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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Thank you so much for making portions of this freely available through the live broadcast. I have learned so much and this module will help me in supporting a close friend. I found the tidbit of “what action couldn’t you do as a child when you were traumatized” (Eg, walk away) to help someone become grounded again. Thank you for all your work and your commitment to making this content available to people with different $ means and backgrounds.
I’ve been learning about “echo” tapping (EFT). I’ve experienced times in practice sessions using this tool where the adult client cannot reach the child to be tapped on at all. I am coming to the conclusion that the client has suffered trauma where parts have trust and/or attachment issues. Can you advise whether this form of EFT is useful at all for clients with either Structural Dissociation or Dissociative Identity Disorder?
Wow. This whole session was informative, practical, on point. I work in an Indigenous community and I see dissociation every day in my primary care practice presenting as personality d/o, anxiety, depression and addiction. One step forward and one step back for years with some patients – now I understand this as terminal ambivalence. I loved the introduction to Somatic, experiential and cognitive methods of treatment to help; with the 4Cs. I just enjoyed the whole session.
Thank you for giving me hope that I can eventually find my true self. It’s been so hard during COVID. And, it’s so expensive to do the therapy. Medicare is not very supportive. I need to stop the generational abuse with me. No more!
I will better appreciate moments of co-regulation of breathe for how it both supports me as a therapist and provides a mutative mutual regulation experience for the patient.
Thank you
Very helpful webinar. My biggest takeaway was the piece about how compassion and empathy can be triggering to a client who is dissociated and perpetuate the dissociation.
Really appreciated the professional advice. Always enjoy the authenticity of other professionals who I have admired for so long. Love how Ruth wrapped up at the end appreciating all of us and what we do and the ripple effect for all of us. Will remember not to work with the cute child parts as this can be triggering and when opposition to grounding techniques is apparent, step back and explore further with client. See you next week. Leslie
Leslie – When you say when opposition to grounding techniques is apparent that we should not keep trying to do it, but to step back and explore further with the client, how do you explore it with them? Mary
So validating; Really liked the way it was so practical.
Move more slowly through treatment. Also look more carefully at the meaning of physical complaints in a traumatized patient.
Last week I heard a valuable thing that was repeated and further expressed this week–the idea that our nervous system is responding to our client’s nervous system, and there’s a kind of connection there I’ve never considered. But as soon as it was mentioned I knew what the speaker meant.
The advice to not get pulled into viewing the client as a child was timely for me. As well as the three ways of helping – somatic, experiential, and cognitive.
I enjoyed the free lecture with overview. What was most helpful to me was realizing that trauma can lead to trouble making decisions. I now understand one of my clients so much better and can help better also.
Thanks for another super helpful session.
Now during Covid era, sessions are online or by phone. Wondering if there are any tips to notice dissociation while during virtual sessions. It is much easier in person.
I think eye movement, looking away, spacing out and altered breathing are still detectable via video. Phone is tricky as breathing changes may still be detectable. However, the phone can provide a level of intimacy that at times could be triggering so a modulated tone might be needed. Just my thoughts.
Incredibly insightful and informative! Thank you so much for this. Can someone please remind me what the third “c” is? I got:
1) Cooperative
2) Coordinated and
4) Cohesive
Thanks!
coherent
coherent!
T
Dear NICABM
thanks you for making this free and accessible .such an inspiring bunch of presenters ,all embodying care and compassion to self and others !
Found the psychoed around how self sabotage is often an unconscious process and stemming from fear of progress and the unfamiliar so useful.
Loved the empasis on techiques about how to validate and address the diferent parts and bring them in ..
I’m interested in using this way of understanding trauma and dissociation with clients who compulsively self-sabotage, who respond adversely to SSRIs and/or have psychosomatic symptoms with no outcome from medical investigations. I had not previously considered these symptoms to be dissociative and look forward to using this insight further.
A mental health dinosaur here who was taught in grad school to use hypnosis for dissociative phenomenology. Current thoughts or comments please? Thank you.
I personally think it is very helpful to learn about hypnosis for understanding dissociation. The process is related, but there is a difference in that if one is trauma based (pathological) or normal, everyday phenomena. I think it is helpful to normalize the dissociation, and help one cope with the diagnosis if it’s a DID or OSDD. There are two book that comes to mind on this topic. One is called, Healing the Divided Self: Clinical and Ericksonian Hypnotherapy for Dissociative Conditions, and the other one is The Practitioner’s Guide to Mirroring hands. The later one is not directory related to dissociative disorders, but I think some of them to be helpful in a way that it is bodily based yet non-threatening.
Thank you, Eva,
Looks like I could have used Frederick and Phillips book back in the day.. but my education preceded the publication!
