Treating Trauma-Related Dissociation: 2017 edition - Chapter 3

  • 6 Replies
  • 584 Views
*

Hope67

  • Member
  • 2233
    • View Profile
Treating Trauma-Related Dissociation: 2017 edition - Chapter 3
« on: November 20, 2018, 11:16:47 AM »
This chapter is entitled: "The Therapeutic Relationship: Safety, Threat, and Conflict"

I have been aware that the first page of this chapter is incredibly triggering to me - on many levels, so I'm just going to put that first paragraph in full - with a TW warning - incase it does the same for others - mentions conflict amongst parts - not actual physical conflict, but it's very triggering to me.

"Most patients with dissociative disorders are conflicted about basic connection with the therapist from the first contact.  They may appear overly compliant, ambivalent, highly anxious or fearful, distracted, aggressive, or depersonalized in early sessions.  Their inner conflicts about the therapist may quickly escalate, since it is relationship itself that is both yearned for and threatening.  In fact, relationships are primarily triggers that evoke memories of interpersonal trauma, so patients can easily become flooded by just walking into the therapy room.  Within the patient, some dissociatiatve parts become activated to frantically connect and seek help, while others are simultaneously fearful of connection or punitive with those parts that seek help from the therapist.  Thus, the ways in which therapists approach the patient from the first session can either support regulation or increase the internal war."

OK - I've agreed with my own parts that it was ok for me to write that paragraph out today - as it is very triggering, and brings up a lot of internal conflict within me - it reminds me of the first session I had with my T - whom I don't see anymore - but whom I felt a multitude of contrasting thoughts and feelings.  It also reminds me of any relationships I have with doctors or nurses etc - and the conflicting fears I have when communicating with them.  Same with friendships too - I know there are lots of 'non-realisations' that I've held onto - but whcih I'm beginning to unpack - and look at, and it's helping me.

That's all I can say on this at the moment, but I think I'll take my time in going through this chapter, and will keep adding to it as I progress through it.

My partner is talking to me in the background right now - about putting honey on parsnips, and that is not helpful to my processing of this - I am laughing now, because it seems quite funny to me - and that's lightened my thoughts.

Hope  :)

*

Hope67

  • Member
  • 2233
    • View Profile
Re: Treating Trauma-Related Dissociation: 2017 edition - Chapter 3
« Reply #1 on: November 20, 2018, 02:05:12 PM »
OK, to continue with Chapter 3 - firstly, I think it worked well to agree with my parts to post that first paragraph - because once I had time to leave it there and then come back to it, somehow I feel better than I did before - it's like they've all calmed down - right at this moment - at least.

So - to continue:

Chapter 3:
I'm just going to share the bits that resonated with me from this chapter - I would highly recommend reading this book - because the bits that resonate with me, may be different than the ones that resonate for you.  Infact, depending on which parts are attending at the time I read the book, I notice different things each time - although this is my second reading of this book - and I am trying to actively 'process' things this time round.  Whilst pacing myself - which is proving a challenge - I tend to push myself - but I do recognise the need to pace too.

p54 "There are 2 major attachment strategies that emerge from disorganized attachment: controlling punitive and controlling caregiving (Liotti, 2011; Main & Cassidy, 1988).  In the controlling-punitive strategy, the child, or at least one dissociative part, learns to defensively engage the caregiver in a power struggle of dominance.  These patients, or dissociative parts, may be angry, obstinate, and highly demanding of the therapist and others around them. (As I wrote this I thought of my sister, and wondered if she had reacted in this way).  "In the controlling-caregiving strategy, the child, or dissociative parts, takes an apparently submissive role, but is actually caring for the care-giver.  Both strategies are intended to help the child receive what she or he needs."

This makes me think that I relate to the second attachment strategy more than the first, but I see my sister's reactions more in the first - and I wonder if we both tried to handle the disorganized attachment of our NM in this contrasting way.

What is interesting is that they go on to say "Various dissociative parts can manifest in one or the other of these strategies."

There is a section talking about 'Parts Fixed in Defense' and in this section, I relate in particular to this sentence:
"Threat-related dissociative parts are typically activated in social or relational situations, regardless of how benign the situations may actually be, because as noted above, relationships themselves have been traumatizing."

There's a section on p. 55 entitled "Parts Fixed in Attachment-Cry and Attachment-Seeking Behaviours" - and in particular this sentence resonated with me: "They may try to please or appease the therapist (controlling-caregiving strategies) and often react intensely to perceived rejection or abandonment".  I do relate very much to that, and have a phobia about 'goodbyes' (although the fact I can write that word right now and not feel anything - it interests me - maybe I'm dissociated right now as I write this - I will probably read this back later, and then 'feel' the emotion during the re-reading. 

