[Disclaimer: I have used aliases to protect the confidentiality and identity of clients or patients. No other names have been changed.]

Throughout this section of the book, I will present my experiences working with people who had various disorders, problems, or conditions. So, in case you are wondering, no, I didn't stop focusing on one condition and move to the next. I am merely describing different treatments or issues in different chapters.

Keep in mind that all this was happening at the same time. It's not like I stopped treating the clients who had problems or issues that were described previously and moved onto other things.

In addition, while it is true that psychotherapists do specialize in treating certain conditions, issues, or problems and they specialize in using certain techniques we also need to be eclectic – skilled in using various techniques depending on the problems that a client is facing. Actually, not every therapist is eclectic but many of us are.

I was keeping my options open but I did have my own toolset that I brought to the treatment of various issues or problems.

Ever since I first got started in the psychiatric field, I was using the DSM-IV to make diagnoses that describe the problems that clients or patients were confronting when they sought treatment or were required to receive psychiatric care, i.e., they were involuntarily committed to a psychiatric facility.

The DSM-IV is the Diagnostic and Statistical Manual of Psychiatric Disorders Volume IV (four).

One particular class of disorders seemed to be particularly mysterious and controversial. Those are dissociative disorders. The most extreme of these disorders was Dissociative Identity Disorder (DID) which used to be called Multiple Personality Disorder (MPD). To me, these disorders did not seem any more unusual or perplexing than many other disorders.

If someone were to state that they are seeing or hearing things that are not there, we would not say they are just making that up.

In addition, for me, hypnosis offered me some valuable insights into these mysterious conditions. During a hypnotic trance, we seek to alter a person's consciousness and help them to focus on a particular stimulus, idea, or to visualize something.

At this time, I was interested in learning about dissociative disorders, and I will describe this below. As a point of reference, the condition DID is only one of a variety of dissociative disorders. The understanding was that these were trauma disorders. If you are wondering what the heck a dissociative disorder is, I will be getting to that.

Before I discuss the treatment of or understanding of dissociative disorders, I wanted to talk about trauma disorders more broadly. In particular, I am describing Post Traumatic Stress Disorder (PTSD).

We can organize the symptoms of PTSD into an outline. This will be important in understanding what my own experiences were later in the book. I also noticed later that some of the symptoms of PTSD and/or dissociative symptoms can occur in response to events that do not seem to be "traumatic" from an objective standpoint.

So, to describe PTSD let's consider the following points.

First, we have exposure to or learning about events that could cause death, or that involve serious injury or sexual violence.

Then we have intrusive symptoms. This can include involuntary and intrusive memories of the event, nightmares, flashbacks, heightened reactivity to stimuli that are similar to the traumatic event, and things such as a heightened startle response.

Third, we have avoidance symptoms that involve efforts to avoid triggers that remind us of the traumatic event.

Forth, we have negative emotions and thoughts about the event and things related to the event.

Fifth, we have marked changes in arousal and reactivity. This can include a heightened startle response, heightened vigilance, irritability, trouble sleeping, and problems with concentration.

I could go on, but this is good enough to create an understanding of the problem or condition.

When describing the impact of a traumatic rape on one particular client, let's call her Tina, I will be touching on a few of the many shifting symptoms (over time) that she had described to me. Now, due to confidentiality and the nature of this trauma, I am not going to get into the details.

I can say that it was not at all remarkable to me that she chose to tell this to me as a male therapist. The feedback I have received over the years has been such that I knew how I came across as someone gentle, caring, easy to talk to, safe, accepting, and someone who had unconditional positive regard for everyone with whom I worked.

Tina had stated that she had not gone to the police to report the rape. I wasn't there to encourage or discourage taking legal action because I happened to be focused on her reactions to the trauma.

Clients do not come to their therapist asking for you to help them get justice, for the most part. We are asked to help as a witness though with them.

I noted that for Tina her memories of the event were fragmented. She had not integrated everything as a narrative from start to finish. So, her memories of what she saw, heard, and felt were not integrated together.

There was a technique that I learned from Neuro-Linguistic Programing (NLP) that I felt would help with this processing of the memories.

