Defects of Character or Emotional Parts: Using Structural Dissociation to Reframe Step Six by Michael Gargano, LMHC, CASAC-2
“We were entirely ready to have God remove all these defects of character.”
--Alcoholics Anonymous, Step 6
Treatment centers and 12-step communities need to begin normalizing dissociation within the addicted person’s experience. Trauma and dissociation are often left out of the discussion in addiction treatment and recovery worlds. Survivors of abuse, neglect, abandonment, and other traumatic experiences note with consistency and frequency the value of compartmentalization plays in daily life functioning and avoidance of traumatic memories. As an addiction and trauma specialist, I’ve heard countless clients describe how and why it became necessary to stuff events, emotions, sensations, thoughts, actions, and images deep into the catacombs of the psyche. The self that seeks recovery may sometimes feel like a fraud, fake, or not real, as a result. And this can make the phrase defects of character in Step 6 difficult for addicted survivors of trauma to navigate. Looking at Step 6 through the lens of structural dissociation, may offer the field, recovery communities, and people we serve new insight into both trauma-informing and dissociation-informing the steps. What we commonly call defects of character within 12-Step Literature can be more accurately viewed as dissociative parts of self that impede spiritual progress, acceptance, connectedness, healthy relationships, and recovery
A cursory overview of the Theory of Structural Dissociation is needed to help us understand its theoretical and clinical framework. The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization, a ground-breaking book on trauma and dissociation, written by Onno van der Hart, Ellert R.S. Nijenhus, & Kathy Steele, proposes human beings are not born with an integrated personality. Our early formative life experiences shape our personality, thoughts, feelings, and behaviors. In healthy development our caretakers help us to meaningfully integrate and adapt to our environment. Attachment wounds stemming caretakers who could not meet our essential needs, sooth us, and provide us with restorative experiences sets the stage for fragmentation of the self. The discussion presented in this blog will prepare us to draw connections to how structural dissociation relates to 12 Step work and a trauma-informed approach to embracing our dissociative parts. We challenge the notion of character defects as it is traditionally understood in recovery circles as the term defects of character does not align with a trauma-informed approach. This contention is made with full recognition that the steps can and do work for millions, including me. And it’s also time to have this discussion.
The conception of dissociative parts of the personality is not new. The theory of structural dissociation of the personality is a cogent, comprehensive, and concise description of dissociative parts. The theory holds every person has what is commonly referred to as an Apparently Normal Self/Part (ANP). The ANP is the survivor self or the core persona that is seen by others in public, holds a job, raises a family, forms attachments, and does everything that we often ascribe to the executive functioning in our brains. In response to a traumatic event the ANP fragments with the formation of an Emotional Part (EP). The EPs form to protect the ANP from the wounding that has occurred.
The self as EP displays evolutionary defense mechanisms, emotional reactions, and action systems to protect the core self. Action systems guide us to notice and be drawn to stimuli. They restrict our field of consciousness to relevant stimuli and promote certain action tendencies while inhibiting others. For example, when a fire alarm suddenly goes off, the self as EP may signal “Danger, Danger, Danger!” and the action system related to panic may activate. The action system related to rational thought and decision making may be disinhibited. These mechanisms include responses based on flight, fight, freeze, and submission. If a dissociated part is fixated in a particular action system or subsystem, they may be unable to cope or perceive with their situations because their perceptions are colored by the goals, and a restricted field of consciousness will be restricted to stimuli relevant to that subsystem.
I believe Dr. Bob and Bill W.’s vision of step work helps us to heal our structural dissociation. Step Six invites recovery seekers to dig deeply and invite our EPs into their healing journey. Up to this point in our recovery experience we have accepted the nature of our addiction, we took steps to find a new path, embraced a belief that a power greater than ourselves could restore us to sanity, made a searching and fearless inventory, faced our dissociation, and now we are tasked with integration. Bill W.’s commentary on Step Six hones in on the addicted person’s compulsive tendency for self-destruction and annihilation. We work against our instinct for self-preservation. The commentary goes on to describe structural dissociation like language in discussion of how our drives far exceed their usefulness. The founders of Alcoholics Anonymous understood parts of self. Bill W. writes in 12 Steps and 12 Traditions commentary on Step Six: “When our instincts drive us blindly or willfully demand that they supply us with more satisfaction or pleasure than are possible or due us.” He is talking about an EP. Bill recognized EPs operating within recovery seekers more than 80 years ago.
