My name is Lisa Danilchuk, and I'm a psychotherapist specializing in complex trauma treatment.

我叫 Lisa Danilchuk，是一名心理治療師，擅長複雜創傷治療。

I'm a graduate of UCLA and Harvard University, and I'm thrilled to share these reflections on how we can heal with you today.

我畢業於加州大學洛杉磯分校和哈佛大學，今天很高興能與大家分享這些關於如何治癒的思考。

Today our guest is Kathy Steele.

今天我們請到的嘉賓是凱西-斯蒂爾。

Kathy Steele has been in private practice since 1985 and with Metropolitan Psychotherapy Associates in Atlanta, Georgia since 1988.

凱西-斯蒂爾自 1985 年起開始私人執業，1988 年起在佐治亞州亞特蘭大市的大都會心理治療協會工作。

She was clinical director of Metropolitan Counseling Services, a nonprofit psychotherapy and training center until 2016.

2016 年之前，她一直擔任非營利性心理治療和培訓中心 Metropolitan Counseling Services 的臨床主任。

Kathy received her undergraduate degree from the University of South Carolina and completed her graduate work at Emory University.

凱西在南卡羅來納大學獲得大學學位，並在埃默裡大學完成了研究所學生學業。

She's a past president and fellow of the International Society for the Study of Trauma and Dissociation, or ISSTD, and has also served two terms on the board of the International Society for Kathy served on the International Task Force that developed treatment guidelines for dissociative disorders and on the Joint International Task Force that developed treatment guidelines for complex post-traumatic stress disorder.

她是國際創傷與分離研究學會（ISSTD）的前任主席和研究員，還曾在國際凱西學會董事會任職兩屆，並曾在制定分離障礙治療指南的國際工作組和制定複雜創傷後應激障礙治療指南的國際聯合工作組任職。

Kathy is known for her humor, compassion, respect, and depth of knowledge as a clinician and teacher, and for her capacity to present complex issues in easily understood and clear ways.

作為一名臨床醫生和教師，凱西以其幽默、富有同情心、尊重他人、知識淵博而著稱，她還善於以通俗易懂、清晰明瞭的方式闡述複雜的問題。

She sought out as a consultant and supervisor and as an international lecturer on topics related to trauma, dissociation, attachment, and psychotherapy.

她被聘為顧問和督導，並擔任創傷、解離、依戀和心理治療相關主題的國際講師。

She has co-authored numerous book chapters, peer reviewed journal articles, and three books with her colleagues.

她與同事合作撰寫了大量書籍章節、同行評審期刊文章和三本書。

Kathy and I first connected through our shared time at ISSTD conferences, and I've always appreciated her clarity, humor, and kindness.

凱西和我第一次聯繫是在 ISSTD 會議上，我一直很欣賞她的清晰、幽默和善良。

I'm elated to share her with you today, so let's get going and welcome Kathy to the show.

我很高興今天能和大家分享她，讓我們歡迎凱西來到節目。

Kathy Steele, welcome to the How We Can Heal podcast.

凱西-斯蒂爾（Kathy Steele），歡迎收聽 "我們如何才能治癒 "播客。

I'm so excited to have you here.

我很高興你能來。

Thank you for having me, Lisa.

謝謝你邀請我，麗莎。

I'm excited too.

我也很激動。

Yeah.

是啊

And I'm sure there's plenty of folks listening who know you and know your work well, and there might be some who are just getting introduced to it, so I feel like I have this gem that I can just share and share some of that shine with them.

我相信聽眾中有很多人認識你，對你的作品非常瞭解，也可能有一些人剛開始接觸你的作品，所以我覺得我有這個寶藏，可以和他們分享，分享一些你的閃光點。

And so I've been familiar with your work for a long, long time, and the writing and the trauma, and I've never known how you got into the work and when you first learned about it.

