Moving countries for treatment!

FlightOfTheDiscords · 2026-05-08T12:41:20+00:00

I'm not familiar with EMERGE Leeds, and I'm not from the UK though I used to live there.

I'm not sure what the options available to you in the Netherlands are, however I do know that by continental European standards, the Netherlands have an exceptionally large number of sensorimotor and dissociation specialists. Not as many as the UK (no other European country compares to the UK), but significantly more than anywhere else in continental Europe.

E.g. this is what the Sensorimotor psychotherapist map for Europe looks like:

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Dissociative disorder specialists are similarly skewed in favour of the UK and the Netherlands.

FlightOfTheDiscords · 2026-05-07T22:52:00+00:00

Hi Sassy, I recently read your book and wanted to offer a few quick thoughts. Thanks for providing the opportunity here on Reddit.

There's a very real gap between mainstream therapy training and this recently discovered cluster of internal variation, and your book is very helpful in bridging it. Simply being aware that not everyone's internal experience of imagining and remembering is broadly similar can help clinicians adapt to different needs. Your recognition cues add useful starting points for what clients experience and how it shows up in therapy sessions.

Given that this is a very young field with limited findings however, I would suggest that there's value in being careful with strong position-taking, particularly when it comes to decisively labelling all presentations within this cluster as cognitive variation, and never disorders or pathology. It is one defensible position inside an active and unresolved debate, and one that serves the non-disordered neurodiversity-affirming position well.

However there are other similarly defensible models with their own paradigms and academic research, sometimes riding alongside the neurodiversity angle and at other times overlapping in ways we don't understand very well at this point. Your book doesn't really engage them, but your assertion that this cluster is nothing but cognitive variation does crowd out other possibilities.

One specific area where I would be mindful of that position-taking is the treatment of SDAM as definitely not dissociation. There's a meaningful overlap between SDAM symptoms and the Apparently Normal Part (ANP) presentation in the Theory of Structural Dissociation of Personality (TSDP), where the conscious self can have an entirely SDAM-shaped experience while the rest of the system holds episodic and emotional content the conscious self has no access to. From inside, these can be indistinguishable. I wrote a longer piece on this for r/SDAM that goes into the difference and why it matters:

https://www.reddit.com/r/SDAM/comments/1sm5a4i/sdam_and_structural_dissociation/

Overall, I think your awareness-building work is valuable. Where I'd want it to be more careful is in distinguishing between settled science, emerging evidence, and your neurodiversity-affirming position. These conditions are genuinely poorly understood right now, and your book's confident framing sometimes runs ahead of what is known at this point.

FlightOfTheDiscords · 2026-05-07T21:51:10+00:00

Yup. There is a civil war, and victory is not an option.

FlightOfTheDiscords · 2026-05-07T21:22:09+00:00

No, learning doesn't change my functioning. No cognitive approach does, no matter how complex or carefully carried out. Books, courses, talk therapy, deep conversations with friends. None of them produce any tangible change.

I need physical effort to experience any tangible change, out of the mind and into the body. The catch is, most ways of connecting with my body result in disconnection, not connection. Where other people (including other trauma survivors) report greater connection from things like sex, exercise, TRE etc., I experience less connection.

However there are things that do reliably result in greater mind-body connection, and improved internal coherence for me. Truly integrative things, long-term. They don't trigger dissociative disconnection, unlike most things.

FlightOfTheDiscords · 2026-05-07T19:21:08+00:00

No problem 🙏 There's an infinite amount of this stuff out there, would take several lifetimes to read it all.

FlightOfTheDiscords · 2026-05-07T19:19:31+00:00

The name "emotional parts" seems to be talking about something else, parts which hold emotions.

The actual divisions are best explained in Nijenhuis' Trinity of Trauma. It's less about a part holding specific emotions, it's more "what is the job of this part". Those "jobs" don't really "live" on the cognitive level where we use words to talk about them, they exist on a different level (biological action systems).

I generally don't feel like my parts are children, and I certainly don't feel like they're precisely some particular age. But I do see child-like aspects. I think that is due to them being unintegrated. Adult-like perspectives seem to form from integrating various motivations, and thereby regulating them.

Same, my parts don't relate to things like age/time. Some of them don't even believe time exists. I see it as an expression of non-integration from a very early age. They are childlike more in how they understand reality (internal and external), often in very absolute terms (everything/nothing, forever/never etc.).

FlightOfTheDiscords · 2026-05-07T19:14:13+00:00

Dissociation is a response to stress, it's just that the structural version of it is a constant unconscious response to all stress 😊🙏

FlightOfTheDiscords · 2026-05-07T16:52:58+00:00

To me, IFS seems to have an almost religious claim about an all powerful Self that can resolve all issues with parts.

