#012 Erin Lewis

Erin Lewis: [00:00:00] A lot of people defined association based on symptomology. Mm-hmm. When really, it's really a way that you encode memory, like you're storing memory into the body. So you have like flash bulb memories. You have like your stereotypical, like you both are looking at me right now, and then like it's going into your working memory.

Erin Lewis: Maybe you'll throw it out later. You won't remember this moment potentially. Or maybe you'll hold onto it forever. Who's to say like, sure. Um, but essentially when you have dissociation, it's. Imagine kind of like a grate in front of you of your perception and like the picture of my face, for instance, that you're looking at goes through and then it feels like, it's like, it's like a million little pieces.

Erin Lewis: Like a million is probably like an under store. Mm-hmm. Understated because of the brain, right? Like but either or, essentially like you're not getting the snapshot. Like we don't record in video. A lot of people are like, oh, I see video, like, No, it's like you have snaps, but then when your average snap shots of your memory actually like goes through it, great.

Erin Lewis: All of a sudden [00:01:00] it's like, okay, well the sound might actually store somewhere else then where the picture and image stores and then like the feelings that you somatically held.

Justin Mclendon: Our goal in creating Finding New Waters is to provide a resource for families to help navigate the complexities of supporting a loved one through the struggles with substance use and mental health. When we find ourself in a crisis due to one of these issues, most people have no idea where to turn. We hope to shed some light into what is often the darkest hour for many families.

Justin Mclendon: So today on Finding New Waters, uh, we have our guest, Erin [00:02:00] Lewis joining us today. I'm also joined by Dr. Harold Hong, the medical director at, uh, new Waters Recovery, and as we were discussing many other things as well. Um, Erin Lewis, Ms. Uh lc, m h c n a r m, and master Therapist is a somatic psychotherapist specializing in dissociative disorders and trauma treatment.

Justin Mclendon: Erin began her career in healthcare, working in nursing homes, primarily on the dementia care unit and rehabilitation unit as a certified nursing assistant. This is where she became passionate about mental healthcare, and later, later began working in a residential transitional group home for individuals with acute psychotic disorders.

Justin Mclendon: For several years, Aaron became passionate about the trauma treatment clients were. Receiving, which resulted in their choosing resulted in her choosing a specialty in trauma treatment. Upon having worked in different levels of care, Erin became intrigued with clients who reported [00:03:00] experiencing dissociation.

Justin Mclendon: Erin then decided to receive training and specialized in dissociative disorders, primarily focused on dissociative identity disorder, or d i d. Erin is the co-owner of NC Cutting edge counseling. An advance, an advanced trauma treatment outpatient group practice that bridges the gap between research and clinicians to give individuals with trauma the most effective treatment to date.

Justin Mclendon: Erin lives with d i d and runs community groups for people with d i d. She is involved in with D I D research and educates trains and consults with clinicians on how to treat dissociative disorders. Erin lives with her husband and three dogs in North Carolina where she enjoys connecting to God.

Justin Mclendon: Through Bible study, running comedy, nature, dog walks, hiking and music. Love it.

What

Erin Lewis: kind of music do you like? Aaron? Um, so obviously Eminem is the greatest rapper of all time. Love. [00:04:00] I'll just go on record saying Love Max. Mm-hmm. Um, but also, I mean the rap genre. Okay. Period. Cool. It's just like, so Chan like acid rap, you go back to like Throwback Tupac and Biggie.

Erin Lewis: I like 'em both. All of it. Um, Halsey's good too. Yeah.

Justin Mclendon: Okay, cool. I love that. Love that. So I know we've read a little bit about your background, but maybe we could start with you just shedding a little bit more color, right? Like, Why'd you become a therapist? Why? Why the interest, right?

Erin Lewis: Yeah. So I actually was one of those people that was like, I hate therapists, I hate therapy.

Erin Lewis: I hate the whole, like burn it to the ground kind of a person. Right? And then I think it was cuz I, um, being in the nursing homes specifically, I would see all of these really like, Problematic. Um, clients or patients, really residents of the nursing home. And it wasn't that they were problematic, they were just weren't, weren't receiving the right treatment and they were really being overlooked.

Erin Lewis: I mean, from bipolar to schizophrenia to P T S [00:05:00] D. And I was just like, There has to be a better way. Mm-hmm. For like, especially at the end of life. Towards the end of life. Mm-hmm. Um, or you know, even if you've had a stroke and now you have to live in um, one of these facilities to help. I felt like there had to be some, like, what is missing?

Erin Lewis: And then like, I looked at the staff roster cuz then I was actually gonna go into, um, an administrator type of position. I was looking into going into that like running, um, Uh, not hospitals necessarily, but more nursing homes were my focus. And then I was like, where are the staff therapists? Fun fact, nowhere, like there's occupational therapists.

Erin Lewis: And I was like, the, this is the wrong kind of therapist. It, it felt like mm-hmm. I was like, okay, well what's, what's the gap here? What's missing? Mm-hmm. And then when I went and started working at, um, As a case manager or like, it's a, called a care coordinator at mm-hmm. That place, it's a case manager though position at, um, [00:06:00] a group home that was specific to acute psychosis.

Erin Lewis: Mm-hmm. And it was really like the testing ground. If you're gonna go in the state hospital for an extended period of time, many years, or if you're gonna be able to. Ever go back out in the community. We were that testing ground. So it was like very heightenedly acute. And I was like, okay, crisis work is all right.

Erin Lewis: You know, like I, it was just like that adrenaline. Mm-hmm. And then I was like, oh, I didn't realize that at the time. That was my own trauma. Things that like, right. I love being in crisis. Not me personally, but like helping people through crisis. Um, I have this calm that starts to like, Oh, things feel right, which is the opposite.

Erin Lewis: I learned of like a lot of the, you know, someone's like setting the house on fire, somebody's throwing chairs, and I'm like, all right, well, like let's just figure it out and Right. Yeah. I was like, I think that I want to be a trauma therapist. And so then, you know, many years later after the schooling, um, And think I'm actually [00:07:00] going back to school in, uh, two weeks for my PhD Oh.

