Dissociation and Dissociative Disorders: Therapy for ‘Difficult’ Clients A 2-day training workshop at London with Dr Suzette Boon London, 23 & 24 November 2017 (Thursday & Friday) 9:30am - 5:00pm on both days
Our challenges, as therapists, are manifold when faced with acute manifestations of dissociation, including complex dissociative disorders: Our clients may present with difficult conditions – engendering feelings of guilt, rage, shame, humiliation, helplessness and incompetency while seeming to resist all therapeutic efforts We may not have an in-depth comprehension of dissociation – some schools of thought consider dissociation a phenomenon that exists on a continuum (from normal to pathological) while others consider dissociation as strongly pathological and representative of a divided self Our clients rarely present with explicit dissociative symptoms – they often attempt to hide or dissimulate such manifestations Dissociative disorders are hard to differentiate from cluster B personality disorders and bipolar disorders Even the existence of certain dissociative disorders is a subject of ongoing polarized debates As a consequence of these challenges and in the face of apparent resistance, we run the risk of retreating into destructive enmeshment or distancing from our clients. At this practical, engaging and therapeutically oriented workshop which would be especially relevant for psychotherapists, psychologists, counsellors and psychiatrists, across modalities, Dr Boon draws on her innovative work on dissociative disorders and complex trauma to help us work especially with such difficult clients. Through case vignettes and examples, she equips us with therapeutic tools that prove useful for four interconnected challenges that difficult clients present:
1. Dissociation: the workshop enables us to recognise pathological dissociative symptoms, assess DSM-5 dissociative disorders, distinguish between genuine and false positive cases and explains therapeutic work techniques for dissociative parts 2. Chronic defences: we look at defences against perceived relational threats including criticism, rejection, abandonment, engulfment and control; working with angry and sadistic dissociative parts and self-destructive behaviour 3. Chronic defences against inner experience: the workshop looks at our clients’ defences with reference to affects, cognitions, physical sensations, wishes and needs. We look at the challenges this presents for therapy, especially where regulation of intense emotions becomes a pre-requisite for therapeutic progress 4. Self-regulation difficulties: we look at these through the lens of the three phases of therapy: a. Stabilisation and symptom reduction b. Treatment of traumatic memories, realization of the past c. Integration and rehabilitation The workshop highlights that the actual prognosis of a difficult client depends to some extent on the goodness of fit between client and therapist – as well as on prognostic indicators. In the overall approach advocated by this workshop, interventions are first directed at the therapist who must walk the fine line of acting with reflection rather than reaction. Dr Boon explains that such a reflective stance can prove to be a therapeutic strategy in itself for the client, paving the way for further interventions. Using video vignettes, Dr Boon explains practical therapeutic strategies that incorporate comprehension of: The differences and similarities between dissociation and hypoarousal – when do clients alternate between hypoarousal and hyperarousal? Compartmentalized and disparate senses of self in our clients, thus allowing us to comprehend manifestations as activities of dissociative parts Situations where dissociation and psychosis may co-exist and situations where these may lead to confusing symptomatology The role of dissociative parts in other comorbid clinical manifestations (such as the exacerbation of other symptoms and disorders like depression, self-harm, suicidality, eating problems, addition and panic) Avoiding false positive assessments Overcoming the challenging task of obtaining a therapeutic alliance with clients who have a complex trauma history (in particular with those who exhibit dissociative disorders) Developing a working alliance with hostile and destructive dissociative parts; Techniques for regulating emotions and for dealing with triggers Transference and countertransference considerations in the phase oriented approach; Self-care for the therapist Creating a working alliance with aggressive and / or persecutory personalities About the speaker Suzette A. Boon PhD, is a clinical psychologist and psychotherapist. She is a trainer and supervisor for the Dutch Society for Family Therapy and the Dutch Society for Clinical Hypnosis. Since the late eighties she has specialized in the diagnosis and treatment of complex dissociative disorders. She has worked as a researcher at the free University of Amsterdam (psychiatric department). She translated and validated the Dutch version of the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D) and received a PhD for her thesis “Multiple Personality Disorder in the Netherlands” in 1993. She has published several books, book chapters and articles both on diagnosis as well as treatment of dissociative disorders. She has developed a skills training manual for clients with complex dissociative disorder, the English version of which, with Kathy Steele, MN, CS and Onno van der Hart PhD has been published in March 2011 (Norton publishers). She has developed together with Helga Matthess, a new semi structured interview for complex dissociative disorders and trauma related symptoms: the “Trauma and Dissociation Symptoms Interview (TADS-I)”. A validation study for this interview is currently in progress. She is co-founder of the European Society for Trauma and Dissociation (ESTD) and was the first president of this Society. The International Society for the Study of Trauma and Dissociation (ISSTD) granted her the David Caul Memorial Award in 1993, the Morton Prince Award in 1994 and the President’s Award of distinction and the status of fellow in 1995 for her contributions to diagnosis, treatment, research and education in the field of dissociative disorders. In 2009, she received the Life Time Achievement Award and in 2011 the Pierre Janet writing Award for the book Coping with trauma-related Dissociation: skills training for patients and therapists. She is co-author of a new book: Treating Trauma-Related Dissociation: a Practical Integrative Approach (Steele, Boon & van der Hart, 2017. New York: Norton publishers). Workshop Schedule 23 November 2017, Thursday, Day 1 9:30am to 5:00pm, Lunch at 1:00pm (a light lunch is provided as part of the workshop) 24 November 2017, Friday, Day 2 9:30am to 5:00pm, Lunch at 1:00pm (a light lunch is provided as part of the workshop)

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