Transcript: Episode 113
113. Guest: Kathy Steele
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Kathy Steele 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, and is a recipient of a number of awards for her clinical and published works, including the 2010 Lifetime Achievement Award from the 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. We had the opportunity to hear Kathy Steele speak in Kansas City last spring. You can hear our thoughts in response to that workshop in Episode 43 entitled Dr. E On Shame. It gave us a lot to think about and we learned a great deal, including how to wrestle with new ideas that are helpful and important therapeutically, but not necessarily comfortable personally. We are very honored and excited to talk to Kathy Steele and to welcome her as a guest on the podcast. Welcome Kathy Steele.
*Interview begins*
[Note: Interviewer in bold. Interviewee in standard font]
I'm Kathy Steele. I'm a psychotherapist in Atlanta, Georgia. I've been in practice since 1985. I guess the way I got into this was a little bit sideways. My, my very first private practice client turned out to be DID. I didn't know that at the time, but recognize that at some point as I was working with her. And I also was volunteering in a program through an organization called the Georgia Council On Child Abuse. And I was running year-long incest survivor groups. And so I really found that I liked the work of complex trauma. I liked my clients. And that's kind of how I got into it.
It's quite a journey from that to the workbook and to speaking everywhere.
There's a few steps in between. That's right. Well, and one of the things that I also discovered over the course of the years is that I love to teach and I love to write. So those things just sort of naturally came together over time in a way that I didn't really plan, but it just, there was just some synchronicity to it.
How did the workbook itself, how did that happen?
The workbook itself, the Coping With Trauma-Related Dissociation was actually the idea of my Dutch colleague Suzette Boon. And she had been running these groups for complex PTSD with her colleagues who wrote a book about complex PTSD coping skills. And so she came upon the idea to really refine it to specifically work with clients with dissociation. And so she, myself, and another call Dutch colleague Onno van der Hart had written together before, and we decided to put this workbook together.
It's amazing. And it's hard for me to fathom how, all of those steps in between, like you just said, from that first client and getting to the workbook that is now so accessible to so many people. How do you learn about DID? How did you, once you realize what was going on with that first client, how did you obtain that knowledge and start getting experience or training to be able to help people?
Well that, again, is a little bit of synchronicity in that my, my supervisor in Atlanta happened to be one of the few people in the United States who was working with DID. I didn't even know that at the time when I was in supervision with her. And so there were a couple of people here in Atlanta who were really focused on, we called it multiple personality disorder back then. So I got some really great training and some not so great training. But really learned over time what worked and what didn't work for my clients, both through supervision and honestly a little bit through trial and error because we really didn't know that much about how to treat it very well. And I think our treatment gets better and better as we learn more and more of the nuances and and depth of the issues that are a part of dissociative disorders.
So how would you explain now, knowing what you know now, how would you explain what a dissociative disorder is? You mean like DID. Yes, yeah.
Yeah, well, I think that we all have a sense of self, a sense of who we are. We call that our self. And self is not a thing that we pull out and say, “Here's my self,” in the same way that, you know, our personality is not a thing we pull out and say, “This is my personality.” These are enduring ways of being. And what we really want to look for in a healthy child who's grown up in a good way, is that their sense of self begins to take into account their their history so that who they are incorporates their many different ways of being across many different situations and across time. So that, for example, the ways that I was at school and at home when I was seven years old become incorporated into my experience when I'm seven and eight. What happens in dissociation is that many different experiences are not really incorporated, or we would say integrated, into a single sense of self, but into sort of multiple senses of self that are disconnected from each other. And so there is this difficulty in realizing that, yes, I was seven years old, is one example, and that seven year old was me and is still a part of me, that I'm the same person as I was when I was seven, but of course I'm also quite different. So it's very complicated, I think, to integrate our sense of self across time and across different experiences. And that's, that's every human's task whether they've been traumatized, whether they're dissociative, or whether they haven't been traumatized and they're not dissociative, we all have the same task. But it's made a lot more difficult for people who have good reason not to accept some of their experience that was traumatic or very painful.
One of my favorite things of hearing you speak or reading some of the things that you've written or shared is what you just now did and how much you normalize that experience.
