Transcript: Episode 9
9. Guest: Dr. Colin Ross
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Episode Description and Trigger Warnings:
Our guest is Colin A. Ross, expert in the study of dissociation. He speaks with Dr. E about the four definitions of dissociation, horizontal and vertical splitting, and the spectrum of diagnostic labels. He shares four reasons that explain why such controversy surrounds the topic of dissociation. During this discussion, abuse is referenced without any detail. Around minute 27, pedophiles are referenced and MK Ultra is referenced. No details or in depth discussion about those topics happen otherwise. He then discusses Trauma Model Therapy, phases of treatment, and resources for clinicians and consumers. No graphic or specific memory content is shared in this episode.
Dr. E: Hello, we have a special guest today. I am interviewing Dr. Colin A. Ross, who completed his medical school at the University of Alberta and his psychiatry training at the University of Manitoba, in Canada. He is a past president of the International Society for the Study of Trauma and Dissociation and is the author of over 220 papers and 30 books. He has spoken widely throughout North America and Europe, and in China, Malaysia, Australia, and New Zealand. He has been a keynote speaker at many different conferences and has reviewed for over 30 different professional journals. Dr. Ross is the director of a hospital-based trauma programs in Denton Texas, Torrance California, and Grand Rapids Michigan. He provides weekly cognitive groups at all three locations, in person in Texas and by video conference in Michigan and California. He has been running a hospital trauma program in the Dallas area since 1991. Dr. Ross’s books cover a wide range of topics, his clinical books focus on trauma and dissociation, and include Dissociative Identity Disorder: Diagnosis, Clinical Features and Treatment of Multiple Personality (1997), Schizophrenia Innovations in Diagnosis and Treatment (2004), The Trauma Model: A Solution to the Problem of Comorbidity in Psychiatry (2007), Trauma Model Therapy: A Treatment Approach for Trauma, Dissociation and, Complex Morbidity (2009), Structural Dissociation: A Proposed Modification of the Theory (2013), and Treatment of Dissociative Identity Disorder: Treatments and Strategies for Stabilization, published in 2018. Dr. Ross has published a series of treatment outcome studies in peer-reviewed journals, which provide evidence for the effectiveness of trauma-model therapy. Many of his papers involve large series of cases, with original research data and statistical analyses, including a paper titled Trauma and Dissociation in China in the American Journal of Psychiatry. Besides his clinical psychiatry interests, Dr. Ross has published papers and books on cancer and human energy fields as well as literary works including essays, fiction, poetry, and screen plays. He has several different hobbies including travel.
I actually first found Dr. Ross in the cancer articles when I was looking for information after my parents were diagnosed, and then my own diagnosis. That’s not what we’re talking about today, but what I appreciated at the time was his perspective was so different than the politics and culture of many based medicine, as opposed to science based medicine, and it really impacted me. So when I discovered that he was also one of the early leading experts in the field of dissociation and trauma, I was really surprised and found the same thing: that he holds a unique perspective that can be a bit mind-boggling compared to what everyone else says, when they are so easily dismissive of dissociative disorders, and yet, his research has held out hope, not only to understand dissociation, but to confirm that it exists and that it’s far more common than people think. Because of time constraints for the podcast, I want to skip the story of how he learned about dissociation in his early career, but it’s a really good story so I’ll include a link to one of his videos in the blog.
So, let me welcome Dr. Colin Ross, and let’s start with just defining dissociation. I know that some of what you’ve taught in the past is that part of confusion about what dissociation is, is that there are actually four definitions to dissociation, and people often aren’t even sure what they’re talking about.
Dr. Ross: Well I, I go over that in my workshops and my writings, and there’s at least four definitions of the word dissociation. And so, that does cause confusion because there is cross-talk, because people mean one meaning or another meaning or another meaning. So the first meaning is, uh, it’s just a general systems term, and is really just the same thing as disconnection. So if two things are dissociated, they’re out of relationship with one another, they’re not interacting, they’re disconnected from each other. If two things are associated, they’re linked together, interacting, connected. So dissociation is the opposite of association and basically it means the same thing as connected, or connection. And, this can be true anywhere in the universe, so there’s dissociation constants in physical chemistry for instance. Any two things can be dissociated from each other, so it’s very general term. The second meaning of dissociation is, it’s a technical term in cognitive psychology, experimental psychology, and it’s been used for thirty years or so now, at least. And so, there will be a disconnection between, say, procedural memory and declarative memory. Declarative is more or less like explicit, conscious memory, procedural memory is like implicit, or unconscious memory. And you, there’s tons like thousands of experiments showing, in many different experimental models, that you can have information stored in procedural memory, that’s not available to conscious memory, but it’s affecting behavior and output. And so, this is just a fact in cognitive psychology, you have a dissociation between memory systems, the conscious system and the unconscious system. Third meaning of dissociation is a phenomenological meaning that is dissociation is the symptoms of dissociation. It’s…so how do you define dissociation? Well it’s the items in the measures of dissociation, or in the diagnostic criteria in the DMS-V. So dissociation is, example one, two, three, four, five; It’s just symptoms, which is also true of, say, panic disorder. What is panic disorder? Panic disorder is when you have this, this, this, this, and this. What is depression? It’s this list of symptoms. And so, it’s just symptoms that people report, it’s no different, no more mysterious than any other set of symptoms in the DSM. And then, the fourth meaning, which brings in a lot of the confusion, is that it’s a theoretical defense mechanism, so it’s not something you can observe, or weigh, or measure. Dissociation is a process, or a defense mechanism, going on in your mind. And, so there’s people who, first of all, aren’t clear on these different meanings, and they’ll say “I don’t believe in dissociation”, they’re not saying that they don’t believe in the general idea of dis- disconnection. They’re not saying they don’t believe that there are measures of dissociation that have listed symptoms, they’re saying, most of the time, they don’t believe in this internal process, defense mechanism of dissociation.