The goal of Step Six is not to eradicate our EPs. Total integration of all dissociative parts of self will not happen overnight. Some parts of self will mature or extinguish. Others will take a lifetime to heal. Parts work, trauma work, and working the steps are circular pursuits. We may need to go through the Steps several times to gain a new way of relating in the world. The wisdom of this Step is we are cautioned to “be content with patient improvement.” It is important to seek proper therapy with someone skilled in dissociation and parts work who can help you understand the emotional parts of your personality. In our parts work some of our parts may not want to work on the spiritual aspects of the program. Some might attempt to destroy the whole system. We did not will these EPs to exist. Our minds fractured in a beautiful way to keep us safe, secure, and protected. However, the actions, thoughts, and impulses of our EPs caused us insurmountable problems as we sought to change old patterns.
Change is difficult. Sometimes we get into a routine and become complacent with our EPs. Take procrastination, for example. By not completing a task on time, one does not have to risk failure. This EP could be protecting us also from people hurting us by seeing our vulnerability. Turning in assignments late or showing up on time for appointments means our EPs remain in control of who gets to see our vulnerable side. Procrastination, like other destructive tendencies, could be an EP part designed to hide reality from us.
Our EPs have secondary gains which make it difficult to heal them. Skillful work in this area will explore the systems and rules at play. We will not be perfect in this work nor do we need to be. In Step Six we work to renegotiate the boundaries with our EPs and the alliances between them. Our work here is to meet our needs in more adaptive ways so our lives as ANP is fuller, richer, and more meaningful.
In my recovery experience I relied heavily on EMDR therapy, sponsorship, and the 12-step recovery meetings and literature to heal my fragmented self. I believed I could be restored to sanity. I trusted my Higher Power would allow me to get where I needed to go in the often hard and emotional trauma work, I set for to complete. I had a mindfulness and yoga practice that helped me settle inward to listen to my emotional parts. I had faith in my therapist who guided me through parts work and trauma reprocessing. I was able to see for the first time how my EPs impinged on my ability to live unchained. My EPs were my minds grasps of relating to a world which no longer existed. We must face facets of our personality which do not paint us in a good light. The Shadow side of the personality we must not fear. Step 6 and parts work are reparative processes. What I have learned is I do not have to live in survival mode any longer. Because of this work I can meet needs without reliance on old compulsive behaviors. I can risk authenticity and vulnerability without fear of rejection.
Addiction is a dissociative response. Sounds like common sense, right? For many years we’ve operated in our practices fueled by this assumption. As individuals in personal recovery, the link between unhealed trauma/dissociation and addiction has been blatantly obvious. Even when we share our work with people on developing this new model of Addiction as Dissociation, we are met with a great deal of, “Well yeah, obviously.”
Yet the reality is that no contention in the literature has been directly made addressing this link… until now. The connection between unhealed trauma and addiction has been well asserted, with giants in the field like Gabor Mate, Bessel van der Kolk, and many others speaking to this link. What about dissociation? Dissociation comes from the Latin word meaning to sever. When an experience or a moment becomes too overwhelming for a person’s system to handle, we have a tendency to sever from that present moment, or from our core self. Dissociation is a very normal response of the brainstem that can activate when we are met with overwhelming distress. Dissociation can be adaptive (e.g., spiritual pursuits, proper use of guided imagery, daydreaming, the Netflix binge when you need to decompress) or maladaptive. When the manifestations of dissociation are maladaptive, they are likely to cause functional impairment. The various signs and symptoms of addictive responses can be examples of this phenomenon. Moreover, maladaptive manifestations of dissociation result when traumatic experiences or stressful events have not been processed and reconsolidated.
Both of us have been working very hard in 2019 to scour the literature and create a model that we are now calling Addiction as Dissociation. Regardless of your adopted stance on addiction (e.g., a disease, a response to trauma) or whether you even like the word (i.e., you may prefer behavioral compulsivity), this model will likely be relevant to your practice. We’ve prepared a table version of the model that you can examine in this blog. You are welcome to share it and we also value your comments on what resonates and what may still need refinement. Our scholarly paper that fully supports the contentions and flow of the model is currently under review and we will keep you posted about the more formal debut of this model to the world.
Too Cautious or Not Cautious Enough: Thoughts on the Need for Dissociation Training for EMDR Therapists by Teresa Allen, MFT
Since dissociation is the essence of trauma, it’s not possible to treat trauma without understanding dissociation. As EMDR therapists, we need to understand it. In my view, there are two opposite issues with EMDR therapists and dissociation, and therefore with how to approach education about it.