Erin Lewis: Good's when I I to start. Wow, cool. Um, specializing in trauma, which is kind of silly. Um, I was like, was it silly? Because it's like I already specialize in it and I feel like I'm cheating. I don't know. I was like, maybe I should do addictions or something I don't like, makes it up a little. Um, so that's really how I got into like the therapy world.

Erin Lewis: Before that I was, um, Also like pre-med, I was very much like biochemistry nerd. Okay. Uh, and then I was like, oh, I think I wanna sit and talk to people actually. Mm-hmm. You know, like, um, also organic chemistry is the worst. Hats off to you.

Dr. Harold Hong: I, those are tough days. Dark days in days. Actually, it's, there's trauma there.

Dr. Harold Hong: Actually, we could probably talk about that and probably some dissociation. Certainly

Erin Lewis: I believe it. It's like, what are these covalent bonds? And I was like, oh no. Yeah, just, [00:08:00]

Justin Mclendon: yeah. Oh goodness. So trauma. So, you know, so one thing that comes up for me, uh, is dissociative disorders is, you know, maybe even just starting with like, what is dissociation?

Justin Mclendon: Right? Like, what does that even look like? Mm-hmm. Where does it come about?

Erin Lewis: So a lot of people defined association based on symptomology. Mm-hmm. When really, it's really a way that you encode memory, like you're storing memory into the body. So you have like flash bulb memories. You have like your stereotypical like.

Erin Lewis: You both are looking at me right now and then like it's going into your working memory. Maybe you'll throw it out later. You won't remember this moment potentially. Or maybe you'll hold onto it forever. Who's to say like, sure. Um, but essentially when you have dissociation, it's imagine kind of like a great in front of you, of your perception and like the picture of my face, for instance, that you're looking at goes through and then it feels like it's like, It's like a million little pieces.

Erin Lewis: Like a million is probably like an under story. Mm-hmm. Understated because of the brain, right? Like, [00:09:00] but either or, essentially like you're not getting the snapshot. Like we don't record in video. A lot of people are like, oh, I see video, like, No, it's like you have snaps, but then when your average snap shots of your memory actually like goes through a grate, all of a sudden it's like, okay, well the sound might actually store somewhere else then where the picture and image stores and then like the feelings that you somatically held, um, or like your body feelings can store somewhere else.

Erin Lewis: And then like, so then you have all these fragmentations. So let's say you went through like a trauma. I don't know. I clap my hands. This is traumatic for some reason right now, right? Sure. Yeah. So there's a part like if we're dissociated, right? Like so a part is gonna hold that like sound of clapping, then there's gonna be another part that's gonna hold my voice likely and whatever I am actually saying.

Erin Lewis: And then there's another part that's holding that like body memory, like that's as simple as I can break it down. Essentially, it's the way that you store memory, okay? And it [00:10:00] happens. Um, Commonly in ptsd, it actually happens commonly in um, Every disorder there is. If honestly, so when we look at like, even major depression, like severe major depression where it's like, I can't get out of bed every day is the same day over and over again.

Erin Lewis: What month is it? Like there's a level of dissociation there? Um, now when you look at it from like more of a trauma lens, there's different types of dissociation. So let's say I was handcuffed to this chair and I'm dissociating or something, right? Like. Potentially later on when I'm processing with my therapist or something, my actual left hand could go numb completely.

Erin Lewis: Mm. Not my whole entire body necessarily. That could happen as well. Mm-hmm. Right. Like, so then it's like very selective, like dissociation of like, oh, now I, now my hand is numb. I can't feel anything. Interesting. So there's so many different types of dissociation, um, but it's like, so depersonalization, derealization, for instance.

Erin Lewis: Mm-hmm. An episode [00:11:00] of that happens to 52% of the United States population at least once. So it's, it's very common. Um, so is that a

Dr. Harold Hong: type of dissociating, depersonalizing, dere? Those are specific types Yes. Of dissociation.

Erin Lewis: Definite. It's definite over time. So it's kind of like, Also I had, since I had my, um, start of my career in psychosis, I, a lot of times I'll be like, oh, it's kind of like that.

Erin Lewis: But, so it's not like psychosis just to say uhhuh, but like, I'm making this comparison of like, um, so essentially like once you have certain delusions and you have like a psychotic break, let's say, and let's say you think you're God or something, uh, delusions of grandeur that you're having. Then you come back to reality, you're on medication or whatever.

Erin Lewis: Mm-hmm. You stop taking your meds or something, then you go back to that same delusion. Usually it's along the same lines. Mm-hmm. So dissociation. Sometimes people dis dissociate from their body [00:12:00] specifically, or even their identity where it's just like, Am I a person? Like what's happening? Sometimes it's the environment though.

Erin Lewis: Mm-hmm. Right? Like, it's like, oh, this isn't real, you know? Sure. Like, or maybe it is like, and everything kind of feels like farther away. Um, so if you think of like shock, this is, your body is taking in too much at one time to, to really like take it in. Mm-hmm. Yeah. So it has to store in other places. So those are unprocessed memories.

Erin Lewis: Um, Yeah, I love memory. I can go into memory forever, but I love

Dr. Harold Hong: that. Yeah. Like for, for, for people out there who aren't professionals, um, what are some signs that like a loved one is, It's dissociating,

Erin Lewis: so it can actually be very difficult to catch. Okay. Um, you might not know it or it can be profound.

Erin Lewis: Everything's on a spectrum. So slight dissociation. I mean, even you driving like let's say on a long road trip for a [00:13:00] hundred miles. Mm-hmm. You don't remember 60 of those miles cuz you're thinking about. Oh, spaghetti. Now I'm thinking about spaghetti, but just, or whatever food that like you're thinking about or, yeah.

Erin Lewis: Daydream about like wherever you're gonna be your destination now. Like you've not encoded that entire strip of land, which is 60 miles, right? Like. That's a ti. So like, it's kind of, it can also be kind of like daydreaming. Mm-hmm. So it's just like they're kind of not there, or they can like, have this stare, it's like the thousand mile stare.

Erin Lewis: Mm-hmm. Um, where it's just like, what sometimes if you talk to them as what, like this is more on the profound end. Mm-hmm. Um, sometimes when you talk to them, they take a while to respond. So it can be like, Hey, how are you? And there's like, They're really like, it's, it's taking them some time to mm-hmm. Get that cognitive awareness because they're somewhere else.

