Below please find the schedule for the conference as well as abstracts each presentation. Additional details about each presentation will be available 

Day One Schedule

Day Two Schedule

The Logic of Dissociative Identity Disorder (DID): Essential Concepts for Successful Treatment

Presenter
Richard Loewenstein, MD

AbstractDr. Loewenstein will review concepts for successful long-term psychotherapy of dissociative identity disorder (DID). Despite the often-chaotic presentation of DID individuals in treatment, there is almost always a trauma-based/dissociation-based logic that underlies symptoms, life predicaments, and interactions during therapy.  The workshop begins with a discussion of discrete behavioral states theory (DBST), a transtheoretical, translational theory of human consciousness. Discrete behavioral states are so ubiquitous in normal and pathological human behavior as to be invisible. States can be understood simultaneously at many levels of analysis – as isomorphs (e.g., sleep states have been studied from cellular states to organismic states, and even shared social states of people sleeping together). DBST can be applied to normal human development and attachment systems, altered states of consciousness, and as an organizing framework for many psychiatric disorders as “state-change” disorders, including bipolar and mood disorders, panic and anxiety disorders, substance-use and addictive disorders, trauma-and-stressor-related disorders, and dissociative disorders (DD. All current theories of dissociation and dissociative disorders are fundamentally based on the states concept. DBST is the over-arching framework for affect theory. Tracking of discrete behavioral states has been described as a model for understanding psychotherapy.
 
Dr. Loewenstein reviews the foundational importance of psychodynamic psychotherapy principles for DID treatment, as well as understanding hypnosis and hypnotizability. He will discuss how our language about the mind is inherently metaphorical. In particular, metaphors for the phenomenology of DID are often reified, mechanical, and physicalistic. He will review data to conceptualize DID as a specific posttraumatic developmental disorder of self-integration, with its own unique personality organization. The latter combines marked, typically idiosyncratic posttraumatic reactivity along with preservation of crucial resiliencies that underlie the DID individual’s potential positive responses to psychotherapy (e.g., capacities for logical thinking and insight). DID psychotherapy must attend not only to individual self-states, but to the organization of self-state systems, as well as addressing the mind of the “whole human being”. Dr. Loewenstein will discuss the complex relationship of the concepts of self-states to identity-states and their relationship to the construct of personality. He discusses DID self-states as logical posttraumatic adaptations (e.g., reframing “malevolent introject” self-states as paradoxical protectors and/or “underground freedom fighters”). Working in this framework from the beginning of treatment can help navigate many pitfalls of concretely reifying DID self-states based on superficial labels that pattern how we view self-states (e.g., “persecutory” vs. “helper”). All DID self-states are trauma-based attempts at adaptation by the DID child – “problem solvers” - to unpredictably malevolent attachment figures. Dr. Loewenstein will discuss type-D attachment and betrayal trauma as isomorphs. Also, he will discuss the role of shame and disgust, especially around malevolent attachments, as well as the importance of understanding coercive control. Throughout, Dr. Loewenstein will describe traumatic posttraumatic and dissociative aspects of transference/countertransference in DID treatment, as well as mind-control transference, negative therapeutic reaction, and the ubiquity of unconscious flashbacks and multi-level reenactments during psychotherapy.

At the Intersections of Gender & Trauma: Depth Oriented Therapy with Transgender Adults

Presenters
Lou Himes, PsyD

Abstract
This presentation explores depth-oriented considerations for working with transgender adults—whose very existence is, at best, stressful (i.e., Minority Stress) and at worst compounded by complex, systemic, and multiple “single-incident” traumas. This presentation will explore the complexities of working with such individuals while also navigating the often unfamiliar (and scary) territory of medical intervention. Topics covered will include transference/counter-transference, clinical judgment regarding transition-related concerns, and the dynamics of surgical support letter-writing. Case vignettes and participant questions will be utilized to address a/typical presenting concerns and psychodynamic considerations of working with transgender adults. 

