DISSOCIATIVE IDENTITY DISORDER:
Neuroscience and the Use of the Body in Dissolving Dissociative Barriers
Patients diagnosed with Dissociative Identity Disorder require a treatment that specifically addresses internal communication between alters and dissociation within alters. How do we identify these often invisible patients and understand the dissociation structuring their psyches, both neurobiologically and psychically? How do we structure a treatment and frame to safely contain the subjective experience of many selves? How do we help the patient dream their experience into being when their access to bodily and affective experience is fractured between many self-states, separated by powerful amnesic and sensory barriers?
We will explore the answers to these questions as we discuss what makes treatment of dissociative disorders different from standard analytic work. We will look at how to work with the terror of our most traumatized patients and help them begin to create a sense of safety within.
NCSPP is aware that historically psychoanalysis has either excluded or pathologized groups outside of the dominant population in terms of age, race, ethnicity, nationality, language, gender, religion, sexual orientation, socioeconomic status, disability, and size. As an organization, we are committed to bringing awareness to matters of anti-oppression, inequity, inequality, diversity, and inclusion as they pertain to our educational offerings, our theoretical orientation, our community, and the broader world we all inhabit.
Dissociative disorders, like all disorders, are part of and created by their larger social context; several important aspects of this that directly impact dissociative multiplicity include ongoing and continuous traumatization and dissociation of cultural aspects of identity, including those associated with gender and sexuality, between self-states.
Although many dissociative patients may find themselves either chronically in retraumatizing or unsafe situations or experience chronic fear or uncertainty over whether they (or parts of self) have escaped original abusers, BIPOC patients will have to live with the certainty that they will never escape from chronic traumatization in the form of structural racism. This reality of chronic entrapment will interact with other forms of inescapable trauma in these patients’ histories and particularly with the existence of experiences such as alters not oriented to the present (i.e. who still believe they live in the past when the original gross trauma occurred). In order for these experiences to be fully processed, the reality of the ongoing trauma has to be fully acknowledged as a reality, rather than an unrealistic fear, and be an ongoing part of the therapy conversation, including the ways in which it may retrigger parts holding gross trauma.
Through extreme trauma, multiple aspects of cultural identity, which might otherwise have been permitted to coexist internally as two or more aspects of a multidimensional but unified cultural self may split. For example, in an individual brought up in a bicultural home under situations of extreme traumatic stress, confusing, challenging, or conflicting cultural messages (both from within and without the home) may lead to such a split. This might include messages such as those that disconfirm or devalue one’s racial or cultural identity, or experiences which link cultural identities of privilege or lack thereof (‘part of me is white and privileged, part of me is Black and is not’) with experiences of powerlessness, extreme violence, or terror without solution. This might lead to a dissociation of cultural experience in the form of alters which identify as the Black woman, the Black genderqueer individual, the white woman, the Black man, and so on, in order to cope in an environment in which messages about racial and cultural identity are difficult, if not impossible, to integrate. Similar experiences may occur with a wide variety of culturally-constructed experience, such as gender, sexuality, and so on. The therapist needs then to be sensitively attuned to the cultural meaning of the alters’ identities and of the larger social context associated with those identities that may make co-consciousness and integration more frightening, including possible fears of loss of positive aspects of cultural identity associated with integration, and make this an active part of the therapeutic dialogue.
Dajani, K. (2018). Cultural Dislocation and Ego Functions: Some Considerations in the Analysis of Bi‐cultural Patients. International Journal of Applied Psychoanalytic Studies, 15:1, 1-13, https://doi.org/10.1002/aps.1562
Christopher Bonovitz Psy.D. (2009) Mixed Race and the Negotiation of Racialized Selves: Developing the Capacity for Internal Conflict, Psychoanalytic Dialogues, 19:4, 426-441, DOI: 10.1080/10481880903088021
At the end of this course participants will be able to:
- Recognize dissociative symptoms and differentiate them from psychotic, borderline, and bipolar symptoms, and identify dissociative patients in their practices.
- Describe the neurobiological origins of DID/OSDD and their importance in understanding the mind-body continuum.
