Treating Trauma-Related Dissociation: 2017 edition - Chapter 1

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Hope67

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Treating Trauma-Related Dissociation: 2017 edition - Chapter 1
« on: November 15, 2018, 09:56:07 AM »
Chapter 1: Dissociation as Non-Realization

I hope I've put this in the right place - I wanted to open a thread to discuss the different chapters of the 2017 edition of the book 'Treating Trauma-Related Dissociation" by Kathy Steele, Suzette Boon & Onno Van der Hart.  I know that Wattlebird and me have been reading this, and that Boy22 has also read it.

I hope that anyone who wants to add comments or reflections on the chapters will do so - and I hope to work my way through the book - chapter by chapter.

I read the entire book - and now I'm going back Chapter by chapter - with the hope to really progress and understand and go forward.

p.4  "Realization is not only pivotal to the resolution of trauma but necessary to successful coping with everyday life"
I found this to be especially helpful.  A reminder that it's down to coping with everyday life as a focus.

p.6 "Though patients may talk as if they have insight and have integrated trauma, often this superficial and unemotional narrative is an avoidance accompanied by dissocation and depersonalization' - I really relate to this - I think it describes my experience very well.

p.8 "the division of self is a solution to unbearable and irreconciliable realities" - I really relate to this.  "Becoming aware of and reconciling these confilcts and avoidances becomes the focus of treatment" - I am trying to be aware of communications from my different parts to gain 'awareness'.

p.8 "Helen avoids her traumatic past and tries to go on with daily life" - I did this - for many years - focusing on trying to cope with daily life and avoiding looking at my traumatic past - although I continually read self-help books to learn about so many ways people cope etc.

The fact they talk about Emotional parts of the personality - as being "parts stuck in trauma-time - and often feeling 'too much'  and then other parts which 'feel too little' - I related so much to this - there are parts of me that are distraught, upset, crying, and there are parts which can't feel the temperature of water - and emotionally numb parts.

Again, a theme of "non-realization" contributing to "ongoing inner conflicts" - and that they must be addressed in treatment.  This gives me hope.

p.9 states it well "These poles of too much and too little are manifestations of the highly contradictory experience of trauma survivors who simultaneously know (in some parts of themselves) and do not know (in other parts of themselves) what has happened to them (Laub & Auerhahn, 1993).  Knowing and not knowing are important experiences that coexist and create extreme conflicts in dissociative patients.  The contradiction bewteen the two implies that full realization has not been achieved.  The therapist should notice the conflict and bring it to the awareness of the patient in a way that invites safe curiosity, without taking sides."

I really like the fact that thoughtout the chapters, the authors put clear 'core concepts' - they are easy to read and then they go into detail about these concepts - for example on p.9 they write
Core Concept: Dissociative parts are mesmerizing sleights of hand that cleverly hold and conceal what cannot yet be realized by the patient.  Therapists must keep their eye on the prize of missing and needed realizations rather than on the fascinating features of dissociative parts themselves."

p10 - I underlined this section - as I found it particularly helpful - "They must not confuse the patient's dissociative parts that are manifestations of extreme non-realization with actual people who should be treated separately and differently from each other.  The antidote for psychic equivalence is first to be present and mindful, then to mentalize - to step back and reflect on what is happening - which leads to realization"
I think this is helpful - because when I was initially thinking of my 'inners' and 'fragmented/wounded parts' - I almost thought they were separate people - but I do realise they are 'me' - just frozen or trapped at particular ages - due to my experiences at those times.  At least, that is how I am perceiving them.

p11 - this sentence was emotional for me "As these young parts, the patient avoids the realization that she is now grown up and must grieve what she did not receive in childhood."

p.13 - "Some have a hyper-activated care-giving system, which is commonly referred to as codependence." - I definitely relate to this - I think this is me.  I am codependent - or at least many parts of me are.

p.16 "On the other hand she learned as a child that she was best able to maintain connection by being appeasing and submissive.... so her behaviour is both a defense against threat and a way to maintain attachment within a social ranking system" - I relate to this, and I know I still have younger parts which are desperate to attach and try to latch on to people.  But there are also protective parts that will try to pull them back from that.

TW - mentioning abuse

p.17 "Helen, a child who was smart and competent in school and functioned in daily life, but who avoided thinking and knowing about the abuse.  Later, Helen only has the most fragmentary recall of childhood"

I relate to this so much.    (end of TW)...


p.18 The section entitled "Trauma-Related Phobias That Maintain Dissociation" - this is a very helpful section - and starts by saying "The adult part of Helen has developed a phobia of inner experience" - and I relate so much to the character of Helen and her experiences - I also have a phobia of inner experience.  I recognise this.


The Core Concept is also highly relatable: "Patients with complex dissociative disorders have developed a series of inner-directed phobias related to trauma, which support avoidance and non-realization: the phobia of inner experience (thoughts, emotions, sensations, predictions, wishes, needs); the phobia of dissociative parts of self; the phobia of attachment and attachment loss; the phobia of traumatic memory; and the phobia of adaptive change"

I feel the above concept encapsulates my own experience, and seeing those listed makes me realise that I have quite a lot of work to do - to tackle these areas - but I really want to - because I can see it will help me to face these things. 


p.20 "Helen thus developed attachment-seeking and defensive strategies that contradicted each other" - yes, so did I!!!  They go on to say "Once a child becomes dissociative, one part (or more) of the child avoids connection in favour of defending against threat, while other parts frantically seek connection and still others simply go on with daily life as though there is no danger.  Each part thus has its own physiology when activated.  Each part has its own mental representations, emotions, thoughts, predictions, and movement and body postures based on which defense is activated."

