Transcript: Episode 43
43. Dr. E on Shame
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This is Dr. E and I have shared before about some of what we're learning regarding shame, and I wanted to share what we learned at a conference yesterday about shame, and some of the things that she shared. The speaker was Kathy Steele, who is very well known for traveling to different dissociation conferences all over the world and as part of ISSTD, and presenting about dissociation and trauma. She subscribes to this secondary-tertiary dissociation model where there's dissociating at the trauma responsive level, and then there's also the dissociating among different parts. So, rather than using ANP, for apparently normal parts, she uses DL, meaning daily living part. So for example, I would be considered one of those when I'm doing my daily job. She also does not use EP as a term for parts, but rather TF for trauma-fixated for other parts such as littles. However, she also doesn't think that you should necessarily work with parts directly, but rather only the DL or the daily living part as an adult self. My concern with that is that the D L, as she calls it, who's presenting in therapy is likely not who she is assuming that person is to be. If there is a structural dissociation theory, then that part that she's calling a DL, kind of in a reference to the old school version of a core, or a main part, that one is just an altar as well. And so I have some concerns. And I'm not really sure that I entirely agree or understand with her approach on that. But I'll be talking about that at the Plural Positivity Conference that's coming up in March.
For today, I just want to share about the shame pieces that she taught and how that fits or doesn't fit with some of the things that I have learned before. So to start with, she shared some history, which we know. That in 1987 research showed that shame is already present as a primary emotion at birth. And then it comes online fully during the second year of life, which is part of why there are so many tantrums with two and three year olds. Part of that is also their independence. But you see the shame come in as they are differentiating, when they are struggling with new tasks and have some frustration tolerance that they're building, but also the emotional response to not being able to do what they want to do, and not being able to do everything that older siblings can or that their parents can. And so they are learning then the difference between guilt for when they do something wrong, like being told no, and shame for being not enough, meaning not able to do what other people can do, or also confusing being told no with being told that they're bad. So these are lessons that happen very early in life, both internally and externally.
The other thing that we know about shame is that it's not just one feeling. It's a composite of feelings such as fear and disgust. And sometimes guilt, true or not, or false guilt, can be part of it. I think in this way, I've not heard this presented or seen it in research. But I I believe that in this context, it also has to do with just a level of discernment and part of object relations between what is the difference between you and me, what is the difference between good and bad? How do I hold both? How can I do something wrong, but still be good. And so I think there's a lot more research that will be unfolding as, as the trend continues to study shame and its impact, especially on trauma survivors.
Shame is also one of the self-conscious emotions. Meaning it's something that you're aware of, and something that makes you think about who you are and who you're not. So it's one that's reflected on. So with trauma survivors, when there's cognitively some rumination happening anyway, then this is part of how shame gets reinforced as an internal dialogue.
Further, shame is also an auxiliary emotion that inhibits positive emotions. So Kathy Steele gave the example of a client who has severe shame issues, but had done something really well in school and was telling her story about being really proud of herself for doing well on this paper or an exam or something. And her effect was bright. She was animated and energetic, and she told this story. And then as soon as she finished telling the story, she just completely shut down and slumped. Her head turned down, her effect was flat. And it's because she had this shame dialogue that was so intense that told her even when she had done something well, that something was still not good enough, or that there was this was going to be taken from her in some way. And so even though it was a positive experience, the neurocircuitry in her brain was so hard wired toward shame that she immediately felt bad because she had done something good. It wasn't just that she had done a lot of things wrong, it was that she had done something well, but then had been proud of herself. And that triggered danger signals in her brain. And so you can see in the neurocircuitry, which I will also talk about at the conference, how the brain adapts. And when these signals get reinforced, and these neural pathways get reinforced, then they almost trigger themselves even when the circumstances and environment are now positive and good.
This is one reason that therapy is so necessary for these issues because, as our systems as, Now Time is safe, but if your brain doesn't know that, you can't do the other work to hold on to it or other work to work on past issues, because it's not differentiated. So it's really important, for example, that our therapist is working on Now Time is safe from the very beginning, and first, before we've done anything else.
There are different ways that shame shows up, such as feeling inadequate or incompetent, such as needing help, a lack of perfection, feeling broken or damaged. And again, some of these things may initially appear as false guilt. You don't need to feel bad because other people abused you, and yet all of us do. And so that's an example of feeling shame because there was badness even though the badness wasn't yours.
Also, when you are a trauma survivor it is hard to ask for help because help either didn't come, or had strings attached, or became an opportunity for punishment. And, in addition to that, there's the experience of your needs not actually ever being met. And so this goes back to what Patricia DeYoung shares about shame being related to feeling bad for who you are and that you had needs, rather than needs being a healthy and normal and appropriate part of development at any age, or in even any new skill. It also goes back to the Still Face Experiment, which you can see on YouTube if you don't know the video, where the baby works so hard to match the expression of the mother just to have some attunement and to meet that need of connection. So the drive for connection is so deep that it will be matched in negative or poor ways, even if that's not the initial need that the child or person has.
