's a lot of energy,a lot of controversy, and a lot
of angry people, which which isnot too hard to find on the
Internet.
Speaker 2 (26:12):
Right.
Speaker 1 (26:12):
So it's just a very charged topic, and DID is really
connected into that charge. Sowhy would people get so upset
about that topic? Well, I thinkthere's several explanations
there. Besides the fact thatthey're just generally
uncomfortable with it and don'twanna think about it and don't
wanna deal with it, there'sgonna be there's no reason to
(26:35):
think that the rates ofchildhood sexual abuse are lower
in psychiatrists, psychologists,social workers, counselors than
the general population. Ifanything, it's likely to be
higher because sexual abusepeople might want to go into
those fields to try and figurethemselves out or to help other
people.
So the rates of childhood sexualabuse are not gonna be, you
(26:57):
know, less than the generalpopulation, which is I know
we're talking fairly seriousabuse, not just one touch. Five
percent in boys, fifteen percentin girls is kind of the basic
ballpark. So, therefore, there'sno reason to think that less
than five, ten percent ofpsychiatrists, psychologists,
social workers themselves weresexually abused as children. So
(27:20):
they're gonna have a lot ofreaction to these topics. And if
they don't wanna think about,feel, or know their own abuse,
they're gonna discredit DID.
And especially if they'reworried that there may be even
more abuse buried inside themthat they don't know about yet,
they're gonna wanna discreditrecovered memories dissociation.
Then the other set of peoplewould be people who themselves
(27:44):
are perpetrators of physicalabuse, sexual abuse, emotional
abuse of adults and children.They're not gonna want anybody
blowing the lid on that. And weknow that there's, you know,
pedophiles in the Catholicchurch. We know there's lots of
them.
We know that there's beenpedophiles in the Boy Scouts,
football coaches, gymnasticscoaches for the Olympics team.
(28:07):
So there's pedophiles all overthe place. There's no reason
again that there's not gonna bepedophiles in psychiatry,
psychology, social work. So ifyou are, in fact, a pedophile or
perpetrator of domesticviolence, you wanna put the lid
on all that, and one way to putthe lid on is to discredit DID.
Speaker 2 (28:28):
Both of those choices are really frightening.
Speaker 1 (28:31):
Well, yeah.
Speaker 2 (28:32):
Right.
Speaker 1 (28:33):
And so then another this will sound a little bit
fantastic unless we went into itfor a couple hours, but it's
it's an objective documentedfact that two of the original
board members, professionaladvisory board members of the
False Memory Syndrome Foundationwere Martin Orne and Jolly West,
two famous psychiatrists, andthey were part of the
(28:56):
organization that wasspearheading trying to
completely suppress multiplepersonality disorder, now DID,
discredited, discreditedrecovered memories. What what
might have been theirmotivations? Well, absolutely
documented for a fact, both ofthose guys were top secret
cleared contractors on MKUltra,and we're contracting with the
(29:19):
CIA on how to study, create, andunderstand dissociation to
multiple personalities, andwe're part of the mentoring
candidate candidate programs inthe CIA. That's just a fact.
Wow.
So so then there's gonna that'sgonna be another motive to try
and cover up all this stuffbecause what if somebody is
(29:40):
spilling the beans in somecivilian therapy? So there's
gonna be and then there'sanother another set of motives
is just hardcore biologicalpeople who think that what
happens to you, like abuse,doesn't have anything to do with
anything. It's all genes andchemicals in your brain, and so
we have to discredit anybodywho's coming forward saying no.
(30:02):
These serious mental disordersare coming from what happens in
the environment. They're notcoming from your genes, and
they're not coming from eatingthe wrong flavor of Jell O.
They're coming from seriousstuff like sexual abuse. And
then the final one I would sayis the literature on
dissociative identity disorder,there's we have multiple studies
(30:24):
from multiple differentcountries showing that DID is
affecting in the ballpark of onepercent of the general
population, and that includes alot of much milder cases than we
see clinically. Just like ifschizophrenia affects one
percent of the population, whichis the basic statistic, that
doesn't include cases that areas severe as you'll see in the
(30:47):
state mental hospital. Itincludes those plus a lot of
much minor versions ofschizophrenia. Same for DID.