Honestly, I think this is brilliant writing - it makes so much sense to me. 


p.23  "Excessive memory work was destablizing her patient, and that her caretaking of child parts without encouraging the adult self to help these parts had created a dependency on her, about which the patient felt both shame and urgency" - this was referring to a therapist who had 'looked after' the client's child parts - rather than enabled the client to do this via the adult part of herself - this made me think that it's so important to recognise that my adult part needs to take the lead in helping my wounded/fragmented parts.


p.24 is a secion entitled 'The Road to Realization' and talks about 2 forms of Realization - Personification and Presentification. 

"The personal owning of our experience is called personification (Janet, 1929; Van der Hart et al. 2006; Van der Hart, Steele, Boon & Brown, 1993)  Patients eventually must accept or realise that whatever has happened to their lives has happened to them, for better or worse.  This engraving of experience as one's own is an essential step toward integration:That happend to me!  That part is me!  My uncle hurt me!  Personification is acceptance of one's own reality."


The second aspect is necessary - as "Many pateints can say, I know it happened to me, but I don't feel anything about it."  They go on to to say "Realization must also include being in the present with a relatively integrated sense of both our past and future, something far more complex than mindfulness of the present moment (Janet, 1928).  This is called presentification ' "the ability to simultaneously be and act in the moment, influenced but not controlled by the past (or anticipated future)."


They give a good example of this: "Once patients realize a certain memory belongs to them (That happened to me), they are further able to understand their behaviour (So that's why I hate sex so much), and then change their behaviour (I can enjoy sex in the present, where I am an adult and with a safe and loving partner).


p.25 I found this sentence very emotional (potential TW)  "How much more difficult then, to realise extremely traumatic experiences of overwhelming pain and betrayal that have been avoided for decades because they are so overwhelming"


The final part of the chapter go through 'Gradual Steps of Realization' and the final section of the chapter is entitled 'Phase-Oriented Treatment and Realization' - they conclude that "Most authors adhere to a three-phase model, consisting of a) safety, stabilization, symptom reduction, and skills training; b) treatment of traumatic memories; and c) personality (re)integration and rehabilitation.   In actual practice, and more so when the degree of non-realization is high, the application of this model takes the form of a spiral, in which different phases are alternated according to the needs of the patient.

**TW (mentioning abuse)
They conclude the chapter with a few points that are said to be 'further explorations' and I related in particular to this sentence: from p.31 where it says "A tough adolescent part might be protecting from the realization that the patient was helpless during the abuse, and might also contain anger that the adult self of the patient is unable to accept." End of TW...

My conclusions on this chapter are that it is really well written, and meaningful.  I was surprised by how emotional I found it to read the case presentations - and how much I related to the people portrayed - in particular 'Helen'. 

Hope  :)



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Three Roses

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Re: Treating Trauma-Related Dissociation: 2017 edition - Chapter 1
« Reply #1 on: November 15, 2018, 03:02:38 PM »
I think I'll have to read this book. This is me -
Quote
"Though patients may talk as if they have insight and have integrated trauma, often this superficial and unemotional narrative is an avoidance accompanied by dissocation and depersonalization'

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Hope67

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Re: Treating Trauma-Related Dissociation: 2017 edition - Chapter 1
« Reply #2 on: November 16, 2018, 10:13:39 AM »
Hi Three Roses, I do think this book is really helpful.   :hug: to you.
Hope  :)

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Kalmer

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Re: Treating Trauma-Related Dissociation: 2017 edition - Chapter 1
« Reply #3 on: November 16, 2018, 10:52:12 AM »
Thanks for writing this out Hope, it was a helpful read.

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Hope67

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Re: Treating Trauma-Related Dissociation: 2017 edition - Chapter 1
« Reply #4 on: November 16, 2018, 12:47:20 PM »
Hi Kalmer,
I'm really glad you found it a helpful read - I think it's a really useful book.
Hope  :)

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Wattlebird

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Re: Treating Trauma-Related Dissociation: 2017 edition - Chapter 1
« Reply #5 on: November 21, 2018, 02:54:18 PM »
Hi hope, I read your chpt 1 summary, well done, I've reread chpt 1 of my copy, they don't talk about realisation and I found your notes on them very applicable to me as well, other sections you discuss seem to be similar to my copy like feeling too much and too little, I related a lot to that, my copy went on to talk about mindfulness and learning to anchor to the present, stuff I've been practicing for a while,
I took a bit of a break for family dramas but getting back to it now.

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Hope67

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Re: Treating Trauma-Related Dissociation: 2017 edition - Chapter 1
« Reply #6 on: November 22, 2018, 10:22:40 AM »
Hi Wattlebird,
Thank you, and it's interesting to hear the differences between the chapters (due to different editions) - and also that your chapter includes mindfulness and anchoring to the present.  Wishing you the best with continued reading and processing.  Well done to you.   Good that you took that break too  - I find that taking breaks is very valuable. 
Hope  :)