So one thing that I encourage survivors to do is to surround themselves with things that are good and positive, not in a fake Pollyanna way, but in a way that models some of those nurturing needs, even if that was not your parent or your primary caregiver. You can do this through books or through movies, or through finding role models or mentors or positive people who can encourage and strengthen you and provide some of that attunement, even before you get to a good therapist or before you are able to do your own trauma work. I know that doesn't solve everything, but it provides some attunement needs and can shape some of your perspective and sort of a holding pattern until you're able to engage in the therapeutic process.
We can also feel ashamed for feeling unlovable or unacceptable, and that includes body shame. And again, this has to do with the history of trauma survivors for sure. We can also feel ashamed of our loss of dignity. And that goes back to abuse issues such as humiliation, objectification, degradation or dehumanization. It's no wonder that you feel badly about your body, or who you are or, or even existing sometimes, when you've been through the things that you've been through.
You can also be ashamed of your inner experience such as emotions, thoughts or sensations. So I know when I was initially diagnosed when I was in college, I had already been in therapy for two years and had no memory of it. And I was deeply ashamed of this. And deeply ashamed of my behavior and my interactions and my choices when I was not the one out front. I didn't have the words for being out front or fronting, I didn't have the words for what happened when I lost time, or even the phrase “lost time,” I didn't have those words yet. But I had deep feelings for shame about these issues. Further, as I continued it through grad school, I had deep shame that I had such trauma issues, and felt it very difficult to claim them as my own because I only knew about them through that therapist that diagnosed me. I had no recollection of them, and I had no recollection of the others or any contact with them. And the more that I built up those walls, the less in touch with myself I became. And it wasn't even until that interview that I did with Susan Pease Banitt that I was ever even able to out myself, for lack of better words, as DID in a professional setting, even though that was still just the context of the podcast. For me, it was a really big deal. So sometimes that shame is eased, or healed, even when it's just brought to the surface in those ways.
We can also feel ashamed of our behaviors such as substance abuse, or sex addictions, or other issues that are behavioral and related to our past or are associated in some way with trauma, even if we don't fully understand it. So for example, I know that we collectively are super sensitive about having our picture taken or being in videos. And I know now, not the full details of or the story of or the experience have, but finally, because of reading the notebooks for therapy, I know pieces of why that might be possible and what brought that on. But that feels really distant from me and not at all connected to any experience that I have any direct recollection of. And so what I only feel is the shame of “I don't want to be in pictures.” Even professionally, it's very difficult to me. I've had different scenarios where I had to provide a professional photo for work, or for presenting somewhere, or doing radio interviews or being on television, or different things. And it was very difficult for me and very uncomfortable for me. And I only felt the shame for that behavior, that such a simple thing was so hard for me. And that shame was there long before I had any context for why that might be.
We can also be ashamed of uncontrollable and overwhelming experiences, such as poverty or trauma. We actually learned a lot about poverty during the years that our youngest child was in the hospital for several years after she was born. I had always been very careful with my money, and I regulate the money for our system, meaning I give everyone an allowance. And we are careful with how we spend our money and manage it, have come to learn how to manage it in that way. So I'm really good at budgeting and really careful with money. But when both of our parents died very close together and we had to pay to bury them and all the final expenses, there was no one else to pay for that. And they had no arrangements made for that. And covering that used up all of my savings, even like my 401k that I built thus far as a young adult. So in some ways I was grateful because I had that money to do it. Like we were able to take care of it because I had that money. And that's kind of the kind of emergency that a 401k or those things are for. But at the same time, I was really frustrated. And I don't know that I've ever spoken about this directly. But I was also really frustrated because I had very little relationship with the parents, very little memory of the parents. And so to me it was, for lack of better words, like a nail on the coffin of those relationships. That they had this one final way, even though we were not in contact, they had this one final way to just take what I had for me. So there's shame in that memory and some anger I think there that I don't know where it is or how it shows up or where it's going, but I can sense it and I'm aware of it. And that's maybe the closest emotional response to any of my history that I'm aware of. But because of that experience that used up all of my financial resources as a young adult, so when we then got cancer the year after that, and then had this child born that had medical problems the year after that, we were starting at zero. We had no reserves to rely on during those times. And it created a lot of crisis just because of poverty.
And there are things about poverty in America that I learned through that experience that I had no idea was part of our society or culture. It is very expensive to be poor. You have to pay higher fines and extra fees when you are poor. You have fewer choices when you were poor. It's exponential. It's a very difficult thing to crawl out of. And we ultimately even sold our house to pay for the medical bills for our youngest child. So, doing that we were able to recover. But again, started us out at zero.