Have a lovely day
Remarkable webinar. Thank you experts who are devoted to educating practitioners who work with Dissociative and DID clientele. It requires distinctive and pervasive awareness in recognizing subtle signs of this hidden suffering. I believe the advancement of practical techniques fair well within real-world settings. Teaching or rather modeling for clients how to regulate their emotions within a non-threatening conduit heightens therapist’s clarity and build trustworthy relatedness, respectfully. Treatment modalities centered around client uniqueness bridge transparent learning opportunities in an ever evolving technological world.
I am a retired clinical psychotherapist, and found this presentation VERY interesting and informative. I now realize that Dissociative Disorcer may easily be mistaken for Bordrerine Personality Disorder, and would like to know how to CLEARLY distinguish between both. Also, I must admit that I did not know that dissociative disordered clients can hear multiple voices!! ,and that for this reason such patients may have wrongly been diagnosed with and medicated for Schizophrenia. I have not practiced in about 20 years, due to Burnout -related early retirement, from a badly understaffed Community Mental Health Center, but remianed very intersted in ‘the Field’. I am excited about the new discoveries and diagnoses we now have. Due to the exceptional Corona- related circumstances, I have started to dust off my professional skills to occasionally help people in need again, free of charge,when they cannot acess the services of a qualified therapist. l am very grateful and glad that I discovered your excellent Seminar. Thank you for offering it!
Best regards, from D. Koob
Listening to today’s training was helpful in several ways. The trainers shored up my understanding of DID-its genesis, identification, tx strategies and pitfalls to avoid-and helped to connect it to pesonality disorders. Most helpful is putting words to innate or intuitive responses I might have as a therapist so that I understand why they are helpful, along with when to they might be less helpful (over-connecting with the child part when it is the Protector thst first needs to be reassured). It was aso validating of what I do already know/feel about the work (greatly helpful as I switch back to private practice!).
I am a psychiatric nurse practitioner working collaboratively with a therapist treating a client who experiences dissociation. I have found this presentation very helpful in recognizing dissociation and attempting to respond helpfully in a medication-oriented session. I found the sigh a good suggestion for grounding. Also the insight that too much of an empathetic tone may not be best. Interestingly I worked for the VA for many years and have experience with combat trauma but less so with childhood. I have much more to learn and will be purchasing the gold membership at some point in the future.
I find great difficulty in relating these ideas to other sevices, such as child protection, when parents are being triggered in formal meetings about their perceived bad parenting, closing them down or triggering fight responses. I find my colleagues unreceptive to these ideas, as their goal and measurement is the parents engagement with the process, when the parent is barely able to be in the room. When I comment, the response is the focus is on the child not the parent.. Behaviour is then viewed as easive or oppositional, with a potential for losing the care of their children.
I have found the same working with parents and families referred for therapy services due to an open DCBS case. The lack of a trauma informed perspective toward the parents and the lack of trauma informed policies and procedures within the DCBS process that the family must navigate is counterproductive. Instead of supporting these parents, which is in the best interest of the children, much of what I witness is triggering and harmful to the parents and counterproductive to the goal of preserving or unifying families.
I too have seen the same and it is shameful. IF we are advocating for children and interested in improving the situation- we cannot demonize the care givers they are attached to and if we really want to affect change we need often to address the trauma in the parents’ backgrounds that have lead them to parent the way they do.
Thank you to everyone making this point. I am a lay person deeply grateful for being allowed access to these hugely informative sessions. I am here in part to share my own experience of having a loved-one who is traumatised in the hope that the trauma therapist community – who are truly amazing as these sessions demonstrate – can help advocate for those of us drawn into the world of trauma through connection. What I have noticed time and time again is that as the traumatised person tries to manage their trauma, whole swathes of other people, young and old (not therapists, nor care professionals but ‘loved-ones’) are pulled into the storm and often subjected to intense hostility. The emotional damage is enormous, far-reaching, and feels irrevocable. As ‘carers’ (though the word barely fits given that we are often rejected and demonised) we too become traumatised (literally – our sense of safety is taken away, we are on constant alert for further attack, etc). It feels like a deeply depressing cycle.
As a teacher/counsellor I can relate to the fragmentation that many of the children I work with experience and that need to be close to the very person causing them harm. The physical symptoms of trauma I find present frequently with the children I work with, almost like a cry for help. It is so important to model breathing and other grounding techniques. So much information and all so valuable. If only more people were able to read the signs! Thank you
I am a teacher who works with children with Special Needs and Disabilities, including chidren with complex medical needs and autism. The course ideas
link in well with current thinking and pedagogy, but from a different perspective. Its fascinating and validates my use of sensory laddders and sensory profiling, particularly helping us to understand the moods and communications of many children who may be non verbal and express themselves in a variety of ways.
