One challenge of working with trauma is when a patient’s dissociated “parts” are operating independently . . .
. . . or worse, they’re at odds with each other.
This can be very distressing for the patient (and lead to a dysregulated nervous system).
But the Structural Dissociation Model developed by Kathy Steele, MN, CS, Onno van der Hart, PhD, and Ellert Nijenhuis, PhD can help us work more effectively with patients who are experiencing this.
We’ve created an infographic to lay it out for you below.
Click the image to enlarge
Defense System
When a child is abused, their defense system will naturally work to shield them from harm, BUT . . .
Attachment System
. . . their attachment system will still want to be loved and cared for by the parent
This creates an internal tug-of-war where different motivational systems are working against each other simultaneously.
This can cause a patient’s conflicting parts to separate. That can lead to a split in their sense of self and a dysregulated nervous system.
Click the image to enlarge
Left Brain
The “Going on with Normal Life” Part of the Self
This is the rational, present-oriented, and grounded self.
This self handles daily life – social interaction, attachment, work, play, exploration, learning, and taking care of physical needs.
Right Brain
The “Traumatized Child” Part of the Self
This part contains the trauma.
This part is often drawn out by the reminders of the trauma, and it may not experience much of everyday life.
The survival responses of this self may include Attach/Cry for Help, Collapse/Submit, Please/Appease, Freeze. Along with Fight and Flight.
The key to recovery is helping a patient have full awareness of all their parts without feeling overwhelmed.
If you’d like to print a copy to share, please click here: Color or Print-friendly
(If you’re sharing this infographic, please attribute it to NICABM. We put a lot of work into creating these resources for you. And if you’re sharing this digitally, please link back to this page in your attribution. Thanks!)
In the Advanced Master Program on the Treatment of Trauma, we share 3 distinct ways to work with structural dissociation. To find out what those are and more, sign up here.
What strategies have you found most helpful for working with structural dissociation? Please let us know by leaving a comment below.
If you found this helpful, here are a few more resources you might be interested in:
A Three-Step Approach to Treating Trauma-Related Dissociation, with Thema Bryant-Davis, PhD
How to Integrate the Brain and Prevent Dissociation After Trauma, with Pat Ogden, PhD
This is one of the clearest trainings I have tried thus far!
Trauma can unnerve me for fear of getting things wrong. This has been very worthwhile and I plan to watch each presentation and then start again using all the extra information, infographics and guides included in the gold package. Thank you for the clarity and putting this excellent piece of work together. Hugely appreciated.
Agree
Hello Elizabeth,
Reading your stories touched me. I can relate well to your story. I however do not have children. I’ve come to realize that my choice of not having children is due to early childhood adverse experiences.
I continue to do a lot of work to become aware of C-PTSD and experience safety and love. Feeling safe is paramount for me and at times is paralyzing not to feel so.
I engage in somatic practices which have been important as I ‘thaw’. I work with a psychologist and do work with Compassionate Inquiry and Dr.Gabor Mate’ work. I encourage you to check Science and Nonduality website too, SAND, they gave great resources and exposure to trauma informed care.
Be well,
F
Thank you for these infographics. A lot of gratitude. They help a lot in understanding the structural dissociation model.
I feel it would be a great boon to show a third frame with visualization of a healthy integrated self. Maybe there are a few ways this can occur naturally and be shown.
Yes!!
Helping people to become an observer of how the react… accept acknowledge and listen with love to each part of themselves… then after expressing all feelings and beliefs… listening with love….No judgements! Then respond. We invite Spirit if Love to guide all… silently or out aloud. Profound. For 20 years breakthrus have been profound.
Thank-you great for understanding push pull from pictures
Thank you for these images. I will share in session.
