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.
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.
First published in 2001. Routledge is an imprint of Taylor & Francis, an informa company.
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.
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.
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.
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.
Healing the Fragmented Selves of Trauma Survivors integrates a neurobiologically informed understanding of trauma, dissociation, and attachment with a practical approach to treatment, all communicated in straightforward language accessible to both client and therapist. Readers will be exposed to a model that emphasizes "resolution"—a transformation in the relationship to one’s self, replacing shame, self-loathing, and assumptions of guilt with compassionate acceptance. Its unique interventions have been adapted from a number of cutting-edge therapeutic approaches, including Sensorimotor Psychotherapy, Internal Family Systems, mindfulness-based therapies, and clinical hypnosis. Readers will close the pages of Healing the Fragmented Selves of Trauma Survivors with a solid grasp of therapeutic approaches to traumatic attachment, working with undiagnosed dissociative symptoms and disorders, integrating "right brain-to-right brain" treatment methods, and much more. Most of all, they will come away with tools for helping clients create an internal sense of safety and compassionate connection to even their most dis-owned selves.
17 true stories about dissociative identity disorder and living with multiple parts, alters, identities & personalities
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
Traumatic Dissociation: Neurobiology and Treatment offers an advanced introduction to this symptom, process, and pattern of personality organization seen in several trauma-related disorders, including acute stress disorder, posttraumatic stress disorder (PTSD), and the dissociative disorders. Our understanding of traumatic dissociation has recently been advanced by neuroimaging technology, empirically-based investigation, and an acknowledgment of its importance in psychopathology. The authors of this volume tie these findings together, tracking the condition from its earliest historical conceptualization to its most recent neurobiological understanding to provide even greater insight into traumatic dissociation and its treatment. Bringing together for the first time theoretical, cognitive, and neurobiological perspectives on traumatic dissociation, this volume is designed to provide both empirical and therapeutic insights by drawing on the work of many of the main contributors to the field. Opening chapters examine historical, conceptual, and theoretical issues and how other fields, such as cognitive psychology, have been applied to the study of traumatic dissociation. The following section focuses specifically on how neurobiological investigations have deepened our understanding of dissociation and concluding chapters explore issues pertinent to the assessment and treatment of traumatic dissociation. The interacting effects of traumatic experience, developmental history, neurobiological function, and specific vulnerabilities to dissociative processes that underlie the occurrence of traumatic dissociation are among some of the key issues covered. The book's significant contributions include A review of cognitive experimental findings on attention and memory functioning in dissociative identity disorder An appreciation of how the literature on hypnosis provides a greater understanding of perceptual processing and traumatic stress Ascertaining symptoms of dissociation in a military setting and in other situations of extreme stress An outline of key issues for planning assessment of traumatic dissociation, including a critique of its primary empirically supported standardized measures An examination of the association between child abuse or neglect and the development of eating disorders, suggesting ways to therapeutically deal with negative body experience to reduce events that trigger dissociation A description of neuroendocrine alterations associated with stress, pointing toward a better understanding of the developmental effects of deprivation and trauma on PTSD and dissociation A review of the relation of attachment and dissociation A discussion of new research findings in the neuroimaging of dissociation and a link between cerebellar functioning and specific peritraumatic experiences Useful as a clinical reference or as ancillary textbook, Traumatic Dissociation reorganizes phenomenological observations that have been overlooked, misunderstood, or neglected in traditional training. The research and clinical experience described here will provide the basis for further clinical and theoretical formulations of traumatic dissociation and will advance empirical examination and treatment of the phenomenon.
Dissociation, Mindfulness, and Creative Meditations explores the potential of mindfulness and explains why this level of developmental human achievement is so precarious within traumatic stress, especially traumatic dissociation. Chapters discuss the connection and disconnection between mindfulness and dissociative disorders and highlight the importance of gently creating a mindfulness practice for traumatized individuals. Readers will learn how to exercise the part of the brain that is responsible for mindfulness and how to regulate the part that is responsible for dissociation, and they’ll come away from the book with tips that will help even the most dissociative client to reap the benefits of mindfulness practices.
"This read truly does have something for everyone who works with trauma and dissociative processes." --American Journal of Clinical Hypnosis "This volume, which takes a multi-perspective approach to the practice of EMDR and Ego State Therapy, presents a wide variety of ways to integrate these two therapies, both with each other and with other complementary methods in the treatment of trauma and dissociation." --European Association for Body Psychotherapy EMDRIA has approved this book for a Distance Learning Book Course for 8 EMDRIA credits. "This book pioneers the integration of EMDR with ego state techniques. and opens new and exciting vistas for the practitioners of each." --From the foreword by John G. Watkins, PhD, founder of ego state therapy "This read truly does have something for everyone who works with trauma and dissociative processes." --American Journal of Clinical Hypnosis "The editors have gathered many experts in the field who explain in clear informative ways how to expand the clinician's abilities to work with this terribly injured population. This book blends concepts from neurobiology, hypnosis, family systems theory and cognitive therapy to enhance treating this population. It is a well written book that the novice as well as the seasoned clinician can benefit from." --Mark Dworkin, author of EMDR and the Relational Imperative "[This book] conveys complex concepts that will be of interest to seasoned therapists... with a clarity that will appeal to the novice as well. This is really a wonderful text with many excellent ideas and I highly recommend it to anyone who treats trauma." --Sarah Chana Radcliffe, M.Ed.,C.Psych.Assoc. Author, Raise Your Kids without Raising Your Voice "I believe that this book is a significant contribution to the fields of psychology and EMDR. It is the first of its kind... anyone who reads this will gain greater confidence in using EMDR and ego state therapy witih highly dissociative and complicated clients." --Sara G. Gilman, in Journal of EMDR Practice and Research, Volume 3, 2009 "This is a book about polypsychism and trauma. It offers a number of creative syntheses of EMDR with several models of polypsychism. It also surveys and includes many other models of contemporary trauma theory and treatment techniques. The reader will appreciate its enrichment with case examples and very generous bibliographic material. If you are a therapist who works with patients who have been traumatized, you will want this book in your library." --Claire Frederick, MD, Distinguished Consulting Faculty, Saybrook Graduate School and Research Center "Training in EMDR seems to have spread rapidly among therapists in recent years. In the process, awareness is growing that basic EMDR training may not be adequate to prepare clinicians to effectively treat the many cases of complex trauma and dissociation that are likely to be encountered in general practice. By integrating it with ego state therapy, this book may just serve as a crucial turning point in the development of EMDR by providing a model for productively applying it to the treatment of this important and sizeable clinical population." --Steven N. Gold, PhD, President Elect, APA Division of Trauma The powerful benefits of EMDR in treating PTSD have been solidly validated. In this groundbreaking new work nine master clinicians show how complex PTSD involving dissociation and other challenging diagnoses can be treated safely and effectively. They stress the careful preparation of clients for EMDR and the inclusion of ego state therapy to target the dissociated ego states that arise in response to severe and prolonged trauma.