Janina Fisher Perspective on Trauma and IFS

Full Transcription

Today on IFS Talks, we have the honor of welcoming Dr. Janina Fisher. Janina is the assistant educational director of the Sensorimotor Psychotherapy Institute. She's a former instructor at Harvard Medical School and an instructor at the Trauma Center, an outpatient clinic and research center founded by Besser van der Kolk. She is an international expert on the treatment of trauma and is the author of Healing the Fragmented Selves of Trauma Survivors, Overcoming Self-Alienation, and his coauthor with Pat Ogden of Sensory Motor Psychotherapy, Interventions for Attachment and Trauma. She's known for her work on integrating neuroscience research and newer body centered interventions into traditional psychotherapy approaches. Thank you so much for being here with us today on IFS Talks, Janina.

Janina Fisher: It's a pleasure.

Aníbal Henriques: Thanks much, Janina, for willing to sit with us. What parts come up for you today, hearing your bio?

Janina: You know, I realized that it's missing two things, which are probably important for this audience. One of the things that I specialize in, besides somatic approaches to trauma, is integrating parts approaches to trauma, a lot of IFS and some hypnotic ego state work. So, this is, I feel like I'm talking to my people.

Aníbal: Yes.

Janina: We're the people who know about parts.

Aníbal: Exactly.

Tisha: Janina, will you tell us a little bit about your backstory? What got you interested to explore working with trauma as a career?

Janina: I was inspired by Judith Herman. I can still remember the day. It was September 1989. It was the first day of my pre-doctoral internship and she spoke at a grand round, and she talked... Remember 1989 was still the age of Freud. I mean, still the age where everybody was very much a proponent of the talking cure. And she said something that just changed my world. She said “Doesn’t it make more sense that people have developed symptoms because of real things that happened to them, not because of their infantile fantasies?” And I thought "Oh my God, of course, this makes so much more sense." And, so I just was inspired in that moment to commit my career to the study and treatment of trauma.

Aníbal: Janina, you are a renowned expert on trauma. In this amazing book of yours Healing the Fragmented Selves of Trauma Survivors, 2017, you put together the best in trauma theory and trauma therapy. We can see the work of giants in the field of trauma theory like Judith Herman that you just named, Bessel van der Kolk, Onno van der Hart and many others, also the influence of big names in attachment and development psychology like Alan Shore and Dan Siegel. On the somatic side, names like Ron Kurtz and Pat Ogden, the Hakomi and Sensorimotor Psychotherapy originators, and also, Stephen Porges, Polyvagal Theory, and so many more we can see that influenced you and that you honor throughout your book.

Aníbal: So, your book is a masterclass on trauma and thanks for writing it.

Janina: Oh, thank you.

Aníbal: So, was there something originally that attracted you to trauma work besides the work of Judith Herman?

Janina: You know, there wasn't anything I was conscious of at the time. In 1989, I was just conscious of feeling just inspired. Probably, 10 years later, I discovered, from my 85-year-old father, I discovered that both of my parents had been trauma survivors, which he had never disclosed prior and so then it all made sense. I thought "Well, no wonder I felt this passion to do work with trauma." I didn't know why, but of course, in that moment, I knew why.

Aníbal: Janina, coming back to your book. In your book, are you describing and suggesting an integrated model, eventually the Trauma Informed Stabilization Treatment, or are you suggesting a treatment paradigm or a treatment in general, guidelines or all these and above?

Janina: Probably all of the above. I think, you know, I think the trauma field started out as a field of integrating models because in 1989, we didn't have formalized trauma treatment models. We had the talking cure. If you talk about it, you'll be okay, which didn't seem to work very well. So, all of us in the trauma field, we just begged and borrowed any technique and if it worked, we said "Oh, this is trauma treatment."

Janina: In 1996, I was overwhelmed with a number of very severely traumatized clients with Dissociative Identity Disorder. And in desperation, I picked up The Mosaic Mind, Dick Schwartz's book...

Aníbal: Oh, that one, yes.

Janina: And it was another one of these moments of inspiration where I thought "Oh, this is how we should treat dissociative disorders." And it became, it really transformed my practice. I'm self-taught at IFS, but I love it and I love the whole, I think the whole kind of ethos of it, as well as the techniques.

Aníbal: So, what attracted you into IFS, it was that book from Richard Schwartz, The Mosaic Mind?

Janina: It was this idea that these very highly symptomatic out of control high risk suicidal clients had a higher Self inside them. I didn't have to save them. They were fully capable of saving themselves and that's, and so I began to teach my clients how to find Self or how to find Self-energy, because what I found, and Dick and I have had many, many discussions about this over 20 years. The severe clients whom I see, have a very hard time developing Self-energy in the usual ways of asking parts to step back or step aside. But I found they could still develop Self-energy if I help them to consciously and intentionally increase their curiosity, increase their capacity to find calm and clarity, even if we approached it more cognitively, instead of more spiritually, it could work for these very, very extreme cases.