And this is not even a situation where we had done something wrong. There's so much stigma with poverty. I could do another podcast just on that. There's so much stigma with poverty, about people who are not trying hard enough, or were not working hard enough, or just wanting to abuse this system. It's really, really difficult. Actually, there were some places that would say they would provide help or assistance with this and this and this, but only if you fit this category, or only if you had already tried this, or only if that there was there. I remember one time, I remember one time the bishop from our church telling us to go to this community agency because they would help pay our utilities for one month. And we went to that agency, which was a whole other shame issue of having to go ask for help in that way. And then when we got there, they would only cover us if we had already received either an eviction notice or foreclosure notice. And if we were being evicted or foreclosed on, we would not need help with the utilities. Like, we wouldn't be there. And so it's just been very, very difficult to fight this system in that way and to crawl out of that oppression. And we learned so much about the shame in that. Even though nothing happened to us, like we did nothing wrong. The husband worked two jobs all of those years. We worked two or three jobs, sometimes literally for 20 hour days or more when we worked at the hospital so that nothing, we had done nothing wrong to find ourselves in the, like, thralls of poverty. The only thing that happened to cause us to be in this world of poverty was that our parents died, our body got cancer, and our child was born with an airway problem. That's all that happened. None of that was about anything we did wrong. But there was so much shame and so much stigma about poverty, and trying to ask for help, and trying to find resources for help. It was really difficult. And so it's become something very important to us now, to minister, for lack of a better word, to others not necessarily that are just in poverty, but that can prevent some of those things happening.
If people are kind and generous before there's a crisis, before a family is in crisis or a mother is in crisis, you can prevent some of those things that happen. If someone had just helped us in the beginning, or some of those agencies or friends who later said, “Oh, I didn't realize things were so bad, here's this or let me help with that.” If they had helped with those tiny, tiny ways at the beginning, things would not have escalated the way that they did. So now when there's an opportunity to share or to serve in ways that we're able to do now that we could do before, even if it's just in small ways, that's really important to us because I think it makes a bigger difference than you realize. If you can educate women, if you can support women, if you can provide families with things that they need, especially when they're working so hard to do all that they can do, then that's worth it. And it makes a difference. And it rescues families. And that's an example of fighting shame and empowering people instead of shaming people. So that's just a big issue that we learned about that we had no idea was even out there until we experienced it. So maybe that's, as far as finding meaning or meaning making, that may be one reason we had to experience some of those hard years so that we would know how to advocate for other people.
We can also be ashamed of someone or something else such as family or political policy. I have said enough about poverty. I cannot even start talking about politics right now. But definitely there can be a shame. But even if we're looking at the clinical world and the world of therapists right now, a political example would be the shame over some therapists dismissing other therapists who work with dissociative disorders. Or a clinical community dismissing therapists who also have DID themselves. Or different issues, or different camps of how to treat DID. This camp says you should treat it this way, and another camp says you should treat it this way. This is happening with the ICD-11 and complex PTSD, which will come out as an official diagnosis with the ICD-11. Because one group of people says you do not need to do the stabilization phase of therapy, you guys just want to make more money, and you're oppressing clients by making more money off of them. And the other camp says, no, part of healing is the stabilization skills, you do need that phase, you guys just don't want to do it because you want to make money off of this quick model that you say you've developed, but really is the same thing as this just really fast. So even politics among healers divides us instead of empowering us.
The same thing happens within the community when we have different systems acting out internal conflicts with each other in the DID community. It's divisive and it's drama instead of empowering each other and supporting each other. Everyone has been through enough. And we need to heal together and support each other, rather than fighting each other.
The other thing about shame is that it does actually have a social function. That social function is not always positive. So in the example I was just giving in the DID community, you can't have one system calling out another system for things they did wrong, or for or trying to expose who they are in real life. Things like that are attempts to establish power over another. And that's just not okay. Shame helps us learn and keep the boundaries of socially acceptable behavior so that we can be part of our group. So this is true whether we're talking about internal systems, whether we're talking about inter system, like between systems externally, or whether we're talking about a community inside, or a family, or an outside community, or the DID community as a whole, or even a town or a city. Like, any dynamic that you're applying to this systems approach. What it really is, is guilt that we should feel bad when we do things wrong. That's true. That's part of what keeps us from repeating those behaviors or violations of whatever code or moral law that you're referring to or working under. Those boundaries also provide a way for a group or a community to have an optimal level of closeness but also distance. So within a system you may have rules of engagement, so to speak, of, we can all work together and everyone gets a vote, and we can discuss things as a group. But part of that is agreeing as a group that we're not going to hurt the body, or that we're not going to go do X, Y or Z because it's not good for us. And that may look different among different systems. It's the same as different cities have different codes or laws in the city regulations, or different states have different rules, or different countries have different rules and laws.
