Tamara Baker is a Licensed Marriage and Family therapist in California and Idaho. She specializes in complex trauma, dissociation, and couples and family therapy. Tamara spent five years (2004-2009) serving in the United States Navy where she traveled the Pacific Ocean and optained her Associates degree out at sea. Her undergraduate studies are in child and family development, which have proven beneficial in her work with complex trauma and dissociative amnesia. Tamara obtained a graduate degree in counseling psychology (2015) from National University, California. She integrates many modalities together to best meet her client’s where they are, including, but not limited to Art, Attachment Theory, Experiential, Existential, and trauma therapies. Tamara was trained in Eye Movement Desensitization and Reprocessing in 2015 but found Brainspotting in 2016 and has since never looked back! She began assisting in Brainspotting Phase One and Phase Two trainings for Lisa Larson, M.A., LMFT in California in 2017. She has since assisted Dr. Melanie Young, Psy.D., Dr. David Grand, PhD, and others in the training of hundreds of therapists who are seeking to become Brainspotting therapists. Tamara began the process of becoming a Brainspotting consultant in 2020 and over a year-long intensive training course, she is now helping other therapist strengthen and enhance their understanding and application of the Brainspotting theories and set ups. She enjoys the flexibility that the Brainspotting model allows for her to encourage them to integrate their personal strengths and backgrounds into their Brainspotting practice. Tamara currently has a private practice in Ketchum, Idaho, where she lives with her family and dog Odin.
Below is part of the transcript from episode 275, in which we answered an email about how to find a therapist:
Finding a new therapist is brutal. Brutal.
So for those who have not had this experience, let's literally just pause the emails for a minute and walk through this. Let me show you on our side of things as a client—as a survivor—what that's like. So knowing that I need someone who can help with trauma, and someone who can help with dissociative disorders, that's what I start my search with when I'm looking for a new therapist. And the easiest way these days, obviously, is to look online. You can look at the EMDRIA site. You can look at the ISSTD site. You could look at sensorimotor. You could find a particular modality if you really want something specific. Or you can just do a general search for trauma and dissociation therapy or something like that. Right? I don't usually search for DID therapist or dissociative identity disorder therapist, because it limits the results so much that it's you almost can't find anything because most people don't advertise that specifically. But they may advertise dissociative disorders or have that listed either on their Psychology Today profile—which again guys, those are not vetted at all, they're just uploaded by therapists, so you still have to be super careful—or they might have it listed on their website. Okay, so that's the first thing I search for.
And then when I find someone and I look at their profile or their website and it looks like not crazy and not creepy, because sometimes you pull up a profile or a website and there's like weird stuff in their office, or it looks creepy, or it's all dark, or you're just not comfortable for some reason. Like, for us, our agreement is to trust our intuition. So if something feels off just looking at the website or their profile, we definitely just skip that one. Because why go in person to feel something we can already feel just looking. So again, that may limit some of our choices, but it also protects us in a way of adding safety by paying attention to the signals we're getting. They may not be always accurate because there's not actually a lot of information to go by, but it's enough to pay attention. And as survivors, I feel like we're really in tune with that, if we will listen to it. So that's the next step.
And then out of the results that are left, it's a matter of matching, at least for us in America, it is matching insurance and availability. Like can you see me when I'm available to be seen, are you also available? And also can I actually afford to see you? Because therapy is expensive. And as a therapist, I also would like to get paid. And yes, there's so much paperwork that we have to do that is not within the 45 minutes or hour of our session time. And there are trainings we have to do and certifications we have to keep, plus paying for office or zoom or whatever. All of that overhead cost is legitimate. So I get it because I am a therapist, and I am trying to have an office and things like that. And all of those costs don't even count trying to feed my children or actually provide for my family. Like it's even just sustaining to keep the office open so that I can continue to be available for people. So I get that it's difficult. But also as a parent of six children with lots of medical needs, and eight people in our family, our budget is very, very tight, especially through the pandemic. One of our jobs was traveling for the refugee work and the war zones and the disaster sites. We can't do that during the pandemic. So that money is completely on hold, which was our primary income. And most of our clients don't pay us as much as they did before because also the pandemic has impacted them. But we still want to help. And so what do you do? It's a fine line of navigating all that, right. So the therapist’s job, though, is to negotiate the fees for their therapy services that they offer, according to what they are able to do. And then I have to offer what I can do and choose based on what I'm able to pay or not. And when that matches, it works out; when it doesn't match, it doesn't work out. And sometimes that's really hard.
Okay, so when it looks like there's a match for fees based on their profile or their website, and it's someone that I maybe could budget in, and they also see trauma and dissociation, then it's a matter of contacting them to see if they're actually available. The challenge at this stage of things is that the therapists who are really good, are usually really full. And so they have a waitlist, or it's difficult to schedule with them, and that can be really daunting. Especially if you feel like you're in a bit of a crisis and someone can't see you fairly quickly. It's really difficult. So let me read you some of the emails we have actually gotten back from people and why we chose to see them or did not choose to see them.
Okay, so my first example was a lady we contacted. And I'm not going to say any names. And it doesn't give you away because we had to see in the last year therapist in like a four state area, okay. And because of telehealth, that could be anywhere in those states. So I don't think I'm disclosing anything inappropriate. But let me share what that experience is like. So to be clear, for me because I am deaf with cochlear implants, when I contact a new therapists I have to do it over email. I cannot just call the office and them call me back. Like you can't play phone tag with a deaf phone. That's not how it works. I can call out with some special equipment, but it's very difficult and I usually have to have the husband with me. And so I don't do that very often. Although it's something I'm trying to practice a little bit, but it's very difficult. So for something like this, especially because I'm also extra anxious, I do it by email. Because you're doing it by email, and you're not actually signed up into someone's like secure portal or whatever yet, you don't want to give lots of information that is private. Like don't send them your insurance card over email. Don't tell them your birthday or social security card number over email. Does that make sense? But you can say, “Hey, this is me. I'm looking for a therapist on these issues, like trauma and dissociation. And I'm available on these days. Do you have any openings? Do you think you we might be a good fit?” Something like that. And then usually what happens, either they email you back, or they send you a link to their portal so that you can talk to them privately. Or you can set up a time to actually have a free phone consult where you can sort of talk on the phone and see if you feel like a fit and make an appointment. So there's several different things that can happen next, but generally, that's how it goes.
