Treating Trauma-Related Dissociation – A Practical, Integrative Approach
by Kathy Steele, Suzette Boon, and Onno van der Hart (2017)
Review by Bill Brislin
At last we have a comprehensive text which combines solid and current theory with practical clinical approaches to the treatment of complex trauma and dissociation. Goldilocks would approve of this resource: Not as hard as The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization (van-der Hart, Nijenhuis, and Steele, 2006) and not as soft as the workbook Coping with Trauma-Related dissociation: Skills Training for Patients and Therapists (Boon, Steele, and van der Hart, 2011). This volume is “just right” in that the authors provide a one-stop synthesis of theory and practice.
The EMDR therapist will appreciate the clear connections made between The Theory of Structural Dissociation of the Personality and Adaptive Information Processing (p 422). The foundational EMDR concept of Dual Attention is also expanded upon to assist work with complex cases (p. 446.) Also, EMDR specific interventions are referenced, though not specifically taught. Many of these are explained more fully in EMDR and Dissociation: The Progressive Approach (Gonzalez & Mosquera, 2012) and EMDR Toolbox (Knipe, 2014) which are widely referenced throughout.
This volume fills a much needed void in the literature since it informs case conceptualization from an integrated theoretical perspective and guides the therapist through many of the inevitable pitfalls of treatment in a systematic way that allows one to understand where they are on the treatment map and what the next helpful destination is likely to be.
The concepts, skills, and interventions outlined in this book will be immensely useful for treating slightly less complex cases such as personality disorders and chronic depression. I highly recommend this for EMDR therapists who are confident in the standard protocol and are ready to go deeper in treating complex cases.
Integrative Parenting: Strategies for Raising Children Affected by Attachment Trauma
by Debra Wesselmann, Cathy Schweitzer, Stefanie Armstrong
Review by Mary Jo McHaney, LMFT, LMHC, CAP
Parenting is hard. Parenting children with attachment or trauma issues is mega-hard. (p. 90)
This quote sets the stage for parents to truly understand why they are feeling so overwhelmed with regard to their children’s challenging behaviors. This book helps the reader understand exactly what is going one with their wounded children, and what they can do to help their children and themselves.
Here is an easy to read, comprehensive book that allows parents and caregivers of traumatized children to more fully understand attachment trauma, and learn specific ways to interpret the child’s behavior and intervene effectively to create change. Each of the five chapters builds on the previous one, and all provide great insights and strategies.
Chapter One helps parents change their perception of their child’s behavior. (For example, Scared Children vs. Scary Children). It assists the parent to understand the profound neurological effect of attachment trauma. Helping the parent/caregiver with this important paradigm shift will allow them to consider responding in a more intentional way.
Chapter Two details how caregivers can specifically create connections and begin to establish a healthier attunement with their children. It also educates the caregiver on how to bring joy, laughter and play back into the home, and how this serves to strengthen connection.
Chapter Three provides explicit solutions to challenging behaviors. Specifically it discusses “meltdowns” and how to begin to recognize their phases, as well as how to respond effectively in each one.
Chapter Four invites the parent/caregiver to look at their own reactivity and understand how their responses can trigger their children. It also invites them to look at, and possibly work on their own place of “woundedness.”
And finally Chapter Five provides specific “how to’s” and “how not to’s” with regard to boundary setting and consequences. The authors remind the reader that discipline means “to teach”. Helping the child gain insight into cause-and effect relationships will help him or her to link personal choices to outcome. This chapter will assist caregivers to consider how and when to give consequences and how to reward positive behaviors effectively.
This book is written by EMDR trained therapists, but it does not discuss EMDR treatment or use AIP terms. However, EMDR informs the authors’ perspective in providing an excellent and easy to understand reference for parents who seek to understand attachment trauma, be part of an effective treatment team and ultimately help their child heal.
Neurobiology and Treatment of Traumatic Dissociation – Toward an Embodied Self
Edited by Ulrich F. Lanius, Sandra L. Paulsen, and Frank M. Corrigan.
Review by Bill Brislin
An important and much needed addition to the complex trauma literature, this is not light reading! However, if one takes the time to carefully wade through the neurobiology, better informed treatment interventions and strategies can be crafted and utilized for individual clients.
Seventeen authors, all experts in the field, have contributed to this volume which is divided into two parts: Neurobiology and Treatment. The first chapters can be daunting! (Honestly: the first time through Chapter 1, I merely sought to pronounce the words!) As one continues to read, certain key concepts are reinforced from a neurological and clinical perspective. For example: top/down vs bottom/up movement and synthesis of information (or not) in the brain. Traumatic experience often impedes the flow of information from upper, middle, and lower brain regions. Adaptive information processing requires an integrated exchange between these regions.
This book is particularly helpful for EMDR therapists since all of the treatment methods presented are designed to facilitate blocked information processing. Complex trauma implies the failure in the development of secure attachment and the adaptive developmental milestones associated with good-enough parenting. These developmental failures have neurological implications which are not easily responsive to the top/down, (i.e., cognitive/emotional/somatic) interventions of traditional talk therapy. As the reader develops greater insight into the neurological implications that result from early life trauma and attachment disruption, more meaningful and useful interventions can be employed. These are beautifully highlighted in the second part of the book. The three key treatment methodologies given attention are ego state therapy, sensorimotor therapy, and EMDR therapy.
One of my favorite things is a chart in a chapter by Frank Corrigan which lists twenty-one defense response states which can underlie dissociative self-states. For example, the “fight” response can be further subdivided into fight-active, fight-obstructed, fight-frozen, fight-predatory, and fight-submissive. He goes on to indicate characteristic beliefs, emotions, and body states which correspond to each. Different self-states typically hold a different response to the same experience and may need separate interventions from the therapist.
Probably too heavy as an introduction to complex trauma and dissociation, this book has a valuable role in deepening one’s capacity to treat challenging clients more effectively. There are more digestible resources to get started in this area, however, few resound with this level of clinical depth.