Tina was not the only client that I had in private practice who had been victimized but the recent nature of her rape stands out.

Using this technique, which I adapted with the benefit of my training in hypnosis we reviewed the event as if it was being projected onto a screen in front of her. The theory was to see if we could do this without her becoming overwhelmed and unable to face it.

My training in hypnosis would help with this. I had gained certification from the American Society of Clinical Hypnosis (ASCH) and had continued that training after that.

I used the words of Milton Erickson used "And my voice will go with you." It made sense to ground her in the here and now. We (she and I in agreement) wanted her to remain aware that she is currently safe while she reviews what happened.

The theory is that traumatic memories are so disturbing that we have trouble watching them from start to finish and they become intrusive memories that flood our minds when something triggers the memories to return...

In other words, some parts of the event and how they made Tina feel were causing the flashbacks and out-of-order snapshots of what happened.

What we do as a therapist is to resonate with the client as they go through this process. We demonstrate empathy in this way.

In working with Tina, I matched her breathing with my own, and the pacing of my words with her breathing.

"You know you are safe now, right?" I asked.

"Yes."

"Are you ready?"

"Okay," she answered.

The following is an account of what I said to her as I guided her.

"Let's take some deep breaths... breathing in ... and out."

"That's right."

"I'm right here with you."

"You are safe."

"Can you slide your chair to the side so that I hear you beside me instead of in front of me, coming at me?" she asked.

"Okay," I said as I did this.

"Breathing in... that's right... and out... calm and relaxed... calm and relaxed..."

"If you would like you can close your eyes now ... that's right... good."

"Imagine a safe place - someplace that is peaceful and safe for you."

"There is a place by a stream that I like," she said.

Then I continued with the following:

"Good. Let us go there. Now, if you need to you can come here at any time to feel safe and serene. This is your safe place."

"Now imagine a large screen, like a movie screen in front of you."

"You can project the images of what happened to you onto the screen, and you will be safe as you see what happened."

"You are not alone, and you are not being hurt now."

So, this continued for a little while. The therapist tries to match the intensity of the feelings when they rise by speeding up their breathing together with the idea that we will be heading in the direction of safety and relaxation and to remove the association between these images and the fear that they cause at the moment.

The goal is to remove the triggers so that the event is remembered in full but there is no emotional reaction to the recollection of the event. The steadiness of the therapist is for anchoring to the present and to feelings of safety.

I won't dishonor her by describing the fear she felt, her need to cry... her feelings of shame.

She did need someone who was strongly grounded in the here and now, anchoring her - metaphorically. However, she didn't need me to be crying as well.

There is a balance between empathy, compassion, and the solid support that a person needs.

We made progress and she began the process of healing over time.

One of the things that a therapist must do is to make sure that they do not become traumatized themself. There are ways to do this. It is somewhat amazing that it is possible to be so strongly connected and in tune with a person's feelings and experiences without becoming traumatized.

This is how empathy is managed. I knew that a balanced life was important and that is why I described the life that I had when I was not on the job helping others with depression, PTSD, eating disorders, or other problems.

Through my work with trauma survivors like Tina, I began to wonder what could or would happen to a person who was hurt as a child. I had experienced abuse growing up and it had made a big impact on my life - including my decision of what career to pursue.

You hear horror stories about children being victimized by parents, guardians, and other trusted people who should help us form healthy attachments, feel safe in the world, and help us to learn and explore our world.

The coping strategies employed by adults are probably less creative than those employed by children. That seems to stand to reason. A child might try to mentally escape from something painful, shameful, or traumatic.

I decided to join the International Society for the Study of Trauma and Dissociation (ISSTD). My study of clinical hypnosis opened up a window into the world of dissociative disorders as ways to deal with trauma.

In my role as a mental health professional, I was always looking for ways to advance and grow... to learn new skills. I mentioned that I was a member of the local chapter of the Society of Clinical Social Workers.

At about this time, when I was still new with my private practice, I was granted the role of president of the New Hanover County, Wilmington, NC chapter of the Society of Clinical Social Workers.