Erin Lewis: Um, so it can look like that. Um, how else can it look? It can I treat like a lot of the severe side [00:14:00] of dissociation? So what I'm thinking is sometimes people are so afraid and terrified and frightened, just like. Talking in a room with somebody, uh, that they're almost non-verbal or completely non-verbal, that can be, that they're dissociating.

Erin Lewis: It's just too much for them. They're too afraid, right? Um, it can look like all of those things. Sometimes it looks like. Um, so because like I have d a d, right? So I associate fairly often all the time, right? Like, so my husband for instance, he'll be like, oh yeah, we're going to uh, party Saturday. I'm like, cool, cool, cool, cool, cool.

Erin Lewis: And then it'll be like 30 minutes later and I'll be like, Hey, Saturday I was thinking that we would like, uh, go to this place or do this thing. And he's like, So we're going to that party and he is like, just let you know. And I'll be like, right, right, right, right, right. So I like, if you're planning something, you gotta write it down.

Erin Lewis: That's all kind of a thing, but that's like a common one. Um, it's more than [00:15:00] mindlessness though. So if you think of mindfulness, the opposite mindlessness as like you leave cabinets open or something. Right. That's kinda like your mind is somewhere else, but that's not necessarily dissociation just to like, Bridge that gap a bit.

Erin Lewis: Mm-hmm. Yeah. Um, but yeah, those are some ways that

Dr. Harold Hong: because there's, there's being distracted, right? So if, if my wife is, uh, talking to me about errands for the weekend, but I'm thinking about like, Being on call for the weekend, I might just miss a detail. Yeah. That's distraction, not

Erin Lewis: dissociation. Yes.

Erin Lewis: Dissociation is like, oh, I'm paying attention to you. I'm like, yes, I'm in it with you. And then all of a sudden it's like, so it like a lot of times with dissociative identity disorder specifically or like more, um, even O S D D on the size of dissociation. Yeah. That's more profound. It's like they're listening.

Erin Lewis: It's not, they're not necessarily even distracted by anything. Mm-hmm. They're listening and. It's just [00:16:00] gone. And a lot of times they don't know that it's gone until you start doing like these timelines and it's like, oh, they think that they remember everything and they're like, yeah, yeah, yeah, yeah, yeah.

Erin Lewis: Like they're covering a lot. Yeah. And they might not even know that they are covering, cuz this is really a disorder of hiding. Right? So then you do these timelines and it's like, oh yeah, I don't remember second grade or third grade or fourth grade. And all of a sudden it's like, oh, you don't remember 10 years of your life?

Erin Lewis: You know, and or however long, right? Like it could be even more or less. Um, but yeah, distraction is different than dissociation for sure. So

Justin Mclendon: I'm wondering, um, what's happening like neurologically there, like is there something that's kind of going offline or like any, any thoughts on that?

Erin Lewis: Oh yeah. I am a neuro nerd.

Erin Lewis: Okay. Yeah. So let's do that. So, um, we find a couple of interesting things in a brain with d i d We don't know everything that's happening. Mm-hmm. It is widely [00:17:00] being researched and it has been for the 10, the last 10 years or so, however, so there's this, um, hypothalamic pituitary adrenal act, HPA axis.

Erin Lewis: Mm-hmm. Like in the brain. The upticks with trauma specifically, but think of it like almost like a gear that's turning for everybody. It's just like, okay, now you've had some trauma and it's going and it's like, okay, well now you have a dissociation. And it's just like your amygdala is firing. Your hippocampus is firing, your hippocampus is overgeneralizing things.

Erin Lewis: Your amygdala is like everything is a threat. Mm-hmm. Because your hippocampus has overgeneralized it. The amygdala, think of that as like your threat response a little bit. It's just like your little alarm bells. Um, and so what we see over time with that creates these neurological differences in the brain is that from PTSD to D I d cuz there's a trauma spectrum.

Erin Lewis: Um, what we see in people with d i d is they actually have larger matter white track matters in their brain than gray. So you have white matter and gray [00:18:00] matter. Mm-hmm. Mm-hmm. There is a reduced, um, level of gray matter in the brain. Increased white matter. What is really interesting, I'm really into, um, this biomarker right now.

Erin Lewis: It's called, um, tumor necrosis factor alpha, and it's actually reduced in people with d i d, which is like weird because it's increased people with P S D a lot of the research is showing. So it's like what I'm very interested in that specific, um, Because there's really mm-hmm. A lot of interesting, uh, PTSD research being done.

Erin Lewis: And what

Justin Mclendon: is that responsible for? That particular biomarker?

Erin Lewis: Yeah. So it's involved in everything, in my opinion. Okay. There's so many things it's involved with, but there's, uh, inflammation. It's an inflammatory marker. Okay. Um, but it's reduced, which is interesting cuz trauma increases it over time. Um, And in North America, even more interestingly, cuz I treat, um, in multiple different countries if [00:19:00] I can treat there.

Erin Lewis: Right. Germany, I can't. They have certain licenses that I don't have. Okay. But like the UK is different. Um, Anyways. But if you look across the globe, PTs D is kind of joked to be an Americanized disorder. Mm-hmm. Because like there's such high rates here versus anywhere else in the entire world. Um, so there's lots of theories behind that.

Erin Lewis: We don't 100% know what There are some theories. Yeah. Anyways, so like with the dis soci dissociation, um, specifically I think what is super interesting from a global level is. When I read it, I was like, that can't be right. I was just like, I disagree with this statement. And then I had to do a lot of digging in.

Erin Lewis: I was like, oh, mm-hmm. I'm wrong. Like the, the research, you know, I'm always gonna like go to the research. So essentially people in North America with d i d, they have more psychosomatic symptoms, so like body sym. So these are like, uh, pseudo-seizures. Okay. Um, um, you can have parts that have. Parts, [00:20:00] personalities, um, I think of them as neural networks myself, but whatever you wanna call 'em.

Erin Lewis: Um, some can have diabetes. They actually process drugs differently in the, which makes it incredibly, you could likely speak better to this, um, hard to treat medically. Um, it's not like it's a serotonin, retic situation, right? Mm-hmm. It just depends. Your cells are moving dependent on the neurological network that is online essentially, or whatever part is fronting whatever language you would like to use.

Erin Lewis: Sure, yeah.

