Survivorship Webinar “From Fragmentation to Integration” Dr. Cathy Kezelman
Saturday, June 16 3 pm Pacific Time
Presenter: Dr. Cathy Kezelman
“From Fragmentation to Integration”
This webinar will depict my personal psychotherapeutic journey to explore the process of recovery from an extreme dissociative state, which was characterised by a complete amnesia for 10 years of my childhood and fragmentation of my self onto integration and recovery. Despite my therapist providing a safe reliable and contained space it took me a long time to trust her or appreciate that she could keep me in mind. She was empathic, compassionate and skilled and the relationship we developed was core to my survival and my recovery. Over years she bore witness to the dissociated fragments of trauma returning to my consciousness and the intense emotions which were overwhelming me. Through a committed analytical psychotherapeutic process she guided me from terror and confusion through chaos and onto acceptance and understanding.
It will explore the changes in me from having little insight into myself, my inner world, relationships or functioning as a whole being. I now know my own unique feelings and choices, and have the capacity to reflect, form deeper relationships and live a full rich life.
Dr. Cathy Kezelman is President at ASCA (Adults Surviving Child Abuse), an Australian national charity which advocates for a trauma informed approach to care and trauma specific services for survivors of complex trauma secondary to child abuse and neglect. She is a director of MHCC (Mental Health Co-ordinating Council NSW). She is an active advocate for Australian adult survivors of childhood trauma and informed mental health responses to trauma. Early in 2010 she published her memoir, ‘Innocence Revisited’ – a tale in parts, her story of recovery from childhood trauma. Cathy is also a mother of four adult children and a foster child.
From fragmentation to integration
I am going to speak today about my personal story of recovery from a childhood of abuse which left me fragmented and the journey I took through a process of psychotherapeutic support towards integration. While this presentation focuses on my therapeutic process of recovery there are many different paths to recovery. Apart from therapy mine also included the support of my immediate family and a small number of close friends. My story, while individual and for that reason, unique is but one of very many and my path to recovery is far from the only one. Yet it undoubtedly shares many elements common to others. This webinar is entitled from fragmentation to integration. So let’s start by looking at integration, what it means and how my path towards integration evolved.
I don’t remember when my therapist first used the word integration in sessions with me but for several years the mere mention of the word made me recoil and that was before I really understood what it meant. That’s because for a long time I knew at a gut level that integrating my experiences, memories, feelings, thoughts and beliefs i.e. bringing all of those elements and myself together into a confluent whole, was out of the question. That was before I appreciated the degree to which I was fragmented. Only now after years of therapy can I reflect on how vested I was in staying fragmented – this is, in keeping my traumatic experiences separate from one another and blocked off from my mind. After all unbeknownst to me my compartmentalisation and disconnection had enabled me to keep the horrors of my past away from my conscious awareness and so keep me functioning.
Integration was unattainable for a long time and it, like the rest of my therapeutic process, could not be rushed. It took many years of processing both inside and outside of therapy to achieve a good degree of integration but the benefits of achieving it, for me, have been manifold. Those benefits have included a much better sense of myself and knowing who I am, being able to identify and own my own individual thoughts and feelings, as well as be able to ask myself what it is that I want and to identify my desires, and, at least, some of the time, trying to meet them.
My personality, that is my actual self, as well as my memory of most of my childhood experiences, good and bad, had been separated into parts since I was a young child. Those parts did not have any connection with one another and I didn’t have access to the information which was held in them. Effectively each of the parts carried aspects of my history, the memory of which was unavailable to me. For a long time I didn’t know that I was fragmented; in fact I was oblivious that anything was wrong. Relatively speaking, that was a good thing because for many years I didn’t have the capacity or resources to digest the traumatic aspects of my history or process them. I am now aware that much of my early life had been traumatic and the process of coming to terms with that has taken a lot of energy, resources and processing. Luckily I found a therapist who could help, support and guide me through the process of identifying, acknowledging and understanding those parts of myself. I was lucky. I got there. Integration was my path but that does mean that it’s everyone’s.
All survivors of child abuse have a unique history and a journey towards recovery which depends on their experiences, the way they’ve coped, the way their trauma has affected them, their resilience, supports and resources. The story of what happened to me is not as unusual as many would like to believe. Instead of being nurtured and protected, I was sexually abused by family members and others over many years. I also suffered the emotional and physical abuses which often accompany sexual abuse. As the adults around me prioritised their needs over mine, my mind used some ingenious defences to enable the child within me to survive. I didn’t know about those defences or indeed that I had to use defences to survive until I was much older. Yet my defences protected my psyche from being overwhelmed by the trauma of my childhood. In doing so they virtually closed me off completely from my entire childhood. Yet they allowed me to cope and function, apparently quite well.
I think it would be best to go back to my story and describe how I came to understand my process of fragmentation and how indeed I did manage to integrate those parts of myself previously denied and unknown to me.
A long time ago, in what seems like another life I felt invincible; I was the quintessential superwoman. I worked as a doctor in a busy group general practice. I was also a wife and mother with 4 active children and a foster child. Life was frenetic and I dealt with the multiple demands with apparent ease. But I didn’t know how to check in with myself or enjoy the moment… my life was about doing, not being. I didn’t acknowledge my needs and in retrospect knew precious little about myself. I did not question or complain and abhorred weakness – physical and psychological especially my own. Seeking help was not in my lexicon. I was emotionally detached with little patience for the ups and downs of life and expected everyone to just get on with it.
