In 1987, I was more than halfway through a doctorate, working as an unlicensed counselor in a psychiatristās practice. Catherine, my new client, was sitting in the waiting room, looking like someone carrying the weight of the world on her shoulders. Her hair was pulled back, and tears were running down her face. It would be another two years before Iād meet trauma-work pioneer Judith Hermanāso I didnāt think trauma when Catherine told me about her childhood, how her single mother had depended on her to be the adult in the family, how her depressed father had been emotionally unavailable, and how her grandmotherāwho took on a parental role out of necessityāhad been fiercely stern.
But Catherine wasnāt in my office because of childhood neglect; she was there because her husband, Abe, wanted to end their marriageāto ābe freeā as heād put it. She was overwhelmed, brokenhearted, distraught, and unsure how she could go on without him.
Theyād been married for 10 years and had two sons. Catherine was the family breadwinner. Abe was a free-spirited Peter Pan, capable of making a good living but unable to find a job that would allow him to come and go as he pleasedāor do what he pleased. Despite his childlike disposition, she described his presence as her rock. Clearly, he represented the family she never had growing up, but when I made that interpretation, as my psychodynamic training had prepared me to do, it precipitated a new flood of tears and wailing. āWhat will I do now? How can I live?ā she cried.
The more I heard about Abeās behavior, the more I believed my role was to help her say goodbye to this man, whose symbolic meaning far outweighed his actual contribution to her life. He went out late at night with no explanation of his whereabouts, had little patience for her tears and fears, often forgot to pick up the children after school, and liberally spent the money she earned.
I tried to help her see how little he brought to the relationship, but that just evoked more tears. Within a few months, she began talking about suicide as the only answer, saying things like, āI donāt want to live without him!ā
Week by week, her conviction that suicide was the answer became stronger. Looking back, I realize she was experiencing what I call a ālong, slow flashback,ā emotionally reliving the years sheād felt abandoned, alone, and unwelcome. Today, Iād recognize her fear, grief, and despair as feeling memories rather than as situational. Iād understand her suicidal ideation as the only option imaginable to a little girl in a world in which she had no control.
Instead, week by week, I became increasingly anxious. I understood suicidal ideation as a determination to die, rather than a way to self-soothe. I was too new to the role of therapist to know what to do with suicidal clients other than to check in with them and make sure they were still alive. Thatās what my colleagues and supervisor recommended: keep asking her to contract for safety and keep checking in.
A Kernbergian Point of View
Catherine welcomed the check-ins and soon began seeking them out, calling me throughout the day whenever she became overwhelmed. The more contact I offered, the more her need for contact seemed to grow. But I reassured myself that at least she was still alive.
Feeling a bit desperate for advice, I joined a peer supervision group of psychiatrists and psychologists at a local teaching hospital. It was there that I learned about a different approach, espoused by Otto Kernberg, for what we then called borderline clients. Kernberg recommended that the therapist keep a tight treatment frame to limit borderline clientsā āmanipulative, attention-seeking behavior.ā In those years, we didnāt think about trauma or posttraumatic triggering or implicit memory or autonomic dysregulation. We thought about the unconscious and attachment, but not about the brain and nervous system. Kernbergās theory blamed the client for the difficulties in treatment.
Iād never thought of Catherineās crises as manipulative or attention-seeking, but the more the group of senior, mostly male mental health professionals pushed this perspective as the only way to think about her, the more tired I grew of the daily check-ins. If I thought of them as necessary for successful treatment, it was a small price to pay. But if I thought about them from a Kernbergian point of view, they were stressful, inappropriate, and intrusive.
After two years of treatment, I decided to respond to Catherine as Kernberg advised. In 1989, we didnāt have cell phones, but we did have pagers. Ironically, Catherine paged me just I was preparing to leave the hospital after the end of the peer-supervision group meeting. I can still picture the little hospital meeting room from which I called her back.
Looking out the window at the brick wall facing it, I heard her sobs on the other end of the phone. Before she could speak, I said, āCatherine, this is inappropriate. We should not be talking between sessions. Weāll talk about this on Wednesday.ā There was shocked silence on the other end of the phone, and then more sobs. āWe can talk on Wednesday,ā I repeated.
I thought Kernberg would be proud of me, but I felt terrible inside. Iād abandoned Catherine, just as her mother had done so many timesāshowing up, appearing to be loving and supportive, and then disappearing again.
Catherine didnāt come in on Wednesday and didnāt want to discuss what had happened when Iād called. I didnāt see her again for almost 10 years. The peer supervision group members were congratulatory, but the idea that Iād done the right thing didnāt sit well with me. I knew Iād hurt Catherine, and hoped she was okay.
Apologizing for a Mistake of the Heart
By 1998, I was a licensed psychologist and trauma specialist. Iād trained with Judith Herman, and Iād been a supervisor and instructor at Bessel van der Kolkās clinic for several years. At van der Kolkās urging, I trained in eye movement desensitization and reprocessing (EMDR) and spent eight years honing my craft as a trauma therapist. Then, one day, to my shock and surprise, Catherine called me to see if she could make an appointment.