Dr. Harold Hong: Yeah. I mean, trauma, it, it changes not just how we think and how we feel, but our, our bodies. Yeah. Right. Like our, our brains, like there was, uh, in just a couple months ago, the American journalist Psychiatry had this wild study where they looked at, um, brain scans of, um, different races and.

Dr. Harold Hong: Different mixtures of trauma in their history. And the, the, the earth shaking fighting of this was [00:21:00] that, um, the brain volumes for the, the part of your brain that controls like emotion regulation, planning, executive function trauma makes that smaller, right? And also other parts that are involved in emotion, like the amygdala, like all those wines get smaller.

Dr. Harold Hong: Um, and. Races and ethnicities that are more likely to be traumatized have smaller brain volumes. But a white, a white person who was as stressed as a black person, they have like similar brain volumes in those pieces. And so trauma, it, it physically affects how our brains are. And it, it, it's, it's striking.

Dr. Harold Hong: Uh, and then when you have trauma and stress, your cortisol levels go up. Mm-hmm. And that suppresses inflammation by suppressing your immune system. And we know people who have high trauma scores are more likely to get cancer. Mm-hmm. Because we know that cancer is, is in some ways a di a disorder of your body not detecting and eliminating mutated [00:22:00] cells correctly.

Dr. Harold Hong: Yeah. So these are, these are profound things. Mm-hmm. And I think only now is, is the science and our, our awareness of just our everyday living, uh, coming to, to make sense and connect with each other. Um, but like for. You know, the, the, there's so much that our, our nurses can benefit from by understanding like their histories and their bodies and their relationships more deeply.

Dr. Harold Hong: And I get really excited about coming to work because this is where it all connects. Yeah. Right. Um, so I, I know that our patients, our clients are, they use alcohol to deal with pain. Like to, to disconnect from stresses in life. Uh, and there's a lot of parallels between that and other stories I've heard about children being abused and, and they create like this magical world in their mind.

Dr. Harold Hong: [00:23:00] Mm-hmm. And, and when, when their parent is out of control, uh, and that the abuse begins, their mind goes to this magical place and they, they don't feel or remember what happens. And I see a lot of parallels, uh, but you being a therapist who specializes in this world, I would, I would just love to see if you see something like this and if so, like what's going on?

Erin Lewis: I'm like, that is dissociation. Yeah. Like I, I got all smiling cause I was like, oh yeah, like that. Um, That other world, or it's kind of like, this isn't happening. Like it's, it's so, it's not just denial as much as it's, it's profound. Mm-hmm. Right? Like, it's like it's not happening right now. Dad is throwing something across the room.

Erin Lewis: It's like, well, no, that's not happening. Like, look at me in this family that I'm sitting. And you can have created a whole different family, right? Mm-hmm. Um, It, it could be. Um, we see this especially in foster care systems, um, where [00:24:00] they have like this imaginary family that really loves them and cares about them.

Erin Lewis: And um, and it's really helpful in terms of coping cuz sometimes it's like a kid is sometimes in just a really horrible. Situation. They don't have the resources to get out. They don't have like, usually, you know, unless they're like child stars, right? Like they don't have their own homes and right jobs and they can't set those boundaries.

Erin Lewis: Mm-hmm. So that dissociative factor is so helpful. It just becomes too leaned on and all of a sudden it becomes not helpful in adulthood. Right. Um, because then it's also hard from a somatic sense to, I always ask this question, uh, to my clients of, when did you know it was over? Like, when did you know the abuse was over?

Erin Lewis: Whatever it is. Mm-hmm. When did you know it was over? And a lot of times they're like, what are you talking about? And I'm like, I mean, you're sitting here in front of me right now cuz there's so much, um, trauma memories that [00:25:00] are unprocessed by that point that they get to you as an adult, that it's just like they're really in this heightened state, like on edge.

Erin Lewis: So it's never ended. Right.

Justin Mclendon: Yeah.

Erin Lewis: Interesting. And then once you, they say it out loud, like, oh, I guess I knew because then asking them that, it's kind of like a tricksy way of, um, trying to break down those amnestic barriers in the brain between like their memories essentially, or those neural networks that they've created, these amnestic barriers, which is just like the barrier between like, This horrible information.

Erin Lewis: Right. And your life experience and where you are today. Mm-hmm. So then you're asking 'em to reflect. Anytime you're asking reflective questions, they actually have to go back into their memories and think about it. A lot of times you'll see them answer very quickly and they don't think about it at all.

Erin Lewis: Cuz they don't want, they don't want to. So if they're like, oh, just take a, you know, well it's not done. Okay, we'll just take a second and like, Would that be okay to sit with just for a minute this question, when did you know it was over? And then a lot of times once they can [00:26:00] track it back, they might be like, oh, I guess when I went to college, now all of a sudden they're remembering that they went to college.

Erin Lewis: Mm-hmm. Um, you know. Mm-hmm. Like, and that's with the more profound association like PTSD Association is, is more like they know they went to college, they just might not, um, I think in ptsd, I see a lot of times the emotions removed quite a bit unless they're like very volatile cuz they've been triggered.

Erin Lewis: Mm-hmm. Um, but with dissociative disorder sometimes it's like, yeah, I got this four year degree and it's like, who got it? You know, like someone in here did. And it's that level of disconnect, um, really it's the narrative phobia. Mm-hmm. Is what I would say in that client as well that you. You were talking about, um, scenario phobia, I think is really understated, clinically interesting.

Justin Mclendon: Yeah. So I'm thinking as you're talking, um, so I've done some emdr, uh, I don't really practice currently, but, so as you're talking, I'm, I'm [00:27:00] seeing through that lens, the question I guess I'm getting to is like, how do we treat this right? Or how do you treat this? Mm-hmm. But I guess I'll lead with Do you use emdr?

Erin Lewis: I, okay. So in my practice we do have, um, like my business partner does emdr. Mm-hmm. For instance, um, I personally do not treat with emdr. Sure. Cause I can't get, my cades are off and my eyes actually. Okay. And that would, it would probably make me suicidal actually, if I were ever to have EMDR therapy. So it's hard like, cause I got some neurological testing done cuz a part of having d i d is like, This isn't, I don't have this, this is okay.