I was fiercely goal-orientated. I measured life by achievements, and could be quite intolerant and judgmental, as I was intellectually defended. In fact I had perfected my own form of black humour, which could be quite mocking and withering but it helped enforce the barriers I had erected to stop anyone from getting too close to my core.
Great wrap isn’t it? Yet I was a popular doctor and that role worked for me. It gave me an identity I otherwise lacked. When I was at work I was in control, the expert who others consulted for help in managing their lives. I felt empowered in that role, when in my personal life, I didn’t. Even though I couldn’t have defined it back then, that’s very much how it was. I was shy and often silent in social settings, scared of my own shadow and happy for others to speak on my behalf.
I didn’t have much patience for emotional issues although in my work I did refer patients to psychiatrists for treatment of their mental illnesses and to psychologists for help with issues they could not manage. Yet I perceived patients needing such referrals as weak because their frailties were ruling them. I couldn’t relate to vulnerability as mine had always been denied. I’d never countenanced the possibility that one day I would be forced to seek such help myself. But then there is nothing like a humbling personal crisis to bring such preconceptions to their knees.
When I was in my mid-forties, my niece, to whom I was very close, died in a car accident. Her death paralleled another sudden death from my past, the death of someone to whom I had been very close, but whose death in retrospect I had not really grieved. Angela’s death was the trigger which cracked my defences and started my inner world unravelling. People who’ve been abused can experience all sorts of triggers. Such triggers act as cues for past experiences e.g. their children reaching the age at which major trauma occurred, an experience which is reminiscent of prior experiences, a sight, a smell, a sound, a place or which conjures emotions which parallel those associated with the prior trauma.
Some triggers appear innocuous; yet mine was catastrophic by any measure. However the repercussions of Angie’s death were far more profound and sustained than anyone could have anticipated. After Angie died I grieved as one would expect and of course grief takes as long as it takes. In 20 years of practice, I’d witnessed a multitude of other people’s losses and watched them grappling with their grief. From my arm’s length and detached position, I felt I was an expert. But my theories of grief were challenged when, as other members of my family began to come to terms with their loss, my grief became more entrenched. Images of Angie’s mangled body dominated my mind. In fact they would not leave me alone and that left me shattered.
My grief subsumed me and I grew frightened. I was not used to paying attention to my emotions, and especially not to being ruled by them. I struggled to manage and resented losing control. I soon felt overwhelmed by the everyday demands I’d previously taken for granted, and my practice and home life suffered. I struggled to admit that I needed help because doing so meant acknowledging the vulnerability I’d always worked so hard to deny. Unable to cope I finally caved in and reluctantly decided to seek help. I didn’t want to see a psychiatrist– they were for ‘mad’ people or so I characterised such things at the time.
After all I was not only emotionally detached but I had been trained as a medical practitioner. I believed completely in the medical model of symptoms, signs, diagnosis and treatment and didn’t deviate from that model at that time. Buoyed by the defences I had used to manage I carried a lot of judgement then. Needless to say, my attitudes have changed enormously since, but more of that later.
I didn’t know I was in bits until my world came crashing down. Angie’s death was the trigger which cracked the psychological walls between those bits. Keeping my traumatic experiences and reactions disconnected from one another and unavailable to me had allowed me to function in the world. It had meant that aspects of my feelings, experiences, memories, thoughts and beliefs rested in separate compartments in my mind. These compartments were rather like the drawers of a filing cabinet, separated from one another, but also from me and my consciousness. To function holistically each of us needs to have those elements connected. When they are we can develop a coherent sense of self.
Similarly we need to be able to draw on experiences of the past and our feelings and reactions to them, to inform our lives in the present. If we can’t live with awareness in the present we also struggle to envisage a future. I struggled in my world. To many it appeared as though I functioned well. I was a doctor with a successful practice, a mother of 4 children but in retrospect I was emotionally detached, out of touch with, and disconnected, from myself and others. I was robotic, a doer with very little ability to be in the moment or in myself. Because I was not in touch with myself I was not really able to be there for others, certainly not emotionally and my relationships with my friends and family suffered as a result.
Even I had to eventually reluctantly admit that I needed help. I made an appointment with a female clinical psychologist. I’d referred to her from my practice and heard good reports. Besides I’d only need a few sessions, a quick treatment to reset whatever unseasonal imbalance had arisen in my system or so I naively believed. That was fifteen years ago and I still see my therapist!
Within a couple of sessions the psychologist who we’ll call Kate had delineated the boundaries around sessions, making contact between sessions and how she managed cancellations. Little did I appreciate the importance of clear boundaries then or the safety they helped establish! At the time I simply resented being told what to do. After all I was used to being on the other side of the desk, the one calling the shots and dispensing wisdom.
I hated being the patient because the tables were turned, or so I perceived – the therapist was in control and not me. The first session was excruciating and the next few, intensely uncomfortable as I struggled with the alien concept of talking about myself. Lengthy embarrassed silences were further exacerbated by my determination to not reveal anything personal. Despite her office being aesthetic and private, comforting and containing I still felt like a lamb to the slaughter. In those early weeks hardly a session passed in which I didn’t fantasise about bolting. I especially resented having to start the ball rolling in sessions and worked to ‘out-silence’ her by staring her down so she’d be forced to speak rather than me. But after years in the chair she was an expert at sitting with silences and all my attempts at asides and distractions failed miserably in the hands of an expert.
