Not So Much of a Rebel: Making Peace with the Standard EMDR Protocol by Jamie Marich, Ph.D., LPCC-S, LICDC-CS, REAT, RYT-200
When EMDR clinicians learn that one of my specialties is addiction, I usually get asked, “Which protocol do you use? FSAP? DeTUR?”
I’m often met with surprised looks when I respond, “I use the standard protocol mixed with good common sense about how addiction works, which informs my preparation approach. I don’t find any of the specialty protocols particularly useful.”
I realize you may be gasping right now since, in EMDR circles, lots of buzz can be heard about the specialty protocols and methods that EMDR practitioners are developing. I participate in several Facebook EMDR groups and almost every day I read a question to the tune of, “What protocol do you use for addiction?,” “What about dissociation?,” or, “Is there a specialty protocol for condition x, y, z?”
So many times I have bluntly responded, “Um, the standard protocol mixed with clinical judgment about preparation needs and how to use appropriate interweaves.”
One of the reasons I decided to write this piece is so that I can cogently share my position as an EMDR therapy trainer, author, long-time clinician, and notorious EMDR therapy rebel. What’s funny is that when I wrote EMDR Made Simple in 2011 I called out many problems that I saw with party line EMDR. Yet as I’ve matured as a person, a clinician, and a trainer, I’ve realized that maybe I’m not so much of a rebel after all. For me, the standard protocol really is where it’s at. Learn the standard protocol well within the context of the client’s goals for treatment and know where to point the targeting sequences, and you really have all you need to do successful EMDR with a wide variety of presentations. The adaptive information processing model will guide you, as will the larger breadth and depth of what we as trauma-focused clinicians are learning about the importance of embodied, somatically-informed affect regulation skills.
In this piece I further explore my position by explaining my approach as a trainer to client context and adequate preparation. Then I explore my thematic perspective on client history, which allows me to direct the standard protocol in the direction it needs to go in order to work with a particular client presentation. Finally, I look at where interweaves and modifications may be appropriate depending on the complexity of the case involved. Since addiction and dissociation are my two main specialties in EMDR therapy (and the two main conditions for which I have been personally treated), I will draw on several case conceptualization strategies for these special populations.
One of the first pieces of wisdom I internalized from reading Dr. Shapiro’s early works is not to do EMDR with a client you wouldn’t normally feel comfortable treating anyway. In my interpretation, this means that the task falls on us as clinicians to learn more about a particular condition that may be stumping us as a general best practice. One of my biggest concerns with the rising popularity of addiction protocols is that well-intentioned EMDR clinicians who know little about addiction are simply pulling out the protocols and hoping for the best. When this happens absent the larger knowledge about the various models of addiction, the interplay between trauma and addiction, and the impact of the stages of change, inadequate care can be delivered. In one of her first books Shapiro wrote that “addiction should not be treated in a vacuum,” (Shapiro & Forrest, 1997) yet I fear this is what happens when EMDR therapists just pull out one of the specialty protocols without educating themselves more on the intricacies of addiction first. The same applies for dissociation and dissociative disorders, or any other specialty presentations that may puzzle you—start by reading up or furthering your continuing education on the generalities of that population and their needs.
Adequate preparation in EMDR therapy involves much more than just doing one Calm Safe Place exercise. Although I train the skill in my program, I discuss its limitations, and it’s one of only many strategies that I teach. While the classic skills of Calm Safe Place (which often involves changing up the descriptive adjectives to meet the client’s needs), Light Stream and Container are still very useful, they can all be very visually biased if not modified. Furthermore, to truly help a client manage affect, tolerate distress and be prepared for what may arise during trauma reprocessing (Phases 3-6), we must explore other skills.
In our program, we teach a wide variety of mindfulness strategies in a trauma-focused way (i.e., allow for modifications, emphasize not just reading the skills out of the book, rather, having a personal practice yourself as a clinician and teach from that experience). Mindfulness strategies can include traditional sitting meditation, moving meditations, mindful exploration of the expressive arts, and learning how to turn all activities of daily living into chances to practice present-moment awareness. Teaching a client breathing strategies and body scanning skills in a trauma-focused way is also imperative. Existing skills or approaches that you utilize in other modalities like dialectical behavior therapy, 12-step facilitation, or yoga can all be very helpful in teaching principles of lifestyle change and grounding. In the spirit of true trauma-focused care, the needs will vary from client-to-client depending on their existing experience with such skills and the intricacies of their presentation. I’ve learned that the more complex the client, attending to preparation in this total matter is more helpful than any specialty protocol just slapped into the treatment process. You can visit a comprehensive library of these skills and watch how I use trauma-focused language in apply them by visiting the resource site Trauma Made Simple by clicking HERE.
