Kim Howard 00:05
Welcome to the Let’s Talk EMDR podcast brought to you by the EMDR International Association or EMDRIA. I’m your host Kim Howard. In this episode we are talking with EMDR certified therapist Dr. Paul Miller, about EMDR complex trauma and PTSD. Paul is located in Newtown Abbey, Northern Ireland. Let’s get started. Today we are speaking with EMDR certified therapist Dr. Paul Miller, about EMDR therapy and complex trauma. Dr. Miller is a medical doctor and a psychiatrist. Thank you, Paul, for being here today. We are so happy that you said yes.

Paul Miller 00:38
Thank you, Kim, delighted to be here. Really looking forward to having a conversation together.

Kim Howard 00:44
Thank you. So Paul, tell us a little bit about your journey to becoming an EMDR therapist.

Paul Miller 00:50
That’s a very interesting journey. Well, well, first of all, my journey started back in 1997. And I was trained as part of a harp training, which was the first training in Northern Ireland. Really, at that stage. It was a humanitarian training, which I think was very significant for me, but also it was taking place in the city where I was born and grew up up in Derry, Londonderry, and that is a place that had seen a lot of violence over the years. And so for me, there was something very symbolic about it, where it was on the opportunity to take part in the humanitarian training, to be honest, also, a big reason I went was to just be able to see FOB land travel time, as a quite a junior doctor at that stage. So it was, I can’t say that I knew tons of EMDR at that stage when I first trained, but I think the reason why I’m still doing EMDR over 25 years of theater was that journey continued. And firstly, I find lots of really open hearted people within the EMDR community who responded to emails of somebody who you know, I was quite a junior psychiatrist at that stage. And you know, people like Andrew Leeds, Francine, Carl Forgash, Jim Knipe, marked work and meet loads of people who are prepared to sit down and write an answer and help bite somebody across the poem. So I was very struck by the kindness of many of those individuals and under many others that I could continue to mention Marilyn Luber is another one that comes to mind. So, you know, a lot of those individuals for me helped me to lean into learning something which is very new, and also encouraged me. And so the person the, the my mentor, then at that time, worked in the Mater Hospital in Belfast, a doctor called Dr. Peter Curran. And Peter in the hospital where Peter and I worked, 1/3 of all the people killed during The Troubles and 1/3 of all the people injured during The Troubles were in the five postal codes arrived, the hospitals who had had really seen a lot of trauma. And as a student, I’d been in proximity to to you some two of the biggest sort of heinous crimes of the troubles to the Shankle bomb, or many people were killed civilians, and then a reappraisal from the Protestant paramilitaries in the rising sun bar and gray steel. And I saw the sort of mental health response and the primary care physician response to those disasters. And I suppose I have to also say my mother was a mental health nurse. So I sort of had an interest in mental health. I had an interest of seeing trauma and the impact of trauma on I find a mentor and mentors, primarily, I suppose, Dr. Peter Curran, and then Dr. Michael Curran was the one who invited me to the training in Derry, it just made me see mental health and trauma. And actually, a trauma-based model made a lot of sense to me in terms of understanding how people present now I have to say that that in itself was a bit of a journey. Because I started I worked under Professor Kenneth Candler from Virginia Commonwealth University, and was part of the team that looked up the genetics of schizophrenia on per km schizoaffective disorder. And indeed our team, the team that analyzed the data we collected went on to sit down to find the first gene of risk for schizophrenia. So I had those two sorts of parts of my lived experience as a medical doctor, that there was this sort of spectrum and others have a biological part of the spectrum. And I had experience and looking at that and identifying genes of risk, but increasingly, I was discovering the literature and the narrative around trauma. And so for me, it was being confronted by really how in the fact of many of the medications weren’t, but at that stage, cognitive behavioral psychotherapy. Repeat, we’re increasing, there wasn’t so much psychodynamic work. And then EMDR was something that then came into my lived experience as a professional. So gradually applying it, and really seeing people get better seeing people improve. And that’s what really led me then into that journey with the EMDR. My interest then was I’m duly trained as an old aged psychiatrist who specializing in later life, mental health, and also known as a general adult, which is really anything from the age of 16 years of age upwards. And so I would see a wide range of people. And to me the trauma model EMDR, an NC and the effects of that, to me was just that nice mix, where it was a very satisfying professional place to work. And I find that I was able to then bring that in nicely to the National Health Service and set up a number of clinics and the National Health Service and then moved into the private sector, and have gone online to develop the miraculous Health Institute, which I find it which has a rule really in training so many of your your trainers who we myself and a faculty of trainers here, train other people, and then linked with colleagues, I Professor Derek Farrell, Professor Mark Kiernan, Lorraine Knibbs, with there’s a group of us and working together, I’m looking at doing research. So I’m a visiting professor in Ulster University, as part of the maternal fetal infant research center there, and I see. So we currently have three PhDs that all have an EMDR focus now to you’re in the process of finishing, hopefully, a very soon, we have a third does more or less to starting. But a big part of that, again, has been really following through with Francine always talked about, which is gathering the data, publishing and peer review journals. And for me, having started with a very biological view of mental illness with schizophrenia, I discovered EMDR, first of all, and then discovered, really column Ross’s work. And so Collum talked a lot about the a different model for schizophrenia, which really looked at a trauma model, and some work was carried out in Northern Ireland. And what it showed was it when individuals have three traumas before the age of 18, the risk of a pathology level psychosis or like schizophrenia, was increased by 18 times, so pretty significant. But if it was, few more traumas added to the burden before the age of 18, so if you had five traumas before the age of 18, that risk went up to 193 times.