Erin Lewis: Bunch of lies like Sure, sure. Um, so you wanna disprove it no matter what. So I went through all of this, like neurological testing, and then they were like, oh, don't get emdr. And I was like, oh, why not? You know? Cause I was like, hmm. Seems like an, it's a trauma modality and, um, she said my cades were off and that I wouldn't be able to process the trauma that was coming up.

Erin Lewis: It would just flood me [00:28:00] essentially. Interesting. Okay. Um, and I think that's why there's potentially like these hit or misses with emdr sometimes. It's like the best thing you've ever had with clients is just like, breakthrough. Breakthrough. Yeah. Um, so much peace. And then other times they leave and they have a suicide attempt.

Erin Lewis: Mm. And it's like mm-hmm. I am not an EMDR clinician. Sure. I don't think there's anything wrong with it. Um, I think that, I don't, I don't know how you would test the cades or whatever, right. Like, um, in the eyes, but how I treat all trauma, it really is through like an attachment lens, first of all. Mm-hmm. Um, I am, so I'm nar master trained, so that's a neuro effective relational model.

Erin Lewis: A therapy, very attachment oriented and ifs, I think IFS is gold. Mm-hmm. Um, and I mean, what's

Dr. Harold Hong: ifs for, for people

Erin Lewis: who don't know? Oh yeah. My bad. Uh, internal family systems model. Okay. Um, it's created by Dick Schwartz. Mm-hmm. [00:29:00] And I think with, when I look at d i d, there are so many different neural networks.

Erin Lewis: It's like sometimes C B T works for people, right? Like, I think with trauma there's a lot of like cbts, very top down processing right brain. Then to the body. I think you also have to do the body to the brain. Yep. Which is that somatic end. Uh, so NARM meets in the middle, like doing both of those. But, um, people with d i D usually have shock trauma, which I think is better treated by an s sep.

Erin Lewis: I'm not an s sep, um, somatic experiencing practitioner. Mm-hmm. Mm-hmm. Um, but I think people with d i d have to be treated with. Several different modalities cuz like D B T Great. Not great a standalone though. Mm-hmm. Like, uh, dialectical behavioral therapy. Right. Uh mm-hmm. So a lot of times I'll send in with D I D a lot of times and a lot of other dissociative disorders, like O SST D, there are, um, comorbid eating disorders or substance use.

Erin Lewis: Mm-hmm. And it's like, [00:30:00] well you can't be a specialist in everything. So if they have substance use, a lot of times I'll send them out to. I co-treat and like whoever specializes in substance use, I'll send them to a clinician for substance use, I'll work on the trauma piece or in eating, you know, the eating disorder side of things.

Erin Lewis: Um, I send people out for that all the time. Mm-hmm. And then we treat them at the same time, cuz you can't just treat one or the other, treat the trauma, the eating disorder's gonna increase. Right. Treat the eating disorder, it's just like, then you're not treating the tra and then it's like the issue is still there.

Erin Lewis: Mm-hmm. So, um, I, I essentially, it depends on like what the client is wanting, but usually my go-to is, um, internal family systems, neuro effective relational model, uh, and then other kind of se somatic experiencing practices. Mm-hmm.

Dr. Harold Hong: Yeah. And how do those things help your clients move towards recovery?

Erin Lewis: Right, so defining recovery is, Probably the first [00:31:00] step of that que, because what I'm really sitting with is like a lot of practitioners are like, full integration fusion. That's where we're going with d i d. And it's like, I mean, would you tell someone with anxiety like, this is what I planned for you in your life.

Erin Lewis: It's like, right, right. Yeah. Uhhuh con consent at first. Yeah. Um, so essentially, D B T, dialectical Behavioral Therapy. I send people to those groups all the time because like they do need skills, actual taught skills. A lot of times they come from families that it's like they were taught alcoholism. They were taught.

Erin Lewis: Um, self abuse, or they were taught to abuse others and like, that's how you cope. And it's like, okay, well here are these very concrete skills that you can do, like dunking your head in ice water or something when you starts to build up. Um mm-hmm. So that helps in terms of actually being able, like there's a learning part of this for sure, like there's a learning curve of.

Erin Lewis: Wait, [00:32:00] not everybody like drinks at 9:00 AM Oh wait, not everybody starves themselves for 15 days at a time. Like there's a lot of that kind of. Distance. Um, so they do need to learn the skills first to even be able to process the trauma. Um, that helps with the stabilization phase. Uh, you always have to make sure someone's stable before you just go diving into their deepest well of trauma, right?

Erin Lewis: Mm-hmm. Right? Yeah. Or else it's, it's, they'll go poorly. Um, absolutely. And there's like a 70%. The statistic from the DSM is 70% of folks with d i d actually have a serious suicide attempt. Um, so it's like, it's very high. So it's, you gotta go slow treatment, slower is better and then half of that speed, and then like five times slower than whatever half of that speed is.

Erin Lewis: And that's the speed you need to go with somebody who has d I d um, dissociative disorders in general, like O S D D as well. Um, [00:33:00] so yeah, the DBT helps with the skills the IFS helps with. Defining the neurological networks or the parts or, right. Like so ifs language is parts, everyone has parts. Whether you have a boatload of trauma or not, you have parts like, you know, you talk to your mom and a different voice and you talk to your best friend and you talk to your, uh, significant other than you talk to your boss.

Erin Lewis: Like all these different parts coming into play. Mm-hmm. Uh, so the research on parts are really interesting. Um, this type of therapy, because it provides distance that you can actually start, um, having compassion again, it's like too much to have compassion for the self, right? Because, uh, now you've been built on a shame model.

Erin Lewis: Mm-hmm. So it's like, oh, okay, well this part of me, oh yeah, that little kid part, ah, well that's a rough go and then you can have some compa, the right startings of that. Mm-hmm. I think it's great for that. It makes compassion less daunting cuz sometimes [00:34:00] compassion feels like horrible to someone who has d i d If they really, really believe that they are bad inherent inherently, even with PTSDs D um, yep.

Erin Lewis: Trauma in general. Uh, yep. So those, so the ifs, I don't agree completely with any theoretical model actually, I. I side with some more than the other. So then I think where ifs I leave off, I, I focus on more of the immediate moment with Nam of like, well, what, like, let's talk about quality of life. Like what are you wanting for yourself?

