“The inner self that is torn apart by trauma
How does one recover?

It encompasses sensorimotor psychotherapy, internal family systems therapy, and mindfulness-based therapy.
Understanding and Treating the Neurobiology of Trauma, Dissociation, and Attachment

Why do some clients, despite having "overcome" trauma and having good jobs, loving families, and abundant lives, still struggle to achieve a quality of life? This book is the ultimate guide for trauma survivors, whose inner lives remain as dark and painful as their past, and for therapists who acknowledge and heal their fragmented inner selves.

There was something that neither the therapist nor the client could see.
The point is that the client's inner self is fragmented.
In order to adapt, the client had to radically separate his 'self' from his identity, which turned his inner world into a battlefield.


Another thing I noticed was that clients felt relieved when I told them that dissociative splitting was a normal response to trauma.


First, I explain the structural dissociation theory, and then I explain the difficult struggle they are currently going through using the language of the 'parts language' and the 'animal defense survival response', which are the foundations of the structural dissociation theory.


During our conversation, the client often had an expression of understanding, as if what I was saying was nothing new, as if he had already known it but had been unable to express it, and had finally found the right words.
The structural dissociative model seemed much more reassuring than feeling stigmatized or crazy.


A core tenet of the structural dissociation model is that dissociation allows us to adapt and survive more successfully in an unsafe world.
This helps even the most self-conscious and narcissistic people accept fragmentation not as evidence of flaws but as a necessary necessity for survival.
---From "Entering"

The treatment paradigm in this book is not intended to treat any specific disorder.
It is designed for all trauma survivors, regardless of whether they have been diagnosed with post-traumatic stress disorder (PTSD), a commonly diagnosed disorder associated with trauma such as attention deficit hyperactivity disorder (ADHD), bipolar disorder, borderline personality disorder, or dissociative disorder, and whether they have seen a mental health professional before.


If you, the reader, have been rejected, attacked, threatened, abandoned, or abused by someone and are still carrying the emotional and physical scars of such experiences, or if you are helping someone who has, I believe this book will be beneficial to you.

---From "Entering"

To avoid having the rejected child, the "not-me," outside of consciousness, we must continue to resort to dissociation, denial, and self-loathing long after the traumatic event has ended.
Ultimately, this child survived the lack of security, abuse, and betrayal at the cost of denying his most vulnerable and most wounded 'self.'


But he feels hypocritical because he recognizes that his outward appearance and ability to function as a person are only a part of his true self.
As you struggle to distance yourself from the 'bad' side and identify with the good, you may feel like you are 'putting on airs' or trying to be what others want you to be.
As the conviction that they are hypocrites grows, some become indignant, while others are overcome with shame and self-doubt.
But in both cases, the traces of trauma remain unresolved.
---「Chapter 1.
From "The Neurobiological Traces of Trauma: How We Became Fragmented"

Trauma often leaves its mark in ways that don't lend themselves to traditional diagnosis or treatment.
Rather than feeling relieved when revealing their secrets, clients often feel ashamed, suspicious, or exposed.
They have difficulty remembering or generalizing what they have learned in therapy to life outside the therapy room, and like Winnie the Pooh, they keep falling back into the same old patterns.
Otherwise, each time you come to the counseling room, you feel like a different person, leaving the therapist with no one to form a therapeutic alliance with.


A client who was excited and angry last week may be depressed, gloomy, and tight-lipped this week.
And next week, the topic of conversation becomes planning for the future rather than despair and suicide.
When I bring up the sexual abuse I disclosed last week again, the client is startled.
The revelation was forgotten as if it had never happened.


Last week, the client felt the therapy room was the only safe place; today, he feels threatened.
More seriously, the determination to change turns into a fear of change.
When the state of mind changes like this, not only the therapist but also the client becomes confused.
---「Chapter 2.
From "Understanding Parts and Trauma Reactions"

The 'partial approach' offers several new possibilities to address the difficulties mentioned above.
First, if we treat symptoms as manifestations of parts, we can incorporate mindfulness-based techniques.
It is about helping clients to 'become aware' of their experiences rather than 'make contact' with them.


Clients who have suffered psychological trauma may feel overwhelmed or helpless when 'getting in touch with their emotions' due to tension or numbness caused by dysregulation of the autonomic nervous system, which can lead to anxiety, depression, and impulsive behavior.