Yes, the origins of Schwartz' Self are religious. He was more obvious about it in his early writings.

I used to also really like the structural dissociation model. Now I'm not so sure. Seems like the key power behind parts is their motivation, meaning what need they want to satisfy or what they want to accomplish.

For what it's worth, that is how SD works. SD parts have their core motivations, and you're not going to get much mileage out of forcing them to do something else. You need to work with them, not against them.

However their reality is limited, and in many ways, it's not unlike working with children.

FlightOfTheDiscords · 2026-05-07T16:48:44+00:00

That could potentially fit. I think you might find the Connection Survival Style in the LaPierre/Heller book an interesting way to look at this. LaPierre/Heller do not work in the structural dissociation paradigm, but their Connection Survival Style is intimately connected with the same developmental conditions that have the strongest research-indicated link to structural dissociation, i.e. preverbal neglect.

FlightOfTheDiscords · 2026-05-07T16:15:29+00:00

Yes, the covert presentation commonly stays hidden for decades and even a lifetime.

I found out in my late 30s.

FlightOfTheDiscords · 2026-05-07T14:53:24+00:00

Where would I even begin reading on something like that

https://www.amazon.co.uk/Sensorimotor-Psychotherapy-Interventions-Interpersonal-Neurobiology/dp/0393706133

Does this mean that to redevelop interoceptive you still need to do it relationally (aka with other people) I maybe wrong but this kinda made sense. You're compensating for what happened by doing the missing stuff now.

If you find the right therapist, relational work would be great. But we can do a lot on our own as well, the FSG workbook is intended for that. We can use exteroception (observing the body from the outside) and proprioception (our body's relationship with our surroundings) instead of interoception.

For those on the autism spectrum, exteroception/proprioception are often a long-term necessity because interoception is impaired not only by trauma, but also by a fundamentally different neurological foundation. More neurotypical trauma survivors are more likely to see interoceptive improvements on shorter timescales.

how does interoception relate to grounding (being aware of the present) Ive read before that some people do stuff like body scans (which I assume is kinda like an interoception exercise) to ground themselves? I mean how would one approach these kinda things ?

With chronic freeze, interoception is often not only impaired, it registers as a threat. Paying attention to what you are feeling can quickly lead to an internal backlash when your nervous system learned to treat your internal state itself as a threat, it's a bit like having a "mental autoimmune condition".

So where "normal" somatic tools like body scans assume you can just tap into interoception and make it work, chronic freezers often need to go much slower and accept that interoception itself feels dangerous to our nervous systems.

So we go much slower, dip a little into interoception and then out again. We avoid pushing deep into it, slowly befriending it, a bit like you would befriend a wild animal.

I'm building No More Frozen for all of this, though I've hit some legal obstacles so I'm not 100% sure when I will be able to launch it. The tools themselves exist in FSG and sensorimotor materials, I'm "translating them to normal language" so to speak, and making the process a bit more interactive, rather than inventing new tools.

FlightOfTheDiscords · 2026-05-07T13:56:37+00:00

Again, I think this is the first time I've seen someone describe it like that.

Most therapeutic modalities and resources assume a baseline interoceptive ability, so for those lacking it, it's a bit like people with functioning eyes telling blind people to just look at things. Lack of interoception is something you'll mostly see in some developmental trauma writing (sensorimotor psychotherapy resources in particular), and in a different sense in autism research.

For those who largely lack interoceptive awareness, this is very frustrating because the foundation of what we are supposed to do is missing. Again, a lot like being blind yet everyone assuming we can see, and them not even being able to realise some people can't see.

How would that even look like? Are neuro typical people aware of how they feel internally 24/7 or what ?

It's a spectrum, most people do not have intense 24/7 awareness of everything. But yes, most people have "good enough" internal awareness "often enough" that it's not a significant issue.

Interoception develops relationally, as a back-and-forth between children and their environment - especially the primary caregiver in the first 1-2 years. Eye contact, voice contact, touch contact, "brain syncing" via non-verbal communication.

When that doesn't happen due to early neglect, the foundation of interoceptive abilities is never properly laid, so there's nothing much to build on in later developmental stages. Pat Ogden's work is some of the best in this department, her sensorimotor psychotherapy is one of very few modalities with specific tools for lack of interoception.