Speaker 2 (30:54):
You've talked about what you found in China and the
that study where there's not anycultural pieces where people
could have gotten it or got theidea from it for through social
media or films or anything likethat because those pieces aren't
there in the culture.
Speaker 1 (31:13):
Exactly. Yeah. That was I did multiple visits to
Shanghai Mental Health Center,and the the Chinese team, we
translated the standardizedinterviews. Chinese team did
many, many interviews. And thenme and my colleague went over
there and did interviews of someof the people with a Chinese
translator.
(31:33):
It was quite easy to find casesof clear classical American
style DID, which is prettystrong evidence. It's not just,
you know, some kind of fadthat's going on in The United
States. Wow. And so and theother final point I was gonna
make is, so if it is true thatDID affects maybe about ballpark
(31:55):
four percent of general adultpsychiatric inpatients all
around the world, so that's oneout of twenty five inpatients on
psychiatric units all around TheUnited States, Canada, Europe.
If that's a fact, which is thenumber that's in the literature,
this means that all thesepsychiatrists who don't think
about it, don't believe in it,or hostile to it, are missing an
(32:17):
awful lot of diagnoses andfailing to provide the right
treatment day in and day out ona large scale.
So that means that they're notall that competent, and they're
not all that helpful. Andthey're not gonna want to know
that or admit to that, so theyhave to discredit DID.
Speaker 2 (32:35):
Wow. That makes a lot of sense. Good. So what about
tell me about the trauma model.
Speaker 1 (32:44):
Okay. So the trauma model is is in the title of one
of my books, and the traumamodel is a general scientific
model of the mental health fieldand what's the role of trauma
all across the DSM system. Andit's very detailed, and it's
based on the researchliterature, on my thinking, on
(33:06):
clinical experience, and I Iprovide a whole long list of
specific research predictions.For instance, if you do this
research, trauma model predicts,you'll find this. Regular
psychiatry would predict, you'llfind that.
So it's set up so it's not justa belief or a theory or opinion.
It's actually a testablescientific model. And I could
(33:27):
give you a couple examples ifyou want. But Sure. The basic
basic basic idea is that traumais a big deal in the mental
health field, and it's a majorcontributor to a large
percentage of mental healthproblems.
There's also people who haveserious mental health problems
who didn't have trauma. So it'snot an all or nothing thing.
Speaker 2 (33:44):
Right.
Speaker 1 (33:45):
It's it's not just a little sub area or just PTSD all
across the board. And this isnow acknowledged in DSM five,
all across DSM five. Most of thesections, it says that childhood
trauma, including sexual abuse,is a serious risk factor for
whichever section we're in. Wow.So that so that's the trauma
model.
(34:07):
So it's not specific to DID.Trauma model therapy is the
therapy method that kinda sitson top of the trauma model, and
it's also useful for manydifferent diagnoses, not just
DID. Because people with DIDhave all kinds of other problems
besides their DID. Theyfrequently are depressed.
They're anxious.
(34:27):
They have substance abuseproblems. They have PTSD. They
have all kinds of things, all ofwhich have to be treated. And
what's, I'd say, what's new anddifferent about the trauma model
therapy is the way I've kind ofintegrated together into a
(34:48):
single approach attachmentconflicts that come from trauma
when you're people who you lovewho are your caretakers are also
the people you hate who areabusing you. The self there's a
whole way of thinking about theself blame that's almost
universal in trauma survivors.
I call that the locus of controlshift, and it comes from normal
(35:09):
childhood thinking where youthink that you're causing
everything that's going on. SoI'm I'm tying all the self
blame, self hatred, selfpunishment into normal childhood
psychology, psychology, andthat's the way kids think
Speaker 2 (35:22):
about Oh, I had not connected that piece. Like, I'm
thinking of, like, Patricia DeJong and some of the shame based
stuff. I have not connected itto the child actual perspective.
Speaker 1 (35:33):
It's also very similar to moral injury and
combat PTSD.
Speaker 2 (35:38):
Right.
Speaker 1 (35:40):
And then I've I've tied in subsystems principles.
The problem is not the problem.That is the presenting symptom
or behavior is usually some sortof unhealthy attempt to solve
some problem in the background,cope with their feelings, cope
with the situation. So you haveto try and understand the
problem in the background, helpthe person to regulate their
(36:01):
feelings, cope with life better,and then they can kinda let go
of the presenting symptom oraddiction or behavior. Then
there's sort of an addictioncomponent I've blended in.