Some of us find dissociation intimidating and see it as too risky to work with, to the point of being spooked when it emerges in training practicums or in a session. Some of us refer out immediately when we see it. I’m calling this the Too Cautious group, sending clients to another clinician at the first indication of dissociative process, and thus missing an opportunity to help people with all that we know about the Adaptive Information Processing model and EMDR.
While some may be too cautious with dissociation, others know too little about it and so are not cautious enough. This group is not always aware of the potential risks that come with inadequate history taking and preparation. I’m calling this group the Not Cautious Enough group. While I realize there are different views on this subject, my belief is that premature, unprepared processing of memories can result in destabilization and put a client in serious jeopardy resulting in the need for significant therapeutic repair.
Both the Too Cautious group and the Not Cautious Enough group--all of us--need more information about working with persons with dissociative symptoms. What’s needed is training that normalizes and demystifies the subject, while at the same time informing us about ways to recognize and effectively work with it, using Adaptive Information Processing principles and EMDR Therapy Standard Protocol modifications.
Dissociation training should include direction in learning about our own dissociative tendencies and ego states. Reflecting and learning about ourselves in this way can help to make this important subject less “other.” In this way, we can approach learning about dissociation with much less fear. It is after all, something our brains were built to do. One problem is the question of what exactly is dissociation.
One group of authors in treating complex trauma, describes dissociation as “a continuum of non-realization: not real, not true, not mine, not me.” Kathy Steele identifies four ways dissociation is defined in the literature.
Steele points out that alterations in awareness and consciousness are treated with mindfulness; shutting down is treated with physical reactivation; and depersonalization (the most challenging) can be treated with mindfulness. Dissociation of self is treated with mindfulness, reactivation, and system, or “parts,” work.
So, I’m proposing that, as EMDR therapists, we find ourselves sometimes too put off by dissociation and think we cannot work with clients who dissociate. Or, in the opposite direction, a lack of caution with dissociative clients can lead to significant risk, since memory work might be done without proper preparation and stabilization.
Training about dissociation is needed for both groups of us--and everyone in between. The question is how to deliver training in a way that normalizes dissociation as something we all do, and in a way that empowers clinicians to feel we are competent in assessing and treating more serious dissociation and its many attendant issues. With proper preparation and modifications, EMDR Therapy and the Adaptive Information Processing model are powerful tools for helping persons with dissociative symptoms to heal and lead healthy lives. With adequate attention paid to preparation techniques and Standard Protocol modifications, we as EMDR therapists can more effectively treat clients with complex trauma backgrounds and dissociative symptoms.
Gonzalez, Anabel and Dolores, Mosquera, EMDR and Dissociation: The Progressive Approach, First Edition (Revised), 2012.
Knipe, Jim, EMDR Toolbox: Theory and Treatment of Complex PTSD and Dissociation, Second Edition, 2019.
“Dissociation: Sharing From a Personal Place, An Interview with Jamie Marich,” in Go With That, EMDRIA Magazine, June, 2019, pp. 5-6.
Jamie Marich, “Session 424: Demystifying and Humanizing Dissociation in EMDR Therapy Practice” EMDRIA Conference, 2019.
Kathy Steele, Suzette Boon, Onno Van der Hart, Treating Trauma-Related Dissociation: a Practical, Integrative Approach. W.W. Norton & Company, 2017, p. 4.Kathy Steele, “Advanced Issues: Chronic Shame, Resistance, and Traumatic Memory,” Presentation at EMDRIA Kansas City Regional Network, March 1-2, 2019, Kansas City.
Kathy Steele, Webinar on Dissociation, May 25, 2019.
Mosquera, Dolores, Working with Voices and Dissociative Parts Disorders, Institute for the Treatment of Trauma and Personality Disorders, 2019.
“EMDR Adult, Complex Trauma & Dissociation Specialist Intensive Program
An Integrative Progressive Approach to Developmental Trauma: Working with Complex PTSD and Dissociative Disorders,” Dolores Mosquera and Kathy Steele, Agate Institute, Phoenix, July, 2019.
Over the years I’ve been met with, “Oh, you do qualitative research,” in a tone that suggests: That’s cute, but what does it really prove? The findings from qualitative research won’t really help to advance the scientific aspects of trauma therapy. The field and the people making the decisions about what constitutes evidence-based practice want the numbers, the empirical data. Especially when we promote approaches like EMDR therapy. We have to prove it works with science to the naysayers!
What if the important things just can’t be measured with numbers?