Before long I was attending 2 x 50 minute sessions a week with my very own psychotherapist and I’m still not sure how that happened! I struggled to trust her and to feel safe. I had been badly betrayed as a child and I found it very difficult to trust anyone, although I hadn’t ever realised that. A crucial part of my therapeutic process was to allow myself to rely on Kate and become dependent. I had never really depended on anyone and doing so, was critical for my survival.
In addition I also had to give up my usual way of needing to have all the answers straight away. I was impatient, used to going from one task to the next with little awareness or processing – just doing. It was very hard for me to trust the process of therapy, to sit with the ‘not knowing’ and to wait for things to unfold in their own time.
Over the years I did learn to trust Kate but it was a painstaking process which took several years. I would easily flip back at the smallest perceived transgression on her part. Kate was reliable, consistent, steadfast and reassuring. She listened to me and responded to my needs, and those elements started to rewrite the script of my childhood interactions. And Kate could even keep me in mind when I wasn’t with her, and that was something that no-one had ever done consistently before.
My sessions with Kate provided me with a place where my feelings, thoughts and needs could be identified, listened to and heard. They also provided a safe space in which my trauma could be explored and processed, in which the unspeakable could be spoken about.
I’d been in therapy for a few weeks when Kate asked some apparently innocuous questions about my childhood… questions about childhood friends, teachers, classrooms, favourite foods and so on. I could recall the occasional fact from the past but had very little detail I could draw on. I soon became agitated and blurted out the line I’d used for years “I did have a happy childhood. My mother told me so”.
I’d had a lousy memory for as long as I could recall but I’d always dismissed it hating when friends would reminisce. I could recall small snippets like one teacher’s name but could never tell a proper story about school, what happened at camp, or in assembly and so forth. When friends reminisced I’d become very frustrated and feel alienated and angry. Not being able to manage my frustration I would react with sarcastic asides and black humour. Effective but less than appealing means with which I attempted to protect my own deficiencies.
My condition of not remembering as an adult is called dissociative or traumatic amnesia. It means having major gaps in the ability to recall important personal information that is too extensive to be explained by ordinary forgetfulness. The times of the gaps in recall usually parallel periods of trauma. The mechanism of dissociation which forms the basis of traumatic amnesia is a very effective coping mechanism. Dissociation allows a person, most commonly a child, to ‘effectively escape’ being overwhelmed by trauma or traumas.
Dissociating or splitting off from consciousness any memory of the experience/s, allows the victim to mentally escape the fear, pain and horror of the events. Details of when and where the trauma occurred, as well as the feelings experienced at the time of the trauma are lost to recall and the victim’s psyche is protected. Dissociation is particularly common when the trauma is repeated, interpersonal and perpetrated by a care-giver whose role is to nurture the child rather than hurt them. Or when there is no adult who can protect the child or help the child make sense of what has happened to them.
The downside is that recall of the event down the track is partially or completely lost. In my case it crystallised that I had virtually no memory for 10 years of my childhood. I had almost global amnesia in autobiographical recall.
I didn’t appreciate the significance of my memory loss back then. Kate was of course aware of the possibilities but she did not share her thoughts with me. She let my history unfold in its own time. Yet my deficit, now better defined started to disturb me. I was no longer able to dismiss my memory loss as I always had. It troubled me; it was abnormal.
And after all I was a doctor and that must mean that I was reasonably smart. Didn’t it? But if I was smart what was wrong with me? Why couldn’t I remember?
Therapy first months
When I first broke down I thought I was losing my mind. I had previously always felt in control but now I felt chaotic. At first I was grieving but soon I began to feel anxious, and then I was anxious more often than not. As the anxiety built up further I then had my first panic attack. It was the first of many and my medical training was useless. I didn’t know what was happening to me; I thought I was going to die. It took me a few sessions but I eventually described my panic attacks to Kate. I was embarrassed and ashamed. I was unsure as to what she’d think, fearful that she would judge me.
However Kate didn’t judge me. She ‘normalised’ my symptoms and sought to reassure me. Despite myself I was starting to trust her and even depend on her. A degree of dependency and trust are the essence of a good therapeutic relationship but I resented my growing dependency on Kate because I’d been brought up to be fiercely independent and depend on no-one. Doing so was so foreign to me. Although I desperately needed to see Kate, I behaved as though I didn’t. I’d arrive late to sessions and call to cancel. Unbeknownst to me I was trying to show that I was still in control. Kate maintained the boundaries – if I came late she still stopped the session at the scheduled time. If I offered an excuse as to why I shouldn’t come, she’d hold me to the appointment regardless. I tried every technique to not comply. Nothing new to her, no doubt! My approach/avoid dynamic reflected my trust and attachment issues while her consistent availability helped ameliorate them.
As I broke down further I sank into a depression and felt less safe overall. Yet my relationship of trust with Kate was evolving and I did feel safe in her office… just nowhere else. The sense of being psychologically held was new to me and I relished it. Yet it vanished the moment I walked out her door. I couldn’t internalise Kate’s caring or know that she could keep me in mind. The attachment relationship I was forming with Kate was a whole new experience for me. As Kate became the maternal ‘thinking mind’ I needed, I tested her availability by calling her repeatedly. Most often I didn’t want to talk with her. I just wanted to hear her voice on the answering machine. When Kate did answer I would hang up not knowing what to say.