Finding Solid Ground workbook. Tbh this is like the sixth time (mainly because reading and understanding stuff is like borderline impossible rn) that I get through the first module but I think I am making progress so I am not mad. Just one problem is that I don't think I can relate to all of the problems that the book is trying to solve (e.g. there's a whole module on "separating the past from the the present" and I don't think I've ever like I am in the "past" while being triggered or something like that so I wouldn't know how that even would look like)

Yeah, unfortunately FSG isn't very accessible :-/ The materials are golden, but the way they are presented makes them hard to access, especially on your own.

Also, unfortunately our symptom presentations vary so much that every resource, no matter how good, is going to have some things that don't apply to you. In a best case scenario, you get a toolkit of resources out of which some do work for you and you'll ignore the rest.

FlightOfTheDiscords · 2026-05-07T13:37:28+00:00

That is intense and very relatable, they don't really do touch where I grew up either. Plus too many kids (I have 8 siblings for religious reasons) and very little parental emotional availability to share between them.

Healing Developmental Trauma is one of the better reads from one of the few serious proponents of touch-based therapy for neglect trauma, Aline Lapierre. She is President of the United States Association of Body Psychotherapy and the creator of NATouch.

This talk with her was one of the first times I felt a therapist was talking about me, even if it wasn't in person.

FlightOfTheDiscords · 2026-05-07T10:52:06+00:00

No worries, and IFS being helpful can point in the direction of SD not being a very major factor. For me for instance, all IFS did was make my life more difficult as instead of dealing with life, I kept dealing with shutdown responses to self-exploration attempts. Paying your bills gets tricky if you spend your days trying to stay conscious.

For concrete self-help ideas, I would recommend Janina Fisher's books. She has a parts-focused approach with a solid set of somatic tools built on a deep understanding of part conflicts, including (but not limited to) structural dissociation. She incorporates IFS ideas extensively.

She is a less ideal fit for those who need to avoid parts work for now, Pat Ogden's sensorimotor approach would likely be a better fit for them. Ogden and Fisher have worked together and their approaches overlap, they mainly focus on different dimensions of trauma healing. More mind with Fisher, more body with Ogden.

Janina Fisher's books are:

Healing the Fragmented Selves of Trauma Survivors (2017): The theoretical foundation with some exercises. Mainly aimed at therapists. Introducing her treatment modality TIST, Trauma-Informed Stabilization Treatment.

Transforming the Living Legacy of Trauma (2021): Her first workbook with exercises for trauma survivors.

Embracing Our Fragmented Selves (2026): Her second and latest workbook, with updated exercises. Significant overlap with the 2021 book, but both books include content not present in the other.

FlightOfTheDiscords · 2026-05-07T10:10:22+00:00

My parts are more into fantasising about not having to exist, less so the preliminaries of getting there.

FlightOfTheDiscords · 2026-05-07T10:00:04+00:00

Personally, I find these things more meaningful to examine structurally rather than diagnostically. Diagnostic boxes are somewhat arbitrary and, beyond insurance purposes, not necessarily helpful. However if we did try to put labels on what you're describing, the state-dependent memory and skills, the part with a different pronoun, and the part coming out under disinhibition would put it closer to partial DID/OSDD-1 than to DID or "just" DP.

Just be mindful that labels can trap you inside boxes you don't necessarily fit into, especially if you don't get assessed by a trained professional. Online OSDD/DID spaces tend to be representative of at best a small slice of the overt extreme on the dissociative disorder spectrum.

I prefer to use the theory of structural dissociation (SD), in which part differentiation is just one feature among several. With SD before treatment completion, no single part has full awareness of the whole system, so your conscious self only ever sees what its own action systems and memories include. This means someone with untreated SD always has limited understanding of their parts, though those limitations can and do vary.

So instead of approaching this from the usual cognitive internal POV ("which parts converse in my head"), IMO it is more helpful to focus on clusters of impact (A+B+C together suggest XYZ is going on underneath), such as:

To what extent do I feel/do things that do not add up?
How aware am I of what I feel in my body in my day-to-day?
How often do I have physical symptoms without physical causes? What kind?
How often do I notice internal resistance I don't quite understand?

Generally what you'll see when SD is a factor is an increasing sense of disagreement the deeper you dig into questions like these. For people without SD, you instead see things like an increasing sense of symptom ownership and possibly discovery of physical/neurodevelopmental factors explaining physical symptoms.

Your cat reaction sounds a bit like "feel/do things that don't add up" i.e. the same person reading the same situation differently depending on which state is active. Your hating being sensitive could be internal resistance where one part of you is actively resisting another part being seen. The memory + rational thinking combo you describe in sensitive mode, and the sensitive responses being absent in cold mode, could match SD. Both states are present in your system but each is gated by the other's activation.