There's a very well defined andstructured component. And then
the victim rescue or perpetratortriangle, I use that as a a way
(36:22):
of talking about what's goingon. So I've taken elements from
here, there, and everywhere,some of which are somewhat
original, especially locuscontrol shift, but it's just the
way they're all tied together ina kind of seamless, flexible
model. And trauma model therapyis not just, you know, this
little silo here, and then overthere you have that silo, which
(36:44):
is cognitive therapy, and overthere you have EMDR. Trauma
model therapy is very open.
The more tools in the toolbox,the better.
Speaker 2 (36:53):
Oh, wow.
Speaker 1 (36:54):
So it's not like an exclusive little empire of its
own at all. And when I talk totherapists about it, which I do
a lot, who are not talking aboutDID in particular, I just they
all say, this makes so muchsense. I really like this. This
is useful. This is helpful.
(37:14):
And I also have six or seventreatment outcome studies
providing data showing that it'seffective at what's called level
two evidence. So it's actuallyan evidence based therapy.
Speaker 2 (37:27):
Oh, that's great. Tell me just since I since I
have you specifically, tell methat piece that's unique to you
about the locus control shift.What was it?
Speaker 1 (37:36):
Locus of control shift.
Speaker 2 (37:38):
Tell me more about that.
Speaker 1 (37:40):
Okay. So locus of control is just there's a big
literature on that. It's asocial psychology literature.
And the locus of control somepeople have an external locus
control, which is they feel likethe outside world controls them
and is kicking them around allthe time. Some people have an
internal locus of control, whichthey feel like they're in charge
and they're making thingshappen, and then healthy people
(38:02):
have kind of a flexible fluidshift back and forth.
So I just borrowed that term,locus of control. And my
thinking is that the locus ofcontrol shift happens
automatically for abused kids.The locus control being where is
the control point? It's reallyin the adults. But because of
the way the child minds work,the control point gets shifted
(38:26):
inside the kid.
Because kids experience life asI'm at the center of the world.
Everything revolves around me,and I've got this magical power
to make things happen. That'sjust the way kids think.
Speaker 2 (38:38):
Right. Right. Just developmentally. Right. Okay.
Speaker 1 (38:41):
So when there's a whole bunch of abuse and mental
death going on, automaticallyconclude it's my fault. It's
happening because I'm bad. Ideserve it. I'm no good. I'm
this.
I'm that. And so it makes theself blame, the self hatred, the
self punishment, all thisunhealthy behavior
understandable, and it makes itbe more like the person who gets
(39:03):
hit by the drunk driver comesinto the ER with a broken leg,
and their femur is sticking outthrough the skin of their thigh.
Well, the doctor goes, well,that's abnormal. That's
pathological. But the doctordoesn't go, this is a
pathological person, or what'sgenetically wrong with this
(39:23):
person?
The doctor says, well, they justgot hit by a drunk driver. This
is abnormal.
Speaker 2 (39:28):
Oh, wow.
Speaker 1 (39:29):
If you've been through that kind of trauma. And
so the the model is constantlymaking this point that you're
angry. Why? When you threatenand corner a mammal over and
over and over and over, you'regonna activate its fight system.
Your anger is normal, natural.
It comes from being threatenedover and over as a kid. Now how
(39:51):
you handle it is not maybe thehealthiest. We need to work on
that. And the fact that you hateyourself and blame yourself,
that's just the way it is withkids who get abused. And so it
it destigmatizes it.
It takes away a lot of theshame, and now we can get to
work on it.
Speaker 2 (40:09):
So it really it normalizes it, not that what
happened was okay, but that theresponse to what happened is
okay.
Speaker 1 (40:17):
Right. Wow. Exactly the same as getting hit by a
drunk driver is not okay, buthaving a broken leg as a result
can be completely normal. Andnobody goes, what's what's up
with you? How come you got thisbroken leg?
People just don't have thoseattitudes.
Speaker 2 (40:34):
So not what is wrong with you, but a consequence of
what happened to you?
Speaker 1 (40:40):
Yeah. That's the motto.
