How to Identify and Treat Dissociation (Even When It’s Subtle)
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with Peter Levine, PhD;
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with Peter Levine, PhD; Ruth Lanius, MD, PhD; Stephen Porges, PhD; Bessel van der Kolk, MD; Thema Bryant-Davis, PhD; Kathy Steele, MN, CS; Janina Fisher, PhD; Bethany Brand, PhD; Pat Ogden, PhD; Ruth Buczynski, PhD
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This talk touched on my own trauma story so many times. Helped me to view it from a much more enlightened position after 50 years of on and off therapy. Where it still feels painful, where what was said touched a nerve, I knew I still need to do more work on myself. Thank you for sharing all your precious insights obtained directly in the field.
Thank you for these amazing insights. As an OT I work with many who have the added challenge of being neuro-atypical and display many of these similar defensive responses (structural dissiciation, freeze,..) even though they may have lead relatively sheltered lives, do you have any insights for those therapists with this population?
Isabelle Rogers, 17 years psychotherapist, Australia
Thank you for your work in bringing leading experts to speak in such precise and effective ways! I feel inspired to explore the work of each of you more. My take away is about voice hearing in dissociation
Thank you for sharing all this. I’m a psychologist and I’ve so many patients with trauma I’m was desperate seeking for this formation without knowing this program exist. Really, thanks you
These two days have been great !!! Today ( Day two ).. biggest take away is taking things slowly
-slower for diagnosis (DID vs PD?)
-slower intervention (pacing for clients with ct hx… brain is protrcting them from attaching initially, so be patient with clients!!)
Thank you for this very informative session on the differences between DID and Disscoiative disorders, as well as strateegies for working with these clients. I found this information helpful.
Loving the recognition information. As a former nurse I never got this training though personal experience helped in my clinical interactions, though as a patient I can see how it was missed for over a decade by unaware clinicians.
I would note that as a disability pensioner who does volunteer advocacy in the health sector is love to access the further resources but struggle to afford food and medication so it’s cost prohibitive for me.
great additional information, perspectives, and tools for my TFCBT work! thank you!
Thank you for this presentation. I am a counselling degree student going into my first placement next month and I found the information practical and very reassuring. The presentation provoked much thought and opened up several lines of possibility in my mind as I watched, as I am leaning towards working with PTSD sufferers and the list of insights and techniques included material that we have not really gone into. as yet. Moreover, as someone who has been brought to the field of counselling through my own lived experiences, it was interesting to sit hear and recognise some of my past behaviours – (and one of my current behaviours!) – and to think: “My goodness, that was/is dissociative behaviour on my part.” That experience alone was powerfully illustrative and the learning is something I can now take into a therapy room with me. Brilliant.
Thank you for all that you shared today. It was a little bit fast paced and I think one thing that truly wowed me was the difference between DID and schizophrenia. I am curious to besides the fact that the voices are more than 3 and some of them of children…what else is the distinction? In the sense isn’t schizophrenia also a mental unbalance because of trauma? Like all other mental unbalances?
Other things that were extremely interesting was the window of tolerance, the different ways of aproach-somatic, experiential and cognitive and the structure of the effective treatment
As a trauma survivor, the most important part for me today was acknowledging the training of the patient to hide or erase herself, being taught not to feel or take care of herself. I’m 76 and taking care of myself has always felt risky to the point of threatening my survival. Thank you so much. I no longer have to blame or shame myself for this. I can choose compassion.
Very interesting, stimulating, informative and useful. A lot compressed into one hour and difficult to sustain focus on the guest speakers. However, rich food for thought!
I have a deeper understanding of how to tell if a client is suffering from disassociation and then how to gently help them become aware of it. I liked the comment about saying “Now, I see the spaced out part is here” vs. calling them out in a more shameful way. I learned that empathy can be helpful or not helpful depending on their past trauma and use of voice can have an effect. Attunement is so important. I also enjoyed the part about splitting or fragmenting and how that might be a sign of disassociation.
Appreciate how well organized this is and how it includes different therapists’ insights and strategies. Learning more about potential mistakes we may make and concrete ways for how to recover from them is super helpful!
I’m loving these episodes. I’m a student and can’t afford to pay, thank you for the free opportunity to learn such important content.
would love to know more about the different between Dissociation and Regression – while they may be similar they are also different – An over lap?
As a frequent “free loader” attending these stunning presentations, I scrolled through several pages of comments before coming back to make mine. (And, I have only heard the 2nd half. THANK YOU for the opportunity to listen again at 5 pm or 8 pm. I am learning so much and am setting aside time for the rest of this week.)
No matter the stated profession, so many comments mentioned the attention to “too much empathy too soon.” What great wisdom here among these NICABM professionals in their plan to include this focus on empathy! Probably 97% of the participants – professionals and interested alike – would include empathy among their better qualities!