So let me share with you some of the emails. One email that I got back last year was from someone who said: I received your email. I would be happy to discuss with you my services. Are you available at such and such a time. I do work with trauma and dissociative disorders, and I'm also a nurse. So I have special interest in working with medical trauma. I have availability at the following times if you would like to schedule an appointment. Now, you guys, that was like an ideal email. And of course, I snatched her up. And I wanted to see her because she understood medical trauma. So I thought that would be helpful for Em dealing with our daughter and her medical needs. There were things that are difficult to explain to people that maybe she would understand right away. And so we connected with her. But then it turned out that she could not take our insurance and so we did not get to see her.
Another email that we got back from someone last year was really good example as well, said: Thank you for your email. I do take your insurance, and I also help with trauma. Unfortunately, my waitlist is until late March or early April. If you don't mind waiting that long you can call our office at this number and schedule an appointment and also get on our waitlist. I also work with families if that would be helpful to you. Let me know which direction you want to go. So she was very clear about when she was available, whether she took my insurance or not, and how she could help. This is the woman that actually ended up being our family therapist where we used to all go, all eight of us for the children, and just hang out there for two hours rotating everybody through. And she was amazing. And so one thing that was also helpful as she responded so quickly, and she was available by email, which I really need as a deaf person. I do not abuse that privilege. I do not send crisis messages to the therapist. So that one worked out, but for the children, not for us.
As the year progressed last year and the pandemic started, I also needed to find someone who specifically would do telehealth because I was not able to go into the office. And where I live, not everyone took it seriously in the beginning. And so some people were not available on telehealth. So since that was something I needed, that was something to ask upfront. So a good example of this response from a therapist that we actually saw until we moved was: Hi. Thank you for touching base. I do currently have a few openings. Let me know what days and times work for you. I do take your insurance, no problem there. I will be supportive of you in your healing journey and however you integrate your beliefs and family into that just let me know as we go. At this point, I'm doing exclusively telemedicine, I'm considering doing that long term, or with some in office after the pandemic. You can email me here and you can text my phone number at this number. So she was very clear about what is okay and what is not okay with her, her availability, and what she can help with or not. And I asked, I followed up with some more detail questions, and at that point moved to the portal so that I could ask more specific questions privately. And this person we saw most of the beginning of the summer until we moved. So this one really worked out and we only didn't get to stay with her because we had to move.
So those are some good examples. Let me give you some not so good examples. This person emailed back and said: Good afternoon. I do offer telehealth, but please call the clinic to schedule an appointment. They do all of that for me. Thank you for reaching out. So when at that point, I realized that this person was actually in a larger practice or some sort of community building, which I already know is too overwhelming for me. So I didn't even reply to that person. If they could not help me get an appointment scheduled and get me into the building the first time, they are not someone who can help me with some of our issues.
Another person wrote: Thank you for thinking of me. Unfortunately, I have a full caseload right now and do not have room for another client at this time. I know the agency I'm contracted with has several really good trauma therapist, and they maybe could help you. And then ask for so and so, she's great. I think she may have a staff meeting on the day you want. But she could call you back if you wanted. So this person was polite, but totally couldn't help. And if they're a contractor, like they revealed so much about their office dynamics, I just didn't, that was not going to work.
Another one wrote: Thanks for reaching out. What problems are you experiencing? But that's all that they said. No way to contact them, no way to talk to them privately, and no follow up as far as if they're available to help with some of that. And so that person we did not see.
Another one said: I use a sliding scale and I do help telehealth, but I'm not contracted for your insurance. I can only bill for children. You could try and then she gave me the number of a community mental health agency, which I appreciate. But again, that was not the setting that was going to work for us. We had already tried that and it was like a walking panic attack just to get into the therapists office. Which is really sad because the therapist was amazing.
After we moved, a therapist wrote: I am happy to schedule a mental health telesession with you. Are there certain days or times a day that are more open for you? The way we will get started is I will send you an invitation to join our client portal. After joining a client portal, you will find some intake paperwork and a questionnaire. That's also how we do billing. I am happy to answer any more questions you may have on the client portal to protect your privacy. Feel free to reply to this email or use the contact information below, but I will watch for you on the portal. I look forward to hearing from you soon. So this person actually that was an amazing response. It totally worked out. That's who we saw after we moved here until they change portal sites and we somehow got lost in the middle. Their email changed, and their portal site changed, and we just sort of didn't hear back from them. So that was a little bit traumatic because we really liked her.
Someone else wrote to us: Thank you for your email, I understand that you're looking for an appointment. I'm available for ongoing and consistent support. I do cognitive behavioral with trauma informed in parentheses if that is what you want. That is not what I want you guys, and so I did not reply to them.
Here's another email from a therapist who did equine therapy. And she was here after we moved. And so we contacted her to try to set the children up with her. And she sent us the link to the portal that worked really well. We filled out all of the paperwork, which takes ages for children's Medicaid, and six of them at that. And so I spent hours and hours and hours, like an entire day, filling out all the paperwork. I got everything signed, I emailed her back PDFs of that, and gave her list of our availability which she had asked for. And then we never heard from her again. And it was so frustrating because we spent hours filling out that paperwork and never heard from her. I still don't know what happened. Like I don't know if she got COVID, or if our paperwork was just lost, or she didn't want to see us after she saw the issues that children had. I don't know, but we never heard from her. So that's another example.
Here's another one that was really good. This one said: I just got your email, and wanting to send you an invite to my patient portal. You can have a free session so we can get to know each other a little bit and see if we're a fit. I'm also going to send you an invitation for Spruce, which is an app that we can text securely on so that your information is protected, but you can still get ahold of me if you need to, or just share what's going on. Sometimes that's important with trauma clients. We can do video sessions. And we can talk about scheduling sessions during the day. I absolutely have availability during the times you mentioned. And I can meet with you more than once weekly if that would be helpful. And then she gave me a list of her schedule of open times. And you, your choices for payment are these and she gave different ways that we could pay her securely and said, Here's an appointment. You don't have to pay for the first appointment so that we can get to know one another. And this is actually our therapists that we really appreciated this spring who passed away from COVID. She really had things set up in a secure way and we felt safe with her. So then we had to do it all again. When our therapist died from COVID, we had to go through this all again.
