Transcript: Episode 297
297. Guest: Kirsten Stach, MA, Dipl, MIACI (Part 1 of 2)
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Kirsten Stach was born and raised in the former East Germany. During her college years, Kirsten volunteered for the Blue Cross, an organization offering help and support to alcohol addicts. She’d gotten involved with her whole heart and they changed her perspective again and opened up the opportunity to become a psychotherapist. After finishing the Diploma in 1988, she started working in a day clinic for alcohol addicts, and at the same time started her training in psychoanalysis, psychodynamic, and body-oriented psychotherapy. On the humanitarian initiative of a Reverend, Kirsten, her former supervisor and a solicitor founded a nonprofit organization in 1990, for the reintegration of released prisoners and inmates, a forensic psychiatric unit. Kirsten conducted psychodynamic group work in different prisons. From 1995 on she worked for nonprofit organizations, the childcare and social and probation services, and amongst others, specialized in working with difficult, complex, dangerous and unmanageable clients like former inmates, mercenaries from the Yugoslavian Civil War, punks, Nazis and young heroin addicts. Her first encounter and subsequent interest in dissociative disorders started in 1997. In 2005, Kirsten relocated to West Cork in Ireland and has since moved to Malta. She established her own psychotherapy practice in 2007 and is licensed by the IACP. She joined ISSTD in 2010. Kirsten is mainly working with adult trauma survivors from different countries and cultural backgrounds. A high percentage of her caseload are clients with dissociative disorders. In 2019, Kirsten was awarded an MA for integrative psychotherapy from CIT Cork. Welcome Kirsten Stach.
*Conversations begins*
[Note: Podcast host is in bold. Podcast guest is in standard font]
My name is Kirsten Stach. I'm a native German person, but I have lived in Ireland for 15 years. And in December I moved to Malta. So now I live and work and practice here in Malta. And yeah. I'm 60 years old. I'm for 33 years in my profession as a social worker and psychotherapist. And I, yeah. I really love my job. I think I'm really, really lucky because of that. So, after all the years that stayed perfectly fine with me. And yeah, I live here in Malta with my partner, two dogs, two cats. And I'm very interested in history. So I'm in a really right place here because it's an amazing history. And, yeah, this probably I have the whole balcony full this flowers and plants. So I think given my job as a therapist, that's actually a really good thing. Loads of very pleasant self-care, I would say. So.
That's so lovely. How did you get into studying about trauma and dissociation? How did that start for you?
I was from the beginning. Then I started in a clinic for alcohol addict in the former East Germany, which was actually a great clinic, which would be very good today. We worked the psychodynamic approach. And it was group work and individually work. So it was a really pleasant place to work. So from the beginning, this working this addicts, I worked with very traumatized people. The sound that it would especially be called this way. I think in the 80s, you know, in Germany, it wasn't common. So yeah. It was normal, you work with addicts, they had some awkward things in their life and you work with them to that. And later in Germany, I worked with marginalized groups like prisoners. I worked for five years in person and did psychodynamic group work. So very traumatized, very traumatizing individuals. I worked with heroin addicts and their families, this asylum seekers, this homeless people, saw this punks, two full houses full of punks. They were lovely. I worked with young Nazis, I think quite successful to normalize their life and their thinking and everything.
So, and how I got directly into trauma was in 2010, in Ireland. And I remember that night because I had a client who I know now was very, very severely dissociated, obviously, very severe DID and a lot of hallucination. A lot of psychotic episodes. And one evening after he had left, I said, “No, I don't know enough.” So I had to do something. And I sat on the internet and I found ISSTD. So I was probably very lucky. And I wrote to them. So, and eventually started my, my training with ISSTD in, I believe, October 2010. And from there, yeah, I, it was a very conscious, yeah, really, really good journey. I could look back at all the work I had done in the past. And yes, I think I had mainly worked with traumatized people all my life. Yeah. But now, I had the framework for that and the end concept. So that was great.
My friend, I have a friend in Germany, who says that, in German, it is not dissociative identity disorder, that it is dissociative identity structure.
