My name is Lisa Danilchuk, and I'm a psychotherapist specializing in complex trauma treatment.

I'm a graduate of UCLA and Harvard University, and I'm thrilled to share these reflections on how we can heal with you today.

Today our guest is Kathy Steele.

Kathy Steele has been in private practice since 1985 and with Metropolitan Psychotherapy Associates in Atlanta, Georgia since 1988.

She was clinical director of Metropolitan Counseling Services, a nonprofit psychotherapy and training center until 2016.

Kathy received her undergraduate degree from the University of South Carolina and completed her graduate work at Emory University.

She's a past president and fellow of the International Society for the Study of Trauma and Dissociation, or ISSTD, and has also served two terms on the board of the International Society for Kathy served on the International Task Force that developed treatment guidelines for dissociative disorders and on the Joint International Task Force that developed treatment guidelines for complex post-traumatic stress disorder.

Kathy is known for her humor, compassion, respect, and depth of knowledge as a clinician and teacher, and for her capacity to present complex issues in easily understood and clear ways.

She sought out as a consultant and supervisor and as an international lecturer on topics related to trauma, dissociation, attachment, and psychotherapy.

She has co-authored numerous book chapters, peer reviewed journal articles, and three books with her colleagues.

Kathy and I first connected through our shared time at ISSTD conferences, and I've always appreciated her clarity, humor, and kindness.

I'm elated to share her with you today, so let's get going and welcome Kathy to the show.

Kathy Steele, welcome to the How We Can Heal podcast.

I'm so excited to have you here.

Thank you for having me, Lisa.

I'm excited too.

Yeah.

And I'm sure there's plenty of folks listening who know you and know your work well, and there might be some who are just getting introduced to it, so I feel like I have this gem that I can just share and share some of that shine with them.

And so I've been familiar with your work for a long, long time, and the writing and the trauma, and I've never known how you got into the work and when you first learned about it.

And I feel like there's people that are just starting to learn about dissociation now, and I know folks like you who learned about it a long time ago.

So what was that like?

Well, it was interesting.

It was quite a different time.

On the one hand, this was in the early 1980s.

Part of what was happening during that time was this sort of upswelling of recognition of the fact that one in four women were sexually abused in some way.

And so that was the background for what happened for me.

And of course, like many people, I fell into this in a sort of accidental and serendipitous way.

The first thing was that I had just started private practice and sort of wanted to get to know other people in the community.

And so I volunteered like really blindly to run this one-year incest group.

I had no idea of what in the world was happening.

This was even before Chris Courtois' first book on healing the incest wound, right?

So it was really early.

But there was a group that was running these one-year...

This organization was running these one-year groups and they were offering some supervision.

And I had the experience of meeting with the group members to sort of see if they'd be a good fit for the group.

And I remember one person in particular ended up on the floor sucking her thumb.

And I had never seen that before.

I had no idea what that was.

Now I go, oh, yeah, of course.

But at the time, it was quite shocking.

And fortunately, the people who were supervisors there had some inkling about this.

And they really weren't talking about DID so much, but they were talking about the wounded child and there was dissociation going on.

And so that's how I got into it.

And then my first...

One of my first private practice clients turned out to be DID.

I thought she was psychotically depressed with these characters.

She was hallucinating, but it turned out that she was DID.

And so by the seat of my pants, I was flying blind and doing the best I could.

I got in a supervision group with some of the really early folks who were doing DID work and made my first debut at the ISSTD conference in 1986.

Nice.

When I was a wee six years old.

I wasn't quite at the conferences yet.

Give me 10 more years.

That is funny.

Yeah.

It feels like yesterday and it feels like a lifetime.

So time is weird.

I bet.

It is in that way.

So what was the journey like for you to start teaching?

I know a lot of folks in this field, there's just a need.

And once you know something, you want to share it.

What was that trajectory like for you?

Well, it was really wonderful.

I think I'll talk about my own personal experience.

I have always loved teaching and actually thought I would be a teacher and instead became a nurse who became a psychotherapist who became a teacher.

So it was sort of this roundabout thing.

So I liked it and I found some wonderful mentors in ISSTD who encouraged me to write, to give some presentations.

I was so anxious and nervous, of course, as we all are when we first start out.

But I remember that support of these people that I thought were way up here was really wonderful and it was instrumental in helping me get the confidence to get out there and to try things with them and kind of get my feet on the ground with it.

So I would say those mentors are really important.

And I feel the responsibility as an older clinician to offer that to as many people as I can because it really facilitates the therapist development.

That's one of the things I so appreciate about ISSTD, and I'm sure this exists in other places, but it does feel a little bit unique, particularly in academia, where there's a real sense of leaning towards younger generations and going, yes, you've got this, you're doing it to help build that confidence that I think most people need in that transition from, what is happening in front of me?

I have no idea what this is to, okay, now I have a sense of what this is, now I understand it somewhat.

Let me start talking about it.

There's that sort of crisis of confidence can come up or just for anyone who's public speaking, right?

Standing in front of a big group.

And so having that support I think is so valuable and I see it across ISSTD with people like you said.

It's always been that way.

Yeah.

You might know their names from publications or books and then you just meet them and they're so humble and encouraging.

And I find that so refreshing and helpful for everyone, right, because the more people get help.

That's right.

And that's how you become an expert and a good therapist.

Yeah.

So you've written a ton and some pretty, I would say, you've written on complex topics.

I love your presentations, I have to say, because you'll have a really complex, something to communicate and then there'll be this slide of like a flamingo with feathers sticking out or something really funny to teach to it.

