Working with the Shattered Self
Full Program Title:
Working with the Shattered Self: Treating the Spectrum of Dissociative Disorders and Dissociative Symptomology
Led By: David L. Calof
Especially for clinicians unfamiliar with the autohypnotic basis of dissociative symptomology, the treatment of dissociative disorders can be bewildering, frustrating, and taxing to client and clinician alike. Multiple transferences, frequent crises, entrenched patterns of self- (and other) harming behaviors, highly conflicted interpersonal fields, gross cognitive distortions and trenchant dysfunctional beliefs can overwhelm and disorient even the experienced clinician Working with issues of severe and extreme abuse may challenge or shatter the therapist’s basic beliefs about safety, goodness, and meaning, leaving one anxious, vulnerable, and uncertain.
These factors often conspire to promote common clinical errors such as:
- Failure to create or hold the therapeutic framework
- Fascination/reification of the disorder
- Errors in pacing/timing sequencing
- Safety and containment failures
- Role/boundary confusion/diffusion, multiple roles
- Over-functioning, over-involvement
- Countertransference counterresistant avoidance of difficult affects, themes
- Countertransference Compensation of Client (codependency)
- Making “memory work” the purpose or goal of treatment to the detriment of personality integration and functionality.
The presenter will discuss effective clinical management, common treatment errors and other issues in the treatment of disorders along the dissociative spectrum.
The session will conclude with a videotaped clinical demonstration showing the presenter’s emergency consultation with an acutely and chronically suicidal, chronically self-injuring, dissociative identity disordered client with imminent plans to kill herself. The therapist is seen making rapport with a group of highly oppositional, emotionally charged, self-destructive ego-states and, using techniques drawn from hypnotherapy, along with other direct and indirect techniques, helping the client to metabolize painful affects, shift cognitive frameworks, build expectancy for positive change, and incorporate safety measures. The therapist draws upon a variety of formal hypnotic techniques and phenomena (i.e., hallucination, eidetic imagery, age progression, amnesia, and so on) but also utilizes and directs the client’s dissociative capacities as an extension of the hypno-dissociative working medium. The presenter will share some of his own thoughts and feelings that occurred at critical points in the session as well as field questions and discussion between tape segments. Finally, he will present a four year follow-up on the case.
Through lecture, discussion, Q+A, exercises, handouts, clinical observation (via video), and case consultation, students will be able to:
1. List the five dissociative disorders and describe their major symptoms and common phenomenology.
2. Summarize at least two theoretical frameworks for the etiology of dissociative disorders.
3. Conduct an assessment and perform a differential diagnosis for the dissociative disorders.
4. Distinguish between assessment, stabilization, and working through stages of treatment and be able to describe the clinical tasks for each stage.
5. Create treatment plans specific to individual cases taking into account client resources and limitations, symptomology, as well as other idiosyncratic features.
6. Describe a phased approach to the treatment of dissociative disorders.
7. Describe common clinical errors in the treatment of dissociative disorders including errors of avoidance/fascination, containment, pacing, sequencing, over-involvement, and others, as well as strategies for preventing them.
8. Identify and discuss common transference and countertransference dynamics as well as other issues of the self of the therapist in the treatment of dissociative disorders.
9. List and describe a variety of clinical techniques for managing suicidality and parasuicidality (self-injury), metabolizing traumatic rage and grief, gaining rapport with hostile ego-states, and deactivating self-destructive conditioning in dissociatively disordered patients.