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One of the greatest challenges in working with complex dissociative disorders is to provide a step-wise, rational, and relatively steady treatment approach. Chaos, crises, avoidance strategies, resistances, intense transference and countertransference, conflicts among dissociative parts, and a disorganized attachment style are only a few issues that contribute to difficulties in maintaining a stable therapy. We will explore specific ways to conceptualize a case that offers the therapist a meta-view of how the client is organized, opening a path toward a rational treatment plan. We will explore how to assess specific prognostic factors and set collaborative therapeutic goals. We will discuss general guidelines about how treatment might differ when there is more than one part that functions in daily life; which parts to work with first; when it is better to work with all, some or only one part at a time; steps toward integration even before traumatic memories can be addressed; and effective ways to work with particular types of parts.
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Psychotherapy outcome research shows that the relationship between therapist and client is highly predictive of therapy outcome. This is especially so for chronically traumatized persons, who have been relationally violated so often. In the therapy of complex trauma patients, there are six choice points that present typical relational challenges.
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This presentation features ways to understand and utilize blending skills for a variety of of problem situations faced by clinicians treating dissociative disorders. Our understanding of the development of alters in the lives of our patients/clients rests on the view that they emerge into consciousness in order to solve life problems encountered by abused children.
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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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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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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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When chronic traumatization occurs, inner experience (emotions, needs, thoughts, fantasies, desires, bodily feelings, etc.) can become frightening, shame-inducing, and baffling aspects of the survivor’s world. The physical sensations, impulses, gestures and actions that correspond to such inner experience may also be a source of fear, shame and confusion.
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Mentalizing is the process by which we make sense of the contents of our own minds and that of others. Requiring an optimal level of arousal as well as a nurturing and safe attachment relationship to develop, mentalizing is conspicuously impaired and even frightening for patients who have suffered attachment trauma. Mentalizing requires the capacity to be present, to accurately read relational cues, and to be mindful and tolerant of one’s own inner experiences.
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