Dr. E: Hmm.
Dr. Ross: Uh, so you can not believe in the internal defense mechanism meaning of dissociation, and completely believe in the other three meanings. So the- it’s not like all-, all-or-none.
Dr. E: Oh wow…what it-, what is it that you’ve spoken about, the horizontal and the vertical splitting?
Dr. Ross: Okay, so that’s a good, uh, a good thing to get into next, ‘cuz part of the confusion is, and the controversy is, that there’s no such thing as repressed memories, there’s no such thing as repression, and repression is the same thing as dissociation. So skeptics or critics, will say “well there’s no evidence for repression, that’s just a bunch of bogus Freudian theory, dissociation is the same thing, there’s no evidence for that either, so the whole thing’s bogus and un-scientific”.
Dr. E: Wow…
Dr. Ross: So meanwhile, they’re ignoring the face that there’s a huge literature on measuring dissociation and questionnaires for it, diagnostic criteria for it, that follow all the same rules as the regular DSM-V. But, so, why is it not true that even at the level of a defense mechanism, dissociation and repression are the same thin? And, uh, there’s this very handy little diagram to use to explain that which was first invented by, [Dr. Ross clears his throat] a guy who was writing in the late 70’s, Ernest Hilgard, he had a book called Neo-Dissociation Theory. And he had this little diagram, so he says that repression is based on horizontal splitting, so that’s a horizontal line in your mind, and dissociation is vertical splitting, so it’s a vertical line in your mind.
Dr. E: Right
Dr. Ross: So, this is just a metaphor or diagram. But, in Freudian theory, there’s two subtypes of repression, so it’s also important to be clear what does Freud mean by the word repression?
Dr. E: Right
Dr. Ross: So, there’s primal repression, which has absolutely nothing to do with memories, events, trauma, abuse, or anything else. In primal repression, you have id impulses, urges, drives, that are emerging into the ego, consciousness, the ego’s got some sort of conflict or phobia of them, so they get pushed back down into the unconscious, before they even really fully emerge into conscious awareness. So that’s just impulses, drives, instincts and so on, nothing to with experience, nothing to do with trauma, nothing to do with memory. The second meaning is repression proper, and these are terms Freud defined in his essays on repression.
Dr. E: Okay
Dr. Ross: In repression proper, you have material in your ego, in your conscious mind, and it has to do with things that have happened, and you have conflict about it or you don’t want to deal with it, so you push it down through this horizontal barrier in your mind, into your unconscious. So it was up top in the ego, now it’s down below in the id. And when it’s down in the id then it’s subject to all kinds of primary process, dream mechanisms, fantasy, all these things that the unconscious mind does, and it can get distorted.
Dr. E: Wow
Dr. Ross: [Dr. Ross clears his throat] So that’s Freudian theory. So what is dissociation? [Dr. Ross clear’s his throat] If we use dissociative identity disorder as, uh, the main example, in dissociation nothing is pushed down from the conscious mind into the unconscious mind. There’s no horizontal splitting; things are pushed from one compartment in the ego, to another compartment in the ego, across a vertical split. And, the..the point there is that things are not varied in the unconscious, they’re not getting all mixed up with dreams, and when you reco- quotes “recover” memory with somebody with dissociative identity disorder, all you’re doing is removing the horizontal barrier between one alter personality and the other alter personality. So for, say the, 8-year old alter personality that remembers, uh, sexual abuse by dad, that 8-year old alter personality has always remembered that information, it’s always been in the conscious mind, it’s just in one compartment and not in the out front adult compartment. So it’s a ver-, it’s a completely different process.
Dr. E: So it’s not that a memory is falsified or recovered, so much as access is gained to where it already was, and still present.
Dr. Ross: Right, and it was in the conscious mind.
Dr. E: Okay.
Dr. Ross: All…all along. It- but all- the point I’m making is that the repression is not the same thing as dissociation. So if you, blow off repression, say it’s not real, there’s no science for it, that tells us nothing about the scientific status of dissociation, ‘cuz they’re not the same thing.