And no, I cannot give you a script about how many of these skills you’ll need and in what dosage. That is where clinical judgment and having done your own personal work comes in to make you as effective as possible. Personal work with these skills is important so that you know what it means to modify and adapt skills for your optimal benefit, which puts you in a better position to do this with clients. While scripts can help us build our skills, a practice that most adult learners need and that I endorse, scripts can rarely help you apply them in the absence of practice and context. To intone the wisdom of Jennifer Emch, one of my program graduates and director of Ubuntu Wellness in Chardon, OH, “Life isn’t scripted and neither are people.”
In addition to understanding the imperative of trauma-focused and enhanced preparation in EMDR therapy, we must also consider as EMDR therapists that taking a chronological history is not the best way to go. Although I agree with Shapiro’s essential position that targeting the earliest memories first is ideal for getting to the root of any given problem, due to the nature of how complex traumatic memories are stored in the limbic brain, taking a chronological client history may be impossible. Or at very least, impractical. Most clients I’ve worked with over the years cannot track a chronology, have blanked out significant pieces of time, or get very tangential when we try to take a conventional history due to the disorganization in the limbic system. When I was trained many years ago I learned the 10 best memories and 10 worst memories method for taking client history, and I’ve also found this ineffective. The most effective approach to holistic client history taking I’ve found over the years, and the approach I teach in my program, is to discover potential targets thematically. Let’s use an addiction-specific example.
For many clients new to a recovery process, there is a willingness to do EMDR therapy reprocessing and yet there may be insufficient affect tolerance to go to the earliest instances of abuse or trauma. For optimizing engagement, you may be better suited to work with their goals for recovery first, while respecting the trauma history that led to the problem in the first place. Many individuals struggling to get better, regardless of their specific goals, carry a negative belief like, “I cannot deal with my feelings without alcohol (or other drugs/behaviors). That is a negative belief that can be “floated back” using questions like, “Thinking back over the course of your whole life, when is the first time you got the message that I cannot deal with my feelings without alcohol.” You can also ask the question for the worst or most recent. What you get from the client all represent potential areas that you can target. Might these targeting sequences link in to earlier, more impacting traumatic experiences? Of course. Yet targeting them this manner is, in my experience, a kinder, gentler way to go and helps them to see the relevant connection of the EMDR work to what may be their biggest issue of concern in therapy. To see some examples of how I conduct client history in a thematic way, please visit the video demonstrations section of the Institute for Creative Mindfulness website by clicking HERE.
One of the wisest pieces of direction I received in my rather traditional basic training many years ago is that the greater the degree of complexity in the case, the more level of interweave you will need. I feel that learning the principles of cognitive interweaves (as described by Shapiro in her texts and further elucidated by other great minds in the EMDR community) is essential to doing EMDR with addiction, dissociation, and other special situations that may throw you for a loop. Yes, the classic directive in EMDR therapy is to stay out of the way as much as possible. Yet I was delighted to see Shapiro (2018) use the phrase proactive measures so much in the third edition of her text. To me, solid interweaves work as a plunger of sorts. When the flow of reprocessing is clogged, we can apply good open-ended questions, gentle pieces of encouragement or psychoeducation, and mindful or somatic techniques to get the flow going again. Although I teach a list of common interweaves in my program and Shapiro offers some solid examples of them in her text, the best interweaves are the ones that you develop through constant practice of EMDR and working with consultation to hone your craft.
Sometimes we can get nervous talking to consultants or other EMDR therapists about modifications, fearing that we’ll get “called out” on deviating from protocol. Yet consider how all of these specialty protocols that we can get so excited about in the scripted books or special trainings are really just twists and turns on the standard protocol anyway. They are proactive measures. One final modification tip that I can offer from my clinical experience on working with complex issues like addiction and dissociation related to the part of the standard protocol where we are asked to get an image (or worst part) from the client. I’ve always liked the language of worst part because it recognizes that some memories, especially pre-verbal ones, may not be stored with an image. With folks who may not have sufficient affect tolerance to handle going to the “worst part,” yet who have done all they can with preparation skills, you may be better suited to ask, “What part of this target memory are you willing to work on today?” Then proceed with the standard protocol from there. This may make reprocessing more digestible for the client in the spirit of EMDR therapy Phase 2.5. Yes, you will likely have to go back later and check to see if there is an image or worst part in a separate targeting sequence in order to achieve completion of the target in a technical sense. Yet consider how this modification may be more tolerable for individuals.