我對你的作品、你的寫作和你的創傷已經熟悉很久很久了，但我一直不知道你是怎麼開始接觸這些作品的，也不知道你是什麼時候開始瞭解這些作品的。

And I feel like there's people that are just starting to learn about dissociation now, and I know folks like you who learned about it a long time ago.

我覺得有些人現在才開始瞭解解離症，而我知道像你這樣的人很早以前就瞭解它了。

So what was that like?

那是什麼感覺？

Well, it was interesting.

嗯，很有趣。

It was quite a different time.

那是一個截然不同的時代。

On the one hand, this was in the early 1980s.

一方面，這是在 20 世紀 80 年代初。

Part of what was happening during that time was this sort of upswelling of recognition of the fact that one in four women were sexually abused in some way.

那段時間發生的部分事情是，人們開始認識到，每四名婦女中就有一人受到過某種形式的性虐待。

And so that was the background for what happened for me.

是以，這就是發生在我身上的事情的背景。

And of course, like many people, I fell into this in a sort of accidental and serendipitous way.

當然，和很多人一樣，我也是以一種偶然和偶然的方式進入這個行業的。

The first thing was that I had just started private practice and sort of wanted to get to know other people in the community.

首先，我剛剛開始私人執業，有點想認識社區裡的其他人。

And so I volunteered like really blindly to run this one-year incest group.

於是我盲目地自願參加了這個為期一年的亂倫小組。

I had no idea of what in the world was happening.

我完全不知道到底發生了什麼。

This was even before Chris Courtois' first book on healing the incest wound, right?

這甚至比克里斯-庫爾圖瓦的第一本治癒亂倫創傷的書還要早，對嗎？

So it was really early.

所以那時候真的很早。

But there was a group that was running these one-year...

但是，有一個組織正在開展為期一年的...

This organization was running these one-year groups and they were offering some supervision.

這個組織正在運行這些為期一年的小組，他們提供一些監督。

And I had the experience of meeting with the group members to sort of see if they'd be a good fit for the group.

我有幸與小組成員會面，瞭解他們是否適合參加小組活動。

And I remember one person in particular ended up on the floor sucking her thumb.

我還記得有一個人最後躺在地上吮吸拇指。

And I had never seen that before.

我以前從未見過這種情況。

I had no idea what that was.

我不知道那是什麼。

Now I go, oh, yeah, of course.

現在我會說，哦，是的，當然。

But at the time, it was quite shocking.

但在當時，這是相當令人震驚的。

And fortunately, the people who were supervisors there had some inkling about this.

幸運的是，在那裡擔任主管的人對此有所瞭解。

And they really weren't talking about DID so much, but they were talking about the wounded child and there was dissociation going on.

他們並不是在談論 DID，而是在談論受傷的孩子和分離現象。

And so that's how I got into it.

就這樣，我進入了這個行業。

And then my first...

然後我的第一個...

One of my first private practice clients turned out to be DID.

我的第一批私人診所客戶中就有一位是 DID。

I thought she was psychotically depressed with these characters.

我還以為她對這些角色有精神抑鬱。

She was hallucinating, but it turned out that she was DID.

她產生了幻覺，但事實證明她是 DID。

And so by the seat of my pants, I was flying blind and doing the best I could.

是以，我只能盲目飛行，盡力而為。

I got in a supervision group with some of the really early folks who were doing DID work and made my first debut at the ISSTD conference in 1986.

我和一些早期從事 DID 工作的人組成了一個監督小組，並在 1986 年的 ISSTD 會議上首次亮相。

Nice.

不錯。

When I was a wee six years old.

在我六歲的時候。

I wasn't quite at the conferences yet.

我還沒有完全進入會議狀態。

Give me 10 more years.

再給我十年時間

That is funny.

真有趣。

Yeah.

是啊

It feels like yesterday and it feels like a lifetime.

一切恍如昨日，又恍如隔世。

So time is weird.

時間就是這麼奇怪。

I bet.