Hi Joan,
I also ground teeth and still do in my sleep, but not as much as before. I am 60. I now have caps and my dentist wanted me to wear a night guard, but it blocks my breathing too much as I need to breathe through my mouth because of a deviated septum. I also hid under the bed, but it didn’t help. At times the grinding has manifested as a (fake) double ear infection, but it turned out that the muscles were sore. Please know that there are many of us out here! I pray that you will find the love that will melt all of your wounds away. That’s what we need more than any medicine, that’s for sure (though my anti-depressants do help an awful lot!)
Hi Elizabeth,
I have come across some of the approaches the other commenters mentioned as successful (IFS and EFT in their own ways). EFT because of the mind body process (can find processes online at least maybe providers, can also find havening technique online- similar but different). And IFS for internal work dealing with the Self, especially the wounded child. There’s such much more to us than in the thinking brain, like an iceberg. The other approaches can be helpful also. EMDR is something Bessel Van deer Kolk talks about and uses.
I recommend getting on Psychology Today and searching for types of treatment and insurance. The benefit of pandemic is that more providers are online and as long as they are licensed for the state they can provide service online statewide. Many have adapted EMDR to online!
I’m sorry to hear how much you and your family have gone through. It’s invaluable that you have been able to recognize and get out of the situation to begin to break the cycle. When you can stand up for yourself you’re better able to stand up for others and, as long as continue to become equipped (especially developing boundaries, loving self, whatever is needed), then you’re less likely to keep getting in those circumstances. It’s a major turning point with a lot of opportunity in internal development and your environment. It’s not easy but sounds like you’re on the right track! Hoping the best for you and yours.
You asked us to include the copyright information but there’s no copyright information on either of these images.
Hi Michelle, our copyright information can be located at the very bottom of the infographic. Hope this helps!
Great work! This has many applications which I can use nn my practice and research. Love the images, will be clear for anyone as a “mental take-home” clarification of what they are going through. Will spread the word.
Thanks much, Hans Miller, PhD
Seeking love may not be the conflict in this case as children repress and self blame. Our ( right -left)brain cells are all connected .The trauma itself from a loved one( parent) causes disassociation in that it creates a new personality/ego ( I am to blame,I am bad ,I am unworthy ).
And as we know this is not true (and on one level kids know this) so there is confusion at the new identity( ego) and (repressed as it is too painful) emotional possession as the kid is overcome by the emotion and cant deal with it. Anyhow thats my take on it. Its protective response but in our relatively unconscious world that child sometimes never deals fully with the trauma or the new personality created by it (ego) or never knows themselves. So they may always recreate the abuse in relationships that support the neg beliefs they hold.
In this world that is energy all connected I do not believe in the “structural disassociation” theory.
I believe in “Not being present in daily life brought about by emotional repression of past trauma”.
I agree with your take, as well. That is a very real possibility. Maybe this is where you move forward in love and positivity, surrounding patient in (again) love and safety. Perhaps not always necessary to review/ relive trauma details to move forward. Address the issue. Do not ignore it. Moving forward is possible. Patients must know they are more than survivors they are successful and they have purpose.
I aggree 100%
This describes me! I am sitting here in tears… this will help me profoundly, as all of your info does, as I finally seek counseling in late middle age to pull my pieces back together… and maybe even gain enough wholeness to get education and certification to counsel or in some way be of help to others. But firstly and mostly, to heal myself inside. Thank you and bless you all.
You don’t need to do this alone. Healing trauma is often intergenerational and best done with other humans who potential share similar ‘roots’. Reach out and find your tribe.
Not necessarily In my experience do we find our tribe or not easily or without harm . Perhaps I was”nt receptive enough, or was guarded but I found some folks quite cold, or quirky in a 12 step group I joined and felt uncomfortable sharing.Ditto in some other situations where I thought.warmth. understanding might be coming.
So helpful. Thank you so much for sharing this resource. Images speak to me in profound ways.
After a long, sometimes re-traumatizing (the worst being impatient), search for help… I can truly say IFS (Internal Family Systems) therapy is what I needed all along. The other therapies (ACT, DBT, CBT, PET, etc.) have their place/usefulness… but for dissociative parts and resolving trauma… IFS is a game changer! Be prepared, it’s no quick fix… but I have finally found true sustainable progress in healing… at 52. Wish I had found it when I started searching at 16.