I don't know about that, to be honest. I, then I think, you know, the, my good colleagues from and friends from the Trauma Institute in [location indistinguishable], I think they still would call it dissociative identity disorder. So that would be new for me to be honest. I have to ask them because we have a symposium at the weekend, so I find out because the symposium is very very interesting and multidisciplinary on dissociative identity disorder. So then I know more.
That's interesting. I will be interesting to hear what you find out because it made me think, again, about the difference between sort of structure and process and what's going on. But also, even just what you just shared about a conference with multidisciplinary, like, that's really important, the whole team. They're doing something right.
This is, you know, and is not, I think it's not so common to do this way of a conference. Because they invite, for instance, medical doctors, GPs, speech therapists, even singing teachers. So, you know, it's, it's amazing so how they basically work together from a lot of different sides. Yeah. And I remember, two years ago, the conference where there was, you know, the singing teacher who, we all had to sing in the conference, which was really, really great practical. And she showed us a video from a young man who was severely dissociated. And he stood in different places in the room, in colored areas, I think it was like spot wings, like hula hoop rings. And he's sang the same song, which was the classic German song, in all his different self states. And it was really interesting to see. That was amazing. And the better he got, the better he felt, then all of his parts sang together, and this sounded completely different. So, you know, to see it from that side was actually very eye opening. Was brilliant.
That's beautiful. That's amazing.
So I really look forward to that symposium, you know. And I looked, Irina and Ralf Vogt, you know, they are members of ISSTD as well, and they are fellows. I've definitely a soprano. And look dated presentation at conferences here. So, but it would be different, obviously, when they do their own conference. You know?
That's incredible. Even the part about you singing. I know that. When I am in America, a lot of the conferences, you are sitting, you are listening. And when I am in Europe, a lot of the conferences there is there are lectures, and there are things that you learn, but there's also that it can be very experiential differently than only sitting and listening. It’s a cultural difference.
Yeah, that is, you know, that may be possible. This was actually two years ago. The first trauma conference I attended in Germany. Yeah. So but it was really good experience. Yeah. Otherwise, I attended all conferences from ISSTD, and they were, you know, I really, really enjoyed it. And I'm probably eternally thankful, you know, for, for everything that I learned. So I, yeah, I came every year since 2010. So.
It's helped us so much as well. And it is really made a significant difference, like, really changed our understanding of trauma and dissociation both. How would you define dissociation if you were working with a client or someone? How would you explain dissociation to them?
When I work with clients, I do a lot of sketching, you know, images and so, and I would explain it, you know, in a way that when somebody is really really small, you know, so you have no power. You cannot run away. You cannot fight back. And very often in family or other situation, there is no hiding place at all. So that as a child, you escape in your mind. It’s the only chance you have. Basically, you know, the separation between the body and the mind that you know, on the, on the onset, before the age of three, this is the only chance a child has. And that this can be combined with an out of body experience where they basically, it's an example one young man described it, he escaped into a photograph that was on the wall. He went into this photo, and then he was in the landscape.
And I would use, I find it very hopeful, you know, to go from the attachment side as well. So I would explain the attachment theory. And, you know, hopefully, I try my best, understandable way to every client I work with. And I find and they have time to think about it at home, or they, you know, over the week before the next session, it brings a lot of things to mind. And so, the approach to dissociation via the attachment theory would be very oversimplified. If you have dad and dad is drinking heavily, the baby does know what it is that the baby would know, that so different. And the child has to totally suppress their own needs and completely tune in to a probably erotic or violent or very angry adult. I mean, this could be mom as well. So, the child adjusts to the different states that the parent displays and is basically forced to develop self states that can deal with accordingly how the parents act.
And another thing I explain as well, so, it takes me about, you know, sometimes the different sessions to explain that is polyvagal theory and the window of tolerance. So, I kind of combine it in my explanation. And it’s the three different states and that in extreme hyperarousal or hyporarousal state, so the immobilized state, that, then the mind, the nervous system takes care that the way the brain works will change. So that any kind of integration, baby interrupted for the benefit of a child that has no other escape than to compartmentalize things and put things in containers in the mind. And I do sketches for that. I show, I have some shots, some brain images, and that usually make sense to them. And yeah.