So one person wrote back: I'm taking new clients now, yes. We can do in person or telehealth. I can help you with trauma. It's actually something I really enjoy helping people through. My sessions are $250 out of pocket. Let me know when you want to meet. Yeah, you guys. That didn't happen. I don't have $250 a pop.
So the next one wrote back and said: I can help with trauma, and here are some of the trainings I've done and experiences I have that shows I'm able to do so. Which I actually really appreciated. However, I get several requests for telehealth, so I'm thinking I will move those to their own day. Do you want to do this day only at this time? So then she talked about her schedule, and we set an appointment, and that was fine. But then she emailed back and had to move things because she decided to move of her telehealth people to one day. And then she emailed again because she had to cancel for something else she was doing. Like, she was just too busy. So that one didn't work out.
There were other emails we've gotten that literally said: I can help with your issues. But I don't have time right now. Like, if you can’t squeeze me in for an hour, there's no way that you can squeeze me into your head space. You know what I mean? Like, if they don't have time to just schedule something, then they certainly don't have time to actually like hold space and presence with us. When DID is such a long term and intense experience, which I already feel guilty for. Like I'm going into therapy, feeling bad for what I'm going to have to put this person through just for me to get better. Like it feels so yucky and abusive, even if that's all not like entirely accurate thinking. Or even if the therapist can explain how it's done from their side of things. Which technically I understand, because I get in that role too for work, right. So it's really tricky.
The therapist we have now that we have been able to see five times in a row, we went ahead and set up with her because she gave us lots of availability times. She was careful about our confidentiality. She demonstrated that she understood about trauma and dissociation without being overly intrusive before we were ready to go there. And because she was available on telehealth and had a sliding scale that we could do within the budget of our family, even though we don't actually even have that money. Like it's really, really hard, right. But we can work extra and just do our best because being tired and worn out is somehow better than not making it. Right, so.
So we accepted an appointment with that therapist, and then going to the first session, and feeling how she talked about things, the respectful language that she used, this safety that she created in the rapport between us, even though clearly we have some serious therapy issues. And her capacity to sort of get some of that information out of us in a general way without being pushy, is what got us back for this second appointment.
The second appointment we're just going to call a wash, because we basically cried the whole time, because our other therapist was dead, and the therapist before that is just like a hole in our heart, right. And so there is that just pain. But it was coming out and it was coming out in a safe place. And it was coming out in a way that we were not alone. And so that is why we showed up for the third appointment.
The third appointment, she gave us some new resources, which we'll talk about on the podcast later. But some books we hadn't even heard of, although you probably have heard of them, but we hadn't heard of them. And gave us some homework to get these books and to read some specific things to talk about how they apply to us. And that is when we started learning and giving that framework of a way to ease back into therapy through a safe context, as opposed to jumping back into trying to establish a relationship with a therapist. Because right now that's where our wound is. And so that's not happening. There is no parade of altars. There no little showing up in therapy, even if it's to distract things. Like they are not coming. They are not participating. They are not going there. And we won't let them. Like, that it hurts too much. But having this framework of let's talk about dissociation, and let's talk about trauma through these books, and in a very safe window of tolerance kind of way, gave us a way to at least engage with the process and to attempt to hold on in a way that at least put some footing under our feet a little bit again. And that's why we showed up for the fourth appointment.
At the fourth appointment, she had all kinds of stuff ready that reminded us of things that we learned from like Christine Forner about the brain, and some of the things we've learned through the ISSTD courses over the last year. And so that was familiar enough that it built somehow on this safety through the books and that framework. It added a layer of familiarity, which helped us bring down those walls just a little bit. Not enough to engage, not enough to give any pieces away. And we spent the whole time crying again. So it was embarrassing. But she used some art, we did some art together. And she used some of the reading to help us put into words what was going on and noticing patterns of what was triggering these big responses that would get us so tangled with our friends, or so tangled from what happened in therapy before. And that at least was like a balm on the wound, even though it's so raw and vulnerable. And so that was huge. And that's what got us back to the fifth session.
And then in the fifth session, we somehow through conversations stumbled upon both of us knowing—like Bible knowing—I don't mean the actual Bible. But I mean, like our other Bible is the Wolves book, the Women Who Run With the Wolves. And she is the first person that we have ever met, who not only also knew the book, but like knew knew the book. Like we could quote something or reference something to try to express what we were feeling. And she got it. And you guys for whatever reason, that nailed it. Like it was out of the ballpark. It is the first time that we felt safe and comfortable and expressive in therapy in over a year, almost two years. It was so good. And it was so helpful. And she gave so much homework, which we're not thrilled about. But all of this we'll be talking about in other episodes to share what we're learning and how things are progressing. But yes, finally, things are going very well.
So I'm sorry to go off on all that tangent, but I'm saying I get it and finding a new therapist is exhausting. But also, when you find that therapist that knows how to help you and is accessible, and is available, and is respectful of your experience, and builds safety in that way. You guys, you've got to do everything on your end to do that work. To honor that opportunity. It is such a privilege space. It is such a sacred space. And there is hope there again in a way there hasn't been in a long time.
Our guest this week is Dr. Lou Himes.
Dr. Lou Himes is a licensed clinical psychologist and gender specialist in New York.
They identify as gender non-binary and use they/them/theirs pronouns.
Lou maintains a strong commitment to social justice and aspires to play an active role in eliminating mental health disparities for members of queer communities. Lou has more than 10 years experience working with the LGBTQIA+ community. They are a WPATH (World Professional Association for Transgender Health) certified specialist in mental health and provides consultation regarding the current WPATH Standards of Care (7) guidelines for the appropriate treatment of transgender individuals.
