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Sandra Paulsen July 7th, 2005 07:26 PM

Re: Imaginal Nurturing
I am surprised and sorry that Ms Steele has withdrawn from the discussion. My statement about IN being touted as a treatment for dissociation is in response to the following quote of Ms Steele's above:

"I would say that the majority of clients are not highly dissociative, most of those who are can benefit a great deal from this approach, and if introjected perpetrators of highly dissociative clients intrude, ego state work is incorporated into the therapy at that point."

I'm sure there is a way to do the work for dissociative clients if one is trained for it, but the statements above nor the statements in the workshop did not make it clear about the risks of working with this group without training. That point must be made clearly in my opinion. I continue to be interested in how the workshop has been changed to accommodate this safety issue. I hope Ms Steele will rejoin to make this point clear.

Sandra Paulsen July 7th, 2005 09:11 PM

Re: Imaginal Nurturing
An additional post, between clients:

I’m surprised and sorry to hear that Ms Steele interpreted my tone to be hostile. I try hard to keep the focus on the content, and avoid ad hominem (about the person) comments. The readers can decide for themselves if I have done that.

Rather, my emphasis all along has been on safety for DID clients. Although Ms Steele has said that she hasn’t made statements advocating IN for DID clients, she has said things that give that impression, as I pointed out in my immediately prior post. She said she was puzzled why I persist, presumably she means in my emphasizing ego state work and DID when her treatment approach doesn’t deal with those matters.

My point is precisely that the concept of dissociation must be considered in any approach that uses EMDR/BLS because it is unavoidably associative. Whenever BLS is done, in IN or anything else, we must consider the fact that some clients are DID in teaching that approach. Ms Steele has said that she “trusts that clinicians working with highly dissociative clients have the training and support to do so,” but that assumption is not warranted in my experience. That’s my point.

In the early 90s, the EMDR trainings assumed that therapists would know to not use EMDR for DID without proper training; it was not emphasized in the training. Because of the vulnerability of the client population of DID, this deficit was rectified from 1992 forward because the assumption was not warranted. However, even in 2005 many EMDR practitioners continue to make errors of these types: 1) failing to screen for DID and proceeding with an EMDR/BLS procedure, resulting in destabilization at worst or aborted processing at best; 2) thinking they can treat DID with EMDR without training in dissociation. I’m full of cautions about ANY training, including a good one like Ms. Steele’s IN workshop, that doesn’t explicitly address the problem.

Ms Steele has said that in all these years she has heard of no examples where IN had resulted in destabilization. I have. (I do an average of 4-6 consultation sessions a week, usually about complex cases and ego state work). I use nurturing with ego state work daily and help others to do so. I hear with what procedures they’ve had trouble. I have seen repeatedly that cruel maternal introjects act to block efforts at internal nurturing and at times become punitive when there are attempts at IN.

Finally, I continue to find that Internal Nurturing is a valuable procedure and workshop, and commend Ms Steele for her considerable contribution to the field. I mention her and her work to people all the time, including in my workshops, as important and helpful.

Respectfully submitted,
Sandra Paulsen PhD
Bainbridge Island WA

Carol Ann Rowland July 7th, 2005 10:20 PM

Re: Imaginal Nurturing
I am really sorry - all I wanted to know was if there were special instructions for using IN with people who are DID so that I knew if it was worth me looking into, purchasing the manual and/or taking the training if it was ever offered in my area again. The one time it was in the past, I missed it due to being on vacation at the time. My colleague who went told me that there weren't instructions for people with DID and so she was confused about how to use it with this population. Although it is not touted as being for people with DID, it is described as being excellent for dealing with those with attachment issues and early childhood trauma, and people with DID certainly fit that bill.

I actually was not speaking of necessarily switching to different introjector parts though I can see where that would be an issue as well - I meant switching back and forth between the child and adult self. Clearly I stand corrected if everyone would have that difficulty.