我敢打賭。

It is in that way.

就是這樣。

So what was the journey like for you to start teaching?

那麼，您開始教學的歷程是怎樣的？

I know a lot of folks in this field, there's just a need.

我認識很多這方面的人，只是需要而已。

And once you know something, you want to share it.

一旦你知道了什麼，你就會想要分享它。

What was that trajectory like for you?

你的人生軌跡是怎樣的？

Well, it was really wonderful.

嗯，真的很棒。

I think I'll talk about my own personal experience.

我想我還是談談自己的親身經歷吧。

I have always loved teaching and actually thought I would be a teacher and instead became a nurse who became a psychotherapist who became a teacher.

我一直很喜歡教書，實際上我也曾想過要當一名教師，但後來卻成了一名護士，後來又成了一名心理治療師，後來又成了一名教師。

So it was sort of this roundabout thing.

就這樣迂迴前進。

So I liked it and I found some wonderful mentors in ISSTD who encouraged me to write, to give some presentations.

所以我很喜歡它，我在 ISSTD 找到了一些很好的導師，他們鼓勵我寫作，做一些演講。

I was so anxious and nervous, of course, as we all are when we first start out.

當然，我非常焦慮和緊張，就像我們剛開始工作時一樣。

But I remember that support of these people that I thought were way up here was really wonderful and it was instrumental in helping me get the confidence to get out there and to try things with them and kind of get my feet on the ground with it.

但我記得，這些我認為高高在上的人對我的支持真的很棒，這有助於幫助我樹立信心，走出去和他們一起嘗試各種事情，讓我的腳踏實地。

So I would say those mentors are really important.

是以，我認為這些導師真的很重要。

And I feel the responsibility as an older clinician to offer that to as many people as I can because it really facilitates the therapist development.

作為一名年長的臨床醫生，我覺得自己有責任為儘可能多的人提供這樣的機會，因為這確實有利於治療師的發展。

That's one of the things I so appreciate about ISSTD, and I'm sure this exists in other places, but it does feel a little bit unique, particularly in academia, where there's a real sense of leaning towards younger generations and going, yes, you've got this, you're doing it to help build that confidence that I think most people need in that transition from, what is happening in front of me?

這是我非常欣賞 ISSTD 的一點，我相信其他地方也有這種情況，但它確實有點獨特，尤其是在學術界，那裡有一種真正向年輕一代傾斜的感覺，並且會說，是的，你已經得到了這個，你這樣做是為了幫助建立信心，我認為大多數人在從 "我面前發生了什麼 "過渡時都需要這種信心。

I have no idea what this is to, okay, now I have a sense of what this is, now I understand it somewhat.

我根本不知道這是什麼，好吧，現在我知道這是什麼了，現在我有點明白了。

Let me start talking about it.

讓我開始說吧。

There's that sort of crisis of confidence can come up or just for anyone who's public speaking, right?

任何人在公開演講時都會遇到這種自信危機，對嗎？

Standing in front of a big group.

站在一大群人面前

And so having that support I think is so valuable and I see it across ISSTD with people like you said.

是以，我認為這種支持非常寶貴，我看到整個 ISSTD 都有像你說的這樣的人。

It's always been that way.

一直都是這樣。

Yeah.

是啊

You might know their names from publications or books and then you just meet them and they're so humble and encouraging.

你可能從出版品或書籍中知道他們的名字，然後你見到他們時，他們是如此謙遜和令人鼓舞。

And I find that so refreshing and helpful for everyone, right, because the more people get help.

我覺得這讓人耳目一新，對每個人都很有幫助，對吧，因為得到幫助的人越多。

That's right.

這就對了。

And that's how you become an expert and a good therapist.

這樣你才能成為一名專家和優秀的治療師。

Yeah.

是啊

So you've written a ton and some pretty, I would say, you've written on complex topics.