I didn’t have the capacity to communicate my needs directly. Yet I was very needy, anxious and agitated much of the time. Just listening to her recorded message would help contain my panic. Occasionally I would leave a message and when I did I would anxiously wait for her to call back. I expected her to be at my beck and call, with no other demands on her time– only me! When she didn’t call straight back I’d wonder why she was ignoring me. Perhaps she didn’t really care after all. Maybe she was just going through the motions because I paid her and she had to. My underlying fear of course was that Kate would abandon me just like everyone else had, but I wasn’t aware of that then.
For much of my adult life I hadn’t dreamt or certainly hadn’t remembered my dreams. Soon I was assaulted by nightmares. They were terrifying and all had a similar theme. I was trapped, in dire risk of my life and had no visible means of escape. I didn’t realise that those nightmares heralded that my subconscious beginning to unlock.
Soon after the nightmares started I experienced my first flashback. That flashback scared the living daylights out of me as my mind took control of me and my body adopted a life of its own. It struck outside of therapy, in the safety of my husband’s arms, as he was the person I trusted most. We were both terrified. As I writhed in pain, terror and confusion I thought I was losing my mind. I didn’t know that flashbacks couldn’t hurt me – that they were fragments of dissociated experiences returning to consciousness. As the flashbacks intensified and became more frequent I described what would happen without revealing their actual content. I was too shocked and ashamed to reveal their content. I was reassured that Kate seemed to have come across similar experiences to mine before. What a relief that was – maybe I wasn’t going mad after all. Kate suggested that I should write the details from the flashbacks down and bring the writing to therapy. At first I couldn’t read out what I’d written so withering was my shame; I’d hand the material to Kate and she’d read through it. Eventually I could articulate some of it and we’d explore the content together. It was hard to piece the content of the flashbacks together – sensations, feelings, body reactions and movements, smells, sounds and sights which assaulted me with very little context. As a narrative of different experienced formed I grappled with accepting horrors which seemed to be outside of my realm of experience.
Little did I know that years of flashbacks would ensue and that they would release a barrage of traumatic memories. Traumatic memories are stored in fragments without any context or chronology. They return as involuntary experiences which consist of visual images, sensations and physical acts which feel like they are happening in the present. They come in all sorts of combinations, sometimes just the image or the feeling, but with the full terror, pain and horror of the event, yet without the facts to explain what is happening, how they were triggered or where they fit into one’s life story. There is often no narrative because they are free-floating fragments and nothing is connected. All of those fragments needed to be explored and processed and over time a narrative constructed as best one can.
As the flashbacks intensified, and became not just a daily occurrence but occurred many times a day, my depression deepened. Kate’s availability during sessions, on the phone, and by email was pivotal. And when she went away on holidays and breaks she always ensured that appointments were set up with a replacement therapist, and that I had her email address to contact her as I needed. Thank goodness I now trusted Kate more, because that relationship of safety and trust became crucial to not just my process but my survival as well.
Past subsumed present
As the process progressed I became more overtly dissociative and from a deeply dissociative state, would relive the trauma. My life became my memories, and the past subsumed the present to such a degree that my everyday life rarely got a look-in.
Kate would work hard to ground me. She’d inquire about my plans and activities always talking about my children to connect me back to my world in the present. And scrutinise where I was going when I left the session, what I was doing during the next hour? Not only was I a bundle of nerves but I was profoundly depressed and barely functioning. I couldn’t continue to work; I was too unwell. As a result I was forced to leave my medical practice, so relinquishing my identity as a doctor.
Losing that role cut me further adrift. It has protected me, but I had no choice. I could barely get out of bed in the morning. My neediness consumed me and attending to my children’s needs was more than I could cope with. As I flipped between my present-day life as a middle-aged mother of 4, to being a 4 or a 10 or a 14 year-old terrified and agonised child my husband picked up the pieces of home and family. And so began a psychic dance between my once competent adult self and the traumatised child parts.
Kate made herself more freely available, extending the boundaries around when and how often I could contact her. Yet she always ensured that those boundaries were clear to me. She was reliable and predictable, rarely running late for a session or being interrupted during one. I became obsessed with seeing her realising at some level that she was my lifeline. I started the countdown to our next session as soon as I awoke. Seeing Kate was the grounding in my day. I longed to feel safe, if only for 50 minutes a day – now 3 or sometimes 4 times a week. That didn’t stop me testing Kate and our relationship and I did so regularly. She was firm when she needed to be to keep me safe but always stayed patient, empathic and validating.
Kate was the only person I sought out for a couple of years. Unless someone rang me, which became rarer over time, I interacted only with her, my immediate family and a couple of friends. Most friends could not support me for the time my recovery took and that was understandable because I was giving so little back. People were confronted by the change in me; it challenged their idea of me and perhaps also of themselves. Doesn’t mean it didn’t hurt; I felt abandoned and as a result withdrew further into my depressed isolation. I withdrew from friends first but then from my family too. Disconnecting from my loved ones was dangerous, and as I withdrew into my familiar isolated childhood space I put myself at serious risk. Kate worked hard to keep me connected. She told me to walk into my children’s bedrooms when they weren’t home, to look through photo albums whenever I could and keep family photos with me in my wallet and in the car. And that helped to ground me.
