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ForwardWhen the Self Cannot Speak: Listening to the Voices of Dissociation in Childhood Trauma
Abstract
This presentation explores the clinical process of working with a child who had been exposed to multiple adverse childhood experiences, therefore developmental trauma, with particular attention to dissociation, diagnostic challenges, the specific dynamics of the therapeutic alliance and the beginnings of therapeutic integration. Through the lens of a single clinical case, the speaker discusses the early phases of psychotherapeutic work with a young girl presenting with symptoms consistent with Post-Traumatic Stress Disorder (PTSD), Complex PTSD (C-PTSD), and emerging signs of Dissociative Identity Disorder (DID).
The therapeutic approach was carried out within a complex psychotherapeutic setting that emphasized strong family involvement and was grounded in contextual therapies and EMDR. This multifaceted framework supported a nuanced exploration of the child’s internal world and the relational dynamics that sustained dissociative patterns over time. While highlighting the importance of drawing therapy from a trauma-informed lens, the presentation examines how fragmented self-states and dissociative processes may be misinterpreted or overlooked in child and adolescent populations. The case illustrates how an attuned and differentiated diagnostic process—beyond symptom-based checklists—can be crucial in guiding treatment planning and fostering a safe therapeutic relationship.
Particular emphasis is placed on the clinical task of “listening for the unspoken and seeing the unseen.” In dissociative presentations, this often means that it is not the presenting self who has seen or heard the traumatic events, but rather a dissociated part who carries that knowledge. In such cases, it is only through careful and compassionate engagement with these inner parts that the unspeakable can begin to be voiced, and the invisible can come into view.
The speaker reflects on the evolving therapeutic alliance and the child’s gradual improvements in emotion regulation, memory integration, and internal communication among dissociated parts. These clinical gains, though modest, underscore the importance of diagnostic clarity, trauma-specific interventions, and systemic support in helping young clients reclaim coherence and agency. This case-based presentation invites clinicians and researchers to deepen their understanding of how complex trauma and dissociation manifest in childhood, and how careful, integrative psychotherapeutic work can illuminate paths toward healing. In doing so, it contributes to the broader conversation on bridging gaps in trauma care, particularly in populations whose suffering often remains unseen or misunderstood.
Potential to Distress: Yes
Target Audience
Beginning/Introductory
Learning Objectives
At the conclusion of this session participants will be able to:
- Explain use of diagnostic categories and reconsider differential diagnoses in complex clinical presentations involving developmental trauma and dissociation
- Identify key clinical indicators of dissociation and complex trauma presentations in children and adolescents
- Analyze the specific role of the therapeutic alliance and family involvement in supporting integration and safety in trauma treatment
- Differentiate between PTSD, Complex PTSD, and Dissociative Identity Disorder through trauma-informed and developmentally sensitive diagnostic processes
- Discuss the clinical relevance of dissociated self-states and how they can inform the therapeutic process when the primary self is unaware of traumatic material
Juan Matias Santojanni, Psychotherapist
Juan Matias Santojanni is a licensed Psychologist (USAL) with advanced specializations in Integrative Cognitive Psychotherapy (UNMDP), Diagnosis and Treatment of Child Abuse and Maltreatment (UNC), and Cognitive Neurosciences (UNSAM). With nearly 10 years of clinical experience, Juan currently serves as a university professor, teaching “Psychotherapy” and “Professional Ethics” at the undergraduate level. He also teaches graduate-level courses on child maltreatment (UNC), shaping the next generation of professionals in this vital field. In his clinical practice, Juan works with children, adolescents, and adults, applying behavioral-contextual therapy models and EMDR. His approach is deeply rooted in trauma-informed conceptualization and interventions, helping clients navigate the process of psychological integration and healing.
Juan has made significant contributions to public health, having worked for five years within Buenos Aires' public healthcare system. Additionally, he has been involved in criminal research and profiling, as well as in mediation and conflict resolution within armed conflicts for the Ministry of Justice of Buenos Aires Province. Throughout his career, Juan has pursued extensive training in trauma, dissociation, and neuroscience. He is currently deepening his education and will soon begin his doctoral studies. He is also an affiliated member of EMDR Iberoamérica Argentina and ACBS - Association for Contextual Behavioral Science-, furthering his professional development and connections within the field of trauma treatment.
Available Credit
- 1.50 APAThe 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.
- 1.50 ASWB ACEThe International Society for the Study of Trauma and Dissociation (ISSTD), #1744, is approved as an ACE provider to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Regulatory boards are the final authority on courses accepted for continuing education credit. ACE provider approval period: 08/20/2024 – 08/20/2027. Social workers completing this course receive 1.50 continuing education credits.
- 1.50 ISSTD Certificate ProgramThis program is eligible for 1.50 credits in the ISSTD Certificate Program. No certificate of completion is generated for this type of credit.
Early registration ends August 31, 2025 at 5:00 PM US Eastern Time. Prices will increase for emerging professional and professional/retired rates at that time by $50.
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ISSTD defines a student as those enrolled in a program of study leading to a degree or certification in the mental health field and who have an interest in trauma and dissociation.
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If you do not fall into one of the above categories please register as Professional/Retired.
Available Discounts
- These prices are for Tier I countries. For a list of countries by Tier click here. If you are located in a country that falls into Tier II-VI please contact ISSTD at [email protected] to receive the appropriate discount code.
- Group rates are available for groups of five or more from the same hospital, facility, or university. Please email ISSTD HQ for assistance with group rates. For groups of 5-9 the discount is 10% off registration fees, for groups of 10 or more the discount is 15% off registration fees.
Cancellation Policy
Cancellations must be received in writing via email or fax. A processing fee of $45 will be charged for cancellations received on or before Sunday, August 31, 2025 at 5:00 PM US Eastern Time. No refunds will be issued for no-shows. Refund requests will not be accepted after August 31, 2025. Not all requests will be granted. Substitutions for attendees are accepted until September 23, 2025.
Grievance Policy
ISSTD is fully committed to conducting all activities in strict conformation with the APA and ASWB grievance procedures.
During this conference, conference organizers, presenters and staff will address any concerns that arise. Every effort will be made to address the concerns during the conference when possible. If these individuals are unable to address the participant’s concerns, the complaints and grievances shall be presented in writing to ISSTD Headquarters at [email protected]. These will be forwarded on for review by the Virtual and Regional Conference Committee.
Social Workers: Should social workers have a specific grievance, these grievances will be addressed by D. Michael Coy, LICSW. In situations where the social worker would have a conflict of interest, then, Christine Forner, MSW will review the grievance.
ISSTD strives to resolve grievances in a manner that is in the best interest of the participant. All complaints and grievances are reviewed within 5 working days. Formal grievances are required to be written and emailed as directed above and will be responded to within 15 business days.
Disability Policy (ADA)
We would be happy to accommodate your ADA needs. Please contact ISSTD Headquarters via email at [email protected] or via phone at 844.994.7783 for assistance.
Registration Contact Information
Email: [email protected]
Phone: 844.994.7783
Fax: 888.966.0310