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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Excellent program. I was thinking of specific clients and missed opportunities for keeping the session within tolerance levels.
Naomi M
Great information. I wish you presented the information more slowly. If you really want people to learn and mature with this information, present it so that the information can be grasped/. Information is useless unless it can be understood. I wish I could afford the Gold package, but I am on disability and have a fixed income. I really wish the information was presented thoughtfully and slower, please. Thank you so much,
Ray Pilkington
Hi Ray, This is really important information so write to them (nicabm.com) and ask if they would send you the Gold package for free or a nominal fee. I would like to think that they would work to accommodate you. All of my best, Michael
Thank You,so much.I am just a ”Lay Person”.However I find it all so helpful in my everyday life of being in relationships with myself and other peope.
Thank you so much for offering this for free… due to Covid I can’t afford to pay for the course right now… I am hoping that perhaps before the end of the sessions that I might have saved enough to be able to afford the course at the special price, but I’m not sure how long you will have the discount on for. Please keep doing this important work. Suzanne
I learned so much today – thank you! My understanding of dissociation, parts, fragmentation is more rounded now and that understanding gives meaning to why the strategies offered by these wise practitioners can be effective. Thank you!
I used the audio only for this session because despite all of the instructions you gave, there was no audio with the video. I know this problem was not at my end. The audio track on the video kicked in when the audio feed ended. But at the beginning of the session there was at least three minutes of no audio before I went to audio only feed.
Lisa Poultney, RP
Dear Ruth:
First of all, thanks for this knowledge you are giving to us free. I am really appreciative…I have learned to identify dissociation, in my practice I have founded, in general it relates to any kind of abuse: physical, emotional and sexual abuse. You are giving us a plethora of information and the names of expert on Dissociative Identity Disorders….I am doing research about trauma in general. I have followed Dr. Bessel Van der Kohl since 2004 when I went to a Conference in NYC, my practice on trauma has changed…I am interested on the innovations of treatment suggested by Dr. Bessel Van der Kohl, Dr. Levine, Dr. Lieneus, and other approach stemmedfrom her work. I am finding Dr Janina Fisher fascinating by her work on sensory motor I wish I could afford the Gold Packet, I can’t on this time of COVID19. Most of my practice is for low income level population where there is low paying job and have not worked since February. I have hope eventually would have more discount….You know I have bought several of your work.
Aida L Redondo MA; MS; MFT; Lic. MFT in Rhode Island and Florida, the CEUS would be very convenient to get.
great info! I’m thinking my sons ASD behaviours are more so Trauma Disassociation? The fight flight, the unfocused, hyper ungrounded starring into space zoned out stuff?? i’ll need to explore this more as other typical strategies are not working and behaviours in teen years are intensifying??
Love the practical tips shared by so many experts in the field. Ruth, you summarised and brought it all together very well too. I am beginning to understand what I have been hearing from some hotline callers. Thank you for making this freely available.
I appreciated Dr. Lanius’ 4 questions to help identify if a client struggles with dissociation and that the presence of child voices/parts are not typical of schizophrenia. A growing edge for me is to increase my “in the moment” observations and to incorporate them into growing the client’s self awareness as Dr. Fisher mentioned re. “the spacey part”. Also good to remember that clients will be more likely to join a grounding activity than to follow directions.
There was so much meat in this session which was just touched on. Also would have liked to hear how trauma treatment of dissociated parts could employ Internal Family Systems approaches. It seemed that some of the interventions (growing awareness and acceptance of parts, harmonizing and building connection between the parts) fit with IFS.
What a shame that there was no mention of OSDD-1 (DID but noite quite). It’s more common than DID and the treatment is the same. Lack of amnesia between parts (or alters) makes it more difficult to recognise.
Tina, VERY significant point you make. So many therapists use the diagnosis “Dysthymic Disorder.” No wonder why so many people I know including myself have gone to so many therapists without much relief for their emotional pain nor able to cope better in life.I sense that a heck of a lot more people are walking around with far deeper weoundedness and pain than most therapists realize. Thank you for your comment and I’ll lok up OSDD. Michael
Parent of a highly-medicalized child (not a practicing psychotherapist), and I have observed certain signs and behaviours in my daughter that I would like to learn more about. I am very appreciative that I saw the info for these sessions on instagram. Many take-aways from this session, in particular about medical exams/treatments and looking for signs of dissociation such as spacing out, fight/flight/freeze, and strategies. Moving forward I will better advocate for my daughter, looking for these signs and suggesting that medical practitioners back off and pause their assessment so that we can show our daughter that she has control, that she is safe. Thank you for offering these sessions to lay people like myself.