Kim Howard 07:36
Wow, that’s incredible.

Paul Miller 07:39
It was incredible. And if you think of that was smoking, or if that was eating some particular unhealthy substance, or exposing yourself to, you know, certain amounts of alcohol, let’s say, you can imagine the public outcry and the public health outcry because it was trauma. We just never saw that. So that always challenged me to look at that, and getting involved with colleagues working in the humanitarian side of EMDR. But also realizing there’s just so much stuff we still did not understand. And I think one of the really nice things was that, as I spoke to people, like for example, arry Bergman, who was great encouragement around the neurobiology that, as we began to discover more stuff about neurobiology, it was just lovely to see how that fitted suit well, with actually the model that Francine had created, and that we were taking something that somebody as a clinician who was attuned had picked up on that this was a sensible way of dealing EMDR. This made sense to make the hit phases in this sequence with the procedural steps in the sequence. And it just amazes me how we were beginning to see like that make sense from what we know about the neurobiology. So there’s still loads that we don’t understand, I think, and it’s always good to acknowledge that. But I think that in the end of the day, certainly, as a specialist working with a lot of complex trauma, seeing how EMDR can have a substantial impact on those individuals is really, really important. That’s why I still do.

Kim Howard 09:06
That’s a That’s a great story. And I like the intersection. We talked about this earlier, the intersection of your medical degree and your work as a psychiatrist melding with your work as a as an EMDR therapist; it just seems like the perfect trifecta. I mean, not everyone can go out and get a medical degree and be a doctor and then turn around and become a psychiatrist as well. So there’s that, but I think it’s a great intersection. Because you’ve, you know, who do you go to first we have a problem. You go to your medical doctor, right? It’s something physical, I have this issue or whatever. And then you discover, oh, maybe I need therapy, you know, so you might go to a psychiatrist or a therapist. And so this it’s a great combination. Not everyone has that that option. But I love the fact that that that that’s how you do your your job.