Dr. E: Okay
Dr. Ross: And then, the other curious twist on the history is, a lot of the hostile skeptics will say “well it’s all a bunch of bogus Freudian theory, and, you know, we don’t believe in Freud anymore, and we’re scientists, and we’re in the 21st century now, and so therefore we don’t re- believe in all this recovered memory stuff, we think that these are all false memories”. But the problem is, if you go back to actual Freud and his actual writings, in his, uh, 1895 book, called Studies on Hysteria, with Josef Breuer, he describes a whole series of women who clearly have partial or full dissociative identity disorder, they have all kinds of symptoms, and he attributes those symptoms, to childhood sexual abuse, that he thinks actually happened. So this is the, uh, seduction theory of hysteria. Back then hysteria didn’t mean what it does today.
Dr. E: Right
Dr. Ross: Back, back then hysteria meant, basically, a combination of post-traumatic stress disorder, dissociative disorders, borderline personality disorder, psycho-somatic symptoms. So all these symptoms, he thought, were directly, causally, related to sexual abuse in childhood that actually happened, and he describes this in great detail, and talks about double consciousness, and, ya know, amnesia for things, etcetera. Then in 1897, in his letter to Wilhelm Fliess, he repudiated the seduction theory, he decided that all this abuse never happened, and the abuse was being reported to him by father- uh daughters of his Jewish friends’ neighbors and colleagues in a small section of Vienna, so it was very uncomfortable for him. So, when Freud assumed that the memories are accurate, it really did happen, by-in large they’re not perfectly accurate, then he had, basically, a dissociation theory. When he decided that these were false memories, now he had a pu- puzzle: why are all these hysterical women coming into therapy with all these false memories of sexual abuse that never happened. In order to solve that puzzle for himself, he developed repression theory. So repression theory is designed and developed, for when the memories are false, so, so the skeptics today have it completely backwards. If you follow repression theory, or you agree with it, and you base your treatment on it, you’re going to say that the memories are false. So, the – the whole things very mixed up.
Dr. E: Wow. Tell me about structural dissociation, and OSDD, and these changes. What’s happened there?
Dr. Ross: Okay. Uh, well structural dissociation is a theory, um, and there’s a book called The Haunted Self, in which the authors, uh, Onno van der Hart, Ellert Nijenhuis and Kathy Steele, write at great length about this model and the treatment that follows from it and so on, and then they also have published a series of papers, and they do lots of speaking about it. Umm, and I’ve have written commentaries on that, and a short book about it, and so I’m very familiar with it. In one way, structural dissociation is nothing new. It’s just a, a restatement of the theories of Pierre Janet from the late 19th Century, but in another way it’s something new because these authors have really, uh, fleshed it out in full, added a lot of detail and talked a lot about treatment. The basic idea is that something traumatic happens, and it’s too overwhelming, it’s too much, so your mind just, kinda, pushes it over to the side, walls it off, and you either, don’t remember the information at all, which would be full dissociation, or you kind of remember the information but the, the feelings aren’t there, just emotionless information. So that’s, that’s dissociation. In structural dissociation, there has to be formation of an actual separate ego state, alter personality, or identity. So the memories, the feelings, the conflicts are held in a split off section of your psyche that may have, in full DID it may have a name, an age, different hair color, all kinds of personal attributes, that’s full dissociative identity disorder. In, what used to be DDNOS, dissociative disorder not otherwise specified, in DSM-IV, which is now other specified dissociative disorder (OSDD) in DSM-V, ‘cuz they changed the names.
Dr. E: Mhhm.
Dr. Ross: Which they did for all the sections, anxiety, depression and so on.
Dr. E: Right.
Dr. Ross: In OSDD, I always just explain to people as it’s the same thing as DID but only half or three quarters as much. So, you have a separate split off, dissociated off, section of your psyche, its holding thoughts, feelings, memories, but it maybe doesn’t have a specific name, or a different age, or it just stays internal, it doesn’t come out to the surface and you don’t see the other person switch to another character.
Dr. E: Mhhm.
Dr. Ross: So, so it’s like the same thing, just not as much.
Dr. E: Mhhm.
Dr. Ross: In structural dissociation theory, there’s got to be some sort of, in- dissociated internal state with its own subjective sense of a separate identity.
Dr. E: Okay.
Dr. Ross: And, so, that’s just what DID has always been, it’s always been described that way, it’s nothing new. These authors have just come up with some, tying it into animal defense mechanisms like fight, flight, and freeze, elaborating on it, and describing the treatment interventions in more detail, and some research that follows from it as well.
Dr. E: Okay.
Dr. Ross: So tha- that’s basically what structural dissociation is.
Dr. E: So is there a little bit of a spectrum between OSDD all the way to i- DID, or…
Dr. Ross: Yeah, it’s- ever thing in mental health is on a spectrum, basically. So you’ve got one person who’s- never drinks at all, you got another person who drinks, you know, the odd glass of wine, maybe a couple of times a month, then somebody who has glass of wine most nights of the week, but not every day, and then next person drinks a couple of beer, sometimes two, three, four beers during the week and then on the weekend has maybe six beers on Saturday, or six beers on Sunday, and then you’ve got the person who drinks 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. On the other…
Dr. E: That makes a lot of sense, and it kind of makes DID, or dissociation in general, um, sort of consistent with everything else rather than being such an outlier.
