Dissociation: The key to understanding and treating traumitization

A precise understanding of trauma-related dissociation is essential for clinical practice, including the use of EMDR with traumatized patients. The existence of many conflicting and vague definitions of dissociation that include a mixture of constructs has obscured understanding of the nature of dissociation. Thus, it is viewed alternately as a process, a structure, a defense mechanism, a deficit, and as various symptoms. Most contemporary clinicians and researchers working with traumatized people have lost a connection with the unifying and comprehensive theory of trauma-related dissociation already outlined over the course of the history of psychiatry. Thus, a return to the original major studies on trauma-related dissociation is essential in clarifying the concept of dissociation, in reconciling it with contemporary science, and in realizing its importance in treatment. The works of two Masters will be used to highlight this basic concept: Pierre Janet (1859-1947) and Charles Myers (1873-1947). The theory of structural dissociation of the personality integrates their original views on dissociation with modern findings from clinical practice and research and developments in the neurosciences. It emphasizes that the personality system of the trauma survivor becomes structurally divided into two or more self-conscious psychobiological subsystems. Some of these subsystems, which we have called “dissociative parts of the personality”, are engaged in daily living and avoidance of traumatic memories, other parts are fixated in traumatic experiences and essentially engaged in animal defensive actions toward perceived danger. More severe chronic traumatization leads to more complex structural dissociation, and thus to more complex trauma-related disorders. Although short-term, intensive treatments such as prolonged exposure and EMDR are appropriate for simple trauma-related disorders, a phase-oriented treatment is the standard of care formore complex disorders. Regardless of treatment modalities employed, be it EMDR or other approaches, therapists need to be skilled in the recognition of symptoms of dissociation and in special treatment approaches that support personality integration among dissociative parts, particularly in working with traumatic memories.

Conference

English

Onno van der Hart

van der Hart, O. (2007). Dissociation: The key to understanding and treating traumitization. Keynote presented at the 8th EMDR Europe Association Conference, Paris, France