By practicing mindfulness-based awareness, or 'noticing,' clients can achieve 'dual awareness,' that is, they can remain connected to their emotional or physical experiences while simultaneously observing what they are experiencing from a bit of psychological distance.
(Omitted) This ability is very important for treatment.
---「Chapter 3.
From “Changes in the Roles of Clients and Therapists”

It is not difficult to understand that humans have additional subdivisions, each of which contributes to different survival strategies.
Ask clients who understand these to consider what they already know about each part so that they can connect their case to the theoretical model.
Do you recognize your "normal self"? Do you recognize the part of yourself that knows how to ask for help, the part that knows how to fight or get angry? Can you recognize the part that feels fearful, ashamed, or conforming? What parts of yourself are the most difficult for the client to deal with? Which parts do they find most rewarding?

Using Figure 4.1, I will show how each part sees the world through its own lens, how each part responds to different emergent animal defenses, and how each part relates to the other parts based on its biological role as well as its own history.
Each part has different implicit memories and interpretations of what happened, and each part also has different expectations about what to do.
---「Chapter 4.
From "Learning to See My 'Self': Meeting the Part"

'Dual awareness' is the mental ability or habit of mind that allows one to keep two or more states of consciousness in mind simultaneously.
Dual awareness is when a client stays in the present while mindfully becoming aware of both the experience of the present moment and the implicit or explicit memories connected to the past.


If clients can feel the length and stability of their spine, their inhalation and exhalation, their heartbeat, and the ground beneath their feet, while simultaneously connecting with the somatic sensations of painful emotions felt by their younger selves, they can tolerate intense emotions.
Some of our most popular therapies, such as Eye Movement Desensitization Therapy (EMDR) and Somatic Experiencing Therapy (SE), as well as Sensorimotor Psychotherapy, Internal Family Systems Therapy, and Ego State Therapy using Hypnosis, are all based on mindfulness.
---「Chapter 5.
From “Becoming Friends of Parts: Sowing the Seeds of Compassion”

Traces of disorganized attachment and control strategies affect all interpersonal relationships in adulthood, including treatment.
Van der Hart, Nijenhuis, Steele, and others call this phenomenon related to therapy "therapy and therapist phobia."
The more traumatized clients seek reassurance, understanding, and care from their therapists (seeking proximity), the more likely they are to experience fear and distrust in the early stages of treatment or as their relationship with the therapist progresses.
The prospect of trusting someone, being seen, and having your secrets exposed doesn't bring comfort; it breeds fear.

As Jessica Benjamin says, “To be known or recognized is to immediately experience the power of another.
The other person becomes someone who can either acknowledge me or ignore me.
“It is about becoming someone who can see what is hidden, reach the core of oneself, and perhaps even invade it.”


The life experiences of a traumatized person create an inescapable and painful paradox: intimacy is untrustworthy, yet solitude is unsafe.
They learned from experience that while being alone or unprotected makes them more vulnerable, being close to others is also unsafe.
---「Chapter 6.
From “Stumbling Blocks to Treatment: Attachment Trauma”

When it comes to understanding risky behaviors, the most common mistake both professionals and laypeople make is assuming that self-harm, suicide, suicidal thoughts, eating disorders, and substance abuse are about "seeking destruction" rather than "seeking relief."


If self-harm is assumed to cause pain, then interpretations of it as masochism, self-punishment, or a cry for help follow.
If we assume that suicidal thoughts reflect a conscious desire to die, we would interpret them as either a threat to life or a cry for help.
Interpreting it this way misses the core issue of self-harm: an attempt to successfully control unbearable emotions or a quest for relief.


At the heart of all self-destructive behavior lies a simple fact:
Injuring one's body, starving oneself, planning one's own death, or compulsively engaging in addictive behaviors often have the welcome consequence of relieving physical and emotional pain.


Ironically, given their physiological effects, high-risk behaviors appear to be ingenious attempts by clients to cope with or live with pain using the limited means they know.
If we can acknowledge to clients that there is no better way to soothe themselves now, or that self-destructive behaviors like self-harm or suicidal thoughts paradoxically bring relief, we can create an opportunity to build a collaborative relationship with the client and the parts of themselves that are struggling or fleeing in the pursuit of relief.

