Living a Life in Balance - PODCAST
Living a Life in Balance with Abdullah Boulad
Honest conversations about mental health, relationships, purpose, and being human.
I’m Abdullah Boulad, founder and CEO of THE BALANCE and author of Be Human First.
Together with my guests, I explore the experiences that shape us—from addiction and trauma to the search for connection and a more balanced life. We bring curiosity, care, and different perspectives to questions that don’t always have simple answers.
My hope is that you leave each episode with a new perspective, a better understanding of yourself and others, or simply the feeling that you’re not alone.
Thank you for being here.
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https://thebalance.clinic
Living a Life in Balance - PODCAST
Why Trauma Healing Starts With Safety, Not the Story | Dr. Janina Fisher, PhD
What if healing from trauma isn't about revisiting the worst moments of your past, but learning to befriend the parts of yourself still carrying them?
Dr. Janina Fisher joins Abdullah Boulad to explore trauma, stabilization, and the parts of us shaped by difficult experiences.
Janina shares what first drew her into trauma work, including her father's traumatic childhood and his journey through alcoholism and sobriety. She talks about why the word "trauma" has become overused today, and walks through her evolution as a clinician, from EMDR to somatic work, Internal Family Systems, and clinical hypnosis.
The conversation also covers what trauma therapy often gets wrong, why TIST starts with stabilization rather than history-taking, how old wounds get triggered within family relationships, and the role of co-regulation in healing. Janina closes with her hope for a more integrated future in mental health care, and one piece of advice: get curious about the parts of you that you like the least.
About Janina: Janina Fisher is a licensed clinical psychologist and former instructor at Harvard Medical School. An international expert on the treatment of trauma, she serves on the Executive Board of the Trauma Research Foundation. She is best known for integrating mindfulness-based and somatic interventions into trauma treatment, and her model, Trauma-Informed Stabilization Treatment (TIST), is now taught around the world.
00:00:00 - Introduction: Dr. Janina Fisher on Trauma and Recovery
00:01:38 - What Inspired Dr. Fisher's Path Into Trauma Therapy
00:05:29 - Growing Up With a Father's Trauma and Alcoholism
00:11:53 - Why the Word "Trauma" Is Overused Today
00:14:31 - From EMDR to Somatic Work and Internal Family Systems (IFS)
00:17:51 - What Is TIST? Trauma-Informed Stabilization Treatment Explained
00:22:28 - Using TIST in Therapy: Individual, Group & VA Settings
00:28:31 - The Biggest Mistake in Trauma Therapy Today
00:30:55 - Stabilizing Trauma Survivors Through Mindful Noticing
00:38:43 - How Mindfulness Calms the Amygdala and Regulates Emotion
00:45:43 - How Trauma Shows Up in Family Relationships
00:49:50 - US vs. Europe: Different Approaches to Trauma Treatment
00:52:15 - What Is Co-Regulation and Why It Matters in Healing
00:55:42 - Breaking Down Silos Between Addiction and Mental Health Care
00:58:52 - How Dr. Fisher Stays Balanced Doing Trauma Work
01:00:33 - Dr. Fisher's Advice: Befriend the Parts of Yourself You Dislike Most
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#traumahealing #recoveryjourney #mentalhealth #trauma #therapyhelps
Introduction: Dr. Janina Fisher on Trauma and Recovery
SPEAKER_01I have a special interest in addiction because my father was an alcoholic. He had had a very traumatic child. He died 56 years sober.
SPEAKER_00Is the term trauma by itself like overused today?
SPEAKER_01Yes. That's something that I find very upsetting. We fought so hard to have trauma. Understood and respected, and now it's being used for I had a bad day. In a traumatic world, you are in danger every single day. Not just on the days you get hurt. You are in danger on all the days that you might get hurt. Emotions are valuable if we have a relationship to them. Becoming friends with our least-liked parts is a really a recipe, I think, for a much happier life.
SPEAKER_00Welcome to the Living a Life and Balance podcast. My name is Abdullah Bulad. I'm the founder and CEO of the Balance Rehab Clinic. My guest today is Dr. Janina Fisher, a clinical psychologist and former instructor in psychiatry at Harvard Medical School. She's a creator of trauma-informed stabilization treatment, one of the world's most adapted models for complex trauma in dissociation worldwide. I hope you will enjoy. Hi.
