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.

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.

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.

An edited collection from some of the most influential writers in mental health. Books in the Norton Series on Interpersonal Neurobiology have collectively sold close to 1 million copies and contributed to a revolution in cutting-edge mental health care. An interpersonal neurobiology of human development enables us to understand that the structure and function of the mind and brain are shaped by experiences, especially those involving emotional relationships. Here, the three series editors have enlisted some of the most widely read IPNB authors to reflect on the impact of IPNB on their clinical practice and offer words of wisdom to the hundreds of thousands of IPNB-informed clinicians around the world. Topics include: Dan Hill on dysregulation and impaired states of consciousness; Bonnie Badenoch on therapeutic presence; Kathy Steele on motivational systems in complex trauma.

Encompassing the contributions of expert clinicians and researchers in the area of traumatic stress and dissociation, this volume is the first to integrate current neuroscience research regarding traumatic dissociation with several cutting-edge approaches to treatment, providing a comprehensive, neurobiologically based treatment approach. The text discusses current neuroscientific research regarding traumatic stress and dissociation that includes attachment, affective neuroscience, polyvagal theory, structural dissociation, and information processing theory, yielding a comprehensive model that guides treatment and clinical interventions for traumatic dissociation. It then integrates this model with stage-oriented treatment and current therapeutic interventions, including EMDR, somatic and body psychotherapy approaches, Ego State Therapy, and adjunctive pharmacological interventions. Readers are given hands-on practical guidance regarding clinical decision making, enabling them to make sound choices about interventions that will facilitate optimal treatment outcomes. Key Features: Provides a broad-based treatment approach to traumatic stress syndromes and dissociation Offers accessible current research in the basic neurosciences relevant to our understanding of attachment, traumatic stress, and dissociation Includes practical suggestions for integrating EMDR, somatic, and body psychotherapy approaches with Ego State Therapy and adjunctive pharmacological interventions Integrates concepts from the affective and cognitive neurosciences and the study of consciousness Presents a comprehensive neurobiological model that accounts for the therapeutic effects of both somatic therapies and EMDR, as well as adjunctive pharmacological interventions

The loss of a loved one can be very painful, with the mourner losing an important source of safety, connection, and life balance. Even when uncomplicated, bereavement can have a significant impact on the mourner. Traumatic circumstances can intensify the grief and complicate the mourning process. EMDR (Eye Movement Desensitization and Reprocessing) therapy, an evidenced based treatment for trauma, can help process the trauma of the loss and the obstacles that interfere with the grief and mourning process. In this book, Roger M. Solomon guides the EDMR therapist through the treatment process by understanding grief reactions and the mourning process, providing an overall model of EMDR treatment for grief and mourning, and highlighting how EMDR can help a mourner experience a positive sense of connection through heartfelt, meaningful memories. The author presents an integrative model for EMDR therapy treatment based on the Adaptive Information Processing Model (AIP), which guides EMDR therapy. Several models of grief and mourning that inform EMDR treatment and a discussion of the eight phases and three prongs (past, present, and future) of EMDR therapy are presented, with many case examples including transcripts of sessions, to illustrate treatment principles and clinical teaching points.

Establishing safety and working with dissociative parts in complex trauma therapy.

This book explores the growing understanding and evidence base for the role of trauma in sexual offending. It represents a paradigm shift, in which trauma is becoming an important risk factor to be considered in the treatment of individuals convicted of sexual crime. The authors consider the theoretical and historical explanations and understandings of sexual offending and its relationship with early trauma, paving the way for a volume which considers client’s treatment needs through a new, trauma-informed lens. The experiences and challenges of specific groups are also explored, including young people and women. Readable, yet firmly anchored in a sound evidence base, this book is relevant to psychologists, therapists, criminologists, psychiatrists, mental health nurses, social workers, students, and to practitioners and the general public with an interest in learning more about the topic.