I needed to be drawn out of my isolation repeatedly. Kate urged me to get out of the house; to join a gym and get some exercise; to take the dog for a walk. I tried. I followed Kate’s instructions some of the time, but when I was at my lowest ebb and needed to most I couldn’t.
Despite seeing Kate 3, 4 or sometimes 5 times a week, with phone calls in between, my mood was plummeting and I was struggling to function. Kate referred me to a psychiatrist who prescribed anti-depressants. I took them begrudgingly. I still didn’t want to admit that I was sick, or worse still, needy! At first the medication took the edge off my mood but as my depression deepened, suicidal thoughts filled my days and trips to the Gap, a suicide spot became a daily occurrence. I kept my thoughts and sojourns secret for weeks before sharing them with Kate. She responded calmly when I revealed my suicidality and urged me to call her on her mobile whenever I needed to. Her acceptance was crucial to my growing trust in her. My battle with suicide raged repeatedly in those early years. I was often secretive, not sharing my plans with Kate and certainly not with my husband. The option of suicide presented an ‘out’ which I clutched like a security blanket. Kate sometimes informed me that unless I told my husband how I was feeling, she would have to. I would resist and she would call him in, me feeling like a naughty school girl as my destructive thoughts were revealed. I didn’t really want to die; I just wanted to end my pain.
On several occasions Kate and I talked about me going to hospital. We always decided against it because my relationship with Kate was fundamental to my process. She could not look after me in hospital. On a few occasions Kate urged me to sign a contract whereby I committed to not harming myself. I resented being coerced but would invariably succumb as Kate challenged the thinking which convinced me that suicide was my best and only option. And the thinking which allowed me to minimise the potential impact of my suicide on my family. It’s hard to know why the contract worked but I always promised to contact her if I felt overwhelmed with suicidal urges and did just that.
As time progressed and our relationship of trust developed I learnt to keep Kate’s presence in my mind outside of my sessions. Despite her consistent caring, my trust in her developed slowly. Whenever I misinterpreted the slightest inconsistency in our process she would have to work harder still. I expected her to betray and abandon me as others in my childhood had done. As I became more attached to Kate I felt safer and my growing safety enabled me to unlock and reveal more of my history. And so it was that Kate walked alongside me each step of the way bearing witness to every aspect of my trauma as it unfolded.
Dissociation, as I have already implied was undoubtedly the key defence which enabled me not just to survive but to function. In dissociation the connections between the functions of the mind which usually work together – those of consciousness, memory, sense of self, and how you view the world around you are disrupted. I learnt to dissociate in early childhood because that’s when my abuse started. I didn’t know that I was dissociating then. Nor did I realise that I dissociated in adulthood until I started to recall fragments of memory, initially outside therapy with my husband, because I trusted him most and over time as I trusted Kate more, during my sessions in therapy.
I now started to become more overtly dissociative in my everyday life as well but especially around and during my therapy sessions. As my appointments approached I would sink into a deeply dissociative state. At times Kate would find me in the waiting room spaced out and unable to move. I could not respond when she called me in and she would coax me along, sometimes having to lead me by the hand when I could move myself.
I now trusted her enough to expose my vulnerability. And so Kate became a patient observer to my dissociated state of mind and the outpouring of horror I relived in her presence. She sat with me holding the feelings and the experience in the room. In the session I would relive aspects of the trauma from my dissociated state. Kate would sit bearing witness, without aversion or judgment. Twenty minutes before the end of the session she would fetch a glass of water. The water trickling down my throat became the mechanism which pulled me back through the layers of dissociation so I could share my experiences. After I surfaced I could start to talk about the bits of experience my dissociation had accessed.
The material was terrifying and confusing. It emerged in disarticulated fragments without chronology or context. Kate would sit with me as I struggled to accept and understand the material; together we would question, examine, think and process. We would sit in disbelief trying to digest and process the fragments which had returned. It was challenging because sometimes I only relived my terror, or inexplicable sensations or movements. And we didn’t know where the bits fitted into my history. We would explore the material as best we could before focussing on helping me to feel safe enough to leave.
At the end of each session I would be immobilised. I’d relived ghastly abuses from childhood. I would struggle to leave and sometimes need to sit a bit longer to ground myself. I sometimes couldn’t believe that she could throw me out in that state. My trauma felt raw and my suffering was acute but my session had finished and the next patient was waiting. I’d occasionally be invited to sit in the waiting room but rarely so. Instead I’d work to find my feet, and place them on the floor, one foot in front of another, to walk up her drive back to my car. I’d struggle into the car, tip the seat back and pass out. When I’d recovered sufficiently I’d drive home to rejoin my life in the present. At times I would make my way to my car and fall asleep in the safety of the car and the street outside my therapist’s office. When I came to I would drive back home and try and rejoin my life in the present.
During that time I experienced a range of dissociative phenomena – strange ‘out of body’ experiences with parts of myself disappearing, my mind not feeling like my own, and myself or the world around me feeling unreal.
I vividly remember the day a child’s voice spoke from my mouth for the first time.
Talk about terrifying! There were many occasions during which I was recovering memories that I felt as though I was losing my mind. However this experience freaked me out. I didn’t know who was speaking. Nor could I predict what words would come out. In the first couple of sessions that a new voice spoke Kate seemed rattled and that shook me. When she seemed calm again I calmed down. I regularly monitored her reactions as a gauge for mine.