What Inspired Dr. Fisher's Path Into Trauma Therapy
SPEAKER_00What motivated you to do what you do today?
SPEAKER_01Well, I think it was my children. When I was 25, I had my first child. And I thought, and I'm actually impressed that I had this thought at 25. I thought, there must be other mothers like me who don't know what they're doing.
SPEAKER_03Yes.
SPEAKER_01And they need to know. Obviously, I didn't have, was not in a position to start a career, but I had an inspiration that I would someday become a psychologist and I would help parents learn how to take care of babies, how to be loving, attachment parents.
SPEAKER_00How did you get to this idea? I mean, so many, so many people in the world get children and they don't get to that idea.
SPEAKER_01I think I think because you know, I was lucky. I had parents who were had troubles of their own, but they always they always communicated that they were trying to grow and change.
SPEAKER_03Yes.
SPEAKER_01And that it was important that that we know that they weren't perfect, but they were working on it.
SPEAKER_00So out of love to your to your children, this feeling came up. Uh how can you improve that communication and and grow up?
SPEAKER_01How can you raise a child without harming the child?
SPEAKER_00Yes. Were you scared you could harm your child at that time?
SPEAKER_01I just felt, I as many parents do, I felt an enormous responsibility. Here's a tiny baby and who has no control. So and then the second inspiration, specifically to become an expert in trauma, occurred in 1989. I heard Judith Herman speak, and she said words that changed my life. She said, doesn't it make more sense that people suffer because of the terrible things that have happened to them than that they suffer because of their infantile sexual fantasies? And I thought, of course. But in 1989, the mental health world was still dominated by Freud.
SPEAKER_03Yeah.
SPEAKER_01We hadn't, there was no such thing as trauma. And so that really changed the course of what I was doing. I was still, I was studying still for my degree in psychology.
SPEAKER_00You went then later on um to study further trauma and and addiction. Um how was it at that time? Because trauma is more a modern term from today's perspective. Uh how was it at that time?
Growing Up With a Father's Trauma and Alcoholism
SPEAKER_01Well, I had a special interest in addiction because my father was an alcoholic, which um luckily not a traumatizing alcoholic, but um and he got sober when I was 18 years old. Yes, and it that changed his life, and it changed the lives of his children. And uh, and so during the years from when I was 13, as he began to progress, um it it really became clear what what addiction meant.
SPEAKER_03Okay.
SPEAKER_01Prior to that, um, he was a man who got drunk after work every night, but as his children we didn't know because we were asleep.
SPEAKER_03Yeah.
SPEAKER_01Um, but by the time I was a teenager, it was very clear. And I only learned later that he had had a very traumatic childhood. And and then it everything fell into place. I understood, I I understood his difficulties in being a parent, I understood his need to please everyone, and and his need to feel important. And it all made sense that the alcohol, that that's how his alcoholism had started. And um, and then he spent most of his life, he died 56 years sober, okay, still sponsoring uh NAA.
SPEAKER_00It's wonderful because you could see the positive effects, uh, what therapy and treatment uh has been created.
SPEAKER_01I saw what a happy and good life he could have uh as a sober alcoholic.
SPEAKER_00When did you understand or started to connect the dots that the trauma and connection to alcohol and um was was was connected and and try and understood it better?
SPEAKER_01He became more open during his many years of sobriety. And shortly before his death, he just began telling me the story of his childhood. I think because his wife, my stepmother, had been saying to him, Why do you hate your mother so much? And and uh and then he began telling me a story of traumatic abandonment that was just heartbreaking. Yes um being given to a foster mother when he was a one-year-old baby, okay. Um being taken back at a year and a half, and then being sent to boarding school at age four.
SPEAKER_03Wow.
SPEAKER_01Can you imagine a four-year-old? Apparently there were then.
SPEAKER_03Wow.
SPEAKER_01And then they took him back again and then moved to France and gave him up to a French foster mother. And of course, at that time he didn't speak a word of French.
SPEAKER_03Yeah.
SPEAKER_01Luckily, she adored him, and they kept taking him away from her and then giving her back, giving him back. And I could just see this is in the field. If we heard this as a case, we would say this man had an incredibly traumatic childhood. And then his mother was also quite abusive, in addition. But what struck me was the terrible attachment wounding.
