​When I launched my private practice in the middle of a global pandemic, I was well aware that unprecedented times would call for unconventional measures-at least when it came to getting the word out that I was now a solo practitioner. Fueled by my passion and drive for all things trauma, I plunged headlong into the business world, fortified by caffeine, sarcasm, and an amazing cheering section of fellow professionals. If anything was going to get this done, we were going to have to get it started and I wanted to be sure that my message was heard far and near, so that those who wanted to do the trauma work knew where the resources were.  I was certain that my message would be well received, being a member of a community that is infamous for the amount of trauma that has shaped its demographics-much to my chagrin, I may have been a little overly confident in how that message would land, and I was made aware of that one evening when I received an email from someone who had heard my first attempts at spreading the news; an underwriting campaign on the local public radio station. “I heard your ad, and I want to do trauma work but not with you because of the other populations you work with, so can you refer me to someone else? You must know people”. I was baffled by the statement of ‘other populations’-I work with trauma survivors! Domestic violence, sexual assault, human trafficking, PTSD, first responders, law enforcem……….oh. Oh boy. Ah, so that’s it. There’s that “other population” you speak of. Law enforcement. One more time for the people in the back-I WORK WITH LAW ENFORCEMENT.
 
It never occurred to me when I approved that ad copy, or when I wrote my website, or drafted my Psychology Today profile, that someone would read those five little words and decide that I was not worthy as a therapist. It did not cross my mind, that when I put out there via a brief statement of populations that I work with, I would be inciting vitriolic ire that would inflame someone’s righteous indignation to the point of denying themselves their own healing. Instead of working with someone educated and experienced in healing the very thing that tortures their own soul, they would choose the alternative simply because I have held space for men and women that have seen horrors that the rest of the population cannot begin to fathom; that my chair has held the officer that holds their head in their hands while they take a deep breath to steady themselves, because they just interviewed a victim and they’re working to process what they were just told and not vomit; that I have stood in below zero weather behind a long line of officers and first responders as they lined the street waiting for the hearse carrying their slain brother, in case one of them needed me.
 
In those moments, they deserved compassion as much as anyone. In those hours, and days, and weeks, their brains witnessed, and didn’t process, and didn’t resolve trauma, the same way anyone else’s would. Trauma is an injury-the working definition of trauma is a wound. My charge, my mission, my work, is to recognize and support the healing of those wounds. They did not stop being human, or experiencing the impact of trauma, because of their chosen profession. This concept seemed firmly rooted in the Occam’s Razor principle - the simplest, most obvious explanation is the one we should go with. That explanation is that I am a trauma therapist, and they had experienced trauma.
 
You see, there is this concept called dialectical thinking that we have lost sight of. When we address something through a dialectical lens, we are examining diametrically opposed pieces of information, or opinions, and working to find a middle way, often holding that two things can be true at the same time. I can acknowledge that policing in America needs new policies and procedures in place to eradicate institutional racism AND I can provide critical incident services for a department. I am able to denounce police brutality and demand reform AND engage in EMDR therapy with a suicidal officer diagnosed with PTSD. I continue to advocate for changing how mental health crises are addressed and ceasing to use our law enforcement agencies as social workers and therapists AND hold space for the people that have witnessed the very worst of what one human can do to another.
 
It is a slippery, dangerous slope that we start descending down when we become so convinced that we possess everything we need to reject out of hand anyone or anything that does not strictly adhere to our beliefs. Even more destructive is when we begin to use that belief system as judge and jury, accepting and rejecting entire human beings based on our own snap judgements. Rarely are things what they seem on the surface, and you miss a lot of life along the way when you narrow your field of view to only those things that enhance your confirmation bias.
 
This little foray in the public broadcasting world netted me some new pieces of information-first, apparently, I was successful in letting people know why I’m not the therapist they are looking for-an expensive lesson in more ways than one, to be sure. From an entire month-long underwriting campaign, there was only that single email-but it spoke on behalf of an entire community, and the messaging was the loudest voice in the room. I can assure you, the message was received because there was no mistaking it AND I will continue to place my faith in the humans that I serve, because that it is who I am as a therapist. Now, to move forward deliberately with the intention that those three little letters set, instead of the blinders that those five words apply.

“Thank you for your vulnerability, Dr. Marich.”
           
Since coming out unapologetically as a woman in recovery from a dissociative disorder in 2018, I’ve received so many messages and social media replies that begin with this greeting. Being “out” has many meanings and layers for me—I’ve never hidden the fact that I’m in recovery from alcoholism and drug addiction, even though my advisers in the mental health field cautioned me about the perils of broadcasting it. In 2015 I made the decision to come out in every area of my life—to my professional following and to my conservative family—as bisexual, even though I never kept it a secret from my friends. Inspired by a Robert Ackerman teaching, I realized that I could not be a healthy woman in long-term recovery unless honesty prevailed about everything. And this led me to coming out with the dissociative disorder. Dissociative disorders are still highly stigmatized and largely misunderstood in the mental health professions, let alone by the general public. So many clinicians are afraid of us destabilizing and if the public even recognizes what a dissociative disorder is, old school portrayals of multiple personality disorders as seen in the movies generally serve as the association. In reality we are just people with many parts that form to protect the core self or to meet a need, generally in response to trauma. Sometimes the parts play well with each other, other times they don’t. With each vulnerable step I’ve taken further out of the shame closet, especially as a public figure in my field, I’ve learned an important lesson about vulnerability—people are simultaneously in awe of it and terrified of its power.
           
In this piece, which I write on my eighteenth recovery anniversary, I share what being out in my position has taught me, and continues to teach me about vulnerability. Before deepening this exploration, let’s get on the same page about what vulnerability means. Even though Brené Brown has made the word vulnerability popular in her stellar work over the last decade, people do not seem aware of its true meaning. Vulnerability is not just something you can simply define by one of Brené’s often-memed quotes. Vulnerability is more than just taking a risk or putting yourself out there into the metaphorical arena. At its core, being vulnerable is about engaging in trauma work, aware that this healing work can and usually does cause more pain in the process. If you’ve ever taken a course with me or have read one of my books, you know that I am a language nerd, and that my working definition of trauma is any unhealed wound—physical, emotional, sexual, or spiritual. This simplified definition derives from the word origin of the English word trauma—it comes from the Greek word meaning wound. Well guess what? Vulnerability comes from the Latin vulnarare, meaning to wound; another form, vulnerabilis, means injurious or wounding.

While the pop psychology understanding of vulnerability implies that one might get hurt if they want to take risks to grow, I will go a step farther and contend that hurt of all kind is inevitable. Here’s the lesson I’ve learned in my processes of coming out: Vulnerability is facing our wounding head-on and then deciding what we’re going to do in response to its impact. Are we going to ignore the wounds and thus open ourselves up to being hurt even more, or will we take the chance of feeling the pain we’ve stuffed down all the way through in order to experience freedom on the other side? I will spare you the details of my entire trauma narrative, yet I'll paint enough of a picture to qualify. By age four it was clear to me that I was too sensitive to survive the life I’d been dealt. By age nine I was already thinking of ways to destroy myself because I didn’t feel safe either at home or at school, and by 19 I was in full-blown addiction, the ultimate response of a developing brain that was bonded to dissociation in order to survive. I was born suseptible; life made me increasingly more vulnerable. Hurt was my baseline, and even though I got sober at 23, it wasn’t until 25 that the chronic suicidal ideation largely dissipated. Had I kept all of this bottled in, assuming I would have survived past my thirties, I’d still be hurting, albeit in a much more pervasive way and I’d not be writing this today as a sober woman. Sharing the pain with others is imperative, and I first learned how to do this privately with an amazingly trauma-focused sponsor in a 12-step program, then through high quality trauma therapy. I agree with Brené’s fundamental teaching that shame cannot survive when it is shared in safe spaces.

So why choose to be so public? Isn’t that the opposite of a safe space? In many ways, yes. Even though speaking freely about one’s recovery can be encouraged in certain circles, there is still a faction of the mental health field that is extremely uncomfortable with the practice. A painful lesson I’ve learned is that some people, including other professionals, can be downright hateful with their comments, or dismiss me as someone who can’t be trusted because I am either too unstable or I make it all about me. Some of these comments have been shared directly with me, in public forums or at conferences. Others have suggested that what I have to share from my lived experience isn’t as valuable as what the literature can back up with numbers and protocols. And others get downright silent and squeamish when I talk about surviving a clinically significant dissociative disorder and all that accompanies it (e.g., suicidal ideation, self-injury, addiction). A great deal that has been said behind my back has also been relayed to me—particularly that I have no boundaries for sharing so much of my story, or that it’s dangerous that I’ve let myself be the client in EMDR demonstration videos, letting colleagues work on me.

I expected all of these criticisms when I wrote my coming out article in 2018. I have three very easy answers for these critics that I’ve realized in the two years of ardent advocacy work that’s followed: (a) academic work in dissociation is important, and so is lived experience—we lose our soul as clinical professionals when we minimize that, (b) I don’t share anything publicly that I haven’t first addressed privately; may I suggest you look at what bothers you the most about my disclosures and ask if this is revealing something unhealed in you, (c) why haven’t you let someone do a public demonstration on you? While I respect everyone’s right to privately work on what they need to, if you are a clinical trainer or public figure, showing your vulnerability, i.e., your wounds will always help to diffuse the horrific us vs. them divide that promotes mental health stigma in society. Add these all to the pile of lessons.

I am public for all of the people, especially other professionals, thanking me for being so open in my position of privilege about things that our field has kept shrouded in mystery and shame. Especially dissociation. This is a particularly powerful lesson I’ve learned about vulnerability—when you put yourself out there and take a further beating for it—people who are prepared to hear it will be challenged into healing action. I’ve bore witness to many professional “comings out” as someone with a dissociative disorder, often for the first time. There is so much fear that they will be misunderstood (at best) or terminated (at worst) in their settings or larger clinical communities if they speak freely. Many people with dissociative disorders keep their condition hidden from their partners and their families, scared of the ramifications. For many of us it’s just easier to label what we have as something else—like PTSD or a bipolar disorder.

Yet in reality, dissociative minds have a masterful capacity to solve complex puzzles—we are often the most brilliant thinkers and leaders in any of our chosen professions. We are the ones who, if unafraid, jump in there and get things done, watching the professional committees in our fields wax on philosophically and theoretically about what should be done. Our dissociative minds are made of heart and soul, and when that can be appreciated and worked with instead of denigrated, the world can and will be changed for the better. When I know that my public sharing can validate even one other person with a dissociative disorder or other condition that is accompanied by a great deal of dissociation, being vulnerable in the way I’ve chosen to be feels more than worth it. I live for the day when public vulnerability is accepted as the norm and not seen as something out of the ordinary; I work to make that future a reality. And while recognizing this mission as my life's work is one of the most important lessons of my coming out, it's not the most important.

​Sexual addiction and recovery can be controversial constructs.  Unlike addictions to chemicals or substances, sex and sexuality are intrinsic facets of healthy human life and development. The goal of recovery from sexual addiction for most people is not to give up sex or the expression of one’s sexuality in its entirety. Rather, the purpose of recovery is to live a fulfilled life embracing a healthier model of sexual expression. Recovery is about setting boundaries and freeing one’s self of the suffering caused by acting out.
 
Like eating disorders, shopping addiction, and gambling, sex addiction is a process addiction. Process addictions are generally described as behaviors that are habitual and provide the person with an emotional high. The problematic behavior is often repeated to gain an increased high. A negative feedback loop forms wherein the individual cannot stop the behavior despite negative consequences. The origins of these addictions are rooted in trauma. Most people do not wake up one day and say, “Hey I think I’d like to become a sex addict.” Wounds leave their mark. The pain endured over time often becomes unbearable and prompts a form of escapism we see as addiction.
 
Shame often keeps people from seeking the help so desperately needed to develop healthier lifestyles in their journey for sexual recovery. Sex Addicts Anonymous (SAA) Green Book reminds recovery seekers:
 
Sexual addiction is not just a bad habit. Nor is it the result of poor self-control, a lack of   morals, or a series of mistakes. If it were something we could stop on our own, the negative consequences would be enough to make us stop. Many of us tried to cure ourselves with religious or spiritual practice, moral discipline, or self-improvement. Despite our sincerity and our best efforts, we continued to act out. Our behavior eluded all rational attempts at explanation or correction. We had to face the fact that we had a disease, and that we could not stop the addictive behavior by ourselves (p. 9).
 