If you are the type of adult learner who needs more of a scripted protocol to learn new information, that is more than okay. I know that as a trainer I could not survive without using scripts with my students. And yet there comes a point in your development as an EMDR clinician when you must realize that the scripts are just modifications. These specialty protocols we can all get excited about are just very necessary modifications. No, modification is not a dirty word as long as you are able to clinically justify why you are making the modification or, in the case of Phase 2 preparation, enhancements. Doing this well and in the most trauma-focused manner will eventually involve you moving away from scripts and other peoples’ protocols and working to hone your own clinical common sense.
Shapiro, F., & Forrest, M. (1997). EMDR: The breakthrough “eye movement” therapy for overcoming stress, anxiety, and trauma. New York: Basic Books.
Shapiro, F. (2018). Eye Movement Desensitization and Reprocessing therapy: Basic principles, protocols, and procedures, 3rd ed. New York: The Guilford Press.
Sometime in the sixth grade, I first heard philosopher Soren Kierkegaard’s wisdom, “Once you label me, you negate me.” I wish I could tell you that my exposure to this teaching happened while I was attending some kind of summer symposium for gifted children. But alas, I heard it folded into a joke by Mike Myers’ character Wayne Campbell in the 1992 comedy Wayne’s World. Because Wayne’s World is one of my favorite films and I watch it several times a year, I am often reminded of Kierkegaard’s teaching and am challenged to ponder its layers of meaning. As a woman in long-term recovery who works with others in recovery, and as an out bisexual woman who serves as an LGBT+ advocate, I often handle questions about what it means to label or be labeled versus what it me mean to define or identify. Moreover, discussions rage around me and within me about whether or not we place too much stock in identifying in a certain way or calling ourselves certain things. Do labels or identifiers help to advance recovery and advocacy, or do they keep us stuck in unhelpful pigeon holes? Do labels really negate us, and does it make it any better if we swap out label with the word identifier? And on a spiritual level, does the practice of labeling or identifying keep us cut off from the essence of our true nature?
Let’s begin by looking at the distinction between labeling and identifying, for exploring this distinction sets a foundation to answer these very important questions.
“I don’t like to label things,” is a line I’ve heard from many people around me, from wishy-washy people I’ve tried to date to employers who have been non-committal about issues like job descriptions, expectations, contracts, and titles. Just about every woman I’ve worked with or known has been hurt in some way by a potential partner saying they don’t want to put a label on something, when it is really just an excuse to buy time or not commit. Yet I have also experienced very deep friendships that can be hard to specifically label or define because the feelings and roles involved don’t fit into any kind of a neat box. And I’ve also accepted work gigs that seem to defy the gravity of definitions and labels. On any given day it’s hard to describe exactly what I “do.” In fact, it’s a bit of a running joke in my family as my brother has long asked me, “What do you do?,” and my stepson often asks, “So Jamie, how many jobs exactly do you have? I count nine.” In my view I only have one job, yet it’s composed of so many facets and segments I can understand where it would feel confusing to people who don’t get it.
So an argument to be made for labels is that in many contexts, they can keep people safe (especially in work settings and in certain interpersonal relationships) and minimize confusion. Labels can work very much like boundaries and expectations in this sense, so it may feel better to many to call it a definition. Yet we’ve all run into cases where once somebody gets labeled as something, especially in a binary context, it creates a limiting and maybe even discriminatory tone. In this day and age, we only have to look to how political affiliations have divided us to see how this plays out. Many Democrats don’t trust Republicans, especially if they find out they are supporter of President Trump, and immediately shut them down as people as a result. The opposite can also happen, as I know many people (especially those who knew me when I was younger and more traditionally religious) don’t want to hear what I have to say because I’m now rather liberal. The devil’s advocate response I’ve heard, especially from others in the LGBT+ community, is that knowing if someone voted for Trump or not is a sign, a mark that helps them know if they’re really safe with that person. Although I heavily relate to this sentiment and even experienced a great deal of it myself after the 2016 election, for me it is not that black-and-white.
The issue of labeling comes up quite a bit in the recovery and LGBT+ communities in which I live and work. My Trauma and the Twelve Steps work is brilliant to some because it is integrative. Yet my perspective confuses many because even though trauma-focused in my orientation, I still introduce myself in appropriate contexts as, “Hi! My name is Jamie, and I’m an alcoholic and addict in long term recovery.” For me, this is an identifier and not a label. And it is my choice to identify publicly in this way, which makes it very powerful for me. Saying this identifier out loud keeps me grounded in the reality of my story, and I take great pride in being able to introduce myself in this way. Where it can feel like a label, in a negative sense, is when people judge me by this identifier, or if I completely define myself by this identifier. For me, identifying opens up possibilities where labeling connotes being limited by the way in which I identify (or by the way others try to identify or label me).