你寫過很多文章，我想說的是，你寫過一些非常複雜的話題。

I love your presentations, I have to say, because you'll have a really complex, something to communicate and then there'll be this slide of like a flamingo with feathers sticking out or something really funny to teach to it.

不得不說，我喜歡你的演講，因為你會有一個非常複雜的、需要交流的東西，然後會有這樣一張幻燈片，就像一隻伸出羽毛的火烈鳥，或者一些非常有趣的東西來教導它。

One thing today I was like, oh, I'm meeting with Kathy, but we're not going to have any slides.

今天有一件事，我想，哦，我要和凱西見面，但我們不會有任何幻燈片。

Yeah.

是啊

Those funny animals.

那些有趣的動物

But you've written a lot, you've taught all over the world and I'm curious how you just today, as you sit here now, would define dissociation to folks listening?

但你寫過很多文章，在世界各地教過書，我很好奇，就在今天，就在你坐在這裡的時候，你會如何向聆聽的人們定義解離？

Oh my gosh.

我的天啊

You know, this is not a short conversation, is it?

要知道，這可不是一次簡短的談話，不是嗎？

I think I've come to understand that almost everybody has their own definition of dissociation and I have mine.

我想我已經明白，幾乎每個人都有自己對 "解離 "的定義，我也有自己的定義。

Right.

對

So I'll share mine, which of course I think is the right one, but everybody has a little bit different perspective on it.

是以，我將與大家分享我的觀點，當然，我認為我的觀點是正確的，但每個人對此都有一些不同的看法。

I think because we have, over the course of the history of dissociation, we've incorporated so many different ideas that we keep adding to the definition instead of keeping it narrow.

我認為，在解離症的歷史進程中，我們融入了太多不同的想法，以至於我們不斷增加定義的內容，而不是保持定義的狹義性。

Some of my colleagues have really argued for keeping it narrow.

我的一些同事確實主張保持狹窄的範圍。

I think the barn door has closed on that one.

我想穀倉的門已經關上了。

So I sort of try to divide it up into four parts based on what treatment approach is going to work, right?

是以，我嘗試根據治療方法的效果將其分為四個部分，對嗎？

Because not all dissociation is the same.

因為並非所有的解離都是一樣的。

And so the first kind of dissociation that we talk about that's most common is the checking out, spacing out, not being present.

是以，我們談論的第一種最常見的解離現象是 "退出"、"疏離"、"不在場"。

And of course, the thing we focus on most with that in terms of treatment is mindfulness, being present, grounding, whether that's somatically or using the ventral vagal system, all kinds of ways to get people grounded.

當然，在治療方面，我們最注重的是正念、存在感、接地氣，無論是通過軀體還是使用腹腔迷走神經系統，各種方法都能讓人接地氣。

The second way people talk about dissociation, and I'm talking about this in the literature, is sort of the dorsal vagal shutdown, right?

人們談論解離的第二種方式，也就是我在文獻中提到的那種背迷走神經關閉，對嗎？

I think Stephen Porges talks about it as dissociation, and Alan Shore talks about it as dissociation.

我認為斯蒂芬-波爾格（Stephen Porges）將其稱為 "解離"，艾倫-肖爾（Alan Shore）將其稱為 "解離"。

It really is a physiological condition in which you're just not in contact with the present moment.

這確實是一種生理狀況，在這種狀況下，你根本無法接觸到當下。

But the treatment of that, of course, is to work with that physiological shutdown.

但治療的方法當然是配合生理關閉。

Somatically.

身體方面

And we often use the polyvagal theory to do that, and there are lots of ways to get people more activated and in their window of tolerance.

我們經常使用 "多瓣膜理論 "來做到這一點，有很多方法可以讓人們更加活躍，並處於他們的容忍窗口期。

So that's the second one.

這就是第二個。

The third one is this murky, murky world of depersonalization and derealization, which is kind of like a perceptual issue.