In addition to their work in full time private practice, Lou also offers a variety of educational opportunities for organizations or individual practitioners seeking to provide competent care to queer individuals. This includes basic practices for helping queer and transgender individuals feel safe and welcomed into one’s office, holy space, community, and/or business.
You can see their website HERE.
Our guest this week is Dr. Heather Hall:
Dr. Hall is a board-certified adult psychiatrist. She has over thirty years of experience. She combines her expertise in psychopharmacology and psychotherapy in developing a treatment plan tailored to the needs of each individual.
Before establishing her private practice, Dr. Hall was an associate clinical professor of psychiatry at UCSF and UC Davis.
She is currently on the board of directors of the International Society for the Study of Trauma and Dissociation and specializes in treating complex trauma.
Dr. Hall is a graduate of Smith College in Northampton, MA. She completed her medical training at Drexel University in Philadelphia, PA, and her psychiatric training at The Institute of Pennsylvania hospital, also in Philadelphia.
This week we welcomed Veronique to the podcast, who shared with us about trauma and chronic illness.
Veronique majored in cross-cultural studies & premed for a BA at Antioch college in Yellow Springs, Ohio, where the focus was also on experiential learning. She then found a medical school with a similar emphasis on learning by doing, McMaster University in Hamilton, Ontario, Canada, whose mission is “to create life-long learners.” This style of learning has served her greatly in the exploration of her health and looking into factors that may have contributed to, and continue to perpetuate, her fatigue.
She attended the University of New Mexico for her Family Practice Residency, having spent her early years in Santa Fe, as it has a medical student program, and philosophy, like McMaster’s. After completing her medical training, she traveled the country doing short stints as a temp doc (locum tenens). She tested out different environments such as private, independent outpatient practices in Michigan and Rhode-Island, hospital-based clinics in Maine, the Indian Health Service in North Dakota, and an isolated clinic in the Outer Banks of North Carolina.
She then settled down as full-time faculty in a small, community-based residency training program that was just getting started, in Concord, New Hampshire, where she delivered babies, taught residents and medical students, bought her first house, and made good friends.
In 1998, she took a year off and realized that she could become more like one of her role models, Rachel Naomi Remen, MD, who works with the relationship between mind and body. She went back to school to become a somatic psychotherapist. What she learned helped make sense of her own symptoms. She got a Master’s degree at Naropa University and did specialty training in working with trauma, bonding and attachment.
Her research has taken the form of scouring the medical databases for over twenty years. She has put together new ways of making sense of chronic illness; and finding commonalities between chronic illnesses (chronic fatigue syndrome ME/CFS, MS, diabetes (both type 1 and 2), RA, Inflammatory bowel disease, Lupus, and asthma, among others). She has also been using herself as a case study, examining and working with her symptoms and their relationships to past and present life events, and she shares these throughout her blog to validate just how much is changing in our understanding of disease and tools for healing.
1986 BA Cross Cultural Studies & Pre Med – Antioch College – “learning by doing”
1990 MD – McMaster University Medical School, Ontario, Canada – “how to be lifelong learners”
1993 Family Physician – University of New Mexico in Albuquerque Family Practice Residency
1993-1995 Family Physician Locum Tenens (short term clinical work around the USA)
1995-1998 Assistant Professor – New Hampshire Dartmouth Family Practice Residency Program, teaching; obstetrics and full spectrum care;
2003 MA Somatic Psychology / Body-Based Psychotherapy – Naropa University in Boulder, CO – working with the wisdom & language of the body and symptoms
2000 to present: Nervous System Specialist using Somatic & Trauma Therapies
2001 Training – Sensorimotor Psychotherapy (Trauma)
2006+ Training – Somatic Experiencing Practitioner (Trauma)
2006+ Training – Prenatal and Perinatal Professional Training (Early Trauma)
Master’s Thesis: Mead, V. P. (2003). Somatic psychology theory and the origins of chronic illness: a case study of type 1 diabetes. Somatic Psychology. Boulder (CO), Naropa University: 427 p.
Journal Article: Mead, V. P. (2004). “A new model for understanding the role of environmental factors in the origins of chronic illness: a case study of type 1 diabetes mellitus.” Med Hypotheses 63(6): 1035-1046.
Book Chapter: Mead, V. P. (2007). Timing, Bonding, and Trauma: Applications from experience-dependent maturation and traumatic stress provide insights for understanding environmental origins of disease. Advances in Psychology Research. A. M. Columbus, Nova Science Publishers. 49: 1-80. (downloadable from bottom of free ebooks page)
Special links referenced in the podcast included:
ACEs and chronic illness
https://chronicillnesstraumastudies.com/adverse-childhood-experiences-and-chronic-illness-boyhood/
Her own story and journey with chronic illness from trauma perspectives
https://chronicillnesstraumastudies.com/how-understanding-trauma-is-making-sense-of-my-chronic-illness-and-helping-me-heal/
A list of somatic trauma therapies she recommends for healing trauma and nervous system perceptions of threat
https://chronicillnesstraumastudies.com/chronic-illness-recovery-books-on-trauma/
A list of books on trauma and chronic illness and related perspectives
https://chronicillnesstraumastudies.com/therapies-chronic-illness-stress-triggers-perception-threat/
Her blog is HERE.
Our guest this week is Ken Benau, PhD.
Ken Benau, Ph.D. has been a licensed psychologist for 30 years, with an independent practice in psychotherapy, consulting and training, currently in Kensington, CA (SF Bay Area). Dr. Benau has a special interest in working with children, adolescents and adults living with various learning differences, ADHD and High Functioning Autism, as well as depression and anxiety. Dr. Benau also works with survivors of relational or developmental trauma, all from an integrative approach to psychotherapy. His theoretical orientations include attachment and emotion-focused, psychodynamic, experiential, somatic and Coherence Therapy. Dr. Benau has a special interest in understanding and working with shame and pride in survivors of relational trauma, and has written several articles and is currently working on a book with that theme.
His website is HERE.
Our guest this podcast is Fran Waters, DCSW, LMSW, LMFT.