I recently put the question out to my hivemind on social media and there seemed to be a general consensus that identifying has a much more positive connotation in the English language than labeling. Another common theme is that labeling is more likely to come from without whereas identifying is something that is very personal to the individual doing the identifying—it comes with within. Skeptics or critics may roll their eyes at me when I say things like, “I am an openly bisexual woman in long-term recovery from addiction and dissociation.”
More PC bull crap. Why does everyone need to label themselves? Or be special?
I offer this response: Being open an honest about these things has allowed me to heal and be able to say and claim other parts of my identify like I am a deeply spiritual person, proud of my Eastern European ancestry, and I live each day to the fullest, enjoying life as much as I can and helping and serving others who my Higher Power sees fit to put into my path. I am a yogi, a seeker, a lover, a mystic, a sister, a daughter, a surrogate mother, a friend, a teacher, and author, a guide, a movie lover, an expressive artist… Shall I go on?
I can celebrate the fullness of my human identity because I’ve learned to be honest about my story and what it has meant to shaping my identity. Robert Ackerman, the teacher and recovery writer, said in a 2015 talk: “You cannot expect yourself to become a fully functioning individual (physically, emotionally, spiritually) if you deny a part of yourself. The key is integrating all of who you are.” I felt like he was talking directly to me, and in the months following this message circumstances allowed me to come out fully (not just to my close friends and colleagues) about my bisexual identity. Doing so was a game changer not just for my mental health, but for feeling more authentic and genuine in my professional work. I feel now that no one can label me, and if they do so pejoratively, it’s lost any power to affect me.
The yogic perspectives and teachings from other spiritual paths may offer a slightly different angle to the challenge. Teachers I’ve studied with contend, “As soon as you say I am…, then you are limiting yourself. Because you are really your soul and the pureness of consciousness.” In fact, in many yoga settings, it’s common to introduce yourself by saying, “I’m called Pragya,” instead of “I am Pragya.” Even saying things like “I am anxious” can be discouraged because you are identifying yourself with your anxiety.” It may be preferred to say “I have anxiety.”
Ever the bridge builder, my feelings are that both perspectives are true. I know that when I look at the bigger picture and my Divine essence, it is very limiting to label or to identifying myself in any way. Who I really am exists at a soul level that cannot be damaged or affected by anything on this plane. Yet I also live on the human plane for the time being and to know who I am in this body, a knowing that is empowered by the ways in which I identify, helps me to thrive while I’m here. Knowing the communities to which I belong and where I stand in work or relational contexts is important. Important, yes; everything, no. Like many answers to existential questions answered through the yogic perspective, the key is to not be attached. Freeing myself from the grip of attachment—to outcome, to definitions, to identifiers, to labels, to anything is the key to health and happiness. And this detachment I practice while also being honest about what matters to me is what allows me to be fully human and fully Divine, dancing as One between the worlds.
True of false: Hinduism is a polytheistic religion.
If you grew up in an Abrahamic, Western context, chances are that you answered “True.” I was certainly taught that Hinduism is a polytheistic religion all the way through grade school and high school. Let’s set aside the word “religion” for the purposes of this piece because many would argue that Hinduism is not a religion at all, and the word itself is a rather new invention influenced by British colonial rule. Hinduism is a spiritual path best described by the teaching of sanatan dharma: truth is universal, timeless, and unchanging. A Hindu saint who influences me, Neem Karoli Baba (Maharaj-ji) taught Sub Ek, or "all one." The precepts that all major religions have in common is the essence of this truth, and followers of this teaching do not hold their path in supremacy above others. The rest is really just details, for we know that truth expresses itself in myriad ways. And in the tradition that we generally refer to as Hinduism, there is only one supreme God—the various “gods” like Krishna, Shiva, Sita, Ram, Ganesh, Kali, and Hanuman are simply manifestations of God; different threads through which Divinity is expressed. As scholar Eknath Easwaran explains in his commentary on The Bhagavad Gita, “From the earliest times, Hinduism has proclaimed one God while accommodating worship of him (or her, for to millions God is the Divine Mother) in many different names” (p. 22).