Speaker 2 (40:42):
Wow. The
Speaker 1 (40:42):
motto that dominates the mental health field is
what's wrong with you. But inthis perspective, the motto is
not what's wrong with you, whathappened to you.
Speaker 2 (40:52):
That's a huge shift.
Speaker 1 (40:54):
But I've just, you know, taken that and blended it
into this very well organizedmodel. And the the therapy has
very defined tasks, steps,procedures, strategies. It's not
just kinda vaguely floatingaround.
Speaker 2 (41:11):
So it's structured between the therapist and the
client?
Speaker 1 (41:15):
Yeah.
Speaker 2 (41:16):
Or you mean, like, in a workbook format?
Speaker 1 (41:19):
We have some workbook book aspects, so a bit of both.
Speaker 2 (41:24):
Oh, okay.
Speaker 1 (41:25):
Mostly not in the in the work port workbook fashion.
It's more okay. So we have towork on this. We have to work on
that. We have to work on this.
We have to solve this. We haveto solve this. We have to solve
this. The strategies and thetechniques and the tasks are
well defined, and here are somethings you can do for this. Here
are some things you can do forthat.
So it's just like an examplewould be somebody who's kinda
(41:50):
spacing out, getting tooanxious, losing track of where
they are, getting disorientedbecause there's too much PTSD up
and running. So there's a wholebunch of grounding skills, which
are not unique to this model,but this is an example of you
don't just talk about itforever. So there's specific
things to do. Okay. Work on yourbreathing.
(42:10):
Focus on your breathing. Slowyour breathing down. Shuffle
your feet. Look around. Don't bejust having a fixed stare.
Where are you right now? What'syour name? What year is it? Who
am I? Why are we here?
You're safe now. It could belike squeeze a ball. Talk to
(42:33):
yourself internally. Remindyourself. So there's a whole set
of strategies that can be usedto help the person get grounded,
and that's throughout thistherapy, there's all kinds of
strategies and tasks for allkinds of different things.
Speaker 2 (42:46):
So in your approach, is it more important for the
clinician to establish sort of,I guess, safety and tolerance
skills and things like thatbefore more talking about it, or
it kind of goes hand in handthrough the process?
Speaker 1 (43:04):
A bit of both. So in all different forms of trauma
therapy, there's basically threephases. There's phase one, two,
three. Phase one is gettingthese grounding skills,
accepting the diagnosis,accepting the treatment plan.
And if the person's being beatup by their husband every day,
well, you have to work on thatbefore you start working about
(43:25):
childhood trauma.
So it's stabilization,grounding, being motivated,
making sure there's not too muchother chaos going on in your
life. And then we get into thesort of memory processing,
talking about the trauma,accepting the feelings. And then
the third phase is moreresolution, consolidation,
(43:47):
integration, and learning how tocope with life just as person in
general. So trauma model therapyfollows those three kind of
stages, but that's just a sortof a teaching point. In reality,
you do some stage one, thenthree, then two, then up to
three, back to one.
Oh, more one, up to two.
Speaker 2 (44:08):
That's just the way
Speaker 1 (44:09):
it goes.
Speaker 2 (44:10):
Right.
Speaker 1 (44:11):
But the but, clinically, we do see like, in
my hospital programs, we seepeople admitted who are way
overwhelmed, flooded, too manyflashbacks, too much
hyperarousal because somethinghorrible happened in life, but
also not rarely because thetherapist dove in too fast to
memories, memories, memories,memories. So it's very important
(44:34):
to keep the pace slow enough,but not so slow that it takes
forever. So pacing andcontainment are big themes in
the therapy. And for anytherapy, it doesn't matter what
kind, the literature isoverwhelmingly conclusive, and
basically all expert therapistsagree that a huge part of any
(44:56):
therapy, no matter what yourtheories and no matter what your
techniques, huge part ispositive therapeutic
relationship, good work ethic,the therapist being generally
interested and concerned aboutthe person, realizing they have
a serious problem, knowing whatthey're doing, just the
attitude, just the energy, thevibe, that's a huge part of the
(45:19):
healing no matter what specifictechniques the therapist uses.
Speaker 2 (45:24):
Is that just part of a general attunement kind of
process beyond just rapport, butjust being
Speaker 1 (45:30):
It's it's it's not it's not casual like you just
you're at a bar one night andyou chat with somebody and you
get along well and you never seethem again. It's the same basic
thing, but it's more structuredand it lasts for a long time.