Dr. Ross: Yeah it’s not an outlier in reality, it’s just an outlier in people’s false impressions about it. So…
Dr. E: Why is that? What happened with that shift culturally in the clinical world, when there was so much research, and so many people trying to help, or learn how to help, and then a whole group of people that just sort of said “that’s not a thing anymore”?
Dr. Ross: Well, I have some ideas and theories about that, but, basically, it’s very puzzling to me. But, jumping back to alcohol for a minute, ehh, so it’s true that alcohol’s on a spectrum and there’s no sharp cutoff, so when you’re in, kind of, the grey zone in the middle of the continuum there, one psychiatrist or clinician might say “well this person has a drinking problem”, and the next person might go “mhnnnaah, he drinks a little bit too much, but it’s not really a drinking problem, I wouldn’t say it’s a substance use disorder, it is kind of getting near that” and, the rate of agreement between different psychiatrists on who is an alcoholic and who is not, in that kind of grey zone, is going to be very low. But if psychiatrists who interview a hundred people who don’t drink at all, and a hundred people who’ve had a bottle of whiskey every day for the last twenty years, they’ll have perfect agreement on who is an alcoholic and who isn’t.
Dr. E: So you’re talking about concordance.
Dr. Ross: Yeah, uhhhhh, no inter-rater agreement thing. 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, more, more, more, and more, when you get all the way out to DID, there’s clearly things going on that most people don’t experience. So in most people don’t have the experience of: they’re at home making lunch, and next thing they know, it’s 9pm at night, they’re downtown, they’re at a bar, they don’t know how they got there. That’s not an experience that, you know, most people have a little bit of the time. And similarly, uh, people don’t generally, unless they have some neurological problem, they don’t look in the mirror and not know who that is. But people with DID have these kind of experiences. So, it’s both a continuum and a discreet category; when you get out to the far end it’s just a different category, it’s not the same as normal. And both things are true.
Dr. E: Hmm.
Dr. Ross: Which is also true of anxiety, depression, substance abuse, alcohol, whatever.
Dr. E: Right.
Dr. Ross: Do you mind if we jump back to the controversy and the disbelief?
Dr. E: Oh! Please, please, absolutely.
Dr. Ross: Okay, so, first of all there’s controversy and disbelief about a lot of things in the DSM. So there’s a whole group of people who have their own organization, their own conference, their own journal, their own series of books, who are very skeptical that schizophrenia is a legitimate disorder, and they think that maybe we should change the name all together, uhh, they are very skeptical about what causes it, and so on. So there’s, and there’s peopl- a large group of people in our culture who think that psychiatry’s just medicalizing everything, and depression isn’t really a disorder, certainly not a disease, they’re just exaggerating and maybe making a big deal out of normal sadness, normal reaction to life events, so there’s plenty of controversy about everything in psychiatry, and everything in the DSM-V, but the controversy about DID is a little bigger, and a little more intellectually violent.
Dr. E: It’s so intense!
Dr. Ross: Yeah, yeah and it’s not that people go “well, you know, I’m a little bit skeptical, I’m just not quite convinced”. Peo- Psychiatrists have very energized, hostile, angry, belittling, dismissive attitudes. There’s a lot of energy behind it, so why? So first of all, that intense energy to me is evidence that this is not just an intellectual question.
Dr. E: Right, right.
Dr. Ross: There’s some sort of- something big at stake personally, like this is touching on som kind of personal…something, I don’t know what that is necessarily, but now we get into my theories. Okay, so, the first theory’s not really a theory it’s just a fact. A lot of people who are highly skeptical about DID, a- don’t even read the literature. They’re not familiar with the scientific literature on DID, so there just speaking, really, out of ignorance.
Dr. E: Right
Dr. Ross: So that’s problem number one. Problem number two is they have all these misconceptions like if you- people who diagnose DID think that there is literally separate people in there, and one person’s not responsible, legally, for what the other person does, which is not true at all.
Dr. E: Right.
Dr. Ross: Uhhh, they think that if you have DID you can get away with all kinds of stuff ‘cuz you couldn’t help it, ‘cuz somebody else did it and- not true at all.
Dr. E: So, not responsible for the system as a whole.
Dr. Ross: Yeah, but umm, we- I and m- a lot of people in the field hold the person as a whole responsible for the behavior of all the parts in just the same that we would any person without DID.
Dr. E: Okay.
Dr. Ross: So, so DID doesn’t necessarily lead, the diagnosis, doesn’t lead to “oh you can get away with anything”. That’s just a misconception. The next thing that’s contributing is…DID is very strongly tied into childhood abuse, uh, including sexual abuse, physical abuse, emotional abuse, neglect and so on. So, that makes it a very hot-button topic just by itself, because if, if the topic is some neutral thing about, you know, what is the function of some certain part of the brain in obsessive-compulsive disorder, nobody gets that hot about it, except maybe a few academics.
