Dissociative vs. associative techniques to treat dissociation

(November 21, 2009) International Society for the Study of Trauma and Dissociation ISSTD Washington. (April 9, 2010)  Second European conference of the European Society of Trauma and Dissociation ESTD in Belfast. (June 19, 2010) International Congress of Psychotherapy, Lucerne (Switzerland).

In the past two decades, various effective techniques have been developed to treat trauma: EMDR, EMI, EFT, NLP, SE, etc.  These different techniques inevitably raise the question: “Which techniques should be used for which patients? “ Because dissociative disordered patients may react to trauma work with dissociative detachment, a “low impact” technique is needed. Thus, therapeutic approaches that employ a certain degree of dissociative distancing seem well-suited to dissociative patients. Richard Bandler (NLP) and, more recently, Cary Craig (EFT) have developed calm, nondramatic ways to address trauma and solve problems. EMDR, a more associative method, seems better suited to stable patients with good resources. This workshop will present a continuum that locates techniques along a scale of increasing degrees of confrontation. Special attention will be given to EFT (Emotional Freedom Techniques), an easy-to-learn method. Techniques for reinforcing the Somatic Self during EMDR sessions will be explained. The second part of this workshop will present a conceptualization for these techniques based on the works of Stephen Porges, Ellert Nijenhuis, and Mihaly Csikszentmihalyi (Flow Theory).

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EFT3, a dissociative technique of integration

(March 31, 2012) Third European Conference of the European Society of Trauma and Dissociation, Berlin (Germany)

EFT is a healing technique combining the tapping of acupuncture points and verbalizing the identified problem. EFT3 intends to improve upon EFT by adding two dissociative artifices. First, the patient is invited to formulate the problem in the third person. Second, he mentally projects an imaginary double of himself in front of him at the age where the problem appeared. The therapist and patient then tap simultaneously: therapist on the patient and patient on the double (as if the double were present). This way, we get a protective distance, and it is easier to bypass resistance to the therapeutic work due to emotional avoidance. Paradoxically, the patient can – in an impersonal way – go deeper emotionally around the issue, allowing more reflection and compassion for self. The patient observes immediate changes in the double, leading to the following therapeutic intervention. While the therapist and patient further tap, it is possible to invite new resources (helpers or other doubles) to take their place on the imaginary stage. This process allows the integration of lost aspects/states of the self without feeling them in the first person. Therapists in psychotraumatology will benefit from this safe and highly effective approach.

This workshop proposes a demonstration of this method, illustrated with different patient cases. Through short exercises, the participants will also have the opportunity to get some live experience of this process.

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Creating a visual teaching of dissociation that people understand

(March 28, 2014) Fourth European conference of the European Society of Trauma and Dissociation, Copenhagen (Denmark).

This workshop demonstrates how visual language facilitates the teaching of dissociation. Division of the mental space in specific compartments is the key phenomenon of dissociation. How do these parts form? I suggest stopping thinking about neuroanatomy (localization), phylogenetic or threat management and adopting an energetic perspective (force, movement, posture) instead. This energy states model, describing three activation levels, can quickly be transcribed in a visual color-coding system (red, blue, green). The therapist then has a dual way of representing a clinical issue graphically. Spatial metaphors (e.g., icons, lines, circles) illustrate parts of personality, introjects, resources, and their mutual relationships.  Color coding indicates their energy state. A graph can be created during the session, commented on, discussed, modified, or completed. Displaying a complex problem, including multiple parts, as one “big picture” gives the patient a better acceptance of his complexity. Visual language makes the understanding and memorization of theoretical knowledge (psychoeducation) much more accessible. Using several patient cases as examples, I will demonstrate how to use didactic visual tools (iPad, interactive board) in daily therapeutic practice.

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The good dissociation

(March 29, 2014) Fourth European conference of the European Society of Trauma and Dissociation, Copenhagen (Denmark).

Dissociation is usually considered to be a negative phenomenon. Nevertheless, many therapists have already recognized the advantages of a therapeutic dissociative setting. In eft3, a double dissociative imagery technique using EFT from a third-person perspective, the patient is invited to “stage” all the aspects of a critical issue as different characters. The staging may include adult parts, children alters, allies, or aggressors. To obtain perfect disambiguation, “sub-characters” are created every time different energy states (e.g., caregiver and predator) are identified.  It is then much easier to target the therapeutic work on one sub-character. The therapist's primary role is to install and maintain the double dissociation thoroughly. As the patient becomes familiar with this staging process, he discovers unexpected self-images emerging from the unconscious. In this safe setting, forgotten, ugly, denied, lovely, and shy parts may appear, ready to be acknowledged and integrated. It allows the observer to build a new self-caring attachment system based on respect and empathy. Teaching patients dissociative strategies is an effective way to cope with invasions (?) and ambiguous issues.  It adapts the concept of structural dissociation – mainly used (?) in cases of high dissociation – to a broader spectrum of patients.