Well, I think DID is just one variation of what is normal. And the more we can help people learn to accept all of themselves. And of course, that's a task for all of us, right? Because even anybody can say, “Oh, that wasn't like me, the way I behaved” or “I'm not myself today.” We all say those kinds of things. And they're like minor little glitches that we want to try to integrate. I think unfortunately, for people who are dissociative, these are not minor glitches, they're major. Like, like, I can't really accept that I was ever seven years old and that vulnerable. Those kinds of those kinds of issues are are a real struggle for people.
And when you talk about knowing more now than what they knew when you first started. One of those things, or one of the examples of that sort of progress of research unfolding, has been the structural dissociation theory. Right. Right. Can you explain that just a little bit? And I know that, I've heard you speak. I heard you speak in Kansas City, actually. Okay, great. So I know that you refer to ANPs, you prefer to call that a daily living part. Can you kind of explain some of that?
Yeah. Our theory is kind of based on neurobiology and evolutionary psychology. It gets a little complicated. But the fact is that we all like, are our friends the mammals, are sort of organized by different what we call motivational systems. They are, they're sort of neural networks that prime us to operate in in certain ways and avoid other things. For example, there are several different kinds of defensive systems that are online in our brain, and they're, they're very automatic so that when we feel threat, we will automatically engage in some kind of behavior that makes us run away or fight or freeze or shut down, depending on the kind of threat. But there are also motivational systems that organize our daily life. For example, attachment is a big motivational system that organizes our relationships. We have the motivational system of exploration; it makes us curious about our lives and about our experience so we get to explore. So there many of these systems. And what we have proposed is that dissociation happens primarily along the lines of a division between those systems that are organized to keep us safe under threat, or to defend us under threat, and those that are organized to keep us going on with daily life. So we talk about parts that are fixed in the trauma. It doesn't mean that daily life parts are traumatized, not by any mean, because the whole person is traumatized. But that these parts are are the part of the person that tries to avoid the trauma in order to go on with daily life. And the parts that are kind of fixed in the trauma are the ones that are sort of constantly living in what we call trauma time. They're living in the moment of trauma and can't quite get out. And it's the conflict between these two kinds of parts—parts that need to avoid to go on with daily life, and parts that are stuck in the trauma—it’s that conflict that keeps dissociation going. That, that's our that's our theory in a nutshell.
I feel like that. I feel like those pieces explain several things, actually. It explains the structure, like what you just said at that level. Right. Right. But the conflict description also explains things like why starting therapy is so hard, because that internal conflict goes up, like the level of conflict sort of, the intensity of it.
Yeah, absolutely. Well, one of our, one of our principles in in our theory is that dissociation is maintained by what we call trauma-related phobias. And we, we think of phobias as like external things, like “oh, I'm afraid of spiders,” but phobias can be of inner experience, like “I'm afraid of my feelings,” or “I'm afraid of that dissociative part of me” or “I'm afraid of that memory.” Or even ashamed, it doesn't just have to be fear, it might be shame. And so that the inner organization of a person is organized around avoiding things that are fearful or shameful. And I think that is another important piece of our theory. Because that really helps us to know what to focus on to reduce the intensity of those conflicts. Like “I want to know what happened;” “I really don't want to know, I'd rather died than know.” I mean, those are big, big conflicts in dissociation.
And then the same thing plays out when things do start moving forward in therapy and some of those walls, for for just for use of the word, some of those walls start coming down. Things happen so quickly.
Yeah. And, and it's really a struggle sometimes because walls come down more quickly than either the client or the therapists anticipate sometimes, and we we sometimes have to deal with that aftermath. I mean, what we really want to do is our very, very best at, I think of an image of a eroding the wall instead of tearing it down. But sometimes they come down on their own accord for some reason, and a client gets really flooded and overwhelmed. And that's hard.
But the same thing, also, and I just learned this after talking to Dan Siegel and Kelly McDaniel. The same thing happens with good too, though. I think lots of us who are survivors, or who have been through therapy at any level of the process, have experienced that where it's hard or there’s some flashbacks or flooding or different things like that. But sometimes what is just pouring in is good, which I never thought about in context. But when those walls come down, it's not just about keeping the bad out. Like, the good comes to.
