Working with structural dissociation can be critical in the treatment of severe or prolonged trauma . . .
. . . but it’s often difficult to detect.
According to Janina Fisher, PhD, structural dissociation is commonly underdiagnosed, or it’s misdiagnosed as a personality disorder. And when left undetected, it could lead to ineffective treatments that stall progress.
So in the infographic below, we’ve laid out three warning signs of structural dissociation.
Have a look.
Click the image to enlarge
Adapted from Janina Fisher, PhD
Structural dissociation is often overlooked, underdiagnosed, or misdiagnosed as a personality disorder – all of which can be key reasons that a client’s progress stalls, or treatments prove to be ineffective.
So how can we more effectively recognize structural dissociation?
Janina Fisher, PhD describes three explicit signs, or red flags, that can help you detect structural dissociation.
- 1.Paradox and Contradiction
- Your client alternately idealizes and devalues you as a therapist.
- Your client reports a certain phobia, but engages in actions that are counterphobic.
- Your client reports feelings of shame, but also acts superior to others.
The first red flag is when a client’s actions seem to contradict their desires.
This can be a signal that their attachment system is attempting to reach out for comfort while in the same moment their defense system is trying to protect them.
- 2.Terminal Ambivalence
- Your client struggles equally with decisions big and small – like where to attend college or where to go for dinner.
- Your client completes an assignment or task but is afraid to talk about it or show the results.
The second red flag is when clients struggle to make decisions or won’t follow through on the decisions they have made.
This may look like self-sabotage, but this “stuckness” is actually the result of an inner struggle between the client’s desire and a part that’s afraid to take a step forward or be visible to others.
- 3.Somatic Indicators
- Your client reports that prescribed medications have no effect, or the opposite effect.
- A medication that is normally activating puts your client to sleep.
The third red flag is when clients report bodily reactions that are unexpected or differ from the norm.
Dissociation can help clients disconnect their mind from bodily sensations – like pain during a traumatic event. But it can also disconnect them from other bodily experiences, like the effects of medications.
According to Janina, when a client is stuck with various treatments proving ineffective, and the client has a history of turbulent relationships with therapists, this is a likely indicator of structural dissociation.
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This week in the Advanced Master Program on the Treatment of Trauma, we’ll be looking at expert strategies to identify and treat dissociation (even when it’s subtle).
It’s free to watch – you just have to sign up here.
In the session, we’ll look at how dissociation plays out in the brain and nervous system, and how you can overcome some of the challenges of working with dissociation.
You’ll hear from Bessel van der Kolk, MD; Peter Levine, PhD; Pat Ogden, PhD; Stephen Porges, PhD; Janina Fisher, PhD; and other leaders in the field.
Now we’d like to hear your takeaways from this infographic. Please let us know in the comments below.