I adore this teaching, as a humanitarian whose heart breaks to see the devastation caused throughout history in the name of religion and fundamentalism. I also adore it as a person with a dissociative mind who sees the world through multiple lenses and angles. In this piece I hope to demonstrate how getting familiar with the Hindu gods can offer a beautiful systemic metaphor for people to explore their internal world. Yes, there is one God—in the Hindu tradition, God shows up in roughly 330 million ways (the approximate number of major and minor gods). Raised primarily as a Roman Catholic, it always seemed plausible to me that the Almighty could choose to manifest in human form, born of a woman, in the person of Jesus. And I do love Jesus the social rebel and adore that many people find God’s love through Jesus. I could just never get behind the teaching, at least with my whole heart, that Jesus died for my sins and that professing belief in him is the only way to salvation. So it’s safe to say that even as a child, sanatan dharma was alive within me.
I still hang out in Catholic circles, even though I dislike mainstream Catholic social teaching. I draw strength from many aspects of Catholicism and similar Christian paths, and I have a particular fondness for the saints. I adore the saints for a similar reason to why I love the Hindu gods; the saints represent the different ways that God shows up in the world. There are many saints whose lives and teachings have spoken to me, saints like Therese of Lisieux, Teresa of Avila, Hildegard of Bingen, Benedict, Anthony, Jude, Augustine, Ignatius, Maria Goretti, and St. John of the Cross. Not to mention those who are not officially “saints” according to the Vatican yet whose lives and writings inspire me, specifically Fr. Henri Nouwen and Fr. Thomas (Louis) Merton. I love them for their humanity and for the overcoming of struggle, owing all glory to the Divine.
You may be familiar with the concept of patron saints. For example, St. Anthony is the patron saint of lost objects, St. Jude is the patron saint of lost causes, and while she’s not been officially labeled this, for me St. Hildegard of Bingen is a patroness of the holistic and expressive arts. Catholics pray to saints who they feel most connected to or who most get their struggle, asking them to intervene before God. For me, the Hindu gods hold similar appeal; the major difference is that they are not intermediaries, they are actually parts or aspects of the One Divine presence. Ganesh, the mighty elephant, is known as the remover of obstacles. Sonu, one of my drivers on my pilgrimage to India shared with me, “Pray to Ganesh first; he removes the blocks that keep you from getting to everything else.” Like many people keep a rosary or medal hanging from their car mirror, he keeps a little Ganesh on his dashboard. Ganesh is an expression of the God, the Divine remover of obstacles.
In Hinduism, gods are often paired by their masculine and feminine qualities to represent the union of consciousness (masculine) and energy (feminine). For instance, you often see Krishna and Radha together, Shiva and Parvati, and my favorite holy couple, Sita and Ram. One of the most meaningful stories in the Hindu tradition is that of Sita (energy), Ram (consciousness), and Hanuman (the monkey god representing breath and the ability to shape shift. Once, the demon Ravana (who represents the ego mind) lured and captured Sita (energy) to exploit her for his own benefit. Ram called upon his devoted servant, the beloved Hanuman. Hanuman mustered the forces of his entire monkey army and they found Sita at the southern tip of India (symbolic because in our lower chakras is where we expel all of our life energy that we waste through worry and fear). They rescued her so she could be reunited with her beloved. Hanuman’s role in this story represents the power of the breath to reunite energy and consciousness. In this powerful fusion of energy and consciousness made possible by the breath, order is restored and we are deeply healed. It is amazing to me how Hanuman took on a large, angry form to destroy Ravana and the city of Lanka by fire; and yet he was able to assume a small, gentle form when he came to rescue mother Sita so she would not be afraid.
If you’ve read my work before on this blog, you know that I have a thing for Hanuman. To use Catholic language, I have a great devotion to him. Yes, his qualities displayed in the Sita-Ram story are a big part of why I love him. I am also drawn to the teaching of Hanuman as a bridge—because he is a monkey, he is the bridge between the human world and the animal world. And in my work I aspire to be a bridge. As a woman living with and healing from a dissociative disorder, all work on myself requires that I bridge the aspects of myself to live in wholeness. As a trauma survivor I draw great strength from Hanuman. As a miracle baby and incarnation of Shiva, born through the intervention of the wind God, others were threatened by Hanuman as his powers began to manifest in the form of a rather naughty toddler. The monkey king, Bali, threatened by Hanuman, devised a poisonous concoction of five metals to kill Hanuman. When Hanuman ingested the potion it only made him more brilliant, graceful, and powerful. A better metaphor for post-traumatic growth I have never heard. Jai Hanuman! Victory to Hanuman and victory to the Hanuman spirit within me.
