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The Dissociative Mind in Psychoanalysis: Understanding and Working With Trauma is an invaluable and cutting edge resource providing the current theory, practice, and research on trauma and dissociation within psychoanalysis. Elizabeth Howell and Sheldon Itzkowitz bring together experts in the field of dissociation and psychoanalysis, providing a comprehensive and forward-looking overview of the current thinking on trauma and dissociation. The volume contains articles on the history of concepts of trauma and dissociation, the linkage of complex trauma and dissociative problems in living, different modalities of treatment and theoretical approaches based on a new understanding of this linkage, as well as reviews of important new research. Overarching all of these is a clear explanation of how pathological dissociation is caused by trauma, and how this affects psychological organization -- concepts which have often been largely misunderstood. The Dissociative Mind in Psychoanalysis will be essential reading for psychoanalysts, psychoanalytically oriented psychotherapists, trauma therapists, and students.
Drawing on the pioneering work of Janet, Freud, Sullivan, and Fairbairn and making extensive use of recent literature, Elizabeth Howell develops a comprehensive model of the dissociative mind. Dissociation, for her, suffuses everyday life; it is a relationally structured survival strategy that arises out of the mind’s need to allow interaction with frightening but still urgently needed others. For therapists dissociated self-states are among the everyday fare of clinical work and gain expression in dreams, projective identifications, and enactments. Pathological dissociation, on the other hand, results when the psyche is overwhelmed by trauma and signals the collapse of relationality and an addictive clinging to dissociative solutions. Howell examines the relationship of segregated models of attachment, disorganized attachment, mentalization, and defensive exclusion to dissociative processes in general and to particular kinds of dissociative solutions. Enactments are reframed as unconscious procedural ways of being with others that often result in segregated systems of attachment. Clinical phenomena associated with splitting are assigned to a model of “attachment-based dissociation” in which alternating dissociated self-states develop along an axis of relational trauma. Later chapters of the book examine dissociation in relation to pathological narcissism; the creation and reproduction of gender; and psychopathy. Elegant in conception, thoughtful in tone, broad and deep in clinical applications, Howell takes the reader from neurophysiology to attachment theory to the clinical remediation of trauma states to the reality of evil. It provides a masterful overview of a literature that extends forward to the writings of Bromberg, Stern, Ryle, and others. The capstone of contemporary understandings of dissociation in relation to development and psychopathology, The Dissociative Mind will be an adventure and an education for its many clinical readers.
Building on the comprehensive theoretical model of dissociation elegantly developed in The Dissociative Mind, Elizabeth Howell makes another invaluable contribution to the clinical understanding of dissociative states with Understanding and Treating Dissociative Identity Disorder. Howell, working within the realm of relational psychoanalysis, explicates a multifaceted approach to the treatment of this fascinating yet often misunderstood condition, which involves the partitioning of the personality into part-selves that remain unaware of one another, usually the result of severely traumatic experiences. Howell begins with an explication of dissociation theory and research that includes the dynamic unconscious, trauma theory, attachment, and neuroscience. She then discusses the identification and diagnosis of Dissociative Identity Disorder (DID) before moving on to outline a phase-oriented treatment plan, which includes facilitating a multileveled co-constructed therapeutic relationship, emphasizing the multiplicity of transferences, countertransferences, and kinds of potential enactments. She then expands the treatment possibilities to include dreamwork, before moving on to discuss the risks involved in the treatment of DID and how to mitigate them. All concepts and technical approaches are permeated with rich clinical examples.
Early in these essays, Bromberg contemplates how one might engage schizoid detachment within an interpersonal perspective. To his surprise, he finds that the road to the patient's disavowed experiences most frequently passes through the analyst's internal conversation, as multiple configurations of self-other interaction, previously dissociated, are set loose first in the analyst and then played out in the interpersonal field. This insight leads to other discoveries. Beneath the dissociative structures seen in schizoid patients, and also in other personality disorders, Bromberg regularly finds traumatic experience -- even in patients not otherwise viewed as traumatized. This discovery allows interpersonal notions of psychic structure to emerge in a new light, as Bromberg arrives at the view that all severe character pathology masks dissociative defenses erected to ward off the internal experience of trauma and to keep the external world at bay to avoid retraumatization. These insights, in turn, open to a new understanding of dissociative processes as intrinsic to the therapeutic process per se. For Bromberg, it is the unanticipated eruption of the patient's relational world, with its push-pull impact on the analyst's effort to maintain a therapeutic stance, that makes possible the deepest and most therapeutically fruitful type of analytic experience. Bromberg's essays are delightfully unpredictable, as they strive to keep the reader continually abreast of how words can and cannot capture the subtle shifts in relatedness that characterize the clinical process. Indeed, at times Bromberg's writing seems vividly to recreate the alternating states of mind of the relational analyst at work. Stirringly evocative in character and radiating clinical wisdom infused with compassion and wit, Standing in the Spaces is a classic destined to be read and reread by analysts and therapists for decades to come.
Rediscovering Pierre Janet explores the legacy left by the pioneering French psychologist, philosopher and psychotherapist (1859–1947), from the relationship of between Janet and Freud, to the influence of his dissociation theory on contemporary psychotraumatology. Divided into three parts, the first section places Janetian psychological analysis and psychoanalysis in context with the foundational tenets of psychoanalysis, from Freud to relational theory, before the book explores Janet’s work on trauma and dissociation and its influence on contemporary thinking. Part three presents several contemporary psychotherapy approaches directly influenced by Janetian theory, including the treatment of posttraumatic stress disorder and dissociative identity disorder. Rediscovering Pierre Janet draws together eminent scholars from a variety of backgrounds, each of whom has developed Janetian constructs according to his or her own theoretical and clinical models. It provides an integrative approach that offers contemporary perspectives on Janet’s work, and will be of significant interest to practicing psychoanalysts, psychiatrists and psychotherapists, especially those treating trauma-related dissociative disorders, as well as researchers with an interest in psychological trauma.
