Managing Unmanaged Dissociation: 15-minute Checksheet

Regaining Control of Unmanaged Dissociation

Dissociation is a beautiful, intelligent, and highly adaptive skill. It makes everything from the painfully mundane to the horrifically traumatic more survivable. It also gives us the gift of diluting physical pain, holding back overwhelming emotions, compartmentalizing daily stressors and difficult memories, and zooming out to gain different perspectives. When dissociation is unmanaged, however, its consequences can range anywhere from frustrating to life-limiting, scary, or even dangerous. Some of those experiences can include:

• frequently losing minutes to hours of the day – possibly stuck in flashbacks, performing self-destructive or compulsive behaviors, zoned out, or doing other atypical actions,

• unwanted switching between alters in a DID/OSDD system – possibly having no way to be filled in on what was missed later and/or switch back,

• missing important events/meetings/moments due to not being oriented to the correct year, month, or day,

• rapid-cycle switching between multiple parts of a DID/OSDD system (having no control over who is forward),

• extended spells of non-responsive zoning out, becoming “locked in,” or even appearing ‘catatonic,’ for potentially hours,

• unknowingly engaging in self-harmful or unlawful behaviors, without recollection or ability to regain control over the mind/body,

• becoming so disoriented from the current time/place they’re unable to find their way home, to work, or another important location – potentially so unaware of the present year, they don’t know about GPS, smartphones to call for help, or who in their life today they should even call for help,

• living life so detached - or “on autopilot” - for long enough that derealization leads to significant existential panic/paranoia (e.g. fears of truly not being real, alive, or having ever been in control of their body/life/etc, etc),

• uncontrolled switches to child alters in public or behind the wheel, with no way to negotiate a switch back to a safe, more mature part,

• having chronic, unexplained moments of not being present whilst driving, cooking, showering, out in public, or other very dangerous situations,

• or many other disabling experiences.

For all these reasons and more, employing every last option to regain control over one’s symptoms may become a welcome solution. If learning about, and diligently using, your very best grounding tools isn’t enough, you’ve done journaling and internal communication with parts, tried modulation and containment skills for intrusive symptoms, and even asked for external supports to help keep you present, it may be time to turn to a higher-level intervention. Welcome in a 15-minute checksheet! You can download it here (to print or fill in on your devices).

What is a 15-minute checksheet?

Conveniently, it’s exactly as it sounds! It’s a daily tracking sheet for folks to check-in every 15 minutes - jotting down just a few pieces of information like, where are ya, who are ya (DID/OSDD specifically), how grounded are you, what are you feeling, and what are you up to. While 15 minutes may sound incredibly intimidating, or even unreasonable, keeping track of things in this much detail can provide vital information that we just can’t get when unmanaged dissociation is stealing this much of our memory, sense of self-awareness, cognitive power, and our best problem-solving abilities.

This tool encourages us to pause, briefly connect with our internal experience, and jot it down somewhere for safe-keeping until we’re ready to look at it in the bigger picture. It takes the required brainpower out of it and helps us spot trends and patterns in the areas we’re getting hung up - ones we never could have noticed on our own. …at least, not when our dissociation’s this bad. Answering questions like:

Is there a certain activity I’m doing that keeps setting off this dissociation?
An emotion I’m feeling that’s prompting these huge gaps on the page every time?
Is there someone in my life who’s making me get extra spacey or begin rapidly switching?
An actual location or room in my house that’s fueling the fire?
Does it only happen at my job, at a certain relative’s house, or once I’m in my car?
Is it only in the mornings, right before bedtime, or some other oddly specific time?
Is my sheet completely blank from the time I make dinner onward? …why is that?
Do I only start seeing my grounding numbers tank after taking this one medication? Is it sedating me and/or do I need to talk to my doctor about it?
Do we have huge holes in the sheet right after one particular alter comes out? How can we work on that with them together?
…and so much more.

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now comes the biggest question: EVERY 15 MINUTES, really?!

Yes, we really do want to encourage you to set a little alarm and at least try doing so for as long as you can stand it. As this is often an intervention for folks teetering on the edge of needing a Higher Level of Care (e.g. Intensive Outpatient, Partial Hospitalization, or Inpatient Care), the minute frequency is quite high. But, whether you utilize this tool in those 15-minute increments or spread it out to meet a less critical need, there is no shortage of valuable information to be gathered from a tool like this. Customization is key!