Dr. E: Right.
Dr. Ross: But as- if the subject is child sexual abuse, and people accusing their fathers of incest, all of a sudden there’s a lot of energy, a lot of controversy, and a lot of angry people, which is not too hard to find on the internet.
Dr. E: Right.
Dr. Ross: So it’s just a very charged topic, and DID’s really connected into that charge, so why would people get so upset about that topic? Well, I think there’s several epil- explanations there. Besides the fact that they are just generally uncomfortable with it an don’t want to think about it and don’t want to deal with it, there’s ‘gonna be- there’s no reason to think that the rates of childhood sexual abuse are lower in psychiatrists, psychologists, social workers, counselors, than the general population. If anything, it’s likely to be higher because sexually abused people might want to go into those fields to try and figure themselves out, or to help other people. So the rates of childhood sexual abuse are not going to be, you know, less than the general population which is, and now we’re talking fairly serious abuse, not just one touch, 5% in boys and 15% in girls is kind of the basic ballpark, so therefore, there’s no reason to think that less than five, ten percent of psychiatrists, psychologists, social workers themselves were sexually abused as children. So they’re going to have a lot of reaction to these topics and if they don’t want to think about, feel, or know their own abuse, they’re going to discredit DID, and especially, if they’re worried that there may be even more abuse buried inside them that they don’t know about yet, they’re going to want to discredit recovered memories, dissociation. Them the other set of people would be, uh, people who themselves are perpetrators of physical abuse, sexual abuse, emotional abuse of adults and children. They’re not going to want anybody blowing the lid on that, and we know that there’s, you know, pedophiles in the catholic church, and we know there’s lots of ‘em. We know that there’s been pedophiles in the boy scouts, football coaches, gymnastics coaches for the Olympics team, so there’s pedophiles all over the place, there’s no reason, again, that there’s not going to be pedophiles in psychiatry, psychology, social work. So if you are, in fact, a pedophile or perpetrator of domestic violence, you want to put the lid on all that, and one way to put the lid on is to discredit DID.
Dr. E: Both of those choices are really frightening.
Dr. Ross: Well, yeah.
Dr. E: Right
Dr. Ross: And so then, another- this will sound a little bit fantastic unless we went into it for a couple hours, but, uh, it’s an objective document and fact that two of the original board members, professional advisory board members, of the False Memory Syndrome Foundation were Martin Orne and Joly West, two famous psychiatrists, and they were part of the organization that were spearheading, trying to completely suppress multiple personality disorder, now DID, discredit it, discredit recovered memories. What, what might have been their motivations? Well, absolutely documented for a fact, both of those guys were top secret cleared contractors on MK Ultra, and were contracting with the CIA on how to study, create, and understand dissociation, d- multiple personalities, and were part of the Manturian Candidate programs in the CIA. That’s just a fact.
Dr. E: Wow.
Dr. Ross: So, so then there’s going to-, that’s going to be another motive for trying to cover up all this stuff, because what if somebody is spilling the beans in some civilian therapy? So there’s going to be, and then there’s another, another set of motives is just hardcore biological people who think that what happens to you, like abuse doesn’t have to do with anything, it’s all genes and chemicals in your brain, and so we have to discredit anyone who’s, who’s coming forward saying no, these serious mental disorders are coming from what happens in the environment, they’re not coming from your genes, and they’re not coming from eating the wrong flavor of jello, they’re coming from serious stuff like sexual abuse. And then the final one I would say is the literature on dissociative identity disorder, there’s- we have multiple studies from multiple different countries showing that DID is effecting, in the ballpark, of 1% of the general population, and that includes a lot of much milder cases that we see clinically, just like if schizophrenia effects one percent of the population, which is the basic statistic, that doesn’t include, uh, cases that are as severe as you’ll see in the state mental hospital, it includes those plus a lot of much minor versions of schizophrenia, same for DID.
Dr. E: You’ve talked about what you’ve found in China and that study, where there’s not any cultural pieces where people could have gotten it, or gotten the idea from it, for- through social media, or, um, films, or anything like that because those pieces aren’t there in the culture.
Dr. Ross: Exactly. Yeah, that was uhh, I did multiple visits to Shanghai Mental Health Center, and the, the Chinese team, we translated the standardized interviews, Chinese team did many, many interviews and then me and my colleague went over there and did interviews of some of the people with a Chinese translator, it was quite easy to find cases of clear, classical, American style DID, which is pretty strong evidence that it’s not just in some kind of fad that’s going on in the United States.
Dr. E: Wow.
Dr. Ross: And so, then, another, the final point that I was going to make is, so if it is true that DID effects maybe about, uh, ballpark 4% of general adult psychiatric inpatients all around the world, so that’s one out of every 25 inpatients on psychiatric units all around the United States, Canada, Europe. If that’s a fact, which is the number that’s in the literature, this means that all these psychiatrists who don’t think about, don’t believe in it, or are hostile to it, are missing an awful lot of diagnoses, and failing to provide the right treatment, day-in and day-out on a large scale. So, that means that, uh, they’re not all that competent, and they’re not all that helpful, and they’re not going to want to know that, or admit to that, so they have to discredit DID.
