This video resource pack contains two complete workshops (CPD hours: 11 / CE credits: 11) that cover:

Part 1: Wading Through Mud: Fragmented Minds, Dissociation and Psychosis (Christiane Sanderson,CPD / CE credits: 5)
In the presence of repeated traumatic experiences in which there is no escape, including child sexual abuse (CSA), sibling sexual abuse (SSA), relational trauma or domestic violence; dissociation becomes the default setting, making it hard to remain present in the body. While dissociation is in essence an adaptive response to complex trauma it can lead to a range of dissociative disorders in adulthood, including:

• Depersonalisation
• Derealisation and
• Dissociative Identity Disorder (DID)

As dissociation separates the mind from the body, impairing the integration of experiences and feelings in conscious awareness, it hijacks emotional and cognitive functioning. This gives rise to a range of clinical manifestations including:

• Amnesia and memory lapses, trance like states and slowed down responses
• Rapid shifts in mood and behaviour, confusing shifts in access to knowledge, memory and skills
• Disturbances in sense of self, auditory and visual hallucinations, and imaginary companions

As our clients emotionally shut down, they become disconnected and often experience a deep sense of emptiness, numbness or deadness, which can make them seem unreachable, even in therapy.

They also tend to experience their surroundings as unreal, as though they are in a dream or fog and feel as if their body belongs to someone else. As they become increasingly disconnected from their body they become out of contact with their of emotions, bodily sensations and somatic states, leading to a lack of self-awareness, and concomitant lack of control over their body or behaviour.

This ‘separation’ of mind and body can significantly diminish the client’s ability to create a coherent narrative of trauma, or make sense of what has happened, and is happening to them. In essence, trauma generated dissociation can be chronic and become a default setting, resulting in a disconnection with reality, interpersonal relationships, behaviours and a disconnection within the self.

To enable practitioners to gain a deeper understanding of dissociation, we will examine the nature of trauma generated dissociation, how it manifests in practice, and how it differs from psychosis and schizophrenia. The workshop will highlight the need for accurate assessment and formulation, and how best to work with survivors suffering from dissociation or DID using a trauma informed practice model that emphasises stabilisation, boundaries, pacing, processing of trauma and working with different parts of the personality to aid integration.

The training day will be of interest to counsellors and psychotherapists, health professionals such as psychiatrists, clinical or counselling psychologists, community mental health teams, social workers, safeguarding officers and those in the criminal justice system such as police, probation and prison offices, as well as solicitors.

Specifically, we will discuss:

• What is dissociation and its link to childhood abuse and complex trauma
• The role of trauma generated dissociation in Post-Traumatic Stress Disorder (PTSD), Complex Post-Traumatic Stress Disorder (C-PTSD) and Developmental Trauma Disorder (DTD)
• The continuum of dissociation from everyday dissociation to Dissociative Identity Disorder (DID)
• How dissociation differs from psychosis or schizophrenia
• The symptoms of dissociation in depersonalisation, derealisation, dissociative fugue and Dissociative Identity Disorder
• The role of shame in dissociation
• The impact of dissociation on the sense of self, self-identity and relationships
• The hallmark signs of dissociation in session and how to manage these
• How to Identify the triggers to dissociation
• The lived experience of dissociation
• The role of grounding, stabilisation and integration
• The challenges faced by practitioners when working with dissociative disorders
• Somatic Countertransference and the practitioner’s own capacity to dissociate

Part 2: Healing the Divided Mind: A Practical, Integrative Approach to Working with Dissociative Clients (Kathy Steele, CPD / CE credits: 6)
The overall objective of the workshop is to learn practical skills, which can help improve our client’s functioning in daily life and cultivating our client’s ability to engage as a collaborative partner in therapy. Through a series of clinical vignettes, we, as participants at this workshop will learn a wide range of interventions to stabilize clients prior to working with traumatic memories. Trauma-related conflicts and phobias, especially the phobia of inner experience (i.e., thoughts, emotions, sensations, memories, wishes, needs), will be addressed, and their treatment will be described as a central part of therapy. Also, we will explore specific avoidance defences that are common in these clients and learn compassionate approaches to resolve them.

Our learning objectives at this workshop are:

• Apply at least five interventions to help clients overcome trauma-related phobias: The central roles of fear and shame
  • The phobia of inner experience
    • Learning to normalize, accept, regulate and tolerate inner experience
    • Mentalizing and compassion as strategies to cope with inner experience
  • The phobia of attachment and attachment loss
    • Relational strategies to deal with simultaneous or alternating approach and avoidance
  • The phobia of adaptive change: “If I change, I will not be myself.”
  • The phobia of dissociative self-states: “Not me, not mine, not real, not true”
    • Working with dissociative self-states in an integrative, stepwise fashion which emphasises the integrity of the whole person
  • The phobia of traumatic memory: Reliving versus remembering
    • Containment strategies
    • Titration of traumatic memory work
  • Relational strategies for grounding, containment, and integration of traumatic memory
• Identify and help the client resolve specific conflicts that are common in developmental trauma
• Identify interventions to help resolve the client’s disorganized (dissociative) attachment style
• Apply interventions to improve stabilization by working with dissociative parts of self
• Identify common avoidance defences in clients who are dissociative and employ interventions to resolve them

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.