The Nature of Trauma and Dissociation

In this presentation, Remy Aquarone, director of the Pottergate Centre, Norwich, UK, explains the value of the Structured Clinical Interview (SCID-D). This assessment instrument was created for the diagnosis of DSM-IV Axis 1 disorders, a list that includes Dissociative Disorders. Remy Aquarone takes us through the criteria for the assessment and diagnosis of dissociation disorders, giving detailed explanation of key symptoms. These include the five dissociative disorders outlined in DSM-IV: Dissociative amnesia, dissociative fugue, depersonalisation disorder, dissociative disorders (not otherwise specified) and dissociative identity disorders (DID).

Video lecture – 1 hr 3 mins

Philip Bromberg here proposes that the process of psychoanalysis is mediated by participating in a complex relationship that enables the patient to reclaim his or her dissociated self-states. Trauma is defined as a precipitous, psychological event that disrupts the patterns of meaning that constitute the person’s overarching experience of self. The work of analysis is the co-creation of a relational unconscious, via state-sharing, that enables restoration of links between dissociated aspects of self so that the conditions for intra-psychic conflicts and resolution can be present.

Audio – 43 mins

In this commentary, Dr Doris Brothers describes trauma as an unbearable experience of existential uncertainty. She discusses how trauma disrupts our relational system and why she has thus come to understand its impact through a relational systems approach.

Audio – 23 mins

In this audio presentation, Dr Onno van der Hart explains dissociative disorders as an acute disintegration of the personality into sub-systems that become a fixed ‘structural dissociation’ of the personality, as a result of severe child abuse. This system of self-protection is fully explained, and a phase-oriented treatment approach detailed.

Audio with diagrams – 38 mins

Psychoanalytic couple therapist, Professor Brett Kahr discusses the powerful, unconscious and painful impact of childhood trauma on sexuality. With reference to his work with both individuals and couples, and his theoretical study of over 20,000 sexual fantasies, he explores the strong direct relationship between early relational abuse and otherwise inexplicable sexual desire. The subject is elucidated through psychoanalytic theory and a detailed case analysis.

Part 1 Audio – 33 mins
Part 2 Audio – 32 mins

This presentation explores the multi-facetted nature of empathy – the neuroscientific and implicit behavioural interactions that together deepen the therapist’s capacity to introject the traumatised patient’s emotional experience and so come to know that person ‘from the inside out’.

Video of lecture – 40 mins

This presentation considers how we can recognise and witness the inherited effects of slavery and colonialism in the narratives of Afro-Caribbean psychotherapy clients to acknowledge the impact of trauma on those gone before so we can work towards integration in the present.

Video of lecture with slides – 1 hr 20 mins

By exploring the body’s natural impulse to resolve and heal from psychological or physical trauma, Pat Ogden details how a Sensorimotor Psychotherapy approach to Post Traumatic Stress Disorder leads to integration of the embodied traumatic memory.

Audio with images – 35 mins

The seminar covers the key diagnostic issues in identifying traumatic experiences that are rooted in childhood and differentiating these from traumas experienced by otherwise healthy adults that may result in PTSD and a disruption in their self-reflective functioning. The seminar considers implications for planning an appropriate treatment strategy and is illustrated with case material.

Video lecture (part 1) – 47 mins

Treatment approaches for complex PTSD and simple PTSD in the otherwise healthy adult – PART 2

This lecture considers implications and differences in planning an appropriate treatment strategy for people with single incident PTSD and complex PTSD. Illustrated with case material.

Video lecture (part 2) – 45 mins

Here Dr Allan Schore proposes that psychotherapy is a question of restructuring the unconscious itself. He proposes that working with dissociated affects requires a deep level of empathy that helps the patient to re-visit their past trauma in tolerable doses. The work involves right-brain to right-brain interactions that allow unconscious self-images to be expressed in the form of enactments and thus be integrated through a safe relational environment.

Video of lecture – 20 mins

Theoretical developments in the field of trauma and neuroscience

In this audio commentary Allan Schore explores the nature of trauma, and the advances of trauma therapy led by neuroscientific findings and new paradigms in therapeutic theory. He reflects on the importance of sharing of knowledge across disciplines including neurobiology, psychology and relational psychoanalysis in advancing our understanding of attachment trauma and its treatment. He discusses the emergence of the field of interpersonal neurobiology and its importance in our understanding of dissociation, and other symptoms arising from a weakness in the right-brain’s capacities for affect regulation and relational attunement.

