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[Infographic] Working with Structural Dissociation

99 Comments

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

Managing Stress and Anxiety Infographic

Click here for the text-only version of the infographic
Title: Structual Dissociation Model

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

What is Structural Dissociation? Infographic

Click here for the text-only version of the infographic
Title: Structual Dissociation Model

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

Working with Dissociation

How to Integrate the Brain and Prevent Dissociation After Trauma, with Pat Ogden, PhD

 

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Related Posts: Brain, Healing Trauma, Infographics, Trauma, Trauma Therapy

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This is a learning community for practitioners. We can’t wait to hear what you’re going to use with your clients.
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99 Comments

  1. Edward Sibley, Counseling, Worcester, MA, USA says

    Although I’ve read a lot, I will never find “all” the answers. One of the issues I’ve searched for in SDTheory and seems to be missing is forgiveness (unless it’s hidden between the lines). Another is anger or what can become enraged/outraged behaviors or when the trauma victim becomes another enraged perpetrator or an outraged advocate for recovery and change. Both these items I see in relation to a Nature-based (Laws of the Universe) model… your reply is most welcomed…

    Reply
  2. Niki H, Counseling, Phoenix, AZ, USA says

    This is the best way that I have ever had it explained to me. This was definitely helpful to me. Thank you!

    Reply
  3. Kate Nelligan, Social Work, Irmo, SC, USA says

    Having just found nicabm I am exploring with interest and fascination. I have not decided what training to start my educational journey.
    Kate Nelligan, LISW-CP, LAC, Polyvagal informed

    Reply
  4. Eileen Ridgway, Psychotherapy, IE says

    I like the focus being on the very basic, fundamental pillars of working with another person. the nuts and bolts of forming a therapeutic relationship is important to understand at this basic level, the presentation does a great job in simplifying complex theories making them easy to engage with and comprehend

    Reply
  5. lincoln stoller, Psychotherapy, CA says

    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!

    Reply
  6. lincoln stoller, Psychotherapy, CA says

    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

    Reply
    • Gail Kinn, Psychotherapy, New York City, NY, USA says

      Appreciate your comments. Do keep them coming.

      Reply
  7. lincoln stoller, Psychotherapy, CA says

    the repeated upselling is obnoxious

    Reply
  8. elaine Hosie, Psychology, AU says

    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

    Reply
  9. Helen Schwencke, Teacher, AU says

    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.

    Reply
  10. Pamela Peyton, Other, Memphis, TN, USA says

    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.

    Reply
  11. J Wyatt, Clergy, Dallas, TX, USA says

    Will there be a workbook to go with this?

    Reply
  12. Margie Peterson, Another Field, MN, USA says

    Thank you for these visuals. It helps me understand what is going on with some coworkers.

    Reply
  13. Tadeusz Kakol, Other, GB says

    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.

    Reply
  14. Fionna Blair, Another Field, CA says

    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.

    Reply
    • Mary O'Neill, Psychotherapy, IE says

      Essential and wonderful work. Great, as you say, that it’s coming to the fore.

      Reply
  15. Suzanne Drouin, Nursing, CA says

    Wow !! I love the infographics. It’s crystal clear.

    Reply
  16. Warwick Baird, Another Field, AU says

    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.

    Reply
    • David Esposito, Other, Wheaton, IL, USA says

      How would you describe it differently, I’ve watched his videos but not read his book.

      Reply
  17. Jae Kite, Psychotherapy, GB says

    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.

    Reply
  18. Bobby R, WV, USA says

    This is an amazing infographic & descriptions of what the client might be experiencing. Nice job.

    Reply
  19. V Byrd, Counseling, Greenville, SC, USA says

    Great infographic. Easy use with clients in explaining impact of trauma on the brain resulting in one’s behavior. Thank you for sharing!

    Reply
  20. James Noyes, Social Work, USA says

    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.

    Reply
  21. Robyn Wren, Teacher, AU says

    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!

    Reply
  22. Terri Johnson, Social Work, Baltimore, MD, USA says

    This is awesome and helpful visually to explain to my client who already expressed symptoms of disassociation disorder sx. Thank you so much.

    Reply
  23. Nadia Yuan, Psychotherapy, PT says

    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.

    Reply
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