Trauma and Dissociation

Online Conference Transcript

Our guest, Sheila Fox Sherwin, L.C.S.W., is a specialist in trauma recovery and dissociation. Here, she talks about different aspects of trauma recovery and why certain people dissociate. We also discussed dissociative identity disorder, memories of the abuse that some people have and whether remembering the details of the abuse is important or not to the process of healing.

David Roberts: HealthyPlace.com moderator.

The people in blue are audience members.

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David: Good Evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. Our topic tonight is "Trauma and Dissociation." Our guest is Sheila Fox Sherwin, L.C.S.W., a psychotherapist in private practice in Media, PA. Ms. Sherwin has over 20 years of experience working with individuals, couples, families, and groups. Formerly a senior clinician at the Dissociative Disorders Unit of the Institute of Pennsylvania Hospital, and a graduate of the Family Institute of Philadelphia, she specializes in working with trauma recovery and dissociation.

Good Evening Ms. Sherwin and welcome to HealthyPlace.com. Many of our visitors here tonight may know the term Dissociative Identity Disorder or DID, but may not be familiar with the term "dissociation." Could you explain that to use, please?

Sheila Fox Sherwin: Dissociation is a defense mechanism that we all have to some degree, where one part of the mind is blocked off by other parts of the mind. We all know about "highway hypnosis" while driving in the car we can get into a trance-like state. The same possibility exists when we go to the movies. These are common examples of dissociation.

David: In terms of traumatic emotional experiences, like being abused in any fashion, how intense does the experience have to be before one begins to dissociate?

Sheila Fox Sherwin: It depends on our childhood experiences and how vulnerable we are to a trance state. There are all levels of dissociation, from simple daydreaming to the mind fragmentation of DID/MPD.

David: Would you classify dissociation as a good or bad thing, in terms of the way an individual copes with certain events?

Sheila Fox Sherwin: Dissociation can be a very positive survival mechanism, that can allow a person to cope with terrible trauma and still function. It becomes a negative when it gets in the way of our functioning in our everyday life.

David: You have worked with many individuals who have been abused in some fashion. Is there a "Best Way" that an individual can deal with a traumatic event? And I'm meaning that in terms of coming out on the other side of the event in reasonably good psychological condition.

Sheila Fox Sherwin: We are all individuals, and there is no best way, but in general, working with an experienced clinician, developing a treatment plan together and following through with it can be very successful.

David: Is it possible for "most" people to recover? And I ask that because there are many visitors to our site that express the feeling that it's extremely difficult and they feel they'll never get better.

Sheila Fox Sherwin: Yes, I think it is possible for most people to recover. It does take a lot of hard work and commitment though.

David: And when you use the word "recover," how do you define that?

Sheila Fox Sherwin: I mean that we can have the kind of life we want to a reasonable extent. We can work, have relationships, etc.

David: We have a lot of audience questions, Sheila. Let's get to a few of those and then we'll continue with our conversation. Here's the first question:

kerry-dennis: So, is dissociation really a kind of self-hypnosis? Why do some people dissociate and others not?

Sheila Fox Sherwin: Yes, you are absolutely right. We all dissociate to some degree. When we are talking about more severe forms of dissociation, some people are more vulnerable to self-hypnosis, dissociation, while others develop other coping mechanisms.

lostime: I feel like I can't trust my memories of the abuse I went through. I know the facts about it ( like who and where), but I can't even remember his face or the place where I was kept. Where did all that information go? And why do I still lose long pieces of my life if I can't remember the scary stuff? I feel like a stranger in my own life.

Sheila Fox Sherwin: The information probably has been dissociated into another part of the mind in order to protect you.

David: Sheila, do you think it's important for someone to remember all the details of their abuse? For instance, lostime expresses that she's frustrated that she can't.

Sheila Fox Sherwin: NO. I think someone can get all hung up in the details. There is a process for healing. It does take time and remember, we are all unique.