Just like there are many parts of me, there are many gods that speak to my various parts. In addition to Hanuman I have great devotions to Saraswati, the goddess of music, art, and knowledge. Indeed her quality of knowledge, or Pragya, is the origin of the spiritual name I was given. I cannot think of a better goddess for an expressive artist to serve! Many other feminine expressions like Kali, Sita, Durga, and Lakshmi also give me strength. Just like Christianity uses the term trinity, Hinduism also makes use of a similar concept with the holy trinity of Brahma (the creator), Vishnu (the preserver) and Shiva (the destroyer) governing the necessary functions of life. On the feminine side, Parvati (fertility, love, beauty), Saraswati, and Lakshmi (wealth, fortune, and prosperity) compose a Tridev, or trinity. Whether you embrace these stories and qualities as spiritual teaching or as myth, there are numerous opportunities to notice where you experience resonance. Whether you are doing parts work for your own healing or with clients, the Hindu gods offer rich opportunities for helping one describe their own internal system with these metaphors and allegories. The stories are numerous and if you can step outside of your spiritual comfort zone and explore some of them, you may discover that they lead you closer to the oneness that is God because they can meet you as you are right now.
And isn’t one of the goals of parts work in healing trauma to honor and recognize the parts yet let them lead us to a sense of wholeness or integration? If the word integration is a sticking point for you—don’t use it. Indeed, many of us who’ve struggled with dissociative issues over the years can equate integration with a therapist’s desire to smash out or ignore what the parts have to say. So while the word integration may work for you, consider replacing it with wholeness or totality. This idea works similar to how the Hindu gods operate—many awesomely beautiful parts that compose one, unified whole. Even from this place of wholeness, the parts can be called upon when they are needed. And like in my internal system, one god/part (like Hanuman for me) may be the key to establishing balance and peace in the system.
There is one final aspect of Hindu teaching I wish to discuss here that you may also find useful in your own path of healing as it relates to parts. In the Hindu system the gods are constantly interconnecting and incarnating as other gods (e.g., Hanuman is an incarnation of Shiva, Ram is an incarnation of Vishnu, etc.) and this vibrancy serves the whole. A demon, like Ravana in the Hanuman story, is a part that thinks it is the whole - a part that tries to override the system for its own desires or survival. So the next time you talk about your demons, remember that you are not your demons. Like Ravana the ego mind, they are just an aspect of your experience that’s trying to overtake your entire system. Instead, consider learning to call upon other warriors to help you understand sanatan dharma--that truth is one. That we are not separate. And the largest most healing truth I’ve learned from studying Hinduism is that I am not my demons. I am not even my singular parts. Rather, learning about, connecting with, and healing my parts has allowed me to uncover the truth of who I really am, never separated from Divine presence. Even if working in the Hindu system like this doesn’t do it for you, I hope that you find something in your own faith tradition or in other areas of life (e.g., mythology, pop culture) that helps you to explore your internal world. May we all ultimately live in wholeness, honoring how every part is connected.
To read more:
Achuthananda, Swami (2013). Many many many gods of Hinduism: Culture, concepts, and controversies. Reliant.
Johari, H. (2016). Spiritual traditions of India coloring book. Destiny Books.
Markus, P. (2015). Love everyone: The transcendent wisdom of Neem Karoli Baba told through the stories of westerners whose lives he transformed. New York: HarperCollins Publishers.
Easwaran, E. (2007). The Bhagavad Gita—Translation and commentary by Eknath Easwaran (2nd ed). Tomales, CA: Blue Mountain Center for Meditation.
Fighting Dissociation Phobia and Coming Out as a Professional with a Dissociative Disorder (Dr. Jamie Marich)
To access original piece with full comments published on 5-18-18, go to:
As you read the title of this article, I am somewhat scared about how you are judging me…judging us. If your information about dissociative disorders—or what the general public may still call “multiple personalities” - is from the movies (e.g., Split, Sybil, Primal Fear), we assure you, what you’ve learned about us is inaccurate. When I say dissociative disorder, it’s not lost on us that many of you reference these portrayals and maybe even assume that a deeply disturbed, murderous “alter” will pop out and get you. Or that, like in Primal Fear, our struggles are all an act to get us off the hook for bad behavior. What saddens me the most is the level of phobic responses to dissociation that we witness from other professionals in our helping fields—mental health and addiction recovery—even from those who claim to specialize in trauma treatments like EMDR therapy. Terms like Islamophobia, homophobia, and transphobia are now regularly used in public discourse. We assure you, dissociation phobia is a real thing and needs to be added to the list.
Every week we hear of or directly encounter stories like these:
This is a short list composed only of clinical examples. We can fill an entire book of tales on how family, friends, and the public are quick to label us crazy or defective when, in reality, the dissociative mind is one of the most beautiful constructs of creation.