Hi Elizabeth
I am writing in response to your post to share my own experience.
I am 59 years old and the last 5 years have been hugely healing for my CPTSD. I had tried all kinds of therapy: CBT, psychodynamic, interpersonal which helped me feel somewhat more able to cope. Like treading water without swallowing and bobbing.
I started training as an EFT (Emotional Freedom Technique, Tapping) practitioner and ended up healing myself through work with others in my class. EFT helps reduce distress by tapping on acupressure points while talking about what is stressing you. I started to release trauma stored in the body while confronting memories too overwhelming to talk about before.
I am now, 5 years later, feeling like I have successfully swam to land and am standing firm. Grounded and calm.
I can share two resources:
CPTSD Foundation which provides all sorts of resources and support just google them
EFT resources to find a practitioner for you and your children….EFT helps break the cycle of intergenerational trauma safely and effectively. Children love to tap and 4 year olds can easily learn.
If you want to contact me feel free and can help you connect to someone.
marinajohnston.ca
All the best
These are a great way to help both families and therapists increase their mental health literacy about childhood trauma !
Excellent information
Hi
This infographic is very good, can you also do one on how to overcome structural dissociation please*
As a schoolteacher recently diagnosed with c-PTSD i asked my psychiatrist what happened when an incident made all the buildings move back and a sensation in part of my brain. She explained it was dissociation and spoke briefly about it. This visual gives me a deeper understanding with what really happened. Thank you.
My God I love this. This really nails some home truths for adoptees. Appreciate you sharing this info graphic.
Yes, as an adoptee I very much relate to this split sense of self.
After reading the comments, I am thinking about the question of left and right hemispheres of the brain. I am thinking of the hemispheres as 2 differentiated parts of the brain . As I learned from Dr. Dan Siegel, “Integration” is the foundation of health. My question to the brilliant creators of this infographic: Are we looking at the 2 Hemispheres as differentiated parts of the structure of the brain and to repair the trauma , one needs to “integrate” these parts? Thank you.
If you are interested in the two hemispheres of the brain I recommend Dr Iain McGilchrist’s work (The Master and His Emissary).
Dr. Dan Siegel’s paradigm on attachment: The 4 S’s of Attachment: Seen, Safe, Soothed , Secure and Tara Brach’s R.A.I.N. meditation: Recognize, Allow, Investigate, Nurture have been comprehensive resources for me as a woman who has suffered the trauma of insecure attachment, and as a Well-Being Coach for my clients and for myself.
Wonderful resources to share. Thank you. Love your work and dedication! Kaz
I’m wondering about this too. I’m thinking not, but why present it this way?
I agree. Hope we get an answer!
Brilliant . Love your work !
Love the works you guys are doing.
Wow, this is brilliant: completely hitting the nail of how navigating life by a mind weighed down by c-PTSD feels like … i must say that i attributed the conflict to “false self” and the ensuing “hunger for authenticity” but your exposition makes just so much more sense and so vividly delineates the constant dichotomy a traumatised mind is in – and i say this by experience, not practice!
Thank you for your mind-blowing and incredibly hepful work
Thank you for this infographic! I surely will use it with clients! When I work with clients with structural dissociation I’m totally accepting of all their parts or alters. Most of my clients can accept their more positive parts or alters, but struggle so much to accept their protective parts or alters, especially those that hold the anger and rage. They’re often ashamed of their behavior when those parts are triggered, so I have to very patiently assist them in understanding how important those parts were for their survival and assist them in forming a relationship with those protective parts of themselves. Sometimes it takes a few sessions.
I have parts that are the protective parts and while I am becoming used to them and can see their value, the family around me can’t. They don’t want to deal with these parts at all and I am very filled with shame and guilt when they ‘front’ and I can’t control my reactions. Any tips would be gratefully accepted. I think your comments are great and I’m quite astounded that you say it’s just a couple of sessions.. I’ve been trying to work on this for years on a weekly basis
Inner Relationship Focusing and its Untangling approach has helped me the most with integration of parts and lasting transformation.