After 25 years as a mental health therapist, I now work as hospice chaplain with people experiencing life limiting illnesses. This material helps seeing and sorting end of life trauma and earlier life trauma. Thank you! Rev. Ken Weaver, LCSW, LCAC
I found it difficult to differentiate dissociation from traumatic event from bipolar disorder dissociation. Client had traumatic childhood, psychiatrist diagnosed client with both, PTSD and Bipolar disorder. Client was hospitalized and given same diagnosis. I have been working on her trauma and dissociation, and she is taking meds prescribed for personality disorder.
I’ve known a few people who were in the same situation you are describing – at the end (after decades later, faithfully taking prescribed meds to no help), they were finally correctly dxed with DID, stopped all meds and got better by good DID therapy. Their younger years are gone with damaged livers to live with.
The Multidimensional Inventory of Dissociation by Paul F. Dell, Ph.D. is a useful tool. There are times there is true co-morbidity, though.
I found the most important take away from today’s lecture to be Identifying Thoughts. Both for my own healing path, as well as those of my clients, the cyclical thought patterns can become overwhelming. The simple phrases of “What happens when you have that thought,” “Let’s find out about the part of you that holds that thought,” as well as “Let’s go where you feel that thought;” these are all crucial in the demystification of getting wrapped up in why or when the thoughts occur. Posing these questions when the person feels safe in their surroundings and grounded within themselves allows for a compassionate viewpoint that may not otherwise be achievable.
This has been really helpful for my clinical work. I especially around some of the ways to avoid shaming the client when I see them dissociate in session and how to avoid some of common clinical errors. Thank you.
Great overview! I think the most helpful reminder to me was when the client starts to be aggressive or hostile NOT to take it personally and NOT to avoid it! Recognize that any time we work with child parts, the protectors will show up. Get to know the protector, help the client see the function of the protector and how it has helped them all these years. Build a relationship with the protector and help the client build a relationship with it. I recall in my own journey, befriending my protectors is what eventually allowed for me to reach the child parts. That is where we begin to build trust. It’s like creating trust with a parent before they allow us to spend time alone with their child – any parent in their right mind would insist on it!
Such an interesting session. Loved the details about how to dissociation can manifest itself in the way the patient presents, making it easier to spot.
Very insightful sharing! Learned so much from the various speakers… didn’t know too much empathy can actually backfired our treatment. Thank you so much!!!
Yes! This was something I hadn’t considered, but it makes sense! Intimacy and empathy could definitely be triggers for people with relational trauma.
Thank you. Very useful. You presented many new ways for me to deal with dissociation.
To start with I will look much closer to grounding and safety.
Two things I took away was the importance of participating in assigned activities with the client, i.e breathing.
Slowing down speed if self harm begins. I work with young clients and find that valuable.
Really appreciate the Red Flags piece and the power struggle between attachment physiology and defense physiology. This series is bringing together a lot of training pieces I’ve had over the last 20+ years. Thank you for making this available.
I learned to be more sensitive to dissociative clients by tuning into the different parts.
I missed Brand’s 5 types of dissociation needed to arrive at a diagnosis. Can anyone respond with these answers?
Depersonalization
Derealization
Identity alteration
Identity confusion
Dissociative amnesia
The differences between DIssociation and DID. About half way through I couldn’t access the speakers only their voices????
Useful concept was, red flags for presence of dissociation that come from ourselves as therapists. That is, feelings of being unsafe, of confusion, and disjointedness. Thanks!
I liked the question “are you with me” “what %” “what can we do to help you feel more here”
To Walk could be that unfinished Action, that Undischarged survival energy in the nervous system
They can even just imagine walking or running, getting away
Very informative
Thanks
I share many of the feedback of others. Great to see Janina Fisher imparting her wisdom on the forum and promoting a sense of radical curiosity in the face of dissociation. Very grounding for clients and therapists.
I found it so useful although I missed the first minutes due to tech issues. I usually /intuitively also do the breathing/sighing with the client but I had never thought about how important it is for the trauma survivor not to feel watched.
And I loved the idea of saying with curiosity ” now the spacy part is with us”. So unthreatening and curiosity always opens up so many possibilities.