So often weāre advised not to apologize for our therapeutic errors because of risk-management concerns. I agree that apologizing to litigious, chronically devaluing clients is indeed risky, but I think we can always apologize for what I call mistakes of the heartāmade out of a wish to help, out of well-meaning attempts to do what weāre advised to do, or because we care too much. It was a mistake of the heart to cut Catherine off suddenly and change therapeutic frameworks without explanationāon the phone, no less. Thinking I knew too little and believing my white, male colleagues with doctorates and MDs to know more, I did what theyād told me to do. Had I listened to myself, I wouldāve found a more relational way to contain the phone calls and bring order to the treatment. I now know how to prevent long meetings outside of the therapy, but I didnāt back then.
Catherine received my apology with tears and gratitude. It meant so much to her to have me take back the pathologizing of her behavior and the abrupt rejection that had devastated her. Sheād been wounded before but had never experienced someone taking responsibility for hurting her and trying to repair the relationship. We both felt closer as a result, thanks to her courage in coming back to therapy with me.
Still prone to tears, she was more confident and centered in sessions this time. She and Abe had weathered the storm of his midlife crisis, and their children were doing well. The reason she was wanting to see me was that her mother had recently died, unexpectedly opening the floodgates to a tidal wave of traumatic, overwhelming memories.
It made sense now why Abeās threat to leave had triggered her collapse. The traumatic memories bubbling up were all connected to her parentsā divorce and subsequent traumas, like being molested by one of her motherās boyfriends, physical abuse by her father, and emotional abuse by her mother and grandmother. Sheād come to me with the hope that she could regain her balance before more old traumas caused her to crumble.
In the 10 years since weād last met, trauma treatment had changed, and with it, psychotherapy. Brain experts like Allan Schore and Dan Siegel had made neuroscience mainstream. Van der Kolk had introduced the concept that the body keeps the score. Now, Catherine and I could talk about her desperation to talk to me as a feeling memory of her childhood experience, when no one listened, understood, or took the time to make sure she was safe.
āOf course that desperation gets triggered when youāre flooded by these memories,ā I told her. āThatās only natural. Itās part of the memory you must have felt many times.ā I validated her experience again and again, but I did not offer, nor did she ask me, to be available by phone.
I did offer to do EMDR with her. We found she could easily access memories and tolerate the intense feelings that came up, once she discovered that they subsided if we just kept on going. Still, she got blocked when she tried to process certain emotionally painful pieces of her past. Other times, sheād suddenly lose connection to the feelings and memories and space out or go numb.
After seeing this pattern repeat session after session, we both felt certain that, deep down, Catherine had a fear of going any further, and it seemed pointless to keep pushing against the immovable block she kept encountering. At this point in my career, I wasnāt sure how to move us forward. This time, however, we said goodbye with mutual warmth and appreciation.
But apparently our work wasnāt over.
Becoming a Parts Whisperer
Earlier this year, I received an email from Catherine, asking if Iād see her again. The pandemic had triggered a frightening level of panic in her, and she was beginning to feel depressed.
With more than 40 years of practice since we first met and two books under my belt, Iām now an over-the-hill therapist, but one whoās still committed to exploring approaches to trauma that were unimaginable in 1998. I knew this time that Catherine and I could work with her body and nervous system, or we could work with my Fragmented Selves model, Trauma-Informed Stabilization Treatment (TIST). TIST is inspired by concepts from Sensorimotor Psychotherapy, Internal Family Systems, and Structural Dissociation, conceptualizing trauma survivors as inherently fragmented and self-alienated. The imperative to survive at all costs, especially when weāre young, depends on the mindās ability to split, fragment, or dissociate, so that part of us can keep on keeping on, and part of us can remain vigilantly focused on the traumatic threat.
After hearing Catherine describe the struggles sheād been experiencing since the pandemic, I grasped the fragmentation that had always existed within her. I hadnāt seen it earlier because I hadnāt understood it myself back then. In the 1980s and 1990s, parts were an extreme symptom of dissociative identity disorder. As far as we knew back then, ānormalā clients didnāt have parts.
By 2021, however, Iād become a parts whisperer, and I could hear the parts speak through Catherine. She described the panic she was feeling every morning, the separation anxiety that mounted when Abe would go out to the store or coffee shop. I was reminded of the 1989 Catherine, realizing Iād been treating her cry-for-help part then, the young part overwhelmed with separation anxiety. Starting with the assumption that every distressing thought, feeling, or physical reaction is a communication from a part, I asked Catherine to assume that her fear belonged to a part trying to tell her how scared she was. It took some practice for her to notice the fear as the panic of a child part, rather than her own feeling, but when she did, she immediately felt more curious about it than afraid.
