Dancing with dissociation: Working with dysfunctionally stored elements in EMDR therapy

Dissociative processes are at the heart of the traumatic sequelae, a timeless battle between knowing and not knowing, feeling and not feeling, remembering and not remembering. Representing the polar opposite of an integration, the hallmark EMDR therapy and the AIP model, it not surprising that the greatest number of reported difficulties, clinical problems and potential harm through the improper use of EMDR have involved clients presenting with dissociative disorders (Shapiro, 2001). That being said, the experience of seasoned clinicians specializing in dissociative disorders (e.g., Forgash & Copeley, 2008; Gonzalez & Mosquera, 2012; Knipe, 2015; Manfield, Lovett, Engel, & Manfield, 2017; van der Hart, Groenendijk, Gonzalez, Mosquera, & Solomon, 2014) shows that proper application of EMDR Therapy greatly accelerates and eases the treatment process of this unique population (Shapiro, 2001), providing clients with hope and change. This proposed talk will address two main issues in the psychotherapy of clients suffering from dissociative disorders. The first, in accordance with the EMDR dissociative disorders task force recommended guidelines (Shapiro, 2001), will stress that EMDR for dissociative disorders is best embedded within a total psychotherapeutic approach and not as a standalone therapy. Following this, current guidelines and best practices for the psychotherapy of individuals coping with dissociative disorders will be shortly presented. Next, the talk will present an EMDR Therapy framework for working with dissociative disorders from the perspective of the AIP model and the concept of dysfunctionally stored elements (DSE's; Gonzalez & Mosquera, 2012; Knipe, 2015). DSE’s, as opposed to dysfunctionally stored information (DSI, represented as discrete remembered traumatic events), have been defined as pathological patterns that develop in the context of chronic trauma in childhood and include attachment patterns, pathological defenses, blocking beliefs and dissociative parts of the personality (Knipe, 2015). Through the presentation of case reports, it will be demonstrated how the work with DSE’s is an essential ingredient for change and a central aspect of processing in dissociative disorders, allowing for slow but sure progression towards the traumatic kernel of the events from which dissociation was born from in the first place. Participants will be introduced to different presentations of dissociation within a broader diagnostic context, and suggestions for appropriate pacing methods for each client will be given, with an emphasis on the building of resources, affect regulation and stabilization to support therapeutic change. Next, participants will learn to recognize various DSE’s as “survivor skills” (Barrett & Stone Fish, 2014), or defensive patterns of response (i.e. psychological defenses, dissociative barriers, dissociative parts) that are part of the client’s internal system. Following the perspective that the heart of processing is embedded in the working through of these patterns, methods for resolution and enhancement through the use of EMDR protocols along the different phases of treatment will be demonstrated. Finally, participants will also learn how to enhance information processing in the EMDR therapy of clients presenting with dissociative disorders, through the use of the therapist’s self and the use of clinical interweaves, especially of the somatic type. Following Kluft’s (Kluft, in Shapiro, 2001) recommendation to “expect the unexpected”- common pitfalls in working with clients coping with dissociative disorders will be addressed throughout the talk, with an emphasis on the enhancement of safe recovery for clients.

Conference

English

Keren Mintz Malchi

Malchi, K. M.  (2018, June).  Dancing with dissociation: Working with dysfunctionally stored elements in EMDR therapy. In EMDR psychotherapy in complex cases and dissociation. Presentation at the at the 19th EMDR Europe Association Conference, Strasbourg, France