SPEAKER_00In his case, um, was he able to overcome this at some point? Because so sobriety is one thing, but the trauma is another thing which could have affected him for the rest of his life.
SPEAKER_01Absolutely. I think it I think his marriage to my stepmother was really helped him to transform the trauma. Um because she was she was just she was wonderful with him and uh very loving, but also um she was very clear that he had to work on certain things. Okay.
SPEAKER_00Very supportive and uh caring for yourself. What what led then later to dive into the trauma field uh more intensive?
SPEAKER_01Well, that was the inspiration of Judith Herman. I also have known Bessel for 52 years. I knew him socially before he became interested in trauma, and obviously before I became interested in trauma. So I had once once he had become interested in trauma, he kept saying to me, this is what you're doing. I was doing research at the time. He said, This is a waste of your time. Yeah, you should be in the trauma field.
SPEAKER_00So it was his uh second motivation.
SPEAKER_01And also I just had a very um a very natural um interest in complicated people. So so I was drawn to what we would now understand as the trauma patients. Yes. And and I seemed to be able to understand them in a way that other people didn't.
Why the Word "Trauma" Is Overused Today
SPEAKER_00Is the term trauma by itself like overused today?
SPEAKER_01Yes, absolutely. That's something that I find very upsetting because in the early days in the 1990s, people like Bessel and Judy and myself fought to have trauma recognized. Yes. Well, we fought to change the attitudes of um of particularly psychiatrists who would say, this is it's not a diagnosis. It's it's not well, they would say, oh, if the father sexually abused the daughter, that's no big deal. And and so, and at the time, when PTSD was first acknowledged as a diagnosis, it was applied only to military veterans and rape survivors.
SPEAKER_03Yes.
SPEAKER_01So somehow it was all right to rape children, but it was not okay to rape adults. It's just it so we fought so hard to have trauma understood and respected, and now it's being used for I had a bad day.
SPEAKER_00Yeah, I had a bad day, I'm traumatized from my lost relationship, I'm traumatized from the plane which came late.
SPEAKER_01Right. Exactly, exactly.
SPEAKER_00How do you see trauma today? Are we there where we need to be or want to be from your perspective?
SPEAKER_01Well, if we look at we are both at the Boston Trauma Conference, so we can see thousands of people are here because they take the treatment of trauma very seriously. I think we're in a better place than we've ever been.
SPEAKER_03Yeah.
SPEAKER_01And uh and you know, in large part thanks to Besselt. Yes, and the Trauma Foundation and the Trauma Research Foundation, yes.
SPEAKER_00How is your approach to um treating trauma and addiction? How how do you understand that field and how a therapeutic relationship should be um between a patient and an institution or an individual therapist?
From EMDR to Somatic Work and Internal Family Systems (IFS)
SPEAKER_01I have evolved, and I hope all trauma therapists have evolved. Um you know, and initially we all started by training in EMDR. So for many years I was an EMDR therapist. Yes, but I saw that it it only helped a percentage. It helped many people who were not helped by talking about their trauma, but it didn't help everybody, and so then I Bessel was saying the body keeps the score. So I said, okay, I have to study the body, and I became uh trained in sensory motor psychotherapy, and for many years I taught sensory motor psychotherapy, and that helped even more patients, but not everybody.
SPEAKER_03Okay.
SPEAKER_01And so, and then I was influenced, I never trained in it, but I was influenced by internal family systems, and to me, I had been interested in parts approaches for many years. Um, because of course there were many approaches to parts before IFS. And um, and so I began to to integrate parts work with the somatic work. And that seemed to help that group that couldn't be helped otherwise. Yes, I finally had gotten to an approach that worked for everybody. And and so this method, which is now called trauma-informed stabilization treatment, um, evolved with all kinds of influences. So it has the influence and techniques from internal family systems, it has somatic, a somatic bias, you could say, from sensory motorpsychotherapy, it has techniques from the world of clinical hypnosis, um, which of course um hypnotic ego state work was one of the first kinds of parts work, okay, methods. Um but years, years ago, 50 plus years ago.
SPEAKER_00Interesting. Uh so you you you combined like the body work um with more the the the parts side. Can can you explain the um more in detail how like therapeutic sessions uh ideally would work?
