Overview of Conference Program

Complex posttraumatic and dissociative conditions often develop in the aftermath of chronic cumulative trauma, particularly severe child abuse and neglect.

The objective of this workshop is to provide clinicians with an increased understanding of the nature, diagnosis, and treatment of these conditions, described as the New Consensus Model of treatment and drawing upon recent clinical writings and empirical findings.

Topics to be covered include: description of the diagnostic criteria for complex forms of Posttraumatic Stress Disorder and the Dissociative Disorders; assessment issues and instruments; treatment philosophy; treatment frame issues; sequenced treatment; and specific strategies, various approaches, durations, and intensities, especially those directed towards affect regulation, ego-enhancement, symptom stabilization, and the maintenance of the client's functioning.

The importance of the therapeutic relationship to the treatment will be stressed; discussion of transference and countertransference issues will be interwoven throughout the presentation.

Learning Objectives

1. Attendees will be able to identify the after effects of chronic cumulative trauma (particularly during childhood) as a complex posttraumatic condition that is often dissociative and will be able to identify criteria of these conditions and disorders.

2. Attendees will gain an understanding of the philosophy and sequencing of assessment and treatment of complex posttraumatic/dissociative conditions and disorders.

3. Attendees will be able to identify a variety of treatment strategies and techniques for complex posttraumatic and dissociative conditions and disorders.

4. Attendees will gain an understanding of some of the major transference and counter-transference issues in treatment of complex posttraumatic and dissociative disorders.

Program Outline

I. Complex trauma, Complex PTSD, and dissociation
            a. Conditions related to complex trauma and dissociation
            b. Criteria for Complex PTSD and presentation for treatment
            c. Criteria for Dissociative Disorders
            d. Issues of comorbidity
            e. Is it BPD or Complex PTSD? - and why it matters

II . Assessment
            a. Posttraumatic symptoms: To diagnose them, clinician must recognize them
            b. Dissociative symptoms: To diagnose them, clinician must recognize them
            c. Recommended approaches
            d. Instruments and interviews

III . Treatment: The New Consensus Model of Trauma Treatment
            a. Sequenced
                        1. Usually three stages
                        2. Safety and stabilization first
                        3. With an emphasis on functioning
            b. Titrated
                        1. Intensity and pace geared to the client's resources/deficits
                        2. Differing goals and trajectories
            c. Multimodal
                        1. Bio-psycho-social-developmental treatment
                        2. Different approaches for different issues
            d. Treatment frame issues
                        1. Positive risk management: A defined treatment frame
                        2. Dilemmas in providing treatment to this population
            e. Treating post-traumatic symptoms
                        1. Re-framing symptoms
                        2. Approaches and timing
                        3. Treating specific symptoms
            f. Treating dissociative symptoms
                        1. Techniques for working with dissociation
            g. Treating attachment symptoms
                         1. Attachment/relational styles and impact in treatment
                         2. The role of the therapeutic relationship
            h. Treating affect dysregulation
                        1. Strategies
                        2. The role of the therapeutic relationship
            i. Treating ego deficits/self-impairment and cognitive distortions associated with trauma
                        1. Identifying self/other schema
                        2. Challenging schema and distortions
            j. Treating associated/co-morbid conditions : eating disorders, substance abuse, self-injury, suicidality
            k. The importance of the therapeutic relationship
                        1. Transference and countertransference issues
                        2. Vicarious traumatization and therapist self-care