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Winner of the 2017 International Society for the Study of Trauma and Dissociation (ISSTD) Pierre Janet Writing Award. Establishing safety and working with dissociative parts in complex trauma therapy. Therapists around the world ask similar questions and struggle with similar challenges treating highly dissociative patients. This book arose not only out of countless hours of treating patients with dissociative disorders, but also out of the crucible of supervision and consultation, where therapists bring their most urgent questions, needs, and vulnerabilities. The book offers an overview of the neuropsychology of dissociation as a disorder of non-realization, as well as chapters on assessment, prognosis, case formulation, treatment planning, and treatment phases and goals, based on best practices. The authors describe what to focus on first in a complex therapy, and how to do it; how to help patients establish both internal and external safety without rescuing; how to work systematically with dissociative parts of a patient in ways that facilitate integration rather than further dissociation; how to set and maintain helpful boundaries; specific ways to stay focused on process instead of content; how to deal compassionately and effectively with disorganized attachment and dependency on the therapist; how to help patients integrate traumatic memories; what to do when the patient is enraged, chronically ashamed, avoidant, or unable to trust the therapist; and how to compassionately understand and work with resistances as a co-creation of both patient and therapist. Relational ways of being with the patient are the backbone of treatment, and are themselves essential therapeutic interventions. As such, the book also focused not only on highly practical and theoretically sound interventions, not only on what to do and say, but places strong emphasis on how to be with patients, describing innovative, compassionately collaborative approaches based on the latest research on attachment and evolutionary psychology. Throughout the book, core concepts—fundamental ideas that are highlighted in the text in bold so they can be seen at a glance—are emphasized. These serve as guiding principles in treatment as well as a summing-up of many of the most important notions in each chapter. Each chapter concludes with a section for further examination. These sections include additional ideas and questions, exercises for practicing skills, and suggestions for peer discussions based on topics in a particular chapter, meant to inspire further curiosity, discovery, and growth.
This training manual for pateints who have suffered severe trauma includes a short educational piece, homework sheets, and exercises that promote essential emotional and life skills.
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Geared to the needs of mental health practitioners unfamiliar with dissociative disorders, this volume presents a comprehensive and integrated approach to diagnosis and treatment. Each step--from first interview to final post-integrative treatment--is systematically reviewed, with detailed instructions on specific diagnostic and therapeutic techniques and examples of their clinical applications. Concise yet thorough, the volume offers expert advice on such topics as how to foster a strong therapeutic alliance, how to manage crises, and what basic errors to avoid.
Dissociation, Mindfulness, and Creative Meditations explores the potential of mindfulness and explains why this level of developmental human achievement is so precarious within traumatic stress, especially traumatic dissociation. Chapters discuss the connection and disconnection between mindfulness and dissociative disorders and highlight the importance of gently creating a mindfulness practice for traumatized individuals. Readers will learn how to exercise the part of the brain that is responsible for mindfulness and how to regulate the part that is responsible for dissociation, and they’ll come away from the book with tips that will help even the most dissociative client to reap the benefits of mindfulness practices.
This book, part of the acclaimed Norton Series on Interpersonal Neurobiology, brings interpersonal neurobiology into the counseling room, weaving the concepts of neurobiology into the ever-changing flow of therapy. Neuroscientific discoveries have begun to illuminate the workings of the active brain in intricate detail. In fact, sometimes it seems that in order to be a cutting-edge therapist, not only do you need knowledge of traditional psychotherapeutic models, but a solid understanding of the role the brain plays as well. But theory is never enough. You also need to know how to apply the theories to work with actual clients during sessions. In easy-to-understand prose, Being a Brain-Wise Therapist reviews the basic principles about brain structure, function, and development, and explains the neurobiological correlates of some familiar diagnostic categories. You will learn how to make theory come to life in the midst of clinical work, so that the principles of interpersonal neurobiology can be applied to a range of patients and issues, such as couples, teens, and children, and those dealing with depression, anxiety, and other disorders. Liberal use of exercises and case histories enliven the material and make this an essential guide for seamlessly integrating the latest neuroscientific research into your therapeutic practice.
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.
Life is an ongoing struggle for patients who have been chronically traumatized. They typically have a wide array of symptoms, often classified under different combinations of comorbidity, which can make assessment and treatment complicated and confusing for the therapist. Many patients have substantial problems with daily living and relationships, including serious intrapsychic conflicts and maladaptive coping strategies. Their suffering essentially relates to a terrifying and painful past that haunts them. Even when survivors attempt to hide their distress beneath a facade of normality—a common strategy—therapists often feel besieged by their many symptoms and serious pain. Small wonder that many survivors of chronic traumatization have seen several therapists with little if any gains, and that quite a few have been labeled as untreatable or resistant. In this book, three leading researchers and clinicians share what they have learned from treating and studying chronically traumatized individuals across more than 65 years of collective experience. Based on the theory of structural dissociation of the personality in combination with a Janetian psychology of action, the authors have developed a model of phase-oriented treatment that focuses on the identification and treatment of structural dissociation and related maladaptive mental and behavioral actions. The foundation of this approach is to support patients in learning more effective mental and behavioral actions that will enable them to become more adaptive in life and to resolve their structural dissociation. This principle implies an overall therapeutic goal of raising the integrative capacity, in order to cope with the demands of daily life and deal with the haunting remnants of the past, with the “unfinished business” of traumatic memories. Of interest to clinicians, students of clinical psychology and psychiatry, as well as to researchers, all those interested in adult survivors of chronic child abuse and neglect will find helpful insights and tools that may make the treatment more effective and efficient, and more tolerable for the suffering patient.
The accompanying manual to Dissociation Model of Borderline Personality Disorder. This manual offers therapists and patients a user-friendly guide to general principles of treatment via case examples, therapeutic conversations, and common comorbid problems. Borderline Personality Disorder (BPD) has a suicide rate similar to schizophrenia and major depression, but for many years, it was considered intractable. The Conversational Model is scientifically-based on the research data described in Meares’s Dissociation Model of Borderline Personality Disorder, and offers unique treatment protocols for the trauma associated with BPD. Rich with clinical tips and case examples, this book will help a range of mental health professionals working with patients suffering from this debilitating disorder.
Born out of the excitement of a convergence of ideas and passions, this book provides a synthesis of the work of researchers, clinicians, and theoreticians who are leaders in the field of trauma, attachment, and psychotherapy. As we move into the third millennium, the field of mental health is in an exciting position to bring together diverse ideas from a range of disciplines that illuminate our understanding of human experience: neurobiology, developmental psychology, traumatology, and systems theory. The contributors emphasize the ways in which the social environment, including relationships of childhood, adulthood, and the treatment milieu change aspects of the structure of the brain and ultimately alter the mind.