Interview with Clare

Ellis: Clare, let our readers know a bit about how you became a therapist. 

Clare: I didn’t start out my career as a therapist, I actually thought I was going to become an academic (anthropology/gender studies)! In the early 2000s, I was doing field research in the Boston area, interviewing trans/gender non-conforming people who had survived transphobic hate crimes in an effort to both raise awareness, and contribute to the discourse on gender-based violence in the U.S. As I was sitting with people who were sharing their stories of trauma and oppression, I came to realize that I was more drawn to the  “sitting with” part than anything else. I started volunteering at a hospice agency, where I sat with people in end-stage dementia. I then started working for the only domestic program of Partners in Health, a program called the PACT Project, which worked with people living with HIV/AIDS who were struggling to maintain adherence to their medical treatments (PACT is now part of JRI Health). From there, I went to social work school at the University of Chicago, where I focused my clinical training on trauma-informed therapy for LGBTQIA+ people. Before I went into private practice in 2016 at The Meeting Point, I was working in HIV/AIDS services organizations primarily serving chronically homeless people and those in recovery from addiction. 

Ellis: What type of psychotherapy do you practice, and which types of clients do you most frequently serve?

Clare: Once I got into private practice, I increasingly focused my clinical work and training on trauma treatment for LGBTQIA+ adults. Working with depression, anxiety, chronic pain/illness, addiction and relationship issues are also inevitable clinical aspects of working with trauma survivors. I began learning more about complex PTSD, a diagnosis that (despite concerted efforts) is not included in the DSM, but is a common cluster of symptoms and experiences that I see in my practice. On my own healing journey, I was also diagnosed with and began treatment for complex PTSD. These simultaneous personal and the professional processes challenged me to understand that talk therapy was simply not enough to gain traction for myself or others. We had to go to the deeper, subcortical, somatic, exiled places where this type of trauma had gotten stuck, and which often left us at the whim of what Pete Walker calls “emotional flashbacks'' in our present-day lives. To that end, I got training in more “bottom-up” modalities, like IFS (Internal Family Systems), Sensorimotor Psychotherapy, EMDR (Eye-Movement Desensitization and Reprocessing), and psychedelic-assisted therapy for the treatment of trauma. I currently provide ketamine-assisted psychotherapy (KAP) to my clients, and intend to offer MDMA-assisted therapy for the treatment of trauma once it is legalized some time in 2024.

E: Tell us about some of the unique challenges you come across as you specialize with queer clients facing the effects of complex PTSD or developmental trauma? Is there any connection between your queer client focus and your background in bottom up approaches like Sensorimotor Psychotherapy, EMDR, and KAP?

C: In my experience, bottom-up approaches are simply more effective in treating trauma, regardless of the person’s identities. But my effort has always been to think about any particular concerns/needs that LGBTQIA+ folks might face when accessing trauma treatment, and to adapt these bottom-up approaches to better serve my community. 

Some of the unique challenges that I see for those of us who are LGBTQIA+ and who are living with C-PTSD/developmental trauma are brought on by transphobia/homophobia–both interpersonally in our families of origin/communities, and structurally in forms of ostracism, pathologization and discrimination. For a person who might already be experiencing abuse/neglect during childhood, the threat of anti-trans/queer violence, rejection, and stigma generates even more stress, toxic shame, and survival defenses to their nervous/attachment systems. This increases the likelihood of developing attachment issues as adults–codependency, and possibly retraumatization through abusive or toxic relationships. For LGBGTIA+ survivors of childhood sexual abuse or assault, which may have occurred prior to their coming out as queer or coming into their trans/nonbinary identity, the sexual violence/abuse may contribute to further dissociation or fragmentation in their internal system. It’s a big ask for an LGBTQIA+ person with C-PTSD to bring down some of these survival defenses, and overcome toxic shame, when society at large is still cosigning a message that their queerness or transness is “wrong” and needs to be erased. 

Healing for LGBTQIA+ people living with C-PTSD is a journey into authenticity, self-leadership, coming safely back into our bodies, and re-parenting wounded parts of Self. It’s ending learned patterns of self-abandonment (e.g. through fawning behaviors) and toxic shame. In addition to growing up in a family of origin with a lot of abuse, I then wound up reenacting that pattern in a very abusive queer relationship in early adulthood. The more that I re-parented and healed my relationship with my fearful or deeply critical/shamed parts, the more I was also clearly hearing a greater truth about my gender nonconformity and queerness that was previously too shameful or scary to acknowledge or express. If that isn’t queer liberation, then I don’t know what is! 

E: Give us a simplified example of a client suffering from complex trauma. How have you and would you use your therapeutic skills or toolkit to help them in ways you could not have helped them earlier in your career?