But the difference is that chronic shame no longer serves a social purpose, creating chronic disconnection and profound inner anguish. Which is not the same as setting healthy boundaries and feeling bad when you cross them. This is again, rather than guilt for doing something wrong that you did, this is shame for who you are, which is not healthy or functional. It creates disconnect, whether that's internally or externally with other people. And it is stressful. And I love that word “anguish” that she used, the inner anguish. That's so true.
Historically, shame is a primary affect associated with the innate motivational system concerned with social ranking. It has to do with dominance and submission in the animal kingdom. And it's one reason why it's such a violation from abusers to survivors because for something to be abuse, because it automatically involves the misuse of power, and a child is already in a submissive state. I don't mean submissive as in obedient or oppressed, but already when there's abuse of a child, there is already an imbalance between age, and understanding, and capacity, and power, and physical strength, and physical size, and all of these things that already put the child in a submissive state compared to the power dominance when we're talking about the dynamics between the abuser and that survivor. Shame as part of this creates a hypoaroused state of submission. And there's a higher order of cognitive experience that involves feeling less than or lower than. So this imbalance of power is always part of abuse. This is an important piece to remember when we're talking also about organizational abuse, or any kind of ritual abuse. But it's still a thread with any kind of abuse at all.
Shame is also an inhibitor. It can serve to inhibit positive emotions like joy, interest or connection with others. That's why shame is one reason it's really hard to ask for help in the first place. And then even with our therapists, for example, when they go to therapy, I will hear them talk all the way there, or all week long between sessions, about all the things that they want to tell the therapist and how much they miss the therapist and what they're going to do in therapy. But then when we get there, no one can talk. They don't, it's really hard for them to talk. So this is part of what makes it hard to open up. Again, when you're talking about healthy boundaries, part of the social function of shame serves to protect. And so for example, that helps you not open up to just everyone, or even not tell every therapist everything until you know which therapist is really able to help you, or until you have a safe place with a safe therapist to go ahead and open up and start sharing. And even when we're talking about plural positivity, there may be some people that it's actually not safe or appropriate for you to tell about DID. There may be some people that you have in your life that are safe and appropriate, you can tell them. So shame doesn't always have to control you or be oppressive in some way. It sometimes can help you be wise and careful with what you share with whom, and help in some boundaries.
It can also serve as a defense against other negative emotions such as anger, grief, or disappointment. So when some of these harder emotions come up, if you're already more familiar with shame, it may be easier to default to shame and to feel shame rather than feeling some of these more complicated feelings. And then when there are some things that you should feel shame about but you don't, then it's kind of important to look at that red flag as, as far as what piece of the experience you may be dissociating from.
A research study in 2014 talked about how the child abuse is a major risk factor for shame. And we also know that shame is a mediator between child abuse and adult psychopathology. So if we don't deal with the shame, even though it's hard, we're going to get sicker and we're going to be unwell. So regardless of political issues, like functional multiplicity or things like that that you have the right to choose in your own therapeutic process, we have to deal with the layers of shame in order to be well. And that's one reason why there's such a movement for survivors to connect, because it's a way of addressing the shame. When you're standing with someone else who understands what it's like to be where you have been, or who understands what you have been through already, or who can help you carry that shame so that you're not alone in it, that's a powerful thing. Whether that's with a good therapist or with another survivor with healthy boundaries.
Shame is a mediator between child abuse and dissociation as well. That study came out in 2000. And there's some way that shame is part of the process of dissociation. It's not just that it's too much to feel or just that it's too hard, but also that there is shame involved and you need a way to to separate yourself from that.
Shame is pervasive in dissociative clients. That's, those studies have been all over the place from 2017, 2015, 2011. I can put these references on the blog. But shame is also thought to evoke and maintain chronic dissociation. That's from Patricia DeYoung in 2015, but also goes all the way back to Kluft in 1996, with other studies as well. So again, shame plays a big role in dissociative disorders, not just be because of the nature of what we've been through, but the process of living life having gone through what we've gone through. So this is why it's critical to find a good therapist, a connective therapist, a relational therapist in some way, who can see through those things and see to you, and that you can see them seeing you in that way. It has to be experienced relationally. Even if it's not a formal relational therapy by model of therapy, the therapy itself has to be relational in some way to bring healing to the shame piece. And without healing to the shame piece, the dissociation will not get better.
Experiences that evoke chronic shame may be dissociated and thus are typically not accessible to the client. So again, even the wording of that sentence has the assumption that the body is a person, and that person is dissociated from itself. But when we're talking about structural dissociation, there's a failure to integrate during development. And so any part that you're working with, even if you think that's the daily living part, is also an alter. They're all alters. Chronically ashamed clients feel that they are defective, but are also often unable to connect that belief with actual events. So when you have chronic shame, you walk around all the time knowing there's something wrong with you. But you don't necessarily know why, or what it is, or why you feel that way.