Aníbal: Beautiful.

Tisha: I was listening to a talk that you gave on YouTube and you talked about healing trauma and gave this beautiful quote from Rachel Yehuda who asks "What does it mean to treat trauma? Does it mean to treat the event, or does it mean to treat the shame, the sense of defenselessness, the hopelessness..." And I was struck by how, how beautiful that holding of the space of what happens for our clients when they are working through trauma to really have that perspective and understanding.

Janina: And it's so...

Tisha: Beautiful.

Janina: To me it's so clarifying, because it's so often when we talk about trauma, the assumption is we mean the event, as opposed to the parts, as opposed to the... What I call the body and feeling memories held by the parts

Aníbal: Janina, it looks like, when it comes to using parts language, to address the splitting resulting from trauma, you were influenced and inspired both by the works of Onno van der Hart's Theory of Structural Dissociation and by IFS. Do they integrate well? How do they go together?

Janina: I think so. I think, I mean, again, if Dick were here, he and I would have, you know, we would have our usual disagreement, but I, again, I'm coming from the perspective of severely traumatized people who struggle just to get through the day. And so, the theories of Onno van der Hart bring this idea that we all have an instinct to go on with normal life, to fight to function, to fight to raise our children in a loving, healthy environment. And to me that's more than a manager. And I think that my somatic approach influences me because that instinct to function no matter what and every therapist knows that there, you know, there are times in the therapist's life when we're struggling with something in our own lives, a loss, a tragedy, illness, and we think "How can I possibly be there for someone else?" But as soon as the client shows up, there we are, that instinct to keep on keeping on is more than a manager. So, I started to integrate the clinical techniques of IFS with this theoretical model, from Onno van der Hart, so that we had a more, a more neuro-biological theory with the beautiful, and I think healing IFS techniques.

Tisha: Why is including the body so important in the healing of trauma and in your work?

Janina: Because, we now know, thanks to Bessel van der Kolk, that trauma has very dramatic physiological effects. And that most likely we believe because from an evolutionary sense, the cave men and women whose trauma responses remained active live to become the next generation. Because if those physical effects of trauma get reactivated, anytime we're triggered, it means that the body continues to perpetuate the sense of threat or the sense of shame or the sense of being compelled to do what we don't want to do or the impulse to fight. So we have to, I mean, we have years of research that shows that if we don't address the body, either directly or indirectly, we don't, we don't resolve the, what we call the implicit aspect of trauma, which are the non-verbal memories that I believe are held by the parts, that the parts hold those nonverbal somatic responses. And so, we have to work with the parts, but we have to work with the parts and the body.

Aníbal: Janina, you say you believe the key to healing is not just knowing what happened, but to transforming how the mind, body, and soul still remember it. So somehow you help your clients to remember traumatic events differently. So, what does different mean?

Janina: Well, I actually don't try to help anybody remember traumatic events. What I do is I help them to understand their feeling and body memories as the trauma they're caring. So, rather than say what, you know, let's let that little part tell us what happened, I'm more likely to say, notice what gets triggered for her in this moment, because that's what I'm most interested in. I'm most interested in the implicit memories. Most of the time, most clients know, at least in a general sense what's happened to them. The, the ex, you know, if we go for the exile who holds the details of the event, that obviously brings more awareness, but it doesn't necessarily resolve the trauma.

I'm working right now with a client. I'm doing video sessions with a client of an IFS therapist. She's my former client. She's Frank Anderson's current client, and we're going to be doing a workshop together in which we compare and contrast our related, but slightly different ways of working. So, her exiles are sharing a tremendous number of traumatic event memories, but she has a very, very difficult time after they do so, because she has such intense physical and emotional responses. So, I'm using my integrated model to help her, to resolve the feeling and body memory piece of it. And, and I think it's a wonderful collaboration because she benefits so much from the IFS piece of her work and she also benefits so much from what we do.

Tisha: Can you share what some of those techniques look like?

Janina: So, I'll use this client as an example. In that, in the first of the series of sessions we scheduled, she said to me "I have a problem. I can't find Self. And my parts don't like Self. They think Self is another part. And they're really freaked out by this part that they don't know." And I said "Oh, a shame that those parts are so afraid of Self." I said "Self is not a part. Self is a place in your brain.” And we're just offering the parts a place in the brain that's already there. They can choose to take advantage of that Self-energy or that place in their brain. I have to be careful not to say Self to her. I always say that place in your brain. And since then her Self-energy has been growing, because there is no longer all this kind of interference by protectors "Stay away from Self, scary." I taught her clarity by giving her a somatic cue. I said, you know, what's missing here. I did it this way. If this is...You know, somatic therapy is not just about what do you feel in your body? It's the therapist using his or her own body. So, I said to her, I said, you know, each part sees the world through its little telescope, right? So, they all look through their little telescopes and they see just that part of the world that is scary or meaningful to them. They need you to have a wide-angle lens. And I, and I brought my hands up to show her the difference between a zoom lens and a wide-angle lens. So, now she's developing clarity by using her wide-angle lens. And, so we've been doing this with, you know, her protector parts didn't like the word compassion, compassion, bad idea, not going near that, god forbid.

