New Release: STARTTS Masterclass Lectures

Intolerable Pain: Trauma, Invalidating Environments and Pervasive Emotion Dysregulation in Refugees and Asylum Seekers

Borderline personality disorder (BPD) is often associated with a history of traumatic experiences and/or exposure to an invalidating environment. In the trauma field many researchers and clinicians acknowledge that Post Traumatic Stress Disorder (PTSD) is limiting diagnostically in capturing the complex symptom presentations for some individuals who have experienced cumulative and prolonged exposure to trauma, as is common for many refugees and asylum seekers. In order to address this gap expert trauma clinicians have developed criteria to fit more appropriately with the presenting problems commonly exhibited by survivors of severe and cumulative trauma and the diagnostic category of Complex Post Traumatic Stress Disorder (CPTSD) has emerged. Refugee and asylum seeker clients with significant and prolonged trauma histories at times present with prominent symptoms of emotion dysregulation, reduced ability to tolerate distress, interpersonal difficulties and unstable identity concepts, which may be consistent with aspects of both BPD and CPTSD criteria. Through an exploration of a case study of a male asylum seeker, this presentation will demonstrate the potential for overlap between CPTSD and BPD presentations, the challenges of working with such a client within an environment of invalidating refugee status determination processes and the importance of a staged therapeutic approach with an emphasis on validation, non-judgement and skill development.

Caring in Hospital for Children Transferred from Nauru

Presented by Prof. David Isaacs

In this presentation Professor David Isaacs who works and conducts research in both Children’s Hospital at Westmead and University of Sydney will talk about providing care for children after they are transferred from Nauru due to infections as well as psychiatric problems. Over 150 children were transferred from Nauru in 10 months, having been there over five years or all their life if younger. Some came with both parents, some with only one parent. In hospital the children and their relatives were still in detention and the interactions of guards with children and parents and of guards with staff were often a source of tension. Therefore, Professor Isaac will also explore on some of the challenges faced in caring for these refugee children and their families in hospital settings.

Walking the Line: Borderline States in Context

Presented by Dr Anthony Korner

Borderline Personality Disorder is a 20^th Century construct although one with resonances to earlier diagnoses such as ‘hysteria’. In the 21^st Century, the DSM 5 decision to make Personality Disorder and “Axis 1” disorder adds weight to its recognition as a medical disorder. Arguably this has moral implications with respect to the duty to treat. In this talk BPD will be considered with attention to the contexts in which BPD is more likely to develop. The question will be raised as to whether the construct can be understood as a ‘within-the-individual’ phenomenon. From the perspective of the Conversational Model, BPD reflects a disorder of self often related to traumatic impingement and neglect in early life. Dissociation is often a prominent feature and needs to be considered in assessment. Effective treatment requires engagement with self in addition to the processing of the trauma. The conditions required for growth of self will be discussed.

The complexity of ‘borderline states’ will be discussed from a philosophical perspective with reference to two books, Reinterpreting the Borderline (Paul Cammell) and Mapping the edges and the in-between (Nancy Nyquist Potter). Particular attention will be paid to the idea that the anger of people in ‘borderline states’ needs to be given uptake (Potter). Clinicians sometimes walk a fine line in providing containment while encouraging full expression of the patient’s experience.

Working Therapeutically with Children from Offshore Detention Centres: Jordan and Jordan’s Family

Presented by Naila Hassan

This presentation focuses on the case of Jordan and his family to outline the common presentations of families seen at STARTTS, particularly the impact of refugee-related trauma on children between 0-6 years who have gone through offshore Detention Centres and their parents. For the parents, this impact includes conflict between families, inability to develop a secure attachment, feelings of guilt, and finding it difficult to nurture the children and set boundaries. For the children, the impact includes being hyper or hypo aroused, struggling with gross motor milestones, language acquisition delay, and attachment issues.

The presentation traces the trauma history of Jordan, a four and a half year old boy of Middle Eastern background who was born and lived in detention for the first year of his life. It examines the assessment, treatment and outcome processes for Jordan. The therapeutic approaches applied in treating Jordan which include play therapy, circle of security, parent-child interaction therapy, speech therapy and knowledge of the Montessori approach are presented. The presentation illustrates that a coordination of different approaches and working collaboratively with parents to negotiate the challenges and difficulties presented by the experience of children from Offshore Detention Centres has positive outcomes.