I'm jumping now to p.58 where there is a section called 'Relational Reenactments' and it says "WE can think of dissociative parts as being characters or roles in traumatic reenactments."
They list a number of dyadic reenactments that can happen between therapist and dissociative parts, and I must admit I can't understand this section - somehow I just can't work out what they mean - so I think I need to come back to that.

The remainder of that chapter has some case examples - they are powerful and interesting.  They then give a table of Tips for Therapists to Regulate Themselves in Session - which shows how difficult it must be to work effectively with clients, when there are so many things to regulate - in order to get things right.

I don't really have anything else I can say about that chapter - but I'm glad I've read it and it's made me think about my relationships and also the relationships between my dissociated parts - who I do feel are beginning to communicate more with me - even though I feel they blend with me more than I can perhaps handle sometimes.

Hope  :)

*

Hope67

  • Member
  • 2233
    • View Profile
Re: Treating Trauma-Related Dissociation: 2017 edition - Chapter 3
« Reply #2 on: November 22, 2018, 01:52:19 PM »
Relational Reenactments - is a section in p.58 of Chapter 3 - and I'm coming back to it today, because I was struggling to understand it, and I want to try to do so - to move on.  Wattlebird has just helped me enormously with this (thank you Wattlebird), and she wrote:

Quoting Wattlebird: "Hi hope,
The reenactment thing, I have identified reenactments with my therapist,
1. Example to explain the concept, I was never allowed to say no as a child, if I utterly refused to do something, I was "disowned " of sorts, love was removed and I was shamed a lot. in my marriage I ended up saying no to every request, it was like a test of love, I say no and want him to love me anyway, It got so bad my hubby had to ask the kids to ask me to do something, I just saw this as manipulation, but can see now that I was triggered every time he made a request, I'm learning to do what I think is right rather than react so badly to requests for help etc.
Hope that explains the concept ? I seem to reenact quite a bit, but working this out has helped enormously "

(Wattlebird - I hope that was ok to copy and paste what you wrote to this section, but it was incredibly helpful to me, and I wanted to remember it in context with this Chapter).

On p.60 they comment that "Specific interactions among dissociative parts are often the first indication of what is being reenacted, even though the patient does not recall or cannot put into adequate words what happened."


p.61 has a case example, and describes a T called Myra who "was embedded in a double reenactment: She played the role of her own neglectful mother who di dnot see her needs, and also the role of the patient's mother.  She allied herself with the part of the patient that denied any needs, because it was a familiar and valued coping strategy in herself to deny her own needs.  This alliance with one part of the patient served to help Myra and her patient continue to avoid accepting their own needs and grieving that these important emotional needs had never been met in childhood.  In supervision, Myra was able to recognsize what was happening: I am rejecting the part of the patient that is enraged and needy, and I am siding with the part that insists she needs no support.  And I am enacting the role of the neglectful mother - my own and my patient's! - and keeping the patient from accepting her own needs, anger, and grief.  I realize that I am avoiding my own shame, rage, and need by being disgusted by my patient's entitled demands.  In disowning her needs and rage, I can continue to avoid my own."


The above paragraph really resonates with me, as I relate so much to that particular re-enactment. 

They then talk about recognising the reenactment, and then working on "further acceptance of her own needs, anger, and grief while also helping Jody (the patient) to express needs in a more adaptive way."


I am going to try to think through my own personal re-enactments - I think I do relate to this concept more now I have heard Wattlebird's example, from her own experience, and also the examples in the book - and it does make more sense. 

Wattlebird, thank you again for your help. 

Hope  :)


*

Wattlebird

  • Member
  • 614
    • View Profile
Re: Treating Trauma-Related Dissociation: 2017 edition - Chapter 3
« Reply #3 on: November 22, 2018, 03:34:19 PM »
Thanks and no problem

*

Hope67

  • Member
  • 2233
    • View Profile
Re: Treating Trauma-Related Dissociation: 2017 edition - Chapter 3
« Reply #4 on: November 23, 2018, 11:32:02 AM »
Thanks Wattlebird, much appreciated - and thank you again.  :-)
Hope  :)

*

Boy22

  • Member
  • 169
    • View Profile
Re: Treating Trauma-Related Dissociation: 2017 edition - Chapter 3
« Reply #5 on: November 23, 2018, 07:56:19 PM »
I definitely love the saying “NO!” (My empasis). It is my knee jerk response to a request from anyone in a position of authority.
« Last Edit: November 23, 2018, 08:13:59 PM by Boy22 »

*

Hope67

  • Member
  • 2233
    • View Profile
Re: Treating Trauma-Related Dissociation: 2017 edition - Chapter 3
« Reply #6 on: November 27, 2018, 07:25:05 PM »
Hi Boy22,
I also find it challenging to come across people in authority - although I don't have that same knee-jerk reaction that you have to say 'No' - but I do feel some issues regarding people trying to tell me what to do, or control me.
Hope  :)