That's right. And sometimes the good is scary because people have all kinds of experiences around that, like, “Oh, it won't last.” Or I, “It's better to feel bad most of the time instead of feel good and then crash and burn again.” Or “I don't deserve to feel good.” I mean, there are many, many reasons why that good flooding in can cause problems, and really unexpected problems. But the more we know about that, I think the more we can help prepare an individual for the fact that taking in good might not be as easy as it seemed like it would have been.
So that's the same conflict again.
Yeah, yeah. And I think lots of people, I mean, not just traumatized people, but lots of people say, “Oh, my life is going to good. I wonder what's going to happen next.” I mean people are a little bit superstitious about that. And of course, our lives are a series of good and bad and indifferent things. Of course something else is going to follow the good. But I think the more, and this is true for all of us, for me, too, the more I can take in the good while it’s here, the more adaptive I can be when the bad comes.
That's really helpful. And I think it was a challenge that I experienced when I heard you in Kansas City. There were a few things, I don't mean like in a triggering way, but a few things that I learned that I really had to wrestle with over time that I had not thought about in the way that you said. And even some things I thought in the beginning that I disagreed with but then came to understand as I continued wrestling with it. But wrestling with those things actually taught me how to have some tolerance for it a little bit. Because when I just thought, that same conflict you were talking about. This is too hard so I just have to disagree, because it's not comfortable to agree. Because if I agree, then it means this and it means this and it means this. Uh huh. Uh huh. And so to hold that tension, and have to sit with it, and wrestle with it, and see the truth in what you were sharing, and understand the process of why it is the way it is. Then also sort of did the same thing of “Oh, but now that means this and this and this.” and things opened up. Well, it changed things, right? Right.
When you change your perspective. And I think that's also true for me too, Emma. And I don't ever want to say that I'm right about all this stuff. I mean, a theory is a theory. It's not fact. And so I'm always trying to listen to my clients and they will challenge me, and I have learned and changed too. So I think it's it's that both therapists and clients together as human beings are challenging each other, and challenging themselves, and learning new perspectives. And, and that's the beauty of it, because that's being human. That's life, to challenge our perspective. And, you know, one of the hardest things is to change a belief that you have, even when you're confronted with facts that show your belief is not true. It's really, really hard. There's lots of research around that. So I think you you are describing a really brave and courageous thing to challenge some of your own perceptions and beliefs with me, and then I get to challenge my own sometimes. I think that's pretty cool. But it's hard. You're right, it's really hard.
Well, and and some of it was negotiate-. Like, I can think of, I can think of two neutral examples. And I'll share with them just for the learning process of the listeners, too. One is, that doesn't even have to do with DID. In Kansas City, you talked about not driving long distances for your therapist. Uh huh. And that's something I have to do actually because of who I supervised and because of the rural area I live in. And those are my reasons, as opposed to like a dependency thing. And so when you first said that I just bristled all over because I was like, “No, that is my therapist and I'm keeping her and da da da da.” But what I realized as I wrestled with it is that in my context that might be might be true, it's also not my only choice. And so what I was able to do was find some support groups and some other resources that I was not utilizing, because I wasn't even looking for it.
Oh, cool, cool. Yeah. And that's great. And sometimes I say things in workshops as though they're absolute, and of course there are exceptions to almost every single things. For example, I really recognize people in rural areas have a terrible time finding good treatment, I think. A little bit about more specifically, what I was talking about is people flying across the country or several states over. Oh wow. Yeah. So it's really different. Like, people actually getting on a plane and going somewhere on a regular basis. Those kinds of things. So, yeah, of course. And and I think it's really good that you don't take what I say as the perfect truth, because I do not pretend to have it for sure.