Therapists should begin by expressing curiosity rather than immediately reacting to suicidal thoughts, active addiction, and self-harm as safety concerns.
'What problem is this a solution to?' 'What triggered this impulse?' 'What does the client hope to achieve as a result of this behavior?' 'Has the client found relief in this way before?'
---From "Chapter 7: Encountering the Parts That Lead to Suicide, Self-Destruction, Eating Disorders, and Addiction"

What makes things more difficult is that DID clients often have an "eraser" part, a "thought-stopping" part, or a "snatching" part that actively interferes with the encoding of new, present-oriented information.
These parts feel that trusting new information is risky.
In a dangerous world of implicit memory, they fear that changing the assumptions related to survival is reckless.
---「Chapter 8.
From “Therapeutic Tasks: Dissociative Systems and Dissociative Disorders”

The sword discovered a 'gatekeeper' part that acts as a barrier to forming attachment bonds with young and vulnerable parts.
The gatekeeper had obviously learned this rule from Carl's parents.
In his home, only rational and goal-oriented behavior was welcomed.

But Carl was a sensitive child, and although he didn't yet know he was gay, he was anxious about the fact that he was different from other children.
I suffered from separation anxiety from my mother and was afraid of my father.
The message from his parents was that our son should not act like a "girl" and that he had to live up to their standards to be loved.
The gatekeeper part developed to protect this young boy from rejection.
“Don’t take your eyes off the ‘important things.’
Then you will be accepted and respected.”

The gatekeeper's tireless efforts culminated in Carl successfully graduating from law school to the congratulations of his parents.
A series of rejections from men that followed triggered a powerful feeling in the young boy, leaving Carl gripped by a fear of abandonment and an intense desire to feel special to someone.
The gatekeeper's judgment and distraction alone were not enough to prevent this child's wounds and deprivation.
This was followed by several rounds where another gatekeeper appeared and created obstacles to prevent the sword from forming an attachment with the child part.
---「Chapter 9.
From "Recovering the Past: Embracing Ourselves"

For clients who are unable to communicate freely internally or are in the early stages of learning how to communicate freely, more structured internal dialogue that does not require much capacity on the part of the client may be helpful.
The Four Questions to Become a Friend is structured and easy to learn to help you conduct your inner dialogue even if you have a personality disorder or adjustment disorder.

The idea behind this technique is to make the parts feel welcome and heard by befriending them, as the name suggests.
The first three questions focus on understanding the core fears of the parts, which are primarily fears of harm, extinction, and abandonment.
Whenever there is any emotion or issue that reflects the communication of the parts, use the four questions that become your friend.
I often use this conversational technique to help clients regain stability when they feel overwhelmed by parts of their daily lives.
It is also useful when the parts of us that fear everyday triggers are inhibiting our lives.


Annie was invited to the birthday party of an old friend she hadn't seen in years, and the very thought of going to the party was too embarrassing.
I guided her through the steps below, asking her to focus on the feeling of shame as a message from a part of her.

· Ask this part of you who is so embarrassed what you would worry about if you went to the party.
Annie: She says she's worried that people will see her.

· Ask people what concerns them when they see you.
Annie: People won't like seeing you.
People say it's disgusting.


· So what are you worried about that people don't like?
Annie: She tells them that they will reject her and she will end up alone.
(core fear)

· Ask the fourth and final question.
“To avoid being so afraid of rejection and abandonment, ask your child what he or she needs from you right here and now.”
---「Chapter 10.
From “Reclaiming What Was Lost: Deepening the Connection with Your Childhood”

As I listened carefully to the story Mark's symptoms told me, there were instances where it became clear to me that it was unsafe to express that my words or opinions were worth listening to.
Josh often reported experiencing poverty, neglect, humiliating verbal abuse, and peer bullying, but his symptoms revealed some details he didn't share.


Josh had to survive by avoiding the attention of others, pleasing his parents, and appeasing those who tormented him.
His desire to learn and his fear of failure combined to make him an excellent student.


Although he didn't feel like he belonged anywhere, his intellectual resources gave him the opportunity to disappear and start a new life.
This was the story his symptoms told (just as in the world Diane described, even the smallest child was never allowed to show weakness).
In each case, the events were important only in that they created a context for understanding and empathizing with the parts.
The resolution of trauma fundamentally occurs in the context of restoring attachment to each part.

---「Chapter 11.
From “Safety and Welcome: The Experience of Acquired Secure Attachment”