David: Could you briefly describe what that process for healing is and what it entails?

Sheila Fox Sherwin: Again, it depends on the extent of the trauma and our own childhood experiences, but we need to engage in a therapeutic alliance with an experienced clinician, where the treatment goals are clear and there is a therapeutic partnership.

David: Here's the next question:

Anyone: When you've dissociated away a memory or pretty much all of them, how do you know if what is recalled in therapy is truth or made up lies?

Sheila Fox Sherwin: In my experience, we don't need to know "the truth" in order to heal. We begin with what you remember, and begin to explore that. Sometimes the truth is impossible to know.

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knitmom: There are a couple of times in my life that are blank, but they were years ago and nothing has happened since. Is this still dissociation? Does it have to be a continuing thing?

Sheila Fox Sherwin: It could be dissociation. No, it doesn't have to be a continuing thing.

funnyduck: What is the difference between dwelling on the abuse and dealing with the abuse?

Sheila Fox Sherwin: Well, when we deal with the abuse, we begin to heal and move forward in our lives.

David: Sheila, earlier in our discussion, you mentioned the importance of forming an alliance with an experienced therapist. What constitutes an "experienced therapist" and what is so important about forming an alliance with this person?

Sheila Fox Sherwin: An experienced therapist has the training and clinical experience working with people who have experienced trauma, PTSD and dissociation. They should have at least a master's degree. They should be able to answer any questions you have about their expertise and training. They should have years of experience. A therapeutic alliance is based on mutual respect, partnership, and evolving trust. Honesty is important.

David: Here's an audience comment on what's been said tonight:

honesttogod2000: I agree that getting hung up in the details is not always that important. I have lost way too much time focusing on how bad my abuse was and making people understand that about me. Truthfully, they can sympathize, but then they go on with their life. I had no life after awhile. I just had abuse residue. I am glad I focus more on recovery today than abuse. Recovery is for me. It helps me to live a better life for my family.

Sheila Fox Sherwin: This is a terrific attitude, and it is sure paying off for you.

David:Just a few side notes here, and then we'll continue:

Here's the link to the HealthyPlace.com Abuse Issues Community. You can click on this link, sign up for the mail list on the side of the page so you can keep up with events like this, take a look around and still keep chatting:

Here's the next audience question, Sheila:

@: Would you please comment on trauma and dissociative disorders in practitioners themselves? Particularly when seeing clients with abuse histories and/or dissociative issues.

Sheila Fox Sherwin: A practitioner who has his/her own experience with trauma, PTSD and dissociation can be a very effective healer IF this clinician has a good course of psychotherapy, and also maintains good ongoing supervision.

Chalice: My therapist and I are currently working with EMDR therapy. It is effective for me, but exhaustive work. What is your opinion on this type of therapy and do you feel that one can build a tolerance to the effectiveness of it, to the point that it is no longer a useful method?

Sheila Fox Sherwin: EMDR is a very effective form of treatment. I have never heard of anyone developing a tolerance to it.

David: And for those in the audience, we'll be doing a chat on EMDR next month, so stay tuned for that. Could you give a brief description of what EMDR is, Sheila, and what it's used for?

Sheila Fox Sherwin: EMDR, is a form of treatment developed by Francine Shapiro, Ph.D., that involves a reprocessing of trauma through a protocol of eye movements. It is used for all kinds of trauma recovery and can speed up the recovery process.

happiness: I am confused between dissociation and multiple personality disorder (MPD). I see them both used interchangeably. Are they really the same thing?

Sheila Fox Sherwin: No. Dissociation is a defense mechanism we all use. It becomes a disorder when it impedes our functioning. MPD is at the end of the dissociative spectrum. It is when the mind fragments into distinct parts. Each part of the mind holds a different part of the trauma or traumas.

David: So you are saying it's really a matter of degree. People can dissociate when thinking about certain events or topics, but when it becomes frequent, or uncontrollable, or impacts their ability to function normally, then it's a problem/disorder.

