PHASE 1 TREATMENT OF COMPLEX DISSOCIATIVE DISORDERS: LEARNING SKILLS AND OVERCOMING IMPASSES
WITH SUZETTE BOON, PHD
The workshop consists of two parts. In the morning we will offer specific skills that help stabilize individuals with complex dissociative disorders. We will discuss integrated skills which are designed or modified to address dissociation at the same time as skills deficits. These include emotional, impulse, and cognitive regulation strategies, mentalizing and other reflective skills, self and dyadic regulation in relationships, capacity for positive affect and experience, managing inner conflict and ambivalence, and strategies to establish healthy routines. Most importantly, specific ways to work with dissociative parts in the context of skills development will be described.
In the afternoon we will focus on resolving impasses and resistances in the dissociative client, including management of dissociative parts that interfere with therapy. We will begin with the therapist, who needs a non-defensive and empathic stance that is clear, well-boundaried, and firm. In this relational context, we will examine a number of issues including chronic crisis, ongoing involvement in abuse, uncontained flashbacks, self-harm and suicidality, maladaptive dependency, extreme avoidance and detachment, passivity in therapy, pervasive guilt or shame, entitlement, and chronic attempts to violate therapeutic boundaries. As difficult as these behaviors can be, many of them can be understood as resulting from four related issues: (1) dissociation; (2) chronic defenses against perceived threat (e.g., physical danger, criticism, rejection, abandonment, or engulfment and control); (3) a phobia of inner experience (e.g., affects, cognitions, physical sensations, wishes, needs); and (4) regulatory difficulties. We will offer practical and sequenced strategies to improve the client’s integrative capacity and reduce impasse and resistance.