Thursday, 28 March 2019
P1 – SHAME, AVOIDANCE AND REJECTION IN THE CLINICAL WORK WITH DISSOCIATIVE CHILDREN AND ADOLESCENTS
Presenter: Sandra Baita
In the treatment of children with developmental trauma and dissociation there are certain big goals every clinician will need to address: the assessment of environmental safety, stabilization and symptom reduction, psychoeducation about trauma and dissociation, assessment of the internal world of the child in search of dissociative parts, and the biggest of all treatment goals: trauma processing. However, beneath the surface of these big treatment goals, some processes and affective experiences remain hidden or disguised, contributing to the reinforcement and maintenance of traumatic dissociation. Without addressing these processes and experiences treatment outcomes could be easily hampered. Through the abusive and neglectful actions and interwoven messages that were repeated over and over again along their development, these children and adolescents have developed a strong, harsh sense of worthlessness that lies behind a felt sense of core shame (Cozolino, 2014). In order to protect themselves from the painful feeling of being unworthy and then unlovable, they have learned to develop powerful shields to hide their “defective” self. Sexualized behaviors, stealing and aggression towards others are some of the most disturbing behaviors that have the power to activate core shame. Clinicians will then need to act as careful explorers getting into a deep cave to get in contact with the heart of this painful experience.
Attendees to this pre-conference will learn ways to recognize core shame in their young clients and to develop a compassionate engagement with their experience about themselves. Do´s and don’ts of therapeutic interventions will also be discussed. The two most relevant theories to explain dissociation -both in adult (Theory of Structural Dissociation) and children (Affect Avoidance Theory) alike- have drawn attention to the strong link between avoidance and dissociation. Avoidance is one of the stronger shields human beings have to elude the feeling of core shame, and children and adolescents are not the exception. They don´t want to withdraw from the transient feeling of relief resulting from avoidance. The question is how we convince them that this relief is not only transient but also illusory? Attendees to this pre-conference will learn ways to creatively engage children to discuss their avoidance and work through it. The behaviors listed above – sexual acting out, stealing, aggression- are part of the heritage of chronic interpersonal trauma, and can be the most poisoning barrier to bonding within new attachment relationships for foster and adopted children. Foster and adoptive parents´ rejection of the child fuels the child´s felt sense of shame and reinforces the misbehavior. Strategies to recognize and work through parent´s rejection will be presented and discussed. Through clinical vignettes and videos attendees will learn how to use self-compassion practices, storytelling, art and EMDR informed interventions to address shame, avoidance and parent´s rejection in the treatment of children and adolescents.
P2 – INTEGRATING THE MULTIDIMENSIONAL INVENTORY OF DISSOCIATION INTO CLINICAL PRACTICE
Presenters: D. Michael Coy, Jennifer Madere
Since the development of EMDR in the early 1990s, a large body of research has shown that it is efficacious for PTSD. Clinicians and researchers have found positive treatment effects beyond PTSD for more complicated conditions. Unfortunately, clinicians soon discovered that EMDR seemed to move complex trauma patients into dysregulated states rather than towards the expected, adaptive resolution of targeted traumatic memories.
Stories of uncontrolled abreactions, the unplanned emergence of self-states, and subsequent destabilization leading to major setbacks or harm prompted some clinicians to dismiss EMDR as a viable treatment option for persons with dissociative features. Although some advanced EMDR trainings and publications address these complexities, ‘basic’ EMDR therapy trainings historically have not. Therapists new to EMDR gain a powerful tool, yet they are frequently caught unprepared to recognize dissociative features, conceptualize treatment in terms of dissociation, or modify treatment when dissociative symptoms pose a treatment challenge.
The Multidimensional Inventory of Dissociation (MID) has thus become a valuable assessment tool for trauma-focused clinicians–and EMDR practitioners in particular–both to determine the presence of pathological dissociation and to develop more fine-grained interventions for preparation and successful trauma accessing/reprocessing. The MID is a 218-item, self-administered instrument with 168 dissociation items and 50 validity items developed by Paul F. Dell, PhD (2006, 2011). The MID reliably differentiates and offers a diagnostic impression for Post-Traumatic Stress Disorder, Otherwise Specified Dissociative Disorder, Dissociative Identity Disorder, Somatization Disorder and Borderline Personality Disorder.
Participants will be introduced to the MID in this ‘walk through’, during which they will learn to administer and score the MID; navigate the MID Analysis to enter data, interpret results, and conduct a follow-up interview; and begin to understand how the information offered up by the MID Report may influence treatment. Those who are new to the study of dissociation will also learn about later-treatment phase Indicators to go back and assess for pathological dissociation, as well as, in a concrete way, to connect MID impressions with what clinicians may see (or have already seen) in client sessions.
