A patient-oriented manual for complex trauma survivors.
A patient-oriented manual for complex trauma survivors.
A patient-oriented manual for complex trauma survivors. This training manual for patients who have a trauma-related dissociative disorder includes short educational pieces, homework sheets, and exercises that address ways in which dissociation interferes with essential emotional and life skills, and support inner communication and collaboration with dissociative parts of the personality. Topics include understanding dissociation and PTSD, using inner reflection, emotion regulation, coping with dissociative problems related to triggers and traumatic memories, resolving sleep problems related to dissociation, coping with relational difficulties, and help with many other difficulties with daily life. The manual can be used in individual therapy or structured groups.
Establishing safety and working with dissociative parts in complex trauma therapy. Therapists around the world ask similar questions and struggle with similar challenges treating highly dissociative patients. This book arose not only out of countless hours of treating patients with dissociative disorders, but also out of the crucible of supervision and consultation, where therapists bring their most urgent questions, needs, and vulnerabilities. The book offers an overview of the neuropsychology of dissociation as a disorder of non-realization, as well as chapters on assessment, prognosis, case formulation, treatment planning, and treatment phases and goals, based on best practices. The authors describe what to focus on first in a complex therapy, and how to do it; how to help patients establish both internal and external safety without rescuing; how to work systematically with dissociative parts of a patient in ways that facilitate integration rather than further dissociation; how to set and maintain helpful boundaries; specific ways to stay focused on process instead of content; how to deal compassionately and effectively with disorganized attachment and dependency on the therapist; how to help patients integrate traumatic memories; what to do when the patient is enraged, chronically ashamed, avoidant, or unable to trust the therapist; and how to compassionately understand and work with resistances as a co-creation of both patient and therapist. Relational ways of being with the patient are the backbone of treatment, and are themselves essential therapeutic interventions. As such, the book also focused not only on highly practical and theoretically sound interventions, not only on what to do and say, but places strong emphasis on how to be with patients, describing innovative, compassionately collaborative approaches based on the latest research on attachment and evolutionary psychology. Throughout the book, core concepts—fundamental ideas that are highlighted in the text in bold so they can be seen at a glance—are emphasized. These serve as guiding principles in treatment as well as a summing-up of many of the most important notions in each chapter. Each chapter concludes with a section for further examination. These sections include additional ideas and questions, exercises for practicing skills, and suggestions for peer discussions based on topics in a particular chapter, meant to inspire further curiosity, discovery, and growth.
They typically have a wide array of symptoms, often classified under different combinations of comorbidity, which can make assessment and treatment complicated and confusing for the therapist. Many patients have substantial problems with daily living and relationships, including serious intrapsychic conflicts and maladaptive coping strategies. Their suffering essentially relates to a terrifying and painful past that haunts them. Even when survivors attempt to hide their distress beneath a facade of normality—a common strategy—therapists often feel besieged by their many symptoms and serious pain. Small wonder that many survivors of chronic traumatization have seen several therapists with little if any gains, and that quite a few have been labeled as untreatable or resistant. In this book, three leading researchers and clinicians share what they have learned from treating and studying chronically traumatized individuals across more than 65 years of collective experience. Based on the theory of structural dissociation of the personality in combination with a Janetian psychology of action, the authors have developed a model of phase-oriented treatment that focuses on the identification and treatment of structural dissociation and related maladaptive mental and behavioral actions. The foundation of this approach is to support patients in learning more effective mental and behavioral actions that will enable them to become more adaptive in life and to resolve their structural dissociation. This principle implies an overall therapeutic goal of raising the integrative capacity, in order to cope with the demands of daily life and deal with the haunting remnants of the past, with the “unfinished business” of traumatic memories. Of interest to clinicians, students of clinical psychology and psychiatry, as well as to researchers, all those interested in adult survivors of chronic child abuse and neglect will find helpful insights and tools that may make the treatment more effective and efficient, and more tolerable for the suffering patient.