There are, however, some places folks can get a bit tripped up, so we wanted to include a section just for you! We also made sure to keep it with the downloadable PDF version (which also has a detailed List of Emotions, as that’s something many survivors of complex trauma can struggle with). This way you’ll always have it with you. No need to return or remember this page link! We know this is a tough time and you don’t need any added barriers.

Here are things that may help you along the way:

• Blanks are okay - good even!
  You aren’t expected to make every check-in time. If you could do that already, you wouldn’t be doing this sheet :) And, gaps give us information. That information will help us develop more effective solutions to combat your symptoms. Do your best to fill as many as you can, but consider a sheet with chunks missing a success!

• No back-filling.
  It may be tempting to go back and fill in time slots you can reasonably recall. Try not to do this. Forgetting to jot things down still lets us know you weren’t 100% grounded or in a clear enough mind to remember to do the task (i.e. increase in ADHD symptoms, etc.). That’s more information for us! Unless you physically couldn’t write it down at the time (e.g. driving, doing a work task, making dinner, showering, etc), try not to backfill. If you do think it would be helpful to still have the other info, just notate somewhere (*) that these are retroactive answers. That will tell us a bit more about the quality of those assessments, in addition to your degree of present-ness at that time.

• Don’t panic, this task won’t last forever!
  Just a handful of days is often enough to gather a lot of helpful information. If you can simply commit to giving your best effort those few days, you’ll do yourself a huge solid and be that much closer to getting your life back!

• Set yourself some timers if you need.
  Nothing wrong with using all tools available to you to keep you on-task! Timers can also be easier than alarms since you can simply hit reset for a new 15-minute interval instead of having to create new clock times every quarter. If you’re getting startled or sensorily overwhelmed by all the timers, try a simple vibration alert instead.

• Call on parts inside to help!
  Still struggling to remember? If you have parts inside, try assigning someone inside the job of watching the clock and reminding you when it’s time to check in. Parts like to feel important and valued; this can be a unifying experience and a good exercise in team building/bonding for systems.

• Too overwhelmed or wanting to give up?
  If every 15 minutes really is just too much, try spacing it out to every half-hour. Or, conversely, start by checking in each hour, then tomorrow every 30 minutes, and the next day every 15. We’re just in search of helpful information, not aiming to flood, frustrate, or panic you. Some info is always better than none at all!

• Still too overwhelming?
  Pick a chunk of hours in the day that you tend to lose the most time or struggle with other symptoms most prominently. Extend an hour in either direction and commit to just checking in as much as you can during that timeframe.

• Making it to every check-in?
  Awesome! You’re doing so well with your grounding that you can now try spacing things out a good bit. Let’s see if things continue to hold without as much structure. If you start noticing more gaps without these consistent check-ins, we can re-evaluate and see if returning to 15 minutes would be beneficial. Or, you may discover that these are positive gaps due to living an active, grounded, well-lived life!

final thoughts

There is so much we can glean from such a meticulous tracking tool—even if your dissociation isn’t terribly unmanaged. Simply noticing and correctly labeling our emotions, observing patterns and catching where we’re spending too much of our time, discovering relationships or activities that may be harder on our health than we realized, becoming aware of or establishing communication with new parts inside, or even finding out that you’re more in control of your life than you realized — these all have tremendous benefits! And, you deserve to reap them. You deserve to live a life with full authority, agency, and confidence. May you reclaim exactly that if it’d been lost, or even better, unearth it for the very first time!

If, at any point throughout this exercise, you do discover yourself feeling particularly ungrounded, emotionally dysregulated, or more broadly overwhelmed, we encourage you to bookmark some of these pages for supportive symptom management: Grounding 101, Modulation 101, Color Breathing, and/or Self-Care 101. There, you’ll find hundreds (literally) of techniques to help you re-stabilize. Additional symptom management resources are listed at the bottom of this article!

We will be thinking of you and are here to answer any of your questions. As a reminder, you can download this fillable PDF to print or use on your devices. For therapists, you are welcome to offer this to your clients in either form. Healing tools should be for everyone.

