Dissociation 201: Treating Complex Trauma and Dissociation

This session is available for 6.00 APA and ASWB credits.

Increasingly, clinicians are recognizing many of their clients have histories of complex and chronic abuse and may be struggling with complex post-traumatic stress disorder (c-PTSD) dissociative defenses. The lack of training in undergraduate and post graduate education results in therapists feeling unprepared and overwhelmed to help their most wounded clients.

Clinicians, unfamiliar with the diagnosis, struggle to support their clients through a complex array of intra-psychic dynamics, overwhelming emotions, and distorted beliefs generating internal storms and external anguish. Their clients’ lives are marked by constant crisis, frequent self-mutilation, and repeated threats of suicide. People with c-PTSD manifest a profound sense of shame with a corresponding diminished sense of self, further complicating their ability to establish healthy interpersonal relationships. Limbic reactivity and inadequate affect regulation skills trigger extreme emotional lability and dissociative responses.

This workshop synthesizes state of the art knowledge about complex post-traumatic stress disorder, attachment theory, and dissociative defenses as well as often overlooked but equally critical issues of power, control and shame; exploring how the chronically traumatized client utilizes dissociative defenses to modulate affect and control attachment crises and conflicts. Reframing client reactions from oppositional or manipulative through an empathic attunement to the nature of their defenses, the history of their abuse, and the direction of their healing empowers therapists to formulate effective and nuanced treatment plans.

In the earliest stage of therapy, the focus is on building the foundations needed to support the work ahead. Central to this is a therapeutic alliance based on profound respect and understanding. Building internal and external stability and security is an on-going task complicated by the intensity and injuries inherent to the traumatic material. Developing self-care, and learning affect regulation skills are essential objectives.

Stage Two therapy consists of working through and processing the trauma while maintaining stability in life and in the therapeutic relationship. The power of the trauma destabilizes both the client and the therapist, leading to reenactments and experiences of being stuck. In Stage Three, as clients move past dissociation as a defense, they address therapeutic concerns central to the sense of self. Existential questions arise, “Who am I? What does it mean to be me? How do I cope in an emotionally intimate relationship? How do I manage shame, conflicts, other big feelings, and life issues while remaining present and connected? How do I grieve what was lost, all the time caught up in trauma?”

The therapist is challenged to identify their client’s subjective experience of trauma by exploring what is being expressed through the therapeutic relationship. The therapist is challenged to be sensitive to the dynamics within the transference and counter-transferential interplay while maintaining empathic engagement. The therapist is challenged to communicate in ways and on levels where language often fails. The therapist is challenged to guide the client through new ways of thinking, perceiving, and relating.