Erin Lewis: What does your recovery look like? Mm-hmm. What is your treatment look like? What are your goals here? Mm-hmm. Sometimes it's like, I wanna get a job, or I wanna talk to people or, yeah. Whatever their, or I just don't wanna have flashbacks every day like, okay, well, like, let's start working towards those steps of whatever this looks like for you.

Erin Lewis: Mm-hmm. Some people are like, I want fusion if they've been on the internet a lot. You know, like, I want

Dr. Harold Hong: like [00:35:00] TikTok. Oh, oh, come on. TikTok got a love. TikTok.

Erin Lewis: I love tea. TikTok for like dog videos. Like those silly, like those park horror videos where it's like they're jumping over water and then they land on something.

Erin Lewis: Yeah, yeah. Um, I've had

Dr. Harold Hong: a lot of conversations with patients saying, I saw this on TikTok. I want to get checked out for it. So, I mean, it, it, it's, there's a lot of unusual perspectives out there. Um, but it's getting people. Out of their chairs and into clinics. Sure. Yeah. Uh, face to face with new providers.

Dr. Harold Hong: So I think if, if people can handle the curve ball of, uh, redirecting the TikTok momentum, it could actually be really, really great. But I agree, it's, it's not like the the usual best first. Uh, step for people to take. Yeah.

Justin Mclendon: Yeah. Maybe you don't want to just necessarily take your mental health advice from there, right?

Dr. Harold Hong: Yeah, yeah. Talk to a professional. Yeah. There we go.

Erin Lewis: Yes. I think the, I think my reaction was [00:36:00] like, oh, TikTok is cause, um, the d i d community specifically, I steer people away completely from Reddit, completely from tech. Okay. Any, um, so there is about a 12 to 24%. Rate of malingering with d I d. It's being very fetishized right now.

Erin Lewis: So at higher levels of care, huh? You're looking more around 20% or the higher ends. Wow. Wow. And I think a lot of times, like I have a lot of compassion for it. It does make me anger at one end, right? Mm-hmm. Like, mm-hmm. And like, sure. But like if we take a compassion lens, a lot of times people have been neglected and now it's like, oh, look at, look at this.

Erin Lewis: Look at me. Totally. Meet this part. Meet the, and like,

Dr. Harold Hong: Uh, it's true cuz there there are a lot of families where, uh, they're so busy that you can only get attention when there's a, a crisis, right? And they're, these, these are not bad parents. These are not malicious parents. These are, these are busy parents who have a lot of parties, many of which are their [00:37:00] children's wellbeing.

Dr. Harold Hong: Um, but sometimes they're, they're missing like what the child's wanting or needing and like, kind of over reprioritizing. I gotta stay for college, I gotta pay the mortgage. But you know, a lot of times the kid, they just want your attention. Yeah, yeah.

Erin Lewis: And they can only get it through crisis sometimes since, right.

Erin Lewis: So it's, I, I see why it's happening. It's also like, cuz they could have a different dissociative disorder or they could have higher levels of suggestibility, which now they really believe that they have d I D. And like there are people out there self-diagnosing with d i d which is just like, it doesn't make sense.

Erin Lewis: Mm-hmm. Like you can't diagnose your own time loss if you've lost the time.

Dr. Harold Hong: Right, right. Oh yeah. I, I've had a lot of interesting interactions with people, uh, who are like, I remember all of these things that I forgot. I think I have dementia and, and mm-hmm. There's always like a really fun conversation to have and, and then we'll, we'll do the objective [00:38:00] testing and give some reassurance, but, Uh, but sure you, maybe you don't have dementia, but there's something going on, right?

Dr. Harold Hong: So maybe it's not d i d, maybe it's not dementia, maybe it's not a d h adhd, but there's certainly something treatable here. Uh mm-hmm. But the consent piece is huge. Like, can we agree to treat what's actually underneath these things that it's showing up as, yeah,

Erin Lewis: the. I think consent is like the biggest thing.

Erin Lewis: Totally. Period. Absolutely. Totally. And, and any treatment, um, that, that agreeing piece, cuz I've had to, because of my practice being so specialized in d a d mm-hmm. The triangle area, essentially even people from out of state, out of the country, they look to us to diagnose, assess, um, d i d and what we've, we've had an influx lately of definite malingering.

Erin Lewis: Mm. And. So like there are certain tests for that, right? The series, there's the MFAs, there's, there's a [00:39:00] lot of these tests that we do Okay. To kind of point us out of like, okay, there are some things going on here. However, if they don't, if you look in terms of prognosis or like, are they gonna recover? Like what are the rates of this?

Erin Lewis: If they don't admit essentially like that they're purposely doing something. The rates are very low in terms of recovery and treatment. Mm-hmm. Like, there's a lot of treatment failures over and over and over again. Mm-hmm. And then people become addicted to higher levels of care. And it's a very specific issue.

Erin Lewis: And that is not my specialty. I do not specialize in, um, treating that. I'm just like, do you have d i d Do you not have d i d? Is it O S D D? Like what dissociative disorder or trauma is this? Mm-hmm. Um, and then I can treat that dependent on like, What they end up having with my specialty. But, or if they don't, I usually send them out because this is not the place then.

Erin Lewis: Okay. But, um, [00:40:00] if anyone wants to, you know, treat malingering and specify, like it would be helpful for the area to have, which is, I don't know anyone that specializes in it. In malingering. Yeah. Uhhuh. I can't think. It's a tough one. Think of one. It is tough. Yeah. Um, Definitely a conversation to be had.

Erin Lewis: Mm-hmm. Uh, I know that McLean is really great about that. Um, it's a Harvard affiliated right. Hospital. Yeah. Um, yeah. It's just like we don't have McLean here. Right. Uhhuh. Yeah. So, but yeah, consent I think is a huge piece in any kind of recovery where I think the clinician is coming up to the clients being like, well, we have to integrate, we have to fuse.

Erin Lewis: And it's like, If you don't have consent, like I've, so in the support group, I run about half, let's say a little, maybe a little less than half, but about half or so. Mm-hmm. Are [00:41:00] deciding towards like healthy multiplicity it's called, which is just kind of like, Nope, we don't wanna integrate. Like horrible things happened.