MORE POSTS YOU MAY FIND HELPFUL:

  ✧  Grounding 101: 101 Grounding Techniques
  ✧  Flashbacks 101: 4 Tools to Cope with Flashbacks
✧ Self-Care 101: 101 Self-Care Tools
✧  Distraction 101: 101 Distraction Tools
  ✧  Nighttime 101 and Nighttime 201: Sleep Strategies for Complex PTSD
✧ Color Breathing 101: How to Calm Overwhelming Emotions and Physical Pain
  ✧  Imagery 101: Healing Pool and Healing Light
  ✧  Modulation 101: Using Dials to Modulate Intrusive Mental Health Symptoms
  ✧  DID Myths: Dispelling Common Misconceptions about Dissociative Identity Disorder
 
  ❖  Article Index  ❖

 
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The BASK Model of Trauma Memory

In previous articles, we have talked a fair bit about flashbacks, particularly offering several tools and strategies to manage them. We have also discussed the more specific and unique phenomena of Emotional Flashbacks and Body Memories — all in the hopes of providing a few ways to work through them! But, we haven’t taken a proper detour into the mechanism behind all flashbacks, to really solidify the ways traumatic memory gets stored differently from regular, unfractionated, safe memory. To do this, we look to something called The BASK Model of dissociation and memory.

When a traumatic event occurs, for many folks, strong dissociation steps in as a means of self-protection. It helps compartmentalize the experience, or cast parts of it far outside of conscious thought, where it cannot be reached. It would be too distressing to be fresh on your mind, or even easily-accessible, when you're trying to go to work or are just making dinner. But, memories are made up of a vast, colorful array of mental, physical, emotional, and sensory experiences! Simplistically, we recognize them in four main categories: Behavior, Affect, Sensory, and Knowledge (BASK). We break down each of these further in the graphics below.

Let’s break those down a little further!

• Behavior — What was the action in this memory? What did you physically do - or feel the overwhelming compulsion to do - with your body? Hide, flinch, run away, attack, duck/cover, stop speaking, yell, isolate, use self-destructive behaviors, go to a certain place, turn to stone, etc?

• Affect — What were your emotions in this moment - even those stifled or shut-off? Were you sad, afraid, angry, worried, calm, disgusted, helpless, ashamed, enraged, suspicious, defeated, conflicted, intimidated, or even entirely numb or apathetic? Try to discern them from what you feel about the moment today.

• Sensory — What were the sensations in your body? Racing heart, physical pain, thirst, trouble breathing, chills, numbness, clenched jaw, dizzy, sweaty palms, nauseous, muscle tension, off-balance/spinning, intoxicated, exhaustion, etc? Were you smelling anything in particular? Hearing specific things? Keys, footsteps, loud bangs, painful silence, whispering, creaking in a floor or door, cars, extreme weather, music, etc? Did you have any tastes? External feelings against your skin?

• Knowledge — What were you intellectually aware of at the moment (the who, what, when, where, how)? The narrative, information, sequence of events? Additionally, what were your thoughts at the time? Even those that you later found out to be incorrect? What did you believe was happening or think to yourself as this moment was occurring?

During the unconscious process of putting thick dissociative barriers around this extremely sensitive material, some of those pieces scatter apart into far corners of the mind. They may each be fully detached from one another or linked up in unique, and sometimes perplexing, combinations. We know that a defining trait of PTSD, and one of its criterion for diagnosis, is "re-experiencing". When we push anything out of our awareness long enough (like when we stuff our feelings or pretend they don't exist for awhile) - but particularly if we've had to traumatically dissociate it away - it is likely to be intrusively thrust upon us against our will at some point. ...aaand typically when we're most vulnerable, least expect it, and it's the most inconvenient!

When we look to the BASK Model, and some of the unusual pairings that traumatic information can become linked, you can see how having them suddenly surface and come alive in your body without other important contextual pieces, can be deeply disorienting. It is understandably confusing, sometimes quite scary, and often easier to explain away by a hundred other things. You can now understand how this can manifest in symptoms like Body Memories (S + sometimes B), Emotional Flashbacks (A), or the ability to recount your trauma to someone without a single emotion or attachment to it in the world (K without A, and sometimes no B or S, either). Conversely, you may have every single indicator of a deeply terrifying event - it’s erupting in your thoughts, your skin, your emotions - and you know a trauma has to be there by context clues alone, but you’ve got zero intellectual awareness of what it is or where it's coming from (B+A+S). These scenarios only magnify in complexity when they’re become additionally scattered amongst parts of self in DID and OSDD systems.

