Challenges in Phase-Oriented Treatment For Patients with Dissociative Symptoms – Central Time – Solomon and Boon

Course Description

Already skilled in treating complex trauma? Then register for Saturday & Sunday's workshop (14 CEs). If you'd like to refresh your skills in complex trauma, be sure to register for Friday's workshop (7 CEs) -- with or without the 2-day workshop on Saturday & Sunday. Please note that when registering, these 2 workshops are being offered separately.

It is important that EMDR therapists be knowledgeable about dissociative symptoms and the clinical phenomena that accompanies such disorders. Challenging treatment issues can arise with clients with complex trauma and dissociative symptoms that impede treatment. This workshop will focus on assessment of complex trauma / dissociative symptoms and treatment of the complications that can occur. Friday's workshop is intended for participants with little or no background in complex trauma and EMDR, which will help participants get the most out of Saturday and Sunday involving assessment and treatment.

Saturday will focus on assessment and differential diagnosis and Sunday will focus on dealing with treatment challenges and how EMDR therapy can be integrated within an overall treatment plan. Teaching points will be illustrated by videos of client sessions.

Abstract
Assessment issues and dealing with treatment challenges

Early and chronic childhood abuse such as physical abuse, sexual abuse and emotional neglect may result in trauma related distress and dissociation. Dissociative symptoms and disorders are not easy to recognize however for the following reasons:

• Patients generally do not present with dissociative symptoms but have a tendency to hide or avoid the underlying issues
• There is a lot of overlap in symptoms with other disorders such as personality disorders
• There are different opinions on the concept of dissociation and what dissociative symptoms actually are
• Clinicians do not receive systematic education with regard to diagnosis and treatment of dissociative symptoms
• There is an ongoing polarized debate about the existence of dissociative identity disorder (DID) as a reliable and valid diagnosis.
• This workshop will help clinicians to recognize pathological dissociative symptoms and assess the presence of a dissociative disorder.

After assessment and case formulation, the first treatment phase stresses the need for careful pacing and regulation of arousal as many of these patients are phobic for therapy and the therapist, are prone to regulatory difficulties and lack essential life skills. It can be a challenging task to obtain a working alliance with patients with a dissociative disorder as many of these patients also have severe attachment problems. Angry, aggressive and self-destructive parts often dysregulate the therapeutic relationship as a way to protect the patient. Needy patients may put the therapeutic relationship under enormous pressure when the therapist feels the need to rescue.

But the treatment of these patients has many more challenges:

• What do we do when none of our stabilizing techniques work?
• What do we do when a patient is dissociating all session?
• What do we do when a patient starts hurting herself in session?
• What do we do when we find out during treatment that abuse is still going on?
• How do we know that we have done enough stabilizing work to make the decision to transition to the treatment of traumatic memories?
• How and where do we start with EMDR memory processing?

Objectives

Participant will be able to:

• Discuss the criteria for dissociative disorder and be able to explain possible complications in the therapeutic relationship
• Make a distinction between more general alterations of consciousness and symptoms indicating a division of the personality
• Make a distinction between alterations of consciousness that do not indicate a division of the personality
• Explain the spectrum of dissociative symptoms
• Describe the conceptual difference between ego states, modes, and dissociative parts
• Describe the levels of structural dissociation of the personality
• Describe the three phases of phase-oriented treatment
• Describe when to work on stabilization of the client
• Describe the pitfalls in therapy with patients with complex dissociative symptoms
• Implement treatment strategies for working with perpetrator imitating parts
• Recognize contraindications to memory work
• Identify strategies for working with shame