I’m very glad you responded about focusing. Along with Internal Family Systems, focusing has been very helpful to me in my healing journey.
I’m a recovering survivor of severe trauma and I have struggled with shame re my parts’ behaviors. Doing Internal Family Systems work along with self-compassion (see Kristen Neff’s work) has helped me develop compassion for my protector parts and the traumatized/exiled parts of me they work(ed) so hard to protect. When protectors feel valued for their life- and sanity-saving efforts they reveal more information about how they had to do what they did for my survival. My compassion for them helps them move closer to me (my Self) and they let me have more contact with the exiled, traumatized parts of me so I can hear their stories and comfort them and bring them into the present. The safer and more comforted and accepted the protectors and the exiled feel the more the protectors can let down their guard and soften and view themselves with more compassion so that if they do get triggered and “act out” my fear or my sadness-covered-in-rage/pain I have a choice to not shame them for it. Baby steps, a work in progress.
Very helpful infographic, thanks.
I work with it with PRI, Past Reality Integration. It sees the dissociated parts as one of five different defense mechanisms the child needed to develop when it was faced with stressful situations that were too overwhelming to cope with, usually when the child had not reached the age of three.
PRI is a method to help the patient first to recognize when they are in a defense mechanism, what triggered it and what meaning that trigger unconsciously has been given. Then to change the defensive behavior and feel what pain is released when focusing on the mental image of the trigger and its meaning, knowing that this is a symbolic situation of something from the past. This takes a little exercise but after a while the patient or client can use this technique to integrate both parts of the self and experience the present unburdened.
Yes, you reach me with this nice image of how when I go out walking in the bush here in OZ, I can get triggered so quickly by the Q – where am I exactly? The GPS signal on my phone helps me settle down, register where I am, guage whether I have allowed enough time to achieve the objective OR back out and retrace my steps! Knowing where I am has become crucial in helping me judge my capacity to achieve what I set out to do. R brain given a leg-up by GPS?!
This is an amazing conceptual image, Ruth. It provides insight in such a succinct and sensitive way.
I love all your snippets, Ruth, but that is just brilliant! Thank-you!
This diagram is excellent! Thank you for the great series!
I find poetry and writing back and forth between parts very helpful for finding out the experiences and emotions of parts. A person can find out things very quickly this way that parts may not divulge with another person in therapy.
Also, the music I write and sing has helped both children and adults to put words to the experiences and emotions.
Three key protocols:
Understand the split created by trauma
Exploring parts created and naming them, understand their current behaviour and role in the psyche
Left brain versus right brain responses and how to mobilise these concepts to their advantage in daily living
Amazing work this! thank you.
The diagrams are very clear and well thought out.
The 0-3 pre-verbal trauma, does not take into account the trauma to the nervous system during development in the womb (pre-birth trauma).
Upon which the 0-3 pre-verbal trauma then becomes structured, as well as all of the later developing self concepts (the many selves), which develop at the necessary different develplmental stages.
Erickson’s 8 stages, did not go far enough back for some, though may well be accurate for most.
So true. As I participate in various webinars to observe/learn from therapist talk and their struggle to comprehend the world of trauma, very absent is any understanding of traumatic womb experience.
Especially the impacts of being a ‘womb twin survivor’ with awareness of wombmates and their ultimate demise pre-birth. All left as imprints to surface in born life in different ways. Exacerbating this could be traumatic loss through an abortion attempt.
An understanding of trauma must expand into this pre-cognitive area to truly get to the roots of client discontent, and manifestation of c-PTSD.
Hi
The body is self organizing. It has an innate intelligence to move toward the health. The foundation of this function is determine in the first year of life. This is where the base line is determine of what will be overwhelming of the individual as well as the integration of the left and right brain . This foundation of function is formed based on nutrition , environment and MOVEMENT.