My name is Michael and I am a recovering sex addict, anorexic, and alcoholic. What follows comes from my lived experience as a person in recovery and as a clinician trained in trauma, addiction, and mental health. I work the twelve steps and traditions of Alcoholics Anonymous (AA) and Sex Addicts Anonymous (SAA). I will forever be indebted Eye Movement Desensitization and Reprocessing Therapy (EMDR) and to 12-step recovery programs for the gift of living free from the bondage of addictions.
 
The spiritual principles, tools, and suggestions contained within 12-step recovery helped me to find a life that was worth living. I learned that I deserved to be recovered, loved, and that I have worth. Recovery and trauma work helped me to thrive and accept who I am, was, and can be.  In an earlier piece I wrote about the Step 1: “We admitted we were powerless over alcohol and sex, and that our lives became unmanageable.” The process to admit that I was powerless and that my life had become unmanageable took what felt like a lifetime to achieve. I bought the SAA Green Book and read through the entire text cover to cover in search for the answer of how to remain in sexual recovery.
 
The first task of this sexual recovery journey started 90 days of abstinence from all sexual behaviors. Let me tell you that it the most difficult thing I ever had to do in my life. I experienced withdrawal symptoms which included body shakes, anxiety, depression, angst, despair, craving, hypersensitivity, suicidal thoughts, and intense dreams. That list does not do justice to my lived experience during that time. It was a miserable experience, and yet a necessary one for recovery in my eyes.
 
When I joined SAA, I continued to hear a concept called “3 Circles.” It was all everyone talked about in meetings and in literature. In the Fellowship these three circles are how each member defines what is addictive and healthy sexual behavior for themselves. The program is quick to recognize the personal nature of addiction to sex. Not every human being acts out in the same way. For some their addiction is pornography. And for others it may be masturbation, destructive relationships, power and control, romantic obsession, cruising the streets for sexual partners, cybersex, prostitution, cross-dressing, having affairs, and fantasy. The list is endless.
 
Understanding what is addictive and is healthy requires distance and reflection. That 90-day embargo on sex and thinking or acting on sexual thoughts/desires were critical. The help of incredible trauma-informed sponsorship and therapy also played a major role in my recovery. I recall early in recovery listening to others share first step presentations about their powerlessness and unmanageability. I got into recovery in a Pre-COVID19 world with no local SAA meetings. My only options were telephone meetings all over the country.
 
Living with an addiction in isolation often drove me to act out. The beauty of phone and video meetings with others was that I could stay connected. I leaned early on in my process that recovery thrives in connectedness. I made several phone meetings part of my routine schedule. I volunteered on calls to read literature. During meetings I spoke up about my struggles and desires for a life built on a firm bedrock of recovery. It did not matter the time of day or hour of night. I made meetings a priority in my life. I stayed for fellowship hour at the end of each call. I exchanged numbers with other recovering sex addicts, and made phone calls during the week to talk about life, recovery, successes, and struggles.
 
I already received the gift of desperation. I needed something to give me hope in my life. As I called into these meetings, I heard men and women who shared their experience of what it was like, consequences of their acting out, and steps to stay in recovery. I sat and reflected on my own life after each presentation. I saw patterns of what behaviors I could not control. My first SAA sponsor, Adam, was a man who attended these phone meetings. We exchanged contact information and started to work the steps. I owe him a debt of gratitude for helping me to define what sexual recovery would look like for me. We have never met face to face. We conduct step work via email and phone calls. Sponsorship and meetings are my lifelines for connectedness. These are some of the tools in my recovery toolkit:
 
The Three Circles (diagrammed below) consist of three concentric circles. Each level represents a layer of addiction and recovery. Inner Circle behaviors are ones that cannot be safely practiced and/or controlled (seeking out emotionally unavailable people, pornography, drug use, alcohol use, disordered eating, etc.). Middle circle behaviors are actions, desires or behaviors that may lead to a slip or are risky (using sex to avoid emotions, lying, hiding, justification, etc.). Outer circle behaviors promote recovery (healthy sex based on choice, mutuality, and respect; meetings, sponsor, therapy, family time, staying connected, hobbies, step work, spiritual community time, dating, writing, dancing, creating music, etc.).

The process was a spiritual awakening.  For the first time I could see my addiction; it had a name. It was real. It had a list of behaviors and symptoms. Defining healthy sexuality shifted my understanding. The best advice I received from my sponsor was live in the outer circle. What a jewel that insight was. The way I interacted with people and my surroundings changed. I noticed a shift in mind, body, and spirit. I felt alive again.
 
As a professional and a person in recovery it was important to define my boundaries especially around addiction. I carried intense shame for my addictions. I often felt that I lived a double life. My recovery work centered around integration of all the parts and pieces of myself. I never could be who I was. All the parts of me were cut off. Sexuality was one piece. Intellectual me was another. Emotional side was another. Creativity was lost in the abyss. I felt if I came out about my addictions or my parts of self, I would be shunned from the profession. My recovery integrated into every domain of my life. I turned a new leaf thanks to the program, recovery support systems, and others who have opened the door that I may walked through.
 
I am who I am. I will not change this inner-knowing for any person or institution. The process of recovery has instilled within me radical acceptance for who I am. I am not alone. Acceptance, I discovered, was key to healing. Once I made a thorough first step and opened the flood gates of the past, I quickly realized the need for trauma work. I could not stay in recovery from sex addiction without resolving the past that impeded on my present life.  Spiritual awakening lead me to start EMDR.
 
I went to see Tom Buckles, LMHC, a former professor and licensed mental health clinician, who offered EMDR treatment. I quickly learned about my dissociative mind and how my parts of self directly influenced my acting out behaviors. Each of my eleven parts represented a wounded piece of my life. These parts were cut off facets of my life. I recall asking each of the parts to work together to help me heal. I believe because of this dissociative trauma work I was able to heal. At each session we completed between 4-5 trauma memories. I continued to see gains in EMDR. I started running, and I never thought I would be the running type. I restarted playing instruments, painting. My relationships with others took on a deeper meaning. I was free! I could remain present.
 
I have learned that my circles may change over time. In order to move something out of my inner or middle circle it requires an honest and willing conversation with my sponsor, recovery community and close friends whom I trust. My spirituality also plays a key role in helping to keep me on the road. Throughout this journey I have relied on faith to guide me. I turned over everything to the Higher Power of my understanding. I went back to the Roman Catholic Church, made confession, took spiritual direction, restarted mindfulness and yogic Practices, practiced spiritual principles in all my affairs. I remained open to what the universe, other people both inside and outside the fellowship, and my higher power were teaching me. I was an eager student.
 
The 3 Circles tool evolves with the person. Recovery is not stagnant. As I grew in healthiness and worked on the traumatic events that feed my addictions, sexuality took on a richer meaning for me. Today I am open to the potential in any situation. SAA and EMDR gave me the gift to live in the moment.  Both 12-step programming and EMDR allowed me to face what seemed previously impossible. Today I can live a life that I never dreamed was possible. I realize today that sexuality is creativity and a vital life force. I channel that energy for good.
 
Today, I am a trained EMDR therapist. I get to help others in their quest to heal.
 
Recovery made this possible.

Painting by Michael Gargano
To read more about Michael and his work click HERE

The response to COVID-19 is unlike anything I’ve witnessed in my forty years on this planet. Seeing so many events and yes, even whole sporting seasons being suspended, has me wondering if I’m living in some kind of twilight zone. Or in one of the apocalyptic movies that I love so much. While I appreciate the arguments I’ve read about mitigating risk and slowing the spread of the potentially deadly virus, my mixed emotions about everything are boiling over, prompting me to write this piece and share something I want to scream from the rooftops. Why don’t you care this much about risk and contamination when it comes to trauma?

There is so much rhetoric out there, much of it legitimate, about putting the vulnerable at risk by exposing them to the virus. Even though I’ve soldiered on to finish some planned events this week, a concern exists over how people may judge me for potentially putting others at risk. Where is this same level of concern in a country and indeed a world where violence against women and children is the most brutal pandemic of them all? What about the endless stream of brutality and invalidation that developmentally vulnerable children can be exposed to on a daily basis from parents, other family members, teachers or peers? And have you ever stopped to consider the systemic injustices that the poor, underprivileged, and underrepresented minorities in our society have to battle consistently? All of these are a short list of risk factors living in our midst every day that, if left untreated, will tragically blossom into complex post-traumatic stress disorder, addictions, “personality disorders,” dissociative disorders, and cause or complicate a whole host of other physical health conditions like heart disease, hypertension fibromyalgia, or cancer. Read the Adverse Childhood Experiences study and the public health initiatives from that study for a primer if you don’t believe me.

The heart of my teaching as an author and clinical specialist in traumatic stress disorders is that to truly understand the human phenomenon of unhealed trauma and how to treat it, you must break down the word origin. The English word trauma is a direct translation from the Greek word meaning wound. My working definition of trauma is any unhealed wound. You can check out my TEDx talk on the trauma as wound metaphor from 2015 on YouTube for the full teaching. Here are the highlights: understanding how physical wounding, illness, and injury works is the key to understanding all other kinds of trauma—emotional, sexual, spiritual, etc. Think of everything you know about physical wounds. They come in all shapes and sizes. Some may require more urgent care than others or they can be fatal. Whether you are talking about a scrape or a gunshot wound, all wounds need care. Sometimes that care is to wash it out and then give it time and space to breathe, and other times the care needs to be professional. Of course, people with compromised immune systems or other health problems are naturally more vulnerable and professional care may be imperative.

Wounds generally need treated from the outside-in to stabilize, although true healing occurs from the inside-out, over time. Check out the talk if you want even more of the metaphorical parallels between physical and emotional wounding; believe me, I can’t shut up about them. A major point to highlight is that it can feel easier to deal with a physical injury or illness, especially one that is visible like a broken leg or an audible cough. Because they are visible in the realm of the five senses, they are more likely to be validated by others as problematic. And if the risk of a more immediate fatality looms, the concern is generally worse. I argue that this is due to humankind’s overall fear of death and dying, but there’s not enough room in this blog to even begin to go there. Maybe the next one…

Yet if wounds are unseen, like the kind we experience in our hearts, through our emotions, and in our souls, we are more likely to get told things like “get over it,” or “pick yourself up by the bootstraps.” Or my favorite: “You’re triggered all the time! Enough already.” Usually it’s the people who complain about our triggering that are the ones who have done some, if not most of the wounding. Let me be clear—we’ve all hurt other people and we’ve all been hurt by other people. The severity of some wounds may require professional intervention, just like with physical wounding, while other wounds may simply need a little space, time, and tender loving care from another human being like a friend or confidant in order to heal. Having an awareness of how we are wounded and how we’ve wounded others is the key to understanding the risk of contaminating others with the blood of our own unhealed trauma. Hopefully this awareness can inspire willingness to proactively heal ourselves so that we do not contaminate others with our words, actions, behaviors, and the sordid fruit of our own unhealed wounds. Because it is often those we love—our partners, our children, other members of our family, and our friends—that we can harm the most. Until that widespread awareness happens, perhaps we can at least do less harm. In physical healthcare there is a greater sense of awareness that safety measures must be taken to minimize the spread of bodily fluids and pathogens in order to prevent disease. When we heal ourselves emotionally, we engage in similar prevention and initiative for mental health…see the parallel?

There’s another angle for me to share this week, this one much more personal. Like many in the clinical professions, my own struggles with trauma, mental illness, and addiction led me to this work. In recent years I’ve been much more public about my seventeen year journey in recovery from addictions, a dissociative disorder, and bouts of persistent depressive disorder (formerly called dysthymia). Due to reasons having nothing to do with the Corona virus, the last three months have been hell. I’m struggling to date again after an adulthood filled with poor romantic relationship choices resulting from the impact of childhood and adolescent trauma. Just before Christmas, one of my best friends died by suicide and I’m still dealing with a flurry of emotions stemming from his loss. And the mounting pressure of growing a business and becoming a more public figure in my field, I have to admit, is getting to me. I am privileged to have access to the best possible mental health care. I have the most kickass recovery support system in the world, an inner circle of friends that would walk through the fire for me or with me, a daily wellness practice, grounded spirituality, and a solid commitment to self-care. Yet the sheer volume of work and travel, coupled with a growing disconnect from relationships I value, is causing a level of exhaustion unlike anything I’ve ever experienced.