Paul Miller 09:50
I mean, I mean, I’ve definitely been very blessed. But I think working in old age psychiatry, I think we always had a lot of multidisciplinary teams even whenever our general psychiatrists colleagues did not. And I think that’s the thing that have gone on to build a unit that has, has a multidisciplinary team element to it. And it’s really, I think, important because what we’re finding at the moment is, there are a lot of very exciting things coming down the line, which is important for the people that we see, I tend to do a lot of blue light works. I’ve worked a lot of law enforcement, and a lot of work with those here, frontline workers and first responders, and then also individuals who have complex trauma from childhood sexual abuse, and other abuses. And you know, one of the things that I often find is that the services out there don’t involve a range of professionals enough. And, you know, I think that whilst it’s nice to have a combination of sort of the medical side, and then the psychotherapeutic EMDR side, I welcome having colleagues here also trained in CBT, trained in different psychodynamic therapies, a number of mental health nurses who have years of experience and my my daughter has it just qualified as a mental health nurse, she doesn’t work for me at the minute but about seriously quite well to work with that quite. It was quite funny, because one of the things that she was in the cohort that I trian, just before the get registered, I did an introductory training for the mental health nurses, so she had to listen to dads to your training. But she didn’t complain too much about that. But I think is a wonderful skill to have. Because I think we have so many people come on medication I’ve always looked upon as a bit of a fertilizer, the medication helps to make the wheels turn sometimes helps them to turn a tool, sometimes it helps them to turn more smoothly. And I think the difficulty that I see as a medical doctor is a lot of people. Because there hasn’t been the availability of psychotherapeutic endeavor. The problem is that all people have been given his medication. And you know, it’s what’s available, it can help people. But in my experience, people generally need a range of different things. And I think that’s why, for my clinic nine, we’re looking at New Year things. So we partner with the Vermont Center for Responder Wellness with Sonny Provetto and his team. So we look at being able to train peer responders, training them in group EMDR methods to help them with EMDR earlier intervention work. So there’s less toxicity hopefully from the burden of trauma early on, we look at things that are coming down the pipeline, like the effectiveness of the stellate ganglion blocks was like a physical procedure, where you inject a local anesthetic into the neck into a thing called the stellate ganglion. What it does is it helps to down regulate the amygdala uses so many dots on the right hand side. And so again, my clinic here is benefiting from that connection professionally with some nice team in Vermont. And so we’re, we’re able to bring those new innovations and see them a place. We were talking just before by NIH bringing all board down, we’ve just been licensed as a psychedelic research center. So we’re starting to look at that as well. And I think the thing that really excites me is when we listen to people like Rachel Yehuda. Rachel and people like Rick Doblin of MAPS, they emphasize that it’s not just about taking the psychedelic, not makes you better. But the importance of having that psychotherapeutic endeavor with it as well, I think it’s so important and seeing that’s really exciting for me, and it’s interesting, I hear a number of EMDR clinicians who have then been taking additional training as psychedelic psychotherapists and stuff. So I think it’s an exciting place to be. I think that it’s something that allows us to offer hope to the people that we have who often for a sounder, like mine are coming through your door saying, You’re my last chance. And I think that’s sad. And when I hear that, and I often think that’s also not true, because I think it’s sometimes people aren’t being able to be offered things when they ought to be offered them. And they end up going through maybe a series of medications, and they tell themselves a story by field to get better on all these medications. Therefore, I must be on you know, untreatable. That’s not true. It’s just simply maybe the sequences been wrong, or maybe the medication was okay. But it needed the psychotherapeutic app that time and that wasn’t available. So there’s a lot of new things I think we’re learning and I think the EMDR community is growing up and is developing in terms of high. It looks at conditions that once upon we had the medical model of illness, and a question that Colin Ross and I have often heard asked is, you know, is this psychosis, or is this dissociation or is this complex trauma? I think phenomenologically a lot of time these things are the same thing. And so it’s a by looking at the trauma model and and the beauty of the AAP model as articulated by Francine and Rogers so all of them. It wasn’t just about that being something which explained the medical model a harvest explains why you’ve got depression or this experience why you’ve got post traumatic stress disorder. The trauma model, as I understand it, as I hear Dr. Colin Ross articulated is it it’s a way of helping people to understand that you are understandably disordered, given the set of extreme circumstances you’ve been through this is not because you’ve just been unlucky with the hand of genes that you’ve been given, this is understandable. Of what’s more, so not only is it understandable, it’s that it that allows it to be routable. And I think we have you we’re learning all the time about this stuff. And so that’s what I always say to people. Look, you are where you are. Okay, maybe this is a good as it gets for for now. But you know, there’s stuff coming down the pipeline. You know, that could be new stuff next week. And so I always remember Napoleon Bonaparte used to say of his generals that they were to be purveyors of hope. It sounds a bit like a strange thing to say about and military generals, but in a sense, that’s how you describe them. But I think that’s true were to sometimes as therapists, we have to hold out hope for people. And I think that’s a really beautiful thing to hold on to. And for me, that then begs the question, well, what is hope? And so there was a philosopher and politician who was the last president of Czechoslovakia, called Václav Havel, and he became the first president of the Czech Republic. The translation of what he said is basically, ‘Hope is not the certainty that everything will turn out well. Rather, it’s a sense that no matter how things turn out, that they have meaning.’ I think that’s the beauty of the trauma model. Because none of us as clinicians can sit down and say, ‘Kim, you are going to definitely get better, this will definitely completely heal you.’ We can’t say that we ought not to say that. But what we can say is doing say, ‘Kim, this makes sense why you’re experiencing this. And let me explain a bit about that.’ And I think that’s a really powerful thing. And I think it encourages me that the EMDR community has elements within it that has asked that why does this work. But I also think that it’s also important that I see that the EMDR community has has pragmatic aspects within that don’t care how it works, he just knew what those so they deliver it. And I think both have a place.