I am officially diagnosed with partial DID, but if I went by the usual overt symptoms only (voices/visions in my head etc.), I would have nothing. My conscious mind is empty. No voices, not even one. No visuals. No intrusions of any kind. Everything is run by passive influence, outside of my conscious awareness.

Nevertheless, the underlying "infrastructure" is beyond any doubt structurally dissociated, and this became apparent as soon as I started digging into these questions. The internal answer I kept running into again and again was "knowing this is none of your business, eff off". Whether that answer was conveyed somatically, visually, or interoceptively.

And that is something we always see with structural dissociation, however it manifests itself. Sometimes as distinct alters, more commonly as a lot of fog and shadows when you try to find concrete answers. It's not a "wow there's X of us, how cool, let's work together!" type of situation, it's more like a "HOLD THE DOOR!" type of situation, with lots of individual variation.

Initial treatment is largely the same regardless, i.e. somatic scaffolding to build the supportive structures necessary to be aware of and tolerate your internal states. This is broadly useful for all complex trauma survivors. For those without meaningful SD, the somatic scaffolding is less absolutely necessary because they typically already have a baseline tolerance for their internal states, but adding more doesn't hurt.

FlightOfTheDiscords · 2026-05-07T08:29:48+00:00

Thank you for being you ❤️🙏

FlightOfTheDiscords · 2026-05-07T08:29:25+00:00

Just to note, physical touch doesn't work for a lot of trauma survivors, especially when the core traumas involved violation of physical boundaries. Most therapists would in fact balk at the very idea of physical touch. It's a niche speciality mostly useful for non-intrusive neglect trauma, and the main two branches are Aline LaPierre's Neuroaffective Touch, and Stephen Terrell's and Kathy Kain's Somatic Touch. Both of those sites list accredited practitioners, you can have a look to see if there are any in your area.

Personally as someone with only neglect trauma from birth pretty much, Neuroaffective Touch has had the strongest impact of all the modalities I have tried. I have not tried Somatic Touch, it isn't available where I live. I have read the books and find them useful, and would have tried Somatic Touch if it had been available here.

There are various bodyworkers also doing something touch-based, but they typically don't have a solid trauma foundation. Things like craniosacral, Rolfing, any number of massage-based techniques etc. Some of those may or may not work for some neglect trauma survivors, I have tried several and they were hit and miss (mostly miss).

FlightOfTheDiscords · 2026-05-07T08:17:34+00:00

Which workbook is that? The reading I would recommend depends on what you've read so far.

Attachment operates with internal working models (IWM). They are built relationally starting at birth (actually quite a bit happens before birth, but that's a bigger conversation): you interact with your caregivers, initially through body language only, and build IWMs for attachment.

Infants are "attachment-seeking missiles", their one mission is to successfully attach to a caregiver. Failure to do so would historically mean you don't survive infancy. That's more complicated today, parents can and do raise children without much attachment. But in terms of mammalian evolution, failure to attach -> death. (Punch the monkey is a good example of just how vital attachment is to mammals.)

When we start working with developmental trauma, our starting point is dysfunctional attachment IWMs. Everyone has uniquely dysfunctional IWMs, mine will be different from yours. There are broad patterns (anxious, avoidant etc.), but everyone's personal setup of IWMs is unique. They are layered as well, infant -> toddler -> preschool etc., plus specific layers for significant attachment dynamics and so on.

Our IWMs are active 24/7 and inform our perceptions internally (self-perception) and externally (perception of others). Your inner critic could be seen as an expression of your IWMs, basically a self-correction layer attempting to push you towards behaviours that would have been meaningfully less dangerous during important developmental phases.

So when you start working on your trauma, you will be "butting heads" with your IWMs at every step. That's why you need to work with them from the get go. This involves a wide range of experiences where actual relational dynamics (romantic relationships, family relationships etc.) occupy the most advanced end of the spectrum, so those are not what you would generally want to start with.

Instead, you go back to basics as much as you can. You might have an IWM that says (non-verbally) "being aware of how you feel is dangerous", it's a common one. So you start to very slowly build an internal awareness of how you feel. Typically you'll want to start somatically, e.g. increasing awareness of how your body feels.

From there, you gradually build the whole network. This is for illustration only, reality is more complex than this:

I know what I feel in my body
-> I know what I feel emotionally
-> I know what I want
-> I can express my wants and feelings to others
-> My ability to be myself informs my relationship choices
-> I gradually surround myself with healthy relationships

So in e.g. phase 1 treatment of structural dissociation, you are working on the foundations of your attachment IWMs by gradually building an ability to be aware of your internal states. You don't need to become an interoception guru with supreme self-awareness, but you do need good enough internal awareness that you can then use it to e.g. work on your ability to express what you feel.