Well, and I think part of that is cultural because now we have the internet. And so we have access to each other as clinicians and as survivors in ways that we've never had before technology like this. And so I think one thing that happens even on the podcast, someone will say, “Oh, I listened to episode whatever, and so I know you're dealing with such and such and da da da da. But that was like a postcard from a year ago. That doesn't have anything to what's happening right now. But people are just trying to connect with one piece, or they think this or that. And the same thing happens with the internet. I just talked last week with the president of the ISSTD, and she was talking about how things have shifted and what she wants to do while she's with the ISSTD in this position. And one thing that we talked about was how because of like the online groups and things like that—survivors having access to each other in a different way before, than before—there is almost a culture that's developing that has never been before. Uh huh. And there are some strengths to that where information can be shared and support can be gleaned. But there's also some challenges to that. Right. And one of the things that I think is, I mean, there's several challenges. But one of them is about this, someone will hear one piece of something at a conference and say, “Well, this researcher believes this, and so it's a problem because of all these reasons,” or something.
Right. There has to be, there has to be a lot of context to it. And to also know that, you know, different theories are both compatible and conflict with each other. And that different clients respond differently to different treatments. I mean, it's a really complicated, not one size fits all treatment.
Well, and and that one person who is speaking on a conference, or one person who shares what they know in a book, doesn't mean that it fits everything or that they even assume it fits everything. All right, absolutely. So there's this poll-. One thing we really push for on the podcast is sort of connecting these groups, between clinicians and survivors, because of like what happened in the 90s, and all of these different issues that have been so divisive. and people trying to get help. And so in some ways, help is becoming more accessible. But people don't always have the context or the practice that goes with it. And it's really difficult. But in other ways, we can clarify that as we talk to each other. So after I heard you in Kansas City, uh huh, I sent a message to my friends in the Netherlands and said “She's going to be there, you need to go listen and understand,” and it clarified some issues that they had. And so that's a powerful thing. And you are all over the place.
Yeah. And and I think the the wonderful thing is that we create some capacity to, to have conversations instead of talking at each other about “This is what I believe.” “No, you're wrong. I'm right.” I think we we really have to have deeper conversations and hear each other, even if we don't agree. And it's okay that we don't agree. But I think the point is, we're all trying to get at what what is healing? And how can it happen? And that, actually, it happens differently for different people. And so I can write a book about how I think healing happens, and it's not going to fit 5%, or 10%, or 20% of the people who who look at the book. And I think that's important to acknowledge and just accept.
Yeah, even even, even within that cultural aspect. I appreciate that that's there, and that there's support and information available, but I also don't want-. And this is even offensive to some people. I don't mean it offensive, but it will offend some people. I don't want necessarily that to become my identity. Right. Because there is more to my story and more to putting things together. That that's kind of my whole point in what healing means to me. Right. And so I don't want to just overidentify with one part of it. And that is sometimes a struggle in trying to identify with them as a culture. Right. Because while I appreciate the help and support that's accessible, and absolutely honor other friends who are also survivors, I don't want to stay in that place. I don't want that to be who I always am.
Right. And I hope that that is something that we all do. We all define ourselves in particular ways. Like I can say, “Well, I'm a therapist.” But you know, I'm in my 60s. Probably in my 70s, I'm not going to be a therapist anymore. So how am I going to define my identity? And, and defining ourselves by what's wrong or what's right, both of those are limiting. You know, I want to really think about as a whole human being, how can I be in the world and contribute and take in what's given to me in a way that honors my whole being. And I think that's a developmental task for each human being that far far transcends our work identities, or our our disorders, or however we want to frame that.
And having having compassion in that conversation. Right. Understanding that the clinicians or researchers that are up on whatever stage or platform it is at a given time, are also in the process of learning. Absolutely. And the same with the cultural group, which I'm using a very broad phrase. But while I don't necessarily want to identify with that, I also understand that there are people in places that don't have access to help. And so it has become their identity, because they don't have the same access I have. That's right. And so I have to understand and be a little more tolerant and patient with some of those pieces. Uh huh. Because they don't. But then at the same time, there are more resources than there were in the past, like the workbook. There are a lot more resources out there now, both online and in print, for sure.
What do you feel is important for clinicians to understand-. We talked about survivors a little bit, but what do clinicians need to understand about DID that maybe they don't know yet?