SPEAKER_01Something
What Is TIST? Trauma-Informed Stabilization Treatment Explained
SPEAKER_01to understand about about body psychotherapy, because of course when you think about the body, you think about movement and action. But in fact, a body psychotherapy has to begin with mindfulness because it's the awareness of the body that is the the most important ingredient. So starts with helping people to notice and and to notice their distressing thoughts and feelings and somatic responses as parts. Okay now one there's one other ingredient I forgot I left out of the recipe, which is the structural dissociation model of Anno Vanderhart, Alec Nanhoos, and Kathy Steele, um, which is a parts model that is neurobiologically based, which is what drew me to it. It's of course very familiar to most therapists in Europe, very unfamiliar to most American therapists. Um and what particularly interested me about structural dissociation was the idea that the parts are holders of survival defenses, that the parts are not focused on remembering the past, which is of course the focus in IFS. In structural dissociation, the parts are there to defend the individual. And and so they're they're connected to the body, right? The fight response is a somatic response, the flight response is a somatic response. And I added one more defensive response that Anno Vanderhart doesn't talk about, which is the cry for help response. Because uh because I think that's also a very, very important component of our survival defense system, but also in the later legacy of trauma. So I was combining, you know, the structural dissociation model is a theoretical model, but it's not a treatment model. Also, the other thing I liked about the structural dissociation model is that it says that we we retain a left brain mediated part of ourselves that keeps on developing normally. So although, of course, as Anna would say, the whole body is traumatized, we still have that ability to split or fragment so that part of us continues on. So the child who is being traumatized gets up every morning and goes to school, plays with friends, reads or draws, or is interested in nature and And so we don't stop developing. Part of us continues to develop normally, and part of us becomes vigilant because in a traumatic world, you are in danger every single day.
SPEAKER_03Yes.
SPEAKER_01Not just on the days you get hurt, you are in danger on all the days that you might get
Using TIST in Therapy: Individual, Group & VA Settings
SPEAKER_01hurt.
SPEAKER_00How is this implemented ideally in a therapeutic setting? So what should therapists or treatment centers ideally structure their offerings?
SPEAKER_01So what we do is we explain the theory to people who are struggling with addiction, with suicidality, with depression that does not respond to treatment, anxiety that doesn't respond to treatment, people with chronic difficulties in relationship. And we say there's a model that might explain what you have been struggling with. And we explain the structural dissociation model to the patient, and we say, are any of these parts familiar to you? And 90% of the time they say, Oh yes, they're very, very familiar to me. They just haven't thought of those responses as parts. They've thought, I'm just bad at relationships. I'm not lovable, right? I don't deserve to be happy, right? I don't deserve to live. Um they I mean it's very, very interesting when it comes to addiction, because so often in in addictive disorders, there is a part of that person who has gone on with normal life. Yeah, like my father, functioning at a very high level, being respected, um, being looked up to. And then there is the addict side. Because they are a way, they're ways of changing your state of consciousness. And and although as addictive disorders um you don't begin to get more and more severe, the changes in state um last for shorter and shorter amounts of time. Initially, um very good at changing people's state of consciousness.
SPEAKER_00Kind of an escape, yeah. So that's what you're describing. Escape, numbing emotions, feelings they don't know how to deal with.
SPEAKER_01Right. Exactly. Okay, exactly. And and and that is true for trauma survivors because of the effects of trauma on the nervous system. Ordinary feelings um feel overwhelming. So not only is it difficult for you know reasons of attachment and development, it's difficult to deal with feelings. If we're talking about trauma, we're talking about huge, overwhelming uh feelings and body sensations that are much, much harder to tolerate for anyone.
SPEAKER_00Back to my question: what to implement in a therapeutic set setting. Uh, so is this model primarily created for like one-on-one sessions or supporting a patient or also in a in a residential setting?
SPEAKER_01So at the moment, um we are doing a pilot research study at Motenbad Hospital in Norway, um, where it's being done as a group, as a group approach.
SPEAKER_03Okay.
SPEAKER_01And we're having a wonderful response. It's very, very exciting.
SPEAKER_00Yeah, that's interesting. Um, can trauma be treated in a group?
SPEAKER_01In San Francisco, California, I'm working with the veterans administration, um, and they are using it as a group model with very severely traumatized veterans.
SPEAKER_00Are there any differences in success rates between individual versus uh group-based?
SPEAKER_01I would say individual probably has, I mean, the highest success rate is going to be the combination of individual and group.