The goal of traumatic processing is to find and link - or integrate - all these pieces to one another into one full, complete memory, then further integrate them into your self-concept, your narrative, the story of your life. If you're missing any vital pieces, not only are they still likely to revisit intrusively, but you may be drawing incomplete or inaccurate conclusions about the very trauma itself or what it means in the broader context of your life. You may believe a certain person in your life is much safer or more helpful than they really are; that you "didn't even react" when you maybe did so in a very powerful way; that you're at fault, when you unequivocally were not; that what occurred never hurt or 'wasn't that bad', when it very much did and absolutely was; that you felt fine, content, or enjoyment, when you really felt anger, disgust, or betrayal. The truth may completely reshape how you see yourself and everything around you. There is so much to be gleaned from these pieces coming together, and you deserve to know them in full, even though they're painful and difficult.

You also deserve to have control over your mind - no longer at its mercy when it throws these things at you when your guard’s at its lowest. Until then, we hope the some of the tools we have offered elsewhere can help to mitigate some of their effects (such as Flashbacks 101, Healing Pool/Light, Color Breathing, or Imagery with Dials), and additionally arm you with a different kind of strength and control over your symptoms.

Let's help take that power back!

MORE POSTS YOU MAY FIND HELPFUL:

  ✧  Grounding 101: 101 Grounding Techniques
  ✧  Distraction 101: 101 Distraction Tools
  ✧  Flashbacks 101: 4 Tools to Cope with Flashbacks
✧ Self-Care 101: 101 Self-Care Tools
  ✧  Nighttime 101 and Nighttime 201: Sleep Strategies for Complex PTSD
✧ Color Breathing 101: How to Calm Overwhelming Emotions and Physical Pain
  ✧  Imagery 101: Healing Pool and Healing Light
  ✧  DID Myths: Dispelling Common Misconceptions about Dissociative Identity Disorder
  ✧  Did You Know?: 8 Things We Should All Know about C-PTSD and DID
  ✧  Trauma and Attachment: 3-Part Series on Attachment Theory with Jade Miller
 
  ❖  Article Index  ❖

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Dissociation and Survival vs. Living: A Survivor's Story

 

A CSA Survivor's Relationship with Dissociation, Survival and Living:

     
    "There are many things I wish I could help people understand about childhood trauma; this just happens to be one I hear very little about. Like many survivors, I struggle to hear sentiments like, "Oh my! I'm so so glad that's over now and you got through it!", "I can't believe you got out of that alive. I couldn't even do that now! I'd give up," or "At least you know your worst days are behind you. You know you can conquer anything!". Even resources and groups for trauma survivors, as well as therapists and clinicians, can share quips like "You survived the abuse, you're going to survive the recovery!". While these things intend to uplift or highlight our strength, they all categorically deny the fundamental mechanism that allowed us to survive in the first place, and why adulthood is the real hard part: dissociation.

    Make no mistake, those of us who endured trauma as children are courageously strong. We were forced to be tougher than most, and - by nature or necessity - we became resilient, creative, and sharp. But Little Me didn't even experience the bulk of the trauma back then. I wasn't connected to the physical pain or sheer terror. I wasn't incapacitated by shame, disgust, or uncleanliness. I wasn't aware of the immorality, nor was I having a crisis of conscience. I didn't even know who was hurting me for much of my childhood – parts of my mind did, but not me.

Little Me wasn't facing the anger or the blistering sting of betrayal knowing that those I loved most hurt me in such inhumane ways. I wasn't yet aware this was abnormal or something that could make me feel alien or 'different' from my peers. I was numb, hyperfocused on the things I could control, and was even made to feel special or self-confident in certain traumatic areas very early on. While some of that confidence dwindled over time and I became more aware of my unhappiness, insecurity, and "irrational" fears, none of that compares to what you might imagine a tortured child feels — let alone what I was about to feel later in life.