Erin Lewis: And let's just function in this life. We want have a job, we wanna have a home, and these are our goals and we don't want to go beyond that. Mm-hmm. And it's like, okay, like I think about 65% of the clients I have, um, without d i d or dissociative disorders, you know, people come in for depression, they're like, I wanna get out of bed, I wanna do what I used to do.

Erin Lewis: It's not that we always, um, Heal from like the underlying, they heal as much as they want to, and they're like, yeah, I'm good for right now, and I'll come back in a couple years or something. You know, like, yeah. And it's like, okay. Like that's, that's consent. They're saying, I want this much. Cool, cool, cool, cool, cool.

Erin Lewis: Right? Yeah,

Justin Mclendon: right. Gotta meet 'em where they're at, right?

Dr. Harold Hong: Yeah. Yeah. So if you were, if, I know we're short on time, but if you were talking to someone who's, who feels a lot of gratitude about their progress [00:42:00] and, and their, their. About to say, I think we can meet less frequently, or maybe we don't need to meet anymore.

Dr. Harold Hong: And they were to say, here's how I felt when I started and here's how I'm doing now. I'm curious, what might they say?

Erin Lewis: So I've had, it's. All right, so I'm talking specifically with dissociative disorders. Mm-hmm. Mm-hmm. Okay. Because I was like, well, that's big. I mean, it depends on what you're treating, but Okay.

Erin Lewis: With dissociative disorders, a lot of times they're like, I feel more grounded. I feel more present with my family. Okay. I feel more here. Um, Or like, a lot of times it's st bringing that stability factor in. Like, okay, well now you have a job, or now you, maybe they don't have a job, but now they have friends and they never had friends before and they feel more grounded and able to pay their bills mm-hmm.

Erin Lewis: And go to their doctor's appointments and mm-hmm. They're like, yeah, this is enough. And it's like, okay. Like if this is what is enough for you, Like, who am I to judge [00:43:00] that? Like, you're the expert of you, um, and this is your life, your treatment. Like, all right. But, uh, sometimes they'll also say things like, well, it depends like if they've done integration or not.

Erin Lewis: Mm-hmm. Right. Like sometimes they'll be like, I feel like a more whole version of myself. Um, and that's, that's huge. That's huge. And sometimes it's like very scary. So sometimes they do wanna take treatment breaks of like, I just need to like, Do nothing for the next three months and just go to work. Pay bills.

Erin Lewis: Like, just live like a very normal stereotypical, go get the groceries. Yeah. You know, like, it's like, okay, sure. Um, like the doors open if you want to come back. Uh, but that's some of the things that they might say. Usually it's about being grounded and remembering and just participating in life instead of just, A lot of people have this like, observe observation or this observer kind of effect.

Erin Lewis: Mm-hmm. Um, And it's like, oh, I feel like I'm here in my body. Oh, look, I can look at my son [00:44:00] and like, I actually feel the joy in my chest. Mm-hmm. Instead of just like in my eyes or smile or it's like, okay. It's a more full embodied experience. That's awesome. Even if they still do have like neural networks that are split.

Erin Lewis: Mm-hmm. Like, all right,

Justin Mclendon: that's progress. Right. So maybe in closing, um, If there's a family member, uh, of someone that maybe they're concerned that may be struggling with this or knows that they're struggling with, with trauma, or maybe there's an individual that's, that's listening to this, that, uh, is relating to some of this and saying like, oh, maybe this is what's going on with me.

Justin Mclendon: What would be kind of like a advice or first step that you would encourage someone to take?

Erin Lewis: Advice one, stay off the internet. Okay. There you go. Um, advice two. Seek a trauma specialist, specifically a trauma specialist. Um, and I, they don't have to be a specialist even in [00:45:00] dissociative disorders, honestly.

Erin Lewis: Mm-hmm. Like anyone that really treats trauma and like, that's their focus. Mm-hmm. They understand that there are different parts. They under, they know what they're looking for and if it's something they haven't seen before, a lot of times I'll have, you know, um, People in the community, therapists in the community would be like, Hey, can I have a consultation?

Erin Lewis: Like something's going on. Mm-hmm. So even if you can't find a dissociative disorder specialist in your area, which you might not be able to mm-hmm. That's okay. Like, seek out a trauma specialist. Okay. Specifically a therapist. Um, yeah. That's in terms of family members, like kudos to you if you're listening to this as a family member, right?

Erin Lewis: Yeah. Like, um, And there are support, I think New Waters has support mm-hmm. For families. Mm-hmm. Right. We sure do.

Dr. Harold Hong: Every once a night

Justin Mclendon: That's right. From six to seven,

Erin Lewis: look at that.

Dr. Harold Hong: I mean, it's an amazing resource, honestly. So, uh, I think it's, it's a, a real gift for the community and, uh, all are welcome. Yeah, absolutely.

Dr. Harold Hong: And [00:46:00] NC cutting edge counseling? That's right.

Erin Lewis: Oh yeah. Yep. Definitely. We have support groups. Um, I do a lot of research and we're, I have a research team, then we are creating new treatments for group therapy, specifically for d i d. Okay. Um, and then my business partner is working on, um, new treatments for B bp D um, oh, wow.

Erin Lewis: Borderline personality disorder. Mm-hmm. Very cool. Yeah.

Justin Mclendon: So how many, um, clinicians do you have in your

Erin Lewis: practice? Oh, we just hired some, um, somewhere between eight to 10. Eight to 10 ish. That's great. Um, and we're hiring more. We have to turn away work a lot. Okay. Actually, so we're still hiring. Um, For trauma specialists specifically, or anyone interested in trauma mm-hmm.

Erin Lewis: Treating, yeah. Trauma, but that's great. Yeah.

Dr. Harold Hong: In network, out

Erin Lewis: of your network. Oh, blue Cross Blue Shield in network all the way. Okay. Oh, nice. I remember. Good. Yeah. I, you know, blue Cross Blue Shield in this area is huge. Um, yeah, absolutely. Yeah. So definitely Blue Cross or we have [00:47:00] self-pay. Okay. You know, but definitely, um, Yeah, check us out if you feel like you want an assessment.