So this is an example of something that I experienced because I was aware my entire life. My first memories are in kindergarten, what I did was school and our education, that was my job. But I was not aware that that was my job. Those were just all the memories I had. I had no memories of my parents, other than a few times when they did not come to pick me up at school, but I had no idea other people remembered their parents differently until I was older and engaged with my peers at a more social level. But even then, I was so different from them and could not relate to the way they experienced the world that I simply resolved that by isolating myself from other people, and just did not have friends at school, and did not engage in social relationships. So there was a disconnect between what I could sense about myself and how I understood myself, and the actual events causing those experiences.
In the physiology of shame there's hyperarousal. This comes from DeYoung that the hyperarousal includes anxiety, fear, panic, disgust, there's an initial reaction of being seen or found out. We, this is a big theme for us. We really have a problem with feeling that. Even so much as trying to attend a CEU training or conference which is required for me to keep my license. I have to arrive almost two hours early to get through the panic attack and anxiety early enough to be able to get myself into the building and into a seat in time for the conference to start. Like it’s a really difficult thing. And it's why something like Family Services coming at Christmas time was such a big deal because it reinforces that feeling of “Oh, we've been caught. We've been found out. It's really us that is bad. It's really us that is wrong.” And that goes back to shame. Because experiences like that reinforce that, “Oh, we were the ones who did something wrong. We were the ones who were bad. We did deserve what happened or it was our fault that this happened.” Those are all trauma responses.
There's also an initial sympathetic surge hyperarousal followed by freeze and parasympathetic activation hypoarousal. So it goes, like there's an initial this flushing of feelings of adrenaline or that engages the fight or flight response, and then hyperarousal from the dorsal vagal nerve with parasympathetic activation and an inability to speak. So this happens to us in therapy when we start to face something, there's the initial anxiety of going into the therapists office, even though we're glad to see her and relationally we feel pretty strong in the connection now after a year. But once we enter the room and sit down, there's this rush of awareness of what we're about to face, even though we don't necessarily know, whoever is there doesn't know what we're going to talk about or what exactly we're about to face, there's an awareness of the proximity of the danger, and then as those chemicals flush through the brain and settle back down, the response to balance that, to handle that rush of chemicals is to shut down the things that are dangerous. And it causes the shutdown of the brain, the area of the brain that you use to speak and find words for what your experience is.
So this is the ironic thing about therapy and why it's so hard for survivors to engage in therapy. Because when you finally work through the layers of shame to ask for help, and you do the work to find a good and safe therapist who knows how to help, and you work through all those brain chemicals to actually get yourself into the office, then the way your brain handles that level of anxiety and shame is by shutting down the part of you that is able to talk. The part of your brain that is able to express stories and words and feelings associated with what your experiences were. This is why therapy takes so long and it's not just an easy thing.
So Kathy Steele also said that shame is about seeing oneself through the eyes of a critical other. And she proposes that dissociation is actually a process of internalizing that critical other. So she has a model, she has a model rather than a ANPs or EPs, as I said earlier, that if you see a circle, that the top part of the circle, the surface of who is presenting out, is a daily living part who is the adult part associated with the body age—this is her perspective, okay—associated with the body's age. And if someone is actually DID there may be several adult daily living parts handling different functions. But that everything internal, from the trauma-fixated part, such as littles for example, filters through this critical other. And I can put a picture of it on the blog so that you can see her model diagram. But this is how she approaches it. So it's actually a picture of the shame.
But the ironic part is, I feel like what she's done is draw a picture of shame itself rather than a model of personality states. Because it puts, it literally puts the daily living people over, like overpowering like, like what she just talked about with the imbalance of power. It literally puts them over the trauma-fixated parts. And I know that that's what she wants to do as far as, that's how she sees maintaining control and maintaining functioning. And there's some truth in that, in that, for example, my family and my own survival, especially coming out of the years of financial hardship that we've had, our family depends on my income. And if I cannot function and I cannot work, then our whole family, not just internally like in the past, but our whole family of eight people will be in crisis. And so I'm very careful and very limited about how much I get involved with therapy or how much I do. I want to be aware. I want to participate in meetings or discussions in ways that are helpful. But as far as trauma information or doing the therapy, we are not in a place yet where I can address that. If it comes time for that later, I'm confident that our therapist will know how to help me with that. But right now, we are just stabilizing even financially and functioning. And even that, we've had to be creative to do. I literally work from my home. We don't leave our house except for therapy. Very rarely. Going to the conference is a big deal. We don't leave the house. I don't know if that counts as agoraphobia or not, or what those issues are, or if it's just all under the umbrella of DID. But it's a very difficult thing and a very big process. And for us to maintain safety and functioning as a family, I cannot lose my job. And already I have to work from home. So I have found ways to create income online so that I can be at home and work from home and see my clients from home so that, so that we can function even when we're not functioning.