    That suffering is here now. Adulthood is when all of it breaks through and confronts you with a vengeance. No, the abuse is not "over", it is not "behind me", it is not "something I got through". As far as my mind and body are concerned, it is NOW. It is very alive and in full-effect. Each excruciating detail of physical pain, disgust, and revulsion. Every tidal wave of anger at those who knew and did nothing, those who saw my innocence as an opportunity, and those who failed me at my every attempt for help. Each immobilizing shockwave of new material that re-writes my entire life story from how I once knew it. It is all alive in my spine, my eyes, my heart, my mind. THIS is when my survival is tested.

I am hypervigilant, terrified, exhausted, unsure if I'm even real. I exist in hollowing spaces of grief for Little Me and the life I should have had. ...lost in an endless state of confusion, horror, disbelief, and dismay. It is all-consuming, all day, and all night. ...especially the night. THIS is active trauma in my brain and body. THIS is my battleground. I am fighting for my life NOW. As an adult, not as a child.

     Furthermore, the dissociative process not only contorts the timeline of when we experience our trauma, but the independent symptom of dissociation itself challenges life as an adult, too. ..even beyond the forgetfulness, memory gaps, driving troubles, safety, maintaining a job, etc.. Two of the most critical elements of trauma recovery are in establishing healthy relationships and improving our overall worldview. It's very hard to want to carry on when all you've known is the absolute worst of mankind; being able to look around, connect, and believe the world is still good is vital to our sanity, safety, and healing. But, dissociation challenges this.

It can dull your senses, leave you numb to positive feelings, keep you at an emotional distance from love or affections shown to you. It can keep you trapped in a surreal in-between state of both the past and the present—where you respond to what's happening today with the same emotional maturity you had as a child. Emotional flashbacks, unexpected triggers, and other sudden symptoms that crop up - particularly in intimate relationships or the more meaningful aspects of life - can complicate joy and frustrate the people in your life. But most of all, no one wants to just "be alive", we want to LIVE. Fully and authentically, with all the vibrance and richness available to us. But, dissociation has a way of diluting and blurring the world - stripping it of its color and beauty. How do you hold onto a light that you can barely see, feel, or trust is even there?

    Like most all means of sheer survival, dissociation has its pros and cons. Just like chemotherapy and emergency surgery, they can keep you alive, but there are risks. They are also unpleasant in the moment and - separate from the conditions that necessitate these interventions - they carry longterm consequences of their own. But, without them, you wouldn't be here—so it's a constant tug of war with perspective and gratitude. Dissociation is no different.

It got me through. It saved my life. It gave Little Me a fighting chance. But it also made life after abuse so. darn. difficult. Because, I should feel free. The abuse has ended, I am safe. I should be dancing and singing and holding everything I love dear to my chest. But instead, now is when I fight. Now is when I stare down my trauma, my innocence, my perpetrators - all with adult intellect and understanding - and try to decide if this life is worth living or if I'm up for the task.

    It is worth it. And, I am up for the fight. I'm going to do this and will do it with grace and strength. But then, and only then, can you say I survived the impossible or that 'it's over now'. This is the battle. ..and not for just survival, but for life. To make this existence meaningful now. I get the autonomy of choice today, not just get to be along for the ride. I get to choose Life and choose Me each day. The fight is no longer to endure the day just see the next one, or go through the motions while feeling trapped here by obligation to those I love, but instead to fill each day with things of meaning and substance. Things I GET to do. Things I’m so grateful I got to do before my time comes.

    I get to discover texture and nuance, vibrance and stillness, range in opacity and brightness - all for the first time. I get to engage with the world like a child, but with it in my control and at my direction. There is so much to learn and discover, so much I've not tasted or touched, and I get to let that excitement lead me. I can trust it. Grow from it. Share it with another. Because I know I am going to conquer this. The trauma, the feelings, the defeat, the difficult relationships, even the dissociation. I will remain appreciative of what dissociation made possible for me, despite its thorns.

I want Young Me to get credit for surviving the horror. But I want Adult Me to get credit for not just surviving additional anguish, but for learning to LIVE, too.