My experience from common life: The matter-of-factly approach is also recommended when dealing with a “toxic person” who cannot be avoided. In my experience this approach works very well in combination with setting clear boundaries – and when done in a profoundly interested way, it seems to get the best out of people “drifting off” in any direction.
… to bring the best out in people …
Really like the new additions to the forum. Learn so much from all of them, especially Dr. Brandt earlier in the broadcast and Janina. Her book has been a regular go-to for me. Now she is on your forum. Wish I had had Brandt in my history of working with DID clients. She is a breath of fresh air as are all the newly added speakers. Thanks for the webinars and NICABM staying up to date on this much needed information for trauma. It makes our jobs so much more in keeping with our recent societal issues as they compound.
This was excellent. A really useful idea is the rethinking of “spacing out” (getting lost), especially with very skilled and very prepared performers/athletes/speakers, etc. Thank you.
Reflecting on some of my past clients, I do think there were some precious beings experiencing disassociation.It is not too late to imagine how I could better have served them. I especially liked the suggestion to address a part (who is scared, terrified, etc) in a kind and non judgmental way, with curiosity. Oh lets find out about that part. Also pause and sigh – together- very powerful technique. Very interesting that physical ailments MAY be part of disassociation. Good material to work with, thank you all so much.
Thanks for this, Michael!
I really enjoyed the session. I enjoyed the practical application in sessions. It was very informative in understanding the difference between dissociation and DID.
Aloha, the session tonight was very informative in giving direction to distinguish between disassociation and DID. The skills to know when someone is disassociation was very enlightening in addition to knowing how to screen for DID. I will be purchasing gold membership. Wonderful.
I liked it very much. It helped me to clarify Ways to treat persons (clientes) better
It would have been more beneficial if you could highlight the main points of the speakers simultaneously as many a times I found it difficult to catch up with accent and speed. However, sincere thanks for the informations and efforts.
Thank you so much for the great session. I really like the term Structural Dissociation. To me this is a more validating and hopeful way to understand symptoms/presentation than some of the terms used elsewhere (such as personality disorders).
I have a question about hearing voices with dissociation/trauma. I have always made the distinction between voices that seem like they are coming from inside the patient’s head and those that feel like they are coming from outside. I have generally considered the ones that patient’s say seem like they are coming from inside their own heads to be trauma symptoms. What do others think of this? Thanks for any feedback!
I have also experienced witnessing patients with dissociative disorders stating that they heard voices outside of themselves, as if a conversation was happening behind them, as well as seeing shadows, reporting seeing figures on the side of the road while driving, or even seeing people in the room with us, having full-blown visual hallucinations, which may very well have been flashbacks. I also used to work with people with schizophrenia, and they most often reported that when they were hearing voices, they were internal, though less often external. It’s very difficult to tell the difference at times, and of course there’s always the possibility that someone could be suffering concurrent disorders. I have read some research that stated that those with DID can share all of the first-rank Schneiderian symptoms of schizophrenia.
I liked that they mentioned that those with schizophrenia usually don’t have child voices, and that with DID there are 3 or more. I’ve noticed a typical “trifecta” of voices that makes me pretty suspicious that it’s DID–a child, a harsh/critical voice that’s more extreme than all of our “”inner critics” perhaps advising the patient not to talk or threatening the client or me, and a more nurturing/going on with normal life voice.
I don’t know if that’s helpful, but hopefully I can at least validate how difficult it can be to make this distinction!
Will someone please list the 5 types of dissociation listed by Brand to identify DID. I am missing 2 of them. It went fast and was never repeated. Help!
-Identity alteration
-Depersonalization
-Derealization
-Amnesia
-Hearing voices
1. Depersonalisation
2. Derealisation
3. Identity alteration
4. Identity confusion
5. Dissociative amnesia
Depersonalization
Derealization
Identity alteration
Identity confusion
Dissociative amnesia
I appreciated the discussion on DID and would love to further discussions to deconstruct that more in relation to dissociative features of PTSD.
I also appreciated the distinction made about the use or overuse of empathy and leading the therapeutic process down a rabbit hole. To remember, as the therapist, that we are not developing a relationship with the Child part seeking attachment but to guide the adult patient to awareness and understanding of this part. In my work, I see those moments as opportunities for attachment repair and reparenting where the patient can build trust through acting from any of the 8 Cs (curiosity, calm, compassion, etc) with that young part. Thanks for the video clip, Bethany Brand is fabulous!
