A Practical, Integrative Approach to Treatment of Clients with Complex PTSD and Dissociative Disorders
A one-day seminar with Kathy Steele, MN, CS
London, November 8, 2016 (Tuesday)
Regent’s Conference Rooms, Regent's University, Inner Circle, London NW1 4NS
Therapists can sometimes feel overwhelmed by the challenges and complex presentations of clients who have been chronically traumatized. This highly practical workshop will offer in-depth skills to understand and work with clients who suffer from Complex PTSD and dissociative disorders. The integrative approach explained in this workshop is drawn from psychodynamic, attachment, affect regulation, neurobiological, hypnotic, and sensorimotor psychotherapy perspectives. Complex developmental trauma is both a physiological and psychological problem, with a need for interventions that address both effectively. A brief overview of the concept of dissociation from the perspective of child development and neuroscience will be provided, as well as an outline of phased or sequenced treatment, which is the current standard of care for these disorders. The need for careful dilution of traumatic memory work in many clients will also be discussed. The following issues will be specifically addressed:
- The inner organization of the highly traumatized client who maintains dis-integration
- How to work systemically to support the individual as a whole person, using approaches that facilitate integration of mind and body
- Specific skills include increasing reflective abilities; approaches to improve daily life functioning; overcoming the phobia of inner experience; improving self and relational regulation; decreasing suicidality and self-harm; increasing the capacity to have positive emotions and experiences; managing dissociation and triggers; containing overwhelming traumatic memory and distressed dissociative self states; grounding; mindfulness, and development of self-compassion
- Trauma-related phobias and their treatment will be described as a central part of treatment, particularly the phobia of inner experience, that is, of emotions, thoughts, wishes, needs, fantasies and body sensations
While techniques are helpful adjuncts to treatment, a consistent and predictable therapeutic relationship is a primary factor in whether and how clients improve. Participants will learn how to maintain optimal relational closeness/distance with clients who simultaneously experience the therapist as both needed and dangerous, as well as how to effectively repair frequent ruptures in the relationship. Ample case examples will illustrate specific approaches and interventions.
About the speaker
Kathy Steele, MN, CS is Clinical Director at Metropolitan Counselling Services, a psychotherapy and training centre, and has been in private practice in Atlanta, Georgia for over three decades. She is also an Adjunct Faculty at Emory University. She is a Fellow and a past President of the International Society for the Study of Trauma and Dissociation (ISSTD), and is the recipient of a number of awards for her clinical and published works, including the 2010 Lifetime Achievement Award from ISSTD. She has numerous publications in the field of trauma and dissociation, including three books. Ms. Steele is known for her humour, warmth, respect, and depth of knowledge as a clinician and teacher, and for her capacity to present complex issues in easily understood and clear ways. She has a foundation in psychodynamic psychotherapy, but has integrated attachment and affect theories, somatic approaches, and many trauma-informed practices in her work.
10:00AM: Session 1: Overview of Complex PTSD and Dissociative Disorders
In the first session, we examine the neurobiological foundations of complex PTSD and Dissociative Disorders. Specifically, we consider:
- Understanding the psychobiological effects of complex trauma as integrative deficits: Dysregulation and dissociation
- Phase oriented treatment: How to organize a rational and relational integrative approach that allows work within the window of tolerance of the client
- Setting mutual treatment goals that are collaborative, and deciding what comes first in treatment
- Developing a relational stance that takes into account disorganized attachment strategies of approach and avoidance
11:30AM: Coffee Break
11:45AM: Session 2: Stabilization Skills
In the second session we focus on specific skills to help clients improve functioning in daily life and engage effectively in psychotherapy as a collaborative partner.
- Basic strategies for daily life: the importance of nutrition, sleep, exercise, daily structure, recreation and play, and social connections
- Four regulation strategies
- o Relational regulation
- o Self regulation
- o Positive emotions and experiences
- o Pacing of therapy
- o Helping clients learn when to use which skills
- Addressing safety
- o Crisis as an attachment cry
- o Crisis as a consequence of dysregulation and dissociation
- o Chronic suicidality
- o Self-destructive behaviours: self-injury, addictions, etc.
1:00PM: Lunch Break (a light lunch is provided as part of the seminar)
1:45PM: Session 3: Treatment interventions
In Session 3 we focus on resolving several major trauma-related phobias and their consequences, and understand resistance in treatment as a protection against what is phobically avoided.
- Overcoming trauma-related phobias: The central roles of fear and shame
- o The phobia of inner experience
- § Learning to normalize, accept, regulate and tolerate inner experience
- § Mentalizing and compassion as strategies to cope with inner experience
- o The phobia of attachment and attachment losso The phobia of adaptive change: “If I change, I will not be myself.”
- § Relational strategies to deal with simultaneous or alternating approach and avoidance
- o The phobia of inner experience
- Resistance as protection
- o A therapeutic stance toward “resistance”
2:45PM: Coffee Break
3:00PM: Session 4: Therapeutic Interventions for complex cases
In Session 4, we will continue with treatment interventions, particularly focused on clients with more serious dissociative disorders, as well as approaches to traumatic memory.
- Ego states versus dissociative self-states: Is it important to know the difference?
- The phobia of dissociative self-states: “Not me, not mine, not real, not true”
- o Working with dissociative self-states in an integrative, step-wise fashion
- The phobia of traumatic memory: Reliving versus remembering
- o Containment strategies
- o Titration of traumatic memory work
- o Relational strategies for grounding, containment, and integration of traumatic memory
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