Case examples will be discussed, with particular attention paid to how certain clusters of dissociative symptoms could influence clinician’s decisions regarding the use of specific kinds of preparation and trauma accessing methods. Implications for stabilization and potential markers for readiness for trauma accessing in an EMDR therapy frame will be offered.
MID documents are available without charge to mental health professionals and researchers atwww.mid-assessment.com.
P3 – DISSOCIATIVE DISORDERS AND PUBLIC HEALTH
Presenters: Heather Hall, Michael Salter
Recognizing the prevalence of complex traumatic and dissociative disorders, this workshop seeks to develop a social ecological approach to the primary prevention of complex trauma and dissociation. In clinical literature, pathological dissociation is widely understood as an adaptive response to intolerable circumstances. While adaptive it is also associated with lifetime mental health and psychosocial sequelae that significantly complicates recovery. The human and economic costs of complex trauma and dissociation are significant. This workshop identifies the unique role dissociation, that results from mistreatment, plays in the maintenance of social inequities that are found in marginalized communities worldwide. Preventing complex trauma and dissociation before it occurs would not only promote community health and safety and improve treatment outcomes but is key to accomplishing key public policy goals including gender equality and racial justice. Through the application of social ecology theory, the paper examines the social determinants that make dissociative adaptations more likely, emphasized the central role of shaming in the development of the dissociative disorders and those social structures and processes that visit shaming more intensely on some groups than others. The workshop concludes with recommendations for key interventions to reduce the prevalence of complex trauma and the dissociative disorders.
P4 – Harmonizing Body and Mind – Sensorimotor Psychotherapy, Trauma, and Dissociation
Presenters: Rochelle Sharpe Lohrasbe
The foundations of Sensorimotor Psychotherapy (SP), particularly striving for a Resource|Full perspective, provide guidance in harmonizing body and mind in complex trauma therapy. This workshop will introduce SP Foundations and explore not only an SP Phase I resourcing approach but also offer suggestions for maintaining a strength-based and mind-body balanced perspective through all phases of the tri-phasic model. Brief mindful and movement exercises and video will be used throughout to illustrate key concepts.
P5 – Remembering the Vanishing Forms of 9/11: Ruptures, Ripples, and Reflections
Presenters: Billie Pivnick, Jill Bellinson, Moderated by Joan Turkus
The events of 9/11 have been vanishing from memories into history. And yet, it was a pivotal event in world history and in many family’s individual life cycles, since the losses and ruptures have endured – rippling even into our sociopolitical processes.
Memorializing is an act that involves collective grieving through creating shared memory. The National Sept 11 Memorial Museum is designed to help us remember and grieve lives lost in, during, and after the terror attacks of 1993 and 2001 at the former World Trade Center, in the Pentagon, and in Shanksville, Pennsylvania. At the same time, it honors the site, considered by many to be sacred. Continuing to bear witness to the devastation caused by the events intended to create suffering, undermine beliefs, and break up communities reaffirms that we value the dignity of human life, as well as an end to ignorance, hatred, and intolerance.
This workshop will reflect on 9/11 through the lens of mass trauma and its treatment, as well as from the view of the individuals caught in the ruptures such an event causes. In the morning, Dr. Pivnick and Dr. Turkus will lead lecture/discussions about lessons learned in our practices relevant to the treatment of mass catastrophe and historical trauma, as well as how these lessons were applied to the design of the Memorial Museum at Ground Zero. In the afternoon, we will visit the museum under the guidance of Dr. Bellinson, a psychoanalyst in private practice in New York City.
PH1 – BODY POSITIVITY AND SELF-NURTURANCE IN CLIENTS WITH DISORDERED EATING BEHAVIORS
Presenter: Lori Kucharski
Half-Day afternoon Workshop
Purpose: Disordered eating behaviors often do not generally occur outside of relationship to body dissatisfaction, trauma, and attachment disrupt. Disordered eating is considered to be a form of dissociation that, like traditional forms of dissociation, ranges from mild to severe in complexity and acuity. The treatment of co-occurring body dysmorphia, complex trauma, and eating disorders will be discussed using an approach that addresses body positivity, self-nurturance, and comprehensive aspects of wellness (e.g., physical, social/relational, emotional, intellectual/mental, spiritual, sexual, environmental, occupational, and financial). Step-by-step suggestions will be offered for application to client assessments and intakes, diagnosis, treatment planning, and ongoing care. Socio-political factors, cultural implications, body-positive terminology, and disordered eating “do’s and don’ts” will be described. Case examples will be offered to assist in conceptualization of principles. Participants will have the option to engage in exercises and interventions that can be used with clients struggling with body positivity and self-nurturance.