 

 

MORE POSTS YOU MAY FIND HELPFUL:

  ✧  Grounding 101: 101 Grounding Techniques
  ✧  Distraction 101: 101 Distraction Tools
  ✧  Flashbacks 101: 4 Tools to Cope with Flashbacks
✧ Self-Care 101: 101 Self-Care Tools
  ✧  Nighttime 101 and Nighttime 201: Sleep Strategies for Complex PTSD
✧ Color Breathing 101: How to Calm Overwhelming Emotions and Physical Pain
  ✧  Imagery 101: Healing Pool and Healing Light
  ✧  DID Myths: Dispelling Common Misconceptions about Dissociative Identity Disorder
  ✧  Did You Know?: 8 Things We Should All Know about C-PTSD and DID
  ✧  Trauma and Attachment: 3-Part Series on Attachment Theory with Jade Miller
 
  ❖  Article Index  ❖

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An In-Depth Conversation with Elizabeth Vermilyea

   If you've worked in the field of trauma and dissociation for any amount of time, the name Elizabeth Vermilyea will likely be very familiar to you. For survivors new to their healing, you may not know her by name, but you've most certainly been using her tools and symptom management skills! In part due to her own humility and unassuming disposition, it's quite possible to be unaware of the impact of Elizabeth's work, despite having benefitted from it for years and years. If learning the detailed process of containment, modulation, healing pool/healing light imagery, or the more welcoming takes on internal communication, sounds familiar to you -- you have her to thank for that!

   Elizabeth's workbook, "Growing Beyond Survival: A Self-Help Toolkit for Managing Traumatic Stress" truly revolutionized the way that trauma survivors could not only learn about their conditions, but explore a variety of tools to alleviate their suffering at the same time. An unintimidating and easy to understand look at complex trauma, it allowed survivors to really work at their own pace. Clinicians were also given a new language with which to explain coping skills to their clients, and most importantly, a chance to work on them together.  Elizabeth's message of educating with compassion and warmth, and always including survivors in the process, has remained steadfast throughout the years and is a lasting legacy on the community. Through her continued work in the field, she keeps the momentum of trauma education and care headed in the right direction -- always focused but empathic.

    It is our absolute honor and privilege to bring to you an in-depth interview with someone we admire and value so deeply. You'll get a chance to learn more about Elizabeth's personal journey, her experience weeding through the at-times tepid and contentious world of trauma, and also explore the past, present and future of trauma care! We sincerely hope you enjoy!

❧     ❧     ❧

Let’s start with some background for those who are being introduced to you for the first time.

・Where are you from/currently residing? Where did you attend school and what did you earn your degree in?
How long have you been practicing and in what capacity do you currently work with trauma survivors?

     I was born in Raleigh, NC, and I currently live in Napa, CA. I don’t like to focus on schools and degrees because I don’t think they tell us anything about who someone is. Suffice it to say, I’ve spent a great deal of time on my education, but I really learned the most from the people I’ve worked with over the years both as clients and colleagues. Currently I do not treat survivors, but I do train and consult with professionals and survivors alike. My consultation with survivors focuses on managing traumatic stress symptoms.

・What made you interested in pursuing trauma disorders? Did you always know you wanted to focus here, or was it something that found you?

     I like to say that I tripped and fell into this work, and then fell in love with it. I had intended to become an experimental psychologist. My first job out of college was at the Masters & Johnson Sexual Trauma program at River Oaks in Louisiana, and I got that job after sending out resumes everywhere I could. They were the ones who called back! It didn’t take long for me to realize that I wanted to make a career in the trauma field.

・When did you come to understand the full impact of complex childhood trauma vs. trauma as an adult? What was your introduction to dissociative disorders like?

     My work at River Oaks was my introduction to all of this. I remember going home one night in tears after having heard some horrific stories of abuse at the hands of a man’s parents. I found my mom and said, “Thank you for not abusing your power over me.” I realized how much that relationship means, how it can be twisted, how it can torment a child. Most of the clients in that program were diagnosed with a dissociative disorder, so I learned a great deal there. The program took a relational approach to the work, and I appreciated that. It wasn’t so hierarchical or tied to the strict medical model.

You began your work in this field over 25 years ago — a time where dissociative disorders were even more heavily stigmatized, disbelieved and could even be used to question the integrity of the very clinicians who supported their existence.

・What would you say the climate was like when you were first starting out? Did you face any particular challenges — clinically, interpersonally or even within yourself? 