SPEAKER_03Probably, yes. Right.
SPEAKER_01And at the Veterans Administration, um I can ask them which they think is more successful. But I think they would say the group.
SPEAKER_00What are we getting probably wrong in trauma therapy today? And and how from your perspective should be ideally uh a trauma therapy, highly traumatized person be treated, and in what steps?
The Biggest Mistake in Trauma Therapy Today
SPEAKER_01Well, I think the major thing we get wrong, um, which is a huge problem, is we have been focused on the events, on what happened to people. And and it makes no sense. Right. I always say, you know, if my friend was in some terrible accident, I wouldn't say, tell me every detail of what happened. Yeah I would say, are you all right?
SPEAKER_00Yes.
SPEAKER_01How is this still affecting?
SPEAKER_00It's a first responder reaction.
SPEAKER_01Well, no, I'm thinking as a friend.
SPEAKER_00Yes.
SPEAKER_01Right? Right. You wouldn't you wouldn't say tell me about it. You would say, how are you?
SPEAKER_03Yeah.
SPEAKER_01It's never made sense to me that we focus on events. And and in fact, I would say it misses something very important, which is that our patients are survivors of traumatic environments. They're not just victims of the specific events. They have suffered living and growing up in an unsafe environment. The same is true of war, right? It's not the events, it's the condition. We can think of Ukraine as an example, right? It's the condition of being unsafe every single day, every hour of every day. So I think that's why some of Bessel's uh methods, like theater, have been so successful because they don't treat the events, they treat they focus on giving people a new experience. And that is both physical and emotional and intellectual.
Stabilizing Trauma Survivors Through Mindful Noticing
SPEAKER_00And you speak about also first to stabilize, as you said, you wouldn't ask, you wouldn't ask what happened wrong. And so how how do we ideally stabilize a person who's highly traumatized?
SPEAKER_01We the best way, and I say this, I've now been a therapist for 46 years. So this is 40 after 46 years, this is what I understand. Um we start by helping them to mindfully notice their experience. Right? So we I don't ask for a history when I meet a new patient. Uh I say what brings you here, but I don't say what happened to you.
SPEAKER_00Yeah. And you think therapists go too quick to um fast into what happened to you.
SPEAKER_01I think it's the goal in the therapist's mind.
SPEAKER_00To fix.
SPEAKER_01That's what we have. But the but you know, what Freud said is you talk about the event, you have the feelings associated with it, and it's all it's all over. But that has not been the experience of traumatized people. But I I've I've talked to people who say I've told what happened to me hundreds of times, and I'm no better. Freud was a pioneer, but but he was wrong.
SPEAKER_03Yeah.
SPEAKER_01It's and so, but in the late 1980s, that was all we had.
SPEAKER_03Yes.
SPEAKER_01And so the thing that I'm trying to change in the minds of therapists is the focus on events. I think we should be focused on the legacy of trauma. How is the trauma still affecting that person? And it might be that that what is still affecting that person the most is the effect of the neglect. Which usually goes with trauma.
SPEAKER_03Yes.
SPEAKER_01Um, it may be the the loss of attachment, the betrayal of attachment. I mean, it's so different for so many people.
SPEAKER_03Yes.
SPEAKER_01But if you think about who comes to therapy, most people do not come to therapy saying I was sexually abused, I was physically abused. They say, I'm depressed, I'm anxious, I can't sleep, my relationships are terrible, um, and I hate myself.
SPEAKER_02Yeah.
SPEAKER_01And sometimes, sometimes they say, I'm drinking too much. Sometimes you find that out later.
SPEAKER_00Yes, I mean they follow their feelings and current thoughts in that moment and not a certain framework. Exactly.
SPEAKER_01Exactly.
SPEAKER_00I understand stabilization is important to get started. Um, but when is when does a therapist ideally identify when the right time is to start processing?
SPEAKER_01I mean, I I'm a big believer in stabilization, but in TIST, processing is very different because we don't focus on events.
SPEAKER_03Yeah.
SPEAKER_01And processing has always meant events. So in TIST, the processing um phase is centered around helping people offer their parts what we can call missing or contradictory experiences. So if the part is afraid and the patient learns to be present and calming when the part is afraid, that is a reparative experience. If the part is angry and the patient is able to hold calmness and interest and anger all at the same time, that allows the part to process the anger. Because what does anger want? Anger wants to be heard, right? Anger wants to be respected. Anger wants someone to say, yes, you're right. That was not seen. Yes, seen, exactly. So the emphasis in TIST is on the client seeing the part through mindfulness from the very, very beginning, through stabilization, through processing. Um, every session is focused on notice that part.