Over time different disavowed child parts came to therapy, some only fragments, others holding a single horror, others more formed, having played a pivotal role in my survival. And each of them would find their voice and speak, while the adult part of me and Kate would listen in disbelief.
I’d typically begin those sessions dissociated as in previous years but soon feel myself slipping further away. From a profoundly dissociated state I would start speaking in a child’s voice, and the child would use children’s language and concepts. Sometimes the parts would converse with one another, with Kate or my adult self. My mouth would switch between different voices. I never knew what to expect until the words came out. To cope with my trauma I had compartmentalised my essence, creating different child parts. These child parts which appeared to be different personalities were now making themselves and their experiences known to me, Kate and one another.
Some of the parts which spoke were aggressive or angry. They scared me but they didn’t scare Kate. She understood the trauma they had suffered when they were abused. I however felt as though my head had been populated by intruders. Even when the parts weren’t speaking I could hear voices conversing inside my head. It was hard for me to accept that I was not psychotic.
I struggled to accept the parts, their memories and so my history. These parts were parts of the developing child, sometimes known as “personalities”. They represented different ages and experiences. Some parts were fully formed, others fragments, some held multiple experiences and memories and others single memories or emotions for a single trauma. These parts were unaware of one another. They each held their own bits of memory, discrete parts of my history, and emotions within my psyche which they had kept to themselves. I was a giant unaware humpty dumpty. So what did help put me back together again?
Engage with parts
Kate welcomed every part to therapy. She spoke with them in turn, addressing them at the appropriate age and comprehension level. She validated their feelings and experiences. She treated them as she would any patient, helping them to learn to trust her and feel safe. Through observing her I started to appreciate the roles the parts had played in keeping me alive. And why the parts had formed in the first place.
The trauma I experienced as a child was too much for any child. Had the child remembered it all she would have been overwhelmed. Dividing the trauma up into bits and the child into parts made perfect sense.
The parts had formed to protect the child me but now the danger had passed. The parts were no longer needed as separate parts. They were all valuable but they were all part of me. If they could be integrated all of my history could be connected inside of me.
Some parts were scared of integration as they felt they would die. They struggled to understand that they would live on inside me. As the parts gained faith that the child was now safe, and that their courage had been honoured, they no longer felt like they were dying.
My therapist would tell me to put my arms around the parts and embrace them. I was reluctant at first because I resented and hated some of the parts. Over many months all of the parts introduced themselves. Some parts were suspicious, others angry and hurt and the road to them accepting one another and to me accepting them all, was fraught with resentments, fear and aversion. I struggled to facilitate connections between them as did the parts between one another.
I also struggled to accept the parts which had carried the worst of the abuse, those of which I was ashamed and which the other parts blamed for them being abused. These parts felt ‘bad’ and ‘dirty’ to the others and to me. At first I rejected them but Kate modelled acceptance and understood why the different parts played their particular roles.
The parts I sought to reject had suffered the most. I wanted to throw them and my feelings of shame over the Gap and get rid of them. But they had experienced the worst of the abuse and saved me. I needed to learn to trust all of my parts and they had to learn to trust one another. And we all needed to feel safe. Over time I became more compassionate and could psychologically embrace them. Doing so was especially important with the parts of which I was ashamed and therefore hated. Overcoming my shame was the key to further integration.
Yet Kate’s tolerance for all the parts encouraged me to accept them. Kate helped me appreciate the role each of them had played in protecting the child me. She encouraged me to put my arm around the hurt, scared and ‘shameful parts’ and as I accepted all of the child parts of me, they were absorbed. Over time the fragmented turbulent ‘we’ became a more peaceful resolving ‘me’.
I can now reflect on my struggle to reach that point. I can recall in retrospect the ludicrous conversations Kate and I had. Conversations during which I would tell her that if she like the parts so much that she should keep them over the weekend. I often wanted to leave a part called Growly behind as Growly had done the most terrible things of all and I hated him.
“Growly’s snoring makes me come back out. I look out at him and am able to see him clearly; he looks like someone who has been badly beaten.
Why didn’t you tell us?” I shout. “why didn’t you let us know?”
Growly shakes his head and looks away; I can see tears in his eyes.
“Look what he had to do!” I shout to the others.
“But how do you know that Growly won’t hurt us?” Long Suffering’s voice shudders. When I see how scared Long-Suffering is, I get confused and don’t know what to think. We’ve all been scared of Growly for a long time and it’s hard to let go of that fear.
“Cathy, sometimes you have trouble being compassionate, don’t you? One minute you’re feeling sorry for what Growly experience and the next you’re being harsh and rejecting him.” Kate’s voice cut me to the quick. “Why don’t you put your arm around him?”
I screw up my face. The thought of putting my arm around Growly makes me sick. Growly is smelly and yucky and I don’t want to put my arm around him.
I hate Growly and I want to scream at Kate: If you love Growly so much, you put your arms around him! You take him home!”
The internal battle to accept Growly raged for months. Accepting Growly meant accepting a part of me which had perpetrated despicable acts. And it meant absorbing the pain and the guilt of being Growly. Dissociating any memory of Growly and the other parts had allowed me to externalise those negative feelings and behaviours, but in so doing I had lost large parts of myself. Through the process of integration I reclaimed parts which were previously unknown to me and the bits of trauma each of them carried. I could now begin to take those bits of my history and weave a narrative of my past together.
