The study and the treatment of the dissociative disorders has generated a plethora of newer theories and approaches, none of which have demonstrated effectiveness superior to the models they are put forward to replace. I will argue that while conceptually-driven patterns of intervention have certain strengths, the fact that no model advanced to date actually addresses the full range of dissociative phenomena guarantees that each will fall short of providing optimal guidance to the clinician. Instead, I will describe how the intense study of selected clinical phenomena and clinical research suggest insights that in turn facilitate the development of new treatment interventions.
Critical incidents related to the defensive use of aggressive sexualisation, sexual re-enactments, dedicated preoccupation with self-destruction, prolonged silences and associated stalemates in treatment, and moments of decompensation during trauma work will be explored to demonstrate how many techniques are useful for the treatment of DID and related states are the natural outcome of working up from clinical observations rather than down from theoretical models. Dissociative phenomena are always trying to teach us how to help dissociative patients, but sometimes we must engage in quite a struggle to clear our own minds and appreciate those lessons.
Hurt and complex trauma resulting from childhood maltreatment has serious consequences for the lifespan development of the survivor (Kezelman, Hossack, Stavropoulos, & Burley, 2015; van der Kolk, 2014). Child abuse and neglect involves a betrayal of trust, care and protection within the very relationships that the child relies upon for care (Courtois & Ford, 2013). Despite this, complex trauma research has focussed on symptomology rather than on relational difficulties (Chu, 2011). This qualitative study explored the meaning that 19 adult survivors of childhood abuse and neglect made of their relationship with their parent and their experiences of trust, hurt and healing. Interpretative Phenomenological Analysis (IPA) was used to examine participants’ responses to three open-answer questions.
The debate between proponents of the Trauma vs. Fantasy Models of dissociation has recently been advanced by thorough reviews of the literature and published discussion between proponents of both models. In this plenary talk, Dr Brand will provide an overview of the research addressing this debate. Proponents of the Fantasy Model argue that iatrogenic and cognitive variables cause dissociation and DID, and that DID treatment is harmful to patients. Contrary to these hypotheses, the preponderance of the evidence indicates that trauma causes dissociation and that DID treatment that is consistent with expert consensus guidelines is beneficial to patients. Using results from the Treatment of Patients with Dissociative Disorders (TOP DD) study, Dr Brand will address the notion that DID treatment is harmful to patients.