Shame and the Unbearable Lightness of Being

Presenters
Faige Flakser, LCSW

Abstract
This presentation will explore shame, as it relates to complex trauma. The presentation will define shame, and unpack the many elements of shame, with a focus on how to recognize its presence in therapy. Distinctions will be made between shame and disgust, shame and self-hate, and shame and low self-esteem. Shame will be examined as existing in connection to others, including enactments that may come up in the therapy relationship. The presentation will also analyze the pathways linking trauma to shame, both those in which shame was an intentional part of the trauma, and those in which shame was a byproduct of trauma. The presentation will show how shame serves as a defense mechanism, protecting the core wound by inhibiting, avoiding, hiding and covering up, and how stripping away that defense leads to unbearable shame, a potential collapse of the nervous system, and even possible suicidality. There will also be opportunity to learn how shame can be camouflaged as its opposite: narcissism and arrogance, adding a complex layer of defense over the defense, presenting as strong and tough, while keeping the shame, and the wound it protects, invisible and untouchable, while it continues to corrode the core sense of worthiness inside. Attendees will learn how to approach shame delicately and with care, handle it skillfully and work with the shame as its own treatment goal; since ignoring it, or mishandling it, will consistently lead to treatment failure. Furthermore, the presentation will explain how the deep understanding and acceptance in the therapy relationship cools the burning shame to a level that can be observed, discussed, unpacked and diffused. Only then can the vulnerability beneath the shame be accessed and true healing can begin, fulfilling the mission of trauma treatment; for while we cannot change what happened, we can change the meaning we make of it. 

Parts in Play: From “Us Me” to “The Me”- In the Treatment Room with a Young Dissociative Boy

Presenters
Eva T. Young, MFA, MPS, ATR-BC, LCAT

Abstract
“It is in playing and only in playing that the individual child or adult is able to be creative and to use the whole personality, and it is only in being creative that the individual discovers the self.” (Winnicott, D.W. 1971,p. 54) This case presentation follows the treatment of a severely dissociated young boy who survived repeated organized abuse outside his home. Symptoms included the presence of compartmentalized, dissociated self-states. Session vignettes from treatment, beginning when Andrew was 5 years old and ending just before his 9th birthday, will illustrate how the treatment room became the reliable play space, holding the potential for discovery, expression and healing for the young boy and his parents.

Children express themselves through action…Thru play they explore conflicting feelings and gain a sense of control in their lives. (Landreth, G.L. 2001). Trauma disrupts a child’s natural use of play, resulting in difficulty identifying and communicating feelings and needs. Children like Andrew create relationships and engage in play that can be described as disorganized and chaotic. The sensitive therapist will invite all the ways of being into the play space, while also allowing the child to set the pace. Beginning in his first session, the therapist provided a variety of mediums to facilitate collaborative self-expression. Art materials became a bridge for communication, promoting meaningful discoveries about the dynamics underlying the young child’s dissociative system.

The role of the therapist, as an “organizing, enhancing and engaged play partner” (Slade, 1994. pp.81) will be emphasized. General treatment principles recommended by the ISSTD (2004) and currently in revision will be discussed, highlighting the significance of the therapist’s authentic presence and playfulness, regardless of technique or clinical orientation.

Through the hard work of play, the child’s capacity to recognize and move seamlessly between affect-states increased as he developed the capacity to sustain a sense of cohesion within himself and in relationships. In a treatment room that promoted self-expression, respect and hope, Andrew and his parents created meaningful connections, leading to the development of alternate coping strategies and an increased capacity to regulate and be in charge of his emotions while utilizing age-appropriate resources in his world.

“We play with kids to help solve mysteries-mysteries of betrayal, mysteries of experience, mysteries of meaning, and mysteries of life itself…The chance to enter the (child’s world) of fear and pain exists in our ability to join in. We play right along... We think “sideways”. And the wonder of all this: we have fun” (Webb, N.B. 2015, pp.xi)