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This Webinar, based on the presenter’s 35 years experience with medication management of severely traumatized dissociative individuals, will address the role of psychopharmacology and somatic treatments such as electroconvulsive therapy (ECT) in the treatment of patients with complex trauma (CT) and dissociative disorders. (DD), in particular dissociative identity disorder (DID).
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For many years, the practice of psychotherapy for dissociative disorders was largely focused on working with adult survivors. Over the last 10 to 15 years, there has been increased recognition and focus on working with younger trauma survivors in developmentally appropriate ways to more effectively reduce or eliminate the need for dissociative processes as an ongoing coping mechanism. A clear advantage of this approach is that the earlier developmentally these coping mechanisms are addressed, the less firmly entrenched they are.
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Over the past decade, meditation and yoga have become increasingly popular in mental health treatment and in the world at large. While the practices can be helpful, clients will receive the most benefit from work that is trauma informed and delivered with an understanding of how these healing mechanisms impact the mind, brain and body.
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Substantial numbers of patients with Dissociative Identity Disorder at the time of presentation as adults report incestuous abuse continuing into the adult years and for many, the abuse is current and ongoing. Data relating to a series of 10 such incestuously abused women is presented. Such patients usually have been sexually abused from a very early age (typically from under age 3), with the manipulation of their sexual response a key component in conditioning an enduring sexualized attachment, at the same time shame and fear are used as key components in maintaining compliance and silence.
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Therapists can be overwhelmed by working with clients with frequent crises that threaten the life, safety, and health of the client. Often, clients suffering from Complex Trauma and Dissociative Disorders present with a phenomenal array of crisis events. Therapists often struggle with the complexity, frequency, and severity of these events, and their overwhelming emotional toll on both client and therapist.
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In the wake of traumatic experience, survivors tend to be overwhelmed by intense emotions and body sensations, loss of faith in the universe, and unrelenting punitive introspection. Addictive craving and behavior seem to offer an ‘out,’ the promise of blessed relief from both the emotional and somatic overwhelm. The result is the frequent co-occurrence of addictive disorders that ultimately poses an equal or even greater threat to the patient as do the trauma symptoms.
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The Office Mental Status Exam for Dissociative Disorders was originally developed to assist psychiatric residents with assessment of complex dissociative and posttraumatic psychopathologies. Accordingly, it uses a phenomological approach to symptom clusters that commonly appear in patients with dissociative disorders and complex PTSD. This system was designed at a time when diagnosis of dissociative identity disorder (then multiple personality disorder) was primarily based in attempts to elicit alter self states, often by using hypnosis or similar intrusive methods.
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Dr. Brand will describe ways to manage common assessment challenges such as mistrust, amnesia and conflicting and variable experiences of symptoms. She will review the behaviors exhibited by DD patients during psychological assessment, describe a method for obtaining valid assessment data from them, and review some of the trauma-specific tests (DES, TSI, MID, MDI) and interviews (SCID-D-R, DDIS) that are useful in making a differential diagnosis of DD for adults.
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This workshop will provide an overview of the research on DD patients’ profiles on personality inventories (MMPI/MMPI-2, MCMI-II/MCMI-III) and projectives (Rorschach, Rotter Incomplete sentences, TAT). Dr. Brand will focus on how these tests can be useful in making differential diagnoses. She will review ways to clarify if the high levels of symptomatology seen in clients with DD are due to exaggerating and/or feigning symptomatology, including using an interview that assesses feigning of psychiatric disorders (SIRS).
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This webinar will review the triphasic unfolding of psychotherapy for DID, DDNos and chronic PTSD. It will particularly focus on that which differs from standard psychotherapeutic engagement and will use DID as its paradigmatic and emblematic disorder. It will describe how to engage the DID patient in a planful, organized psychotherapy which will favor functional stability and support the unfolding of dissociated material contained within the personalities.
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