Kim Howard 17:19
One of our presenters at our EMDRIA Virtual Summit, Friday and Saturday, last weekend, and one of them gave a really good analogy, which I thought was really good and vivid, and people can understand and relate to it. She said, ‘You know, your body is like a windshield. And trauma, whether it’s small trauma, or large trauma, or like rocks coming into your windshield, it might make a dent, it might make a line, it might crack it all the way it might crack it in several places, it might break it completely.’ And I thought wow, that’s that was really eye opening in terms of trying to get that information out there to the audience. But I’d also like to comment on the fact that you said you had to give your your daughter her introductory class. And so maybe she’s at an age now where she finally says, Oh my gosh, my father actually knows what he’s talking about. Because you know how kids grow up and they never think their parents know anything when they’re teenagers. Yeah, they don’t know anything, right? You could be the smartest person in the world. And you’re my parent, you don’t know much. And so that’s interesting that you had.

Paul Miller 18:15
It’s funny. I’m not sure she would admit it to me. But I think both my children my son’s a bit younger. He’s did Cinematic Arts, but I think they’re both of me is that people pay to listen to me. Abused people actually listen to me.

Kim Howard 18:30
Yes, tell your children. Yes, many people worldwide listen to you. Before the podcast. Paul, can you please define complex trauma?