Fran S. Waters, DCSW, LMSW, LMFT, is an internationally recognized trainer and consultant in the field of childhood trauma, abuse, and dissociation. As an invited presenter, she has conducted extensive training programs nationally and internationally ranging from a day to 5 days in Europe, Africa, Australia, South America, and North America on a variety of related topics.
She is the author of Healing the Fractured Child: Diagnosing and Treating Youth with Dissociation, and past
president of the International Society for the Study of Dissociation (ISSTD). She is a Fellow of the ISSTD, and received ISSTD's Presidential Award and Cornelia Wilbert Award, the Media Award from American Professional Society on Abuse of Children for her 3 Part DVD on Trauma and Dissociation of Children, and the William Friedrich Memorial Child Sexual Abuse Research, Assessment and/or Treatment Award from Institute on Violence, Abuse and Trauma. She maintains a private practice in Marquette, MI.
You can visit her website for more information HERE.
Our guest this week was Richard Schwartz, PhD, who developed the Internal Family Systems (IFS) model of treatment for trauma and other therapeutic issues:
Richard Schwartz began his career as a systemic family therapist and an academic. Grounded in systems thinking, Dr. Schwartz developed Internal Family Systems (IFS) in response to clients’ descriptions of various parts within themselves. He focused on the relationships among these parts and noticed that there were systemic patterns to the way they were organized across clients. He also found that when the clients’ parts felt safe and were allowed to relax, the clients would experience spontaneously the qualities of confidence, openness, and compassion that Dr. Schwartz came to call the Self. He found that when in that state of Self, clients would know how to heal their parts.
A featured speaker for national professional organizations, Dr. Schwartz has published many books and over fifty articles about IFS. You can read more about him and about IFS on his website HERE.
On the podcast today, we shared about a disaster with the family therapist, where we froze up at simple questions and couldn’t speak or respond… but so much was happening so fast inside.
We said we were able to draw about it later, and wanted to share it so that clinicians could see what the experience is like for survivors, and so that other survivors would understand they are not alone in the experience.
This is raw and vulnerable, and somewhat triggering material, so please care for yourself, as always, before and during and after looking and listening to the podcast.
In the “Fish Tank” episode, the Husband shared about his experience with EMDR. He talked about having headphones he listens to, and small paddles or “dongles” that he holds one of in each hand. He said that he hears beeps and feels vibrations on alternating sides as part of the experience. He talked about the family therapist having a box where she could adjust the speed or other settings of those beeps and vibrations as needed.
In response to this episode, a friend shared a picture of one kind of these devices, though there are different kinds and different ways of doing EMDR with the different tools. This is just one example, and very similar to what the husband was describing.
While he found it particularly useful for his depression, the device itself may be triggering to some survivors of certain kinds of organized or ritual abuse. Some clinicians use a light bar of colored lights instead of this kind of device, which may be triggering to survivors of pornography or traffficking type settings. In addition, EMDR does not help everyone with everything, and we have been told by many survivors and clinicians alike that timing and containment of some sort is critical to a positive experience with EMDR.
That said, many survivors who have used EMDR in safe ways with good clinicians when they are ready for it as an intervention, describe very positive experiences and good results.
This podcast episode was not about EMDR or when to use it or who should or not, but simply about the husband’s experience of it while being treated for depression. The picture is provided simply for those who wanted to see to be able to understand what he was talking about with the “dongles”.
You can listen to other episodes about EMDR specifically to learn more about it, or check out their website HERE.
Pam Stavropoulos, PhD
We welcome Pam Stavropoulos, PhD (Politics), Grad. Dip. Psychotherapy to the podcast to share about her research work with complex trauma at Blue Knot Foundation.
Specifically, she shares with us about the recently released 2019 updated Practice Guidelines for the Treatment of Complex Trauma, which you can read HERE. It is available for download for free, with permission to share.
In the podcast, she shares about the research behind the updated guidelines, and also mentions therapist compentancies, which you can read HERE.
A list of selected publications can be viewed HERE.
Dr. Chefetz is a psychiatrist in private practice in Washington, D.C.
He was President of the International Society for the Study of Trauma and Dissociation (ISSTD) from 2002-2003, and is a Distinguished Visiting Lecturer at the William Alanson White Institute of Psychiatry, Psychoanalysis, and Psychology. He is a faculty member at the Washington School of Psychiatry, the Institute of Contemporary Psychotherapy & Psychoanalysis, and the Washington Baltimore Center for Psychoanalysis. . He is a Certified Consultant at the American Society of Clinical Hypnosis and is trained in Level I and II EMDR.
Dr. Chefetz was editor of “Dissociative Disorders: An Expanding Window into the Psychobiology of Mind” for the Psychiatric Clinics of North America, March 2006, “Neuroscientific and Therapeutic Advances in Dissociative Disorders,” Psychiatric Annals, August 2005, and “Multimodal Treatment of Complex Dissociative Disorders,” Psychoanalytic Inquiry, 20:2, 2000, as well as numerous journal articles on psychodynamic and psychoanalytic perspectives on trauma and dissociation. In 2015 he published Intensive Psychotherapy for Persistent Dissociative Process: The Fear of Feeling Real, with W.W. Norton, in their Interpersonal Neurobiology series.
His website is HERE.
This week on the podcast, we discussed an article published by Sarah Clark of the Stronghold System on their website, PowerToThePlurals.com, and shared in her facebook support group AlterNation.
Their article discusses the Theory of Structural Dissociation.
In the article, they consider it to almost be a theory of structural integration instead, and call the theory out for being ableist due to it emphasis on functioning through one ANP in therapy rather than whoever presents, and because of the emphasis on integration as the only treatment option. As they said in the podcast interview, the theory of structural dissociation is being used to push integration as the only option “because it sets up the idea we were never “split off” in the first place, so it’s easier to integrate us back to together again”. Here’s the quote from their article that they reference in the podcast:
We read in the same book (page 7) ‘’Structural dissociation involves hindrance or breakdown of a natural progression toward integration of psychobiological systems of the personality that have been described as discrete behavioral states.’’ (Putnam, 1997).
This is what most people refer to when explaining that we are not broken, not split off. We are all born with different states and early childhood trauma survivors can’t integrate in early childhood due to that trauma. But as you can see it was actually Putnam in 1997 who introduced this idea.
