Presented by: Suzette Boon, Dolores Mosquera, & Kathy Steele
This workshop will focus on the essential assessment and treatment of the subtle clinical differences among clients with Borderline and other Personality Disorder, Complex PTSD, and OSDD-Type 1 and Dissociative Identity Disorder. Although there are many similarities and overlaps, these groups can be distinguished by the severity and clusters of dissociative symptoms. These distinctions have treatment implications, which will be highlighted during the workshop. Participants will learn how to use detailed assessment of both diagnostic and clinical differences in complex trauma and dissociation as part of a thorough case conceptualization that also considers the client’s capacities to engage in treatment. Participants will learn how to distinguish between ego states, borderline modes, and dissociative parts, as well as learn positive and negative symptoms and other subtle signs of complex dissociation. We will discuss when it may and may not be helpful to use the concepts of “parts.” We will also focus on practical integrative approaches to treating clients across this broad spectrum of trauma-related diagnoses, including how to work with challenging avoidance strategies and resistance. Video vignettes will illustrate complex diagnostic and treatment issues.
PRE-CONFERENCE WORKSHOP #2 - Anabel Gonzalez
Working on conversion disorder: Somatoform dissociation and emotion dysregulation
Presented by: Anabel Gonzalez
Somatoform dissociation has been related to early, severe, and chronic traumatization, including early attachment disturbances. Conversion disorders are not homogeneous conditions, presenting different levels and subtypes of concurrent psychoform dissociation and emotion dysregulation. In this workshop this diagnostic group will be described, including different clinical pictures, and presenting some proposals of clinical interventions.
Some aspects included in this workshop are the different types of dysfuncional emotion regulation, conversion symptoms as peripheral or nuclear phenomena in different patients, the different types of conversion manifestations and their neurobiological underpinnings, and the connections between conversion symptoms and early attachment issues.
All these aspects are in the basis of the clinical interventions that are proposed, illustrated through clinical vignettes and video cases.
PRE-CONFERENCE WORKSHOP #3 - Renée Potgieter Marks
Unspeakable Trauma: Exploring Prenatal and Preverbal Trauma and Dissociation in Children and Adolescents
Presented by: Renée Potgieter Marks
It is sometimes accepted that prenatal and preverbal trauma might impact the child on long term, but at the same time most professionals are still uncertain whether it is possible to actually access these memories, because the children ‘cannot remember’ or ‘cannot speak about it’.
This training will explore the theory and long terms impact on children and adolescents of living with prenatal and preverbal trauma and dissociation. The main focus of this training will, however, be on accessing the prenatal and preverbal trauma and dissociation and the treatment process.
The training will include multiple therapeutic techniques and tools that can be used to enable children and adolescents to explore their earliest traumatic experiences. This will be done at the hand of practical case studies, children’s drawings, photographic information of sessions and videos about actual sessions. It will also include the use of EMDR/BLS during this process.
PRE-CONFERENCE WORKSHOP #4 - Luca Ostacoli
Neurolobiologically-based EMDR Therapy of Trauma and Dissociation in Depression
Presented by: Luca Ostacoli
Depression is a world leading cause of disability, with enormous human and social costs. The relationship with self and others is compromised. Attention is directed inward, with a detachment from resources, rumination, and a blaming and judging attitude. In addition, the window of tolerance may be very narrow, with activation shifting between hyper- and hypo-arousal and limited space for free contact with feelings and thoughts. Anhedonia and impotence may reduce motivation both in the client and in the therapist. The modern conceptualization of dissociation helped to distinguish how its role is transversal to diagnostic categories and affects their treatments.The presence of dissociation in depression increases difficulties in processing trauma, reinforcing harsh vicious circles. Research in “affective neuroscience” opens to new promising developments, offering the possibility to “tailor” psychotherapeutic treatments to individual neurobiological profiles, based on the close connection between Central and Autonomic Nervous System in affective processing and in relational engagement. Porges’ Polyvagal Theory is widely used as a functional model of autonomic arousal but its efficacy can be improved integrating it with new models of Central Nervous System processing. Richard Davidson identified six neurobiologically grounded "Emotional Styles",reflecting activity levels in specific and identifiable brain circuits. Each dimension is a continuum according to the degree of activation.In our center at the Clinical Psychology Service at University of Turin, we developed EMDR and Mindful approaches based on these neurobiological findings. The workshop will focus on these integrative tools for a comprehensive neurobiologically-based EMDR treatment of trauma and dissociation in depression, choosing some techniques with the best ratio between simplicity and effectiveness. These techniques will be described in their subsequent steps and illustrated with audio visual clinical material.
PRE-CONFERENCE WORKSHOP #5 - Lisa Schwarz
Understanding Paradoxes and Negotiating Obstacles in Complex Dissociative Patients: Case Conceptualization and Clinical Treatment with CRM (Comprehensive Resource Model)
Presented by: Lisa Schwarz
The treatment of complex dissociation requires a significant amount of time and energy focused on dismantling and transforming obstacles to the healing work. Obstacles are sourced in fears of the therapeutic process, change and the responsibility of free will, along with aversion to embodiment and a changed relationship to self and others. Examples include but are not limited to: substantial emotional and behavioral dysregulation, refusal to resource, increase in between-session crises, perpetration of pain on self/others, addiction relapse and flare-ups of medical conditions. Disarming intolerable paradox, a state of holding the chronic tension of opposites for which there is no “solution”, is not only necessary for successful obstacle work but also throughout the course of treatment. An initial source of this untenable state is the paradox of early attachment (i.e, 'I need to attach to survive but attaching makes me feel like I will die'). These manifest cognitively, behaviorally, emotionally and somatically in the client and require an understanding of the origins and clinical interventions needed to render paradox powerless in perpetuating blocks to healing.
The Comprehensive Resource Model (CRM) is an emotion-focused treatment model which facilitates healing of traumatic experiences; the solid neurobiological foundation of this model was developed by Dr. Frank Corrigan. CRM includes an internally-sourced scaffold of resources which are attachment related and somatically developed, the sequencing and combination of which provide the opportunity for affective responses to be dismantled while the client is fully aware. The resources in CRM are used as a framework from which to experience the intolerable as tolerable and consequently clients are not re-traumatized by the therapeutic process itself. CRM appears to allow individuals to orient fully towards the most frightening material, accessing and clearing the origin of the split-second moments of survival threat and intolerable affects which are sourced in the midbrain and driving sub-cortical and cortical defense responses (obstacles) and which are an inherent element of paradox.