SPEAKER_00And to realize that each part is a type of a coping mechanism which has been built like within the IFS system as a protection?
SPEAKER_01Um no, not so much. Because in in in TIST, one of the things that that I disagree with IFS about, uh, first of all, I I disagree that functioning is just a part.
SPEAKER_03Yeah.
SPEAKER_01Um, because I believe our functioning has meaning. Right. Which is why you asked me about questions about what inspired me to function as I do. Um and and also um I think of the parts as holding the emotional memories and the somatic memories rather than the event memories. Okay. Right? Because a somatic memory is a feeling of fear disconnected from the event. And I would say, if we could study this, that the majority of trauma survivors suffer because of their implicit memories. They don't have, usually beyond the stabilization period, they don't have a lot of flashbacks.
SPEAKER_03Yeah.
SPEAKER_01But they have a lot of depression and a lot of anxiety, a lot of anger, a lot of shame.
SPEAKER_00How successful have you found that uh method in treating trauma?
How Mindfulness Calms the Amygdala and Regulates Emotion
SPEAKER_01Very successful. Because the mindfulness of I keep doing this, yeah. Starts there, pointing to the middle of my forehead, because this medial prefrontal cortex, the middle part of the prefrontal cortex, has been associated in brain scan research with awareness. So from this part of our brain, we can be aware. And when the medial prefrontal cortex is stimulated, the amygdala becomes less active. The amygdala, as we know from Bessel, is the part of the brain that is the fire alarm. And and so stabilization becomes about decreasing amygdala activity through helping people to just notice things.
SPEAKER_03Yes.
SPEAKER_00Just noticing can be also overwhelming for some people.
SPEAKER_01That's not the case. Um, because noticing is, I mean, in meditation, noticing can become overwhelming because you're creating a kind of um, you know, an opening into and inviting anything that wants to come up to come up. In TIST, we're starting with a feeling the individual is having at that moment. So my patient comes in and she says, I'm ready to give up, nothing is working, I hate myself, and so and I say, notice the part that hates herself. Right. So now there is my patient, and there is the part that hates herself. And and so my if my client can can notice the part that hates herself, but the client is not feeling I hate myself. The part is so now we have a relationship between the feeling or the thought and the individual. And that's what we want because emotions are valuable if we have a relationship to them. If they simply overwhelm us, it's not helpful.
SPEAKER_00Yes, yes, it's not the self-identification with everything we feel and experience.
SPEAKER_01Exactly. Exactly. And I I actually think in in addictions recovery, that becomes a very big issue because addicts in recovery are asked to feel their feelings, yes, and a lot of feelings are coming up because now they're sober. Um, but they're not taught how to have a relationship to the feeling, right? They their experience is the feeling comes up and you drown it or you drug it. I always talk uh with my addicts about you've been putting whiskey in the baby bottle. You have been trying to drug those young, wounded parts of you. And how do you think that baby feels when he or she wakes up the next morning after having been drugged? Do you think that baby feels better or worse? And they say, Oh, I think the baby probably feels worse. Right, right. So then the next day you have to put more whiskey in the baby bottle. And usually that that that way of understanding it is very helpful in creating a mindful perspective.
SPEAKER_03Yes.
SPEAKER_01I'm I'm thinking actually of an of an old patient of mine who was addicted to alcohol, food, sex, and he was a um um and sort of intermittent abuser of crack cooking. Um and and I remember. We worked with his 15-year-old part who had discovered that that alcohol helped him. Um, but at the age where his friends were all um becoming very social and sexual, and they all had a girlfriend, wanted a girlfriend, and he was very alone because the trauma had impaired his capacity for all these relationships he was supposed to have. And and and the work centered on helping his 15-year-old to see that he wasn't isolated anymore. That he was respected, um, he was um he was warmly welcomed. Um and it was it was so lovely because the 15-year-old was surprised. The 15-year-old couldn't believe all these people are saying hello to you in the halls. Like, how could that be? Right? Because of course, in high school, um girl, especially girls, had looked the other way.
SPEAKER_03Yes.