Two weeks ago, I experienced my first significant suicidal impulse in years and earlier this week, it flared up again. There are plenty of factors that keep me protected, yet the reality is that I just want off the fucking merry-go-round. Exhaustion was the main culprit, coupled with a persistent conflict I’ve been feeling over having such success in my professional life while still struggling with interpersonal relationships and my inner world. I hate that the more honest I can get about my suffering, the better that I teach. People draw strength from it, and it can also make me feel like all I was put on this earth for is to teach and to help others. I struggle knowing that so many people see me as someone who inspires them when I still feel like such a train wreck who has been having trouble getting out of bed in the morning on more days than not. On the day of the second major bout, I told my manager and friend that when I meditated and listened to my body, the one word that came up was, “Rest.” I had this overwhelming sense that my body needed a good few weeks to rest and reset herself, in the larger scope of reevaluation I’ve been conducting about my life, my work, and how I spend my time.

Of course, Dr. Jamie the public figure was hesitant to cancel anything—I have commitments and a reputation and a business! Although I have taken time off for my mental health in the past, I feel like I’m in a whole new territory now regarding my schedule and how many people rely on me. I’m not proud to admit this, but I actually said to my manager, “Maybe if I get this Coronavirus thing, I would actually get some rest and nobody would question it.” That was a wakeup call. And when widespread suspensions forced me to cancel my upcoming teaching tour of the UK and Ireland, it was even more of a wakeup call for me that I wasn’t really disappointed. I adore traveling and teaching abroad. And yet my body, mind, and soul needs the rest more. I’ve been granted it due to the risk and contamination precautions around a physical virus, and yes, I feel less guilty taking the time because of this physical manifestation of a disease and its implications for spreading. Yet would people in my work world—the people who book me, the people who come to my trainings, the people who depend on me in my life—have been as compassionate if I needed to rest citing a preventative mental health concern?     

Maybe yes, maybe no.

The bigger problems is that me—Jamie—wasn’t even compassionate enough with herself.

Could this be the result of some healing in me that I still have to let happen? Of course. Yet I also believe it’s the result of societal conditioning that none of us are immune to—this idea that physical health care will always take precedence over mental health care. That the medical model trumps the holistic model. And that what shows up in, on, or through our physical bodies and appearances is more important than what is inside.

Enough of this already.

Let’s connect in a way that honors the physical in a healthy way, yet values that who we really are as people is so much more.

The healing power of human connection rests at the center of my work, and this week I’ve been given multiple personal reminders about how this power is where our hope rests. Nothing is more important to me than human connection, and I want to reestablish this primacy before the endless grind of touring and “being public” makes me resent it. My manager and long-time friend Mary, my best friend Allie, and countless other people in my kickass support village have breathed me back to life this week. Whether in person, on the phone, or even through the sometimes cold medium of text, my people were there for me and I am grateful beyond measure for their time and their love. Allie, who lost her own father to suicide, reminded me that in order to get through this I would have to be fully honest about what I am feeling, especially with the inner circle. I teach this stuff all the time! It’s not lost on me that the teacher can be the most likely to forget, especially when she’s flirting with burnout. In those moments, the healing power of friendship and being rigorously vulnerable helped me to hear my own lesson.

I wasn’t expecting to share this vulnerably with my readership this soon, and yet here it is. With the healing power of human connection a potential casualty on the COVID-19 chopping block, a reminder is in order. If my story as its unfolding this week has done this in some small way, I’m truly glad I shared it.        

After 30 years of working in the field of behavioral health in various capacities, I’m owning the fact that I have dealt with vicarious trauma and PTSD related issues for many years.  While I can joke and discount many of the encounters I’ve had through the years as “part of the job,” I wasn’t counting on was the physical and emotional toll the job really had on me.  Had I heard some of these stories from others, I wouldn’t hesitate to be concerned at the symptoms and events; but for me, I could handle anything.  After a while, I had to discard my cape and realize I was not a superhero with powers to deflect the toxins that had been thrown my way.  As much as I dove in and stayed in the trenches to help people overcome their disturbances, I had to pull myself out of those same trenches to find my own healing. 
 
So, what is vicarious trauma, clinician burnout, compassion fatigue?  Vicarious trauma occurs when we have been exposed to, experienced, witnessed, or listened to other’s experiences of traumatic material, usually over a period of time.  When someone shares their traumatic stories with us in such a way that we can visually experience it with them, we are at risk of activating our own trauma responses.  This leads to what some refer to as “burnout”, but what I call vicarious trauma.  It is being personally traumatized through the eyes of someone else.  Vicarious trauma has a host of signs and symptoms, such as disconnection and/or depersonalization, lack of energy, social withdrawal or isolation, cynicism, despair and hopelessness, sleep and appetite disturbances, disrupted frame of reference, such as an inability to trust our own decisions, minimization, hyper-vigilance, self-loathing, emotional numbness, feeling overwhelmed, intense rage or bouts of crying, anxiety, nightmares, resentments towards others, including clients, feeling unsafe, poor self-care, concentration problems, and feelings of being on an emotional rollercoaster.   This list could go on and sounds in large part like the symptoms of Post-Traumatic Stress Disorder.  They are indeed trauma reactions, even if we did not directly witness the trauma, and have been a large piece of my life for quite a while now.  I’ve worked to gain an understanding of my own vicarious trauma reactions and feel lead to share this with others.  We are not “burned out clinicians” who need to retire; on the contrary, we are wounded healers who understand some things so intensely. Our clients are actually in the best hands they can be in, when we are well ourselves.   
 
When the whole of your work is to help others bear the weight of their souls, the pressure of their pasts, and the anguish of their current situations, it bears on us in a profound way.  We dissociate from our emotions just enough to show compassions and empathy but be still able to cut off from those feelings in order to help clients heal.  We may find ourselves subject to this pendulating force regardless of the situation, including in our own personal lives.
 
I have come to believe in the practice of self-care. For me, it’s more than just compassion and healing – it’s survival.  When I am in a spiral of negative cause and effects related to the vicarious trauma I’ve witnessed, the replay of my own demons, or a combination of the dark side of the world in which we live, I have to have the escape, the outlet, the life that still exists.  Expressions of art, music, prose, or meaningful conversations help me to share that emotional wound.  When I write, my soul unburdens itself without fear of judgement, accusations, or denial.  What I have inside me needs to be expressed from a place of non-judgement or I will not allow it to purge, and, not purging those feelings is disastrous.  It can mean the shutting down of emotional regulation, the disregard for others and myself in a variety of areas, and a general sense of mistrust with the world around me.  I need to have light in the times of darkness, for if the cold dampness is allowed to fester, the beauty within is left to ruin.  Expression is my escape from the center of my mind which I so desperately need at times.  Without the escape, I become tainted and ineffective as a clinician and as a person. And so, my hope in writing about this is that this act of self-expression and owning my experiences with vicarious trauma will help others find an outlet to express their own feelings and experiences.  What is left alone too long no longer serves any purpose, except to destroy. 
 
And so, this writing comes from a state of necessity.  I am now noticing that the depth of the pain of what I hear all day has had a tremendous effect on me over the course of 30 years, and I’m sure other clinicians feel this way as well.  By sharing this experience, I hope we are all able to find the core piece of ourselves that was what started our paths on this journey again.  The times of wanting to cancel clients and take the day off, sleep disturbances, experiences with hyper-vigilance and intrusive thoughts were creeping in again like a familiar, but terrifying, old friend.  The ghosts of those past mentors, clients, clinicians, and eras had been overtaking each other until I no longer heard the words which needed now be spoken, to me or others.  When I can no longer distinguish between clinical appropriateness, my own bias, therapeutic boundaries, and personal fears, it’s time to pull back the reigns and allow some healing to occur.  So, as I offer these perspectives to my colleagues, I should also note how very personal this is for me.  My life’s work in the field of behavioral health has taken different avenues, but I have never lost my desire to be a guide to those who may need a light.  By shedding light on this issue, I hope to find my own light source again in a way that it no longer burns down quite so far. This is how I make amends with my own past mistakes and come to a place of true trauma-informed care, that starts, inevitably, with me. 

They’re doing it for the attention.
It’s a refrain uttered everywhere, as people attempt to explain why troubled adults, adolescents, and children behave the way they do. Overused and indiscriminately applied, doing it for the attention has bothered me since I was a trainee in child psychology. Surely, humans do what they do for a wide range of reasons. And if someone is crying out for attention, don’t they deserve—need—us to notice? To attend?

Instead, seeking attention from others is all too often reviled. It’s dismissed as indulgent, considered a reward for undesirable behavior, a reinforcement of disavowed emotion. So, we stop being curious about others’ internal experiences — disconnecting from what they know, feel, need, want, fear — and, necessarily, we disconnect from our own. Rather than noticing, bringing attention to what’s happening inside no matter how confusing or intense or messy, we learn to turn our attention away. We numb, avoid, put aside. It feels safer to stop noticing. If we don’t give it attention, we can make it disappear or pretend it’s not real.

Not so in the process of EMDR therapy. There, the words, “Just notice,” are the foundational guideposts.

“Just notice,” we therapists say. “Let whatever happens, happen.” We may repeat this mantra countless times a day-- a reflex woven into procedural memory as we support clients dealing with trauma.

Just notice? The mother wonders, just notice what?, as she stands over the warming bed of her two-pound baby in the NICU. She tries desperately, silently, to notice what the nurse is showing her about her newborn baby’s skin tone. What if I never get it? she thinks. What if my ability to notice what’s important is broken?

“…and let whatever happens, happen,” we say, as the newly bereaved parent of a baby who died at birth looks at us with wide eyes.
“Let whatever happens, happen? I can’t just notice. I can’t trust my judgment. Just look at this baby, who my body failed, who I have failed…”

We say these words because we know that the key to healing begins with simply noticing. Pay attention. Be curious, see what happens next.

But it’s a catch-22. Trauma fractures our natural ability to notice. It disrupts our capacity to access that calm curiosity that allows us to stay connected to what’s happening inside. Bringing our attention to pain, even though it’s uncomfortable, seems to be essential to recovery. It’s as if we need people to be healed in order to access the healing.


Fortunately, as in all relational psychotherapy, EMDR therapists offer our attuned presence as scaffolding and support as people begin to turn their attention to their internal world. With EMDR therapy, we provide precisely the sort of nuanced appreciation for the ebb and flow of thought and feeling, somatic sensation, and memory that parents must bring to their babies and that, especially in the face of disruptions on the road to parenthood, can seem both frightening and out of reach.

It goes something like this:
As you bring your attention to yourself, just noticing, I will help you. I will notice with you. I will notice the subtle changes in your skin tone, as your cheeks redden and clear, as the tears rise and fall. I will note your breathing and breathe with you. I will not turn away from your fear or your pain or your anger. My nervous system will listen to the rhythms coming from yours. I will notice and then you can notice, too.

That subtle sensation, that flickering emotion, it all matters. “Notice that,” we say, inviting gentle curiosity, remaining just as engaged and attentive as when tears are flowing. “What are you noticing now?” we ask. So often, language is elusive but the emotion, the emergent shift, is palpable and so we lean in. “Just notice it,” we say, affirming that it exists even when it can’t yet be articulated. “That blossoming warmth? That stab in your chest? Just notice it. And when you do, when you let whatever happens happen, we will notice together. We will know its truth and meaning together.”

This is how we walk with our clients into the process of EMDR therapy where everything they notice, no matter how subtle, counts, not just the sobs or the searing flash of memory. It’s also how we accompany bereaved and traumatized parents into the new world born in the face of perinatal trauma. We notice the shrapnel causing pain and blocking healing. Just as important, we nourish and support the gradual creation of connective tissue that forms the foundation of a new sense of self: as a parent to this baby within the matrix of relationships, within this family.

