Structural Dissociation and Trauma Survivors: The Suicide Self

Suicidality is one of the most complex, difficult-to-treat issues that therapists face. Because expert training in managing suicidal thoughts and behaviours can be hard to find, we’re giving you a free look at our online CPD course: Working With Suicide: Essential Suicide Intervention & Prevention Strategies.
In this live presentation and Q&A call, world-renowned trauma expert Kathy Steele provides unique insights and answers to treating structural dissociation, trauma, and suicidality. Please note that while we welcome your comments and feedback, the presenter will be unable to answer questions posted on social media.
Want access to in-demand CPD that covers up-to-date insights on the top assessment tools, effective crisis planning techniques, and more? Then join us for the completely free online CPD course: Working With Suicide.
To learn more and register: bit.ly/33JRLD2

[@whenpigsfly3271]

These two talk as if suicide ideation exists by itself, like its a mysterious condition as a form of dissociation. (I'm speaking as a patient). What they have yet to discuss is pain that comes with the perception of marginalization. The perception of marginalization causes self-isolation. This marginalization/self-isolation is a self-confirming downward spiral. The pain that results is overwhelming. In my view, suicide is no different than self-medicating to relieve pain. They both are dissociating acts to avoid emotional pain. Obviously suicide is much more permanent relief than drugs or alcohol. The proper mode of care would be to learn ways to relieve the pain of social disconnection and the consequent feeling of worthlessness. Therapists typically fixate on the drama of the impending suicide itself rather than dealing with the underlying causes of the pain. The whole reason a therapist loses a patient to suicide is because they don't understand the underlying dynamic that brings on the ideation. The root of the problem can usually be traced to the frozen child that was subjected to neglect or abandonment as a child. The question becomes: how do you thaw the frozen child and encourage him/her to grow up to match the maturity of the part of the person that interacts with the external world?

[@ArtyAntics]

I didn’t read the conversation the same way, but I understand why those things would make you feel that way. I have experienced them myself. I think the difficulty with these videos is that they are talking to clinicians not clients. I’d never label a part as ‘the suicidal’ part because their identity would become that which adds shame and adds to the danger and inner alienation of them by other parts. But when I’m making notes about how the system is working I would attribute behaviours to parts to help me work out the functioning. They are showing their workings in the video for other clinicians to follow. But I 100% agree that it can feel stigmatising and triggering to hear.

[@nomiadventurer]

I get what you’re saying. The causes of suicidal thoughts and crises are numerous. And there is a lot of distress that leads to suicidal thinking that can be addressed. I have an understanding of suicidal experiences on a spectrum of different stages. Yes i agree that we need to address distress and ideation to prevent suicide. But when someone is already at the point of suicidal crisis and they are very near a suicide attempt, (like they have a plan and means) then the immediate physical danger becomes the priority and keeping people alive. Once the crisis ends, and the person is still alive, then understanding the ideation can happen. Im watching this and can see how this can be helpful for acute mental health services. But I definitely agree that suicide aftercare (after a crisis) and prevention is also super important. I think clinicians tend to talk about “suicide” only in terms of the end of the spectrum- the crisis attempt or deaths- because all the other work, the distress the ideation work the prevention is what they do all the time. In saying that though. I still think you’re right and a lot of clinicians dont always consciously acknowledge that their are different stages (and not always linear). And I would say that’s why at the very beginning it was mentioned that a lot of clinicians are overly worried and risk averse, because they don’t distinguish between what u say, suicidal ideation and an imminent risk of loss of life.

[@gSWG3R]

Suicide attempts OCCUR during episodes of dissociation. Suicidality is rather a specific problem/symptom that may result from a more broader and self-perpetuating functional problem such as dissociation.

[@DisabledPsychedelica]

It’s literally a talk on suicide and self harm in DISSOCIATIVE DISORDERS and the DISSOCIATIVE nature of suicide and self harm… if you aren’t plural or have a dissociative disorder or dissociative symptomology with suicide and self harm then this isn’t for you. This probably too complex for you if you have those issues and don’t get this. It isn’t meant for everyone

[@Gandalf_the_quantum_G]

Brilliantly crystallised! I can follow your logic and can assure other comment writers above my comments position here, that the logic of it absolutely applicable for cases of DID spectrums as well. Amazing. I like when people have laser-like thoughts that cut through material and additionally are able of putting it together in an organized structured way.