Even though the question refers to working with clients, I along with others, would like a way to find therapists who think along the same lines as the presenters. Do you encourage the people who take your courses to become “members” or have some other way to help find therapists with a NICABM mindset? I know you are not a “certifying” organization, but are there, for example, “key words” to look for in a therapist’s description of services? HELP needed!
Thank you for this so informative video, I appreciate how much effort was put in it. I work in addiction treatment so I found very useful the red flags and the suggested questions in order to identify DID. Integrating all this helpful ideas and tips in my practice will be a huge step forward for my work. Looking forward to the following sessions!
Practising the posture where fragmented parts are being brought and held together provided and working carefully with decreased capacity for regulation and window of tolerance were most interesting insights.
Thank you so much. IT WAS MEANINGFUL FOR ME TODAY TO HEAR THAT FORMING A RELATIONSHIP WITH A TRAUMATIZED CHILD IN A PERSON WITH DID SHOULD NOT BE A FOCUS OF TREATMENT. I work with a 30-year-old survivor of several years of severe abuse with DID who dissociates daily, even several times, into a 5 and a half year old girl. I was under the impression that I should work with both personalities so they can make contact with one another and somehow find a way to resolve their separateness and merge. I’m not sure now to what extent this the right approach – she is very resistant to accepting the dissociated child and constantly tries to “control” her dissociations by not feeling. Yet I realize that this client needs to put a lot of work into identifying and staying with her feelings because she dissociates to “escape” unbearable feelings (often flashbacks).
wow, please consider to seek professional counseling or supervision advice from someone recommended by NICABM!
We are not supposed to give asvice here. Do not try to integrate parts. That is not your job. When therapists do that, it is called “blending,” a false re-association thst covers up the core causes of the dissociation. In my experience as a pastoral counselor, not as a licensed Psychologist, I accompanied clients with DID on their rounds of treatment to various clinicians. I was asked to sit in with them on their sessions, fir various reasons. I observed that one client sought out male therapists. She brought out alter-states that were manipulative of the specific therapist. If she was with a compassionate clergyman, then out came the pathetic 5 year old alters. She also broke rules by forcing the clergymen to see her privately, even though they could get fired for doing so. They (she and others) got nowhere in treatment and Licensed psychologists finally refused them treatment. Be very careful with this unpredictable population, both males and females. They are treatment-resistant and highly manipulative. They mainly want to satisfy deeply unmet attachment needs. They will sometimes betray therapists who get too close and cause the licensed clinicians to go out of business.
I am a psychotherapist in Baja California, Mexico. I have worked with adult and adolescent survivors of sexual abuse and spousal abuse. Today’s session sheds a lot of light on all the work done so far and on how to improve the care I provide. Thank you so much.
I find the info here very inspiring as it sheds lots of light on behaviours that we may all share to some extent. So inquiry is of such importance.
That was really good thank you. I learned more about the signs of dissociation and the right questions to ask my patients. It was almost impossible to keep up with the notes however and to fill in the handout 🙁
Why is this a sign of dissociation?
> Clients claim NO benefit from ANY medications or they experience paradoxical side-effects from medication
Traditionally, it was taught that the vatmrious dissociated parts in a structurally fragmented system have different biological or physiological responses. Also, many have have a “dual diagnosis” of allergic reactions to alcohol or psychoactive drugs, making them intolerant to meds often prescribed for mental health. SSRIs can worsen or intensify dissociative symptoms. I am not a medical doctor. These negative effects were reported by clients in treatment.
Extreme helpful !
The guidance that keep coming back to me is :
1) Go slowly… I work with children and their families. In can recall times when my observations, and my body cues suggested there were something really wrong, if not dangerous, for the child’s development happening in how the family system worked, but when I also detected something that looked like DID (what I am learning is DID) in parents. Whwn this happened, it is as if I wanted to go so fast to reverse intergenerational transmission of very maladaptative behaviors… I see that sometimes I had started rushing in trying to make a cognitive-fonctional alliance with the parents as if this rational alliance would prevent the repetition of traumas… I know intellectually that this is not the case but this ackward family situation where the parents may present themselves in one state on certain days or moments and in other states on other days, made it very difficult for myself to pace myself. Confronted to these paradoxes and contradictions in parents and to the confusing effect on my analysis, it is as if a part of me had wanted to believe I had misread the situation. It is very difficult to be confronted to a parent who’s dissociative strategies that come up to deal with his/her own history of trauma render him/her incapable of protecting his/her child from experiencing traumas or may even render him/her capable of parental abuse. Keeping in mind certain specific little patients where this rush into exploration happened, I can understand the back movement of my little client, and of his/her parents as well. I had emphasised the Terminal ambivalence which Dr Janina Fisher talked about. When I slowed down, and accepted that to go somewhere I could only accept this slower pace, my little patients and parents were more able to open up. We have then been able to work with a team that made sure this family received the complet help needed to protect the child form intergenerational acting out of Traumas, and parents to work toward the integration of self needed to do that.
