Negative Therapeutic Reaction and Stuck Cases: Mind Control Transference in the Treatment of Dissociative Identity Disorder
The mind control (invasion) transference (MCT) is an extreme form of traumatic transference in patients with dissociative identity disorder (DID) and related very severe, complex dissociative trauma disorders. It is defined as he patient’s belief that the therapist’s overt helpfulness and concern is really in the interest of gaining access to the patient’s mind in order to malevolently invade and control the patient psychologically. To some extent, all DID patients have some aspect of this type of transference. This is because coercive control is at the center of the type of extreme, tortuous perpetration that most DID patients report experiencing. The MCT becomes a dominant transference in several specific clinical situations, that are not mutually exclusive: 1) Intra- or extra-familial childhood perpetrators that are mental health clinicians, who use “therapy” like techniques, including hypnosis as part of childhood abuse, and/or are psychologically extremely intrusive. 2) Parents with DID who are psychologically invasive and consciously or not invade the child’s mind, often to access, control, or create self-states that correspond in some way to their own. 3) Sadistic abusers, often in organized groups, with a variety of manifest belief systems, who focus on complete enslavement of victims using extreme torture to dominate, control, completely abase, and humiliate victims, and to create automatic obedience. 4) Patients who have been abused psychologically as adults by mental health providers, often involving sexual victimization, where the perpetrator uses psychological techniques to control, dominate, and humiliate victims. Many victims of these types of abuse may continue to be victimized/revictimized and/or trafficked by perpetrators into adulthood. They are often susceptible to intimate partner violence with extreme coercive control, and may be particularly vulnerable to coercively controlling mental health providers. For many of these patients, psychotherapy, especially by providers knowledgeable about dissociation, may be experienced as another attempt at mind control/invasion for the purpose of enslavement. This may lead to a myriad of seemingly endless impediments to progress in treatment. In this presentation, I will describe the MCT, and mind-control countertransference, in depth, and how both manifest in psychotherapy. I will discuss clinical interventions that can assist therapy to move forward – if only very slowly - particularly if there has been superimposed revictimization in adulthood by mental health providers.
At the conclusion of this session participants will be able to:
- Describe mind control transference, and how it manifests in psychotherapy
- Assess and make more successful clinical interventions with patients manifesting this type of traumatic transference
- List the types of countertransference that may be particularly evoked in this clinical situation
Presenter: Richard J. Loewenstein, MD
Presenter Bio: Richard J. Loewenstein M.D. is the founder and Medical Director of The Trauma Disorders Program at Sheppard Pratt Health Systems, Baltimore, MD and Clinical Professor of Psychiatry at the University of Maryland School of Medicine. The Trauma Disorders Program includes a 22-bed inpatient unit, an outpatient program, a fellowship program, and research, consultation and teaching components. He did a research fellowship at the National Institute of Mental Health in Bethesda, MD. He is the author of over 75 papers and chapters on sleep disorders, consultation-liaison psychiatry, dissociation, dissociative disorders, and trauma disorders. He is a fellow of the International Society for the Study of Dissociation and Distinguished Life Fellow of the American Psychiatric Association. He has received numerous awards including the Lifetime Achievement Award of the International Society for the Study of Trauma and Dissociation (the organizations highest award). He is an advisor to the longitudinal Treatment of Patients with Dissociative Disorders (TOPDD) Study headed by Bethany Brand, Ph.D. of Towson University. He has over 30 years experience in the diagnosis and treatment of thousands of adults with severe complex trauma and dissociative disorders (CT/DD), particularly those with dissociative identity disorder (DID). Since 1992, he has been attending psychiatrist and team leader on the inpatient Trauma Disorders Unit at Sheppard Pratt Health System. Here he gained extensive experience in the medication management and provision of electroconvulsive therapy (ECT) for complex trauma and dissociative disorder patients. In addition, since the early 1980s, he has worked with CT/DD/DID outpatients, either as individual therapist, or as medication manager in collaboration with non-medical therapists. Also, he has extensive experience in the differential diagnosis and management of somatic symptoms and conversion disorders in this patient population, to assess the contribution of medical and/or psychological factors in the somatic symptoms in these patients.
- 1.50 ISSTD Certificate ProgramThis program is eligible for 1.50 credits in the ISSTD Certificate Program.
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