第三種是人格解體和去人格化的陰暗世界，這有點像知覺問題。

If we think about checking out, that's more cognitive and attentive.

如果我們想退房，那就需要更多的認知和注意力。

But depersonalization is more a perceptual problem, like I perceive myself as not being real or the world around me is not being real, that kind of thing.

但人格解體更多的是一種感知問題，比如我覺得自己不真實，或者周圍的世界不真實，諸如此類。

I think the jury is still out on a totally effective way to treat depersonalization disorder, but it seems to involve all of the components that we're familiar with, like mindfulness, getting present in the body, learning emotional tolerance and regulation, those kinds of things.

我認為，治療人格解體障礙的完全有效方法還沒有定論，但它似乎涉及我們熟悉的所有組成部分，如正念、身體呈現、學習情緒容忍和調節，等等。

And then we've got DID-like phenomenon over here, which is all about parts.

我們這裡還有類似於 DID 的現象，它與部件有關。

Yeah.

是啊

And so I just think that's a more encompassing type of dissociation, where you've not just got attention or perception, you've also got emotion, and you've even got sense of self that is dissociated, right?

是以，我認為這是一種更全面的解離類型，在這種類型中，你不僅有注意力或感知，還有情感，甚至還有被解離的自我意識，對嗎？

And that requires treatment that involves all of the other treatments, plus working with the parts to improve integration.

這就要求在治療過程中採用其他所有治療方法，並與各部分配合，以提高整合度。

Yes.

是的。

I really appreciate how you've organized it, because you can just breaking it down into those four parts.

我非常欣賞你的組織方式，因為你可以把它抽成這四個部分。

I mean, sometimes, as you've just said, all four are alive, and so you're working with each of them.

我的意思是，有時候，就像你剛才說的，四個人都活著，所以你要和他們每個人一起工作。

Right.

對

And they're often alive in the same client, right?

它們經常在同一個客戶那裡活著，對嗎？

So yeah, I think for people who have DID, they have other of those experiences all the time, because they're substrates of the DID, yeah.

所以是的，我認為對於患有 DID 的人來說，他們總是會有其他這些經歷，因為它們是 DID 的基質，是的。

So with all of that understanding, what do you...

那麼，在瞭解了這一切之後，您...

Are you still in private practice?

你還在私人診所工作嗎？

Yeah.

是啊

Do you still...

你還...

Yeah.

是啊

What do you still find tricky about dissociation when you're sitting with it?

當你面對解離時，你還會覺得什麼地方很棘手？

Well, I think it's the avoidance, right?

嗯，我覺得是逃避，對嗎？

And even if we think about comorbidity, like personality disorders, I don't really like that term.

即使我們考慮到合併症，比如人格障礙，我也不太喜歡這個詞。

You could talk about personality accommodations in some way, but even those are all about avoidance, and so I've sort of stripped it down to this.

你可以用某種方式來談論性格適應，但即使是那些也都是關於逃避的，所以我把它歸結為這一點。

Maybe it's too simplistic, but the biggest struggle in dissociation is avoidance, whether that's avoidance of your own inner experience, avoidance of relationship, avoidance of what's presently, or avoidance of the trauma.

也許這太簡單化了，但解離過程中最大的掙扎就是逃避，無論是逃避自己的內心體驗、逃避人際關係、逃避現在，還是逃避創傷。

That's the tricky part.

這就是棘手的地方。

And I think the other hardest part for me, and I think for most therapists, are the relational enactments that happen in trauma, which can occur without dissociation, certainly.

對我來說，我認為最難的部分是創傷中發生的關係形成，當然，這可能在沒有解離的情況下發生。

Yes.

是的。

Yeah.

是啊

I agree in that the avoidance is such a challenging thing to work with, and I see this push-pull between treatments that want to really get in there, let's go to the root, let's pull it up, let's find it, let's fix it, which is understandable.