All of it, every single nuance, counts.
“My baby only spent a few days in the NICU,” said one father to me in response to a call for interviewees for our book. “Are you sure you want our story?” “Our baby died,” whispered another. “Do you really want to interview us?”
It’s a common concern that parents express to therapists. Does it count? Does our experience really matter? Even if my baby is fine now, or if there are no marks on my body to prove that we’ve walked through the fire or no living baby to parent after all we endured? Do I have permission to notice what this means to me, how it actually feels? And if I do notice where it hurts, can I show you? Will you pay attention?
So we sit across from the families who land in our offices-- parents unmoored from what they used to know about themselves, about babies, pregnancies, and the way the world is supposed to work when you’ve followed all the rules, and we pay attention. We notice and most importantly, we trust what they notice. We show them with our engaged, calm presence, staying out of the way but staying.


If we’ve been fortunate to become a parent to a full-term, healthy baby, conceived, gestated, and born without incident, it can be challenging to learn to decipher these signs of dislocation and the consequences. When the road to parenthood has been pitted with earthquakes and storms, parents cannot trust in what once seemed natural and easy. Without that steady sense of “I can figure this out,” or “everything will be okay,” parents feel unmoored and may desperately turn to others to steady themselves.


They often turn to professionals, like us.
And yes, they are doing it for the attention.
And in fact, they benefit when we pay attention-- when we see them as they are, validate their experience of their journey, acknowledge their pain, and accompany them as nonjudgmental witnesses. Our attention is what helps them learn to notice both the obvious and the nuanced and let what happens happen. Our attention is what helps them regain feelings of confidence and competence. Gradually, they begin to believe in themselves as parents, including, “I can learn to read this baby’s cues,” or, “I can trust my sense that something is wrong (or right) with myself or my baby,” or, “My pain counts even though other parents are experiencing a grief and fear I can’t even fathom.” Or even, “I feel love and hope and joy even though strangers glance at my baby and turn away,” or, “I am a loving parent even though my baby died.”


Our attention validates these truths. Noticing them guides our clients to turn their own attention back to their lived experience in all its mess and meaning. Only then can they weave together the strands of their experience, appreciating them all as part of a larger whole.

​In the last two weeks I have suffered three injuries. None of them so terrible that I required major medical intervention, but bad enough to leave me generally pretty bruised and crappy feeling. It was on the heels of some bruised ribs and a fall down the stairs that my partner invited me to attend a woodshop orientation workshop in which we’d be introduced to various saws and machinery and how to use them correctly. You can see where this is going…
 
The second saw in, the instructor casually referenced the availability of a safety mechanism and cavalierly noted that most people find it a nuisance and moved along without showing us how to use it. Naturally, when it came to my turn the saw spit back a piece of wood at me which rocketed into my hip at what felt like 8,000 mph. The pain shot down my leg and my body went tingly then numb. I could barely stand. The instructor and other participant just looked on in silence and moved on to the next machine. My partner, who’d invited me, looked at me with genuine concern and whispered, “are you ok??” I clenched my jaw and nodded and hobbled along behind the group to the next machine where I put on a brave face and completed shaving off an eighth of an inch of a piece of wood on a drum saw. Afterwards, I began to feel overheated and a little faint, so I turned to my fella and said, “I think I’m gonna sit this one out, you stay here!” It was at this point that I exited to the parking lot and proceeded to cry my eyes out. Every part of my body hurt, and I was so tired and overwhelmed there was no way to keep it in. Awhile later, I sent him a kindly text explaining that I was not feeling well and I’d walk back home and for him to enjoy the rest of the workshop. My partner responded in the sanest way possible by immediately calling me, asking where I was and if I was ok. After admitting that I’d been crying in a parking lot by myself, he said rather plainly, “you sitting in a parking lot crying by yourself is more important than me learning to use a band saw. You hide what you’re feeling really well.”
 
He’s not wrong. I grew up in a feelings phobic household. Sure, my parents cared for us and treated us well, but I don’t even need one hand to count the number of times I’ve seen family members cry in front of me. Sadness was treated as a medical problem, rather than a natural emotional response. So many people have it worse! Pull yourself up by your bootstraps! And power through! Were the well-intended mantras of our household. Sadness was something tucked away and saved for the medical professionals. And to be clear, I have dealt with diagnosable depression that has required medical intervention. But I do wonder if the inability to express sadness only compounded those feelings.
 
It wasn’t until the day after my woodworking injury when talking with a friend that I realized how insane my response had been. My natural response had been to save those feelings until I was by myself and walk home on a crippled hip so as not to bother anyone. In that moment I did not believe that my pain and experience might be more important than someone else learning to use a dumb saw. I did not realize that it might be a little out there to suppose I needed to keep it together in front of an instructor who clearly wasn’t interested in my safety, a stranger, and a person who cares deeply about my well-being.
 
These are the lies we tell ourselves: my pain isn’t important, or least not important enough to bother anyone. I cannot show what I’m feeling. It’s better to suffer in silence. No one likes someone who’s always complaining. I cannot look weak. I need to have it together.   It’s always a little funny when I become aware of this stuff, because like hey, it’s literally my job to help people process feelings in a variety of ways. And as much as I write about it, and give talks, and work with others, I’m still a human for whom this exists. Honestly, it kind of makes me feel like a fraud sometimes. I guess that’s the other lie: you’re not good enough.
 
I think it takes most of us awhile before we even realize that some of the beliefs that underpin the way we operate in the world are lies – mostly, we just think this is the way we are, and the way we handle things without subjecting those beliefs to any litmus tests. It usually takes someone else asking me, “how is that serving you?” before I put those beliefs to the test. How does it serve us to buy into these beliefs we have about ourselves, what we deserve, and what we should do? Are these beliefs and the actions that extend from them benefiting us? Or are they hurting us? Do they make my life better? Or worse? I’m going out on a limb here, but in retrospect it seems like deciding to walk home on a busted leg because of the belief that I cannot show my feelings wasn’t making my life any better.
 
But seeing the lie still isn’t always enough for me to do things differently. It’s hard to get away from that initial gut reaction to default into the same old way of doing things. There are a million reasons we find to not do things different. It’s hard. It might not even be better anyway. It will definitely be uncomfortable. These are just a few that I can buy into. I mean if you grow up in a household where crying in front of another person is never experienced, how do you even begin to test out that kind of vulnerability? Truthfully, I’m not sure. But I know this, after I let it all out to someone I care about and whom I trust in return, I went home, was tucked in under some blankets and fed chocolate in front of the TV until I fell asleep. And you know what? I felt better. I’m not always sure I know the answer, but I am fairly sure at this point that if I don’t try being vulnerable with the right people in the moment, I will always end up crying by myself in a parking lot. And at this point, that just isn’t serving me well anymore.

I was sitting in front of a client one afternoon as she talked to me about the rape she had experienced a few months ago.  As the tears streamed down her face, I began to feel my hands shake, not that she could see, but enough that I definitely noticed.  She continued in details of what happened and I remember floating to the top of the room.  As she cried, I could only observe her and watch without feeling as I had left my body and floated above myself.  I could see my clipboard, writing nothing, see the steaming coffee beside me, hear her sobs and comments; what I could not do was feel anything…until I came back inside myself.  The session was concluding and I was able to offer some superficial comfort as I escorted her to the door.  When I closed the door behind her, I could see the bathroom door as I opened it.  I saw my best friend standing there with another male friend of ours as they had this coy look on their faces.  I recall thinking I was in trouble but did not seem able to react until they began to pull me along, down the hall, and into the bedroom.  Once I was thrown to the bed and my clothes were being torn off, I could feel the tears on my cheeks, just like my clients.  I slowly started to float above this scene and watched in horror.  When I noticed I was still in my office and I was staring at the door, I came back to the present awareness, went to my desk chair and wept.  I knew it was time to reach out for help.  I could not control these memories, these feelings any longer. 

​I reached out to a colleague who was an EMDR therapist.  She agreed to see me to help with anxiety issues I was having from work.  My agenda was to be able to trust her enough to share this secret and work through it, but I remember being terrified to talk about it.  The longer I met with her, however, the more comfortable I became and it did not take too long before I was able to tell her about the experience.  That was hard enough, but as I sat in her office, I wondered how I would ever be able to release all the pain of the rape.  How do you even begin to talk about this?  How do you let go of this?  How can you possibly ever trust again?  Be whole again? She was very patient with me and, as I could, I began to share what happened with her.  I was able to ask some of the questions I had been thinking and she began to tell me what she thought would help. 

She introduced to me a procedure known as EMDR therapy.  She explained that EMDR works to help resolve traumas and she talked about what we would actually “do” while in sessions.  She said I would watch a light bar, following the light with my eyes, and this would begin to let these emotions process in my brain.  I thought it was weird and probably would not work, but desperate for healing, I agreed to try.  We talked about some of the negative beliefs I had about myself as a result of the sexual assault and how it had altered the way I see myself.  I would have flashbacks and nightmares often and we talked about these as well.  We took things slowly, as I could not handle too much at a time.  She knew that and while pushing me somewhat, she also respected the boundaries, the lines I could not yet cross.

During the sessions, I watched the light bar and also wore headphones, which sounded a rotating “beep” back and forth in unison with the light.  With both these forms of bilateral stimulation being conducted, I would picture things in my mind, feel what was going on in my body, and notice what memories or thoughts would come.  Often a lot of emotion came out, sometimes I was not sure about what.  This was all part of the process.  We would target in on a belief due to a situation and then would let me “process” that, meaning I would watch the light, listen to the beeps and notice what happened in my body and mind.  It only took a few times to realize something was happening with this process.  I was beginning to deal with my past.

We continued to use this therapy to help process other areas of my life as well.  Some of the other situations involved other sexual traumas I had not recalled with this great a detail.  Although I was having these memories surface, I felt safe knowing we were working through this together.  
 
I cannot say I enjoyed the therapy and remember many times leaving her office emotionally drained; yet I knew I was healing slowly.  I recall one of the scariest times of the processing was when she had me hold the picture I was seeing of the rape in my mind and watch the light to begin to process this.  Immediately I began to feel anxious as I pictured the scene.  Although there was fear, what I realized was I was having these feelings anyway, but it was different this time.  I could begin to feel myself releasing some of the pain through this process.  I could feel some of the anxiety go from inside my soul.  I was tearful as I followed this light and at times would sob.  What was important to me, however, was that these images were beginning to change.  I was able to see the incidents and not float away; I could stay inside myself and feel what I had pushed down for the first time in years.  I was allowing myself to heal.  Through the pain of the trauma, I was being led down a safe avenue to process this with the care and safety of my therapist right there, guiding me.  I did not have to be alone in these memories anymore. 

Sharing the story of the rape was one of the hardest things I ever had to do.  To let someone else in to see my pain, shame, embarrassment, anger, and vulnerability was like an ache I had never before felt.  But as my therapist always said, in order for true healing to happen, someone has to witness your grief.  Until we can share that pain with another person, we will never truly be free of it.  This made all the sense in the world to me as I had carried that grief around for years.  Being free of it used to just be an unobtainable thought, but now through EMDR therapy, I could see real hope. 

As I mentioned previously, I also began to recall with more memories and details a few other incidents that occurred in my childhood.   Had I not been doing the bilateral stimulation that EMDR utilizes, I do not think I would have been able to recall some of the specifics that made all the pieces come together.  I was able to remember what happened to me in that day care, in that school office and in that neighbor’s home.  I was also able to share these experiences with my therapist and we worked through these as well.  When I say working through it, it does not mean just forgetting and moving on.  With EMDR, I was able to feel the emotions I had pushed down in regards to these events and begin to let the emotions go.  It was as if all the years of pain came up and passed through me again.  However, in order to be able to truly integrate this as part of me, this had to occur.  I never knew what “processing it” meant until I discovered the EMDR journey.  It was like a life saver to me.  I was able to be free of the pain, not just pushing it away.  I could recall the memories, but allow them to stay in the past where they belonged.  I did not have to let them hurt me anymore in my present life.   I could be free. 
 

I have had a lot of people reaching out to me lately for some advice and insight on balancing private practice work with parenthood, and more specifically, how to handle parental leave.  In the spirit of developing an open dialogue, I have decided to share my experience in the hope that it may be helpful to others.   For some background, I am an EMDRIA Approved Consultant and Certified Therapist, focused primarily on trauma therapy.  I have been in the field of social work for almost twenty years and started my EMDR therapy journey in 2008.  I am a faculty member with The Institute for Creative Mindfulness, and own a small private practice in Columbus, Ohio where I work with clients of all ages who have experienced some form of trauma or adverse life experiences.  I live with my husband, dog, and beautiful one-year-old daughter. 
 