Paul Miller 18:42
Yeah, I think this is a really important question. Because I think whenever I would have started off, even back in the late 90s, I would have been familiar with the conversation about complex trauma. Because really, in in terms of the what we call the Northern Ireland Troubles, basically, a period of over 30 years of terrorist violence, you’re pretty much every family was affected and impacted by that, you know, certainly, we had loads of people where they had real difficulties in terms of what they would do could do. And they were also balancing their need for asking for help with, you know, gee and die in the street, her son has just been murdered. So there’s a lot of people who didn’t feel it, they could ask for help. So as opposed to sort of a more standard presentation with somebody having a, let’s say, route traffic collision, that there was a lot of people who sort of built up these more complex pictures that involved the interpersonal relationships that they had that we saw sometimes two, three generations of people who had experienced trauma, you know, each generation having had somebody murdered and for example, until we had these much more complex presentations, so people talked about more complicated pictures. I then began as, as I became aware, much more aware of dissociation, I began to see then people talking about complex trauma and defining as post-traumatic stress and trauma that had a lot of dissociative elements to it. And really, when we look at the news ologies, the DSM sort of went down a pathway to DSM with the publication of DSM five, rather than include the diagnosis of complex PTSD. What they did was, instead say, you can have a post traumatic stress, but you can add this additional piece to it, which is really talking about there being a dissociative subtype to the Juggernaut as a writer to the classification. And so, I think I began to think of the complex presentations and consider how dissociation linked to that, however, ICD 11, which is neither the latest version that came out, it was really interesting to see it go in a different path. And so what it did was, well, first of all, it put the actual name in so it said, right, we’re going to define a thing, and we’re going to make the lineable complex post traumatic stress disorder. And I think whatever you feel about the definitions, I think the bottom line is that having it written down somewhere can try and help harmonize the research. So DSM chose not to the sort of added the ability to talk about dissociation, but ICD 11 meet a specific definition. So I think, with its publication, at least in beta and 2018, I think as traumatologist we nine need to, to know that there is a definition to it, we may not necessarily always agree with it, some people may think ‘No, I like my definition of complex trauma.’ But strictly speaking, what complex trauma nine is your core post-traumatic stress disorder. But then in addition to that, you have one of one or more of the following so, severe pervasive problems in our fact regulation. So we will recognize that many of your listeners are recognized having the patience that you have to do really have difficulty and ragged healing effect and even fretting neutral environments, persistent beliefs about oneself has diminished, defeated or worthless, often accompanied by deep and pervasive feelings of shame, guilt, or failure related to the traumatic event, that I think that’s probably one of the biggest areas where I see it manifested in terms of the Northern Ireland population. And then lastly, persistent difficulties in sustaining relationships and and being able to feel it looks to other people, and that those things can result in a substantial disability. So I like that definition of complex PTSD, because it really, it puts a nod towards the importance of the interpersonal. And I think when we look back and we listen to the other researchers like Christine Courtois, Bessel van der Kolk, of course, Janina Fisher, the discussion about the impact and the interpersonal is really important that there’s a rehabilitation psychiatrist who works in the UK called Tom Burns. And Tom says, ‘All mental illness os a common thread that happens in the space between people.’ And the fascinating thing about that is it when we look at, you know, the neurobiology, so if we read Harry Bergman’s synthesis of the area. If we look at the work of people like Yaak Punk Sap, if we look at the work by people like Alan Sure, what we’re hearing is, maybe we need to stop focusing on the neurobiology of the individual. And we need to think more about the neurobiology of the dynamic of the inter personal I think is is really important, because we’ve talked as therapists about how important it was in regards to the discovery of mirror neurons, and how we can pick up our fact and emotional tune and others. But we know that as therapists that we can pick that up, you know, somebody might say, I’m happy Sunday might say, I’ve okay, but we know that they’re not we can feel it, we experience it, it’s not. And I think that when we begin to look at an interpersonal neurobiology began to see that really, very clearly. And I think I remember Eric Bergman, as you know, 15 years ago, I remember him saying, if he could have persuaded Francine to add anything to the normal procedural steps of the Standard Model, he would have had her add people doing a constant body scan as the therapist. And you know, that then links in to, for me, working in psychosis and more complex disorders, we need to be really aware of that because it isn’t sufficient to just stay out of the way it isn’t sufficient did just follow the protocol, because these presentations are deeply interpersonal. There’s a lot of issues about some of the thoughts that are held that do require more active interweave have a more active positioning in terms of how we process sometimes reversing some of the procedural steps and such like. So I think it’s important. And I think the ICD 11 diagnosis and new zoology that describes Complex PTSD. I like that as a description, because I think dissociation can be a part of it and can make a presentation complex. But it’s not the only thing. And likewise, I also think that people can have multiple traumas and attachment trauma, but it doesn’t necessarily describe the entirety of the complexity of the presentation. And I think ICD 10, or sorry, ICD 11. Hasn’t done too bad with that. But I think apart from anything else, we can begin to harmonize our research around it now, because we have a description.

Kim Howard 25:46
Great answer. Thank you. You may have touched on this earlier, but what is your favorite part of working with EMDR and complex trauma?