Our minds are prismatic, multi-dimensional, and capable of solving problems that empirical science and its numeric precision can’t even begin to figure out. Many of us are extremely high functioning, creative, intelligent, and capable of bringing about real change in the suffering world because most of us can instantly respect and evaluate multiple sides of a story. Yes, we can be plagued by deep suffering and distress that can impair daily living, especially when triggered, invalidated, or negated. When we’re given the tools for healing—which must start with having our own experiences validated and our existence affirmed—the power of our post-traumatic growth may stun you.
The first client with dissociative identify disorder (DID) I ever treated with EMDR therapy expressed, “People fear what they don’t understand,” in attempting to explain his dissociation, an adaptive response to unspeakable early childhood abuse. Our own experience amends this statement slightly, “People fear what they can’t understand.”
The next phase of my work as a public figure in my field is to do my best to help you understand. It’s scary—we’ve been “out” as a recovering addict throughout our career and in recent years we’ve been fully out in all areas of our life as a bisexual woman. Being out as dissociative isn’t exactly a newsflash if you’ve followed my work closely over the years (I reference it in both of my books on EMDR therapy and disclosed my full diagnosis in an article with Psyched last year). However, coming out this boldly (to the level of using singular we pronouns…did you notice the fluctuation between I and we?) feels like the riskiest step I’ve/we’ve ever taken as a professional and a public figure.
We can hear our colleagues now—which include other writers and trainers in the field—snickering behind our back or in some cases in front of it. They have the potential to write me off as a crazy, unstable, untreated girl who loves the attention. Trust me, we’ve considered the reality that others may try to discredit us and we are remarkably okay with that; it shows just how significant of a phobia we are addressing. We fear that in the current political climate where such a fear of the other abounds, we’ll either be dismissed or targeted for how we interact with the world. A side effect of my dissociative mind has been a fierce love of diversity and pluralism, to the point where even our own liberal friends fear us for combating the cut-and-dry, us vs. them labeling that abounds in these modern times. Loved ones have even threatened or attempted to use my dissociation and its complications against me/us, threatening to expose how bad it can get to make me seem less credible.
I was diagnosed with Dissociative Disorder, NOS (now Unspecified Dissociative Disorder) in 2004 and I am one criterion away from qualifying for a full Dissociative Identity Disorder diagnosis (I have never been and am not amnesic about the experiences of my parts). Although dissociation was a mixed blessing of a survival response and a paralysis in my earlier life, the growth I’ve experienced through being properly diagnosed and treated has helped me to embrace how my mind works instead of resent it. You may be puzzled as to why I can be so candid about something that seems, on the surface, so dramatic. Here is the truth bomb—we all dissociate and we all have parts that compromise our internal worlds. I can come out so freely now because I’ve come to learn that I am not that much different from the rest of you.
Understanding how you personally dissociate and how your parts work is an important first step in understanding what those of us who surpass the clinical threshold experience. Are you ready for this? This may feel a bit daunting if you’ve never looked at it before.
Know Your Dissociation Profile
Have you ever daydreamed?
Have you ever drifted off or zoned out a little, especially when you were feeling distressed or bored?
Do you dive in to Netflix binges to numb out from life or imbibe in intoxicants, especially as a method of escape?
To overstate what may seem obvious, we all have. If you are a therapist, have you ever led your clients through a guided imagery exercise like the Calm Safe Place, prompting them to visualize “somewhere else” to relax? Yup—you’ve deliberately elicited dissociation, albeit a form that is adaptive for many. There’s a chance you may even like and make use of such an exercise yourself.
For those of us who dissociate regularly and tend to cross more clinically significant lines, the response to shut down or escape in our own minds developed early and became a bit more ingrained. It can be more difficult to come back to the present moment, especially if what we’re coming back to is highly distressing. Yet with the tools of recovery and wellness, especially those skills that can be learned in the realm of grounding and embodiment, we can.
As a kid, one of the abusive figures in my life routinely said, “Jamie looks like she’s been beaned in the head with a fastball.” Probably because I was daydreaming so hard to tune him out! My vivid imagination took me to some pretty incredible places and the hope I drew from these places made real life slightly more bearable. As I transitioned into adulthood, I experienced significant difficulties distinguishing fantasy from reality, which made coping with alcohol and pills (more tangibly dissociative methods) appealing. If these themes resonate with any aspect of your personal experience, you are well on your way to understanding our experience.