There are days I feel like I am really succeeding as both a business owner and a mother.  There are other days it seems I am frantically trying to juggle all the pieces of my life, without feeling confident that I am successfully managing any of them.  This has just become part of my personal journey.  Self-care and balance are hard enough concepts when we are solely dealing with being mental health providers in the field.  Add to that a relationship with a partner, and the responsibility of caring for a child, and it’s easy to see how self-care can be pushed to the back burner.  As we preach to our clients though: if we are not taking care of ourselves, we will not be able to care for others.  So here I am, putting on my oxygen mask first and finding ways to balance my sanity, in order to have time and energy to devote to my family and my work.
 
I’ll start off with some of the things to think about as you prepare for taking some leave from work.  Whether you are giving birth, adopting, or your partner is having a baby, there will be a period that you will need to be home with your family. 
 
Things to consider before your leave:
 
1. Think about how and when to tell clients about your baby:  The timing of this is completely your choice.  Some people start telling everyone they know as soon as they get a positive pregnancy test.  Others wait until they are as far along as possible to minimize the risk of having to disclose a lost pregnancy.  Just be sure to think through all of the options before going to one extreme or the other.   If you are pregnant, you cannot assume that your clients won’t notice a growing bump or other symptoms.  This is particularly important when working with trauma survivors; many trauma clients pick up on any small changes.  Their brains have been programmed to attune to others as a form of protection and defense.  So, if you are experiencing extreme fatigue, nausea or other symptoms, you may want to let clients know what is going on so that they don’t form any of their own conclusions.
 
2. Consider that your situation may be triggering for clients:  While you may be bursting at the seams with your exciting news, please keep in mind the impact this could have on your clients.  Some of your clients will be overjoyed for you.  Some clients will immediately start to panic in anticipation of your absence, or even the possibility that you won’t be returning to work at all.  For others, they may have dealt with infertility, had an unplanned pregnancy, had a miscarriage, lost a child, or have a history of terminated pregnancy.  Think about each of your clients carefully and consider how you will deliver your news.
 
3. Decide when to stop taking new clients:  You will need to decide on a reasonable date to ethically stop taking new clients on your caseload knowing that you have an upcoming period of leave.  This time frame should depend on the nature of your populations and scope of practice.  If you have started telling existing clients on your caseload, then you also need to inform potential new clients before they start investing time into coming to see you.  You will also need to consider the type of work that you are doing with clients as you approach your baby’s arrival date.  Be sure to allow ample time to work with your clients on planning their transition.  With some clients, it is not responsible to continue to do trauma processing up until your last day, because of the possibility of destabilization and your inability to be available to support that client.  You also need to consider the possibility that your leave will begin sooner than anticipated.
 
4. Have a plan for coverage while you are on leave: What you do with your cases while you are off is something that you will need to decide with some input from your clients.  Some of your clients will be able to manage a period without attending counseling.  There are some clients that you may think would be able to manage without counseling but will elect to see someone anyway, and vice versa.  Finally, some clients may be required to see a counselor during your leave due to safety reasons.  If you work in a group practice or with colleagues, reach out and see who would be willing to cover your cases while you are on leave.  If you work alone and don’t have many colleagues, reach out in some networking groups to see if anyone is available, or do some of your own research and find some referral sources for your clients.  You can link clients with specific clinicians, or you may provide a list of a few therapists that are available and willing to see them while you are off and leave it up to them to make the contact.
 
5. Clean up your caseload:  I do not recommend leaving any cases open on your caseload while you are on leave.  Complete a discharge summary for each client that outlines your recommendations while you are on leave.  You can always re-open cases when you return to work.  However, this will relieve you of any liability while you are off as well as compensate for any potential delays returning to work or issues that could prevent you from returning to work.  I also recommend creating a form letter that lets clients know that you will be going on leave with general recommendations.  Provide a copy to your clients and keep one in their file.  This can prevent any claims later that you did not provide ample notice or planning.
 
6. Plan how long you intent to be off:  Think about how long you plan to be off and begin financial planning as soon as possible.  If you are in private practice, you may be an independent contractor and not have access to paid time off.  If you plan far enough in advance, there are some short-term disability insurance plans that may fit your needs.  You will need to start paying into the plans before you or your partner are pregnant.  Remember that babies are not always on the same timeline as we are, so consider a window of time that allows for the baby to come earlier or a little later than expected, and consider how you will handle any situations that may require extra time off.  Consider alternative strategies for income to make up for your time off.  If professional development or consultation are within your scope of practice, consider scheduling some trainings before and/or after your leave to bring in some additional income.  Think about hiring someone part-time to supplement your time off (and as an added bonus they can start off by covering some of your cases while they build their own caseload).  In my experience, trainings allowed me to supplement my maternity leave and enabled me to come back to work seeing clients part-time.  I invest about one weekend a month to training, but it allows me to spend more days at home with my daughter overall.  Consultation groups for EMDR therapists have also allowed me to make income in a shorter block of time than seeing a full day of clients.  Balancing a schedule of trauma therapy with consultation and training also facilitates self-care and secondary trauma prevention.
 
7. Identify how you will communicate the start of your leave:  Figure out a plan for how you will communicate that your leave has started.  You may want to pick a date a few days before your baby’s due date as your last day to see clients.  You do not want to be thinking about calling to cancel clients while you or your partner are in labor or arranging plans for the immediate arrival of your child.  If you need to work until your baby comes, create a new voicemail each day that states whether or not you are in the office.  Let your clients know to call the voicemail before heading in for their appointments.  When you start your leave, be sure to change your voicemail and email responses to communicate that your leave has begun, as well as the steps clients should take if they have a clinical need.
 
8. Have a backup plan:  As mentioned earlier, babies do not always follow the plans we have set in our heads.  Some people also fully intend to come back to work but things change while they are home snuggling their new squishy babies.  Be sure you have a strategy for communication of any changes to your schedule to clients that are hoping and planning on coming back to see you when your leave is over.
 
9. Identify how you will communicate your return:  Just like the form letter that you sent to clients to notify them of your upcoming leave, you will want a plan for how to announce that you have returned to the office.  If you have a social media account for your business, you could direct clients to check there and make a post when you have a return date.  You could also send a general announcement to your former client load.
 
10. Establish a plan for working during your leave:  If you plan to do work while you are on leave, I would encourage you to think about how crucial that is.  In my case, I was running a small practice without an office manager, so I didn’t have a choice but to continue to do billing and payroll.  Decide whether any of your tasks can be delegated, and if not, identify specific times in your week to allot to doing work.  You only get parental leave one time with your baby and you want to make the most of it. 
 
Things to consider with your transition back to work: 
 
11. Don’t plan on continuing to work as effectively at home as you do in the office: I thought I would be able to get a lot more work done from home.  As I look back, the time period I probably could have gotten the most work done was the first several weeks of leave when my daughter was mostly sleeping.  However, that was the time I soaked up the most and really bonded with my new baby.  Once they start becoming interactive and eventually mobile, you will need to be more deliberate in delegating a time and space for working in the home.  Fortunately, I have an amazing partner and a lot of family and friends that jump at the chance for some baby time.
 
12. Ease back into your schedule:  Some of you will be itching to get back to work by the time your leave is done, and some of you will be dreading it.  Either way, make sure you plan for a transition back to work.  Not only will you be making the adjustment back to seeing clients and using your brain in a new way again, you will also be adjusting to a new schedule and being away from your baby.  This doesn’t have to mean a very gradual transition, but I don’t recommend planning to see a full day of clients your first day back. 
 
13. Expect to be sleep-deprived:  Sleep deprivation is a real thing.  I know people joked to me about it all the time, but it is the real deal.  I have not slept through the night in almost two years, counting the sleepless nights that started while I was expecting.  I don’t have any good advice here, but I wanted to normalize and validate this for all of you.  You are going to be tired.  There are going to be days you have a full day of intense clients and your child is also teething, has a fever, or just didn’t sleep the night before.  Take care of yourself.  And coffee.  Sweet, sweet coffee.
 
14. Prepare for a range of emotions:  As I mentioned earlier, you are going to experience a lot of emotions as you return to work.  Whatever those emotions are, notice and pay attention to them.  Take care of yourself and your needs.  If you feel you need extra support and you don’t already have a good therapist, find one!  EMDR therapy can work wonders for postpartum depression and anxiety.  There are also some great groups on social media if you are looking for some camaraderie with other working parents, such as “Moms in Private Practice (Mental Health).”
 
15. Think about countertransference:  As trauma therapists, you may find that you experience some new countertransference now that you are a parent.  As a clinician, I validate to my clients that as their own children reach certain developmental stages, they may find themselves newly triggered by their past experiences at those ages.  The same can happen as clinicians.  Hearing about trauma and adverse life experiences your clients experienced as children may feel different to you now that you have your own child.  Just be aware of what you are experiencing, and find someone that you trust and that you can process these feelings with: a coworker, supervisor, consultant or even your own therapist. 
 
16. Establish a self-care plan:  Establish a self-care plan, and don’t minimize it.  As a new parent, I have to schedule time that is set aside for myself.  I make an extra effort to go to bed at a certain time, drink water, and eat healthy meals.  I also schedule purposeful social interaction with other adults.  Identify self-care strategies that are small and some that take more time, and figure out how these can fit into your routine.  If we just assume that it will get done, it won’t.  You need to be purposeful about this.  I have found bullet journaling to be especially effective for tracking my daily, weekly, and monthly goals.
 
17. Prepare for pumping needs:  If you will be breastfeeding, you will need to think about your pumping needs.  Be sure to schedule time for pumping.  Because of the nature of our work, most of us already have a private office, but if not, find out how to establish a private space for pumping.  Kellymom has some great articles for support with pumping at work.
 
18. Re-examine your boundaries:  The biggest change for me since going back to work as a mother has been my boundaries with my schedule.  If you ask any of my colleagues, they will be the first to tell you I used to work a ridiculous schedule.  I was known to see nine or ten clients in a day and work sixty hours a week.  As a new mom and recovering workaholic, I am now forced to say “no” to appointments that are outside of my scheduled week.  Primarily because I would need to arrange additional childcare, but also because it intrudes on my time with my family.  I learned the hard way that coming home right at my daughter’s bedtime to put her to bed didn’t go as smoothly as I planned.  I also know that I cannot allot exactly enough time to drive to pick up my daughter from my last scheduled session.  Sometimes sessions run over, or I need to make a client phone call at the end of the day. 
 
19. Let the guilt go: The first day I went back to work, I definitely cried more than my daughter did.  Looking back now, I’m actually not sure how much she noticed me walking out the door.  At the time, my guilt was at an all-time high, and I had an unrealistic impression of how much my work would affect her.  In reality, she has been able to spend much more time bonding with family members and caregivers and finding ways to develop.  I had to let go of the grief around not getting to see every single thing she did, said, and discovered.  Instead, I make an effort to be fully present when I am with her.  There are going to be things that I don’t get to see, but I try to make up for it by mindfully experiencing the events I am there for.
 
20. Find a new balance: I have to be more purposeful about when I check work email and when I do work from home.  I want to be fully present at work and fully present with my family.  I am definitely not always perfect, but I don’t feel good about my role as a mother when I am trying to do work while simultaneously feeding my daughter lunch, nor do I feel like a great clinician when I am responding to an email while trying to sing Old MacDonald.
 
Final Notes:
I hope that this article has been a useful resource for considering your parental leave, and I hope to hear from many of you with more helpful additions to this conversation.  I have to make a conscious effort every day to try to practice the kind of self-care and balance that I encourage for my clients.  It is my hope that by sharing my experience some of you may be inspired to begin planning for balance in your new journey. 
 
Suzi Rutti, LISW-S
Rutti Counseling & Consultation, LLC
www.suzannerutti.com
https://www.facebook.com/suzanneruttilisws/
​

For as long as I can remember, I have adored flowers. Looking at wildflowers in the fields or noticing several varieties alongside houses in my neighborhood are some of the first pictures that come up in my head when I float my memory back. I remember having to ask my mother’s permission before picking them in my own yard or my grandfather’s yard nearby because I once got in trouble for plucking some of the neighbor’s tulips. I’ve only recently started to appreciate the awesomeness that my mother is named Rosie (which she prefers to Rose)—and that literally makes me a flower child!