Population: Mental health or medical professionals treating disordered eating clients.
Main points: Disordered eating is thought by many to be a form of dissociation from traumatic material, as well as a way of maintaining a sense of control and safety. By assisting clients in healing developmental and attachment trauma wounds and filling attachment voids, disordered eating behavior is no longer needed to avoid trauma, dissociate, or maintain a sense of control and safety. Disordered eating does not happen in isolation, so it is important to be aware of co-occurring symptoms and possibility of emergence of related disorders (e.g., primarily anorectic behaviors decreasing, but bingeing and purging behaviors increasing).Conclusion: Self-nurturance and body positivity reduce the risk of emergence of other disorders when disordered eating is addressed.
Friday, 29 March 2019
P6 – INTEGRATION FAILURES ACROSS DIAGNOSTIC CATEGORIES IN TRAUMATIZED INDIVIDUALS
Presenters: Kathy Steele, Dolores Mosquera, Suzette Boon
Dissociation is not the only kind of integrative failure in traumatized clients. In the first part of this workshop, we will focus on essential assessment of the subtle clinical differences among many kinds of integrative failures in sense of self and emotion regulation in clients with Borderline and other Personality Disorders, Complex PTSD, and various Dissociative Disorders. Although there are many similarities, these diagnostic groups can be distinguished to a large degree by the severity and clusters of dissociative symptoms. These distinctions have major treatment implications. Participants will learn how to identify the subtle differences between ego states, borderline modes, and dissociative parts, and accurately assess whether a personality disorder exists alone or is comorbid with a dissociative disorder. Based on assessment, we will concentrate in the second part of the day on practical integrative approaches to treating clients across this broad spectrum of trauma-related diagnoses, including how to work with serious comorbid problems. We will discuss what is similar and different in treating personality disorders, Complex PTSD, and Dissociative Disorders. What are the different treatment implications when the client has modes, ego states or dissociative parts? When and when is it not helpful to use the concept of “parts” of self? When should we address personality disorder issues and when should we work with dissociation in those with comorbidity? When is it important to work with the person as a whole versus when to address specific parts as a step toward integration? We will make ample use of video and case vignettes to uncover how the experienced therapist thinks through and treats these complex issues.
P7 – PRIDE AND SHAME IN PSYCHOTHERAPY WITH RELATIONAL TRAUMA AND DISSOCIATIVE DISORDERS
Presenters: Ken Benau, Sarah Krakauer
Pride and shame are affects basic to being human, reflecting our valuation of self, others, and relationship. These affects are vital to understanding and working psychotherapeutically with relational trauma and dissociation. Benau will define pride and shame, differentiating adaptive and maladaptive subtypes. Requisite concepts, principles and attitudes when working with pride and shame in trauma and dissociation follow. Krakauer describes how shame is created and perpetuated in dissociative disorders, how the healing of shame is essential to integration, and how her Collective Heart Model, with its utilization of inner guidance, supports the client’s discovery of inherent value and power. Benau discusses “pro-being pride,” defined as “delighting in being me delighting in you delighting in being you,” and how it manifests clinically in such phenomena as polarities, acceptance, creativity, and humor. Session transcripts from psychotherapy with a relational and sexual trauma survivor flesh out these phenomena. Krakauer’s case presentation includes a discussion of her “Two-Part Film Technique” (TPF) with a poly-fragmented DID patient, and how it complements the notion of pro-being pride. Her adaptation of Bosnak’s dream work with shame in CSA and alcoholism, and her elaboration of Frankel’s Blending Technique, close our presentation. Opportunities for presenters-participants conversation will be plentiful.
