The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization (Norton Series on Interpersonal Neurobiology) by Hart Onno van der & Nijenhuis Ellert R. S. & Steele Kathy

Author:Hart, Onno van der & Nijenhuis, Ellert R. S. & Steele, Kathy
Language: eng
Format: epub
Publisher: W. W. Norton & Company
Published: 2006-11-16T16:00:00+00:00

PART III

Treatment of Chronically Traumatized Patients

Introduction to Part III

For everything there is a season, and a time for everything under the sun.

—Ecclesiastes (3:1)

She [the night child] was the key and I knew that unless I could integrate the night child with the day child, my nightmare would continue.

—Marilyn Van Derbur (2003, p. 242)

IN THIS PART OF THE BOOK we describe treatment interventions from the standpoint of the theory of structural dissociation in combination with a psychology of action, with a special focus on trauma-related phobias. The resolution of each phobia requires that the patient’s mental level be raised such that higher level adaptive actions can take place, especially integrative actions of synthesis and realization.

In simple PTSD which only includes a rudimentary EP that encompasses hardly more than the traumatic memory, a straightforward application of empirically validated treatment approaches usually suffices. For example, standard treatments include prolonged exposure, cognitive behavioral approaches (Foa, Keane, & Friedman, 2000; Resick & Schnicke, 1993; Follette, Ruzek, & Abueg, 1998; Rothbaum, Meadows, Resick, & Foy, 2000) and EMDR (Chemtob, Tolin, Van der Kolk, & Pitman, 2000; Gelinas, 2003; Power et al., 2002). Treatment for patients with this type of structural dissociation was formulated long ago by Myers following his observations of acutely traumatized World War I combat soldiers:

The treatment to be recommended … consists in restoring the ‘emotional’ [part of the] personality deprived of its pathological, distracted, uncontrolled character, and in effecting its union with the ‘apparently normal’ [part of the] personality. (1940, pp. 68–9)

Myers observed that when this re-integration has taken place in therapy,

it becomes immediately obvious that the ‘apparently normal’ [part of the] personality differed widely in physical appearance and behaviour, as well as mentally, from the completely normal personality thus at last obtained. Headaches and dreams disappear; the circulatory and digestive symptoms become normal; even the reflexes may change; and all hysterical [i.e., dissociative] symptoms are banished. (1940, p. 69)

Patients thus have become much more adaptive in daily life and have been able to realize that their memories of the traumatic experience(s) are a part of their life history, and are not happening now. Indeed, (re)integration of the personality implies increased adaptation to life.

However, these straightforward treatments often fail or are inadequate in more chronically traumatized individuals. A phase-oriented treatment, the standard of care for chronic traumatization (D. Brown, Scheflin, & Hammond, 1998), is considered the most effective approach for these patients. A strong emphasis on skills building and the improvement of the mental level in Phase 1 is essential prior to direct treatment of traumatic memories. Phase-oriented treatment aims to combine the best of therapeutic techniques for improving daily living, for resolving traumatic memories, and helping the patient (re)integrate his or her personality. The field is especially indebted to the pioneers of the contemporary treatment of complex PTSD and dissociative disorders, notably Daniel Brown, Chris Courtois, Catherine Fine, Erika Fromm, Judith Herman, Richard Kluft, Richard Loewenstein, Erwin Parson, Laurie Pearlman, Frank Putnam, and Colin Ross, among others. These clinicians made ground-breaking strides

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