​I can’t remember when I first received flowers—it was likely when I made my first communion around age seven. I fondly recall getting flowers from my friends and family when I was in my first big stage show at twelve. The confirmation name I chose for myself when I received the sacrament in the Roman Catholic Church is Marie-Therese. I selected the name to honor St. Therese of Lisieux, also called the Little Flower. The first tattoo I got was of a flower (a peace lily on my hip). Even though both of my marriages ended in bitter divorce, I still have several fond memories from both relationships that involve receiving flowers. On a recent pilgrimage to India, one of my drivers—a lovely man named Ratan—climbed a tree to pick me the state flower of Uttrakhand in the foothills of the Himalayas. This gesture had me beaming from ear-to-ear and made me realize just how much I love receiving flowers.
 
So what better way to honor the sacredness that I am than to practice buying myself flowers? We can put so much weight, especially as women, on what it means to receive flowers as a gesture of love or appreciation. But who is to say that for flowers to have such appreciative value, they have to be gifted by someone else?
 
Although I’ve picked flowers for myself over the years, I do not consciously recall buying myself a bouquet of flowers until about two years ago. I purchased a beautiful dozen of pink roses to celebrate my separation from marriage number two and all of the pain it represented. After that marriage ended, I entered into a period of deep inquiry to investigate and ultimately heal the remaining layers of relational trauma that kept me in this loop of unserving relationships. And in my sadhana (spiritual practice), my guides led me back to a favorite poem from which I’ve drawn great strength over the years, After A While by Veronica A. Shofstall. After my first divorce, I wrote a song called “Grace of a Woman” (which became the title track to the last album I recorded in 2012) based on a line from this poem. The repeating line in her poem is “after a while you learn”… During that period in my life, this line most resonated for me:

And you begin to accept your defeat with your head up and your eyes ahead
With  the grace of a woman, not the grief of a child

Clearly that was the lesson my foolish heart needed at the time. Yet with one of the classical definitions of foolish being “slow to learn,” there was still more healing to be done…
 
Within a few weeks after my second husband and I parted ways, I remember standing at the entrance to the grocery store near my home where the florist is located and Veronica’s poem came back to me like a lightning bolt. Specifically the wisdom:

After a while you learn that even sunshine burns if you get too much
So you plant your own garden, and decorate your own soul
Instead of waiting for someone to bring your flowers
​
Thus, as a ceremony representing the new phase of healing that life was bringing me through, I bought myself that bouquet of the most beautiful pink roses. I brought them home, put them in a vase, and all felt right with the world.
 
“I can do this,” I resolved, “I can be okay by myself, as I am.”
 
During the period of initial healing I bought myself flowers regularly to keep reminding myself of this lesson. Truthfully, I fell out of the practice after about six months. I started to feel much better. And then, about a year after the separation, I started seeing someone. Although not to the same extent as in earlier seasons of my life, I noticed some of the same patterns about needing to be wanted pop back up and disturb the peace in my life. Even though I’m slow to learn when it comes to my personal healing, I do learn and I’ve been able to nip much of this potential destruction in the bud.
 
Getting my latest book Process Not Perfection prepared and ready for publication happened alongside me doing some deep therapeutic digging about the remnants of relational trauma. Healing those wounds has proven to be the greatest process of my life. The day that the book officially released, I allowed myself to sit on my couch, breathe, and take it all in. And then the wisdom inherent in Veronica’s poem came back once again—go out and buy yourself flowers. Celebrate you! Celebrate not just all that you’ve accomplished, celebrate the wonder that you are! Indeed, decorate your own soul…
 
We can decorate our soul in a variety of ways along our healing path in ways that are not entangled with attachments to others. Even if you are in a committed relationship, please consider nourishing yourself in this way. Perhaps planting a garden is more your style than buying flowers. Do it. Do whatever is going to help you celebrate your own wonder while cultivating beauty in your life. I am worth it, you are worth it. And perhaps if we deepen into this practice of gifting ourselves with the beauty we deserve, we will indeed spread that healing like wildflowers through this suffering world desperately in need of that colorful energy.  

​In the summer of 2000, I set out on my first proper backpacking tour of Central and Eastern Europe. For six weeks I would be visiting all of these historical places that I studied about for years, and I was ill-prepared! The cheap $20 rolling duffle bag with pieces of things pretending to be straps just would not do, especially on the trains. During my first stop—Prague—I saw how much easier it was for other young travelers to navigate the trains having proper backpacks. So at my next stop—Krakow—I found an outdoor shop and paid $80 for my first real backpack. She was amazing! Blue with black trimming, she was so easy to pack, and so wonderful to carry on the trains. I feel like she opened up the world for me and the possibilities in it even wider. For the next nineteen years, she would literally help me carry the baggage of my life and my transformation.
 
The word “baggage” has taken on an interesting emotional connotation in modern times. My mother always warned me not to date a guy with “baggage.” By the time I got to my mid-thirties, I was brave enough to respond, “Um…mother, I got quite a bit of my own baggage by now.” There’s even a Game Show Network series called Baggage hosted by none other than Jerry Springer where dating show contestants evaluate each other by whether or not they can live with each other’s baggage. And as a trauma therapist I’ve long helped people come to terms with their baggage, a word they often use for the burdens they carry. Sometimes I help them to shed the load that’s weighing them down and other times I help them to make peace with their past and how they carry it. Using the backpacker’s metaphor, sometimes we just need to get a more efficient piece of luggage.
 
Recent events prompted me into some deep introspection about baggage and all of its metaphors and meanings. I am currently on a one-month tour of the U.K., teaching and writing. When I got to the airport, I noticed that one of the last two functional buckles holding my old girl together had cracked and broken. Over the years everything that once made the old girl an ideal backpack went bad—the waist buckle, the chest strap, some chords and zippers. The two back straps were still intact which made her still okay to use. And suddenly that was no longer the case. I checked in at Cleveland for my flight to London. Yet trying to haul a month’s worth of gear into London city from the airport with a broken backpack was exhausting. I gave her one more go as I proceeded up to Scotland last week and the strain wreaked havoc on my shoulder and back. Knowing that there was no way to fix or to replace the buckle, it was time to lay her to rest and get a new pack.
 
I was surprised at how difficult that was for me. I’m not really the type to get attached to material things, yet there I was, attachment sick over literal baggage.
 
“Wow, Buddha would have a field day with this,” I snickered.
 
The old girl was different. She carried me through the healing journey of the second nineteen years that sought to unravel the confusion and pain that tangled me up in the first twenty. Setting out to travel the world was a major component in my recovery for it showed me new perspectives and different energies. When I ended up moving to Europe for three years in November 2000, I carried everything I needed in the old girl. She came with me on every international trip that followed as I connected with these lost pieces of myself.
 
When I walked into the outdoor shop in Inverness, Scotland, I reflected on just how far that 20-year-old girl who walked into a similar shop in Krakow had traveled. Two marriages come and gone, sobriety, a doctorate, seven books written, a successful business established, major mental health relapses healed and still healing, coming out in various ways, a story of transformation still in process… Most importantly, we’ve achieved liberation by connecting to the certainly of who we really are and what we stand for—we are total and yet continually evolving towards wholeness. Traveling, embracing the journey—both literal and metaphorical—brought me these gifts.    
 
And now the time had come to get a more functional, efficient pack for the next nineteen years and beyond. When Mark, the lovely salesman in Inverness, explained all of the features on the state-of-the-art red Osprey pack I was privileged enough to buy, my first response was, “But the pouches on the new pack aren’t like the old one—I liked that feature better!” I chuckled at myself—realizing how it’s so easy for all of us to do that during the change process. Without a doubt my new pack is better for my body, contoured for a larger woman’s back and hips and full of efficient features. This new pack is 15 gallons smaller than the old girl, which will force me to pack more efficiently. That’s probably a good thing! I knew in that moment that as attached as I can get to the things I’ve gotten used to, they may no longer be what serves me the best presently.
 
I’ve learned to travel lighter in the last nineteen years, both literally and metaphorically, and this adjustment certainly helps. I am also a human being struggling to make sense of attachment and heal or release the storylines I carry. In trauma focused therapy, working with attachment is a topic du jour. As an EMDR therapy trainer, I often entertain questions on how well our curriculum can help trainees to work with attachment trauma. While it’s clear that many people with complex trauma were severely wounded in early childhood by the caretakers with whom they should have formed healthy attachment, I’ve never felt that repairing attachment is the entire answer. As a mindfulness-focused EMDR program committed to East-West integration, detachment is just as important. I heartily believe the Buddha’s teaching that attachment or clinging is one of the three main causes of suffering. Yet we are human and healthy attachment is a legitimate need—so how do I reconcile this one, Buddha? Contemplating this question in meditation has taught me that acceptance and letting go are vital to the change process. We can do this at the same time as we grieve the childhood we needed and never received. We can also bring healing to the younger, wounded parts that may still live inside of us, modeling healthy attachment for them. Letting go of the storylines and the attachments that no longer serve us in the present is paramount. Letting go clears the path for healing at all levels.
 
I ended up letting go of the old girl in my hotel room in Scotland with a note for hotel staff to do what they saw fit. It felt appropriate laying her to rest on the international road, especially in a place as magical as Scotland. I was also blessed to stumble upon a teaching from de-cluttering guru Marie Kondo during the days I wrote in Scotland. She advises, “Have gratitude for the things you're discarding. By giving gratitude, you're giving closure to the relationship with that object, and by doing so, it becomes a lot easier to let go.”
 
I don’t think I’ve ever read anything so wise and so applicable for people on any path of recovery. Gratitude is a quality of recovery that directly helps us to let go of unhealthy or unserving attachments, yet in modern times gratitude can become so difficult to practice. We are socialized, especially in the West, to focus on what we don’t have instead of celebrating what we do. Further, practicing gratitude can feel impossible especially when you’ve been so hurt and so wronged by life and the people in it. Hopefully this will not block you from at least giving the practice of gratitude a try in your process of letting go and lightening the load.
 
I thanked the old girl vocally before I left the room that day, and writing this article is a way of publicly offering my thanks. Yes, it’s to an object, yet think of how much this wisdom can also help us let go of the so-called “baggage” from our past that weighs us down—memories, shame-based scripts, unhealthy coping skills, and the impact of wounding relationships. We can thank those things and those people for the role that they played for us at the time. Even the horrible stuff—if you are willing, thank it for its role in bringing you to where you are today, hopefully on the precipice of a major shift in your continued healing and recovery. 

We try to fit into these names. Take into account the name lists that float around Facebook. Being able to find our names on Coke bottles. Our names mean something to us. However, what if we don’t identify with our birthname? It becomes this scratching walls that is suffocating.

You see, I have a speech impediment from childhood trauma and it impacts my processing (mental stutters) and my ability to pronounce anything with a “R.” “R’s” can go to Hell for all I care. And of all the “R” sounds that could possibly exist, my birthname has one of the hardest configurations of that godforsaken sound.

There have been many speech therapy sessions spent on pronouncing my name. Many. Over time, I developed a sense of shame and embarrassment. My number one label, my number one identifier, and I can’t say it. When out and about with friends and family, it intuitively became a thing that they’d pronounce my name for me. I don’t know if they perceived my shoulders dropping in, my split-second hesitation, whenever anyone asked, “What’s your name?” My voice would get caught in my throat and I’d shrink into myself. “Just call me, M.”

It got worse when people asked where my accent was from. From as far back as I can remember to when I was 26, every day I was asked where my accent was from. When I was younger, I would tell people I moved around a lot. It wasn’t until I was 23 that the internalized shame branched off into anger and I dreaded every interaction with new people.
 
“Where’s your accent from?”
“It’s a speech impediment.”

Whenever I dropped that bombshell, people would begin to squirm. How does one come back from that? This moment is the opportunity I take to remove myself from the conversation. I remember a couple of times when people would learn about my speech impediment and the fact I couldn’t say my name, they kept trying to pressure me into speaking. Into saying my name.