A fresh look at the importance of dissociation in understanding trauma. A new model of therapeutic action, one that heals trauma and dissociation, is overtaking the mental health field. It is not just trauma, but the dissociation of the self, that causes emotional pain and difficulties in functioning. This book discusses how people are universally subject to trauma, what trauma is, and how to understand and work with normative as well as extreme dissociation. In this new model, the client and the practitioner are both traumatized and flawed human beings who affect each other in the mutual process that promotes the healing of the client—psychotherapy. Elizabeth Howell explains the dissociative, relational, and attachment reasons that people blame and punish themselves. She covers the difference between repression and dissociation, and how Freud’s exclusive focus on repression and the one-person fantasy Oedipal model impeded recognition of the serious consequences of external trauma, including child abuse. The book synthesizes trauma/dissociation perspectives and addresses new structural models.
Evil - along with its incarnation in human form, the psychopath - remains underexamined in the psychological and psychoanalytic literature. Given current societal issues ranging from increasingly violent cultural divides to climate change, it is imperative that the topics of psychopathy and human evil be thoughtfully explored. The book brings together social scientists, psychologists, and psychoanalysts to discuss the psychology of psychopaths, and the personal, societal and cultural destruction they leave as their legacy. Chapters address such questions as: Who are psychopaths? How do they think and operate? What causes someone to commit psychopathic acts? And are psychopaths born or created? Psychopaths leave us shocked and bewildered by behavior that violates the notions of common human trust and bonding, but not all psychopaths commit crimes. Because of their unique proclivities to deceive, seduce, and dissemble, they can hide in plain sight; especially when intelligent and highly educated. This latter group comprise the "successful or corporate" psychopaths, frequently found in boardrooms of corporations and among leaders of national movements or heads of state. Addressing a wide range of topics including slavery, genocide, the Holocaust, the individual as psychopath, the mind of the terrorist, sexual abuse, the role of attachment and the neurobiology of psychopathy, this book will appeal to researchers of human evil and psychopathy from a range of different disciplines and represents essential reading for psychotherapists and clinical psychologists.
This book uses case history methodology to illustrate the relationship between theory and practice of the study of Dissociation Identity Disorder (DID). Challenging conventional wisdom on all sides, the book traces the clinical and social history of dissociation in a provocative examination of this widely debated phenomenon. It reviews the current state of DID-related controversy so that readers may draw their own conclusions and examines the evolution of hypnosis and the ways it has been used and misused in the treatment of cases with DID. The book is rigorously illustrated with two centuries’ worth of famous cases.
Winner of the International Society for the Study of Trauma and Dissociation's (ISSTD) Pierre Janet Writing Award, 2015. What really happens in dissociation. Dissociative processes have long burdened trauma survivors with the dilemma of longing to feel “real” at the same time as they desperately want to avoid the pain that comes with that healing—a dilemma that often presents particularly acute difficulties for healing professionals. Recent clinical and neurobiological research sheds some light into the dark corners of a mind undergoing persistent dissociation, but its integration into the practice of talking therapy has never, until now, been fully realized. Intensive Psychotherapy for Persistent Dissociative Processes brings readers into the consultation room, and into the minds of both patient and therapist, like no other work on the treatment of trauma and dissociation. Richard A. Chefetz marries neuroscientific sophistication with a wealth of extended case histories, following patients over several years and offering several verbatim session transcripts. His unpacking of the emotionally impactful experience of psychodynamic talking therapy is masterfully written, clearly accessible, and singularly thorough. From neurobiological foundations he builds a working understanding of dissociation and its clinical manifestations. Drawing on theories of self-states and their involvement in dissociative experiences, he demonstrates how to identify persistent dissociation and its related psychodynamic processes, including repetition compulsion and enactment. He then guides readers through the beginning stages of a treatment, with particular attention to the psychodynamics of emotion in both patient and therapist. The second half of the book immerses readers in emotionally challenging clinical processes, offering insight into the neurobiology of fear and depersonalization, as well as case examples detailing struggles with histories of incest, sexual addiction, severe negativity, negative therapeutic reactions, enactment, and object-coercive doubting. The narrative style of Chefetz’s casework is nearly novelistic, bringing to life the clinical setting and the struggles in both patient and therapist. The only mystery in this clinical exposition, as it explores several cases over a number of years, is what will happen next. In the depth of his examples and in continual, self-reflexive analysis of flaws in past treatments, Chefetz is both a generous guide and an expert storyteller. Intensive Psychotherapy for Persistent Dissociative Processes is unique in its ability to place readers in the consultation room of psychodynamic therapy. With an evidence-focused approach based in neurobiology and a bold clinical scope, it will be indispensible to new and experienced therapists alike as they grapple with the most intractable clinical obstacles.
A contemporary, wide-ranging exploration of one of the most provocative topics currently under psychoanalytic investigation: the relationship of dissociation to varieties of knowing and unknowing. The twenty-eight essays collected here invite readers to reflect upon the ways the mind is structured around and through knowing, not-knowing, and sort-of-knowing or uncertainty. The authors explore the ramifications of being up against the limits of what they can know as through their clinical practice, and theoretical considerations, they simultaneously attempt to open up psychic and physical experience. How, they ask, do we tolerate ambiguity and blind spots as we try to know? And how do we make all of this useful to our patients and ourselves? The authors approach these and similar epistemological questions through an impressively wide variety of clinical dilemmas (e.g., the impact of new technologies upon the analytic dyad) and theoretical specialties (e.g., neurobiology).