Paul Miller 25:55
Oh, I think my favorite part is, because it’s so deeply relational. I think that, you know, working with complex trauma, first of all, it’s it’s helped me to connect to an international community of people who are doing this. And I think I love hearing. Hi, when when I’m working with somebody as an individual, first of all, I love seeing things change, that maybe a person’s being stuck on for a long time. So I still can be amazed by what miracles a person’s own neurobiology can achieve. And I love the fact that there is a really interpersonal piece to it, which really is very present, I think, to saddled site up. And Hank, it’s also important to mention that that’s why I think is so deeply important that we do our homework, because I think that’s you. We’re not a clean screen, we don’t see clearly if we don’t do our own work. And I think that’s really important. And and I think that isn’t just about getting EMDR I think there’s we’re doing lots of work. But I think when we do our work, I think it helps us to be better therapists. But it also protects us from being burned. dite thing I’m very conscious of is at this stage, in my professional career, I’ve been working in trouble for over 25 years now. But I’ve been working and treating trauma in a society that is still emerging from trauma. I tell the story, there’s an illustration that we are about nine, I think 1.7 million people in Northern Ireland. And I remember sitting one day working with a police officer, and he was talking about his trauma. And he talked about how he and his two colleagues, either side of them were approaching a car that looked like there was a body and and as he approached the car, they blew up the car. And there’s two, he came around, and he was still standing. But the blast we have had killed his two colleagues either side of him. And he talked about as just as mighty rushing wind, as he talked about. But as he was describing it, about halfway through the session, I realized that he was describing the murder of somebody I knew, and playing the bandwidth. And he can’t prepare for that. And yet was such a small society, that type of thing, you know, potentially is not uncommon. And so it’s about making sure that you know, we don’t pretend that we then as therapists serve some sort of superhero and don’t need to do your work, but that we help people to understand that we do need to do your own work. There are two windows of tolerance in therapy, the therapist window of tolerance and the clients window of tolerance. And it is important that we attend to both of them. So all of that sort of stuff, I think the being able to get into that space and work safely. And that is what excites me about complex trauma. And I think what I Love NY, is that I’m in a place where I’m able to teach others to do that, towards the sort of latter part of his career. He used to talk about him as the wizard in the desert, he used to talk about he had stopped doing as much therapy and it focused a lot more on teaching. And I said you know what, why have you done that? And he said, because I can treat six people today, but I can teach 30 people today who can all go out and see six people tomorrow and so I think for me the building the research and then sharing the training and teaching I think is that is what really excites me working with complex trauma no i because for me, I’ve always been struck by I started the train initially in surgery and then switched over to psychiatry. And you know, I was a me as that during the troubles. We had like international centers of excellence around plastic surgery because we were having to deal with with bomb injuries and exclusions. We had to develop special skills around respiratory medicine because it conditions like blast lung but yet and turns Mental health we weren’t, that just didn’t happen. And so I think I sort of feel the importance now at this stage of really curating and bringing together and then teaching what we’ve learned in terms of treating with complex trauma, because we’ve had over 30 years of thought, and I think there’s been a, there’s a massive amount of learning, and there’s some brilliant work that’s been undertaken. And I think it’s important that we share that, you know, on suit that I think is what excites me about complex trauma know that we are in a place where we have things which are valuable and can be shared. And we have the opportunity, for example, in a relatively small place, we have two universities. And we have EMDR focus PhD rolling in both of these universities, we have EMDR being taught at different levels. Within the advanced nurse practitioner master’s program, we teach EMDR and Ulster University. Um, so that that is really exciting, because it’s we’re starting to expose people to think about EMDR, and about how we can help with complex trauma. But we’re also not saying that it is the only thing because I think whenever I train, and I always remember Roger solwin, saying EMDR is an integrative psychotherapy. And I’ve always find out to be Su, and I think being able to integrate it with the skill set that people have, because often the people I’m training are people who’ve been, you know, therapists, counselors, psychologists for 20 years. So it’s like saying, I don’t want you to throw all that 20 years away. This is this is building on that standing on that experience, integrating it learning from it. And I think that’s one of the really most powerful things about EMDR. Because it is, so I think that there’s a responsibility for those of us who work in this area that we do record stuff that we do publish it and talk about it. And you know, small things are not trivial. The making a difference. But then teaching people a bite that is incredible, what what good that can bring a bite. And I think that’s the sort of community I want us to have.

Kim Howard 32:03
That’s a good answer. And I like the trainer or professor, whoever he was a gentleman who you could name about how he can impact six people today in his own practice, but he can teach 30. And then they can go out and impact six people each and their practice. And so it spreads the good word, you know, and so the good news about, hey, this is an option for you. And we’ve talked about this on this podcast before. And then the pages of the magazine as well, that EMDR therapy is is an option for people we happen to I mean, we’re EMDRIA. So we think it’s the bee’s knees, right? We think it’s the best out there. But as therapists, you’re really your jobs are really to figure out what works best for your clients, you know, they come in to you, and then you have to sort of put it together, you know, whatever the treatment plan is, and it might involve EMDR therapy that may involve EMDR therapy and other things. And so you have the freedom as the clinician to do that with your with your clients. And I think that that really benefits people who are coming.

Paul Miller 33:01
I couldn’t agree more. Because I think the thing is that when we you know, like I’ve I’ve trained people who are, for example, from a psychodynamic background, or they’ve looked at EMDR. And they’ll have said things like, oh, yeah, well, that’s like, you know, that’s free association, or Yeah, well, what you’re really doing there, this is just a different way of looking at p