I have at least four clients that may be helped by what I have learned today.
Very helpful overview. I especially liked the suggested assessment questions: “Are there traumatic events in your childhood or adulthood that might affect our work together; and how can we work with them so that you feel in control?” I will use that. It is a very respectful and compassionate approach to trauma assessment.
For I love that phrase for practitioners in this world who can utilize this brilliant material: preschool to college teachers, ministers, those who care for special needs children, adults and Alzheimer’s caregivers, both family and professional. I’ve worked with all age groups I mention here, and it is already changing my DNA about how to work with them even more effectively. I am by the material you’ve shared today. Thank you!
I found this genuinely life affirming. As a training practitioner learning to work with trauma, this provided a clear and calm overview and suggested strategies which are both reassuring and provide a platform from which to grow confidence. My two key aways are go slow and, given that anywhere up to 75% of patients are not having their dissociative symptoms recognised, every step forward in having a better understanding and in being able to integrate this knowledge into my practice is a step forward which can and will make a difference. I also really appreciated the ways in which you made this a safe space for people to come into and learn about this topic: how lovely to be so warmly welcomed, accepted and thanked for taking part in this learning journey. Thanks very much and see you next week,
Anne Margaret, Scotland.
I am a integrated health and wellness coach and a have learnt from my childhood trauma. I loved the content about doctors not understanding how to handle patients before medical procedures!! So important for all. Win, win when practitioner and patient are grounded. I have to admit I do disappear into ‘Kairos’ being a reluctant contemplative. ? Love polyvagal theory. Grateful for the teachings here. ?
Not a professional, but a caregiver for someone with dissociative amnesia and CPTSD, and I myself have dissociative seizures. I was particularly interested to learn more about dissociation and plan to look more into structural dissociation, because it connects to a lot of my experience. I also volunteer as a trauma educator at a local grassroots organization, and I can’t wait to share the ideas you are mentioning here. Thank you for bringing these healing concepts to light.
As a yoga instructor I have become aware of how my typical cues for moving the body are not always good for everyone. They can cause trigger events in people who have some trauma experience. I am always seeking ways to learn more about working with people in a way that is accessible and safe for them. Especially with people who seek alternative methods such as yoga and meditation to work through their trauma. Thank you for opening this program to lay people, the information provided here is so relevant to the the work I do as a yoga teacher. I’m often surprised by how little people know about their bodies and how to sense what they are feeling physically. I am honored to be able to share my knowledge and yoga practice to help others find peace.
Hi Valerie, I was really impressed by your response; it is fantastic that you are working to attune yourself to the diverse responses of your students, which reflect their diverse neurobiological states, and life experiences!
Valerie — there is a field of “trauma-informed yoga” or “trauma-sensitive yoga” — where the instructor’s language and movement are different from a “regular” yoga class to be sure not to trigger yoga students with trauma. Maybe something to look into?
One major focus is giving the student control and choice — every instruction is a suggestion they can choose to go with or not, or adapt to their needs. The affirmation is that the student knows their body best, and the yoga instructor is just there to facilitate.
So helpful in understanding what creates falling from, “most helpful” to “rigid discounting” of time together!
superb session on disassociation, most powerful learning was on dissociated parts and identifying that the state has been triggered. thank you so very much for extroadinary teachings
Thankyou so much. I am a fairly inexperienced trauma therapist. So what was most valuable to me, was allowing the language and the presentations of these experienced practitioners ‘wash over me’.
Thankyou again!
Mary LCSW in NJ
Very clear presentation. Really enjoyed the parts of actual words used in situations such as ” Oh the spacey part is here” and avoiding telling clients what to do and then they know they are being watched.
Useful summaries from Ruth at ether end of each section
Thank you for making this information available and accessible to lay people.
Thank you so much.
The strategies were very helpful.
Thank you for this webinar. I plan to use this information in my hypnotherapy practice to help my clients who have experienced trauma.
Excellent! Quick screening for DID with the 4 key questions really helpful. Margaret in Dublin, Ireland.
using body posture to help integrate parts.
Such valuable, impactful, timely information and strategies! As a 50 year old woman with training in occupational therapy, I am now on sabbatical due to compassion fatigue after 20+ years working mostly in pediatrics in various settings while holding my own traumas for too long. Grateful to have found a therapist who uses strategies you have shared. PLEASE find a way to share this with people in the first lines of contact for individuals – primary care physicians and school systems, preschool through college. I often wonder how my life, 30+ years later, may have been different if my physical symptoms were accurately diagnosed and treated?