Winner of the International Society for the Study of Trauma and Dissociation's (ISSTD) Pierre Janet Writing Award, 2015. What really happens in dissociation. Winner of the International Society for the Study of Trauma and Dissociation's (ISSTD) Pierre Janet Writing Award, 2015. What really happens in dissociation. Winner of the International Society for the Study of Trauma and Dissociation's (ISSTD) Pierre Janet Writing Award, 2015. What really happens in dissociation. Winner of the International Society for the Study of Trauma and Dissociation's (ISSTD) Pierre Janet Writing Award, 2015. What really happens in dissociation. Dissociative processes have long burdened trauma survivors with the dilemma of longing to feel “real” at the same time as they desperately want to avoid the pain that comes with that healing—a dilemma that often presents particularly acute difficulties for healing professionals. Recent clinical and neurobiological research sheds some light into the dark corners of a mind undergoing persistent dissociation, but its integration into the practice of talking therapy has never, until now, been fully realized. Intensive Psychotherapy for Persistent Dissociative Processes brings readers into the consultation room, and into the minds of both patient and therapist, like no other work on the treatment of trauma and dissociation. Richard A. Chefetz marries neuroscientific sophistication with a wealth of extended case histories, following patients over several years and offering several verbatim session transcripts. His unpacking of the emotionally impactful experience of psychodynamic talking therapy is masterfully written, clearly accessible, and singularly thorough. From neurobiological foundations he builds a working understanding of dissociation and its clinical manifestations. Drawing on theories of self-states and their involvement in dissociative experiences, he demonstrates how to identify persistent dissociation and its related psychodynamic processes, including repetition compulsion and enactment. He then guides readers through the beginning stages of a treatment, with particular attention to the psychodynamics of emotion in both patient and therapist. The second half of the book immerses readers in emotionally challenging clinical processes, offering insight into the neurobiology of fear and depersonalization, as well as case examples detailing struggles with histories of incest, sexual addiction, severe negativity, negative therapeutic reactions, enactment, and object-coercive doubting. The narrative style of Chefetz’s casework is nearly novelistic, bringing to life the clinical setting and the struggles in both patient and therapist. The only mystery in this clinical exposition, as it explores several cases over a number of years, is what will happen next. In the depth of his examples and in continual, self-reflexive analysis of flaws in past treatments, Chefetz is both a generous guide and an expert storyteller. Intensive Psychotherapy for Persistent Dissociative Processes is unique in its ability to place readers in the consultation room of psychodynamic therapy. With an evidence-focused approach based in neurobiology and a bold clinical scope, it will be indispensible to new and experienced therapists alike as they grapple with the most intractable clinical obstacles.
A book for clinicians and clients to use together that explains key concepts of body psychotherapy. The body’s intelligence is largely an untapped resource in psychotherapy, yet the story told by the “somatic narrative”-- gesture, posture, prosody, facial expressions, eye gaze, and movement -- is arguably more significant than the story told by the words. The language of the body communicates implicit meanings and reveals the legacy of trauma and of early or forgotten dynamics with attachment figures. To omit the body as a target of therapeutic action is an unfortunate oversight that deprives clients of a vital avenue of self-knowledge and change. Written for therapists and clients to explore together in therapy, this book is a practical guide to the language of the body. It begins with a section that orients therapists and clients to the volume and how to use it, followed by an overview of the role of the brain and the use of mindfulness. The last three sections are organized according to a phase approach to therapy, focusing first on developing personal resources, particularly somatic ones; second on utilizing a bottom-up, somatic approach to memory; and third on exploring the impact of attachment on procedural learning, emotional biases, and cognitive distortions. Each chapter is accompanied by a guide to help therapists apply the chapter’s teachings in clinical practice and by worksheets to help clients integrate the material on a personal level. The concepts, interventions, and worksheets introduced in this book are designed as an adjunct to, and in support of, other methods of treatment rather than as a stand-alone treatment or manualized approach. By drawing on the therapeutic relationship and adjusting interventions to the particular needs of each client, thoughtful attention to what is being spoken beneath the words through the body can heighten the intimacy of the therapist/client journey and help change take place more easily in the hidden recesses of the self.
Winner of ISSTD's 2009 Pierre Janet Writing Award for the best publication on dissociation in 2009! Dissociation and the Dissociative Disorders is a book that has no real predecessor in the dissociative disorders field. It reports the most recent scientific findings and conceptualizations about dissociation; defines and establishes the boundaries of current knowledge in the dissociative disorders field; identifies and carefully articulates the field’s current points of confusion, gaps in knowledge, and conjectures; clarifies the different aspects and implications of dissociation; and sets forth a research agenda for the next decade. In many respects, Dissociation and the Dissociative Disorders both defines and redefines the field.