Well, I think a couple of things that I find really important to help newer therapists. Even if they're not new to the field, that I mean, new to therapy, they might be new to working with DID. Number one is there's nothing to be afraid of. And there's also nothing to be particularly fascinated with, except that the human mind is a complex and wonderful thing. But that's true for all of us. So to put it in a human context, rather than a special or fascinating or scary context, which means that we don't really think of parts of a person as separate people. They are different-. My friend Rich Chefetz has said something really beautiful, “These are different ways of being you.” And I love that so much because I think it, it gets to the heart of dissociation. So, yeah, for for therapists to see the whole person, I think is really important. And to not be too eager to rescue somebody. Because rescue doesn't empower the client. And it sometimes burns to therapists out, and it sometimes burns the client. So those are the two things that I see as as most important for therapists to start with. And to really understand that good psychotherapy is the foundation of treating DID in the same way that it is of treating any human malady that people come to therapy for.
How would a clinician work with someone who is themselves not understanding that they're one person beyond just sharing the body?
Of course. Because that's really common is that people come to us experiencing themselves as, as “not me.” And, and so that's a very slow process. And and where I start is just acknowledging that it's a mind-bending thing for both of us that when when you switch to Joe, or Mary or Sally, I still see, you know, Sarah. And so that's a mind-bending thing that your experience and my experience of you are so different. And how can we be curious about that and explore? And what makes it hard to accept that, for example, the Joe part of you is is really part of you and not entirely separate? Like, what what is the struggle there that perhaps I could help with? It's really complicated. But, but I think a compassionate therapist who's not pushy. I never pushed this idea. But just say, you know, wow, this is this pretty amazing. And sometimes it's helpful to point out that there is a little river of knowing that runs through different parts without the client even knowing it. And I'll-. Is it okay, if I give an example of this? Do we have time?
Absolutely. I remember you gave in Kansas City, the example of being able to text your therapists or call the therapists.
Yeah, yeah. And one example is of a client who was switching a lot in session, at work, everywhere, except when she was with her children. And she said that she had no control over this switching, that there there was no agreement among parts. And yet, when you really observed it, there was some kind of implicit, maybe unconscious, agreement that she not switch when she's with her children, which is a very protective thing for her. And in that sense, I think parts are sometimes working together in ways that a client might, it might not be obvious to the client.
So you're not, you're not saying-. I think this is a piece that is often misunderstood, even from the workbook. People will take that piece and think that they're saying that those parts don't exist. You're not saying that these all parts of people don't exist; you're saying that they're so real, they're actually more connected than we're aware of? Like, as a whole?
Yes. I mean, every part of us exist. It's not a matter of existing or not existing. It's a matter of understanding what that part of us means. That's all. It's not that parts don't exist. Of course they exist. But they don't have, you know. If you have three parts, you don't have three separate hearts, you don't have three separate brains, you don't have three separate bodies.
Right. Right. I think that goes back to what you were saying in the beginning, sort of when you were normalizing what a experience it is even though this also involves trauma. I know that my husband, for example, now that he's learned about the podcast, and talked about the podcast, and listen to the podcast, he talks about it all the time now. He does not have anything even near DID. But he's like, this part of me needs this right now, and this part of me needs that, like he's so much more self-aware. Right. Just these different aspects of who we are, and how that works together, and when there is conflict internally, even when you don't have DID.
Right. Right. I mean, an example for me is in the past 15 months, I've become a grandmother twice over for the first time. And that's a whole new identity for me, being grandmother and all that that means, and it's kind of mind-bending. Like, “What? I'm a grandmother, that can't be.” And so integrating that whole experience and who am I as a grandmother. And I know that's a role. But still, it's really interesting to integrate a new way of being and a new way of, you know, what it was like to be with my grandmothers, and what I want to be as a grandparent. And actually putting that into practice has been really interesting journey of growth, that I now have a whole another part of myself. That is, you know, it's pretty cool.
That, I love that example. I think it's, it's absolutely one that applies to everybody. Whether like in any role that we're talking about, and where we get the experience to do something, and how we integrate that into how we want to do it well, whether that's at work or at home or socially.
Going back to the workbook, which I talk about on the podcast all the time actually, kind of going through the workbook and sharing some pieces of that. What other resources would you recommend either for survivors or clinicians?
