Treating Trauma-Related Dissociation: 2017 edition - Chapter 5

  • 4 Replies
  • 302 Views
*

Hope67

  • Member
  • 1989
    • View Profile
Treating Trauma-Related Dissociation: 2017 edition - Chapter 5
« on: December 29, 2018, 01:41:15 PM »
Treating Trauma-Related Dissociation: A Practical Integrative Approach (2017) by Kathy Steele, Suzette Boon & Onno Van der Hart.
Chapter 5: Assessment of Dissociative Disorders.

p.95 The Core concept is "Complex dissociative disorders require specific treatment approaches.  Thus, assessment is of major importance."

They mention that if dissociation is NOT attended to in treatment, then people will continue to have dissociative symptoms and other difficulties (Brand, Classen, McNary & Zaveri, 2009).

p.96 has a section entitled 'Multiple Meanings of Dissociation' and so that section talks about that.  I found a sentence on p.97 very relevant where it said "the patient alternates between hypoarousal and hyperarousal according to which part is in control' - as I relate to that difference.

They talk about how some therapists can lack training in this area, and therefore may not know how to distinguish these disorders of dissociation from other phenomena such as normal ego states, inner conflicts, or dramatic fluctuations in emotions or thoughts.  They also mentiont that clinicians "must be able to distinguish dissociative amnesia from failures to encode memory due to stress, absorption, fatigue, or illness.  Many trauma survivors spent much of their childhood absorbed in fantasy, reading, watching TV, or playing video games and the like as an escape from painful realities.  In addition to dissociative amnesia of traumatic experiences, they may also simply not recall much of childhood because they were abosrbed or spacey so often.  This distinction is essential to discern, otherwise the patient and therapist may make continued fruitless efforts to fill in the blanks of the patient's history."

I think this is very interesting.

The next section on p.99 is entitled "The Hidden Nature of Dissociation" and talks about how it can very often be a hidden thing - i.e. a "private, internal organization that is often not readily visible" (Kluft, 1987)  In particular thye may say that they've "always been this way".  Rarely conceptualising or verbalizing the inner experience of dissociation.  Fear of being perceived as 'crazy' and other fears may mean that a patient may keep their inner experiences 'hidden'.

p.101 has a section entitled "Distinguishing Ego States and Modes from Dissociative Parts" - and I admit that I am struggling to summarise these complex points - I would recommend getting the book and reading it through yourself to try to get a better understanding.  I fear that I am missing out things that will help - but I am purely noting certain things that have stood out to me. 

p.103 has a section entitled "Symptoms of Dissociation of the Personality" and the Core concept here is "Dissociative symptoms can be positive or negative.  Positive symptoms are temporary intrusions such as voices, pain, thoughts and emotions.  Negative symptoms are losses of function that cannot be explained by other reasons, such as emotional numbness, analgesia or anesthesia, paralysis, and sudden loss of skills such as driving a car or cooking."

p.105 has a table which lists "Common symptoms of Dissociation" and is detailed, but there are headers including: Amnesia; Depersonalization and derealization and Passive influence and the table goes on to p.107 so it is very detailed.

p.109 talks about "False-Positive DID Diagnoses

I relate in particular to this paragraph on p.110 "Patients may have read about dissociation or participated in online chat groups or self-help groups and become convinced they have the disorder.  They may have a trauma history and some dissociative symptoms such as depersonalization and PTSD symptoms, but not DID.  And they may have symptoms of a personality disorder and are genuinely confused about who they are.  For them, the idea of having DID provides an acceptable explanation for their fluctuating sense of identity."

Speaking personally - I relate to the idea of parts, and I feel like some of my parts are frozen in time, due to my earlier traumas.  I have not sought a psychiatric label from any system, and I fear looking for one.  I prefer to delve into these self-help realms - but of course this then means that I cannnot be sure of whether I am on the right track for myself or not - but I do relate to this book and its contents, and it makes sense to me.

p110 has a section entitled "Assessing the Level of Dissociative Organization of the Personality"  - they talk of two somewhat different dissociative organizations of the personality, and I related to this one - i.e. "the patient has a single part of the personality that is functioning in daily life, while all other parts are fixed in trauma-time.  Though these parts may intrude on the patient, they rarely take full control.  When they do, they are usually in a flashback, not attempting functions of daily life."  (I think that is mainly how it feels for me, in my experience - but there have been times in my life when I have felt as if another part has taken more control, and led me down a path of behaviour that has felt alien to me, but that's usually been when I'm under undue pressure or stress).

p.112 has a Case Example - and I think the book is excellent for including such examples - I think it is worth getting the book for the case examples as they bring it to life and are relatable. 