They also say that the authors of the theory appropriated or borrowed terms from other authors who used them much earlier. Here’s a quote from their article:
Charles Samual Myers, who in 1916 wrote about Apparently Normal Part (ANP) and Emotional Part (EP) after acute trauma in WW1. So it is fair to say that the theory of Structural dissociation borrowed these terms, not introduced them, as is readable in the haunted self. (page 4)
Drawing conclusions from this, they clarify that you can accept parts of the theory from the original authors, rather than crediting this theory for your understanding.
They go on to say that the Theory of Structural Dissociation is a model about trauma, not a model about dissociation. Here’s the quote from the article:
It is also good to realize that the theory of Structural dissociation is neither about DID, nor is it about alters, as many of us Plurals know them. They speak of ‘dissociative parts of the personality’, caused by trauma. Nota bene, not early childhood trauma, trauma in general. As this theory also explains single trauma, repeated trauma in adulthood and (early) childhood trauma. It is used to describe changes that are diagnosed as (c)PTSD, trauma related borderline personality disorder, DID and more.
This, along with their perspective that because of DSM5 criteria, DID does not actually have to be a “disorder” if the person’s System is not distressed by it and functioning well. From this, they issue a call to the community to refer to themselves as “Plural” culturally, rather than DID therapeutically. They also are calling for “Functional Multiplicty” to be an option in treatment, rather than integration pushed as the goal.
This, they say, is more effective for positive cooperation amongst a system and healthy functioning as a system, with greater participation in therapy than what the Theory of Structural Dissociation offers. They say:
The theory of Structural dissociation idolizes integration. And although they say that ‘’no one has to go away’’, they also clearly explain to therapists, to not engage with us ‘dissociative parts of the personality,’ unless absolutely needed. Instead it is suggested that the therapist speaks whenever possible, through the ANP fronting…
… And in DID, in particular, requiring all communications to relay through one particular (perhaps malleable or favored) ‘alter’ that sounds a lot like silencing to me. Because the therapist (or any other outside person,) can never know (for sure) whether the part who is presenting, is truly conveying all information which is coming from inside. This book talks a lot about shame, but forgets that our ANPs might not feel comfortable repeating what those EPs just said inside, and that the information may be so overwhelming for them as to cause them to have intense dissociative symptoms.
You can see in the article that they use a picture of a slide from a presentation by Kathy Steele to show that the Theory of Structural Dissociation is being taught to only talk to one ANP and focus on integration in that way.
Following this perspective and logic, they conclude in their article, that the Theory of Structural Dissociation is ableist:
We know from a 6 year follow up study that only 12.8% of participants were able to reach integration as described in the theory of Structural dissociation. (page 4 )
That is a very low percentage. In any scientific research for medicine or therapy for example, a 12.8% positive outcome would not be tolerable. Yet the whole theory of treatment within Structural dissociation is based on it.
A chronic disorder, often debilitating, with a much-respected and idolized healing option with only 12.8% success rate, sounds ableist to me.
A 12% success rate is definitely a call for improved access to and quality in treatment, absolutely, and worth talking about - that’s why we shared it on the podcast.
That said, I don’t know how someone would pin-point integration on a timeline, when to us it feels more like a process than an event (Dr. Siegel said this on our podcast!) - so that 12% seems interesting to qualify with things like how they defined integration and what kind of follow-up support they received and who continued maintenance therapy or not and what kind of life stressors they had and those kinds of questions.
However, there is more to this piece we need to look at to see everything. This study mentioned is one of Bethany Brand’s from Top DD Studies, and I interviewed her earlier for the podcast last summer - unfortunately, it was one of the lost episodes because of technology glitches. But what I know from this study is that it does give a 12% success rate for integration, but it also mentions ANOTHER 12% who are “successful” without integration in a final-fusion kind of way. Further, the study also emphasizes other ways success can be measured and were noticed in the study, including: reduced hospitalizations, reduced suicide attempts, and improved GAF (global assessment of functioning) scores. These are significant and worth mentioning.
But, following this discussion on the podcast, Dr. Peter Barach reached out to us (as a friend and colleague, not in any clinical role) in response with more information. He also clarified that:
I think she has some incorrect ideas about what is generally recommended these days as treatment for DID. I think if you take a look at the ISSTD treatment guidelines, you won’t find what she says to be there. The term “integration” refers to “better integrated functioning ,” not to “fusion” of all the alters I to one.
Kluft argues that fusion leads to the most stable outcome of treatment—that’s his opinion, but the only data on that point comes from a series of people he treated himself. Fusion doesn’t always happen, and it’s also clear that some people with DID don’t want it.
He also shared further insights that we shared in the episode “Clinical Response” in the episode following the interview with the Stronghold System. Here is some of what he clarified in response:
Charles Myers wrote a book (1940) describing veterans of World War I in France who had shell shock, which of course is now called PTSD. He said that there are "emotional" personalities, referring to behavior during flashbacks and trauma-related nightmares, and "apparently normal" personalities who are detached from the experiences of reliving trauma.
I think he used the term "personality" in a much looser sense than we think of parts or alters, whatever word we use, in DID. He was not talking about survivors of childhood trauma.
Myers was not talking about parts or alters with different names and ages. An example of this is a veteran with PTSD working as an auto mechanic who hits the ground when there is a loud noise at work, such as a tire popping suddenly off its rim. This is an automatic response without thinking or planning, and leaves the veteran feeling embarrassed.
Here Dr. Barach clarifies that Myers was not talking about DID, but about a PTSD kind of response. In a plural system, the ANP and EP are distinct personalities as in parts or alters, as in distinguished by identity (age, gender, name, etc.), whereas what Myers was referring to was functioning - the veteran being able to function in a work setting upon returning from war (ANP), but having a limbic response triggered (EP). When Van der Hart uses the terms ANP and EP, he is applying them in an extended way to explain the continuum of dissociation.
Further, Dr. Barach points out that Van der Hart does give Myers credit when using the ANP and EP terminology, so it is neither appropriated or used without acknowledging the source.