Dr. E: Wow, that makes a lot of sense.
Dr. Ross: Good.
Dr. E: So, what about, tell me about the trauma model.
Dr. Ross: Okay, so, the trauma model is the title of one of my books, and the trauma model is a general scientific model of the mental health field, and what’s the role of trauma all across the DSM system. And it’s very detailed and it’s, uh, based on the research literature, on my thinking, on clinical experience, and I, I provide a whole long list of specific research predictions. For instance, if you do this research, trauma model predicts you’ll find this, regular psychiatry predicts you’ll find that, so it’s set up so it’s not just a belief, or a theory or an opinion, it’s actually a testable scientific model, ehm, and I could get into a couple of examples if you want. But-
Dr. E: Sure.
Dr. Ross: But the basic idea is that trauma is a big deal in the mental health field and it’s a major contributor to a large percentage of mental health problems. There’s also people who have serious mental health problems that didn’t have trauma, so it’s not an all or nothing thing.
Dr. E: Right.
Dr. Ross: But it’s not just a little sub-area, or just PTSD, i- all across the board. And this is now acknowledged in the DSM-V, all across the DSM-V, most of the sections, it says that childhood trauma including sexual abuse is a serious risk factor for whichever section we’re in.
Dr. E; Wow.
Dr. Ross: So, that’s the trauma model. Ehm, so it’s not specific to DID, uhm, trauma model therapy is the therapy method that kind of sits on top of then trauma model. And it’s also useful for many different diagnoses, not just DID, because people with DID have all kinds of other problems besides their DID, they frequently are depressed, they’re anxious, they have substance abuse problems, they have PTSD, they have all kinds of things, all or which have to be treated. And, ww-what’s, uhh, I’d say, what’s new and different about the trauma model therapy, is the way I’ve kind of integrated together into a single approach,
Dr. E: Hmm
Dr. Ross: Attachment conflicts that come from trauma when you’re, people who you love who are your caretakers are also the people you hate who are abusing you, the self- there’s a whole way of thinking about the self-blame that’s almost universal in trauma survivors, I call that the locus of control shift, and it comes from normal childhood thinking where you think that you’re causing everything that’s going on, so I’m tying all the self-blame, self-hatred, self-punishment into normal childhood psychology, and that’s the way kids think about…
Dr. E: Oh, I had not connected that piece, like I’m thinking of, like, Patricia DeYoung and some of the shame-based stuff, I had not connected it to—
Dr. Ross: Yes, certain—
Dr. E: Like, I had not connected it to the child’s actual perspective.
Dr. Ross: It’s, it’s also very similar to moral injury and combat PTSD.
Dr. E: Right…
Dr. Ross: And then I’ve, I’ve tied in some systems principles, and the problem is not the problem, that is, the presenting symptom or behavior is usually some sort of unhealthy attempt to solve some problem in the background, cope with their feelings, cope with the situation. So you have to try and understand the problem in the background, help the person to regulate their feelings, cope with life better, and then they can kind of let go of the presenting symptom, or addition, or behavior. Uh, and then there’s sort of an addiction component that I’ve blended in, uh, there’s a very well defined and structured desensitization component, uh, and then the victim – rescuer – perpetrator triangle that I use that as a way of, uh, talking about what’s going on. So, I’ve taken elements from here, there, and everywhere, some of which are somewhat original, especially locus of control shift, but it’s just the way they’re all tied together in a, kind of, seamless, flexible model. And trauma model therapy is not just, you know, this little silo here, and then over there you have that silo, which is cognitive therapy, and over there you have EMDR. Trauma model therapy is very open, the more tools in the toolbox the better.
Dr. E: Oh wow.
Dr. Ross: Uhm, so it’s not like an exclusive little empire of it’s own at all. And, when I talk to therapists about it, which I do a lot, uh, not talking about DID in particular, I’ve just, they all say “this just makes so much sense, I really like this, this is useful, this is helpful.” And I also have six or seven treatment outcome studies, providing data, showing that it’s effective at what’s called Level 2 evidence. So it’s actually and evidence based therapy.
Dr. E: Oh that’s great. Tell me, just since I, since I have you specifically, tell me that piece that’s unique to you about the locus control shift, what was it?
Dr. Ross: Locus of Control Shift.
Dr. E: Tell me more about that.
Dr. Ross: Okay, so, locus of control is just, there’s a big literature on that, it’s a social psychology literature, and the locus of control, some people have an external locus of control, which is, they feel like the outside world controls them and is kicking them around all the time, some people have an internal locus of control which is they feel like they’re in charge, they’re making things happen, and then healthy people have kind of a flexible, fluid shift back and forth. So I just borrowed that term, locus of control. My thinking is that the locus of control shift happens automatically for abused kids, the locus of control being where is the control point? It’s really in the adults, but because of the way that child minds work, the control point gets shifted inside the kid, ‘cuz kids experience life as “I am in the center of the world, everything revolves around me and I’ve got this magical power to make things happen”, that’s just the way kids think.