At heart, I am a phenomenologist and I believe that they can’t be. Phenomenology is more than just the study and observation of “phenomena,” as people often surmise. Edmund Husserl (1859-1938), the father of phenomenology, emphasized the importance of lived experience. He rejected the Galilean notion that the human experience could be quantified. When I first studied Husserl during my doctoral program, it seemed as though my whole existence had been validated. When I absorbed that specific teaching, an audible, “Yes! This!,” came out of my mouth during a late night reading session on the couch. My declaration was so loud, it woke up my partner at the time.
Having been raised by a math teacher mother and cheered on by her math teacher father, I was encouraged to study science and math with top priority when I was in school.
“That’s where all the jobs of the future are,” my mother reasoned.
I advanced to organic chemistry and calculus II in my undergraduate studies, forcing myself to get A’s. And yet I truly failed to see how any of it mattered in making me a better person. To be clear, I’m not one of those anti-science types. I recognize the massive importance of empirical inquiry and believe that quantitative thinkers are necessary in an enlightened world. Yet they do not hold all the pieces of the puzzle as the black-and-white ethic that keeps us stuck in the fearfulness of modern times would have us believe. Sometimes what they measure in numbers doesn’t reflect the reality of others’ lived experiences. Intoning the wisdom of a professor in my doctorate program, quantitative inquiry may be like the skeleton of a system, but qualitative offers the muscles, the blood supply, and the vital organs. We need the entire system in order to move forward.
I’ve always seen the world in themes, colors, emotions, and stories. Savoring and reinventing communication is my favorite art form. When I was in school trying to make people believe I was good at math and science, I excelled the most in social studies, English, and the performing arts. They seemed to make my miserable life brighter and worth living. Oddly, I managed to qualify for the International Science and Engineering Fair my junior year of high school. Even my teammates wondered how the content of my project was strong enough to make it through the Ohio selection process. Quite frankly, it was on the power of my presentation skills and connecting the dots of relevance of the science to modern consumers. Indeed, in the field of counseling studies, empirical inquiry is often described as being able to prove that something works, whereas qualitative inquiry shows us how something works. Even as a kid, that was my strong suit!
When I “came out” to my mother during college to tell her I was not going to go the pre-med track, but rather, had decided to study History and English/Pop Culture, I thought she was going to have a heart attack.
“But math… science… that’s where the future is at.”
I told her I was willing to take the risk.
The flow of life brought me to a career in clinical counseling and I became a doctor, although not the type she wanted me to be. I quickly became the kind of counselor who knew I could not be guided by research alone. Client preference, context, culture, and clinical judgment emerging from my own lived experiences (all components of evidenced based practice according to the American Psychological Association[i]) also guided me. Working to heal and to understand myself translated into my enhanced clinical efficacy, as shown by more favorable client outcomes. I took to qualitative phenomenological research like a duck to water. Especially as someone with a mind that has always felt like a mosaic, in it I found beautiful lenses through which to study the world and the people in it.
During the 2008 EMDR International Association (EMDRIA) conference, I won first prize in the research poster competition for my dissertation pilot study on the use of EMDR therapy in addiction continuing care. I was the only qualitative study in the competition, and both research committee chairs, almost through gritted teeth, told me that I was the first qualitative project to ever win the award.
“What can I say, the methodology was solid,” one of them said.
That is an important point to emphasize. Qualitative research is not about pulling concepts out of mid-air or fishing for the lived experience of others’ just to prove your point. There is a systematized way to analyze themes in order to draw conclusions. For instance, Amadeo Giorgi’s Descriptive Phenomenological Psychological Method is a simple yet effective process for reading data—people’s descriptions of their lived experience with the phenomenon being investigated—to extrapolate the common threads. Elisabeth Kübler-Ross used a similar style of research in her work. Brené Brown, who is single-handedly changing the world with her teachings of overcoming shame through vulnerability and courage, is a qualitative researcher known for using such methods. The rich lessons of humanity reveal themselves in themes and stories in a way numbers may never do them justice.
So, that dissertation research went on to get me two publications in major journals of the American Psychological Association, Psychology of Addictive Behaviors and The Journal of Humanistic Psychology. Yet these studies from 2010 and 2012 are rarely, if ever, cited in literature reviews on EMDR therapy. Indeed, one of my major criticisms with Dr. Shapiro’s final edition of EMDR Therapy: Principles, Protocols, and Procedures (2018) was that aside from mentioning a few case studies in passing, not a single, substantial qualitative study was cited. And a lovely collection of qualitative literature exists on EMDR therapy that goes beyond case studies, yet the community at large rarely seems to look at them. In our desperation to prove that EMDR works, we may be missing vital information on why it works and how it brings about transformation in the lives of people we serve. I venture to guess this experience is not unique to the field of EMDR therapy.