我同意，迴避是一項極具挑戰性的工作，我看到了治療方法之間的推拉作用，這些治療方法想要真正深入其中，讓我們去根，讓我們把它拉起來，讓我們找到它，讓我們解決它，這是可以理解的。

Of course, we all want to fix it, right?

當然，我們都想解決這個問題，對嗎？

Client wants to fix it.

客戶希望修復它。

Therapist wants to fix it.

治療師想解決這個問題。

Everyone wants people to feel better.

每個人都希望人們感覺更好。

But then there's this edge, and this is probably what I find most challenging to navigate, especially when you're speaking in general terms.

但還有一個邊緣，這可能是我覺得最難駕馭的地方，尤其是當你泛泛而談的時候。

I think it's a little more approachable when you have a person in front of you to try to find this edge.

我認為，如果有一個人在你面前，你就會更容易找到這種優勢。

But even then, very challenging of like, what's enough for today, right?

但即便如此，也非常具有挑戰性，比如，今天就夠了，對吧？

Where we're not in avoidance, and we're not in dive into the trauma and get completely overwhelmed by it.

我們不會逃避，也不會沉浸在創傷中，被它完全淹沒。

But how do we determine together what's an appropriate chunk?

但我們如何共同確定什麼是合適的大塊？

And I feel like that is such an ongoing process as a therapist sitting with someone, because you start to feel if there's a few weeks in a row where something's not being addressed, it starts to feel kind of dull or not alive, or there's too much being addressed.

作為治療師，我覺得這是一個持續的過程，因為你會開始感覺到，如果連續幾周沒有解決某些問題，就會開始覺得枯燥乏味或沒有活力，或者解決的問題太多。

Maybe it's a swift enactment or calls in between, or some kind of sense of things exploding.

也許是迅速的頒佈，也許是中間的呼喚，也許是某種事物爆炸的感覺。

I'm wondering if you've developed, what has contributed to your sense of that and finding that pace or rhythm?

我想知道你是否發展了這種感覺，是什麼促使你找到了這種節奏或韻律？

And I think even when we say pace, we assume, oh, it's going to be like I'm running a marathon and I'm at a nine minute mile, and I keep going at that pace, but it's always changing.

我認為，即使我們說速度，我們也會假設，哦，這就像我在跑馬拉松，我的速度是 9 分鐘一英里，然後我一直以這個速度前進，但它總是在變化。

Yeah.

是啊

Yeah.

是啊

I have a lot of thoughts on this, and one is what I've mostly learned.

對此，我有很多想法，其中之一就是我的主要心得。

I've learned from falling off that edge with a client and learning if I don't slow down here, there's going to be trouble.

我從與客戶一起從邊緣跌落的經歷中吸取了教訓，知道如果我不在這裡放慢腳步，就會有麻煩。

But I think kind of taking a historical overview of trauma, there has been debate since time immemorial when people have written about trauma, about whether we go in and do the work or whether we don't do the trauma work.

但我認為，縱觀創傷的歷史，自古以來，人們在撰寫有關創傷的文章時，就一直在爭論我們是應該去做創傷工作，還是不做創傷工作。

And that's kind of been the dividing line, right?

這就是分界線，對嗎？

And if you look at military psychiatry, they're always going back and forth with this idea.

如果你看看軍事精神病學，他們總是在這個想法上來回折騰。

And so the idea now about whether people need stabilization or not, it to me is a little bit of a straw man because every client is different.

是以，現在關於人們是否需要穩定的想法，對我來說有點像稻草人，因為每個客戶都是不同的。

So I would never say every client needs stabilization or no clients need stabilization, but it depends on the client.

是以，我不會說每個客戶都需要穩定治療，也不會說沒有客戶需要穩定治療，但這取決於客戶的情況。

It depends on the therapist.

這取決於治療師。

How good is the therapist in helping the client contain and process at the same time and be able to hold that?

治療師在幫助客戶同時控制和處理情緒並保持這種情緒方面的能力如何？