We need the capacity to cope with the pain of facing our trauma. We need confidence that things will get better. And we need a safe therapeutic relationship … Three prerequisites for trauma processing in therapy …
Do female clients prefer female therapists and male clients prefer male clients? Or are there more pressing questions to ask other than gender? Who would you work with?
Should we talk to parts? Or does that make things worse? When someone switches, is this attention-seeking behaviour? And is talking to a ‘part’ in some way dangerous—does it reinforce pathological behaviour? What should you do?
Much has been written about the work in therapy in stages I and II of the phase-oriented approach to treating trauma, but less so about the third stage. The work in phase III aims to consolidate the gains acquired in the early stages and to apply these to everyday life in order to develop ‘a life worth living’.
Phase 2 of the three-phase approach is the aspect of trauma therapy that is most geared towards facing and resolving the intrusive traumatic memories that plague a trauma survivor’s life and manifest in forms such as flashbacks, physiological dysregulation, avoidance, numbing and re-experiencing.
When trauma survivors try to talk about what happened to them, often it is triggering and destabilising to do so. The three phase approach to treating trauma takes this into account. Phase one focuses on safety and stabilisation and this articles explains what is involved.
‘I don’t feel real. All the time—literally all the time—I feel like I’m living life from behind a glass screen, or that I’m watching life as it’s happening on TV but it’s not real. I’m always ten yards removed from it. I don’t cry. I don’t feel things. I feel like I’m in a dream. I feel like I’m going mad. Even now, talking to you, I’m not sure if this is really happening or not or if I’m just imagining it. The GP says I’m just depressed, but I’m not.’
PODS ran a survey in 2016 in association with One in Four (www.oneinfour.org.uk) with the aim of assessing the degree to which counsellors and psychotherapists have received training to work with survivors of child sexual abuse (CSA) and child sexual exploitation (CSE). We also wanted to see the extent to which the topics of trauma, dissociation and shame were included in that training.
Ancedotally, many therapists had said to us that they had not received any significant training in CSA, CSE, trauma or dissociation during their initial training.
I had worked as a counsellor for about twelve years before I went on my first PODS training course on dissociation. I had so many lightbulb moments that day, it felt like my brain was burning.
The issue of boundaries had always been a non-issue for me: I saw my clients for 50 minutes; there was no contact between sessions (no need for contact between sessions, surely?); it was a purely professional relationship. No dramas, no big deal. And then I started work with my first really traumatised client, and everything was called into question
I came to be a therapist quite late in life after a successful but ultimately unrewarding career in business. I always felt that there should be something more to life than making money, and it struck me repeatedly how mental health difficulties disrupted the lives of so many of my staff.
Dr Nick Read, a retired medical professor and now a psychotherapist, explains the link between trauma and irritable bowel syndrome – and what can be done about it.
The beginning of understanding was really just that—a beginning. Little did I know how much I had to learn and how much I really didn’t know. When my peer supervisor mentioned to me this strange word ‘dissociation’, it was an entirely new concept to me. Now I wonder how that can be.
Suddenly, like a party popper, out came her words. ‘It happens all the time. People will be talking to me and I can’t remember what they’ve been saying. I used to think I was just forgetful. But it’s not that. It’s like they can be talking to me and I know rationally who they are but it’s as if I’ve never met them before in my life
Recovery from trauma is hard work, but it is possible. However, there are number of things that inhibit that process, and this article looks at ten of them.
My role as a psychosexual therapist is to help a client understand what ‘language’ their body or their behaviours are speaking. Once people understand their triggers and behaviours, they are more likely to allow a change, if that’s what they want.
The ‘trauma traffic light’ represents three physiological states that the body can shift gear between, depending on levels of threat or security in the world: the green zone, the amber zone or the red zone. Carolyn Spring explains this concept she developed based on Stephen Porges’ polyvagal therory.
‘EMDR psychotherapy is an information processing therapy and uses an eight phase approach to address the experiential contributors of a wide range of pathologies. It attends to the past experiences that have set the groundwork for pathology, the current situations that trigger dysfunctional emotions, beliefs and sensations, and the positive experience needed to enhance future adaptive behaviours and mental health.’
Starting with her very first dissociative client, in this article sensorimotor psychotherapist Margaret Collingwood talks about her journey of working with clients with dissociative identity disorder and how she has learned to understand their parts in terms of their survival function.
‘Dissociative parts of the personality’ grabbed the headlines, but my inability to set boundaries was the silent assassin destroying me from the inside… I said yes to everyone else, and no to myself. Other people mattered; I did not. And so, breakdown.
You don’t need to be an expert to work with people who dissociate, but you do need to understand these fundamental issues. Here are ten steps.
Once we understand dissociation as a logical response to overwhelming trauma, it stops being so dramatic and different, and the person suffering dissociation stops being ‘complex’ and ‘bizarre’ too. There is nothing bizarre about dissociative disorders—what is bizarre is how some people can be so badly mistreated that they end up with a dissociative disorder.
Someone who has dissociative identity disorder may have distinct, coherent identities that are able to assume control of their behaviour and thought.
What medications should be used in the treatment of dissociative identity disorder? This fact sheet takes guidance from the ISSTD’s Treatment Guidelines for DID.
How should dissociative identity disorder be treated? What do the guidelines say, and who produces them?
The way we respond to trauma is not a matter of choice – it is a biologically preprogrammed set of responses which happen in a predictable sequence. Here we look at the five ‘F’ responses to trauma.
For dissociative identity disorder (DID) to develop, there is usually chronic trauma in early childhood along with significant problems in the child-parent relationship.
Diagnosis of dissociative disorders is by no means straightforward, mainly due to a lack of training and knowledge. The main diagnostic criteria can be found in the DSM-5 and this article explains how diagnosis is made.
There are a number of diagnostic tools available for assessing dissociative disorders. This article lists the principle ones.
Dissociative disorders appear as diagnostic categorisations in both the American-based DSM-5 produced by the American Psychological Association (APA, 2013), and the other ‘diagnostic’ bible used more widely in Europe, the World Health Organisation’s ICD-10.