Then that sometimes obvious. It's very, very harsh for somebody to realize and then maybe accept it is a possibility that they may have, you know, a dissociative disorder, which is not a nice word for it because I would really point out it's a very elaborated and creative adaptation process of the mind of a tormented child, it that makes sense.
There's something neutralizing even about understanding the brain and how it works. As opposed to the shame of what's happened to me, or the shame of how crazy I feel because of what's going on in my head.
I, you know, I feel that, you know, what helps a lot, all this and then you take it this some humor. Not to, you know, not too ridiculous or anything or diminish it, but you know, this humor, you know, it can be sometimes very uplifting and very relieving. When the lady I've worked with for a long time after months, very slowly and reluctantly started to work with her parts, then she said, “You know, I have another part, and I didn't want to tell you because then you’ll really think I'm crazy. I have a speaking hedgehog.” So, and I think I burst out laughing. you know, despite, of course, I take it serious. But in this moment, you know, that was somehow, you know, was a great situation. And it was very funny. And eventually we investigated where does the speaking hedgehog come from. And we could figure out that she took these character in out of a children's cartoon. There was a little hedgehog, and when he got angry, he had really flames coming out of his spikes, and he could talk. And he was very cute, but when he somebody angered him, he could really defend himself. So, you know, in the end, it made so much sense. There was nothing crazy about it. This is not, I don't know. I don't even think it is crazy. It wouldn't come to my mind.
I think I realized that in Germany in the 90s. I think at some day, I realized that I totally normalized these things to the point where I had to accompany a long term client to some authority. I don't know what the place it was. Either to a doctor or to the welfare office or so. And everyone in the city center stared at us. Really, people they sometimes stopped and stared at that. And I said, “Oh, my God. These crazy people. What's wrong?” Yeah, you know. And then obvious, I realized the man had tattooed, his whole face was tattooed, which was not very common in the 90s in Germany. So for me, I knew him for so long I didn't see it anymore. You know? For me, it was completely normal. It didn't play a role in regards to him as a person. And then I said it to him. And he said, “Yeah, yeah. I know. Don’t let them.” You know, and so it was, somehow it showed me that I don't take anything as not common, in this regard.
If understanding the brain is neutralizing somehow of the shame because it puts in context what the natural responses, then understanding where some of those images of parts, or parts of self, or ego states, or something, where those self states come from, like your example with a book, somehow gives context and helps it make sense. And that was an interesting example you gave of realizing, oh, it came from this, and it's connected to this, and that's how it happened when there was a child seeing this and, or like going into the photograph, like you gave that example. And I think that that also helps because when we have that phobia of parts, then there's this hesitancy to try or to engage or to just be afraid of what we don't even know, and being able to connect some parts to context like that help put some of those pieces into place and give a, I don't know, foundation of being able to have a context or an understanding of why that part is there, or where that part came from, or how a child brain would even do that.
And that's been interesting as culture changes with technology. Because now I have newer clients who are younger, who some of their parts come from video games, or movies, or something instead of just books or other contexts that have been traditionally written about in books or something in clinical texts. And so it's been interesting to see sort of that shift and that unfolding with younger clients.
But regardless, having-. I don't know. There's something about just having information, whether that's context about where an alter came from, or context about the brain, and why it works, and how it works, and what's going on. There's something that just neutralizes either that shame, or those phobias, or the pieces that make dissociation so scary, enough that you can work with it and get started, I guess.
