One challenge of working with trauma is when a patient’s dissociated “parts” are operating independently . . .
. . . or worse, they’re at odds with each other.
This can be very distressing for the patient (and lead to a dysregulated nervous system).
But the Structural Dissociation Model developed by Kathy Steele, MN, CS, Onno van der Hart, PhD, and Ellert Nijenhuis, PhD can help us work more effectively with patients who are experiencing this.
We’ve created an infographic to lay it out for you below.
Click the image to enlarge
Defense System
When a child is abused, their defense system will naturally work to shield them from harm, BUT . . .
Attachment System
. . . their attachment system will still want to be loved and cared for by the parent
This creates an internal tug-of-war where different motivational systems are working against each other simultaneously.
This can cause a patient’s conflicting parts to separate. That can lead to a split in their sense of self and a dysregulated nervous system.
Click the image to enlarge
Left Brain
The “Going on with Normal Life” Part of the Self
This is the rational, present-oriented, and grounded self.
This self handles daily life – social interaction, attachment, work, play, exploration, learning, and taking care of physical needs.
Right Brain
The “Traumatized Child” Part of the Self
This part contains the trauma.
This part is often drawn out by the reminders of the trauma, and it may not experience much of everyday life.
The survival responses of this self may include Attach/Cry for Help, Collapse/Submit, Please/Appease, Freeze. Along with Fight and Flight.
The key to recovery is helping a patient have full awareness of all their parts without feeling overwhelmed.
If you’d like to print a copy to share, please click here: Color or Print-friendly
(If you’re sharing this infographic, please attribute it to NICABM. We put a lot of work into creating these resources for you. And if you’re sharing this digitally, please link back to this page in your attribution. Thanks!)
In the Advanced Master Program on the Treatment of Trauma, we share 3 distinct ways to work with structural dissociation. To find out what those are and more, sign up here.
What strategies have you found most helpful for working with structural dissociation? Please let us know by leaving a comment below.
If you found this helpful, here are a few more resources you might be interested in:
A Three-Step Approach to Treating Trauma-Related Dissociation, with Thema Bryant-Davis, PhD
How to Integrate the Brain and Prevent Dissociation After Trauma, with Pat Ogden, PhD
I’ve now watched the second session. The production quality is high and the content’s more informed than what was said in the main session. But when will therapists wake up to the clearly stated intention that DSM diagnoses are not and never were intended to describe the client’s condition? They are not profiles of illness. That’s clearly stated by their authors. DSM diagnoses provide a language therapists use in describing THEIR experience with the client. So when Lanius goes on about distinguishing DID from BPD, Siegel is too gentle in reminding her that she’s creating distinctions that may not exist. Therapists persist in misunderstanding this: diagnoses provide a language about conditions, not the conditions themselves. If you don’t get this, then it’s no wonder that your clients resent you!
I’ve now watched the Main Session. This is shockingly basic and seems to address an uninformed audience. Is this an accurate reflection of how ignorant most therapists are, at the level of the average 10th grader? It horrifies me to think therapists at this level actually work with traumatized clients. Well, we’re starting at the very bottom. I’ll add comments as this course goes on, looking to see whether it gets over the bar of basic competence. – LS
the repeated upselling is obnoxious
The infographics of structural dissociation are compellingly clear and informative. The diagram gives clarity to the clients who get stuck between enabling positive life actions only to become overwhelmed by emotion and inaction. Excellent stuff. Sadly I have missed the broadcasts because of a medical episode. Elaine Hosie
I’m curious where this model sits with the “Pathological Demand Avoidance” (PDA) profile that’s being discussed as part of the autism spectrum and especially “internalised” PDA. These look like they border on the “personality disorder” approach. I’d be grateful to see a perspective on this, from this model.
So many good Doctor’s,
it’s of self interest,healing and helping other’s. I’m working on becoming a peer specialist. So important to help.
Will there be a workbook to go with this?
Thank you for these visuals. It helps me understand what is going on with some coworkers.
Yes this makes sense to me . I’ve seen it in others and experienced it in myself. I’ve termed this myself as zombie mode. Functional , able and yet not quite there ie. truly available.
Very well done. These explain the coping and survival strategies, as I created them, all those years ago.
May I say it is a relief that trauma is finally being recognized and their modalities taught within mainstream mental health. As a Professional Peer Educator, I am proud to present trauma informed deescalation to hospital staff… It is designed to change the culture and understanding behind the labels and what has traditionally been attributed to the grab bag of “mental illness” Thanks for all you do.
Essential and wonderful work. Great, as you say, that it’s coming to the fore.
Wow !! I love the infographics. It’s crystal clear.
I wonder how correct it is to attribute the various attributes to the ‘right brain’ and the ‘left brain’. Reading the work of Dr Iain McGilchrist (The Master and his Emissary) suggests this attribution may not be correct or at least not grounded in contemporary understanding of the way the two hemispheres of the brain operate.
Thank you. I like the infographics very much, especially the first one. But I have a question – when you say “left brain” and “right brain” are you saying this is literally true or a metaphore? In my own experience, selves often have access to both reason and feeling.
This is an amazing infographic & descriptions of what the client might be experiencing. Nice job.
Great infographic. Easy use with clients in explaining impact of trauma on the brain resulting in one’s behavior. Thank you for sharing!
Thank you for this excellent info-graphic. It really make good sense regarding a subject that can be difficult to understand. You are doing a tremendous service of expanding the knowledge base.
I’m pleased to hear please/appease, collapse, freeze, etc mentioned as they’re most common auto responses. When I finally reported to police they said “ Fight or flight?! So you just sat there! As if. You’re lying”. they had no trauma response training at all. And all victims had dissociative amnesia so the abuser never went to trial as recovered memory wasn’t believed. This new research on dissociation is great. And obvious!
This is awesome and helpful visually to explain to my client who already expressed symptoms of disassociation disorder sx. Thank you so much.
After accepting the self that is present with me, I try to meet my patient on the level accepted by her. Using the left side brain, can serve as a bridge to go into the rigth side, often forgotten or avoided. I am still trying to enable my patient to earn awareness of the trauma.
I find that to stay present is good but I feel also the urge to guide, so its a balance between meeting her state or intruding with guidance.