Well, there's a wonderful new book out just in the last month by my my Spanish colleague, Dolores Mosquera. And it's in English. It can be accessed on Amazon. And it's called Working With Voices and Dissociative Parts. And I think it's a wonderful book for clinicians, but even, I don't know, it might be a little triggering for for clients. But you know, lots of clients like to read more therapeutic books. But it has many, many case studies and session transcripts so that you know exactly what's happening in therapy. It kind of demystifies it. And I think it's a, it's a wonderful book that helps therapists understand hearing voices much better, and how to work with dissociative parts in a very systematic kind of way. And Dolores is an EMDR therapist. And so it's it's primarily focused on EMDR. But there's a lot of good therapy in it.
Do you do EMDR?
I do a little EMDR. And I'm definitely not an expert in EMDR. I would never say that I was. But it's one of the tools that I have in my my pocket.
How would you explain that to someone who's interested in finding a therapist with EMDR? How would I explain EMDR? Just simply. It’s not a test.
Well, yeah, well, I think we don't entirely know how it works. But that's the great mystery of it. But there's something about bilateral stimulation that helps the brain be able to shift the way you think and feel. EMDR talks about it shifting from, you know, to more adaptive information. But it helps shift really stuck places in people, particularly around trauma. And Dolores, for example, has taken it to a real art form of working with the real stuck places that happen in dissociation. Like if, if parts are really afraid of each other, for example, she uses some EMDR type things, they’re not full EMDR protocols, but some EMDR bilateral stimulation to reduce the intensity of the conflict between parts. It's pretty cool. And it's not for everybody. I have clients that can't tolerate it. They don't like it. They prefer other methods. So I think what's important is that you find a competent therapist that has options for you, and find out what works for you best. And most of my clients, I use a variety of other things, approaches, but more than anything I'm just in the room with the client and and I'm working with their experience in the moment.
So present. Well try to be as best I can.
Is there anything else that you feel like we left out in covering so many broad topics that you would want to include?
Yeah, I I guess the the one thing I would say is that I think there's a lot of hope in in, and healing, in working with dissociative disorders. I've seen it many, many times. And that if you work hard with your therapist, you're much more than likely to get better over time. And that's, that's a hard thing to hold—hope—I think when you've, when you're coming into therapy already feeling hopeless. But I think given so many of my clients have gotten better and gone on to live really productive good lives. It doesn't mean their lives are perfect, because nobody's life is perfect. But they've they've really been able to move forward. That's what I would say is I think there's hope.
I love that that's the one thing that you pick to add.
Well, it's the thing we all need the most, right? Otherwise, how are we going to move forward? And if you haven't ever taken the journey, how would you know if there's hope in it or not? And I can just say, having been on that journey with many, many clients like, “wow, yes, there is definitely hope.”
I just had to let that hang in the air for a minute. Let it soak in.
Yeah, that's right. Because we also know it's a long journey. This is not a quick short term 20 session therapy, right? Right. So it's really hard when you're in the middle of a long slog to to hold the hope. But I'm just real clear that the vast majority of people I've worked with have gotten better. So something must be hopeful about the process.
Well, and even that gives more hope. When you're coming from a place where things have been so hard for so long, and you don't think that they're going to get better, or you won't feel better. And so much of the older literature or or lower quality, if I'm allowed to say that, unofficially stuff says like this is just a long term thing, and kind of sort of stamps that condemning us to it kind of thing. Yeah. Yeah. That getting better is really a possibility.
Yeah, and getting better, you know, happens in increments, of course, for all of us. So taking that little bit of better that you have today and hanging on to it, and building on it for tomorrow, is the way to do it. It's not going to happen, like overnight.
Right. I think that's part of why that culture of some of those groups online, or support systems online, have gained such momentum. Because they're taking advocacy from LGBT and from disability groups, and sort of using that to have some forward momentum when otherwise they wouldn't.
Right. Right. I hope they get that forward momentum.
It's It's such a long journey. And those who are-. Like, the podcast now is in more than 60 countries, and there's so many places that have no help at all.
I know. I know. I know. It's really tough, very tough.
Hope. I love it. Thank you for sharing.
You’re welcome Emma. Thank you for having me.
[Break]
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