One of the great blessings of my life is to have a Jewish mother and a Jewish family in Squirrel Hill. When I heard the news of last week’s massacre at Tree of Life Synagogue in Squirrel Hill (the hub of Jewish life in Pittsburgh, Pennsylvania), I was in Montana leading a clinical training in EMDR therapy, the trauma modality that brought Sharon Saul—my Jewish mother—and I together. Although the news revealed to me that the synagogue attacked was not Sharon’s, it is in close proximity to her home in a community that is very tightly knit. Until I was able to get to Squirrel Hill myself on Tuesday morning and give Sharon a hug, something was unsettled within me. Although Sharon and I remained in touch via text and telephone after she turned hers back on following Shabbat, seeing her was the balm my soul needed. In our communications, she relayed the multiple messages defining the vigils and prayers she attended: The answer to combating all of this hatred is to fight the darkness with light, and to increase our acts of goodness and kindness.

The connection that Sharon and I share is an example of how two very different people can unite in a spirit of goodness and kindness, which is why I feel led (with Sharon’s blessing) to share our story. On Thursday night we sat in her home, a place that's become a haven to me over the years when I offer trainings in Squirrel Hill (about an hour and a half from my home base in Ohio). We were both awestruck by the workings of HaShem in bringing us together. HaShem is a Hebrew name for G-d (literally meaning "The Name") that I’ve come to use in many of my references to Divine presence. Our friendship is, of course, a beautiful Institute for Creative Mindfulness story which is why I’m posting it on our blog. I hope others may also draw some inspiration from our message and our story.

I first met Sharon in Monroeville, Pennsylvania sometime in 2013. I was still working the national circuit for PESI, an educational company, teaching general trainings on trauma-informed care. In this 2-day course, presenting a live clinical demonstration in eye movement desensitization and reprocessing (EMDR), my method of choice for treating trauma-related concerns, was part of the syllabus. As I did dozens of times before and have done hundreds of time since in my teaching, I asked for a willing volunteer for the demonstration, inviting them to come up and see me over break for screening. This lovely, traditionally dressed woman raised her hand immediately. During our screening, as we talked about her background and the issue she’d like to work on, Sharon revealed that she is an Orthodox Jew. Although she seemed to be connecting to what I taught in the course, I experienced a bit of an internal struggle, wondering if someone so traditional would respond to what I had to offer. I’d long identified as rainbow flag-waving tattooed rebel dismissive of most things connected to organized religion or anything traditional. Yet something inside told me immediately that I loved this woman and her willingness, and I was delighted when Sharon responded so well to her work in the demonstration.

Afterwards, in amazement, Sharon declared, “I have to learn this!”

She went on to explain her frustration that every EMDR training she ever found took place over the weekend which would not work for her as an Orthodox Jew. Specifically, Sharon is a Hassidic Jew in the Chabad-Lubavitch movement with a strict adherence to Shabbat observance. Training over a weekend just wasn’t an option for her, even though other folks from religious traditions have missed weekend services before to come to trainings. Sharon began traveling to Ohio to learn from me as I developed my initial training models and ideas around teaching EMDR therapy, expressing only gratitude that she was able to engage in this study during the week and in a mindfully delivered, intuitive way that matched up with her almost forty years of experience as a hypnotherapist. The more she studied and consulted with me, the more I began to trust her as a clinician and to truly love her as a person. The questions she asked helped me to grow as a clinician, and I developed an even deeper sense of wonder about Jewish faith and traditions.

In 2015 when I became officially approved by the EMDR International Association to offer basic trainings in EMDR therapy, Sharon immediately courted me to come to Squirrel Hill where she practiced and lived. She said something like, “I can get you every Orthodox therapist in Pittsburgh to come to the training if you can offer it during the week.”

When one of Sharon’s colleagues first met me, I got the once over, punctuated with the commentary of, “You’re the Jamie, Sharon’s teacher? You’re so young!”

Although I’ve gotten my fair share of the “you’re so young,” comments throughout my career, this one did not impact me with any insult. Rather, it helped me to understand why I respect Sharon so much. She is constantly willing to learn something new, especially from those of us in the younger generations. I watch how her grandchildren teach her new ways of seeing the world, and I hope that I can emulate this spirit of hers to constantly be a learner as I grow up into the example she is setting. And although I started as her teacher, it’s safe to say that we have both been each others’ teachers as our friendship has grown.

Coming to Squirrel Hill to train was a good fit for all of us—for Sharon’s community of clinicians in the neighborhood and for the growing Institute for Creative Mindfulness wanting to establish a base in Pittsburgh. When I visited Squirrel Hill for the first time, some tears filled my eyes. There are moments here when I feel like I’m in Eastern Europe, where I spent a great deal of late teens and early twenties studying and working, primarily in my ancestral homelands of Croatia and Bosnia. There’s just something about the vibe of Squirrel Hill and its Jewish soul, beautifully blended with other cultural influences in the container of Pittsburgh, its own cultural wonder, the visceral epicenter of our region’s heartiness. Something magical happens here at this area around the intersection of Forbes and Murray Avenues. In the past three years I’ve adored working with the people of Squirrel Hill and I enjoy spending time here with both friends and Sharon’s family. Sharon has always taken great care to assure that a guest bedroom in her home that is set up to accommodate her large family for holidays is always ready for me when I come to town. I typically stay in one of the basement guest rooms and sleeping down there feels like I’m in a warm cave being blanketed by an entire house that’s full of tradition and love. I’ve said for several years now that Squirrel Hill is truly my second home.

Sharon has seven children and a slew of grandchildren (I can never keep count). I’ve had the privilege to get to know many of them and their spouses, including one of her sons who is now a budding therapist and has trained with me. I attended the wedding of her youngest son and considered it the greatest honor ever when Sharon began caring for me in a way that led her to declare, “I’m sorry, I can’t turn off the Jewish mother in me.” The first time is when we were leaving her house in Squirrel Hill—it was a rainy morning and we were crossing the street to my parked car, on our way to the training site. A car came unexpectedly whizzing down her street and she brought out the infamous “mom arm” to protect me. Later that year, Sharon and I roomed together at the EMDR International Association conference in Minneapolis. While I’ve enjoyed a wide array of roommate experiences as I’ve traveled for work over the years, Sharon’s attention to detail in making sure I didn’t forget things and that I had a sounding board for things going on at the conference warmed my heart. She once again said something like, “I can’t turn off the Jewish mother,” and I thought to myself, “Nor do I want you to.”

My entire life I’ve struggled with feeling accepted by the people closest to me, especially in my family of origin, because my beliefs and way of being in the world is so different from their traditional (Christian) views. Sharon’s acceptance of me, even as a religious woman, includes a full embrace of my soul and my questions, even when we disagree on certain approaches to life, faith, and identity. While I wish that more devout people from all faith traditions would learn from Sharon’s example of acceptance, knowing her gives me hope that the healing power of what St. Benedict called radical hospitality is possible. Sharon’s willingness to bring me around her family and feel the warmth of their friendliness and the candidness of their interactions with me—even though they are all religious and I am more of a liberal hippie, “spiritual but not religious” type makes me know in my bones that we all have more in common than not. Knowing Sharon Saul and having her as my Jewish Ima (mother) is nothing less than a corrective experience in attachment. And it’s restored my faith that getting to spend substantial time with people from faiths and cultures other than our own is a big part of the answer to bringing about the healing of the world.

So, it’s little wonder that I wanted Sharon to join our Institute for Creative Mindfulness team as both a consultant and a facilitator as soon as she was eligible. In the midst of this Squirrel Hill tragedy she referred to EMDR therapy as “God’s tool for healing,” and I cannot disagree! She is a fabulous educator and mentor and serves our EMDR trainees well. Sharon is responsible for building enthusiasm about EMDR therapy in Squirrel Hill, working very hard to find us good spaces to train during the week. So many of the therapists we have trained here are now on the front lines of working with the community this week and will be in the coming weeks as the people of this neighborhood seek answers and healing.

But even if Sharon didn’t work with me in this professional capacity, I would still want her to me my friend… and of course, my Jewish mother. Even in the midst of debriefing her own experience of this week’s tragedy with me, Sharon still offered me spiritually on point advice about my own love life and my career path, as any attuned mother would. As we sat together the other night in our moment of awe at the Divine dance that brought our lives together, it dawned on me that a friendship like ours and everything it represents is the answer to the madness in which we find ourselves in this modern world. This isn’t something, even as a writer, that I can put elegant syllables together to explain. I simply challenge you to experience it if HaShem ever gives you the chance, because HaShem will.

In her infinite, faith-filled, maternal wisdom Sharon declared, “HaShem, you have a view of the bigger picture. I trust you when I can only see the parts of that bigger tapestry.”

Sharon and I both had the opportunity to do trauma response work this week in Squirrel Hill and were amazed at how this tragedy is bringing other things to the surface for people that have long needed healed. This poses, once more, the age old question: Is tragedy’s hidden gift the sparking potential it holds to stir us into action, first within ourselves and then in our communities? The idea of changing the world can feel overwhelming and impossible, especially with the hopelessness and hatred that seemingly paralyzes our existence. Perhaps the real answer is to heal ourselves and then make a difference on a one-on-one relational level, as Sharon and I have done with each other. When the small pearls of these healings and interactions string together, we create a valuable and beautiful force that will transform the world.
​
After working together today at the Jewish Community Center here in Squirrel Hill Sharon continued with her teaching for me that began the night before on the importance of the bigger picture: “It just feels like the redemption really is at hand and all of us good people doing all the good we can and all the healing we can it’s our job to just tip it. It feels like we’re almost, almost, almost there.” 

​I support and believe Christine Blasey Ford and I am in awe of her courage to come forward and speak her truth.  It has not been an easy thing to do and she has re-lived her trauma and experienced more trauma.  She has been sent death threats and has had to leave her home.  I want her to know I honor her and her story and as a result felt compelled to write this.
 
Since Christine has come forward with her story of being sexually assaulted by Brett Kavanaugh, there have been a lot of questions and comments.  As a sexual assault survivor myself and a trauma therapist who has worked with dozens of sexual assault survivors, I would like to try and answer some of the questions that I have heard and even been asked directly. 
 
Question #1- Why didn’t she tell anyone at the time this incident occurred?
 
She was 15 years old, scared and having a trauma reaction.  Many assaults occur by people who are known to the victim. Sometimes the perpetrator threatens to harm the person if they tell anyone.  Many young survivors are afraid if they tell a parent they will get in “trouble”.  Many victims are blamed with statements such as “you shouldn’t have been at that party”, “you shouldn’t have been drinking”, “your flirting brought this on”, “the way you dressed caused this”, “he’s a good boy, you must be mistaken”, “you are a slut, whore, etc”.  These are just a few of the things that are said to victims.  Many victims/survivors are afraid no one will believe them.  That was her worst fear coming forward now, I’m sure.  Not only did many people not believe her, some people made death threats against her and her family.  Now, wouldn’t that be a reason some people may not come forward?
 
Secondly, a typical trauma reaction is to shut down and try and forget about what happened.  But no one ever forgets.  Sometimes the event is packed away in the recesses of the mind and resurfaces years later when current events occur that trigger the body and mind.  I’ve personally had the experience of early childhood sexual abuse by a known perpetrator that I only remembered after undergoing somatic body work by a trusted friend.  My body knew for a long time that something had occurred as I would have atypical reactions to hearing about childhood sexual abuse. For years I had suicidal thoughts and no idea where they were coming from.  Once the memories surfaced, I was not surprised and it confirmed for me a lot of things I had felt over the years.  My memories were validated by others in my family when I shared them.  I went through some intense therapy for several years after this and to this day from time to time have to do some healing work. Since the “#Metoo” movement began, I and other survivors, have been triggered a lot.  How do we speak our truth?  Where do I speak my truth?  Will speaking my truth help someone else?  Will I make myself too vulnerable in speaking my truth?  Will my family support me in speaking my truth? 

Question #2-One of the other questions people have had is “how can she be sure it was him?”, “maybe her memory is wrong."
 
These incidents are recorded in the brain.  When they occur with someone who is known to the victim, they remember who it was, the voice, the smell, the face, all of it.  Sometimes, a survivor will dissociate during the incident, which is when the mind separates from the body as a way to cope and survive the trauma.  However, the mind  is still present and recording the experience. 
 
