Overview of the Content of this 2 day Seminar

Associate Professor Middleton will focus on the sorts of things he would have most appreciated in relation to an Australian perspective when he was originally grappling with the numerous challenges concerning individuals with dissociative disorders. 

While some such issues are ones that are regularly addressed in seminars on dissociative disorders, others concern things that are not so commonly covered.  In particular, he will convey something of the personal challenges the therapist faces at the intrapsychic but also at the professional level, including the sorts of intense transference/countertransference that can be encountered, the slippery slope to boundary violations, the need to remain grounded and with professional supports, and all the while maintaining care not to go beyond verifiable data in constructing either therapy or theory. 

Warwick will convey a perspective on how dissociation fits in the spectrum of mechanisms that humankind has routinely used in order to "not know" of things that would be overwhelming or markedly discomforting.  Such a perspective leads logically to a consideration of the nature of selfhood, something that embodies self-knowledge, self-reflection, a focus on personal responsibility and the will to grow by confronting that which is painful or difficult. 

The 8 sessions of this 2 day seminar will cover the following topics:

• A World View of Individual Trauma
• Traversing the History of Dissociative Disorders
• The Self and its Boundaries
• Dissociative Disorders and the Neurosis-Psychosis continuum
• The Focus, Objectives and Staging of Therapy
• Specific therapeutic techniques / particular therapeutic challenges
• Memory, Trauma and Dissociation
• The Personal Challenges of Treating Dissociative Patients

A World View of Individual Trauma

• A perspective informed by evolutionary psychology on attachment, narcissism and man's mechanisms of 'not knowing'.
• A world backdrop: the sorts of environments and experiences that produce dissociative defences, including considerations of predators, paedophilia, incest/familial child abuse, church/institutional abuses and nature of the national psyche.
• Perspectives on the histories of child rearing practices, the recognition of trauma and abuse syndromes, the growth of democracy and civil rights movements, feminism.

Traversing the History of Dissociative Disorders

• Dissociation viewed against the backdrop of a progressive but patchy advance in child rearing practices and in the understanding of trauma related syndromes.
• The early history of ‘dual' or ‘multiple personalities', Despine, Breuer, Freud, Janet, Prince, Bleuler, Myers, Rivers, Thigpen and Cleckley, Ellenberger, Bowlby, Winnicott and others.
• The later history of dissociative disorders, multiple personality disorder, dissociative identity disorder, DSM-III/DSM-IIIR/DSM-IV, Wilbur, Bliss, Kluft, Putnam, Ross, Chu, Briere, van der Hart, Nijenhuis, Freyd and others.
• North America from the mid-70's, diagnostic criteria, publications and journals, establishment of specialised treatment programs, ritual abuse controversies, the backlash, psychotherapy on trial, the evolving international nature of the field.
• The Australian history of the dissociative disorders field.

The Self and its Boundaries

• Life narrative, affective stability, self-activation, ability to sustain a relationship, intimacy, the capacity to feel, self esteem, the ability to empathise, autonomous functioning, mature defences.
• Boundaries: boundary violations, boundary crossings.
• A short history of the evolution of the concept of therapeutic boundaries.
• The centrality of boundary issues to understanding the nature of the environments associated with the genesis of dissociative disorders.

Dissociative disorders and the neurosis-psychosis continuum

• The spectrum of dissociative symptomatology.
• Hallucinations as dissociative phenomena.
• The role of trauma in the genesis of psychosis.
• Schneiderian first rank symptoms, schizophrenia and dissociative
  disorders.
• Kraepelin, Bleuler, Schneider, Read, Ross - conceptualizing schizophrenia.
• The assessment of dissociative disorders.

The Focus, Objectives and Staging of Therapy

• The three stage model of therapy.
• Safety, the work of therapy (including the processing of trauma), mourning, integrated functioning, follow-up.
• Personal responsibility, empathy and the therapeutic alliance.
• Awareness of transference, counter transference and Karpman's Triangle.
• Avoidance of rescuing and ‘specialness'.

Specific therapeutic techniques / particular challenges

- Dealing with alters/dissociative ego states.

• Maintaining and emphasising a focus on the emergence of individual selfhood.
• Self-harming, addictions and suicidality.
• Dealing with the repetition compulsion.
• Cognitive restructuring.

-Involvement of partners.

• Medication.
• Stances taken with perpetrators/legal issues.

-The issue of hospitalisation and day programmes.
-The importance of therapeutic competence, consistency and clearly modelled boundaries.

Memory, Trauma and Dissociation

• The nature of memory and the particular nature of traumatic memory.
• Dissociative amnesias in the context of the full spectrum of traumatised patients.
• Child abuse, betrayal trauma and the recovered memory controversy.
• Recovered memories; politics, polarisations, dichotomous thinking and common ground.
• Hallucinations, pseudohallucinations, flashbacks and re-enactments viewed as manifestations of traumatic memory.
• Professional position statements and the concept of therapeutic neutrality.

The Personal Challenges of Treating Dissociative Patients

• Monitoring transference.
• Countertransference, seduction, hate, hostile dependency, idealisation, distrust, testing behaviours and the 'double bind'.
• Vicarious traumatisation, peer support and supervision.
• Paradigm change.
• Narcissism.
• Collaborative treatment models