Recycling Freud’s Discards: Workarounds Toward Enhancing Skills for the Psychodynamic Treatment of DID
When Sigmund Freud abandoned the use of hypnosis, minimized the relevance of dissociation and the dissociative disorders, and replaced exogenous trauma with unconscious fantasies as a prime factor in the etiology of psychic distress, he determined the direction of modern psychoanalysis, exerting influences still powerful today. Recent scholarship reveals that many of his stances were questionable, and some were strategic rather than scientific. Contemporary psychoanalytic/psychodynamic psychotherapists treating patients whose phenomenology and issues have long been exiled from psychoanalytic discourse face a dilemma: Should they privilege their paradigms as they understand them, or plunge into areas where the literatures of their preferred models and practices offer little guidance?
One approach to mitigating this dichotomy involves the detailed study of Freud’s personality, personal agendas, and his willingness to overlook unwelcome dichotomies in his own thinking. For example, Freud discontinued using hypnotic inductions, but his own writings indicate that he had used Bernheim’s autohypnotic/autosuggestive methods, continued to seize upon his patients’ moments of spontaneous trance to pursue deeper associations, and embedded suggestion into the core of analytic technique. These are important concerns to bear in mind when the psychoanalytic/psychodynamic therapist works with psychopathogies associated with high hypnotizability, and may be confused by psychoanalytic injunctions against hypnosis, which Freud himself did not follow.
This presentation will begin with a brief overview of how Freud’s personal issues and ambitions contaminated and confused certain aspects of psychoanalytic thinking, and then demonstrate how understanding and bypassing the sequelae of these misadventures makes possible more scientific, trauma-responsive, and dissociation-aware psychoanalytic/psychodynamic treatments of dissociative disorders and complex trauma. The usefulness of several techniques usually associated with hypnosis will be illustrated with vignettes from psychoanalytic/psychodynamic treatments, although these modalities and hypnosis are often depicted as incompatible.
The application of these techniques to history-taking, and stabilization will be reviewed. The traditional interpretive sequence of confrontation, clarification, interpretation, and working through will be studied in depth as regards dissociation, and the importance of including self psychological concepts in addressing what are clearly dissociative self pathologies will be explained.
The interface of relational and posttraumatic dissociation follows naturally from understanding complex dissociative disorders as self pathologies. A conceptualization of dissociation and a clinical approach to dissociation that embodies relational, hypnotic, and traumatic constructs, together embracing the majority of the dissociative domain, will be outlined. This formulation was inspired by the presenter’s discussion of Cardeña’s (1994) description of the dissociative domain with the late Philip Bromberg (see Kluft, 2022a, 2022b).
The recovery of concepts and techniques long-dissociated from psychoanalysis will provide the psychoanalytic/psychodynamic psychotherapist with useful and powerful tools of known but frequently neglected power. Many have forgotten that the therapeutic results reported by clinicians using psychoanalytic/psychodynamic psychotherapy facilitated with hypnosis (Coons, 1986; Kluft, 1984, 1986), although reported in the 1980s, have yet to be surpassed.
Potential to Distress: Yes
At the conclusion of this presentation, participants will be able to:
- Identify six clinical expressions of dissociative phenomena within Cardeña’s “Dissociative Domain”
- List three advantages attributed to utilizing “Invitational Inclusionism”
- Describe four “hypnotic techniques” able to be used in psychoanalytic/psychodynamic psychotherapy without strong suggestion or trance induction
- Describe and compare relational dissociation and posttraumatic dissociation
- List three negative effects of therapist silence and non-disclosure in treating the traumatized
Presenter: Richard P. Kluft, MD, PhD
Presenter Bio: Dr. Kluft practices psychiatry, psychoanalysis, and medical hypnosis in Bala Cynwyd, PA. A 1964 graduate of Princeton University (A.B., English) and 1968 graduate of Harvard Medical School, he also holds a Ph.D. in Psychology, and graduated from the Psychoanalytic Center of Philadelphia. He has served on the faculties of the University of Pennsylvania, Rush Medical College, and the Harvard Medical School. He currently is Clinical Professor at the Lewis Katz School of Medicine at Temple University, a member of the faculty and Waiver Training Analyst at PCOP, and teaches for the China-America Psychoanalytic Alliance. In addition to his private practice, he was director of training at the West Philadelphia Community Mental Health Consortium and Assistant Director of the Community Psychiatry Residency at Penn. He founded and was Director of the Trauma and Dissociation Program at The Institute of Pennsylvania Hospital, 1989-1997. Dr. Kluft is a Past-President and one of the three co-founders of the ISSTD. He also was President of ASCH, GPSCH, and SCEH, and was International Chair of the 1997 14th International Congress of Hypnosis. He founded the journal DISSOCIATION and was its Editor-in-Chief, 1988-1997. His 290+ publications address topics in trauma, dissociation, hypnosis, psychoanalysis, and the history and implications of the hypnosis/psychoanalysis interface. His awards for his writing, teaching, and clinical interventions are numerous. These include four Milton Erickson Awards for best paper of the year from the American Journal of Clinical Hypnosis, the Pierre Janet Award for Clinical Contributions from the International Society of Hypnosis, and the Ernst Hilgard Award for Contributions to the History of Hypnosis. In addition, Dr. Kluft authors a series of mystery/thriller novels including Good Shrink/Bad Shrink and An Obituary to Die For, and wrote the folkloric novella, How Fievel Stole the Moon – A Tale for Sweet Children and Sour Scholars.
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