So I see what she's saying in that there's a separation between this upper layer of daily living parts, and a lower layer of trauma-fixated parts, but it also could be looked at in the same way through the lens of Now Time and Memory Time. But I think if I were talking with our therapist about this, she would move everybody up. Like that's sort of what she seems to be doing is rather than separate us through this lens of the critical other, she's supporting the critical other so that everybody can move up on top of it. Like, rather than keeping those pressed down and isolated, she's bringing everyone up to be together on the same level. So I don't know what that would look like on this diagram that Kathy Steele has made. But I feel like at least for us, it's a much better and more accurate model than what she's presenting at this conference.
So I was really uncomfortable with the way that this model is presented. And I was really uncomfortable that she was telling 150 people to also use this model. So I may talk about this more at the plural positivity conference, and come up with an adaptation of what she drew as a model to how we do it, which feels much safer, and much more relational. Because I feel like there's something about this model that just feels icky. And that's not even a professional word. But there's something embedded in this model, in this diagram, even that has to do with shame and acts out some of that power imbalance. And I'm just not okay with that or comfortable with that.
But because shame is involved through the eyes of the critical other, which in Memory Time that's true. It involves challenges in learning to mentalize accurately in the present. And she uses this word, she's coined the term “mentalizing.” And what she means by mentalizing is that you're able to accurately read other people. So rather than interpreting other people's actions as fear, or as about you, or taking it personally, that you're able to keep it on them, and separate yourself from them, and accurately understand.
So for example, the therapist is about to go on spring break because she has a child who goes on spring break. We have children that go on spring break. That's just about spring break. It's not about she's abandoning us forever. It's not about we'll never get to see her again. It's not about winter will never stop. It's not about she hates us. Like, none of those things are true. What is true is that it's spring break, she has to stay with her child, we have to stay with our children, because that's part of parenting. That's all it's about. So that is accurate mentalizing, is understanding that dynamic. Unhealthy mentalizing would be taking it personally, or turning it into fear, or having false conclusions based on assumptions that were not accurate. So that's what she means by mentalizing.
It also involves challenges in learning to transform inner representations of self and other. And this is where she's talking about parts. She was saying that, and I will again talk about this more at the plural conference. But she was saying that she does not want to work with individual parts unless that's all that the client would present. This also felt really uncomfortable to me. Because she's saying that doing that reinforces dissociation. And I understand that perspective. I see what she's saying. And it's important that we all work together if we're going to be involved with healing. But my concern about what she said is that she's then, again, very parallel to the abuser dynamic. I'm not saying she's an abuser. But she fits that pattern of, even in her own shame based definition, because she's then externally choosing which part gets declared as the daily living part and the adult part and the chosen one that's more important to work with than everybody else. And I have concerns about that. I have concerns that it's therapist driven instead of client driven. I have concerns that she doesn't necessarily know based on who's presenting in our office who's actually out in everyday life.
And, like, I don't see the therapist ever. I maybe have seen her once. I've talked to her sometimes. I've checked in with her sometimes. I've emailed her sometimes. But mostly I just work. But that is like nine hours of everyday of our life, six days a week. But I don't go to therapy. So what if our therapist just decided that Sasha or Cassie or someone was all of a sudden now the main part who is the only one who gets to work in therapy? The other daily living part that we have would be Em, who does all of the very difficult work of being a wife and mother and is out most of the time that I not. But because but she hasn't been to therapy, she needs to go to therapy and I think she's moving that direction. But she's, but there are so many things to work on. I don't understand how forcing one of them who is either not ready to go to therapy, or not ready to participate, or it's too hard for them yet, or is too hard while we're trying to parent or trying to function at work. I don't understand why choosing one of them and forcing them to be the one in therapy, and not engaging with the others who are asking for help and ready for help and trying and trusting, I don't understand how that's better. That feels manipulative to me and feels abusive to me. But that may just be my own lens, or history, or trigger in some way that I don't understand. But even just from a cognitive perspective, I'm really uncomfortable with that.
The other challenge that shame gives is trying to feel safe with others, which involves accurate neuroception and collaboration and attachment. So she gives three layers, which I think are good layers, that shame makes really hard. One of them is the brain itself. So neurobiologically, when you go through the things that you've been through—neglect or abuse—shame in the brain interferes with your actual capacity to interact with others. I don't just mean your desire to interact with others, or Sasha learning how to make friends, I mean your actual physical capacity, your biological wiring in your brain, neurologically, your capacity, your ability to connect with others, is really, really difficult. And it takes time and practice to rewire that in the brain.