2) Make yourself reassuring and back off and do not to the person if dissociative strategies arise.
3) The importance of the right diagnosis, and of education about DID. Because without this education, people working at the registration of teacher’s, occupational therapist, psychologist’s or other concerns for a child wellfare may be confronted to DID but not know it. Their analysis in these cases may be incomplete, having met a parent in a certain very functional state of self, but not in another more concerning state.
Thanks a lot for your important work,
Diane Dulude, Ph.D., psychologist for children, families and couples
Years ago, when the ISSD International Society for the Study of Dissociation was first being founded, your observations were a frequent concern for the clinical psychotherapists who gathered to discuss treatment modalities. How to treat traumatized dissociated children when they had to live with abusive parents who caused the trauma. Or how to treat the children so they could trust the therapist enough to learn coping strategies without also awakening the children’s attachment needs that could never be met by a clinical therapist. It was a very difficult dilemma to know that children would be returned to dangerous situations.
I’m really happy to be able to get this information. I’m a general physician and I wish they would’ve taught me information like this in med school. A big part of the patients I get to see are somatizing and after many years of practice I finally get the information I need to actually give them what they need. In med school no one said I would be facing patients with problems that are not the classic diseases taught in regular medical literature, and I always felt sad because I knew there was more to it and that my patients were not receiving the care they needed, but I didn’t have the tools to give them better care. The work in this conference gives me hope of becoming a better more complete physician. Thank you so much.
there a way to work with one of the presenters? I have tried phsycologytoday. com website to get a specialist who understand all these and can actually help my 15yo daughter heal from traume I caused because of my own childhood trauma. Basically I was not equipped being a mother who could raise a healthy child. Finally I did ton of research, I guess I have a growth mindset, but now I am drawning in my own guilt, regrets and shame for being such an emotionally neglectfull, even emotionally abusive parent to one person what gives meaning to my being. I have talked to so many therapists but it seems I have learnt more from just attending Super trauma, resilience, attachment related conferences, than any therapist I have spoken with. Is there any specialist out there. I have taken over 10 online courses from Dr Gordon Neufeld institute on attachment and developmnt theories and making sense of adolescence. I have read Oprah’s book on “What happened to you?” and Dr Gabor Mate’s “The Myth of Normal”, and other authors in the field. I cannot help myself, and I cannot help my daughter. I am trying to understand so I can heal my daughter from me, but she is in defensive detachment-survival mode and I can’t help her heal and change into thriving mode. Any suggestions? Please do not refer me to psychologytoday.com. They don’t attend these programs, and they don’t read the books to learn about the latest discoveries. As I struggle to find ways to help her, she is growing up with issues and I am losing precious time 🙁 I am shamed to leave her with such a legacy. The very thing that I was so afraid of (raising a child who will need therapy to heal from a parent), is what I caused her. Maybe one of the professionals presenting here would care enough to reach out and see my daughter (virtually if thats all available) for an hour and suggest a hopeful path forward? I noticed you don’t have a parent as a profession, when thats the number one profession to train… Then we wouldn’t have so many mental health issues. I would have given anything if in the hospital I was given a book on trauma and mental health, rather than just how often to feed the baby, change diaper, sleep,etc..
Perhaps look on the internet for the website for Bessel van Der Kolk. He founded an institute in Massachusetts for treating trauma and dissociation. There are many experts involved with his organization. There are also medical clinics in the Boston area that treat trauma and dissociation. Also, look on the NICABM website. Perhaps it might provide names of professionals or organizations to contact. There are many other free resources on the NICABM website. This field of study is new. It is good you are seeking resources.
I deeply appreciate the brevity and clarity of this series. I have worked many years with complex trauma in children and adults including with DID. It would have saved me (and especially my clients) an immense amount of time to have had such useful guidance so many years ago. And I especially appreciate the emphasis on Somatic approaches and Polyvagal Theory in addition to purely cognitive approaches. My current work is immensely enhanced by past and current studies with some of the master practitioners featured in this series. I am certain that I could have provided much more benefit to clients in the 1980’s and 90’s if I had had these tools to share. Thank you for providing this either free of charge or with the optional Gold package!
These theories are new. These experts developed them. Thank goodness they persevered.
It is not as accessible to learn what all you are putting out there as I would like it to be. Having the sheets without the pause or highlighted information on PowerPoint written is a barrier to learning and applying what is shared here. If the goal is accessibility to these resources I would encourage either a change in the worksheets or insert some visual power points that are directly answering the worksheet. I understand how there needs to be incentives for those who can afford to get the gold package, and I am sure a variety of case studies would be worth that.