Van der Hart always mentions Myers when he uses those terms ANP and EP, so I disagree that he and his coauthors have appropriated or stolen these labels. Van der Hart is also clear that the structural theory of dissociation is talking about ANPs and EPs that are more elaborated than the ANP and EP ideas of Myers.
He then explains this here, using quotes from both Myers and Van der Hart:
Here's what Myers wrote:
"“Now and again there occur alterations of the 'emotional' and the 'apparently normal' personalities, the return of the former often heralded by severe headache, dizziness or by a hysterical convulsion. On its return, the 'apparently normal' personality may recall, as in a dream, the distressing experiences revived during the temporary intrusion of the 'emotional' personality.”
Here's an excerpt from a 2010 article by van der Hart and others:"the EP range in forms from reexperiencing unintegrated (aspects of) trauma in cases of acute and posttraumatic stress disorder (PTSD), to traumatized dissociative parts of the personality in dissociative identity disorder (DID; APA, 1994)."
Dr. Barach then concludes that it’s not accurate to say that Myers was talking about the same thing as DID when he wrote about ANP’s and EP’s, even though that was the original source of the terminology.
He also explained that he wouldn’t consider the OSDD diagnosis as something being used to “step-down” a DID diagnosis, but rather it being related to how the system itself is presenting within the context of what they are dealing with at any given time. He said:
The DSM is a bunch of cubbyholes with labels on them, but the disorders aren't "real" in the same way that a flower or ice cream is real. The DSM is a system of categories. That's all it is.
How things end up in one category or another is a matter of psychiatric politics. For example, PTSD used to be classified as an anxiety disorder. But now it's in the trauma disorder category.
… Well over 95% of people with DID report a history of extensive childhood trauma; there are even some studies confirming the trauma histories of groups of people with DID. But DID is not in the trauma disorders category. It's in the dissociative disorders category. Go figure.
Also the whole issue of OSDD versus DID to me exists only because some psychiatric folks wanted two categories! There are people diagnosed with OSDD whose inner parts never "front," and who don't lose time, unless there is heavy stress. So if I evaluate them on a low stress day, the diagnosis might be OSDD, but an evaluation on a higher stress period of life might lead to a diagnosis of DID.
In regards to whether someone can have DID but it not be a “disorder”, Dr. Barach clarifies that:
“every diagnosis in the DSM requires either "clinically significant distress" or "functional impairment."
So, if one were going for “functional multiplicity”, then that functioning needs to include being able to work, manage relationships, and other ways of functioning. He said:
If someone had parts, wasn't distressed by having them, but wasn't functioning well in relationships or work because of the parts fighting for control or switching a lot, that would count as a disorder.
This put into words what we were trying to explain in the podcast in the follow-up episode, about how (for us) functional multiplicity becomes a natural part of the healing process as internal cooperation and collaboration improves.
In that way, for us, functional multiplicity is a part of the process rather than an end goal alternative to the end of treatment. We - only speaking for our system - are not far enough in treatment to know, experience, or be able to speak of anything else or what we will choose at the end of treatment or understand what that will look like.
However, we understand from our own experience of searching for a good therapist for over a decade, that there is a critical time period where plural systems - especially those in areas without access to treatment - are, indeed, functioning for years and years as multiples (or “Plural”). Even if you are able to find a good therapist, and begin treatment, therapy takes years and years. It makes sense that Functional Multiplicity would be a fantastic goal during this time, regardless of what the “end of treatment” looks like, we think. This is a quality of life issue, in those years after the trauma that caused the multiplicity (or “plurality”), the decades of waiting for help and access to treatment, and the years and years of treatment itself.
In regards to whether DID requires a trauma history, Dr. Barach went on to say that:
She said that there are people who have DID without a trauma history. Well, maybe so, but that is actually an empirical question--and where's the data? There are a number of published case series showing an extremely high rate of childhood trauma (like 95% or more) reported by people in clinical settings who have DID. There are also some people who believe they have DID, but actually they don't--they have just assigned names to aspects of themselves.
We would add that there may be Plural systems who deny trauma as part of the dissociative process, who just do not know yet about their own trauma.
That said, there are people who identify as “Plural” who report no trauma history, who say they have no disorder because they are not distressed by it and functioning just fine.
This is an important cultural development clinicians need to know about, whether they agree with it or not, just for cultural competency, that there are people in the “Plural Community” who do not consider themselves to have DID.
That said, if these people are functioning just fine and not distressed about being Plural, then they would not be seeking treatment for DID - which is likely why clinicians are less familiar with this (more recent) cultural population.
Finally, Dr. Barach responded to one last point:
Although the proponents of the structural theory may say that treatment should take place through the ANP, that treatment idea does NOT necessarily follow from the theory. And while the structural dissociation folks may be teaching therapists to work directly only with an ANP, that is not what a lot of other experienced teachers in the dissociation field are teaching (including me). I well remember Richard Kluft saying very clearly that you cannot treat someone with DID unless you are working with the "alters" (to use his preferred term).
In fact, when I reached out to Kathy Steele herself, to clarify what she was teaching from the slide used in the Stronghold System’s article, she was very responsive.
I try to work with the "adult self" to the degree possible, but do work with parts. I have a sequence of decisions on when you can work through the adult, when to work with a group of parts together and when to work with a single one, and then I work my way back up the ladder. I have never said I only work with the adult part or only ANPs.
We can say that we saw Kathy Steele present in Kansas City, in which the same slide used in the Stronghold System article was also displayed. But throughout the presentation, she did give many examples of how to work with different kinds of parts. So we followed up on this, and not only did she clarify further, but she also was eager to adapt her language so that would be more clear in the future what she meant::
I do emphasize that an "adult" needs to be active in therapy, which is maybe where the confusion comes in. By this, I do not mean any one part, but rather am focused on capacities necessary for successful therapy: the ability to contain behaviors, the ability to reflect, the ability to cooperate on mutually shared therapeutic goals. And in early therapy I always focus on helping the client as a whole to find those capacities and use them. I don't think any diagnosis - no matter which one - precludes these, and these capacities are either explicit or implicit in every single therapeutic approach.