Again, that's why it's so important that you have not just a safe therapist, and not just the therapist who knows a lot about DID, but a compassionate therapist, or a connected therapist, or a relational therapist. All of those are buzzwords that you could use to help find you one. But someone who is real and authentic, and can heal through connection, not just through knowledge. Knowledge is not enough. Because what's wrong with trauma is that it's not a cognitive disorder. CBT is not going to be enough, in and of itself, to heal DID. Cognitive techniques are not going to be enough, in and of itself, to heal the brain from trauma. Trauma is relational. It's not a lack of knowledge. I know more people with DID who know more about trauma and DID from a head perspective, from a cognitive perspective—even myself—than most therapists who present at most conferences. I do. Because we study it. We want to know. We need help. We read all the research. But what that does not do is heal us. It does not stop it from happening. It does not fix it. It does not undo it. The only thing that heals is relational. It has to come through connection. And that leads back to attachment as well. And attachment is also only going to heal relationally.
The other thing that she shared research on is that shameful events are remembered the same way traumatic memories are remembered. There's intense intrusions. There's overwhelming physiological activation. There's an impact in the brain. There are strong avoidance strategies. And so there's a titration, or a level of stepping into it, or stepping down from it required for direct exposure to the shame memories. Shame cannot be banished. Again, shame cannot be banished with words or logic, it must be invited to be part of our own experience as humans. However, in the moment of experiencing shame—so a traumatic memory—shame may be so big and so overwhelming that it's almost impossible to connect with an other.
And I think that, at least for our system, is part of what leaves Em so isolated and so alone. So the goal of treating shame is not to get rid of it, because there are good things about it in the normal human experience. But with abuse and trauma, those normal experiences are exploited. And that's actually what it's like without shame. Because when there's no shame and anything, that's a psychopath. That's pathology. They have no social conscience. But shame is an integral part of human experience and an important signal for boundaries and healthy interactions. So we don't, it's not that we want shame to go away completely, because it has a role and serves a purpose. But chronic shame needs to be attenuated and compassionately accepted and understood. And that's where it goes back to attunement, like in the Still Face Experiment.
So Kathy also gave a list of some antidotes to chronic shame, including pride, such as competency and adequacy. So that's part of where the plural pride movement is coming from. DID Awareness Day is this week on March 5, and there's a big movement in the DID community to celebrate it openly and publicly as part of a pride day, much like the GLBTQ community. And it has to do with accepting vulnerability and fallibility. It gives some dignity back to survivors, that they are feeling in control of themselves and worthy of help and worthy of connection. It offers compassion towards self and from others. There is a relational aspect of mutual understanding and relational connection, a felt sense of emotional trust and closeness instead of a ranking paradigm, who is better and more competent and worthy and who is not. So that's what heals shame. And that's what you need to find in a safe therapist who has an ability to connect and a capacity to connect. Which means they cannot, if they have their own shame issues that are not worked through or that they're not aware of, but if they have their own shame issues that they're aware of and work on, that's part of being human. And that's okay. And that vulnerability, Patricia DeYoung says, is actually helpful.
But what she just said in her own words, I think is the problem I have with her working model of dissociation. She said that “relational connection comes when there's a felt sense of emotional trust and closeness instead of a ranking paradigm.” And I feel like the model of dissociation that she has developed does actually rank the different parts. She is ranking the daily living parts, the ANPs, over the trauma-fixated parts rather than working together to them. And so I think that's where the cognitive dissonance is for me and why I'm not comfortable with her model. Because there's an inauthenticity there where she's not doing what she's saying. Her model says, “These people.” Well, she would never say “people.” My apology. Kathy Steele would never refer to personalities as people. She's saying, “These parts are better than, and more important than, and more functional than these other parts.” But the trauma-fixated parts are functioning. They are functioning in the role and purpose within they have been created, and given, and assigned, and chosen, and do. And all of that is part of their role and purpose. And our therapists would say that they are as important, and as equal, and as vital to the system as a whole, as me who has a job that earns the family money. So I think that's where my problem with her model is, is because she's saying that we need to work on shame because there's no one who's better or more competent or more worthy than anyone else, and then has a model of dissociation that rates these parts who are also part. They're not the person.
If you're going to talk about there's one person who is the person of the entire system and who is the body, that's okay. I understand that that isn't a therapeutic approach, and I understand that that for some therapists and even some clients is a goal. And I'm okay with that being a goal with those people who choose it. But if you're going to say that, then you have to recognize that that person has not yet been created. Because that person is a composite and has access to all of these parts who are a part of who they are. So when you're talking about a part of the whole, then they're all equal parts of the whole, and they all matter. And I think that's a huge thing that is not coming out in the clinical community. And one of the biggest reasons for this global movement of the Plural Positivity Conference that is in response to this kind of oppression that is just written here. So I will talk more about that at the Plural Positivity Conference. But I think that right there where she said that, is where the in congruence is.
So what to address for shame and treatment is: the conflict between wanting to be seen and understood, and not wanting to be seen; the fear of being shamed by others; the fear of feeling shame; the fear of trying to tolerate the physical sensations; the inner shame, and those who are shamed by others inside, so parts shaming other parts; and how shame interferes with other emotions such as joy or curiosity or anger. In therapy, you also need to address flashbacks of shame experiences, reenactments of shame, shame as a regulator of interpersonal closeness, major defenses against shame, hyper and hypo arousal, the social and cultural aspects of shame, and shame resilience.