To unite the parts Begin Moves (ADULTS) and Purposeful PLay (0-3 yrs) is a treatment approach based on developmental movements that integrated and co ordinated the parts of the body , mind and emotion to the whole. Cathy B Burlington Ontario Canada
I use griefcounselling approach to help clients mourn the parts of their childhood experiences that they have lost as a result of the trauma experience
Using or creating a “neutral” center or part that acts as an ombudsman, or negotiator can be very beneficial and effective. Systems follow rules – almost slavishly since that’s how they were created – with rules. You, the therapist, may not know the rules or understand them, but if you learn to do just that – understand the system, you can move mountains quickly inside the system since you’re talking their language. The rules can seem nonsensical, dead-ended, or useless, but each is carefully structured to protect, advance or benefit the system in some critical way. The more rules you understand, the better you’ll understand the system.
Great infographic, and great comment. Just as in psychoanalytic theory it is important to respect repression, it is also important with a systemic view to respect certain rules in the family system – at least until we understand and adress with the family or the patient why they are so important.
I cannot agree with you more here. I’ve seen many therapists make mistakes of learning or reading about one system in a book or seminar, and then try to fit that rules to their clients. Of course this does not work, but so many do this. While there are things in common(traumas, unreliable care givers, etc.), each system is organized to survive their unique circumstances (particular ways they were tortured/environment) differently, so one must really pay attention, and learn how a system you are trying to help is organized. I also add that one cannot just take one part’s words/explanations for the system. A part’s perspective is highly subjective, and there are multiple schemata in play simultaneously in a dissociated system.
Hi, Eva.
I agree that integrative therapeutic approaches are important. Curious about your thoughts on IFS therapy and its practice of always asking for permission and buy-in from protector parts, and how that supports each part’s perspective or version of reality and truth.
Also, would like to hear you expand upon the idea that one cannot take parts’ word as correct or applying to the system.
It’s a very good idea to have this visual clarity “before“ tomorrow’s session in the program. The visual clarity for something that feels so internally complicated gives a good framework for listening! Thank you!
A wonderful addition to trauma therapy. Thank you .
Thank you for your dedication and hard work. All information shared in your courses have proven to be beneficial for both my clients and myself.
Great program. I’m sharing it.
Really helpful handout thankyou,I will be sharing this within my clincial supervision of therapsit sessions.Copyright included of course.
Helping person appreciate the role, strengths, intent of parts they are in opposition with, helps soften and build compassion for the part. I am influenced by IFS approach to parts, which has been very helpful in this regard. Getting parts to communicate, negotiate, see each other’s view, needs, desires; help each other be expressed/have role that is more acceptable to other parts and not extreme…. IFS view of child parts, protector parts, no bad parts, channeling parts energy into more effective and preferred role/behavior has all been very helpful.
Yes. Exactly where I’m at. IFS has helped me personally, with creativity coaching clients, and also as inspiration for children’s stories.
thanks for this very helpful visual. I can’t wait for tomorrow’s session on the 3 key signs…
Thank you for these 2 posters, really helpful to give to clients and family of client’s who are DID. Thank you, it’s very appreciated.
Wonderful resource – thank you! I have a client in mind who will find it empowering. So clear and instructive.
Very nice infographic, thankyou
Thanks for this. =)
To help the persons to registrate emotions and reactions in their bodies.
What do your body tell you and how come it reacts in this way? What are your experiences ?
How do you then react and will there be other possibilities?
Naming the symptoms as communication from parts helps the patient differentiate between the normal self and the traumatic parts. Dual awareness along with curiosity and compassion for the parts provides regulation of the nervous system.
Your advice sounds like an excellent approach in assisting self discovery of parts.
I would love to hear your views on the one who is ‘I’.
Gatekeeper? Central hub?
And IFS, as this theory has never felt realistic to my situation.
I sincerely appreciate your input.