I have experienced other types of sexual assault. Once, three boys in the neighborhood dragged me into the woods with two of them holding my arms back and the other one fondling me.  My “fight” response kicked in and I kicked the one touching me in the groin and was able to get away.  I still remember his name and face.  I never told anyone.  This happened again with a few boys on the front lawn of his house.  I remember who it was and I never told.  Other incidents of boys grabbing my breasts, calling me names, smacking/pinching my rear end, all occurred multiple times.  The only incident I ever told anyone about was when I was 15 years old: While riding my bike, a guy in a gold Camaro stopped and asked for directions.  When I got closer to the car I saw he was masturbating.  I took off on my bike and rode home with my heart pounding.  I remembered the type of car, as it was distinctive.  I told my mom and we did call the police to report what happened.  I don’t know if he was ever caught. 
 
Of all the incidents I experienced, except for that one, I knew who the perpetrator was.  Survivors remember, even when it is hard to acknowledge that it was someone known to them. 
 
Question # 3-Well….what is sexual assault really? 
 
As I’ve shared with my daughter, sexual assault can range from name calling, leering at a woman’s body and making sexual comments, to incest and rape.  There are many types of assault under this umbrella, such as fondling, oral sex, forcing someone to watch porn and/or strip, etc.  The primary elements are that it is unwanted, unsolicited, there is a power differential, and the victim feels extremely unsafe and threatened.  I’ve had women share with me that their fathers, step-fathers, grandfathers, etc. have made sexual comments on their bodies, have looked them up and down and smiled, and have made sexual comments about other women in front of them, and all of this was unwanted, unsolicited, and made them feel extremely uncomfortable and threatened.  This is sexual assault. I’ve had women share that they have been fondled over their clothes by uncles, step-fathers, brothers, cousins, neighbors, friends of parents, etc., and that is sexual assault.  I’ve had women share that they have been sexually abused (fondled, raped, forced to do sexual acts while being watched, etc.) by fathers, mothers, grandparents, coaches, priests, ministers, boyfriends, husbands, teachers, etc., and that is sexual assault.  Some of these incidents were one time and many of them continued over months and years. 
 
In the last year or so women and men are finding the courage to share their stories of sexual assault, abuse and trauma.  This is the beginning of finding more ways to heal and hold perpetrators accountable.  Education is key in changing the way people understand sexual abuse and trauma.  We need more open dialogue on this and movement to change statute of limitations for survivors.
 
I am using my voice and sharing my story for my own healing and in hopes that others will find the courage to share theirs as that is a big part of the healing process.

I have experienced significant trauma recovery as a direct result of my training at Gracie University in Torrance, California. My goal is to start a discussion on the psychological benefits I’ve experienced and how it might benefit other trauma survivors as well. I am a survivor of childhood bullying.  I am also a survivor of 18+ years of severe complex trauma (neglect, emotional, physical and sexual abuses) at the hands of my family and strangers. As a result, I have a history of somatic trauma and triggers around touch, men, women, and assault scenarios. 

I began Gracie Jiu-Jitsu Training in August of 2016 through the Women Empowered (WE) Program. Discovering this program, carefully crafted by women and men focused on trauma-informed empowerment and prevention, has been an incredible gift on my journey towards healing.  After 2 years of training, I am both a pink belt and blue belt in Master Cycle. The following is an outline of the clinical benefits I experienced as a result of this training as they connect with core attitudes of mindfulness.

Non-Judging
I have learned at Gracie to quiet my inner critic. I tend to be a very self-critical, excellence driven person and it took many months of allowing space for imperfection to learn to laugh at myself, shrug it off and keep going. The instructors are skilled in working with the perfectionistic student. They are encouraging and positive throughout.  For example, an instructor would never tell you “you’re doing it wrong”, but instead praise what is right and make small adjustments, always conscious not to overwhelm a student with too many instructions. This was exactly what I needed to stay motivated and feel a sense of mastery developing throughout the process.

Patience / Persistence 
Patience is of tremendous value at Gracie and a significant challenge for me. The teachers continually emphasize that the techniques are complex and many times counterintuitive. There simply is no jiu-jitsu without patience and persistence.  Instructors often remark that is fantastic if a new student gets 25% on the first try of a technique. The benefits of the skills I get at Gracie extend outside those walls. A pronounced example for me is driving. I have always been an aggressive driver speeding, weaving, and wanting people to get out of my way. On difficult days, I find myself falling into old habits of speeding all the way to class at Gracie. As I am leaving their parking lot, driving home, I find myself more patient, waiting my turn, not pushing, not hurrying and letting people in whenever I get a chance. 

Willingness / Beginner’s Mind
Instructors model a humanistic approach in their teaching, regularly sharing personal trials and errors on their journeys of learning jiu-jitsu. They model how to stay motivated and  keep coming back. For the novice, a sense of curiosity and readiness to learn from a place of not knowing is nurtured. Many techniques are counterintuitive and require proper training to conceptualize. The clinch move is an excellent example. If someone attempts to punch you, you move towards them rather than away. To this day, my clinch sometimes needs work when I’m not concentrating as I instinctively don’t want to move myself towards the attacker. 

Trust
Most techniques in jiu-jitsu require a high level of trust. Allowing someone to put their hands on your neck can push a trauma survivor out of their comfort zone. At Gracie they instruct participants to only put hands on shoulders to begin with and then as they advance, to put hands on throats, and eventually pressure. This helps the person desensitize to any associated discomfort and build trust.  In addition, safety is a priority. When teaching a technique, they always emphasize how to keep your training partner safe. Extensive time is spent on how to break falls and accomplish training goals while preventing injury. Instructors and assistants circulate the room at all times, checking everyone’s safety and techniques. Newer participants are paired up with seasoned trainees to help newer students with the technique and also set the structure of safety (moving slowly, tapping early, frequent communication, continued verbalizations of safety tips throughout practicing, etc.).  It has been a significant corrective experience for me to have many women and men take careful consideration of my safety while training.

Non-Striving
When I try too hard and train too hard, my body lets me know immediately. Instructors are quick to encourage taking care of your body. They emphasize that sitting and watching is sometimes better than participating. I was once told “Take breaks from jiu-jitsu before it breaks you.” I find it difficult to take breaks because as a trauma survivor, feeling powerful is intoxicating. 

Acceptance
I have had to learn at Gracie to accept my limitations.  I train with men that are much bigger and stronger than me. When I master techniques, their size and strength doesn’t matter anymore. However, as a result of this difference, I have had to accept the reality that I need to know the techniques better than these men to accomplish control and safety. I have successfully executed the double leg takedown on a 250 pound man. I also managed to keep control of a 250 pound man in side mount control.  I have had to accept the limitations of my age and strength, but in doing so I have also learned how to manage my limitations effectively. 

Letting Go / Attunement
Having fun while making mistakes has been another corrective experience. Much of my abuse was centered on punishment for academic mistakes.  To train in jiu-jitsu is to make 1000’s of mistakes and have fun while doing it. Newcomers to Master Cycle joke often that all they are trying to do is stay safe or just breathe. One of Gracie Jiu-Jitsu principles involves a concept of going with the flow. Once you have become fixated on accomplishing a particular submission, you inevitably create an opening for the attacker to defend against and even roll to an advantage. “Position before submission” is a concept that involves letting go of potential submissions in order to stay fluid and attuned so you can respond to what is given to you. Some of the best jiu-jitsu I have watched seems more like a dance than combat. 

Friendliness / Gentleness 
Smiles, hand shakes, and laughter set the tone at Gracie. Gentleness and consideration of your partner is emphasized every step of the way. Keeping each other safe and happily learning is a top priority and a great deal of time is spent making sure that trainees treat each other with respect and care. If any student is too aggressive or not assisting their partner in the “Gracie” encouraging way, they are quickly addressed and asked to leave if the problem persists. I will never forget my first partner - a young instructor from Mississippi showing me the “trap and roll” technique. He performed this technique with speed and precision while carefully cradling my shoulder and moving me in a way that protected me from muscle strain or injury. I am so grateful that he set the stage for me to know and feel how easy, fun and gentle the learning process could be.

Non-Reactivity / Confidence 
As a trauma survivor, trigger reactivity has caused significant impairment in my life.  When I first thought of testing for my Pink Belt, I knew that most candidates tested with Eve Torres Gracie, the female director of WE.  I was concerned that in the reflex testing portion, where you are approached with a variety of attacks to which you must instinctively respond, that I would be triggered and might actually punch Eve. I came to understand that if I was still in a space of this type of reactivity, I was not ready to test.  
As I continued my training, I instinctively put myself with the stronger partners in Women Empowered in order to push myself outside my comfort zone. As the weeks passed and I was feeling more confident with my skills, I scheduled a “pre-test” with a Alex Ueda.  I felt very comfortable with this instructor and I did well. He explained that had it been a real test, I would have passed. Around the same time, I had noticed that whenever I was called upon to demonstrate a technique with Rener Gracie (Eve’s husband), I became reactive. I was not listening to his words, I moved too quickly and wanted to get as far away from him as fast as I could.  It was odd because I admire his teaching, his gentleness, his encouragement and everything that Eve and Rener had created. But when he came anywhere near me, I got tense. After examining my thoughts, I remembered an ad for their gym about 20 years ago, and at that time decided it was not a safe place for me. I realized that in that ad, Rener looked like an attacker from my childhood.

I searched for the Facebook page of this attacker and it all came flooding back as I looked at his photo. I felt my body tense up, get nauseous, chest and stomach tight and breath being held. I reached out to Eve to share my discovery. She expressed gratitude that I entrusted her with my experience and that they had many trauma survivors over the years participate. She shared her experience that everyone responds to trauma differently and that they valued learning what would help me best (less contact with Rener, more, same).  Her response was healing, validating and assuring that I was safe in this space. I felt so safe with her support that I asked if I might actually test with Rener as I knew it would be a true test for me of my abilities when triggered. Rener said yes.
From the time he entered the room for the test, I became 14 years old all over again. In a small room, door closed with Rener between me and the door, Rener calmly and slowly explained everything step by step. He encouraged me. It was not a surprise to me that I performed worse with Rener than I had performed with Alex.  There were a couple very basic skills that flew straight out of my head when Rener put his hands around my neck. However, I was a triggered “14 year old” with a brand new set of skills and I passed the test. Since then I have had ample time to strengthen the reflexes of the few techniques in which I froze.

The thrill of passing with Rener was an enormous confidence booster. However what happened after the test was really remarkable. I opened up my attackers Facebook page again. Now as I looked at it, my body was calm. There was no reaction, no nausea, no chest tightening. I felt peaceful and I said out loud, “You are not a threat to me anymore, and I forgive you.” After years of therapy to recover from trauma, my logical mind knew I was safe but my body had to catch up. 

The “victim” becomes a warrior at Gracie. It’s the complete opposite of the trauma suffered. I particularly like that almost all of the training emphasizes control over your attacker without submitting or hurting them. I can still remain compassionate and kind while strong in relationship to my attacker. I don’t have to become them (angry, aggressive, violent) to defend myself.

Conclusion
The scattered pieces of myself in my trauma narrative forgot about the warrior that I am (my strengths, my coping skills). This unique opportunity to grow in a safe and supportive environment allowed me to remember my true self and put myself back together. My whole body has learned  to operate with calmness and fluidity to accomplish my jujitsu goals and heal the memory. It’s a challenge to express the full extent of gratitude for this program and what it has done for both my clients and me personally. I wish every trauma survivor would have the experience of profound healing that I have had at Gracie University. It has been, and continues to be, a spiritual jiu-jitsu journey for me.
​

To access original piece with full comments published on 5-18-18, go to: 
​instituteforcreativemindfulness.weebly.com/icm-blog-redefine-therapy/fighting-dissociation-phobia-and-coming-out-as-a-professional-with-a-dissociative-disorder-dr-jamie-marich

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:

• Clinical professionals asking at trainings or in group clinical forums if they should “screen out” for dissociation in their clinical practices, essentially turning away the traumatized clients who most need the help.
• Turning people away from treatment after they show signs of more severe dissociation out of fear that the clinician won’t be able to “bring them back,” or that one of the parts will cause serious harm.
• Clinical trainers taking extreme measures to stop the first signs of dissociation that training participants (fellow therapists) show in practicum sessions. Therapists often have similar reactions to their dissociative clients in sessions.
• Improper or forced admission to inpatient psychiatric facilities under the justification of what the therapist perceives as harm to self or others, when most inpatient facilities which operate under the strict edicts of the medical model are often the most unsafe places for us.

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?
Congratulations—you’ve dissociated!
           
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)