P8 – PUTTING IDEAS AND TECHNIQUES TO WORK IN THE TREATMENT OF DID: A CASE STUDY-DRIVEN APPROACH
Presenter: Richard P. Kluft
One of the most challenging aspects of learning and providing psychotherapy to any patient population is the therapist’s inevitable, inescapable, and perpetually reactivated and renewed struggle to translate ideas and approaches from workshops, lectures, tapes, or publications in which they seem so clear, or are demonstrated with such impressive mastery, into effective work in the therapist’s own consulting room. This workshop will rely on the intense study of clinical situations and materials to demonstrate such translations in action. Accordingly, it will not be recorded. Nor will protocols be distributed. Instead, it will take the form of an extended patient-oriented clinical discussion, in the course of which the concepts and techniques involved in the treatment of DID will emerge from the clinical work being illustrated in a series of presentations. The challenges to be considered and the approaches useful in addressing them will include, among others: 1) the resistant patient #1 (exploited by a prior therapist and has not allowed access to memories or alters for over a decade; 2) the resistant patient #2 (diagnosis denial plus exceptionally severe and refractory self-injury); 3) the apparently limited patient who falls within the autistic spectrum; 4) the patient with misdiagnosed Asperger’s Syndrome and psychosis due to unusually profound dissociation; 5) the diagnostic assessment and treatment of an older patient from a cultural background different from that of the therapist presenting with puzzling apparent dementia; 6) untangling the complexities of a personal and cultural history of a patient with acute trauma, childhood trauma, plus a 500-plus year backstory history of transgenerational trauma; 7) insights garnered from the follow-up of a DID patient who has maintained complete integration for over 39 years; and others. In the course of reviewing these cases the phases of trauma treatment in general and the phases of DID treatment will be taught, with their major elements. Aspects of the formation of a therapeutic alliance under both typical and unusually difficult and challenging circumstances will be taught. The imbrication of technique-oriented therapies within an overall process-oriented therapy will be reviewed and illustrated, such as how the psychodynamically-oriented therapist can make use of insights derived from hypnosis, and vice-versa. Within the illustrations above the design and implementation of abreactive work, a three-fold approach to restabilization, the integration of the alter system, and approaching the therapist-patient relationship both from more traditional models of transference and countertransference, and from a relational perspective, will be addressed.
P9 – ORGANIZED ABUSE: THE CRIMINOLOGY OF SEXUAL EXPLOITATION AND THERAPEUTIC APPROACHES
Presenters: Michael Salter, Adah Sachs
This workshop will provide cutting-edge training on the organized abuse of children and adults from two international leaders in the study of extreme abuse. Professionals in a range of sectors continue to encounter children and adults with dissociative disorders who disclose early traumatization and severe exploitation within abusive families and criminal networks, including sadism, ritual and torture. Accumulating forensic and legal evidence from child abuse investigations indicate that these disclosures should be taken seriously. Clinicians, law enforcement and policy-makers around the world are grappling with the sexual exploitation of victims with deliberately induced dissociation trapped in black markets and violent subcultures. Drawing on original research, Dr Salter will explain the criminological dimensions of organized abuse, including the most common victimization scenarios and the experiences of victims and survivors. He will outline the existing gaps in policy and law that enable organized abuse to flourish, and point to areas of emerging and promising practice. Dr Sachs will discuss the specific significance of the abuse being organized on the process of creating and maintaining the more severe forms of DID, and outline her treatment approach with adults enmeshed in organized abuse and the intersecting role of dissociation and attachment. She will also discuss severe and unusual self-harm as an additional symptom of DID in children. Attendees at the workshop can expect to leave with further insights and renewed confidence in treating very complex dissociative clients, and with expanded understanding of the broader criminal and social contexts in which organized abuse takes place.
P10 – DISSOCIATION 101: A COMPREHENSIVE EXPLORATION INTO THE FIELD OF DISSOCIATION AND COMPLEX TRAUMA
Presenters: Christine Forner, Mary-Anne Kate
For many who first enter the field of dissociation and trauma, there is often not a great deal of information that describes the theoretical foundations and history of the dissociative field. This workshop is intended for students, emerging professionals and experienced practitioners who are interested in learning about the fundamentals of dissociation as a distinct response to trauma. The premise of this workshop is to cover essential information regarding dissociation and the dissociative disorders field. This course will cover 1) theories of trauma and dissociation, 2) the history of the dissociative field, including theories and treatment recommendations from the 1800’s, through to the eighties, nineties and today, 3) The impact of the false memory “war”, 4) finer details of current dissociative models (covering various theoretical foundations, e.g. Structural dissociation, dissociative symptoms/phenomena (the DSM), dissociative defenses 5) rate and prevalence 6) a breakdown of the dissociative disorders, 7) neurobiology of trauma and dissociation, 8) assessment and evaluation, and 9) current treatments. The goal of the workshop is to equip those who attend with enough information to take into their scholarly or new professional practices as well as have a solid foundation for the rest of the conference.
This workshop is designed to demystify dissociation and provide participants with a broad based understanding of it as a response to overwhelming stress.
This workshop will cover:
- What is dissociation: Common theories
- How common is dissociation: Rate and Prevalence
- The history of dissociation and the ISSTD: The story that has taken 150 years to emerge
- Neurobiology of dissociation: The field of trauma and dissociation is expanding daily
- All of the Dissociative Disorders: Breaking down the DSM
- Treatments for Dissociative Disorders: Common and not so common
Updated 20 August 2018