Defects of Character or Emotional Parts: Using Structural Dissociation to Reframe Step Six by Michael Gargano, LMHC, CASAC-2
“We were entirely ready to have God remove all these defects of character.”
--Alcoholics Anonymous, Step 6
Treatment centers and 12-step communities need to begin normalizing dissociation within the addicted person’s experience. Trauma and dissociation are often left out of the discussion in addiction treatment and recovery worlds. Survivors of abuse, neglect, abandonment, and other traumatic experiences note with consistency and frequency the value of compartmentalization plays in daily life functioning and avoidance of traumatic memories. As an addiction and trauma specialist, I’ve heard countless clients describe how and why it became necessary to stuff events, emotions, sensations, thoughts, actions, and images deep into the catacombs of the psyche. The self that seeks recovery may sometimes feel like a fraud, fake, or not real, as a result. And this can make the phrase defects of character in Step 6 difficult for addicted survivors of trauma to navigate. Looking at Step 6 through the lens of structural dissociation, may offer the field, recovery communities, and people we serve new insight into both trauma-informing and dissociation-informing the steps. What we commonly call defects of character within 12-Step Literature can be more accurately viewed as dissociative parts of self that impede spiritual progress, acceptance, connectedness, healthy relationships, and recovery
A cursory overview of the Theory of Structural Dissociation is needed to help us understand its theoretical and clinical framework. The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization, a ground-breaking book on trauma and dissociation, written by Onno van der Hart, Ellert R.S. Nijenhus, & Kathy Steele, proposes human beings are not born with an integrated personality. Our early formative life experiences shape our personality, thoughts, feelings, and behaviors. In healthy development our caretakers help us to meaningfully integrate and adapt to our environment. Attachment wounds stemming caretakers who could not meet our essential needs, sooth us, and provide us with restorative experiences sets the stage for fragmentation of the self. The discussion presented in this blog will prepare us to draw connections to how structural dissociation relates to 12 Step work and a trauma-informed approach to embracing our dissociative parts. We challenge the notion of character defects as it is traditionally understood in recovery circles as the term defects of character does not align with a trauma-informed approach. This contention is made with full recognition that the steps can and do work for millions, including me. And it’s also time to have this discussion.
The conception of dissociative parts of the personality is not new. The theory of structural dissociation of the personality is a cogent, comprehensive, and concise description of dissociative parts. The theory holds every person has what is commonly referred to as an Apparently Normal Self/Part (ANP). The ANP is the survivor self or the core persona that is seen by others in public, holds a job, raises a family, forms attachments, and does everything that we often ascribe to the executive functioning in our brains. In response to a traumatic event the ANP fragments with the formation of an Emotional Part (EP). The EPs form to protect the ANP from the wounding that has occurred.
The self as EP displays evolutionary defense mechanisms, emotional reactions, and action systems to protect the core self. Action systems guide us to notice and be drawn to stimuli. They restrict our field of consciousness to relevant stimuli and promote certain action tendencies while inhibiting others. For example, when a fire alarm suddenly goes off, the self as EP may signal “Danger, Danger, Danger!” and the action system related to panic may activate. The action system related to rational thought and decision making may be disinhibited. These mechanisms include responses based on flight, fight, freeze, and submission. If a dissociated part is fixated in a particular action system or subsystem, they may be unable to cope or perceive with their situations because their perceptions are colored by the goals, and a restricted field of consciousness will be restricted to stimuli relevant to that subsystem.
I believe Dr. Bob and Bill W.’s vision of step work helps us to heal our structural dissociation. Step Six invites recovery seekers to dig deeply and invite our EPs into their healing journey. Up to this point in our recovery experience we have accepted the nature of our addiction, we took steps to find a new path, embraced a belief that a power greater than ourselves could restore us to sanity, made a searching and fearless inventory, faced our dissociation, and now we are tasked with integration. Bill W.’s commentary on Step Six hones in on the addicted person’s compulsive tendency for self-destruction and annihilation. We work against our instinct for self-preservation. The commentary goes on to describe structural dissociation like language in discussion of how our drives far exceed their usefulness. The founders of Alcoholics Anonymous understood parts of self. Bill W. writes in 12 Steps and 12 Traditions commentary on Step Six: “When our instincts drive us blindly or willfully demand that they supply us with more satisfaction or pleasure than are possible or due us.” He is talking about an EP. Bill recognized EPs operating within recovery seekers more than 80 years ago.
The goal of Step Six is not to eradicate our EPs. Total integration of all dissociative parts of self will not happen overnight. Some parts of self will mature or extinguish. Others will take a lifetime to heal. Parts work, trauma work, and working the steps are circular pursuits. We may need to go through the Steps several times to gain a new way of relating in the world. The wisdom of this Step is we are cautioned to “be content with patient improvement.” It is important to seek proper therapy with someone skilled in dissociation and parts work who can help you understand the emotional parts of your personality. In our parts work some of our parts may not want to work on the spiritual aspects of the program. Some might attempt to destroy the whole system. We did not will these EPs to exist. Our minds fractured in a beautiful way to keep us safe, secure, and protected. However, the actions, thoughts, and impulses of our EPs caused us insurmountable problems as we sought to change old patterns.
Change is difficult. Sometimes we get into a routine and become complacent with our EPs. Take procrastination, for example. By not completing a task on time, one does not have to risk failure. This EP could be protecting us also from people hurting us by seeing our vulnerability. Turning in assignments late or showing up on time for appointments means our EPs remain in control of who gets to see our vulnerable side. Procrastination, like other destructive tendencies, could be an EP part designed to hide reality from us.
Our EPs have secondary gains which make it difficult to heal them. Skillful work in this area will explore the systems and rules at play. We will not be perfect in this work nor do we need to be. In Step Six we work to renegotiate the boundaries with our EPs and the alliances between them. Our work here is to meet our needs in more adaptive ways so our lives as ANP is fuller, richer, and more meaningful.
In my recovery experience I relied heavily on EMDR therapy, sponsorship, and the 12-step recovery meetings and literature to heal my fragmented self. I believed I could be restored to sanity. I trusted my Higher Power would allow me to get where I needed to go in the often hard and emotional trauma work, I set for to complete. I had a mindfulness and yoga practice that helped me settle inward to listen to my emotional parts. I had faith in my therapist who guided me through parts work and trauma reprocessing. I was able to see for the first time how my EPs impinged on my ability to live unchained. My EPs were my minds grasps of relating to a world which no longer existed. We must face facets of our personality which do not paint us in a good light. The Shadow side of the personality we must not fear. Step 6 and parts work are reparative processes. What I have learned is I do not have to live in survival mode any longer. Because of this work I can meet needs without reliance on old compulsive behaviors. I can risk authenticity and vulnerability without fear of rejection.
Parental Leave and Parenthood in Private Practice: 20 Ways to be Trauma-Informed by Suzanne Rutti, LISW-S
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.
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
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