Complex trauma and dissociation throughout the lifespan: Ana Gomez, Dolores Mosquera, and Kathy Steele
EMDR therapists Laura Beech and Victoria Walford share their reflections on the EMDR UK 2022 Conference held in Cardiff on 25th and 26th March. Laura watched online, and Victoria was there in person. If you didn’t manage to attend the conference you can access the recording online until Sunday 24th April, using this form to register: https://lnkd.in/d4hY8fE7
There was so much rich detail in the presentations over the two days of the conference focussing on complex trauma and dissociation throughout the lifespan. The subject was explored with great continuity in the presentations, threads weaving together the themes from each speaker. Ana who spoke about working with children, and Dolores and Kathy who talked about adults, including later life and elderly clients.
Firstly, I found myself thinking about my adult clients and how they came to be where they are now, through listening to Ana talk about childhood. She spoke of how children are not just small adults; there’s a distinct difference between the adult’s and the child’s brain: “Genes are impacted by experience, so the human brain needs another brain to develop.” There’s a constant state of movement in children, depending on their environment and developmental pathways. A big takeaway was rejecting the common assumption that we are born whole and then fragmented through trauma. I learned that childhood is a journey with opportunities on that journey for development. We are seeking to unify or to be whole and we do that through interactive processes with the caregiver throughout the period of development.
Ana stated: “We need co-regulation and validation by the caregiver,” and to find “…existence in the mind of the other”. Babies are hard-wired to seek out connection This is done through repetitive experiences: “This is me; this is you; this is our connection.” Our existence needs to be found and validated by the other. It follows then that when working with a dissociative child, as a therapist your presence is the most important toy or thing in the room to allow the child to find their own mind. She also talked about the process of mirroring and how important it is in the caregiving relationship, in that the child discovers the mind of the other to find a unified sense of self. Positive mirroring and co-regulation by the caregiver give a coherent sense of self to the baby.
The theory is that neurobiologically, trauma interferes with the associative pathways and if the environment does not provide what the child needs, dissociation can occur. Dissociation is not simply a product of a discrete event but is part of a developmental journey especially if the child is consistently exposed to an environment where the parent is unable to provide co-regulation, safety, and security. The child must detach from the painful wound of disconnection inflicted by the parent and idealises them to stay in that relationship for their survival. The child is in conflict both relying on the caregiver and fearing them: this can cause fragmentation and chaos in the mind. Through these experiences, the child learns to believe there is something wrong with them and/or the world and becomes unable to connect to their bodies and emotions. Some people who were not parented well themselves are still able to do so by instinct, others can be taught through psychological education and parenting classes.
Kathy brought in the link to adults, talking about how the caregiving system can be triggered in therapy and how the therapist needs to take care of the young parts of the client. In treatment, she is interested in why different parts of the client are separated and why they don’t talk to each other. The work is how to bring them together in therapy. A marker of progress in therapy is the level of functioning in daily life. Both Kathy and Dolores were big on goals. You need to know where you are going with your client and what your goals are even if they are small.
Dolores gave us a comprehensive talk on how she works with parts. She emphasised that a good clinical assessment is imperative, and that the standard protocol does not always work with complex clients. However, we can do trauma processing by doing more work in phases 1 and 2 with this client group who usually present with dissociative parts that have internal conflicts.
What seemed important is to work initially with the phobias and internal conflicts, otherwise, there can be a backlash from other parts that internally protect or defend the trauma parts of clients. The framework in her slides was very clear and she had a gentle and compassionate manner. She comes from a position of curiosity, of not knowing, talking about taking a journey together with your client in a collaborative process.
Kathy took us to the end of the lifespan, saying interesting things about older people. They don’t have so much time ahead of them, so too much future-orientated work is not so helpful. I found this a very good consideration since with EMDR we work with past, present, and future prongs, but with older patients we should be mindful of the limit on future oriented time and think about how to work most effectively with this client group.
The consistency in the speakers’ approaches and how they worked together meant that exploring trauma across the lifespan was covered very comprehensively by them and left me with much to think about.
This conference was really good for understanding how to use EMDR therapy for more complex presentations.
As a result, I think it probably took some EMDR practitioners to a new place in terms of the question ‘what can I do with EMDR?’ Some therapists come away from learning EMDR therapy thinking ‘when can I use EMDR?’, but for me it’s not when, rather how to use EMDR. The conference showed people how to use EMDR a little bit more.
EMDR is a powerful psychotherapy. The seminars highlighted how to use EMDR in the wider context, particularly in relation to complex trauma and dissociative adult patients.
For complex cases trauma starts in childhood and let’s face it, most people who turn up to EMDR therapy are complex). There is a particular language used to talk about trauma in childhood namely around attachment, parts and younger/adult self. The speakers at this conference demonstrated how to bring all this together in relation to EMDR. What’s more the speaker highlighted the echoing out of childhood states in the adult presentation – for example we see this in the change of tone of voice, movement, etc.
The conference also touched on how to work with complex dissociative disorders whilst maintaining present safety in the room with the patient. It’s good to think about how the child would have felt and behaved in his/her experience, because you will be dealing with that same child in the therapy room. As the EMDR therapist you will be navigating the pain through the child’s eyes whilst in the adult body.
There is an attachment informed approach to EMDR which of course is linked to childhood experience so naturally in these cases you would be working with younger states. The conference also touched on this.
Overall, this conference gave an introduction to considering the child in the room in your practice – if you weren’t doing so already, and I think it would have been very useful from that perspective. The speakers were clear and calm in their delivery, so the audience got a lot out of listening to them. Good food for thought. I recommend reading their books if you want to find out more. Google Scholar is a great resource for wider reading.
And of course, it goes without saying that it was a pleasure to have some social engagement again. I met new people and caught up with some I already knew from when I studied EMDR which was great – and to be reminded of a world outside of your own modus operandi as a private practitioner. So, I am most grateful to have had the chance for further connection and ignition of ideas that only came about thanks to attending the conference.