Treating Trauma-Related Dissociation: A Practical, Integrative Approach

by Onno van der Hart, Suzette Boon, Kathy Steele

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.

Genres: Psychology, Mental Health, Counselling, Nonfiction, Professional Development, Social Work

560 pages, Hardcover

Published November 29, 2016

Reviews

[Stephanie Mitchell · Rating 2 out of 5]

I found this book missed the mark. If you really listen to clients with extensive trauma they dont need grounding techniques they need relationship. I am grateful to have found Internal Family Systems therapy a much more robust model for working with trauma. I was dissappointed in this book.

[Lore LongSoulSystem · Rating 5 out of 5]

Buenísimo, aunque hubo cosas con las que no estuve de acuerdo, en general abarca muchísimos temas necesarios. De las cosas en las que no estuve nada de acuerdo es la opinión de que "la pareja de una persona con TID no debe involucrarse con las partes y debe mantener la narrativa de 'la parte de ti que está enojada' y nunca llamar a las partes por su nombre". En parte no estoy de acuerdo porque esa es exactamente la posición en la que se coloca un terapeuta, y una pareja no debería sostener una postura de terapeuta. Creo que esto debe ser una decisión de lo que cada pareja pueda hacer y necesiten en la relación, además de que puede ser de verdad sanador que la pareja reconozca y pueda estar con estas partes.
En resumen, como terapeutas entienden bien su postura, pero no comprenden aún la posición de no terapeuta y lo mucho que pueden aportar desde otras perspectivas que no necesariamente empujen la "realization".
Esa es una cosa que no me gustó, pero en general hubo más cosas que me encantaron del libro que las que no. La parte de la vergüenza me ayudó muchísimo.

[Steven · Rating 5 out of 5]

A well written and informative book that supplements my EMDR practice with complex PTSD and dissociative disorders. I have read it in its entirety and worked to apply its lessons in practice and I feel that I and my clients are much better off for it. I wouldn’t just recommend this book as a guide for treating dissociation, but more so as a guide for being a good therapist regardless of specialty.

[Patrick Moore · Rating 5 out of 5]

very helpful for understanding the causes and structure in the mind and for how to approach resolution. I have read a number of books on body-therapies for people carrying trauma and landed here. I feel these authors are the current most-enlightened on the subject of trauma.

The voice is 90% nonjudgmental (best of the authors I've read on this topic as of 2019), of course, so necessary for being of service to people who are scared. Qualities also mentioned: patience, curiosity, and great coverage of countertransference.

(Does anyone realize how bad massage therapy education is, when it comes to countertransference?)

Read twice, and also read their book Coping With T-R D, written not for therapists bot for the people who have the compartments.

I also valued the books by David P. Celani on Fairbairn's model of dissociation into four partitions, based upon relating to the Ideal Parent, the Unacceptable Parent, and the two child parts that must bend to relate to these.

It would be nice to find one book that more generally describes dissociation, or how the child forms the compartments that are soundproof from one another, that is not specifically about the Trauma way this happens nor the Family Dynamics way, but more the process of dissociat-ING.

I have a question none of these books has explained yet to my satisfaction. Is there a difference in nature between dissociating and compartmentalizing? Or simply a difference in intensity? To my reading so far it looks like dissociation is when the compartments become totally soundproof.

What about the metaphor of "go to your room"? The parent literally puts the child into a compartment?! The parent does this exactly at the moment when the child is doing something the parent cannot process or tolerate! I hope a future author describes this in more detail thanks.

Thanks for the marvelous book that is currently the best available on this topic, and looking forward to what comes next.

[Manuel · Rating 5 out of 5]

Un libro necesario para los profesionales interesados en todo lo relativo a la
Disociación con ejemplos prácticos y enfocado a todo lo relativo a la disociación

[Roberta Fish · Rating 5 out of 5]

Great book! Lots of helpful information for therapists and clients.

[Jessica · Rating 5 out of 5]

Amazing. As both a professional and a person with lived experience of DID I found this book hit the marks on both sides. Essential reading if working with this cohort.

[Emily VH · Rating 5 out of 5]

van der Hart, Steele & Boon are everything

[Shanna Tipton · Rating 5 out of 5]

Very informative, helpful, easy to read and well written!

[Sidnee Sawyer · Rating 5 out of 5]

“Personality is a developmental achievement: we are not born with a fully developed personality. Highly traumatized children may never have developed a cohesive personality in the first place.”