Thank you for sharing nonetheless.
I am so glad and grateful again for this highly advanced knowledge regarding the key issue of dissociation.
I specifically enjoyed the emphasis on structural dissociation being usually confused as a personality disorders, yet it is more like a state of FRAGMENTED identities of the Self.
I also really appreciate all the highly valuable recommandations concerning the pace of therapy, having to check on the patient’s current state and using techniques engaging the body and breathing : SO IMPORTANT!
Finally, I am glad to see the specific training I have just started in “maïeusthésie”, an approach developed here in France, feels so in tune with all this state of the Art content!
Can’t wait for tomorrow’s session! 🙂
Wholeheartedly,
Dr. Fisher reminded me of the quote from the textbook Alcoholics Anonymous,
“An Egomaniac with an Inferiority complex.
I can’t recall how she stated it.
I am currently working with several clients who are aware of their early childhood trauma to help them integrate and strengthen their inner selves as adults. This seminar will be quite helpful, especially with regard to gauging the speed at which we are working and making those important adjustments. I also am working with a self-harming teenaged girl whom I suspect has childhood trauma, but she has little to no recollection of her childhood prior to age 12. She often reports feeling disconnected, loses blocks of time, closes in on herself and hears voices, so this information will definitely assist me in working with her. Lots of great input here. Thank you!
This was a wonderful and clear presentation and clarification of dissociation; identifying it when it happens and practical tools in working with helping individuals heal. Thank you. I am not a licensed therapist but have a lifetime of work with traumatized individuals and my own journey to more healing. It is for a snapshot into your wonderful course I have – year in clinical counseling master’s program and as a writer am interested in the fragmented sense of self and modern and postmodern times.
Thank you so much, as a MACP student completing my second year and starting practicum in working with clients, I will seek to integrate these important teachings.
Hello, I have two adult children who are dealing and being cared for with extreme trauma. While I would never use any of this to take on care for them myself, all of this is helping me recognize what my adult children are experiencing, and how I can manage my own response to their needs. Thank you for helping me understand what hey, and their therapists, are doing.
Thank you for today.
I will start to watch for confusion and uncertainty in myself as a projection of what my patient is experiencing and which may indicate a dissociative state. I will also be careful to go at my patients pace and to always stabilise and ground them to increase a feeling of safety.
Recognize fear of closeness as defence as sympyom of prior violation of trust
Going way more slowly. Bringing awareness to parts and ways to integrate. Danger that being too sweet/empathetic/close might be taken as a threat. So appreciate that you offered this webinar free of charge.
thank you so much 🙂 the video really helped me to be more compassionate with myself und to understand why I sometimes feel so strange around some kind of people -> they are in a dissociative state i guess. makes sense.
Was useful to learn the signs of dissociation.
How to adress dissociation without inducing shame.
The drawbacks of emphatic response.
Thank you very much.
This is TERRIFIC in every information. Professionally produced, excellent content, good balance between upselling and informing.
Very useful the distinction between dissociation and DID
Many thanks for Module 4 on Shame. It was very good and interesting.
Many thanks for Module 2 and 3. Dr Daoust
clear definitions of parts of structural dissociation is so helpful in moving ahead with treating different states with some insight and confidence.I use my own nervous system responses to be in tune with the patients behaviour and confusion.
Slowing down is a must.
Will buy this superb programme a second time .
it keeps getting better and actually very enjoyable; the joy of true knowing.
Clearly defining each structural states of Dissociation is extremely helpful as that insight helps to follow ,the why’s and how’s of how to work with each and different states.
Superbly done. so I will buy this programme a second time.
With gratitude. Srishti Nigam, Dr.
I want to thank those of you who paid for the Gold Package as you allowed me to attend. I worked in the mental health field back in the days when no one was traumatized, we were all bipolar and BPD. My career didn’t last long once my memories surfaced and at 70 years old I’m finally getting help understanding myself. My sister, who was beaten as a toddler for being born with a birth defect, died this past year and I’m beginning to understand her more, also. I think the hardest part, for me at this time of life, is to give up on ever going back to work. It’s a constant battle to fight the feelings of worthlessness. Being active with non-profits in the community doesn’t work when I’m frequently homeless… I’ve spent a lifetime trying to work Maslow’s Hierarchy upside down. It doesn’t work.
Why does the body disassociate? Besides trauma …
The body is trying to show us something with disassociation specifically
I’m trying to identify the difference between DID and Structural Dissociation. Can anyone clarify this? Thanks in advance 🙂
i think the only difference is severity, different approaches are needed because of severity, so that leads to different labels for the different levels of severity. Otherwise both disorders are more similar than not.