[@Vyjayanthi41]

I have worked with highly dissociative persons. I know this "felt" sense . I agree so fully with Cathy when a client is slowly dissociating and I know when I no longer have any control over the situation. I learnt what triggered them and started grounding them before they disassociate.

[@Vyjayanthi41]

Thank you so much for the support towards losing clients to suicide. Psychotherapy is out of our control are golden words to be repeated often.

[@OmeroPerez]

DBT is ineffective on clients with a history of abuse/neglect….

[@JamieR]

Very true! We need somatic and other forms of work to build bodily security with ourselves. Parts work is also good for very many. Grief work. Learning about Polyvagal Theory. And the whole nine yard. We all might require different things based on what we've experienced, but the somatic work is something which should work for the majority. Speaking from my own experience I never felt security in my body until I started somatic work. I used tv, alcohol, weed, video games, or food to numb and escape my CPTSD. I didn't even understand that the times I had this splitting I would go into my child self who endured all that abuse, and I could feel my adult part stepping aside. Watching myself destroy my life, to not have to feel what I had gone through, and not be able to regain control. Only to wake up and feeling like I came out of a trance. That part thought I was still at that age and still going through it. It didn't realize I am now an adult and am capable of protecting myself. I connected with that part the other day and told it I am now an adult and it could barely believe it. In my case, it was just a lack of integration from my younger self. Which makes parts work so important.

[@OmeroPerez]

@@JamieR I always get asked by older folks on the bus why so many young people (I'm almost 40) always listen to music, and I tell them it's therapeutic. It's the cheapest most accessable form of therapy especially when earbuds/phones are employed. Even the cheapest ones are still therapeutic AS LONG as both sides still work. Yeah, somatics are the way to go. My apartment has lost it's home status and as such it's safety factor, and last night I was feeling very unsafe all of a sudden in there. I could conjure the safety of my mental health counselor's office but I still felt unsafe in my gut (where it matters). I ended distracting myself with food I now realize which feels like cheating myself, but it's better than using drugs and a needle. And it helps to see the story of another to help share my story and get the gross outta me. Thank you for sharing that

[@michaelmcdonald4021]

I had an experience in a psyche hospital (while under observation) where (I previously believed) was a sleepwalking episode ( because of past experiences) I remember kind of like part of a dream Im taking a shower scrubbing my body with a 4 foot ceiling fluorescent light bulb. But it wasnt a dream. When (I) came to ? the next morning (I) was all bandaged up and in a different but more secure room under total observation. I later asked the head psychiatrist there if he thought (I) was trying to kill myself and he said yes. But this wasnt a so called conscious act.? Yes I have been diagnosed with Dissociative amnesia otherwise not specified, but more to be revealed as (Im ) one of the more complex/complicated cases. (I have assulted a doctor in the past which could be in relation to being traumatized by hospital and doctors in the past especially in early childhood. Thats when (I) first started sleep walking and one time in childhood actually fell from a 2nd story window on to the concrete. Now Im wondering ifit was a dissociative fugue and not sleepwalking because one time I woke in a mental hospital and didn't know where I was or how I got there. The episode at the hospital came about because I was maxed out on my antipsychotic med 40 mg. Zyprexa and 12-1400 mg. Tegratol. That had no effect so my doctor changed me to Seroquil and somewhere in my increases around 700 mg.s I started sleepwalking(?) again so they bought me in for observation( that was the shower light bulb incident.

[@tm13tube]

I like hearing suicidal thoughts, intents, just referring to suicide in ways that show the intent to kill yourself is not exactly the goal. Pay attention! But ….. I overdosed several times. My goal wasn’t to die. I wanted to be able like on Bewitched to twitch my nose and make everything stop until I got caught up. The last time I was more intentional. I took enough pills that may have been enough. I laid on the bed for a while then came my moment of gratitude for dissociation. I forgot they could track me by the phone and I called the Suicide Prevention Hotline. A woman answered. I asked her to talk to me until I fell asleep. The bad part of dissociation made me forget they could find me if I called anyone. Then the good, healthy dissociative part got me to call for help. I was surprised when the front door burst open and there were stomping rushing feet. It took me decades to figure out because it was a long time for me to figure out I had been dissociating my whole life. 40:03

[@reverenddaffodil9724]

At 30:15 Kathy refers to observing an "attachment pull" in the client. Is that meaning that the client wishes to attach to the therapist, or that the therapist is feeling a pull of attachment within themselves towards the client?