So, I started playing with the idea, I said “Well, how about kindness? Would it be okay just to offer these young parts kindness?” And she said “No, I don't think they'll go along with kindness, but empathy I can do.” So, now we're working on, I'm just helping her to empathize. And that seems, I mean, you know, obviously we get interference from various protectors, but, but in general, she can do empathy. So, there are just these modifications that help her to begin to develop more Self-energy. And even the, and for instance, another little minor modification I use for trauma is instead of asking parts to step back, or step aside, I asked, would you ask those parts if they'd be willing to sit back? Because what I find in the very traumatized clients is that step back feels like rejection to the young exile parts. And, and then that triggers them, but they're okay with sitting back, right? "So, Mike, I don't want you to go away, but would you be willing just to sit back a little bit."

Aníbal: Lovely.

Janina: And also, I don't know if Dick still uses this language, but he did back in the late nineties. He would talk about what this part or that part be willing to step back and make more room for You. Is that language still used?

Aníbal: Yes. It's in the manual.

Janina: Because it's a wonderful language. And I find the parts really respond to that too.

Aníbal: Janina, you have a chapter on your book called repairing the past. So, is this possible to repair the past?

Janina: Well, I think that's a great question, so thank you for asking it. We can't undo the past. We can't make it not happen, but we can repair. We can repair the wounds of these little parts by providing them what I call the missing experience, whatever that missing experience might be. So, with the client I've been working with recently, she has a teenage part that was molested by an adult she trusted and the repair...So, we had to really, we had to really play around with what that teenager needed and to use the images the part kept giving her to help us figure out what was that part asking for? What was the experience that was missing then? And, as we found it, it was really being heard. It was being acknowledged. It was being believed. So, as she has been able to communicate, I am here and I do believe you, and I'm going to be a helper, not someone who's failed to help. You know, so instead of unburdening, which again, I think I've found unburdening works with clients like us, but I haven't had such good results in clients with the DID and various severe trauma related disorders. It's as if we unburden one part and three more pop up. Then you unburden those three, right? And five more pop up. So, the missing experience approach seems to settle more of the parts down and to provide this sense of healing and sense of that it's different now.

Aníbal: You say also, I'm quoting you again "In the mental health world that rejects the notion that personality and identity can be fragmented and compartmentalized, therapists are rarely trained to see the splits, much less the life or death battle for control being waged by selves with opposite and aims and instincts." So, it's still like you describe, your therapist training programs and this lack of skills to see the splits?

Janina: Again, in the traditional mental health world. In my world, most people believe in parts. Okay.

Aníbal: Good.

Janina: But I'm very blessed. When, you know, when I, for example, consult to clinics and psychiatric hospitals and residential programs, I hear the same old language that has always been used, which is that client is borderline attention-seeking and manipulative. And you know, and no recognition...There's a lot of research that shows that dissociative disorders are dramatically underdiagnosed because it's much easier to call them borderline and relegate them to the bad client, you know, category. So, what the beautiful thing is, the approach I wrote about in Healing the Fragmented Selves has been effective at the state hospital level. So, I've been able to do consulting to several state hospitals, to teach them to understand their borderline patients as fragmented and to understand that the suicidality and the high-risk behavior is really a reflection of the battle inside.

Tisha: There's so much shame and self-loathing in the system of trauma survivors and that very dynamic that you describe really contributes to that. What do you do you do to work people through shame and the self-loathing and self-criticism?

Janina: That's where a parts model is our best hope. So, I usually reframe shame as a relationship between a critical, a harsh, critical part and an ashamed child. So, I ask the client to say "Oh, I'm such a terrible person and it's all my fault." And I say "Is that the voice of a part accusing you of being at fault, or is that the shame of the child?"

Janina: And most people say it's both, when given that choice. So, then what I have to do, which is very much in keeping with IFS, is I have to consistently, without fail, reframe the shame as a part. Which is very hard for many therapists, because you have to have a willingness and a comfort level with interrupting. I think that's true with IFS, right? You have to have a comfort level with interrupting to say "Oh, so a part of you feels ashamed." But it's, I've found a parts’ approach the most effective way, because then I can help the client develop a relation of Self to a shamed part relationship. I can help the client even develop some compassion for this, this critical part that keeps saying you're horrible and you're disgusting, etcetera. So, I reframe the critical part as nervous. I say "You know, that part is such a nervous. Now, think of that part is asking you questions. Are you going to fail? Are you going to blow? Is it your fault? Are you going to look stupid? It's just so worried, It can hardly stand it.” And when they start to hear the judgmental part, as nervous, some of the intimidation that goes with that part decreases, then it's easier to have more compassion for the ashamed child part. But I think that what's tricky about shame is that both, it's a relationship between two parts. It's not one thing.