I will think about maybe not using the term "adult" for these capacities to avoid further confusion.
This is why we do the podcast, for this kind of exploring and these kinds of conversations.
Working to understand the article on Power to the Plurals is important for understanding the client experience and cultural implications, while advocating for improved care and quality of treatment.
Working to understand the clinical response helps us to engage in treatment as we understand what is going on and why we are doing the things we are doing, and to better educate other clinicians and those still waiting for access to treatment.
This is empowering to us all, and a beautiful thing when we work together, even good practice at attunement and being receptive and attending to one another. Well done, everyone!
Kathy Steele, MN, CS has been in private practice in Atlanta, Georgia since 1985, and is an Adjunct Faculty at Emory University. Kathy is a Fellow and a past President of the International Society for the Study of Trauma and Dissociation (ISSTD), and is the recipient of a number of awards for her clinical and published works, including the 2010 Lifetime Achievement Award from ISSTD. She has authored numerous publications in the field of trauma and dissociation, including three books, and frequently lectures internationally on topics related to trauma, dissociation, attachment, and therapeutic resistance and impasses.
CLICK HERE for a link to the workbook mentioned in the podcast!
Christine Forner (Ba, Bsw, Msw, Rsw) has been in the healing profession in one form or another since the age of 16, when she worked on a crisis line for teens. Christine spent the first part of her career in the front lines working at local sexual assault centres, long term therapeutic setting and shelters for domestic violence survivours.
Since 2011, Christine has worked in her own private practice, which specializes in complex trauma and dissociative disorders. Christine has over thirty years of working with individuals with Trauma, Post Traumatic Stress Disorders, Traumatic Dissociation, Developmental Trauma and Dissociative Disorders, with specialized training in EMDR, Sensorimotor Psychotherapy, Psychotherapeutic Meditation techniques, Neurofeedback and Havening. Christine is also the current clinical supervisor for WayPoints, a center in Fort McMurry, Alberta that specializes in sexual assault and domestic violence. Christine teaches locally and at an international level on the issue of dissociation, complex trauma, and the intersection of dissociation and mindfulness.
Christine is the current President for the International Society for the Study of Trauma and Dissociation.
Christine has also served on the board of the ISSTD since 2010 and was the ISSTD treasurer from 2011-2017.
She is the author of Dissociation, Mindfulness and Creative Meditations: Trauma informed practices to facilitate growth (Routledge, 2017).
As well as avidly working with those who have been hurt the most, Christine has dedicated her professional life to educating others on the logic, normality and commonality of dissociation. The summation of her work is to educate practitioners about the vital importance of their presence, patients and care with those who have been through the most severe and brutal injuries so that they get treated with dignity and compassion. The four qualities of presence, patience, dignity and compassion applied to every aspect of the therapeutic process can result in profound inner healing; something every human deserves to experience.
Rachel Lewis-Marlow is a somatically integrative psychotherapist, dually licensed as a Licensed Professional Counselor and a Massage and Bodywork Therapist. Rachel is also a Certified Advanced Practitioner in Sensorimotor Psychotherapy and has advanced training and 30 + years of experience in diverse somatic therapies.
She is the co-founder of the Embodied Recovery Institute which provides training in a trauma-informed, relationally oriented and somatically integrative model for eating disorders treatment.
In her private practice, Rachel specializes in working with people recovering from trauma, eating disorders, and dissociative disorders. She has extensive experience as a teacher and presenter, focusing on accessing the body’s unique capacity to give voice to the subconscious and to lay the foundation for healing and maintaining psychological and physical health.
She authored a chapter on the application of Sensorimotor Psychotherapy to eating disorders treatment in the recently published book, Trauma-Informed Approaches to Eating Disorders.
Today on the podcast, we welcomed Pat Ogden, PhD, a pioneer in somatic psychology, is the Founder and Education Director of the Sensorimotor Psychotherapy Institute.
Dr. Ogden is an internationally recognized school specializing in somatic–cognitive approaches for the treatment of posttraumatic stress and attachment disturbances. Her Institute, based in Colorado, has 19 certified trainers who conduct Sensorimotor Psychotherapy trainings of over 400 hours for mental health professionals throughout the USA, Canada, Europe, and Australia. The Institute has certified hundreds of psychotherapists throughout the world in this method. She is co-founder of the Hakomi Institute, past faculty of Naropa University (1985-2005), a clinician, consultant, and sought after international lecturer.
Dr. Ogden is the first author of two groundbreaking books in somatic psychology: Trauma and the Body: A Sensorimotor Approach to Psychotherapy and Sensorimotor Psychotherapy: Interventions for Trauma and Attachment (2015) , both published in the Interpersonal Neurobiology Series of W. W. Norton. She is currently working on a third book Sensorimotor Psychotherapy for Children, Adolescents and Families with Dr. Bonnie Goldstein.
Her current interests include Sensorimotor Psychotherapy for groups, couples, children, adolescents, families; Embedded Relational Mindfulness, culture and diversity, challenging clients, the relational nature of shame, presence, consciousness and the philosophical/spiritual principles that guide Sensorimotor Psychotherapy.
You can learn more about Sensorimotor Psychotherapy on her website HERE.
In the podcast episode, Emma’s Top Ten, she told the story of a baby bird we saw today at the park. Here is our youngest daughter having a little chat with the baby bird:
Here is the list of ten things Emma shared that she has learned from our therapist:
10. Now time is safe.
9. Now time is different.
8. Memory time does not change now time.
7. She (the therapist, or even ourselves) is real, all the time.
6. We can ask for reassurance; sometimes that’s all you need.
5. You know better than anyone else what you need, and what is right for you.
4. It’s not our secret.
3. You always have a choice.
2. Turn the lights on.
1. You are not a little girl anymore.
DAY ONE SESSIONS
Video Links
KEYNOTE SESSION: A HISTORY OF DID
IS DISSOCIATION ALWAYS MALADAPTIVE?
Day Two Sessions
Video Links
Depersonalization, Derealization, and Denial
Recruits, Rebels, & Adventurers
Worldwide Issues & Advocacy Panel
(S)RA and RA/MC Myths Debunked