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
Janina Fisher, PhD describes three explicit signs, or red flags, that can help you detect structural dissociation.
1.Paradox and ContradictionThe 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.
- 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.
2.Terminal AmbivalenceThe 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.
- 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.
3.Somatic IndicatorsThe 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.
- Your client reports that prescribed medications have no effect, or the opposite effect.
- A medication that is normally activating puts your client to sleep.
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.
(If you’re sharing this infographic, please attribute it to NICABM. We put a lot of work into creating these resources for you. Thanks!)
If you’d like to print a copy, you can use one of these links:
You can get more strategies like this one in the Advanced Master Program on the Treatment of Trauma.
The experts 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.
If you found this helpful, here are a few more resources you might be interested in: