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.
This is THE BOOK of Dissociation, from BPD, PTSD, C-PTSD, OSDD and DID.
A very must read for professionals, therapists, researchers, patients and loved ones. If you want to know how dissociation works, why it works, why we do it, and why it's a covert dissorder, please read this.
It's a tough read. But it will worth it. And yes, this is a theory, but it's absurdly supported and well researched.
Not a psychology major, just someone suffering with PTSD and the dissociative aspects of it. Helped me understand the science behind EMDR treatment. It helped me. If you are the intellectual or curious type, as I like to call myself...this is a very good read, if you don't mind a slow read...due to spending countless hours understanding the phycological terminology, and rightful assumptions by the author that this would be read by only knowledgable and experienced therapists....i am not one of them. but I am a life-long learner...
The theoretical and historical aspects of this book are fascinating. Deeply insightful. (I was happy and unsurprised that my therapist has also read it.) I was somewhat annoyed by the hierarchical nature of some of their framing - I think they regularly undervalue traumatic adaptations despite making an effort not to- and while the basis for treatment seems sound, some of the goals and methods seem kind of... Superficial or dated compared to other books I've read? Quite probably a matter of the book's scope rather than the authors' practice. Overall, a sensitive and kind approach to the topic that will inform my own thinking going forward.
This text is the most accurate and thoroughly-researched explanation of structural dissociation due to chronic/complex trauma, especially in regards to trauma during development. It is a difficult, heartbreaking but insightful read. Would recommend to clinicians and individuals dealing with trauma and dissociation. However, it might be necessary to approach with caution; the book may cause dysregulation as it puts the confusing and overwhelming reality of complex ptsd into words. It hits close to the most sensitive and vulnerable states of shame and identity.
Although it was published in 2006, to me it stands as the best book on the topic.
I wanted to like this one a lot more than I did. It wasn't so much the technical language - though I did struggle with all the jargon at times - it was a remove, a coldness, an othering I felt in the text that didn't really dissipate and stopped me connecting with this work. That isn't to say I didn't find it interesting. It's an interesting theory, and one that's all the rage right now, so it was something I wanted to understand deeper. It is a book I'll reread at some point just to firm up my understanding. But I think a lot of people don't mark what the authors themselves say quite firmly - that it is a theory, one they've worked hard on, yes, but just a theory that is open to input and correction, and one that doesn't have any studies devoted to it, yet.
The theory of structural dissociation just doesn't work for some people. For some systems, it just doesn't fit. For anyone who has a system that strongly identifies as having an original or a core, it doesn't fit. And I've seen at least one high number/polyfragmented system say it doesn't fit their experience at all, too. For people with traumagenic BPD, where do they fit? They're sort of included as having a dissociative disorder in the text, but they don't fit on the neat linear spectrum the book proposes (from simple PTSD right through to DID). Also, what about things like Depersonalisation/Derealisation Disorder, Dissociative Fugue, or Dissociative Amnesia? These aren't addressed as discrete conditions, only as features of the ones on the proposed spectrum, even though people do receive these diagnoses on their own.
A lot of people with a diagnosis on the proposed spectrum have a dual diagnosis of more than one of the listed points on the scale - DID, OSDD, BPD, PTSD, c-PTSD, or some kind of developmental, attachment, or betrayal trauma. Does the linear scale even work as a concept when there are multiple overlapping diagnoses? Surely a colour wheel concept, like this reimagining of the autism spectrum, is going to be more accurate for at least some of these people. A straight line doesn't work for autism, for gender, or for sexuality, because it's limiting things to a two dimensional plane and a binary way of being. I don't think it works for something as individual as trauma, self, or personality, either.
Yes, there's a lot of value in this work. It's been constructed with care. The proposed guide for working through stages in therapy is going to really benefit certain people for whom that approach is helpful. But readers should read it with the understanding that it's not gospel. It's an idea. It's a box that fits some and not others.
Explains the idea of different "parts" of the personality that don't integrate. This is attributed to trauma, usually early in life, of sexual abuse or other violence. My big unanswered question, though, is whether violent events are the only cause of the psychological phenomenon.
(I read in French, but will review in English and I have OSDD, a form of tertiary dissociation)
I cannot pressure enough how this book can have a huge and positive impact on people who have suffered traumas that lead to dissociation (starting from PTSD, to cPTSD, then OSDD, DID...). The book has a clear balance between the neurology, the psychologic, the physical and therapeutic means offered to all person suffering as a base for understanding. It has also the non negligible potential to help all people struggling in life as many concepts introduced in this book (system, inner family, parts) are useful, even taken away from dissociation.
This is not easy read though, and asks a very strong insight into psychology to get away with very niche terms that, for myself, I had difficulties to comprehend. But this smooths down along the read with more general and vital information on therapies, healing, and advancing in a new life. I would suggest to not read the book in one go, because too many information are squashed in there :-)
As part of a system (I am one among other parts), there is, however, few emphasis on how it is possible to live a healthy multiplicity. Although they do not praise over integration, they do not touch much on that as way of healing.
I found the book to be very insightful but found that after the first few chapters, the exact same material was repeated throughout the rest of the remaining chapters. However, I did find information that I felt was helpful to me with my CPTSD and also would be helpful for others with similar diagnoses, as well as the general population.
El mejor libro para entender algo tan complejo como la disociación, causada por el trauma. Súper recomendado para cualquier profesional de la salud mental.
EL YO ATORMENTADO. La disociación estructural y el tratamiento de la traumatización crónica. Onno Van der Hart, Ellert R.S. Nijenhuis, Kathy Steele Leído en 2024-2025 -- 4/5 estrellas. Este libro ha sido todo un reto para mí, de forma personal y profesional. Me parece una tesis que ve el trauma desde una perspectiva muy concreta y mecanizada… digo, el propio nombre de su teoría de la disociación ESTRUCTURAL. No me termina de convencer algunos términos empleados que al final deshumanizan a los pacientes y nos hace verlos como ordenadores (CPU) que ejecutan secuencias específicas. Tiene su mérito, no lo niego; facilita la comprensión del trauma y sus consecuencias: la disociación. Busca explicar cómo se da y cómo funciona según la severidad. Llena de jerga y tecnicismos de neuropsicología, lo que puede hacer pesada la lectura. Finalizo diciendo que solo es una perspectiva, no una verdad absoluta. Hay otros autores… Esta obra considerada una lectura obligada está estructurada en partes: 1. La disociación estructural de la personalidad. Nos introduce a cuestiones conceptuales y básicas para fundamentar su teoría, nadie nace con una personalidad integrada. Y aunque el material en su mayoría es psicología conductivista, no deja de lado el psicoanálisis. La personalidad/identidad está compuesta por el Super yo, ello y yo; que desde la niñez temprana que se desarrollan por separado (Ello: inconsciente, placer inmediato [deseo, voluntad, instinto]. Super yo: subconsciente, todo lo aprendido y condicionado [valores, creencias y normas] para la socialización. Yo: nosotros hacia el exterior, la realidad que busca amortiguar, adoptar/adaptar los otros), cuando crecemos estos 3 niveles comienzan a funcionar para formar semindependientes (relacionados) y se integran para formar una personalidad congruente, flexible y adaptativa. El trauma detiene abruptamente o impide su integración y cada parte/nivel queda con sus propios propósitos y funciones rígidas que impiden la adaptación del individuo.
Continúa abordando el trauma desde una perspectiva científica con la neurofisiología. Definiéndolo como suceso o evento que no sabemos manejar de estrés extremo que produce cambios constitutivos (neuro conexión), temperamentales (emociones), cognitivos (inteligencia) y conductuales. La disociación es una división… de la organización de los sistemas que constituyen la personalidad (YO: contexto que permite reconocer [uno mismo, entorno, tiempo]. SUPER YO: cómo llevar una vida. ELLO: Sentir… [Hiper o hipoactivación]).
Se mete a fondo sobre los sistemas biopsicosociales que rifen nuestras acciones. La jerarquía de estas, el nivel mental… y funciones específicas: INTEGRACIÓN. Asimilar experiencias de nuestra vida (reconocer, aceptar, dejar atrás). Para dar coherencia a nuestra historia de vida. Se requiere de dos acciones indispensables… Síntesis. Asociar/Vincular y diferenciar. Reconocer en algún momento del tiempo y saber en qué se parece y diferencia a otros momentos. Consciencia (darse cuenta). Analizar, digerir y procesar las experiencias que requiere de conocimiento, reflexión, aceptación y una respuesta.
Cuando la integración falla, la experiencia se disocia [no se reconoce, no se acepta, se evita]… no se siente propia, pero atormenta, desequilibra y quebranta el subconsciente (super yo) e inconsciente (ello). Lo que lleva a acciones sustitutivas que buscan bloquear, ignorar o deshacerse de eso.
Se explica que el trauma sigue unas grietas o puntos de quiebre, entonces la parte separada se lleva sus funciones consigo. PAN (Parte Aparentemente Normal). Que está fijada en vivir una vida, se esfuerza en aparentarlo. Lleva un control ejecutivo del paciente y evita cualquier recuerdo del trauma. PE (Parte Emocional).. Atrapada en el trauma, Re experimentando y hacerle frente a la amenaza [Luchando, Huyendo, Paralizándose o siendo sumisa].
Ahora pasamos de la teoría a la supuesta practica clínica, explicar los desórdenes traumático según el grado de disociación. Primaria. Primer grado, leve o menos grave (División simple). Presencia de una sola PAN y PE: TEA (trastorno por estrés agudo) TEPT (estrés postraumático simple)
Secundaria. Segundo grado, moderada a severa (división múltiple y/o repetida). Presencia de una PAN y varias PE: TEPT-C (estrés postraumático complejo) TLP (trastorno límite de la personalidad) TDNE (trastorno disociativo no especificado): amnesia, fuga, despersonalización, desrealización.
Terciaria. Tercer grado, severo a muy severo (traumatización temprana [infancia], grave, múltiple y prolongada). Presencia de varias PAN y PE con autonomía y complejidad. TID (trastorno de identidad disociativa).
Se expone la clínica, criterios diagnósticos y dinámica de los prototipos propuestos por DSM-IV, DSM-V y CIE-11.
2. La traumatización crónica y la psicología janetiana de la acción. Basada en todo lo que propuso Pierre Janet (1859-1947), médico francés especializado en neurología clínica y psiquiatría; aunque formado en psicoanálisis se desvió de esto. Es un materia extenso, pero super enriquecedor para conocer las bases de la teoría, sobre la acción y lo que está detrás de ella. Habla sobre temas conductitas como el condicionamiento.
3. El tratamiento de los pacientes crónicamente traumatizados. Me niego a ver al paciente como un sistema y no una persona, fue muy difícil leer esta parte. Pero, recomendaciones muy bien intencionadas, se agradece que integre casos clínicos y entrevistas reales. Pero, prefiero la modalidad terapéutica de Judith Lewis Herman.
So having DID and reading this was interesting. Of course, thinking here that the structural dissociation theory does not hold up well for a number of reasons, but the treatment plans for especially DID helps a lot.
This was a highly in depth technical read on chronic traumatized patients with varying levels of symptoms going through the process of therapy to fuse the different parts that had emerged as a protective factor that is now maladaptive to a more cohesive unit able to handle the demands of life. For the professional it breaks down structural dissociation in part one. The later parts evolve how to go about in the therapeutic setting treating it.
It's a long read to really dig into a concept of dissociation and a healing process for people from minor dissociation to complex cases of DID. Provides vintages and examples as well.
Overall goof for a professional in the area of trauma wishing to work with these individuals an idea on best case management.
De los libros disponibles en español que abarcan los trastornos disociativos es, hasta ahora, el más completo. En él se desarrolla la teoría de la disociación estructural y su relación con distintas condiciones que conforman el espectro de los trastornos disociativos (TEPT, TLP, TID, etc.). Creo que es un texto imprescindible para la comprensión de las consecuencias del trauma y de los problemas de apego en la infancia.
A serious and clinical framework that gives depth and understanding for something that deeply deserves care. I was cautious at first on the framing through the Janetian psychology of action, but was pleasantly surprised at how accurately it maps onto experience. Similarly the ANP and EP framings are far more helpful the the vague therapyslop Chinese whispers I'd heard of before talking about your "wounded inner child". Fantastic read
Академічне дослідження із розробленою методологією і контекстом практичних досліджень. Мова строга, суха, але дефінітивно серйозно витримана. Структурно теж подобається. Хороше враження від того, що існують монографії, у яких відсутні науково-популярні загравання із публікою.
Рекомендую людям, яким знайомі дисоціативні стани і вони хочуть краще розуміти, які існують терапії.