There is, you know, I would say. I don't know who said it or where I read it. But it, it said, this is normal reaction to an abnormal situation. Yeah? And I think that basically boils it down to the point that everything somebody develops in their mind is a response to something that they experience. And so this is, especially as a child, it's a normal response to whatever happens around them. And I just talk to a colleague here in Malta, and she said, Italy there is a very progressive approach when young children are brought let's say to a child psychologist or therapist or psychiatrist, and there's something not right with them, they work with the parent and not with the child. So that means first of all, they do everything for and with parents, and then later, then that is clarified. And the parents worked or working on their own issues, then they bring the child in. And I think that is the, you know, really the right order to put something from the head on the feet. Yeah. I found that really, really helpful. And, yeah, to say, you know, that everything, somebody may be in the strangest OCD symptoms or reactions, or things that don't seem to make any sense, then in therapy, then we can make sense out of it. Then it is, you know, the whole chain goes away, then things fall into place. And that, you know, that is a big relief to see that. That takes a huge band of people.
That changes everything, when you're addressing the whole system, even when that system is externally like with a child and the actual parents. Not just DID.
You know, that it has a name? Okay. I mean, they had to put some name to, let's say, a group of symptoms, you know, that, you know, come up repeatedly. But, yeah, it's not about the name, you know, it's about what is behind it for a person. So very different, sometimes people are relieve when they know there is a description or name for that. And sometimes they don't like it. And I can adjust to that, you know. The person has to feel comfortable however we name it, or call it, you know. Of people are more comfortable with parts, or self states or so, or when they say different emotional states, it's perfectly fine. It has to, they have to be comfortable whatever is said.
There is such compassion and attunement in that adjusting approach by what they're able to tolerate and what their perspective is. How would you apply that with a DID system internally? Both the, that level of compassion of making the approach even safe, as well as the responsibility of actually doing that work, like with the child and the parents. The parents really need to step up and do their work. How does that apply like internally to a DID system? Both of those pieces, that compassion and that piece of focusing on where that's coming from, not just what is wrong?
I think you know, what makes, I would say for my work experience, what makes most sense for people is when we basically talk about the like it's an internal team that saved you in really difficult, you know, in difficult times in your life. That, you know, regardless how twisted or strange or irrational it may appear, but this internet system saved you, and made sure you would survive these things.
So when people become an adult, these things become, I would explain maladaptive, as you know. I find the expression quite helpful. So I would explain that properly. That things that a child developed in a desperate situation to help themselves, or to somehow stay under the radar, defend themselves, go into hiding, as an adult, very often counterproductive. And what we want to do, we want a, quote, “internal team.” And we may have to change the job description for some of the parts. That they first of all, functioning in daily life. But it's not only about functioning. People want to be content, and sometimes obvious, want to be happy and want to feel safe. So obvious thoughts along the way. And I found that really helpful when Dr. Kluft said at some stage “the doing better comes before the feeling better.” Yeah? But that the, I bought really, I had-.
Maybe it's better to explain it with an example. I talked on Saturday to a young man who was an IT specialist, and in Germany, and he has a voice that constantly is coming in with self-doubts, putting him down. So that unfortunately, typical thing. He's very scared to make mistakes, despite he does make mistakes. But this is obvious put a huge strain on his daily work. And this doesn't stop. And now they want to buy a house. And now the voice is saying, “Oo, you know. Are you sure you want the house? Are you sure you want to live there? Do you know what if it's when you lose your job?” And we could really really figure out that the voice won't go away, this part of him, because he said, “I hate it so much. I want to get rid of it.” And so that was basically then we could very productively discussed that you can get rid of it because this part, when you were young, had a very important role. We'll call it anticipatory obedience, call it staying under the radar, that you couldn't be hurt more than you're already hurt. So, but now, to hate this part. Yeah. You know how it is? Yeah. The whole school class, and the teacher would cast out one child because it misbehaves and, you know, expose it to the class and shame it. The child would get worse. Yeah? So it's a little bit like that. And it made sense. And we agreed that he writes a letter or email or whatever, to himself, to this part. Everything he fears. But one thing is very important. He has to write that he is thankful for what the part did for him when he was small. Yeah? So, and he will not forget that. He understands why it is still acting like it acts. But now it's about doing it better. Yeah? To do it better than it was done to this point. And so basically discuss it on eye level with that part it. Yeah? This respect. I would say that makes sense.
*Conversation pauses*
This conversation continues and part two.
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