So how do you tell that you have a therapist who's good at connection or relational therapy, so that you're getting attachment and healing even in your brain to rewire these things that cannot be healed with only cognitive interventions? There's a simple example that Kathy Steele gave that you can apply to your own setting. A therapist that's only being cognitive and only in their head, you will know because rather than joining you in that shame, the therapists will talk about the shame. Meaning they will say something like, “It's not your fault. You have nothing to be ashamed of. It's the perpetrator shame, it's not yours.” Or if you, like, if the thought is “I am bad and unlovable.” What's not helpful is the therapist saying “No, you're not. You're a good person. I care about you.” Not that those are bad things to say. There can be good times and places to say things like that. But a relational or connected therapist is going to say something like, “That sounds so painful and lonely. Can you share more about what it is like to feel so unlovable?” And be there in the shame with you and help work through it, just like a traumatic memory.
The same thing with traumatic memories. A therapist who's connected and relational, and knows what they're doing will join you in that memory and help you heal through that memory, rather than only talking about the memory or shutting the memory down. A therapist that is connected and relational, and helping to heal the actual brain as well as your system and the parts of your system, will join you where you are, whoever you are, whatever parts are there to participate, and will hear and be with you in whatever memory is there, or whatever shame is there, and meet you with compassion without trying to diminish your experience either of shame, or of trauma, or of parts.
That moment of connection is where the healing starts. When the therapist connects with you in those moments, rather than trying to get rid of parts, or get rid of moments, or dismiss your shame. When they connect with you in it, that's when the healing starts.
She even talked about how to do some of this connection through imagery and EMDR. And because of my own issues with trauma and dissociation, I do not use imagery or EMDR, either one, because I can't stay present to do it. It's as simple as that. I can be vulnerable and share that it's not just that I haven't chosen that model or not been trained in that model. I've specifically avoided those models because it's not something I am able to stay present and do. So I don't do them. And I was not able to stay present even for that part of her presentation. So there's something there that's obviously connected to something else. And I don't know what that is. And I'm okay with not knowing with what that is right now. That will come in time and we'll figure it out. But if you have a therapist who is able to use some of those techniques, and it's helpful, then they'll know how to do that. And you can talk to them about it.
The last thing that I wanted to share that she said, I have actually never heard on any other presentation on dissociation or from any other researcher, and I have never read about it in research. Although I've seen many survivors feel this or express this or discuss it. And so I was really impressed that she brought it up, and I love that she said it. So I was really hard on her about her model, but I loved this piece, and so I wanted to make sure that I mentioned it.
In reference to integration, she said that integration is a journey, not an event, and it's never finished. She talked about how your personality is not a tangible thing, that you can just pull out and put on the table and say, “Here it is, this is what it is.” And she explained that that's why, she says, that the different personalities or parts of any of us, even people without DID, are a representation of who we are. So that helped me understand a little bit more of what she had said earlier, but she's said the challenge with dissociation is that it separates those representations. So what integration looks like is a coming together, not of anybody going away, but of a coherent narrative where there is access to all aspects of self or these representations that make up who we are, and also is adaptive in daily life. And she talked about cases of people who were, quote, quote, “integrated,” but who were not able to function in daily life on their own. And so she said functioning is more important than how many personalities or experiences, and that really the number is irrelevant anyway. What she said is that as parts increase tolerance, skills, and acceptance of their history and of each other, and of the stories of what they have been through, then the need for dissociation decreases. And that this was also true of anyone, not just with DID. So what I really, that she said, was that quote, which is maybe my new favorite quote in regards to dissociation, that “integration is a journey, not an event, and never finished.”
So it's not something that is done to us, and not something that happens, and not something you can just check off the list and then that's how you're stuck forever. It's not about which part wins out in the end, or even, or even only having one part in the end. In this moment of the conference, the way that she defined personality or ego states absolutely fit a functional multiplicity model. And I think if we can work on understanding the terms that she set forth in this description of integration, that it would give us more language and more access for advocating for functional multiplicity as an option for treatment, and better education of clinicians in training of this as an option. Because what she described is what we were talking about and have been asking for as a community, and this is the first time I've heard any clinician even reference something similar. So while it's not exactly what we were talking about, or the same thing that we mean by functional multiplicity, it was a description as close to that as I've heard from any clinical setting ever before. And I think that's progress. We'll take it. If anything, it's a starting place of connection and building bridges between the community and the clinicians.
But I hope this is helpful in some of the things that we've been learning about shame. This was another piece and why I wanted to attend this particular training. So there were some things that were helpful, some things that I learned a lot about that I didn't know before, and also some things I disagreed with that I will talk about more at the plural conference. So I appreciate you listening and the opportunity for us to learn together. Thank you.
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