     I started this work at the beginnings of what would become known as the recovered memory debate era, but I didn’t encounter much of that controversy until I moved to Baltimore and began working at Sheppard Pratt in their Trauma Disorders Program. Across town was Johns Hopkins and Paul McHugh who staunchly denied that recovered memories could be valid and that dissociation was real. The climate among those of us at Sheppard Pratt was one of dedication to the cause and to believing people. When I was starting out, the challenges I faced were related to understanding that horrible things are done to people, but that doesn’t mean the world is horrible. Holding those truths together is an important part of the work for all of us. More challenges came later when I began to chafe against the medical model and hierarchy in the treatment arena, and especially the “once a patient always a patient” mentality.

・When did you decide you wanted to write a book? And not just an informational or educational book but specifically a workbook for survivors?

     For several years I ran a PTSD Symptom Management group at Sheppard Pratt. I used to create worksheets because there weren’t any around that met the needs of the clients and my needs as a helper. Over time, I had a rather large portfolio of these worksheets. My colleagues and the clients started telling me I should write a book. So I began.

・Were there any unique obstacles to getting it published? Did you ever have any reluctance or hesitation, particularly given the atmosphere back then?

     Getting the book published was an incredibly serendipitous series of events. I was meeting with Esther Giller, the President and CEO of Sidran Institute, a publication company specializing in traumatic stress education and advocacy. Let me see if I can remember it the right way. She was looking for someone to come on board as a trainer for a Federal Grant project she was involved in. At the same time, she was looking for someone to produce a self-help symptom management book for a project being underwritten by the States of Maine and New York who were embarking on a massive training effort in their public mental health systems. This is a long story, but a good one.
     Survivors in the State of Maine had sued the state saying not only was the mental health treatment they received not helpful, but worse, it was hurtful. So the State handed down a consent decree that all state mental health personnel be trained in what is now called Trauma-Informed Care. This was the beginning! Esther had located professionals to create the material for training personnel (the good folks at TSI CAAP – Karen Saakvitne, Laurie Ann Pearlman, Beth Tabor-Lev, and Sarah Gamble – who wrote the Risking Connection Curriculum), and they also wanted material for the clients. That’s where I came in. I left Sheppard Pratt to take the training job at Sidran, and Sidran published the book, which was then distributed to survivors in the Maine and New York public health systems for free. I’m really proud of that.

Your workbook, whether you know it or not, truly revolutionized trauma care on the patient level. Worksheets were printed out on trauma units, weekly inpatient groups were held to teach your skills, your techniques and scripts became the go-to standard for coping with specific symptoms, and survivors in countries across the globe use your tools by name (sometimes not even knowing where they came from or having read your book)!

・Did you ever anticipate that your work would have such a profound impact or global reach, let alone become the foundational launchpad for which survivors worldwide would begin their trauma healing? 

     I am humbled beyond words by what you’re saying. I can tell you when I did the second edition I felt really good that there was still an interest in the book and that it was still useful thirteen years after the original publication. It’s mind boggling to think it has the impact you describe. I guess I have to take your word for it! I really felt I had arrived on the day a friend told me her book had been stolen! I replaced it for her, but for someone to steal it… it must be valuable!

・What has it meant to you seeing your work, and not just your book but your advocacy and education in all forms, fill such a massive void in the trauma community?

How does it feel knowing most has stood the test of time?

     Like most people dedicated to this work, I feel good about being able to educate, support, help, advocate, and hopefully change for the better the process of healing for trauma survivors. I know that every professional I am able to help will spread that exponentially outward, and that’s why I do it. I think it has stood the test of time because the material I focus on is universal and not subject to treatment trends. I want to offer something that can help everyone every time.

・What would you say is the biggest change you’ve noticed in the field of trauma since beginning your studies (ex. education, the approach to care, general attitudes toward trauma/dissociative disorders, etc)?

     The biggest change I’ve seen is the mainstreaming of trauma-informed care. There used to be a handful of treatment centers providing good treatment, and now, thanks to the Adverse Childhood Experiences (A.C.E.) study, there’s a deeper understanding of trauma as a public health issue. Even Oprah has got on board recently! I’ll be working with the Oregon Commission for the Blind next month because they want to better serve traumatized persons in their vocational rehabilitation programs. That’s huge! If you Google “Trauma Certificate Programs” you can find them all over the country. That’s amazing!

