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Introduction to Trauma-related Complex Dissociation

This course is a first introduction to the concept of dissociation, the dissociative disorders and some common misunderstanding in relation to those who experience these conditions.

It consists of four units of approximately 25 to 45 minutes each. On completion a certificate for 3 hours of CPD can be downloaded.

Presented by Melanie Goodwin and Kathryn Livingston BEM of First Person Plural – dissociative identity disorders association

Unit 1 – Dissociation : a continuum of normality
This unit looks at everyday dissociation and how this adapts naturally to deal with all types of experience. It discusses the importance of the continuum of dissociation explaining why the child still being abused is not dissociating abnormally by compartmentalising their experience and erecting amnesic barriers; they are using this natural, instinctive survival mechanism in its most extreme form.

It introduces the screening tool – Dissociative Experience Scale (DES) and how this may also be used as an integrated resource with clients to begin to raise an awareness of some of their dissociative experiences they might otherwise be unaware of.

The presenters discuss the five dissociative experiences: – depersonalisation, derealisation, amnesia, identity confusion and identity alteration using lived examples to offer a context for some presenting behaviours that may appear irrational without a framework of understanding. They introduce ‘The Diagnostic and Statistical Manual of Mental Disorders’ (DSM V) diagnostic criteria for dissociative identity disorder (DID) and discuss the need for someone who has DID to be correctly diagnosed and worked with accordingly.

Unit 2 – Dissociation : Finding a language
By sharing some of their own history the presenters explain how finding a language that offered a sense of ‘shape’ and ‘containment’ enabled them to begin to understand and convey their reality and why it has been such an important part of their journey. They discuss how the Structural Dissociation of the Personality Model (Hart. Onno van der, Nijenhuis, Ellert R and Steel, Kathy : The Haunted Self) recognises parts of the personality who manage daily living and others who are stuck back in trauma time; how this concept encourages the start of a dialogue between the therapist and client and internal communication. The unit reflects on the growing understanding of how trauma impacts on a child’s attachment patterns and later relationships and how obsolete behaviour patterns may still impact daily living. Introducing how all trauma-related diagnoses can be described in terms of Structural Dissociation of the Personality helps to clarify the overlap between primary and secondary levels of dissociation and where the tertiary level, (DID) fits in the diagnostic spectrum.

Unit 3 – Dissociation : Understanding misunderstandings
This unit looks at the discrepancies, and contradictions that are recognised as a major part of living with DID. Under the five headings: – early days, trust, attachment, triggers and language the presenters begin to link past experiences that are frozen in time, as though they have ‘just happened’ to conflicting behaviours experienced in the present. Children who experience enduring abuse have few opportunities to learn about affect regulation within a healthy, stable environment. This results in self-regulation in adulthood being complicated, challenging and often frustrating as old behaviour patterns are triggered before an alternative way can be reflected upon. The unit stresses the importance of psycho-education. Within this context, it discusses how the brain has been ‘hard wired’ throughout childhood for managing the abuse; how understanding this allows the development of techniques, strategies and other coping mechanisms to be considered and cautiously implemented while lowering the fear level of behaviours that can feel out of control.

Unit 4 - Dissociation : A foundation for recovery
Completing this unit, you will begin to understand the importance of the first stage of therapy, i.e. stabilisation and symptom reduction; how this is partly accomplished through developing internal co-operation and communication; and how this is achieved through engaging and working with the parts, validating their reality without exploring their traumas, including the narrow path the therapist walks between acceptance, validation and re-traumatisation. The presenters discuss the need for as many parts as possible to establish their therapeutic relationship with the therapist including those parts who may be thought of as perpetrators parts but are actually trying to protect the whole. Through respectful acceptance and reflection these parts can be helped to adapt to the life they are now living and to find new roles that are helpful in the present time. The unit explores why this stage is so important to every aspect of the client’s life including the therapeutic journey. Although stabilization is thought of as the first stage it will be returned to throughout therapy. It can be almost as much about working to equip the client with the wide range of skills everyone needs as it is about addressing specific areas of living with DID.