C: In both my personal and professional spheres, I've found that a combination of various bottom-up approaches yields the most effective results. Personally, I've fostered success by establishing a trusting relationship with a relationally-oriented EMDR therapist. Our sessions also integrate my personal use of psychedelic-assisted treatment. The targets I address in EMDR often correlate closely with material accessed or shifts initiated during psychedelic-assisted treatment experiences. This personal course of treatment significantly influences my approach with clients.

For instance:

Consider a queer, nonbinary adult in their early thirties who endured emotional neglect, abuse, and parentification during childhood. They also faced sexual trauma in adolescence before identifying as nonbinary. In early adulthood, a sexual assault occurred within a queer dating context. Seeking treatment due to chronic patterns of freezing, dissociation, and a hyperactive fear response, they also experience somatic distress (e.g., chronic pain, digestive issues). A strained relationship with their non-accepting family triggers them frequently. Stress and insecurity persist in their relationships, particularly in dating, with past experiences of codependency or partners exhibiting narcissistic or disorganized traits. Interactions with family or partners often trigger intense states of overwhelm, leading to various survival coping mechanisms.

In initial sessions, I focus on building rapport, understanding, safety, and collaboration. I introduce frameworks like parts work/IFS and resources such as strategies for grounding within their window of tolerance. I explore the person's feelings about complex/developmental trauma and educate them about emotional flashbacks and nervous system dysregulation. Identifying survival defenses in the body and internal protector parts provides insight into the landscape of toxic shame, fear of vulnerability, or self-abandonment.

I prepare the person to explore bottom-up modalities, potentially combining parts work/IFS exploration, EMDR reprocessing, and ketamine-assisted psychotherapy (KAP). KAP sessions are spaced approximately 4-6 weeks apart, to allow plenty of time for regular 1-hr sessions to integrate, and continue IFS and/or EMDR processing. Continuing EMDR reprocessing at the tail-end of KAP sessions capitalizes on the grounded, expansive state that clients enter with post-peak drug effects. Structured approaches like EMDR, boosted by KAP's neuroplasticity and mood-lifting benefits, offer clarity on the client's progress. In my experience, this combination can reduce the frequency, intensity, and duration of emotional flashbacks, fostering a sense of safety in the body and relationships, and enhancing self-trust and self-compassion in the ongoing healing journey of C-PTSD/developmental trauma.

E: What else is important for readers to know about you?

C: I used to struggle with the decision of whether to disclose my experience with C-PTSD, but influential figures like Pete Walker have shown that openness about our trauma experiences can profoundly contribute to building trust with clients. I have personally engaged in any therapeutic approach that I recommend to a client. While my experiences may differ, and what worked for me may not be universally applicable, I understand the intense fear of going towards this stuff. When I encourage a client to try a particular approach, it stems from my belief that, within them exists a healing Self capable of navigating this journey. I believe this, because I’m doing it too. 

E: If readers and prospective clients want to learn more about your approach to therapy, besides contacting you directly, can you share any resources, readings, or talks that have helped inform your work?

C: These are some books that I highly recommend: 

• Complex PTSD: From Surviving to Thriving, by Pete Walker – check out all the free resources on his website, linked in the book title. In particular, consider checking out (and practicing!) Pete’s 13 Steps to Managing Emotional Flashbacks. Also check out this recent podcast episode with Pete, in which he explains what C-PTSD is (and even talks about psychedelics!).

• Trust Surrender Receive: How MDMA Can Release Us from Trauma and PTSD, by Anne Other

• A Queer Dharma: Yoga and Meditations for Liberation, by Jacoby Ballard - a queer trans person who explores Buddhist teachings from a queer intersectional anti-oppression lens. 

• Self-Therapy Workbook: An Exercise Book For The IFS Process by Bonnie J. Weiss - this is a great tool for starting to learn about and apply IFS/parts work concepts to your own healing practices. 

Some other resources:

• Lama Rod Owens - A Black queer activist and Tibetan Lama who has written some fabulous books, and also offers some great meditation resources (If you have the Calm app, check out his Radical Self Care Series). 

• The Sentur app - this is a really cool app you can download to really work with your own internal system, including ways of mapping out parts and guided meditations

• Tara Brach - A psychologist and meditation instructor who has a wealth of free resources on her website (you can also search for her meditations on Spotify). In particular, the RAIN meditation is a great one for working with emotional flashbacks. 

• You are welcome to check out some recordings I have made of guided EMDR resourcing exercises, I intend to add more!

E: Clare, thank you so much for your fabulous work, your continued mentorship, and for serving the queer population of Boston with such dedication. 

C: Ellis, thank YOU for your thoughtful questions, support, friendship and guidance. Thank you for spotlighting these issues and concerns!