Dr. E: Right, right, just developmentally.
Dr. Ross: Right.
Dr. E: Okay.
Dr. Ross: And so, when there’s a whole bunch of abuse and mental death going on, they automatically conclude, it’s my fault. It’s happening because I’m bad, I deserve it, I’m no good, I’m this, I’m that. And so, it makes the self-blame, the self-hatred, the self-punishment, all this unhealthy behavior, understandable. And so, it makes the self-blame, the self-hatred, the self-punishment, all this unhealthy behavior, understandable, and it makes it be more like the person who gets hit by the drunk driver, comes into the ER with a broken leg, and, their femur is sticking out through the skin on their thigh, well the doctor goes, “Well that’s abnormal, that’s pathological,” but the doctor doesn’t go, “this is a pathological person,” or “what’s genetically wrong with this person?,” the doctor says “well they just got hit by a drunk driver, this is abnormal, and it’s horrible if you’ve been through that kind of trauma. And so, the model is constantly making this point, that you’re angry, why? When you threaten and corner a mammal over and over and over, you’re going to activate it’s fight system. Your anger is normal, natural, it comes from being threatened over and over and over as a kid. Now, how you handle it is not, maybe, the healthiest, we need to work on that. Uhm, and the fact that you hate yourself and blame yourself, that’s just the way it is with kids who get abused. And so it, it de-stigmatizes it, it takes away a lot of the shame, and now we can get to work on it.
Dr. E: So it really, it really normalizes it, not that what happened was okay, but that the response to what happened is okay.
Dr. Ross: Right.
Dr. E: Wow.
Dr. Ross: So, exactly the same as getting hit by a drunk driver is not okay, but having a broken leg as a result can be completely normal. And nobody goes, “what’s, what’s up with you, how come you’re- got this broken leg?” Er, we, people just don’t have those attitudes.
Dr. E: So not “what is wrong with you?”, but a consequence of what happened to you.
Dr. Ross: Yeah, that’s the motto. It…
Dr. E: Wow.
Dr. Ross: The motto that dominates the mental health field is “what’s wrong with you?”, but in this perspective the motto is not “what’s wrong with you?”, “what happened to you?”
Dr. E: That’s a huge shift.
Dr. Ross: But I’ve just taken that and, you know, blended it in to this, uh, very well organized model. And the, the therapy has very defined tasks, steps, procedures, strategies, it’s not just, kind of, vaguely floating around.
Dr. E: So it’s structured between the therapist and the client?
Dr. Ross: Yeah.
Dr. E: Or you mean like in a workbook format?
Dr. Ross: Uhh, we have some workbook aspects, uh, so a bit of both.
Dr. E: Oh, okay.
Dr. Ross: Mostly not in the, in the workbork- eh- workbook fashion, it’s more, okay so we have to work on this, we have to work on that, we have to work on this, we have to solve this, we have to this, we have to solve this, the strategies and techniques and the tasks are well define and here’s some things you can do for this, here’s some things you can do for that. So it’s just like, uh, an example would be somebody who’s, uh, kind of spacing out, getting too anxious, losing track of where they are, getting disoriented, ‘cus there’s too much PTSD up and running, and so there’s a whole bunch of grounding skills. Which are not unique to this model, but it’s just an example of, you don’t just talk about it forever, so there’s specific things to do, okay work on your breathing, focus on your breathing, slow your breathing down, shuffle your feet, look around, don’t be just having a fixed stare, where are you right now?, what’s your name?, what year is it?, who am I?, why are we here?, you’re safe now, uh, could be like squeeze a ball,…
Dr. E: Right.
Dr. Ross: …talk to yourself internally, remind yourself…there’s a whole set of strategies that can be used to help the person get grounded. And that’s, throughout this therapy there’s all kinds of strategies and tasks for all kinds of things.
Dr. E: So, in your approach is it more important for the clinician to establish, sort of, I guess, safety and tolerance skills and things like that before more talking about it, or it kind of goes hand-in-hand through the process?
Dr. Ross: Uhh, a bit of both. So in all different forms of trauma therapy, there’s basically three phases, there’s phase one, two, three. Phase one is getting these grounding skills, accepting that the diagnosis, accepting the treatment and plan and, if the person’s being beat up by their husband everyday, beaten up by their husband everyday, well you have to work on that before you start working about childhood trauma. Uh, so it’s stabilization…
Dr. E: Oh yeah.
Dr. Ross: …grounding, uh, being motivated, making sure there’s not too much other chaos going on in your life, and then you get into the, sort of, memory processing, talking about the trauma, accepting the feelings, and then the third phase is more resolution, uh, consolidation, integration, and learning how to cope with with life just as a person in general. So, trauma model therapy follows those three, kind of, stages, but that’s just, sort of, a teaching point. In reality, you do some stage one, then three, then two then up to three, back to one, oh…more one up to two…
Dr. E: [Hearty, understanding laugh] Right.