Great information throughout. I remain more hopeful that those in the medical and dental professions become better informed about the effects of trauma on their patients. Another common issue that is triggering is the practice of leaving a patient waiting for a prolonged period of time in a small, confined exam room. The feeling of being trapped with no control just builds the longer the person waits. Some doctors/dentists fear those who tell them they have PTSD, assuming this patient is a lawsuit waiting to happen. This only compounds their patient’s anxiety and shame.
Thank you, deeply and truly, for allowing access to laypeople. I was a teenager in the 80s when my mother was hospitalized with DID (then MPD) and she spent the next several years more or less hospitalized. I was gone to college before she was back at home, a development that was facilitated mostly by necessity when my bipolar alcoholic father finally abandoned her and my younger siblings. There was no treatment or education for the family beyond how to wrestle my mother to the ground should she harm herself in our presence. I have spent the past 35 years piecing together some understanding of what was going on back then as a way of dealing with my own mental health issues. I am enormously pleased to see the compassion that is now brought to this diagnosis. With some new understanding, I may now be in a better position to visit her and possibly even enjoy that time together. Again, my deepest thanks.
Thank you for giving me the opportunity to hear this module today. It was very insightful, down to earth, and helpful. Describing the whole process of dissociation was also beneficial. You are helping so many others grasp concepts that are often quite difficult to communicate. Learning to regulate emotions, thoughts, and behaviors is harder than it looks.
Pat E.
I was very impressed with today’s lecture.
I have worked in the field of sexual assault and family violence for 10 years and have found the training in my country of Australia to be bitsy and unthorough. Thank you for at last providing an integrated and comprehensive approach based on latest developments in a rapidly changing field.
Thank you sincerely for making it free as I have rather limited funds for training.
Also thank you for repeating the lecture at varying times so people, like me, in far away places can watch at a reasonable hour.
For instance I tune in on Thursday mornings at 8 am to listen to your 5pm Wed broadcast.
I will listen again at 11 a.m. if able and I find i always benefit from the second listening.
sincerely
Jenny Jacobs
I think that this session is excellent, and I appreciated many things that were said. I liked Janina Fisher’s suggestion to use a sigh to help people ground and to do it with them. Recently, I was doing some having on line, and the client responded with the comment that she felt calmer watching me and could almost feel the texture of my sweater. I have been thinking about mirror neutrons over the past week and Janina’s comment resonated. I liked the specific information about voice hearing, that dissociative people can hear multiple voices and that schizophrenics don’t hear child voices. I loved how precise that is.
Please keep educating people to look for dissociation. Recently, I saw someone who got dismissed as a personality disorder whose childhood trauma was not seriously looked at. Some practitioners in the public system still dismiss people once they have a Personality Disorder diagnosis. Some clinics are worse than others. Finally, thank you for the reminder to go slowly when sorting out the diagnosis.
All of the presenters were remarkably “clear” and this is so needed. Deep thanks!
Thanks so much Michael for such a great recommendation! It’s the base of everything. Agustina
Dave…try again at 11 eastern time tonight/ It is worth staying up for!
Thank you for these broadcasts. They are very beneficial. I appreciated learning to differentiate between voice-hearing related to schizophrenia vs voice-hearing related to dissociation. Another point I’ll remember to apply, is to not over focus on working with the child-part.
Thank you again. I look forward to the next broadcast.
My most challenging trauma-experienced clients are hostile with themselves, and also push back and passive-aggressively resist working with me (while usually being overtly more positive). My better approach has been to engage the client in working together on the strength of their anger – and perhaps the fear or shame that was once underneath it. “That was then, and this is now” helps, and adding: “let’s play together with what can be?” Hearing from the expert presenters helps me organize my thoughts and add approaches to my work with trauma.
Thank you for the condensed, swift pace. I expect that everyone is paying careful attention as a result.
I am a Specialist Trauma Counsellor working on a phone line in Australia called 1800RESPECT. I speak with callers who are living with the effects of Domestic/Family Violence and Sexual Assault.
What resonated most with me today is the ‘danger’ of being too compassionate and how this can cause further dissociation as it taps into unfulfilled attachment in the client. I have become aware that a recent session with a suicidal caller probably required me to step back a little and ease off on the compassion for a bit and talk about the caller’s cognition related to suicidal ideation, in an effort to help them separate the thought from their sense of self.