SPEAKER_01And and so helping that 15-year-old to feel seen was huge.
How Trauma Shows Up in Family Relationships
SPEAKER_00Can you explain how the taste model um considers also like the family system or the system in general a traumatized person um is affected by their family system of today or the family system of childhood? Um, yeah, good question. Probably today because the work is done today.
SPEAKER_01Yes, yes. People are unaware of how much, how triggering their most close and wonderful relationships. I mean, I'm thinking of a patient of mine who has been married for over 40 years, and but whose marriage has been such so impacted by her parts getting triggered by her husband. Um and and even and by her older son. Her older son is autistic, and so he can be very um, he can be very angry, he can be very rigid, and her parts get triggered by that. They get triggered because she lives in a household with three men. Now that her children, her boys are grown up, they're more triggering. Um, she's triggered when she wakes up in the morning. She's triggered by by household tasks because part of her abuse was being made to do things around the house or be beaten.
SPEAKER_03Yes.
SPEAKER_01So to see how these family relationships have been affected required that she understand her parts. Because otherwise her story was I married the wrong man, he is not loving, he's not caring, when in fact her husband is a very, very loyal, loving man, but the kind of man who does things for you rather than is comforting and emotionally present. And and I I always say to her, if he had been a more emotionally present man, you wouldn't have been able to tolerate him.
SPEAKER_02Yeah.
SPEAKER_01Because he would have had his feelings. And your parts would have been too triggered.
SPEAKER_00Yeah. What I understand is it's the work with the self and the different parts of it, realizing, recognizing how the effects are within a family system, but it does not include families or other other parts of other family members.
SPEAKER_01I mean it could. It could. Um I could see, um, I think it's difficult. If what's difficult is if I do a family session with this person and her husband, the parts are going to be triggered if I say anything that is that suggests that I see the point of view of her husband.
SPEAKER_03Okay.
SPEAKER_01And so it's just not worth it. It's not that it couldn't be done. It's just it's just not worth it.
US vs. Europe: Different Approaches to Trauma Treatment
SPEAKER_00Maybe another question here. Well, you mentioned something, there is a difference between Europe and the US in terms of neurobiological approaches. Uh why is that so? What's uh what's your understanding why why there are these differences, or is there a lack of um um awareness about it, or what's what's the issue?
SPEAKER_01You know, I think it was, I think it's territorial. So in the US, there was a or there was a um, I call them the old guard of the dissociation world, right? There was a group of experts on dissociation, whose point of view is that each part represents unresolved events, and the treatment should focus on having those parts process their memories. Then Anno Vanderhart and colleagues introduced the structural dissociation model in Europe, which I heard, I heard them speak because I've always done a lot of teaching in Europe. So I was exposed to their work, and I thought their point of view makes so much more sense. Events affect us, but so does the context in which the events occur.
SPEAKER_03Yes.
SPEAKER_01So if I just focused on my father's worst day, let's see, my memory of my father's worst day as an alcoholic, right? That would be the event, I would process it. But in fact, if I look at the whole context, he in my lifetime there were more days that I knew him sober and I knew him as a very warm and loving father. So to get his impact on me, I have to look at the whole at the whole context.
What Is Co-Regulation and Why It Matters in Healing
SPEAKER_00Last year I was at a conference where we where you were speaking and you talked about like co-regulation, how the importance.
SPEAKER_02Yes.
SPEAKER_00Uh it's true within a therapeutic set uh setting, but certainly also how for parenting. Can you can you can you tell us your view uh about it and uh the do's and don'ts probably or how to get into it?
SPEAKER_01Well, I think co-regulation involves the ability to to notice both the verbal and nonverbal communication of the other person, to feel the impact of that on ourselves, to notice our impact on them. Right? If I say, how was your day today? Um do they look down, do they look away, do they lean forward eagerly? And and then to adjust what I say next and how I say it in response to them. So so if I say how was your day today, and the patient looks down, I know that that that the question has made the person feel uncomfortable. Yeah. So then I might change, then I might say, what a silly question. Right. Of course it was hard, right? And then I might notice the person looks up now, yeah. Okay, and then I I smile or I laugh, because one of the things I've noticed is that that smiling and laughing helps to co-regulate people. We do that with children all the time, but we do it naturally. We don't think, oh, I have to co-regulate my child.