Dr. Ross: That’s just the way it goes.
Dr. E: Right.
Dr. Ross: But uh, in, clinically we do see, like in my hospital programs we see people admitted who are way overwhelmed, flooded, too many flashbacks , type of arousal, because something horrible happened in life, but also not really because the therapist dove in too fast, memories memories memories memories. So, it’s very important to keep the pace slow enough, but not so slow that it takes forever.
Dr. E: Hmm.
Dr. Ross: So pacing and containment are big themes in therapy. And, for any therapy, doesn’t matter what kind, the literature is overwhelmingly conclusive and basically all expert therapists agree that a huge part of any therapy no matter what your theoretical reason, no matter your techniques, huge part is positive therapeutic relationship, good work ethic, the therapist being generally interested and concerned about the person, realizing they have a serious problem, knowing what they’re doing, it’s just the attitude, the energy, the vibe, that’s a huge part of the healing. No matter what specific technique the therapist uses.
Dr. E: Is that just part of a general attunement kind of process, beyond just rapport, being just…
Dr. Ross: it’s not, it’s not casual just like you’re at a bar one night and you chat with somebody and you get along well and you never see ‘em again, it’s the same basic thing, but it’s more structured and lasts for a long time. And yeah, the therapist has to be attuned, empathic, but not like swallowed up by the persons problems, obviously.
Dr. E: Right. And what about for the other perspective? From the client’s perspective of knowing how to find a therapist like that, or like, what about your program, those sorts of things?
Dr. Ross: Well that’s kind of a hit and miss process. Unfortunately, like everybody else on the planet, therapists range from, well sometimes, grossly unethical and need their licenses taken away, but you know, not very competent, not very effective, not very helpful, medium helpful or like really really helpful. And so, finding out in advance which one’s which is a big challenge for clients, consumers, but generally speaking, uh, somebody who’s got a good reputation in the field, somebody who’s active in their professional associations, uh, word of mouth, other people have had good experience with that person, or you’re referred to them by an expert in the field.
Dr. E: Hmmm.
Dr. Ross: Those are, you know, good starting points. In terms of, so I don’t have an outpatient practice, don’t do consultations, but I do have hospital-based programs. So, if you’re looking for inpatient treatment then you either go to my website, rossinstitute.com, or you can go to ubhdenton.com, university behavioral health Denton, ubhdenton – d-e-n-t-o-n.com, and there’s a trauma program their and there’s phone numbers and you can call in and find out how the program operates and get your insurance checked out and so on. And, also, we have a network or therapists that we can refer to.
Dr. E: You mean outside of the Dallas area, or?
Dr. Ross: Yep.
Dr. E: Oh wow.
Dr. Ross: I mean we don’t have therapists, like, in every town in the country, but we know, and are aware, or quite a few therapists and can search and find people to suggest.
Dr. E: How do clinicians conta- become involved in that, or participate with that, or connect with others who are doing quality of work and not the creepy people who are doing such a bad job? [Dr. E and Dr. Ross chuckle briefly]
Dr. Ross: Yeah, well that’s also challenging, but basically, if you’re and eating disorders person, well then you’re going to read journals about eating disorders, read books about eating disorders, go to conferences about eating disorders, and belong to a professional association focused on eating disorders. Same thing for dissociative disorders; there’s The International Society for the Study of Trauma and Dissociation, which is ISS-, ISST-D.org. And so, you can go there, there’s a journal, you can get into the literature, read the leading books, go to conferences, there’s webinars, uhm…
Dr. E: Their conference is going to be in New York next, right?
Dr. Ross: Right. New York in March. And they have regional conferences scattered around, and webinars.
Dr. E: Oh, okay.
Dr. Ross: And there’s also a ‘Find a Therapist’ tab, where you can just go to the website, you don’t even have to join the organization, and you can do ‘Find a Therapist’ and search in this state, or this town, uh, who is the therapist who knows about dissociative disorders. And sometimes there won’t be one, and sometimes there will be one 300 miles away.
Dr. E: Right, right.
Dr. Ross: And then, I also have, uh, a series of webinars my daughter and I-, my daughter is a psychiatrist in Toronto, and we have a webinar series. We’re just about to do the 12th month, we’ll finish our first full year in, in January.
Dr. E: Wow.
Dr. Ross: It’s trauma education essentials dot com, so it’s traumaedessentials.com is the website.
Dr. E: Okay.
Dr. Ross: And you can go there and check it out, uhh, also you can sign up for the newsletter which is free, which is monthly, written by my daughter, she’s either got a good book review or a nice article, sometimes practical tips for therapy, announcements and so on. So, we have really good speakers, January is John Briere for three hours, he’s, you know, one of the handful top experts on PTSD in Toronto, and a very engaging speaker, uh, very practical, easy to follow.
Dr. E: That was really helpful, thank you so much!
Dr. Ross: Oh you’re welcome, very nice talking to you, thanks for asking.
Dr. E: Sure!
End of Interview.
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