Hi Susie,
I can really identify with you, I am a 50+ year old woman with Occupational Therapy training & past experience of MDT working in the Acute Mental Health Services in the UK (25 – 30 years ago +). I loved my work, but took a big career gap (while I reared my family). In this time, I have lost my self confidence after a longstanding abusive relationship and realisation of past trauma / abuse in my childhood – which I had ‘buried’ until I gave birth to my 4th child.
Like you Susie, I have held onto my traumas for too long, although I have been having Deep Release Therapy since, including PICT Inner Child Therapy, which I found useful to empower me to stop the abusive relationship I have been in for the last 30+ years.
I am also on sabbatical after handing in my notice from charity work (due to relationship difficulties with my boss) & near divorce from my husband, & am now trying to make sense of everything which I have been trying to deal with in my life.
I have been enlightened by today’s training, and although I would love to be helping others, I realise that I need to seek further help for myself first, as I exhibit some of the dissociated symptoms which have been described in the training.
I would love to find out more, and will look online for a local therapist to me.
Ultimately, I would like to use my own experiences to help others, in the field of abuse & trauma.
Thank you for the informative, clear teaching, I am on a journey to healing and recovery – & I hope that I can use my experiences to help others, in the fullness of time.
Thank you for this webinar. So much great info. As a certified Sexual Assault Crisis counselor/advocate, we deal with trauma victims on a daily basis. We help stabilize out clients using grounding techniques and helping them to develop coping skills that best work for them. I especially liked the assessment info so that we might refer our clients more quickly to in-depth therapeutic interventions that will address their needs.
As clinicians we must be aware of our role in serving our clients.
As we maintain awareness of our own empathic desires – and drives for resolution, we must be vigilant in avoiding setting pace but rather keeping pace with our clients, at their pace.
May it be said that going slower is always the safer path to a positive outcome for the client?
This was a great overview. Take homes for me are:
The gentle, inclusive interventions Janina Fisher shared, e.g: “the spacey part is here” and modelling the sigh.
Also, whilst I am aware of the fragmentation of clients who present as PD, the explicit framing especially of the narcissistic split (shameful core self state/grandiose defence) as structurally dissociated parts is helpful and reflects my own clinical experience. I’ll look more into the subject of misdiagnosis in this regard. If you would like to suggest a paper that’d be great.
And finally the comments around devaluation of the therapist as a defence against attachment fears were useful to be reminded of.
Many thanks, I look forward to next week’s session with interest.
Excellent presentation thank you.
Recognizing the importance of working at the pace of the client.Time is so important as is the calming,grounding of the client so the client is safe. Interested in the polyvagal approaches .
I was particularly struck by learning that a trauma-based dissociative disorder could easily be mis-diagnosed as a personality disorder, creating a subset of untreated clients who are also being unintentionally misunderstood and mistreated (in every sense of the word). Control-Mastery Theory has a lot to offer in this regard about how clients “test” their therapists (and everyone else) in the service of their “unconscious plan for health,” and how the therapist can (and must) align with that plan for successful therapeutic outcomes.
I’m not a practitioner, but a friend and relative of traumatized persons (On the freebie deal–thanks for making this available!) I want to educate myself as much as I can about how to support them without being pulled into unhealthy relational dynamics. It’s really helping for me to understand some of the goals of treatment and the approaches used. I related deeply to the comment about ill-timed empathy–I did this for years with my traumatized husband, and over time he developed a weighty emotional dependence upon me, which probably hasn’t helped him to grow in his ability to manage his own emotions. You try to help with ignorance and compassionate impulse and that’s where it gets you.
Thank you for very much for these insights in your groundbreaking work and latest developments! As a nutrition counselor I find a lot of trauma at the root of typical fight or freeze reactions: Irritable bowel syndrome, GERD, auto-immune and eating disorders. My Highlights of this session were the conflict of the attachment seeking and the fighting part, the doing the physical movements with the clients, the increase of self-destructive behaviour or physical symptoms as a result of some dissociated part becoming stressed. NICABM should definitely include dietitians, nutritionists and gastroenterologists as target groups of the webinars because clients see us because of common trauma-related physical symptoms. Since I know about the red flags I identify trauma with a lot of clients and often am the first who made that link between their symptoms and the root cause. AND give them orientation where to get relief beyond symptom-oriented medication, shame and a feeling of helplessness.
I am not a therapist but work as a Mental Health Consultant using reflective practice with teachers, families, and young children who may have experienced complex trauma. Thank you for this incredibly rich information providing me with tools I can apply in my work when considering possible associative identity disorder or disassociation.