[@ArtyAntics]

Speaking as a client, I had both and the one that caused problems was when she couldn’t detach from us. I ended up being suicidal to try and escape her. I believe Kathy was taking about sensing the child part that craves attachment (pull for rescuing) whilst also witnessing the adult part who is guarded and avoidant of attachment. This happens when abuse is perpetrated by a close family member who was meant to give care but withdrew it. Therefore the survivor lived with the double bind of needing to be close for survival but it not being safe/was survival threat to do so. Often it’s easier to not feel the need at all, hence the dissociation. But when something becomes urgent or activated different parts will become present.

[@lissana7]

Tricky when the client doesn't buy into parts work tho.

[@Heyokasireniei468sxso]

has anyone who has studied this professionally also been thru it know what it actually is as a native outsider (meaning that you have healed from it yourself?) or is it all theory and taken far to literal in regard to alters & personas, what would you suggest about most entertainers / athletes/politician/scientist /doctors then especially the amount of cognitive dissonance they experience like for example doctors who smoke , scientist who believe in God , entertainers who are different in private life , athletes who are sensitive, or politicians who actually care wouldn't they all suffer from structural dissociation especially if they have cptsd or ptsd or intergenerational trauma wouldn't that all produce splitting and fragmentation ?

[@whenpigsfly3271]

There are too many "therapists" who are completely worthless when it comes to dealing with suicide. I always attributed it to the idea that they've never personally dealt with it.

[@Heyokasireniei468sxso]

@@whenpigsfly3271 i guess its hard to guide someone blind in the darkness , when you depend on the light to see

[@Heyokasireniei468sxso]

@@whenpigsfly3271 perhaps its also a way to make people feel bad when they(the therapist) have not been thru it themselves let alone healed from it

[@whenpigsfly3271]

@rexmorningstar4985 - I also think that a therapist's education causes a loss of humility, which short-circuits their compassion. When their arrogance makes them mistakenly believe they have all the answers (when they don't), exacerbates their clients' feelings of social disconnection; the source of the pain... the pain that calls up suicide as a solution.

[@Heyokasireniei468sxso]

@@whenpigsfly3271 I vibe with that to be true for the majority of them ( its called introspection illusion ) and dunning Krugger effect ( also appeal to authority bias)

[@FRANKMANGIAPANE]

Damn!

[@tmking7483]

My father was beaten with a brick until he complied to hand his little ones over to the orangemans abuse society for stepford wife creation_ I have two grandpa's who were 33 degrees nuts. I can reassure you that much of the dissociation out there is due to the organized abuse of babies so these children grow as adults who will dissociate to be used as deployable agents. I've watch many of these sessions of disintegration_ and I am one of these kids who figured out eventually that I had to pretend to dissociate for them to stop breaking my bones. Wow _what a trip_when the denial defense mechanism doesn't work anymore. Glory be to the Jesus who held me through all my childhood abuse.

[@user-he6rs8xi7u]

Ah, TDS.

[@sophiareese79]

Hmmmmm

[@Charity-vm4bt]

Suicide ideation can be due to a post-hypnotic suggestion implanted by a perpetrator following a molestation to inhibit the victim from remembering ir reporting. The perp tells the victims if the victim recall and report the abuse, they will be obliged to self-destruct. The client may have an internal part representing the perpetrator. In such a case, the suicide ideation is merely a blockage to recalling a significant memory of an incident of abuse which will incriminate and identify the abuser. In that case, if the ideation is only a post-hypnotic command, then inform the client to dismantle the connection. Inform the client that an implanted hypnosis does not come from the client's mind. Help them realize they need to ignore the idea because it does not come from their mind and get to work on accessing the real memory. It is often a mistake to focus on the clients' systems because they often are decoys implanted by clever perps to prevent reduction of amnesia. In such cases, there is no such thing as a suicide part, rather, it is an internalized post-hypnotic suggestion that can often easily be dismissed and will vanish. Note, the suicidal idea is a temporary, fleeting, an isolated, fleeting idea, it is not a full-blown part. Considering these ideas and applying them will open doors of revelation in working with clients and helping them trust themselves to have self-care and understand it is safe for them to recall and remember. Often, as in the example given, the original perpetrator is long gone and the victim is an adult who is remembering in order to integrate and move ahead in life. Therapists can check in with their own intuition to discern if they are meeting a true part or merely a post-hypnotic implanted suggestion 😉