Indeed, in another area of psychology that interests me greatly, the study of dissociation, I observe similar problems. My lived experience with dissociation is truly lived experience. As followers of my work know, I’ve talked and written openly about my own struggles with dissociation. I gently tested the waters as early as 2011 and in 2018, I came out very fully and unapologetically. I challenged people interested in dissociation to look beyond the heavy textbooks and the numeric inventories like the Dissociative Experiences Scale (DES) and the clunky Multidimensional Inventory of Dissociation (MID) and into their own lived experiences as a treasure trove of inquiry. Being dissociative is a fundamentally protective mechanism of humanity that we’ve all experienced in one form or another. There is nothing fundamentally wrong with using quantitative measures and other people’s scholarly writing to help yourself and the people you work with better understand dissociation, especially if it helps the client. Yet if you are only using the quantitative and other people’s citations to advance your study, you are missing big parts of the picture.
At the 2019 EMDRIA Annual Conference, my identity as a qualitative thinker connected to the beautiful circle that began eleven years earlier as an eager doctoral student. I won EMDRIA’s Advocacy Award for my willingness to be out about my own struggles and use platforms like YouTube and blogging to translate the how and why of EMDR therapy to the masses. Two other happenings at the conference, however, helped me further connect to why I love being a qualitative phenomenologist so much. First, Dr. Derek Farrell, an English EMDR scholar and only EMDR trainer in the world to offer a master’s degree specific to EMDR therapy, endorsed the importance of qualitative research during his Sunday keynote address. He expressed that quantitative research is very top-down in its orientation, whereas qualitative research is bottom-up.
I squealed with the same enthusiasm that woke my partner up back when I first read Edmund Husserl. Finally, a member of the EMDR establishment was making such a bold pitch for the necessity of what thinkers like me can do. In trauma therapy, we generally teach that top-down interventions are very cerebral, whereas bottom up interventions primarily address the body, emotions, and visceral experiences. In sum, we need both top-down and bottom-up, yet what EMDR therapist have long identified as missing from traditional talk therapy is the bottom up. This bottom-up has also been missing from psychotherapy research or dismissed as not that important. That attitude must change if we are going to maintain the soul of our work while also pushing for empirical data. People are holistic beings, so why can’t science be total and integrative as well? Qualitative is artful yet it is not just art. Rather, it is art with power to illuminate the science and make it more relevant and applicable to the people it serves.
Later that day I went on to give a ninety minute talk on my own lived experience as a woman in recovery from a dissociative disorder and how that’s informed my work as a clinician. Every other time I heard a presentation on dissociation at the EMDRIA conference, while not doubting its content and relevance, I felt offended that people like me were being talked about in such cold and technical terms. Something vital has been missing that couldn’t be measured by any score on the DES or the MID, both of which can be very difficult and even impractical for people with dissociative minds to take. Not only that, they attempt to measure in numbers a phenomenon that is experienced in qualitative layers. During the Q & A period I fielded a criticism that my presentation did not rely enough on the citations of others and that perhaps I misunderstood the intent of someone whom I did cite. I answered that by framing this presentation as a true sharing of phenomenology, I wanted to shift the paradigm, or at least open up another portal of inquiry. Some people are not ready for that, which I expected. And yet for the people who are, you are in for a treat.
A few questions later another individual came up to the microphone and asked about a case he was working on where an emerging seven-year old part perplexed him. I asked him a few questions back about his own lived experience as a seven-year old and as the parent of a seven-year old. I wish that other members of the audience could have seen on the big screen just how much his face let up when he realized the answer was with him all along. And when he realized that, he knew exactly how to proceed with his case.
In response, I said, “No citation will teach you that.”
While citations and research, even qualitative research, is important, what life as a phenomenologist has taught me is that your own lived experience have more to teach you than you’ve ever imagined. Learning about the lived experiences of others, with an open mind and heart, and letting them communicate with your own will change the world. That is the future of which I want to play a colorful, thematic, multifaceted, holistic part.
So Mom, I love you, and I respectfully disagree with your career guidance. My present—and my future—is qualitative.
[i] American Psychological Association Presidential Task Force on Evidence-Based Practice, “Evidence-Based Practice in Psychology,” American Psychologist, 61, no. 4 (2005), 271-285.
Photo Credit: Paula Lavocat
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.