- Describe the BASK model of dissociation and its relevance to dissociative disorders treatment.
- Describe triphasic treatment of dissociative disorders and differences between analytic treatment of dissociative and non-dissociative patients.
- Define and describe goals of phase one of triphasic treatment, including ‘co-consciousness’ and be able to identify at least two primary techniques for achieving these goals.
- Define ‘multiple relationships’ and ‘individual therapy’ in the context of dissociative disorders treatment and articulate how the frame can be used avoid ‘multiple relationships’ or ‘individual therapy’ in dissociative disorders treatment Define and describe the goals of phases two and three of triphasic treatment, including ‘trauma processing’ and ‘integration’.
- Describe the use of the body in dissociative disorders treatment to integrate dissociated experience across the mind-body continuum and identify at least two techniques for applying this concept.
- Loewenstein R. J. (2018). Dissociation debates: Everything you know is wrong. Dialogues in clinical neuroscience, 20(3), 229–242. https://doi.org/10.31887/DCNS.2018.20.3/rloewenstein
- Lanius, U., Paulson, S., and Corrigan, F. (2014). Dissociation: Cortical deafferentation and the loss of self. In Lanius, U., Paulson, S., and Corrigan, F. (Eds.), Neurobiology and treatment of traumatic dissociation: Toward an embodied self (pp. 5-25). New York, NY: Springer Publishing Company, LLC.
- Reinders, A. A. T. S., Willemsen A. T. M., den Boer, J. A., Vos, H. P. J., Veltman, D. J., Loewenstein, R. J. Opposite brain emotion-regulation patterns in identity states of dissociative identity disorder: A PET study and neurobiological model. Psychiatry Research: Neuroimaging. 223(3): 236-243. http://dx.doi.org/10.1016/j.pscychresns.2014.05.005i
- Brand, B. L., Loewenstein, R. J., Spiegel, D. (2014). Dispelling myths about dissociative identity disorder treatment: an empirically based approach. Psychiatry. 77(2): 169-189. doi:10.1521/psyc.2014.77.2.169
- Brand, B., Loewenstein, R. J. (2014). Does phasic trauma treatment make patients with dissociative identity disorder treatment more dissociative?. Journal of Trauma and Dissociation. 15(1): 52-65. doi:10.1080/15299732.2013.828150
- Vissia, E. M, Giesen, M. E., Chalavi, S., Nijenhuis, E. R. S., Draijer, N., Brand, B. L., Reinders, A. A. T. S. (2016). Is it trauma‐ or fantasy‐based? Comparing dissociative identity disorder, post‐traumatic stress disorder, simulators, and controls. Acta Psychiatrica Scandinavica. 134(2): 111-128. doi.org/10.1111/acps.12590
Kylie Svenson, ACSW, a conservatory-trained musician, is interested in creativity as an important aspect of the patient's process of dreaming the self into being. She often works with artists and finds their gifts can be both a window to their trauma and a form of integration and elaboration of the traumatized self. She is also interested in dissociative disorders and specializes in working with patients with DID and OSDD.
Her background includes training in specialized treatment for these patients,
which integrates both psychoanalytic and family systems work, informed by structural dissociation theory.
This is an intermediate course for clinicians with moderate to extensive experience in clinical practice and some knowledge of psychoanalytic theory and approaches.
LCSW/MFTs: Course meets the requirements for 8 hours of continuing education credit for LMFTs, LCSWs, LPCCs and/or LEPS, as required by the CA Board of Behavioral Sciences. NCSPP is approved by the California Association of Marriage and Family Therapists (Provider Number 57020), to sponsor continuing education for LMFTs, LCSWs, LPCCS, and/or LEPs. NCSPP maintains responsibility for this program /course and its content.
Psychologists: Division 39 is approved by the American Psychological Association to sponsor continuing education for psychologists. Division 39 maintains responsibility for these programs and their content.
Enrollees who cancel at least SEVEN DAYS prior to the event date will receive a refund minus a $35 administrative charge. No refunds will be allowed after this time. Transfer of registrations are not allowed.