Audio with images – 31 mins

Working with the right brain: a model of clinical expertise for treatment of attachment trauma – Non-verbal communication and bodily-based attunement

Here Allan Schore suggests that the therapist’s capacity for creating a relationship with the patient is the principal agent for therapeutic change. This requires the ability to attune and thus decode the patient’s right-lateralised unconscious mind through a process of introjection – possibly the most difficult aspect of working with dissociative and traumatised patients. It is through such changes in consciousness and sharing of self-states in the therapy relationship that deep structural changes in the unconscious right brain can occur.

Audio with images – 26 mins

Working with the right brain: a model of clinical expertise for treatment of attachment trauma – Clinical intuition, rupture, misattunement and repair

In this presentation, Allan Schore proposes that empathy is essential for therapeutic change in the traumatised patient. He describes this is as a right-brain ability in which the therapist introjects the communications from the patient’s right lateralized unconscious mind. The inevitable process of misattunement and repair between therapist and patient reveals the relational unconscious, and offer the opportunity for traumatic memories to be integrated and emotions of a deeper intensity to become tolerated.

Audio with images – 1 hr 10 mins

In this commentary, Dr Dan Siegel places trauma in the context of developmental psychology and the significant negative impact it can have on a child’s emotional growth. This presentation outlines the neurobiology of the sympathetic nervous system that is involved in PTSD and proposes a model of integration as the foundation of mental health.

Audio with images – 23 mins

This lecture offers a brief psychoanalytic history of how trauma has been conceptualised from Freud to current thinking and the extent to which treatment is affected by the theoretical model of the clinician. In working with trauma and with severe dissociative disorders, the fine balancing of the internal and external worlds is best led by the patient. How does the clinician avoid secondary traumatisation whilst avoiding protectionist pseudo-professionalism to protect them from the power of the patient’s traumatic narrative?

Video of lecture – 1 hr 16 mins

The treatment of dissociative identity disorder

Here, Valerie Sinason describes trauma as an event that could not be defended against and which thus breaks through the psychic skin to leave a raw wound. She discusses the influence of psychoanalytic theorists in her conceptualisation of the unconscious, distinguishing between repression and dissociation. The self-protective function of dissociative splits in the context of childhood sexual abuse is discussed. The problem of sexual and ritual abuse in our society is considered within a socio-political framework.

Audio – 35 mins

Here, Donnel Stern explains the significance of enactment as the interpersonalisation of dissociation, and the only way that dissociated or unformulated parts of the patient’s subjectivity can be represented. The structure of an enactment and the role of therapist as a witness via the enactment process is explained. It is via acts of recognition by the other – the therapist – that our dissociated, unformulated parts of the self become known.

Video of lecture – 15 mins

Dissociation, unformulated experience and therapeutic change

In this audio reflection, Dr Donnel Stern refers to dissociation as the unconscious intention to keep unwanted experience from reaching an articulated or formulated state. Enactment is understood as the interpersonalisation of this dissociation. He thus explains his theory of unformulated experience as an interpersonal and relational way of conceptualising the unconscious that provides new possibilities for working with trauma.

Audio – 24 mins

In this lecture we consider how the early social environment, mediated by the primary caregiver, influences the evolution of structures in the infant’s brain and the impact on these of early and long-term developmental deficits. We will consider how far the brain is plastic and might be responsive to therapeutic or attachment-based intervention in cases of childhood trauma, neglect or abuse. We will be asking what makes an event traumatic.

Video of lecture with notes and diagrams – 1 hr 6 mins

What is PTSD?

In this lecture, Dr Felicity de Zulueta presents Post Traumatic Stress Disorder from an attachment perspective. Examining the DSM AND ICD diagnostic criteria, as well as recent research in epigenetics and the neurobiology of this condition, she interprets these findings in relation to clients/patients’ clinical presentation and their symptoms.

Video of lecture with notes and diagrams – 45 mins

The assessment and treatment of PTSD from an attachment perspective

In this video, Dr Felicity de Zulueta focuses on the assessment and diagnosis of patients with PTSD with reference to a range of assessment procedures, illustrating this talk with clinical examples and pointers to the most appropriate treatment approach. She discusses the diagnostic distinctions between PTSD, Complex PTSD, a borderline disorder or a dissociative disorder, including a range of co-morbid conditions that may accompany a post-traumatic stress disorder.

Video of lecture with notes and diagrams – 49 mins

New therapies for PTSD

This video outlines contemporary therapeutic approaches such as trauma-focused CBT, EMDR and other new therapies that are being used in treating PTSD. We will explore why some patients don’t get better and whether this may be due to a more complex, undiagnosed attachment disorder that first needs to be recognised.

Video of lecture with notes and diagrams – 43 mins