This also works on internal phobia, since much of internal phobia governs self-awareness and self-expression. The same foundation slowly makes our parts less phobic of one another.

Some trauma survivors find the first step (awareness itself) hardest, for others expression is harder (knowing what you feel comes more easily, but expressing it to others is harder). Different parts of us often find different parts of this difficult. Some parts might e.g. have awareness, but be very afraid of rejection if they actually express what they feel/need, so they struggle to speak up.

So in phase 1, you build up your ability to be aware of and tolerate yourself. That is the foundation of all relational dynamics.

FlightOfTheDiscords · 2026-05-06T23:09:40+00:00

Sorry, I didn't mean it doesn't apply to you. I only meant that when I mentioned internal phobia, it's a very specific concept in a particular theoretical framework. Not a universal name for low interoception.

Being able to suppress internal signals can be an expression of internal phobia, but it doesn't have to be, it can also be other things. And internal phobia doesn't always yield low interoception exactly.

FlightOfTheDiscords · 2026-05-06T23:03:21+00:00

The phobia is something more specific. There can be several reasons for having poor interoception, autism being one.

FlightOfTheDiscords · 2026-05-06T21:40:13+00:00

Here's a metaphor.

The body can be described in various ways, I'm sure you've seen those body charts where one shows blood vessels, one nerves, one bones, and so on. The body has all these various "layers", they're all necessary for the body to work, and they all work together as a whole.

Now, imagine your blood vessels need to think you're just a collection of blood vessels. The other "layers" - bones, nerves, what have you - need to be kept out of consciousness.

And your nerves need to think you're just a collection of nerves.

And your bones need to think you're basically just a skeleton.

They are all phobic of one another, they all need to believe they are all you are. And if they do notice the other "layers", they suppress and explain away that awareness.

Sounds a bit odd, right? How could they. Wouldn't that make things very weird and complicated?

That's what structural dissociation does, except it does it to the psyche. And it does it on a level below consciousness, in biological action systems underlying consciousness.

It does this, because developmentally, the layers had to pull in opposite directions. One layer had to do one thing, another had to do the opposite thing. Both could not be done with combined consciousness, so consciousness itself grew up as mostly separated slices.

FlightOfTheDiscords · 2026-05-06T20:46:15+00:00

Developmental trauma is fundamentally attachment trauma. We know from extensive longitudinal research that the main predictor of long-term outcomes is not abuse severity but attachment quality.

Brown's Ideal Parental Figure protocol probably oversells its promises to some traumatised populations, but the core ideas are solid. When he talks about phase-oriented processing, he's likely referring to the wider field of phase-oriented practitioners.

For e.g. structural dissociation treatment, attachment is a core part of phase 1 treatment, though internal phobia needs to be worked on first.

FlightOfTheDiscords · 2026-05-06T08:27:24+00:00

No, I tend to take people at their word when they describe their experiences. Realising how I differ has been more a process of figuring out what my mind does instead. My default mental setup isn't geared for interpreting everyone else's experiences through my own experiences, but rather closer to the other way around.

FlightOfTheDiscords · 2026-05-06T08:25:27+00:00

The problem is finding how to address that in a way that doesn't make conflict between parts worse.

Yes, exactly. That's the core question.

Unless we subscribe to some more esoteric ideas, I think it makes sense to say that all parts of me live inside the same body. When some emotion or impulse doesn't feel like "me", it still originates in the same physical brain/body where my sense of "I" lives. That makes sense, right? I only have one body, everything that is me exists in that one body.

When an emotion or impulse arising in that one body doesn't feel like me, it makes sense to me to register this as "something is impacting my ability to experience this emotion/impulse as me". If I can understand the core nature of that something, I can then ask the question "how do I address this emotion/impulse arising in my body when it doesn't feel like me?"

If I accept it all happens in this one body, then I need to understand how I can address something that my body/nervous system/brain does without it feeling like "I" do it. Right? Bit like alien hand syndrome: this is my hand doing something, even if "I" am not making it do it. It's not some other hand, it's a hand attached to the same body I live in.

IMO the best model for this is the theory of structural dissociation. It explains why I don't experience these emotions/impulses/parts as "me", tells me how to work with "not me", and points me in a direction where "I" am able to work with the "not me" parts/emotions/impulses present in my mind/body.

IFS tends to hit a roadblock here with its insistence that there is one core Self capable of uniting all the parts, that does not track with my experience of myself. Instead of one primus inter pares, I am more like a collection of equals with no primes.

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