How to Identify and Treat Dissociation (Even When It’s Subtle)
 | with Peter Levine, PhD; |  |
with Peter Levine, PhD; Ruth Lanius, MD, PhD; Stephen Porges, PhD; Bessel van der Kolk, MD; Thema Bryant-Davis, PhD; Kathy Steele, MN, CS; Janina Fisher, PhD; Bethany Brand, PhD; Pat Ogden, PhD; Ruth Buczynski, PhD
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Thank you sharing this precious material for free. As a dentist from a far away country, normally I wouldn’t be able to attend this with paid option. I work at a close distance with my patients and it needs unavoidable physical contact with them. some of them has early childhood trauma from dental experiences or directly from dentists themselves. This course is very useful for my dental practice. Especially I will use the grounding exercises from last week when I see a patient go into freeze response. Defining structural disassociation will also be very helpful to decide how to act in practice.
While I found much of the content useful, and sensitivity mentioned towards the dissociative parts, the discussion seemed to be pathologize it as a maladaptive symptom rather than a useful coping skill, when managed properly & respectfully in the self-aware client.
More notably, the absence of Dr. Richard Schwartz from the panel, who uses Internal Family Systems as a therapeutic model, using parts damaged at different stages…to heal the damage.
This was so validating for me to be reassured that voice hearing can come from early trauma. I was suspecting that to be the case.
People who admit they hear voices are usually dismissed as schizophrenic. This invalidation comes from laypersons as well as professionals. It’s very distressing for the client. I’m sure you can understand that if you’ve ever experienced being dismissed out of hand. Given our cultural bias regarding gender, I wonder if this kind of thing happens to women more than men.
I’d like to thank Ruth Lanius for her comments.
I found this presentation very useful, with a profound human touch. Thank you
This was such an Informative and super well explained module on Dissociation and how & which best treatments are offered.
I think that being the client on the couch and pursuing EMDR after my assault which is already a long time ago, I am more effectively able to communicate my “feelings” with my Trauma Therapist who is quite young. She did mention that I didn’t seem to be “feeling anything” or much during the process with the lamp. Finally I had to tell her that at one point towards the end of 1 treatment I had zoned out completely and was unable to follow the light at all & just stared forward. I never knew if she had noticed that but when I told her some weeks later (there had been a break for us) she decided to handle the therapy differently. My impression is, she is trying to gain my trust and thus giving me more time to assimilate the whole process. It just became too overwhelming for me!
On another note, I bumped into my ex-psychiatrist at a restaurant with my family few days ago. Being that she was seated just a chair distance from my side, I took the courage to exchange a few kind words with her. She is the big boss now at Mondriaan Heerlen-Maastricht. I had not seen her for 5)6 years. One concern of mine was, “I’m not sure EMDR is for every patient who is traumatized”; thus exposing some issues I was having with the therapy. She is perfectly “op de hoogte” on my situation as I let my Psy in the same group exchange info on me. In other words, it’s a very tough kind of treatment for any client if abuse, including adult s-abuse. It must be conducted carefully and there needs to be the safety and trust solidified before treatment begins in my opinion. So far I hope to continue w/Anger-EMDR and would like to give a 2nd shot at it.
By the way, upon meeting the new staff..I had expressed that I did not feel there was much “compassion” towards patients in Dutch medicine. Naturally this is not including all practitioners & I so deeply my my long time psychiatrist of “10 years” that I’m sure I expressed that in my eyes when I shared with her briefly.
Thank you again so much for all you put together to teach both practitioners and clients & researchers on the topic of Trauma.
One of the things that I have found difficult is that I as a therapist seem to react to a client who says at the very beginning of therapy. I want to tell you from the onset that I witnessed something terrible and I do not want to talk about it. I feel I have my hands behind my back maybe even handcuffed because I want to make sure that I do not stray into that forbidden territory. Her stated problem is that she cannot sleep because as soon as she is able to take time off (bed time) she starts to think about the terrible incident and then cannot sleep.
Here I realise that it is not all or nothing.There may be places in-between that we may be able to engage with. Tell be how you were on that night before things became so distressing. And as it was happening what did you do first etc. What conversation did you have with yourself, your husband, your children. I am curious about the fact that she may have experienced many of the reactions that have been mentioned. Maybe she froze. Maybe she …..maybe there was something uncompleted at that time. Did she save her own children and feel guilty that others were killed. Really this has helped me to slow down, not feel completely incompetent and not ‘freeze’ as a therapist because the client told me I have to.
Ruth and Team. . .I want to thank you from the bottom of my heart! You are inspiring me and giving me just what I need at this point in my career. The 18 year old son of a client came to mind with information about dissociation. He was severely abused by his father starting at age 2. He has an Autism diagnosis, but I’m wondering how one could differentiate between that and trauma with dissociation?
Thank you for this course, and for offering it for free! As mentioned by others here before: it is crammed with information and tools.