Tisha: Right. There's the shaming manager and then an exile that holds shame. So, getting the nuance of different...

Janina: Yeah, but the shaming manager has a kind of firefighter energy because it's intense often and people really report feeling intimidated by it.

Aníbal: Janina. You also say that we own some parts and that these own others. And why is that?

Janina: I think, you know, I think it's an idea very consistent with IFS. I think most people identify with their managers. That's me. That's why I am. I'm a perfectionist I'm of this I'm of that. And they disown their exiles. And often they disown their firefighters depending on the...You know, sometimes, you know, when people over identify with suicidal parts, that's what gets them in trouble. They don't, instead of disowning, well, not disowning, instead of relating to the suicidality as a part, they relate to it as me and that overidentification heightens the risk.

Aníbal: Janina, the theoretical models for understanding trauma, to which you have committed, have their origins in neuroscience and attachment research. So, mostly empirical supported theories. How did the IFS spiritual side land on you?

Janina: You know, I've always, I've always believed that spirituality and psychotherapy go together. I've never seen spirituality as something alien to psychotherapy, and I've tried as much as possible to integrate people's spiritual resources into the therapy. So, it's very comfortable for me. In Sensorimotor Psychotherapy, we talk about body, mind, spirit. So actually, a spiritual component is embedded in a somatic model. So, it just, it makes sense to me that we have a spiritual life and that spiritual life has an impact on the body. When people meditate, when they pray, their nervous systems calm, right. They feel more centered, they feel lighter. So, if, you know, there are really neuro-biological effects of spirituality, as well as the emotional.

Aníbal: Exactly. Janina, a new book is coming, right?

Janina: Yes. In a few weeks.

Tisha: Congratulations.

Janina: Thank you.

Aníbal: And what is this one about?

Janina: It's called Transforming the Living Legacy of Trauma and lift the living legacy is...this idea of a living legacy is really meant to communicate that trauma is not over when it's over as you know, which, because it continues to be carried by the body, the brain, the parts. And so, it's a workbook for survivors at therapist that takes the survivors step by step from I'm going crazy. I don't know what's wrong with me. I don't want to think about what happened. It takes them step-by-step to not again, not to healing because you'd have to write 10 books to get people, from the very beginning, to I'm healed. That would take many, many, many volumes, but it's really meant to be a trauma kind of one on one and really support the deshaming of what they're going through.

Tisha: It sounds like a great resource. What compelled you to put a workbook together?

Janina: Because one of the things Judy Herman taught me back in 1990 was, she said, she's a political feminist. And she believed that the power differential between victims and perpetrators obviously is huge, but also the power differential between therapist and client. So, she had this theory that if we educated our traumatized clients so they knew as much about trauma as we did, it would equalize that imbalance of power. So, you know, I started my post-doctoral fellowship with having to learn how to teach my clients about the nature of their symptoms and to which in those days in 1990, that was considered non-therapeutic. That was considered too intellectual, right. Cause we were supposed to be delving into the deepest, darkest recesses of their traumatic lives. But what I saw was that people thrived on education, that the more they understood, the more they could be equal partners in the therapy. And, so I developed a psychoeducational flip chart, which consists of 22 very simple diagrams that explain trauma out to people visually more than verbally, because one of the more robust findings of the trauma research is that when trauma responses are triggered, the prefrontal cortex goes offline, which means that the individual, his ability to think, to be mindful, to be in Self are dramatically decreased. So, this, these simple diagrams, which I used to do by hand, I used to have a little easel in my office, and I would just draw a simple diagram of the brain and show my clients what happened when they got triggered. So, I took those drawings and I created a psychoeducational flip chart. And so, I always had this idea to create a workbook to accompany the flip chart so that people could use it for self-healing rather than being dependent on a therapist.

Aníbal: I'm looking forward to seeing that workbook and that new book of yours.

Janina: And there's actually there, there are pieces of Onno van der Hart in there. There's an IFS, there's an IFS piece. So, there's actually a worksheet developing the, what I call the C qualities because again, in a workbook, if it's too complex to try to teach IFS, but I created worksheets that help clients to grow their C qualities.

Aníbal: You do a wonderful integrative work, Janina, thank you so much.

Janina: Thank you.

Aníbal: And It's such a joy to speak with you.

Janina: Thank you.

Aníbal: So, thank you so much for having us. And I hope we can keep meeting and sharing this model, our work and our lives.