SPEAKER_00Yeah, yeah, it's it's to it's to signal I'm not a threat. I'm uh and it helps to create that uh rapport about safe, yes, the safe environment we are having and creating. And yeah, you it's true. With children, we are we're naturally doing it, but with uh with other people we are more protective also.
SPEAKER_01Or we're fulfilling this role that we, you know, if you're a therapist, um, I used to have to apologize for laughing and smiling so much because therapists are supposed to be very serious. Yeah, I just found that if I was very serious, yeah, I would dregulate my patients. And when my body was relaxed and I was smiling, especially if I was saying something that might be difficult to hear, um right, I could, if I laughed and smiled as I said it, yeah, I noticed that people could take it in.
SPEAKER_00Janina,
Breaking Down Silos Between Addiction and Mental Health Care
SPEAKER_00is there anything you would wish to um to happen in the field of trauma and addiction therapy still uh in therapeutic settings?
SPEAKER_01Oh what would I like? Well, of course, I I would love to see TIST um more used more, especially in residential and inpatient programs. Because I think when people are coming with a crisis, I mean we all know the rates of trauma in in uh people in addictions recovery, right? There's such a high percentage. Um obviously, you know, I don't think anybody has done that study with inpatient psychiatric patients, which is very interesting, but I'm sure the rates are equally high. Yeah, if not higher.
SPEAKER_00Yeah, like relapse uh rates, uh.
SPEAKER_01Right. I mean, of all of the psychiatric disorders that lead to hospitalization.
SPEAKER_00Yes. What do you think from your experience is missing?
SPEAKER_01We like to to pigeonhole things. We like to have things in their own compartments. Yeah. So the addictions treatment world has always traditionally been separate from the mental health world.
SPEAKER_03Yeah.
SPEAKER_01Right? And vice versa, right? Trying to get therapists to work with people in recovery is very hard. And certainly almost impossible for anybody who is still who is still active and hasn't bottomed out yet. Um you know, we're either an events processing focused, or we're parts focused, or we're prolonged exposure focused. And um, and everybody's in their own little compartments. And the field, I remember Bessel said this a few years ago. He said everyone talking to the the trauma conference audience, everyone in this room should be trained in all these modalities and should not be afraid to use them integratively.
SPEAKER_00Yes, I agree.
SPEAKER_01Yeah, yeah.
SPEAKER_00Yeah, because we can also not um isolate um this is addiction, this is an eating disorder, this is a personality disorder, or this is pathologies. We cannot isolate them. I mean it's it's a mix. Uh every person would have different traits of uh all of it.
SPEAKER_01Absolutely. Absolutely, yes.
How Dr. Fisher Stays Balanced Doing Trauma Work
SPEAKER_00I'm wondering today, you um what you do to stay in balance in your life.
SPEAKER_01I think I think laughing and smiling. Yeah, I mean um I also have to thank my parents for my nervous system because I don't have a traumatized nervous system. And and I love what I do. Um so I think good friends, loving what you do. Um I find I still find it very intellectually stimulating. I have to think every day. And uh it's it's wonderful, especially when you're in your 80s, yeah, and there's less you can do physically. Um it's a wonderful life to do what you love.
SPEAKER_00I understand also connecting with people and friends, and that's right.
SPEAKER_01That's right. Even though most of my work is virtual, I'm still interacting with people all day long. Yes.
SPEAKER_00Great. Yeah, I hope you you you will continue doing this uh for for as long as you wish. And um if you if you could um recommend something to our listeners uh to implement into their lives or any kind of recommendation you would like to share, what would that
Dr. Fisher's Advice: Befriend the Parts of Yourself You Dislike Most
SPEAKER_00be?
SPEAKER_01Becoming friends with our least liked parts is a really a recipe, I think, for a much happier life.
SPEAKER_00Yeah, yeah, beautiful. So first try to be aware of it, yes, and then become friends with it.
SPEAKER_01Yes, yeah, to be curious about it, because that's how we become friends with people, right? We have a curiosity about them, we want to know more.
SPEAKER_00Thank you so much for your time today. And um, I I also have always admired your work you do um within that field and what you have brought in and supported directly and indirectly so many people. And um that's my hope. Yes, I I think you this uh this is a proven thing from my perspective today, and uh thank you for for all the work you do and bringing more awareness to it.
SPEAKER_01Thank you, thank you.