The body, for a host of reasons, has been left out of the "talking cure." Psychotherapists who have been trained in models of psychodynamic, psychoanalytic, or cognitive therapeutic approaches are skilled at listening to the language and affect of the client. They track the clients' associations, fantasies, and signs of psychic conflict, distress, and defenses. Yet while the majority of therapists are trained to notice the appearance and even the movements of the client's body, thoughtful engagement with the client's embodied experience has remained peripheral to traditional therapeutic interventions. Trauma and the Body is a detailed review of research in neuroscience, trauma, dissociation, and attachment theory that points to the need for an integrative mind-body approach to trauma. The premise of this book is that, by adding body-oriented interventions to their repertoire, traditionally trained therapists can increase the depth and efficacy of their clinical work. Sensorimotor psychotherapy is an approach that builds on traditional psychotherapeutic understanding but includes the body as central in the therapeutic field of awareness, using observational skills, theories, and interventions not usually practiced in psychodynamic psychotherapy. By synthesizing bottom-up and top down interventions, the authors combine the best of both worlds to help chronically traumatized clients find resolution and meaning in their lives and develop a new, somatically integrated sense of self. Topics addressed include: Cognitive, emotional, and sensorimotor dimensions of information processing • modulating arousal • dyadic regulation and the body • the orienting response • defensive subsystems • adaptation and action systems • treatment principles • skills for working with the body in present time • developing somatic resources for stabilization • processing
Finally, a book that addresses your concerns about DID From Eve to Sybil to Truddi Chase, the media have long chronicled the lives of people with dissociative identity disorder (DID), formerly known as multiple personality disorder. The Dissociative Identity Disorder Sourcebook serves as a much-needed bridge for communication between the dissociative individual and therapists, family, and friends who also have to learn to deal with the effects of this truly astonishing disorder.
Praise for Rebuilding Shattered Lives, Second Edition "In this new edition of Rebuilding Shattered Lives, Dr. Chu distills the wisdom he has gained from many years spent building and directing an extraordinary therapeutic community in a major teaching hospital. Both beginners and experienced clinicians will benefit from this book's unfailing clarity, balance, and pragmatism. An invaluable resource."—Judith L. Herman, MD, Director of Training for the Victims of Violence Program, Cambridge Health Alliance, Cambridge, MA "The need for this work is immense, as is the reward. Thank you, Dr. Chu, for continuing to share your sustaining insight and wisdom in this updated edition."— Christine A. Courtois, founder and principal, Christine A. Courtois PhD & Associates, PLC, Washington, DC; author of Healing the Incest Wound: Adult Survivors in Therapy and Recollections of Sexual Abuse Praise for the first edition: "Dr. James Chu charts a deliberate and thoughtful approach to the treatment of severely traumatized patients. Written in a straightforward style and richly illustrated with clinical vignettes, Rebuilding Shattered Lives is filled with practical advice on therapeutic technique and clinical management. This is a reassuring book that moves beyond the confusion and controversies to address the critical underlying issues and integrate traditional psychotherapy with more recent understanding of the effects of trauma and pathological dissociation." —Frank W. Putnam, MD A fully revised, proven approach to the assessment andtreatment of post-traumatic and dissociative disorders—reflecting treatment advances since 1998 Rebuilding Shattered Lives presents valuable insights into the rebuilding of adult psyches shattered in childhood, drawing on the author's extensive research and clinical experience specializing in treating survivors of severe abuse. The new edition includes: Developments in the treatment of complex PTSD More on neurobiology, crisis management, and psychopharmacology for trauma-related disorders Examination of early attachment relationships and their impact on overall development The impact of disorganized attachment on a child's vulnerability to various forms of victimization An update on the management of special issues This is an essential guide for every therapist working with clients who have suffered severe trauma.
Dr Paulsen's narrative and 100 cartoons assist therapists and clients to understand trauma and dissociation, from giving a voice to disowned parts of self, to stabilizing and detoxifying memories.
Treating Complex Trauma and Dissociation is the ideal guide for the front-line clinician whose clients come in with histories of trauma, abuse, self-injury, flashbacks, suicidal behavior, and more. The book helps clinicians develop their own responses and practical solutions to common questions, including "How do I handle this?" "What do I say?" and "What can I do?" Treating Complex Trauma and Dissociation is the book clinicians will want to pick up when they're stuck and is a handy reference that provides the tools needed to deal with difficult issues in therapy. It is supportive and respectful of both therapist and client, and, most of all, useful in the office.
The Child Survivor is a clinically rich, comprehensive overview of the treatment of children and adolescents who have developed dissociative symptoms in response to ongoing developmental trauma. Joyanna Silberg, a widely respected authority in the field, uses case examples to illustrate hard-to-manage clinical dilemmas such as children presenting with rage reactions, amnesia, and dissociative shut-down. These behaviors are often survival strategies, and in The Child Survivor practitioners will find practical management tools that are backed up by recent scientific advances in neurobiology. Clinicians on the front lines of treatment will come away from the book with an arsenal of therapeutic techniques that they can put into practice right away, limiting the need for restrictive hospitalizations or out-of-home placements for their young clients.
EMDR is a psychotherapeutic approach developed for the treatment of PTSD, meanwhile, practicing clinicians have found the application of EMDR to be useful in treating patients who have experienced emotionally traumatic events, which they described as distinctive of their family-of-origin, their personal life history and their attachment relations. In this book the authors describe some of the basic aspects that therapists must understand in order to adequately apply EMDR in the more severe cases, including dissociative disorders, personality disorders and different types of complex traumatization.