āThat part is mostly triggered by Abe,ā she observed. āHe wants to go down to the coffee shop and hang out with the guys. I canāt talk any sense into him.ā
We observed the pattern that occurred almost daily: the child part would panic as Abe would get ready to go out, and then Catherine would lecture him about taking proper precautions, which Abe would brush off, further frightening the child part. I asked her if she could try to offer support to the young part, rather than letting her lecturer part try to control Abe.
āItās okay. Heās always like this,ā she told the part. āBut he always comes home, and he always ends up being okay. Heāll come home, I promise.ā She could feel the child part calm down a little and then get fearful again until Catherine reassured herself once more. While the young part could only anticipate abandonment, Catherine realized that she herself had learned to trust Abeās ability to land on his feet, but the young, frightened part had no way of knowing it without her reassurance.
Next, we addressed Catherineās depression.
āIām up half the night and wake up tired at 1 or 2 in the afternoon,ā Catherine told me. āThen I fall asleep on the couch after lunch, and wake up again around 5 p.m., but I donāt feel like doing anything. Iām just too tired.ā
I asked Catherine to assume that this was a tired part and to ask that part what it was worried about if Catherine didnāt nap.
Catherine paused and closed her eyes. āSheās worried that it will be too muchāthat Iāll be overwhelmed.ā
It made sense that a part of her would be afraid of being overwhelmed. After all, that was the predominant feeling Catherine recalled from childhood.
āThis part is trying to protect you,ā I responded. āShe has no confidence that you can handle the overwhelm any more than you could as a child. She doesnāt know the strong woman you became.ā
Catherine had inadvertently reinforced the partās belief in her inability to cope by identifying with its fatigue and sleeping through most of the day. It took several weeks for her to learn to notice the tiredness as the partās tiredness and not her own, and then to tuck that part into bed each morning and invite her to sleep while she went on with her day.
In just a few weeks, Catherine began to feel she had a life again. Without the tired part overwhelming her with fatigue anymore, she took up activities sheād dropped, and sheād developed a routine that was bringing structure to her day. āI can tell the part feels safer now that Iām in charge,ā she observedāa contrast with the chaos of her motherās and fatherās homes.
Now, with each new challenge or symptom that arises, Catherine and I assume that itās another part letting her know, āI need help, too.ā
One week, a part emerged expressing terror connected to an image of a canister exploding. āI feel like Iām sitting on a dark secret,ā she said, āand I donāt know when it will ignite and overwhelm me.ā The feeling of not wanting to know, of something blocking her, was reminiscent of the EMDR treatment days, but this time, I could remind her that she and the parts had the power to decide if or when to open the canister.
āAs long as the parts feel safe here with you now, the past canāt hurt you anymore. You can choose to know more, and you can choose not to know more. Ask the parts if any of them want you to open the canister. Is there any part that needs you to know whatās inside?ā
In TIST, the goal is not to remember but to repair the wounds of the childhood past. Repair for Catherineās parts meant respecting and caring for their feelings and opinions. Now, thatās what she offers them each day. While once they were invisible to the parent figures charged with their care, today theyāre seen and heard with kindness.

How far the world of mental health has come since 1987!
Parts-based approaches like IFS and TIST have become staples in trauma treatment. EMDR is now well-established as an evidence-based treatment, and we can talk about the body in psychotherapy without sounding āout there.ā Trauma treatment has become a specialty area, with more and more therapists seeking the most up-to-date trainings. And importantly, weāve learned to be flexible, using different approaches as needed on a client-by-client basis.
I couldnāt be flexible in 1987. Even senior therapists of that era didnāt know what we know today. We didnāt think of borderline personality as a trauma-related disorder. We didnāt know child abuse was an epidemic. We didnāt recognize the signs of trauma, and we didnāt know what to do with it, other than to ask victims to describe what had happened to them.
As I look back, Iām so grateful to Catherine for making this journey with me over all these years, bearing with me as I learned to understand trauma and trusting me to do the best I could, even when I wasnāt doing it very well.
As I often tell my trainees, āEverything I will teach you Iāve learned the hard way.ā
Maybe the hard way is how we learn best.
Janina Fisher
Janina Fisher, PhD, is a licensed clinical psychologist and former instructor at The Trauma Center, a research and treatment center founded by Bessel van der Kolk.Ā Known as an expert on the treatment of trauma, Dr. Fisher has also been treating individuals, couples and families since 1980.
She is past president of the New England Society for the Treatment of Trauma and Dissociation, an EMDR International Association Credit Provider, Assistant Educational Director of the Sensorimotor Psychotherapy Institute, and a former Instructor, Harvard Medical School. Dr. Fisher lectures and teaches nationally and internationally on topics related to the integration of the neurobiological research and newer trauma treatment paradigms into traditional therapeutic modalities.
She is author of the bestselling Transforming the Living Legacy of Trauma: A Workbook for Survivors and Therapists (2021), Healing the Fragmented Selves of Trauma Survivors: Overcoming Internal Self-Alienation (2017), and co-author with Pat Ogden of Sensorimotor Psychotherapy: Interventions for Attachment and Trauma.(2015).