Treatment of Dissociative Disorders  by  Suzette Boon, PhD

EMDR Adelaide

Assessment and Treatment of Trauma and Dissociative Disorders

Suzette Boon, PhD, is a clinical psychologist and psychotherapist working in private practice in Maarssen, the Netherlands. She was the co-founder and first President of the European Society for the Study of Trauma and Dissociation. Suzette has over 30 years of experience in working with clients with PTSD, Complex Trauma and she is especially skilled in assessment and treatment of dissociative disorders.Since the late eighties, Suzette has specialised in the diagnosis and treatment of clients with histories of early psychological trauma and complex dissociative disorders. Suzette has developed a skills training manual for clients with a complex dissociative disorder, together with Kathy Steele and Onno van der Hart. Her book Coping with Trauma-Related Dissociation: Skills Training for Patients and Therapists (by Suzette Boon, Kathy Steele, Onno van der Hart) was the winner of the 2011 International Society for the Study of Trauma and Dissociation Pierre Janet Writing Award. She is co-author of Treating Trauma-Related Dissociation, a practical integrative approach (Steele, Boon &amp; Van der Hart, 2017). Suzette developed, with Helga Matthess, the Trauma and Dissociation Symptoms Interview (TADS-I). The TADS-I is a clinician administered semi-structured interview to assess dissociative symptoms and other trauma-related symptoms. The main objective of the TADS-I is to assess the severity and quality of dissociative symptoms and other trauma-related symptoms. Taking the interview should primarily lead to a statement about the presence of a dissociative disorder.<h3>Webinars 1 and 2</h3>Understanding dissociation and complex dissociative disordersDissociative disorders are often not assessed for the following reasons:1. Definitions on dissociation differ and are not always clear. Some clinicians consider dissociation a phenomenon that exists on a continuum (from ‘normal to pathological’) others consider dissociation a phenomenon that is always pathological and refers to a division of self.2. Clients generally do not present with dissociative symptoms but have a tendency to hide or dissimulate these symptoms.2. There is a lot of overlap with other disorders such as complex PTSD and cluster B personality disorders.3. Differential diagnosis from psychosis and bipolar disorder may be difficult.3. Main classification systems (DSM and ICD) differ with respect to dissociative disorders.4. Clinicians do not receive systematic education with regards to diagnosis and treatment of dissociative disorders. 5. There is an ongoing polarised debate about the existence of DID as a reliable and valid diagnosis.As a consequence of poor recognition of dissociative symptomatology, these clients may spend many years in the mental health system, often with different diagnoses, without being treated for their core problems. In addition, if dissociative pathology is not assessed or recognised, treatment of traumatic memories may be a risk, or too early and result in decompensation of the patient. On the other hand, there is a danger of over-diagnosing and false positive cases as both clients as well as therapist sometimes get confused about the symptoms.Webinar 1: 5th of February 2021 from 6pm to 8pm AEDTSuzette will clarify the concept and definition of dissociation. She will describe and clarify pathological dissociative symptoms as found in complex dissociative disorders. Transcripts from interviews with clients and some video clips will form part of the presentation.Webinar 2: 12th of February 2021 from 6pm to 8pm AEDTSuzette will discuss differential diagnoses in particular with, psychosis, BPD and other personality disorder and complex PTSD. She will also talk more about differentiating dissociative parts from ego stated and ‘modes’ as used in Schema therapy.<h3>Webinars 3 and 4 and 5</h3>After the Diagnosis, What Next?Challenges and treatment interventions in phase 1 of the treatment of complex dissociative disorders.Phase-oriented treatment, the accepted standard of care for dissociative disorders, stresses the need for careful pacing and regulation of arousal, because many dissociative clients have many debilitating symptoms, are especially prone to regulatory difficulties, and lack essential life skills. The first phase of therapy is thus focused on symptom reduction, stabilisation, and skills building. Therapists often have many questions about this phase: •	How do I prioritise and begin treatment? •	How do I engage a patient who desperately demands help, but also views me with distrust and fear? •	How do I manage the therapeutic relationship? •	How can I be in charge of the therapy while still making it a collaborative effort with the patient? •	How do I work with different kinds of dissociative parts, such as extremely dependent, avoidant, angry, or persecutory ones? •	How do I keep the focus of the whole person in a very complicated therapy in which I must work with parts? What are the major pitfalls in phase 1? These and many other questions may arise in the first phase. The work that has to be done is not just teaching a ‘toolbox with techniques’. Techniques are helpful but more important is developing a working alliance with all parts of the patient including aggressive or hostile parts. In webinar 5, Suzette will discuss a checklist to evaluate if a patient is ready for phase 2 work such as:•	How much stabilization work do we actually need in order to continue to phase 2? •	And if a patient is ready, where do you start? Webinar 3: 19th of February 2021 from 6pm to 8pm AEDTSuzette will focus on challenges in the therapeutic relationship. Webinar 4: 26th of February 2021 from 6pm to 8pm AEDTSuzette will focus on working with dissociative parts in particular parts that are hostile against self and the therapy. Webinar 5: 5th of March 2021 from 6pm to 8pm AEDTSuzette will focus on helpful stabilising techniques for dissociative parts and make a start with preparation for phase 2 work.<h3>Webinar 6</h3>The treatment of traumatic memories and beyondAfter phase 1, focusing on stabilisation and symptoms reduction, in phase 2 the focus turns to working with memories of traumatic experiences. Effective work in this phase involves remembering, tolerating, processing, and integrating overwhelming past events. Questions and challenges may be•	How do you plan and schedule the sessions?•	What is needed to maintain safety during this phase? •	How can clients contain their feelings if the work becomes too intense? •	How do we know that a memory is sufficiently integrated? In this webinar Suzette will discuss several techniques to integrate traumatic memories. Special focus will be on the ‘guided synthesis technique’ (Boon &amp; van der Hart, 1995; Van der Hart, Nijenhuis &amp; Steele, 2006; Steele, Boon &amp; Van der Hart, 2018). Some short video clips will be included. Phase 3, integration, and rehabilitation will be mentioned shortly at the end of this webinar.Webinar 6: 19th of March 2021 from 6pm to 8pm AEDTSuzette will focus on the treatment of traumatic memories ---------------------------------------------------------When:Webinar 1 - 5th of February 2021, 6pm to 8pm AEDTWebinar 2 - 12th of February 2021, 6pm to 8 pm AEDTWebinar 3 - 19th of February 2021, 6pm to 8pm AEDTWebinar 4 - 26th of February 2021, 6pm to 8pm AEDTWebinar 5 - 5th of March 2021, 6pm to 8pm AEDTWebinar 6 - 19th of March 2021, 6pm to 8pm AEDTWhere:Online via a Zoom meeting linkCosts:$450 including GST for all 6 webinarsRecording will be avilable for 3 months after the date of each webinarRefund policy: We will respond to attendee refund requests on a case by case basis. Attendees can receive refunds before the event start date. The registration fee will be deducted from the full payment, as it has organized by a third party.Literature:Boon, S., Steele, K., &amp; Van der Hart, O. (2011). Coping with Trauma-Related Dissociation: Skills training for patients and therapists. New York/London: W. W. Norton &amp; Co.Steele, K., Boon, S., &amp; Van der Hart, O. (2017). Treating Trauma-Related Dissociation, a Practical, Integrative Approach. New York/London: W. W. Norton &amp; Co.

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