I have not said I am doing IN with clients - however part of my way IS to be a nurturing presence and to encourage clients to nurture parts of self, and utilize nurturing imagery as part of any EMDR (or other) treatment, and I have done so since long before I had ever heard of IN. I do recognize IN is part of an overall approach rather than just "plugging something into" part of treatment. I simply wanted to know how it might be used with DID clients - or mostly if there ARE instructions for how it might vary with this population - so that I would have some idea if I wanted to pursue training in IN. I work predominately with highly dissociative clients. I feel that I have more than adequate tools available already for less dissociative people, but that you can never have too many tools in the bag of tricks so to speak, when working with those who are highly dissociative. I really wouldn't be interested in pursuing IN training if it is not particularly beneficial for those with DID, or if addressing these more complex issues is not part of the training. There's not much point in me learning it for use with those with DID if at the end of training I am left wondering how to do that, as my colleague found herself. Again, it may very well be that she missed something or mis-remembered something - I have had this experience many times at workshops and months later when going over notes I find that it WAS covered but I didn't absorb it - hence the question.

I would have to hope that any good therapist working with clients with DID recognizes the inherent attachment and relationship issues with this population and incorporates a great deal of focus on the relationship as part of treatment. DID is in a sense, an attachment disorder, when it comes down to it.

Again, I didn't mean to cause a problem - I wish I'd never asked anything, it just seemed like a good idea April since you seemed to be here anyways and interested in discussing IN. It does make me wonder what the atmosphere of the workshop is like if this is how questions are responded to. Though my colleague did have only good things to say about the workshop and felt she learned a lot and enjoyed it - she just wasn't sure how to use IN when the client presents as being highly dissociative.

Take care,

Carol Ann

Sandra Paulsen July 7th, 2005 11:44 PM

Re: Imaginal Nurturing
You said, "I actually was not speaking of necessarily switching to different introjector parts though I can see where that would be an issue as well - I meant switching back and forth between the child and adult self. Clearly I stand corrected if everyone would have that difficulty."

I'll offer a comment here. It is true that to be in a child state one can not simultaneously be in an adult state, and that anyone would have to move between the two states, back and forth, seriatum, to accomplish the experience of both. We can say that one is ego-cathected ("I") when the other is object-cathected ("she"), although either the child can be "I" to the nurturing figure's "she" or vice versa.

However, you are entirely correct that the phenomenon of switching is quite different in true DID. It may be uncomfortable, even painful, and there may be amnesia between the two states. So its not identical to a non-DID person moving between two states by any means.

Carol Ann Rowland July 8th, 2005 12:21 AM

Re: Imaginal Nurturing
Yes, this is kind of what I meant.

Anyone may have a difficult time in a sense being in two places at once, but for someone with's a different kind of experience.

I also find with some DID clients they have a hard time in some moments even visualizing or talking to/about a child self without becoming the child self, and I don't find that to be the case with less dissociative least not in the same way. They can say that yes they felt connected with that part and the associated feelings but they remember the experience and still knew who "they" were, etc...

If a client does experience vivid switching, doing the back and forth that is involved in IN (I have experienced it as a "client" so am somewhat familiar with aspects of it beyond what I have gotten from as far as I made it through the manual and listening to the CDs)...I guess I would wonder if it might lead to headaches and/or nausea the way that other kinds of rapid switching sometimes does for those who are highly dissociative. My experience with most clients with DID is that it doesn't tend to feel good when they switch back and forth a lot during one session.

Of course not all people who are highly dissociative will necessarily fully switch during the process, but the colleague I was speaking to did have this experience with a client, and the colleague wasn't sure exactly how she was meant to proceed at that point, hence our discussion regarding the possible lack of information for how to use the technique with clients who are DID, and my resulting uncertainty therefore in taking the training as if this information isn't covered then there's no point it pursuing training for use of IN with my main client group. I guess I will take it as a given that it's not covered as it sounds like that was my colleague's experience and possibly yours as well Sandra, and nothing contrary to that has been indicated.

Carol Ann

Sandra Paulsen July 10th, 2005 11:34 PM

Re: Imaginal Nurturing
A brief note: I met with Ms Steele this afternoon at an event we both attended, and had a lovely conversation. In that discussion, we reviewed the many things that we agree about as it relates to EMDR, Imaginal Nurturing and dissociation. The conversation isn't finished, and I look forward to continuing it here and/or elsewhere with her.

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