Erin Lewis: I do assessments, even if I can't, usually my caseload is full. Mm-hmm. Um, but I do assessments and send people back to their primary therapist and then talk to the therapist and like, Hey, this is what this, this, and this test has said and stated, and this is likely what's happening. And we can tailor a treatment plan, um, even if they don't work with me.

Erin Lewis: Also, Natalie struck, um, Also specializing in associa disorders as well. So like the personality disorder slash d I d kind of crossover. Okay. Um, but yeah, if you look us up, just be like, Hey, I need an assessment. Cool. Cool. Yeah. You know, we do this all the time. That's awesome.

Justin Mclendon: Well, Erin, thank you. Really appreciate you coming to hang out with us today.

Erin Lewis: Thanks for having me in this whole studio. Yeah. Yeah. Thank you.

Justin Mclendon: And Dr. Hong, always pleasure.

Dr. Harold Hong: [00:48:00] Always. Yeah. Thank you Aaron. Yeah, so glad to have met you and Absolutely. I think this is, this is so important, what we're talking about here, and I hope that people are plugging in.

Erin Lewis: Yeah. I appreciate the lens y'all are taking towards trauma and treatment and recovery in general.

Erin Lewis: It's absolutely, it's needed. That holistic version. Yeah.

Justin Mclendon: Yeah. It is. Very passionate about that. And, um, I feel like we just see that more and more with people, right? As, I mean, I think it's so easy to focus on the current presentation or the current set of problems that someone is struggling with, but you know, if we can just kind of pause a little bit, look a little bit deeper.

Justin Mclendon: I think that there's just so much commonality with a lot of things being driven by trauma or just a deeper place in general, right? Mm-hmm. Oh, yeah, yeah,

Dr. Harold Hong: yeah. I mean, one thing I, I love about this place is, Um, I think there, there are tr, there are certain therapists who are cut from like different claws and like, so once, once you have that trauma like perspective, like once that's gotten into like how you see and [00:49:00] hear and from the treatment plan, you, you cannot unsee it.

Dr. Harold Hong: Right? Right. Like can't, there's something about your, the way you experience world, it'll always be different now. Mm-hmm. And, And then it's real interesting when you're working alongside therapist who doesn't see it. Right. We've all been there. Yeah. And, and it's, and it's, you know, it's like you feel, you feel yourself like containing, uh, like something that really wants to get out.

Dr. Harold Hong: Right. Um, and it's not the best feeling to be honest, but when you're working with other people who see it, it is, it's very exciting. Yeah. Right.

Erin Lewis: It's like the energy.

Dr. Harold Hong: Yeah. Mm-hmm. Yeah. Right. Absolutely. And that's, that's definitely the lens that, that we're bringing here because, uh, like there's another therapist, uh, uh, Paige and, you know, she shared this thought that, you know, where there's addiction, there's trauma.

Dr. Harold Hong: Yeah, absolutely. Um, because like the addiction is a way of, in, in a lot of ways, it's a way of disconnecting from reality, which has a lot of overlap with dissociating. [00:50:00] Mm-hmm. Uh, because they are trying to medicate the severe pain. Of ordinary living that's happened in their daily life. Yeah. And I can't blame them for that.

Dr. Harold Hong: Yeah. Um, but we're here to help them find like new ways to deal with that pain in a way that's peaceful, uh, sustainable, healthy, creates connection. And it's, it's terrifying to people though, because they're thinking like, what the heck are you talking about? Yeah. Yeah. Uh, but if no one, uh, can see it and at least like bring them to a, a vista point to look at what's possible, I don't know if they're gonna find it.

Dr. Harold Hong: Right. And so this is like a huge, like, step forward in, uh, getting people to where they actually want to be. Much faster, much safer. So that's, that's why I love being here. There you

Erin Lewis: go. Yeah. That trauma lens is so important. Once you have, like you said, you just, it's like you see the world through that lens almost.

Erin Lewis: Mm-hmm. I think it [00:51:00] provides so much more compassion for humanity. I

Dr. Harold Hong: agree. Yeah. Completely. Yeah. And, and we do a lot to, to de-stigmatize trauma and say, you know, like trauma is, Is something that gave you a dysfunctional set of rules for how you experience yourself, how you experience the world around you.

Dr. Harold Hong: And you know, it could be something, you know, violently criminal that happened to you, like, you know, God forbid. Um, but it could be, um, something as, uh, seemingly non-traumatic as like an over-involved, over supportive parent, right? Mm-hmm. Yeah. And Yeah. And over involved, over supportive parent. Like we've all, many of us have been there and we know how, how annoying it is and, right, right.

Dr. Harold Hong: And it created a lot of pain. Like, cuz it's, it's a, it is a form of control, right? Mm-hmm. Right. And being controlled by another human is unsafe. And danger creates tension and stress. And that is pain. Yeah. Yeah. Right. So this is, there's like a direct line from that to, to drinking, to self-medicating this pain.[00:52:00]

Dr. Harold Hong: And I think it's, it only helps our patients to be just realistic about, about that. Mm-hmm. Right.

Erin Lewis: I agree completely. Yeah. Thank you. Yeah. Yeah. Thanks for having me. Thanks, Aaron. Thanks.

We are delighted to have Erin Lewis joining us on our Finding New Waters podcast. Erin is an accomplished trauma therapist with a particular focus on dissociative disorders. She is a co-founder of NC Cutting Edge Counseling, PLLC, an organization she established together with her business partner, Natalie Strzok. The core purpose behind the inception of this group practice was to empower individuals grappling with profound trauma with more resources. It specifically offers a haven for those suffering from dissociative disorders.The stigma attached to Dissociative Identity Disorder (DID) is a particularly dense one, and Erin is determined to penetrate that by ensuring every team member at NC Cutting Edge Counseling, PLLC undergoes regular and direct training on dissociative disorders. Her vision extends to diminishing the stigma associated with DID globally. To achieve this, she not only emphasizes the importance of educating clinicians on dissociative disorders but also endeavors to reduce stigma by candidly sharing her own experiences with DID.Erin is also dedicated to offering effective treatments for individuals with dissociative disorders and trauma. In her leadership, she exemplifies transparency and authenticity, shedding light on her own dark corners as well as aiding others through their struggles. Her ultimate objective is to foster a sense of connection and vitality among individuals, starting with helping them navigate their own haunted terrains.

Erin's Links:

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