Sheila Fox Sherwin: Yes. I get lost in thought a lot. This is a form of dissociation. It doesn't impact on my functioning. When people lose time, can't remember big parts of their days, this is a big problem.

theplayers: Is dissociation only about facts and information about the abuse or is it about the related feelings about the abuse? For me, I have finally gained most of the pertinent memories of my abuse. But I am DID and so have great difficulty with connecting feelings to factual memories. Is there hope for someone like me to ever be "normal?

Sheila Fox Sherwin: People can dissociate facts, feelings, physical pain. Yes, there is hope for you. You must continue to be patient. I know its hard. Yes, you can lead a normal life. I know many people with DID who do.

pleasurepet: What do we do to help with the RAGE that scares outside people? And that we get blamed for?

Sheila Fox Sherwin: Part of the work is learning how to express rage in a way that that will be healing. It also must be contained so there is no harm to self, others or property.

Anyone: I hate to argue or disagree with the speaker, but I have Dissociative Identity Disorder and am not impeded or disordered in any way. I am accomplished and live a very normal life. Dissociation has a range from mild everyday dissociation to the extreme which was called MPD and is now called DID.

honesttogod2000: You are normal for you, the players. We are unique. You will learn lots and love yourself after awhile.

SpunkyH: My therapist is great when I am with her. I am so open it is like the shut-off part of me comes out to let her know they know everything that is going on but have little control.

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David: Here's the next question:

2sweet2say: Is cooperation or integration of multiple personalities a better choice in treatment efforts?

Sheila Fox Sherwin: It depends on what you and your therapist decide. Cooperation can be very effective. Integration may prevent relapse.

xoxo143J: I have lived through the abuse and recovered the memories. I am wondering why I should want to integrate with the pain - the physical part of my system?

Sheila Fox Sherwin: This is a good question. It is a very important one. I would suggest you continue to explore this in treatment.

SweetPeasJT3: Is it possible to recover the developmental damage to the child's brain in adulthood? If so, what needs to happen?

Sheila Fox Sherwin: It depends. We can't erase the past, but there is more and more research being done about the restorative aspects of psychotherapy to the brain. I would suggest you keep on working in treatment.

David: We have two questions on therapeutic relationships:

funnyduck: What is the difference between an alliance with a therapist and ethical boundaries?

Sheila Fox Sherwin: An alliance with a therapist includes ethical boundaries -- re: safety, time, dates, length of treatment, confidentiality, and honesty. An ethical therapist will not violate you in any way.

AbbySky: How do you know when you have an unhealthy relationship with your therapist?

Sheila Fox Sherwin: One thing you can do is discuss it with your therapist. You can discuss your concerns with other caring people. You can get a second opinion from another therapist.

pleasurepet: Could you please post some info on how to get inpatient help for DID, not having a regular therapist to refer me, but I do have Medicare A and B as well as Medicaid?

xoxo143J: Sometimes therapy is not enough. Are there any good inpatient programs that offer more than short term/crisis help?

Sheila Fox Sherwin: It depends on where you live. The inpatient programs that offer good treatment for DID are fewer and fewer. Many Voices is a self-help group that can help. Search the web sites.

David: In the transcript, I'll also try and post some links to inpatient DID programs. (I received 3 links from one of our visitors. This is not an endorsement of any treatment program, but rather this is posted as information only. Sheppherd Pratt Hospital in Baltimore, Maryland, River Oaks Hospital in New Orleans, Louisiana, and the Colin A. Ross Institute.)

David: Thank you, Sheila, for being our guest tonight and for sharing this information with us. And to those in the audience, thank you for coming and participating. I hope you found it helpful. We have a very large and active community here at HealthyPlace.com. You will always find people interacting with various sites. I hope you'll pass our URL around to your friends, mail list buddies, and others. http://www.healthyplace.com

Sheila Fox Sherwin: Thank you all for sharing this conference with me. I hope I have been helpful.

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Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.