I can't really say more about that chapter, except that it was helpful to know how complex the subject is, and how therapists can struggle - so it's understandable that people experiencing these things would find it complex too. 

Hope  :)

*

woodsgnome

  • Member
  • 1636
  • I did not wish to live what was not life
    • View Profile
Re: Treating Trauma-Related Dissociation: 2017 edition - Chapter 5
« Reply #1 on: December 29, 2018, 06:14:11 PM »
Wow -- that's an impressively honest and provocative review of what seems an equally thorough book.

You note that you haven't sought a psychic label for yourself. I think that's fine, even wise, reflecting where your heart is with all this information. As my own T reminded me at one point, the danger of labeling is getting mired into a one-way situation where the totality of all of these parts gets missed and is squeezed into a therapist's specialty. I ran into that situation with a couple of therapists along my own slog through various forms of therapy.

On the other hand, labeling can be valuable as a framework helping but if not strictly definitive in how any one person will experience the totality of healing.

So much to explore, and sometimes it does overwhelm the desire to find any peace with so much pain. It gets tiring and threatens to collapse into defeatist thinking (e.g. "I'll never get there").

Thanks so much for sharing your insights about the book. Although I haven't read it, your review has helped with my own dissociative struggles and aided in growing my own perception of dissociation  and the struggle to move with and beyond its effects.
« Last Edit: December 29, 2018, 06:19:59 PM by woodsgnome »

*

Hope67

  • Member
  • 1989
    • View Profile
Re: Treating Trauma-Related Dissociation: 2017 edition - Chapter 5
« Reply #2 on: December 30, 2018, 11:57:39 AM »
Hi Woodsgnome,
Thank you so much for all that you said here, I find it very validating, and helpful.  Especially what your T said about the danger of labelling and fitting in with a T's specialty - that makes sense.  You also have your own experience of just that thing, so even more pertinent.  I also agree that if a label helps someone in terms of a framework, then it is indeed valuable.  There is so much to explore, and I agree that it is tiring - which is why I try to take breaks now and then. 
Right at this moment, I am feeling more keen to read further and do more within the book - I have read it through once, and I'm now going back chapter by chapter to try to summarise and process further.  I am particularly glad that I can share my thoughts and reflections somewhere with people who understand, and thank you for what you said.
Hope  :)

*

Wattlebird

  • Member
  • 613
    • View Profile
Re: Treating Trauma-Related Dissociation: 2017 edition - Chapter 5
« Reply #3 on: December 30, 2018, 02:35:27 PM »
Quote: The next section on p.99 is entitled "The Hidden Nature of Dissociation" and talks about how it can very often be a hidden thing - i.e. a "private, internal organization that is often not readily visible" (Kluft, 1987)  In particular thye may say that they've "always been this way".  Rarely conceptualising or verbalizing the inner experience of dissociation.  Fear of being perceived as 'crazy' and other fears may mean that a patient may keep their inner experiences 'hidden'.

Definitly relate to this.

I think I might buy this version as well, it contains a lot that mine doesn't have, although I have been working on a chapter about the fear or avoidance of inner experience. So it is very similar but set out all different.

*

Hope67

  • Member
  • 1989
    • View Profile
Re: Treating Trauma-Related Dissociation: 2017 edition - Chapter 5
« Reply #4 on: December 31, 2018, 03:58:44 PM »
Hi Wattlebird - I didn't realise there were different versions of this book - but they do seem a bit different - but with good overlap I think.  At least we can still talk about it with each other - despite the difference in the laying out of chapters and content etc.  We're 'on the same page' so to speak - the same themes.
Hope  :)