Kate never suggested any conclusions before I reached them myself. She remained open to whoever and whatever I brought to therapy and I took my cues from her. I was hypersensitive to every nuance of her words and even when I had my eyes shut and was deeply regressed I maintained an awareness of her presence and demeanour. She listened and she heard. Most importantly she acknowledged and validated my experiences and pain and that had not happened when I was a child. No processing of my experiences could take place when I was dissociated but after the material was revealed and I returned to the present, we would sit together and try and make sense of what had been revealed. Any attempt by Kate to hurry me or any perceived impatience would send me into a dissociative state or deepen the dissociation. I could not be hurried. I and the material needed to set the pace of therapy, not Kate.
Not to say that Kate didn’t ever challenge me. Some of my thinking needed challenging. Thinking like my assertion that my suicide would only make my children a little sad. That I could throw one part of me, Growly, over the Gap and the rest of us would live on. That as a young terrified child I could have stopped a group of adults from abusing me. Kate guided me towards more grounded thinking. Greater logic to my thought process also helped me manage my emotions better. Eventually the highs and lows became less turbulent and my battle with suicide and depression subsided.
It seemed as though the parts had lived different lives to me. That’s because none of their experiences had been connected to me. I hated some of the parts especially those which carried memories of the worst abuse. I blamed them for the trauma I had experienced, and judged them as being bad and dirty. I was ashamed of those parts and wanted to get rid of them. My shame drove me towards suicide. Somehow I didn’t comprehend that getting rid of one part would meant that I would perish as well.
My shame was one of the largest obstacles to my progress and dealing with it took a long time. I blamed myself for my abuse and judged the child me for being abused. Kate suggested that I look at my own children, especially my 2 youngest daughters and ask myself whether they could have stopped powerful adults abusing them. Or look at children at play, young children of the age at which I was abused. That I should stop judging myself with my adult mind and ask myself how the young child me could protect herself. It took me a long time to show compassion for my child self, to forgive myself and believe that I wasn’t to blame. That I wasn’t worthless and bad. I had internalised those messages from my abuse, and they were ingrained. Those feelings had left me hating myself and rendered me not just self-critical but self-destructive as well.
My history is complex and that complexity coupled with my obsessive nature meant that Kate and I revisited aspects of my history time and again exploring it from a range of angles. I needed to know what had happened to me and understand the impacts of that trauma. Ultimately I had to accept that I would never know and understand certain aspects of my history. I experienced my last flashback several years ago and rarely dissociate anymore, and if I do certainly not to the depths of previously. I have now integrated the bulk of my traumatic experiences, and no longer have parts speaking out on my behalf. Most importantly the trauma is now part of my history. It no longer takes over and permeates my entire existence. Yet my therapy and within it my process of self discovery continue.
As a child my feelings were invalidated and my experiences were denied. The adults in my world imposed their thoughts and feelings on me and I grew up out of touch with myself, installed in the service of others. I became a people pleaser, deferring to others in the vain hope of being acknowledged and cared for. Deferring to others is still my default position although now I can identify when it is happening and start to address it. Kate has modelled kindness and compassion and I have learnt a lot from the dynamics of our relationship. However I am still learning how to value myself and be kind to me in the process. I am also learning to acknowledge my strengths and my achievements. When I was in medical school I hated being asked any questions in tutorials. I used to stand as far back as I could, hiding behind the crowd trying to be invisible. Being singled out was reminiscent of being singled out for abuse and it left me feeling exposed. I often knew the answer but the possibility that I might be wrong and therefore criticised, humiliated or judged to be stupid was chilling.
Finding a voice
And here I am speaking in public, facing one of many people’s greatest phobias. I’m not saying that it’s comfortable mind you but that’s another story. So how has a child who was scared of her own shadow and an adult who was terrified to speak even in social settings ended up so psychically naked in front of so many? In fact as an adult there were times when I was in severe pain in which speaking up would have brought the pain to an end that I still couldn’t speak up. When I was stung by a bee to which I’m allergic and stood passively waiting for a photograph to be taken. The time a periodontist overheated his instrument and burnt a large area of my gum and I didn’t say a word.
Therapy gave me a voice and it was heard. And what I said was respected. I spoke in therapy and I also wrote. Writing started as a private purge, a way of getting the trauma out and onto the page. Later I chronicled my history and for my book had to weave that history into a digestible narrative. Part of that process was weaving myself together as well. Publishing my book and speaking to share my experiences and now my reflections has empowered me. For instead of being ignored, disrespected and violated I have a voice. That voice has grown stronger and moved from therapy into social settings and now through my book, and presentations like that, into the public domain. Like many survivors I have sought to find meaning in what happened to me. I did that initially by reading. I read voraciously, anything I could find about abuse and its impacts, therapy and its processes. I was also driven to become an advocate. And my advocacy role has led me to challenges far beyond what I ever thought possible.
My therapy has also enabled my relationships. I have made substantial progress in the most crucial relationship of all, that with myself, with acknowledging my needs and seeking to meet them. Prioritising them does not come naturally but at least I can identify when I’m ignoring them. Nurturing myself and that odd concept of pampering remain a long way down the track however.