・What areas do you feel still need significant improvement? Is there anything you feel is almost missing entirely? What changes would you like to see be made in those areas?

     We need to improve the awareness, understanding, and addressing of the intersections of trauma with addiction and the criminal justice system. These intersections are at the heart of recidivism in both arenas. We have to keep showing agencies and organizations what’s in it for them and how trauma-informed practice can support and enhance their existing work. Essentially, we have to sell it.

・Do you have any colleagues or mentors that you really look up to or admire?

     Oh gosh, too many to name. I can tell you one person who had tremendous influence on me professionally. Her name was Andrea Karfgin, and she was a psychologist. She died several years ago, but she lives on in me. She taught me how to think about this work, how to understand really important dynamics in the work, and she guided me through tough lessons as a professional. I hesitate to mention other names for fear I’d forget someone. I worked with a number of survivors who were brave and trusting enough to let me into their inner worlds and allow me to walk with them into the wider world with more confidence, faith in themselves, and stronger boundaries toward life beyond survival. I’ve had many colleagues who were instrumental in shaping my professional development. I’ve had the privilege to work with some of the most respected people in the field and to have worked with the amazingly skillful lesser-known warriors for survivors. What I love is that I keep meeting people in the field who continue to inspire me and who keep me on track. I am so grateful that I get to do this work.

・What keeps you going after sitting face-to-face with some of the darkest, heaviest tragedies this world has had to know? What keeps you focused, rejuvenated or inspired?

     In the beginning I wrote a lot of songs to process what I was seeing, feeling, and understanding. I would play music for the clients in the evenings, sometimes songs about them and their struggles and strengths. That helped a lot. I keep a guitar in my office in case any of my staff need to sing the blues. Laughter is important and has always been a way for me to rejuvenate. We have to be able to laugh in the midst of awareness of such pain. I’m fortunate that people put up with my goofy humor. What helps most though is that with every workshop I do, I encounter people who believe, who want to help, and who are eager to learn how to be more effective in the work. It gives me such hope!

・·Do you have any advice to new, or even veteran, clinicians who are seeking to work with trauma patients?

     Do your own work. Get a good clinical supervisor. Make friends with countertransference. It will help you through so many confusing moments, and being able to notice it, understand it and use it to strengthen the relationship will be helpful and a huge protection when facing ethical dilemmas. Cultivate a good support system. Pay attention to and address signs of vicarious trauma, compassion fatigue and secondary traumatic stress. TAKE VACATIONS!

・What is the biggest thing you’ve learned from your patients, or other survivors, over the years? What have they taught you that books could not?

     I’ve learned that I can never give up on a person, never write them off, because people are more resilient that we imagine, and we never know when the moment of hope will come - the moment of immersive transformation that gives someone a reason and the will to continue. I’ve learned to trust people’s judgment about themselves. I’ve learned to be kinder. 

・If there was one thing you wish the world could understand about trauma survivors, or the clinicians that help them, what would it be?

   There is no “them.” There is only us.

❧     ❧     ❧

     Thank you, Elizabeth for your sincerity, your thoughtfulness, and your humble dedication to survivors everywhere.

    You can find more information about Elizabeth here on her website. You can also order the "Growing Beyond Survival" workbook here (or here). [Note: While the blue cover edition is still available on Amazon, the Second Edition (green cover) is the most up-to-date and has the most current perspective on trauma, so we of course recommend that one. The first is also no longer in print, but Amazon has held onto some copies.]  We cannot recommend this workbook highly enough. It has been the first recommendation on our Resource page, since the day it was made, for a reason!
 

 

MORE POSTS YOU MAY FIND HELPFUL:

  ✧  Grounding 101: 101 Grounding Techniques
  ✧  Flashbacks 101: 4 Tools to Cope with Flashbacks
  ✧  Nighttime 101 and Nighttime 201: Sleep Strategies for Complex PTSD
  ✧  Imagery 101: Healing Pool and Healing Light
  ✧  DID Myths: Dispelling Common Misconceptions about Dissociative Identity Disorder
  ✧  Did You Know?: 8 Things We Should All Know about C-PTSD and DID
  ✧  Trauma and Attachment: 3-Part Series on Attachment Theory with Jade Miller

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