Treating Trauma-Related Dissociation: 2017 edition - Chapter 2

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Hope67

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Treating Trauma-Related Dissociation: 2017 edition - Chapter 2
« on: November 16, 2018, 10:12:36 AM »
Treating Trauma-Related Dissociation: 2017 Edition by Kathy Steele, Suzette Boon & Onno Van der Hart.  Chapter 2.

Part 1: The Therapeutic Relationship
Chapter 2: The Good Enough Therapist.

This chapter talks about the difficulties that therapists can have to stay grounded and steady with their patients.  p.36 talks about the humanness of therapists and the aim to be 'good enough'.

They equate the 'good enough therapist' with the 'good enough mother'

p.37 "Patients - or particular dissociative parts - can experience the therapist as being "too much": too punitive, pushing too hard, setting too many limits, asking too many questions, being too emotional or too cognitive, too silent or too talkative, too fast or too slow, too smart or too informed.  Patients may also experience the therapist as "too little": not good enough, not correct in our understanding of them, not responsive or available enough, not kind enough, not helpful enough."

I found the above paragraph really interesting, and shows how complicated the therapeutic process can be, plus the potential for a 'fit' between therapist and patient could be challenging.

The next section of the chapter talks about "The Experience of the Therapist in Reenactments" - then they go on to talk about what makes a 'good enough therapist'.  They talk about collaboration, interest, and compassion being important qualities, rather than caretaking - and also an ability to 'reflect' before acting.  Monitoring progress was also said to be important.  Setting good boundaries and limits and having supervision were also important.

Boundaries = a section considered next.  They spoke of "setting appropriate and therapeutic boundaries that are consistent yet flexible"  p43 "The key is whether the boundaries support the competence, growth and responsibility of the patient, and whether therapists can keep their boundaries and limits respectfully, clearly, and consistently, yet can recognise when or if minor boundary crossings are necessary and helpful (Dalenberg, 2000)."

The section entitled "The Good Enough Therapist and Dissociation" is really interesting to me and they said on p.43:
"The good enough therapist is able to view dissociative parts as unintegrated aspects of a single person, not as things or entitites in their own right.  The focus is on helping the whole person resolve inner conflicts and integrate traumatic memories rather than on developing individual relationships with each part."   Goes on to say "Supporting parts to accept and cooperate with each other, since inner awareness, congruence, and self-compassion are foundations for integration in everyone."

"Patients must gradually come to realize that 'parts' are indeed aspects of their own self, and each part must have the same realization from its own perspective"  - I really relate to that sentence, and can see how that makes sense.

Anther resonating sentence for me include on p.44  "A single individual can have multiple and contradictory experiences with multiple streams of consciousness."

The following sections in the chapter talk about the nature of the therapist and whether complex trauma work is right for that therapist and the toll of trauma work on the the therapist.  On p.48 they said "Therapists who are overly conscientious, perfectionistic, and self-giving without adequate boundaries are perhaps more likely to suffer from burnout or vicarious traumatization.  Those who have poor or limited relationships or high levels of stress in their personal lives are more likely to develop these problems."

I really like the detail and discussion of these factors - as it demonstrates to me how complex the issue of a 'fit' between a 'good enough therapist' and a person with complex PTSD and dissociation brings.

They have a table showing 'Existential issues for patients and therapists - that was quite interesting. 

The final part of the chapter looked at "Self-care of the therapist".

So my thoughts about that chapter are that I was interested to see what elements in therapy are important for working with a client/patient who has my issues - and I am especially keen to consider this as I am not sure that I can find a suitable therapist locally to myself - and I am hoping to work with the self-help book - on my own issues - but with the back-up of a therapist that I do know - and have been to see - and I was considering her qualities as I read this chapter - It's brought up some thoughts that I can consider.  It's therefore been helpful in that respect. 

Hope  :)

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Wattlebird

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Re: Treating Trauma-Related Dissociation: 2017 edition - Chapter 2
« Reply #1 on: November 21, 2018, 03:04:38 PM »
This chpt is very interesting, it's not in my edition at all, I like it, it gives me confidence in my t, she has these qualities and seems like a great fit for me.

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Hope67

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Re: Treating Trauma-Related Dissociation: 2017 edition - Chapter 2
« Reply #2 on: November 22, 2018, 10:23:38 AM »
Hi Wattlebird,
Interesting that this chapter isn't in your edition at all - but great that your T has these qualities and that you have a good fit.  I think that is really great. 
Hope  :)

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Boy22

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Re: Treating Trauma-Related Dissociation: 2017 edition - Chapter 2
« Reply #3 on: November 22, 2018, 06:51:37 PM »
My T(s) are great, even if this chapter isnt in Ed1 either.

Interesting to read of the “good enough” therapists. Echoes of Pete Walkers “good enough” parents.

I still struggle with self acceptance of less than 100%.

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Hope67

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Re: Treating Trauma-Related Dissociation: 2017 edition - Chapter 2
« Reply #4 on: November 23, 2018, 11:31:30 AM »
Hi Boy22,
I am glad to hear that your T's are great - and yes, I also think the 'good enough' therapists represent echoes of Pete Walker's 'good enough' parents - that makes sense.

Self-acceptance of less than 100% - I am wondering if that is possible to accept self 100% - I'm not sure I understand what you meant - sorry - sometimes I am unable to comprehend things - so I tend to check out things, to be on the safe side. 

Those book editions seem very different, don't they. 
Hope  :)

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Boy22

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Re: Treating Trauma-Related Dissociation: 2017 edition - Chapter 2
« Reply #5 on: November 23, 2018, 07:46:07 PM »
My perfectionist drive as a typical trait of CPTSD survivor.

I have to be 100% or else my inner critic will berate me forever more.

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Hope67

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Re: Treating Trauma-Related Dissociation: 2017 edition - Chapter 2
« Reply #6 on: November 27, 2018, 07:26:40 PM »
Hi Boy22,
Thanks for clarifying that - I can see what you're saying.  I recognise perfectionism in myself too - it's tough.  I think it's tough for you to need to be 100% because that would be incredibly hard to achieve. 
Hope  :)