As my relationship with myself develops, so do my relationships with others. Because I am more at peace with my history I am also more at peace with myself. I rarely need to resort to black humour or mocking and can communicate my feelings and needs more directly, most of the time. This has translated into greater empathy, patience and tolerance for others, and along with it, the capacity for deeper more fulfilling relationships. The most important relationships I have are those with my family. My husband and children have also been through one hell of a journey. It has been protracted and chaotic and for many years I couldn’t share what was going on with them. All my energy was spent just surviving. As I’ve understood more about my history and myself we have started to explore our shared history together as well as its impact on us all.
On occasions over the years Kate saw us as a family. Initially those sessions helped reassure other members of my family that Kate was looking after me and keeping me safe. Later sessions gave my children additional perspectives around my history and opened up the conversations within the family. My family observed me at my most vulnerable and I would have done anything to spare them that experience. Yet it wasn’t all bad. We all learnt a number of lessons. As I came to terms with my vulnerability we all came to appreciate that acknowledging vulnerability is a strength. Being vulnerable allowed me to engage in and stay in therapy. For only when I was vulnerable enough could all of the dissociated parts emerge, be processed and integrated. And over time we could all appreciate the positive changes which came about for me and them as a result.
Kate showed me and my children the importance of being ‘dependent’. I had to become dependent on Kate to allow myself to be vulnerable. The good news is that finally I could allow myself to depend on someone! In my children’s formative years I had modelled fierce independence, mocking those who were needy for their weakness. My children observed my growing dependence on Kate, and understood that my dependency was necessary for my survival. Without that relationship I would not be here today. As I became dependent on Kate I became more available to my children. I can now be there for them in a much more committed way than I could when they were young. By Kate’s example and now mine my children have learnt that not only is reaching out in need okay but it is also courageous and laudable.
As a family we have learnt to talk much more openly not just about our shared journey but about our feelings and concerns. All of my children have their challenges as everyone does but they can now give themselves permission to seek help when they need to. Although we still need to work on staying connected we have collectively moved a long way. Kate has shown us the strength and value in making connections and in sustaining them. As a family goals and achievement are no longer the be-all and end-all. We value compassion, openness and being there for one another much more these days. And we are there for one another because now we know how to be.
As my relationships with my family have changed, so have those with my friends. Whereas before I was unable to develop deep friendships I now seek them out. Intimacy in relationships no longer scares me; I am far more open and better connected than before. I am also much more insightful and able to reflect not just on my behaviour but on that of others. This new skill however is a double-edged sword because my new insight often leaves me feeling disappointed by the intransigence of others who haven’t explored and processed their issues. I am also much more confident in social situations, able to step forward and speak my mind. In fact I enjoy the challenge. When I was in medical practice I didn’t attend conferences or professional meetings. I avoided the social situations related to my discipline but now I seek out those related to my advocacy work.
Through my therapy I have developed a reflective capacity which has allowed me to think, explore and question in a way which was not previously possible. Initially I would reflect with Kate on my memories and try and create a coherent narrative for my life. More recently we are reflecting much more on everyday issues and even asking the existential questions of life. Kate has always guided me and my process but in so doing has never made me feel that she knew better. She didn’t impose her views on me. Our therapy has been a collaboration in which she, the surrogate ‘maternal object’ gently nudged me towards self-realisation.
Not only did I grow up out of touch with my feelings but also with my thoughts and beliefs. Other people’s thoughts and beliefs were imposed on me and I was too scared to hold alternate views. Ultimately I didn’t even ask myself what my beliefs were. Nor could I identify my wishes and desires. I didn’t know that I could make choices or determine my own path. As a result of my therapeutic process I know much better who I am; I am stronger, much more in touch with my feelings and thoughts, and learning to acknowledge and honour them. I am still grappling with choosing a path but it’s an exciting journey of discovery from an aware and in touch place, and one which looks to the future with quiet anticipation.
My recovery is testimony to the authenticity of an informed and committed long-term psychotherapeutic process, the key to which was the relationship I developed with Kate. First I needed to feel safe and learn to trust Kate. Only when I became more dependent could our relationship develop to a point where my history, the material it brought and the feelings which arose could be reflected on and worked through. My therapy did not depend on any one treatment modality or model. And there were no gimmicks or quick fixes; rather ours was a process which required the utmost patience. I needed to give up my usual way of needing to have the answers immediately and allow myself to wait and see what unfolded, to sit in the ‘not knowing’ as Kate would most aggravatingly point out. And even when I didn’t trust the process I had to somehow trust Kate’s belief in the process.
As a result of this process I am more the holder of my experiences than an unconscious subject of them. I was fortunate to find a health professionals with the capacity to sit with me and patiently bear witness to my trauma, no matter how disturbing. Kate provided me with the space in which I could engage with her, explore my inner world and ultimately reflect on my experiences.
Kate has been insightful and skilled, compassionate and giving. Her unconditional regard, empathy and commitment were crucial for my recovery. As she was there for me so I learnt to be there for myself, and to value myself as previously I was unable. She walked alongside me every step of the way guiding me from confusion and terror, through chaos, onto stability and understanding. Without her, my family and a few close friends, I would not have survived. And I have not only survived but have been able to move past mere survival to learn how to live well.
We got there. I no longer call myself ‘we’. I am ‘me’. I have my own likes and dislikes and a sense of myself that I never thought possible. So from hating that word ‘integration’ here I am speaking about it. Ironies never cease but then again nor does the living proof that the process of fragmentation to integration is achievable with time, patience, a skilled therapist and a committed psychotherapeutic process.
Reposted here with the permission of the author and Survivorship.