Many teachers describe dissociation as a continuum phenomenon. We all dissociate, some more than others, and the experience may manifest differently at different times depending upon the nature and intensity of stressors. Although the continuum is a good start if you can wrap your mind around this description, for me the idea is too linear. I prefer to think of dissociation as prismatic. Light flows through a prism to reflect a series of colors—the more angles on a prism, the more dramatically light splits as it comes through—resulting in fascinatingly complex and stunningly beautiful patterns and fragments. For a prism to be a prism, at least two angles made of material transparent to the wavelengths of light for which they are designed must exist. Some folks have two angles, others have hundreds. The more intense the light (which can be cast as a metaphor for life stressors in this case), the more radiant the reflection. For those of us who have learned how the angles of our prism serve us under stress, radiant is a great adjective. Prior to learning how they work, the dispersion of light can feel blinding and confusing, to us and to others in our lives. Hence, shutting down the prism altogether can become more appealing. When you notice us go offline in our affect, this could be what’s happening for us.
In discussing dissociation and its various expressions, it’s useful to discuss parts. Although the word “alters” may still be used in context around DID, parts has become a more widely accepted and less shaming term; particularly because even the most conservative, set-in-their-ways reader of this article can identify two or more of their own internal parts.
Do you ever reference having an inner child?
Do you ever see yourself as being one person at home and one person at work?
Are you calm overall yet notice certain things can trigger a rage response in you, like the Hulk popping out of Bruce Banner?
Congratulations—you have parts!
The same parts or internal experiences that shape the theater of your life are similar to what we experience. Ours just may be a tad more fragmented, to the degree that we’ve given them names, numbers, or colors in assigning their roles. Our parts regularly dialogue with each other and fight with each other, just like the discord that you may witness between family and friends. These parts generally developed at different times in our life journeys in response to traumas and other stressors to keep us safe and protected. Some of these parts may still show up as more pronounced when certain situations or triggers wreak havoc in our systems. When parts and their characteristics show up as more pronounced, if you are a therapist or loved one, it does little good to think in terms of, “What’s wrong? What’s happening?” Instead, try “What are you being protected from right now? How is this part protecting you?”
Many of our parts can be quite delightful and even serve us in our public lives and others have the potential to create more problems for us in terms of acting out or shutting us down. Telling those parts to shut up or go away is generally not helpful. They need to be heard. Moreover, placating any one part or even our whole systems with platitudes like, “You’re in a safe place” is generally not productive either. Listen to the part or the series of parts that are most activated and ask them what they need to experience more safety in any given moment. Yes, if you are a therapist some of the parts may scare you or cause you grief. That doesn’t mean that we love or value our parts any less or that integrating these parts into some homogenous alloy is the best solution. Even the parts that we tend to hate or resent for causing us more grief in our adult lives can serve a purpose and resent, maybe even more than the others, this suggestion of classic integration.
Think of the common metaphor of the melting pot that gets used to describe the American nation—i.e., these disparate nationalities coming together, melting down to emerge as “American.” This metaphor has been challenged by many scholars and thinkers because it suggests there is such a thing as an ideal American. Instead, the tossed salad or a pot of stew is proposed as a better metaphor because all the different parts or ingredients contribute to making a tasty whole. With clients who can seem more affected by certain parts reacting to stressors, get to know the composition of the stew or the salad and what it tastes like (or could taste like) when the ideal blend and preparation of ingredients are achieved. If one day there are more tomatoes (for example) than usual, there is likely a reason for it…and don’t assume that the excess tomatoes just need to be cut out. They may be meeting a nutritional need, metaphorically speaking.
The metaphors for understanding parts and how they interplay are various. Explore which ones may work to describe your experience and help clients to determine which ones may work for them. Some like to use versions of a conference or kitchen table, a van, a house, or even a bundle of balloons. My preferred metaphor for my dissociative experience can be explained through Dorothy in The Wizard of Oz. Besides my presenting self (Dorothy), I have three distinctive parts of various ages who serve roles like the Scarecrow, the Tin Man, and the Cowardly Lion. There is also an older, sage/crone part who has more of a spiritual, ethereal presence within me like Glinda the Good Witch. (If you are a fan of Wicked, yes, this sage/crone part is a mixture of Glinda and Elphaba.) Dorothy needed all of them to tap into the vital truth and learning of the story: “You’ve had the answer in you all along.” Dorothy needed all of them to get home.
All of us who dissociate to the level that may cause you to be scared of us are just searching for that yellow brick road that will take us home.
Will you shame us on our quest?
Or will you help us?
If your answer is the latter, thank you for taking the first step by reading this article. May you keep journeying on in your desire to understand your clients, which happens by first learning more about yourselves.
Photograph by Dr. Jamie Marich (March, 2018: Dubai, UAE)
Institute for creative mindfulness
Our work and our mission is to redefine therapy and our conversations are about the art and practice of healing. Blog launched in May 2018 by Dr. Jamie Marich, affiliates, and friends.