Thanks for these sessions. In my training as art-therapist, I’ve had very little material on treating trauma. And now in my practice, most of my clients are survivors of abuse. This is precious education. I use breath work to help grounding during some art-therapy exercises, but sometimes forget to do it myself too. I will now be more careful about that.
Loved it, and have shared widely among my psychiatrist friends and colleagues. As a trainee in my final year of residency, I would love it if there was a student rate for the gold package. Just a thought, wouldn’t it be outstanding if these courses could be made available to psychiatry residents through their programs? My program regularly provides funding for online modules for the resident body at large, for topics which are underrepresented locally. There is a paucity of expertise on trauma in academia in small to medium (and sometimes large) universities, and a fairly widespread appetite among my generation of psychiatrists.
Thank you again for all this valuable info on the treatment of trauma: great work!
The biggest take-away for me was to watch out for empathy and compassion in specific contexts (such as sexual abuse or molestation) where our best intentions can backfire on us and our patients; and so, to be aware of our patients responses or spacing out and to offer them info on what’s happening with them in a more matter-of-fact manner, using our tone of voice and maybe keeping a safe distance from them so that they can feel safe in our presence. Also asking them questions as to track their progress with their internal state, moment to moment: How are you doing? Are you with me? And by acknowledging that maybe this was a little too much for them for now, and that’s ok.
Today was an interesting introduction to the work of a psychologist and therapist, The theory was both fascinating and likely to be factual and a key factor when dealing with with emotionally traumatised children within broken families. Thank you!
I would like to see even more attention paid to how members of groups targeted for oppression experience traumatic stress related to their positionality in a racialized/patriarchal/etc society, and how it can be very different in some ways from the interpersonal traumatic stress of complex childhood/developmental trauma but NO LESS valid and important. And how it is ALSO a form of developmental trauma because it starts at birth that one is the inheritor of generations who’ve been surviving these societal conditions.
These courses help me to integrate techniques and theory already learned into practice; not only clinically, but in real life as I encounter trauma responses in family and Community. I feel authentic and effective. Thank you!
Wow! Thank You for this webinar. The tracking, contact, and recover is very useful to also keep me grounded instead of panicking when the client gets outside WOT. Asking how much of the person is in the room, and asking what is needed for the ‘most’ of the person to feel safe and be present is something I absolutely will incorporate because it facilitates or rather supports return to agency/control of self. Identifying less overt signs of disassociation was much illuminating. Able to stablish difference between DID and a symptom of trauma as a disassociative state was also very much illuminating.
Thanks for a great session. Interesting how expressing empathy could be a trigger for some people depending on their experiences. Checking in with clients and tracking responses are useful tools working with possible dissociation.
Thank you, I appreciated this very much. It brought my attention much more on the difference between DID and the personality disorder. I need to study it more.
My biggest take away from today’s session is that you can track a person’s dissociation through your own somatic/nervous system experience. I had before wondered why I would have a “feeling” that someone was dissociating without being able to explain it, I now understand that nervous system attunement load and co-regulation is the explanation.
I work in Head Start as an Education Coordinator. Part of my responsibilities include coaching teachers in the classroom. I can say that all the teachers I am currently working alongside of have children who experienced trauma. This program is helping me help them by extending and deepening my understanding of trauma. I recently completed my doctorate in education with a focus on trauma-informed practices/teaching. Thank you all for creating this very meaningful program!
Biggest Take-Aways: Be more matter-of-fact and track the response of the receiver when I notice my empathic statements trigger hyperarousal. Physical symptoms can be a stand-in for emotional trauma.
realize these insights and awarenesses are operating with every encounter and relationship I have in my work and personal life
I am thankful to hear about doing Psychoed with the client, I taught this was inappropriate.
I appreciate the defining of Structural Dissociation as something not to ignore.
also taking not of the movement to avoid the self-harm
Great presentation
Thank you !
Loads to reflect on, going through the own story to find the other…
some helpful info here. thank u for making it available. but Dr. Ruth M. Buczynski is making this into an info-mercial. her repeated hawking of the gold package makes me want to shut the program off.
Thank you very much!
What you show is really useful:
Now we really need such help in Kharkov, Ukraine.
Thank you for this webinar. I will be conscious of the empathetic approach, will be cognizant of how that is being received, and utilize a more matter-of-fact approach when needed. Identifying when the nervous system is at odds with the need to attach and defend with FFF. Understanding that hypo/hyperactivity is the patient being out of the window of tolerance.
Major takeaways:
– thinking about structural dissociation versus personality disorders
– parts involved in disorganized attachment and ambivalence/paradoxes
– holding back on empathetic expressions with clients who are dissociating
– greater understanding of DID and how to assess for it
Very appreciative!
I truly appreciate the practical ways to phrase the ways that the client is beginning to disassociate. I also got a great take away about how to express empathy in a matter of fact sense as to not trigger the traumatized parts of the person or create a “unhealthy” therapist/client relationship.
This was extremely valuable. Even the basic tips such as when telling the client to breath, we breath with them. I have noted this in my practice too.
One new thing i learned was about voices that it can be part of dissociation.