One thing today I was like, oh, I'm meeting with Kathy, but we're not going to have any slides.

Yeah.

Those funny animals.

But you've written a lot, you've taught all over the world and I'm curious how you just today, as you sit here now, would define dissociation to folks listening?

Oh my gosh.

You know, this is not a short conversation, is it?

I think I've come to understand that almost everybody has their own definition of dissociation and I have mine.

Right.

So I'll share mine, which of course I think is the right one, but everybody has a little bit different perspective on it.

I think because we have, over the course of the history of dissociation, we've incorporated so many different ideas that we keep adding to the definition instead of keeping it narrow.

Some of my colleagues have really argued for keeping it narrow.

I think the barn door has closed on that one.

So I sort of try to divide it up into four parts based on what treatment approach is going to work, right?

Because not all dissociation is the same.

And so the first kind of dissociation that we talk about that's most common is the checking out, spacing out, not being present.

And of course, the thing we focus on most with that in terms of treatment is mindfulness, being present, grounding, whether that's somatically or using the ventral vagal system, all kinds of ways to get people grounded.

The second way people talk about dissociation, and I'm talking about this in the literature, is sort of the dorsal vagal shutdown, right?

I think Stephen Porges talks about it as dissociation, and Alan Shore talks about it as dissociation.

It really is a physiological condition in which you're just not in contact with the present moment.

But the treatment of that, of course, is to work with that physiological shutdown.

Somatically.

And we often use the polyvagal theory to do that, and there are lots of ways to get people more activated and in their window of tolerance.

So that's the second one.

The third one is this murky, murky world of depersonalization and derealization, which is kind of like a perceptual issue.

If we think about checking out, that's more cognitive and attentive.

But depersonalization is more a perceptual problem, like I perceive myself as not being real or the world around me is not being real, that kind of thing.

I think the jury is still out on a totally effective way to treat depersonalization disorder, but it seems to involve all of the components that we're familiar with, like mindfulness, getting present in the body, learning emotional tolerance and regulation, those kinds of things.

And then we've got DID-like phenomenon over here, which is all about parts.

Yeah.

And so I just think that's a more encompassing type of dissociation, where you've not just got attention or perception, you've also got emotion, and you've even got sense of self that is dissociated, right?

And that requires treatment that involves all of the other treatments, plus working with the parts to improve integration.

Yes.

I really appreciate how you've organized it, because you can just breaking it down into those four parts.

I mean, sometimes, as you've just said, all four are alive, and so you're working with each of them.

Right.

And they're often alive in the same client, right?

So yeah, I think for people who have DID, they have other of those experiences all the time, because they're substrates of the DID, yeah.

So with all of that understanding, what do you...

Are you still in private practice?

Yeah.

Do you still...

Yeah.

What do you still find tricky about dissociation when you're sitting with it?

Well, I think it's the avoidance, right?

And even if we think about comorbidity, like personality disorders, I don't really like that term.

You could talk about personality accommodations in some way, but even those are all about avoidance, and so I've sort of stripped it down to this.

Maybe it's too simplistic, but the biggest struggle in dissociation is avoidance, whether that's avoidance of your own inner experience, avoidance of relationship, avoidance of what's presently, or avoidance of the trauma.

That's the tricky part.

And I think the other hardest part for me, and I think for most therapists, are the relational enactments that happen in trauma, which can occur without dissociation, certainly.

Yes.

Yeah.

I agree in that the avoidance is such a challenging thing to work with, and I see this push-pull between treatments that want to really get in there, let's go to the root, let's pull it up, let's find it, let's fix it, which is understandable.

Of course, we all want to fix it, right?

Client wants to fix it.

Therapist wants to fix it.

Everyone wants people to feel better.

But then there's this edge, and this is probably what I find most challenging to navigate, especially when you're speaking in general terms.

I think it's a little more approachable when you have a person in front of you to try to find this edge.

But even then, very challenging of like, what's enough for today, right?

Where we're not in avoidance, and we're not in dive into the trauma and get completely overwhelmed by it.

But how do we determine together what's an appropriate chunk?

And I feel like that is such an ongoing process as a therapist sitting with someone, because you start to feel if there's a few weeks in a row where something's not being addressed, it starts to feel kind of dull or not alive, or there's too much being addressed.

Maybe it's a swift enactment or calls in between, or some kind of sense of things exploding.

I'm wondering if you've developed, what has contributed to your sense of that and finding that pace or rhythm?

And I think even when we say pace, we assume, oh, it's going to be like I'm running a marathon and I'm at a nine minute mile, and I keep going at that pace, but it's always changing.

Yeah.

Yeah.

I have a lot of thoughts on this, and one is what I've mostly learned.

I've learned from falling off that edge with a client and learning if I don't slow down here, there's going to be trouble.

But I think kind of taking a historical overview of trauma, there has been debate since time immemorial when people have written about trauma, about whether we go in and do the work or whether we don't do the trauma work.

And that's kind of been the dividing line, right?

And if you look at military psychiatry, they're always going back and forth with this idea.

And so the idea now about whether people need stabilization or not, it to me is a little bit of a straw man because every client is different.

So I would never say every client needs stabilization or no clients need stabilization, but it depends on the client.

It depends on the therapist.

How good is the therapist in helping the client contain and process at the same time and be able to hold that?

How strong is the relationship?

And, you know, there is this fact with developmental trauma that people have grown up, some clients have grown up without adequate regulatory skills or skills to reflect.

And it's really hard to move into heavy duty trauma work with them because they end up, you know, not doing well.

Yeah.