Traumatic Transference and Mind Control Transference

October 25, 2024 to October 26, 2024

Abstract
In this presentation, Dr. Loewenstein will review the basic issues in transference and countertransference in DID treatment. He will review that the core transference is fundamentally traumatic, with its most basic variant the anticipation that therapists will inevitably exploit the DID patient in some way for their own narcissistic gratification. This belief exists despite therapists’ apparent concern, helpfulness, probity, and (often) specific statements to the contrary. Dr. Loewenstein will discuss basic variants of traumatic transference in DID treatment. Transference issues in DID treatment will be framed in terms of the development of DID as an early childhood-onset, posttraumatic, dissociative developmental disorder, where dissociative self-states develop in response to typically unpredictable malevolent maltreatment by caregivers. In addition, Dr. Loewenstein will discuss the impact of these transferences on therapists, including posttraumatic and dissociative countertransference responses. Then he will discuss negative therapeutic reaction (NTR) in DID treatment, particularly in response to posttraumatic shame dynamics. Classically, NTR occurs in psychotherapy when interventions that logically should lead to positive change in the patient, repeatedly lead to symptomatic worsening. In DID treatment, NTR is specifically based in posttraumatic relational dynamics involving humiliation. This overview leads to discussion of an extreme traumatic transference response in DID treatment: mind control transference (MCT). Here, DID patients experience that therapists’ overt helpfulness and concern is really in the interest of gaining access to the patient’s mind to malevolently invade, control, and even enslave the patient. MCT occurs to some extent in all DID therapy. However, it dominates therapy in patients with histories of organized abuse; extreme, invasive psychological abuse by attachment figures; abuse by mental health practitioners, including mental health practitioner parents, and combinations of these. In the MCT, the setting of therapy and virtually all interactions with the therapist may activate posttraumatic reminders and cues. Contrary to typical trauma therapist expectations, MCT patients are terrified by the possibility of being “known”, “seen”, or “understood”. In many cases, words used by therapists are themselves literally experienced as a source of danger. Therapy with these DID patients is inevitably prolonged by the complexity of the MCT and its activation in the therapeutic setting itself. Dr. Loewenstein will discuss countertransference responses that may result in even experienced therapists feeling baffled, deskilled, confused, and even angry when previously helpful interventions result in apparent stalemate and seemingly endless NTR. At the same time, understanding MCT dynamics can help therapists make sense of some seemingly intractably “stuck” DID patients. Dr. Loewenstein will describe clinical case material to illustrate what he has found helpful for both MCT transference and countertransference, and the vital importance of therapeutic patience. 

Potential to Distress: Yes

Timed Outline

Day One
15 Minutes - Introduction
30 Minutes - Traumatic Transference in DID treatment
30 Minutes - Posttraumatic and Dissociative Aspects of Countertransference in DID treatment
30 Minutes - Break
60 Minutes - Developmental aspects of DID and its relationship to attachment, humiliation, unpredictably malevolent sadism, and the Negative Therapeutic Reaction in DID treatment 
45 Minutes - Introduction to the concept of Mind Control Transference

Day Two
30 Minutes - Introduction and Recap of Day One
60 Minutes - Mind control transference in the therapeutic encounter Part 1
30 Minutes - Break
45 Minutes - Mind control transference in the therapeutic encounter Part 2
45 Minutes  - Ask Anything” Questions to the Presenter 

Target Audience

Intermediate

Learning Objectives

At the conclusion of this presentation participants will be able to:

  • Discuss the basic types of traumatic transferences in DID treatment
  • Recognize in themselves posttraumatic and dissociative aspects of countertransference in DID treatment
  • Describe the basic negative therapeutic reaction in DID treatment and its relationship to humiliation
  • Explain the dynamics of the mind control transference in DID treatment, its relationship to NTR, and its impact on therapy
  • Recognize indicators of mind control transference dynamics, in particular patients’ dominant fear of being “known”, “understood”, or “seen” by the therapist and conceptualizing why  this is fear is so extreme
Course summary
Available credit: 
  • 6.00 APA
    The International Society for the Study of Trauma and Dissociation is approved by the American Psychological Association to sponsor continuing education for psychologists. The International Society for the Study of Trauma and Dissociation maintains responsibility for this program and its content.
  • 6.00 ASWB ACE
    The International Society for the Study of Trauma and Dissociation (ISSTD), #1744, is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved as ACE providers. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. ISSTD maintains responsibility for this course. ACE provider approval period: 08/20/2021 – 08/20/2024. Social workers completing this course receive 6.00 continuing education credits.
  • 6.00 ISSTD Certificate Program
    This program is eligible for 6.00 credits in the ISSTD Certificate Program.
Course opens: 
05/01/2024
Course expires: 
12/31/2024
Event starts: 
10/25/2024 - 2:00pm EDT
Event ends: 
10/26/2024 - 12:30pm EDT
Rating: 
0

Richard J Loewenstein, MD
Richard J Loewenstein, MD is Adjunct Professor in the Department of Psychiatry at the University of Maryland School of Medicine, Baltimore, MD. He is the founder of, and from 1987-2020 was the Medical Director of The Trauma Disorders Program at Sheppard Pratt, Baltimore, MD, a national referral center for severely traumatized patients. He has been rated by U.S. News and World Report as among America’s top 1 % of psychiatrists. He graduated from Yale University School of Medicine, New Haven, CT in 1975. From 1975-79 he did a psychiatric residency/postdoctoral fellowship, also at Yale University. From 1980-82, he did a research fellowship at the National Institute of Mental Health in Bethesda, MD. He is the author of over 100 papers and book chapters on dissociation, dissociative disorders, trauma disorders, dementia, delirium, somatic symptom disorders, and consultation-liaison psychiatry. He is the Section Editor, Dissociative Disorders, of the American Psychiatric Association (APA), DSM-5 Text Revision (DSM-5-TR). He is co-editor of the 4th Revision (in preparation) of the International Society for the Study of Trauma and Dissociation (ISSTD) Guidelines for Treatment of Dissociative Identity Disorder in Adults. Since 2000, he has primarily been the lead author of the Dissociative Disorders chapter in Kaplan & Sadock’s Comprehensive Textbook of Psychiatry (CTP), with the 11th edition chapter in press. Since 2001, he has authored/co-authored chapters on treatment of dissociative disorders in all editions of the APA’s Treatment of Psychiatric Disorders. He is a distinguished life fellow of the APA and has received the Lifetime Achievement Award of the ISSTD. He is co-investigator and senior advisor to the longitudinal Treatment of Patients with Dissociative Disorders (TOP DD) Study.

Available Credit

  • 6.00 APA
    The International Society for the Study of Trauma and Dissociation is approved by the American Psychological Association to sponsor continuing education for psychologists. The International Society for the Study of Trauma and Dissociation maintains responsibility for this program and its content.
  • 6.00 ASWB ACE
    The International Society for the Study of Trauma and Dissociation (ISSTD), #1744, is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved as ACE providers. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. ISSTD maintains responsibility for this course. ACE provider approval period: 08/20/2021 – 08/20/2024. Social workers completing this course receive 6.00 continuing education credits.
  • 6.00 ISSTD Certificate Program
    This program is eligible for 6.00 credits in the ISSTD Certificate Program.
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