Any other therapist has to bevery attuned, empathic, but not,
like, swallowed up by theperson's problems, obviously.
Speaker 2 (45:51):
Right. And what about for the other perspective from
the client's perspective,knowing how to find a therapist
like that or what like, aboutyour program, those sorts of
things.
Speaker 1 (46:05):
Well, that's kind of a hit and miss process.
Unfortunately, like everybodyelse on the planet, therapists
range from well, sometimesgrossly unethical and need their
licenses taken away. But, youknow, not very competent, not
very effective, not veryhelpful, medium helpful, or,
(46:25):
like, really, really helpful.And so finding out in advance
which one's which is a bigchallenge for clients,
consumers. But generallyspeaking, somebody who's got a
good reputation in the field,somebody who's active in their
professional associations,word-of-mouth, other people have
(46:46):
had good experience with thatperson, or you're referred to
them by an expert in the field.
Those are, you know, goodstarting points. In terms of so
I don't have an outpatientpractice. Don't do
consultations, but I do havehospital based programs. So if
you're looking for inpatienttreatment, then you either go to
(47:07):
my website, the Ross Institute,or you can go to u b h Denton
University Behavioral HealthDenton, u b h Denton, d e n t o
n, dot com. And there's a traumaprogram there, and there's phone
numbers, and you can call in andfind out how program operates
and get your insurance checkedout and so on.
And, also, we have a network oftherapists that we can refer to.
Speaker 2 (47:32):
You mean outside of the Dallas area? Or Yep. Oh,
wow.
Speaker 1 (47:38):
I mean, we don't have therapists, like, in every town
in the country, but we know andare aware of quite a few
therapists and can search andfind people to suggest.
Speaker 2 (47:48):
How do clinicians become involved with that or
participate with that or connectwith others who are doing
quality of work and not thecreepy people who are doing such
a bad job?
Speaker 1 (48:03):
Yeah. Well, that's also a challenge. But,
basically, if you're an eatingdisorders person, well, then
you're gonna read journals abouteating disorders, read books
about eating disorders, go toconferences about eating
disorders, and belong to aprofessional association focused
on eating disorders. Same thingfor dissociative disorders.
There's the InternationalSociety for the Study of Trauma
(48:24):
and Dissociation, which is I s shyphen isst-d.org.
And so you could go there.There's a journal. You get into
the literature, read the leadingbooks, go to conferences.
There's webinars.
Speaker 2 (48:43):
Their conference is gonna be in New York next.
Right?
Speaker 1 (48:46):
Right. New York in March. And they have regional
conferences scattered around andwebinars.
Speaker 2 (48:51):
Oh, okay.
Speaker 1 (48:52):
And there's also a find a therapist tab, whereas
you can just go to the website.You don't have to join the
organization. And you can dofind a therapist and search in
this state or this town who isthe therapist who knows about
dissociative disorders. Andsometimes there won't be one.
Sometimes there'll be one threehundred miles away.
Speaker 2 (49:12):
Right.
Speaker 1 (49:13):
Right. And then I also have a series of webinars.
My daughter and I. My daughter'sa psychiatrist in Toronto, and
we have a webinar series. We'rejust about to do the twelfth
month.
We'll finish our first full yearin in January.
Speaker 2 (49:29):
Wow.
Speaker 1 (49:30):
It's TraumaEducationEssentials.com.
So it's TraumaEdEssentials.comis the website.
Speaker 2 (49:38):
Okay.
Speaker 1 (49:40):
And you can go there. Check it out. Also, you can sign
up for the newsletter, which isfree, which is monthly written
by my daughter. It's usually gota good book review or a nice
article, sometimes practicaltips for therapy announcements,
and so on. So we have reallygood speakers.
In January is John Breyer forthree hours. He's, you know, one
(50:03):
of the handful top experts onPTSD and trauma and a very
engaging speaker, verypractical, easy to follow.
Speaker 2 (50:11):
That was really helpful. Thank you so much.
Speaker 1 (50:13):
No. You're welcome. Very nice talking to you. Thanks
for asking.
Speaker 2 (50:15):
Sure. Thank you for listening. Your support really
helps us feel less alone whilewe sort through all of this and
learn together.
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