Dissociation

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https://hdl.handle.net/1794/1129

The official journal of the International Society for the Study of Trauma and Dissociation (ISSTD), published between 1988 and 1997. The current official journal of ISSTD is the Journal of Trauma & Dissociation. Members of the University of Oregon community can access the Journal of Trauma & Dissociation online.

A print copy of this journal is available through the UO Libraries under the call number: KNIGHT RC553.D5 D57

We appreciate the support for this digitization project by Jennifer Freyd, PhD; Frank Putnam, MD; Richard Kluft, MD; Catherine Fine, PhD; Ruth Blizard, PhD; and ISSD.

If errors are found in any file or the description of any file, users are kindly requested to contact the Scholars' Bank Coordinator, at the University of Oregon Libraries.

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Open Access
Dissociation : Volume 10, No. 4, p. 191 : Guest editorial
(Ridgeview Institute and the International Society for the Study of Dissociation, 1997-12) Chefetz, Richard A.
Open Access
Dissociation : Volume 10, No. 4, p. 230-239 : Desperately seeking attachment: a psychoanalytic reframing of the harsh superego
(Ridgeview Institute and the International Society for the Study of Dissociation, 1997-12) Howell, Elizabeth F., 1946-
This article presents a new model of superego organization that is dissociation-based. Clinicians often work intuitively with the harsh superego as if it were a dissociated internal persecutory fragment or self-state, even though theory has not provided a clear conceptual basis for this kind of approach. Despite differing theoretical understandings of the nature and origins of the harsh superego, there appears to be consensus that the harsh superego is best approached therapeutically with the aim of softening its hold. Although the term superego is commonly used, its meanings are not always clear. Superego is understood both as a source of psychopathology and as a moral agency. Understood as psychopathology, the meaning of superego is problematic, as the theoretical model of superego frequently differs radically from the clinically observed phenomena. Understood as morality, the meaning of superego is also unclear in that it can be relativistic and subject to corruption (Kohlberg, 1971; Sagan, 1988). In addition, the interrelationships of these two meanings can be confusing. This article begins by describing some of the problems in the superego construct. It then recasts this construct in terms of attachment theory and dissociation. It is proposed that in many cases harsh superego may be understood more usefully in terms of dissociation than in terms of the structural model and the Oedipus construct. There may be reasons in the history of psychoanalytic theory that have obscured this possibility. The role of attachment in superego and moral development (Schore, 1997; Lewis, 1981, 1983; Wilson, 1983) is emphasized. It is proposed that it is the attachment, not the rule-following in itself, that is moral. The implications of this model for working more effectively with self-punitive and self-critical behavior are addressed.
Open Access
Dissociation : Volume 10, No. 4, p. 266-267 : Editorial
(Ridgeview Institute and the International Society for the Study of Dissociation, 1997-12) Kluft, Richard P., 1943-
Open Access
Dissociation : Volume 10, No. 4, p. 240-245 : Masochism: a bridge to the other side of abuse
(Ridgeview Institute and the International Society for the Study of Dissociation, 1997-12) Howell, Elizabeth F., 1946-
Masochism is a useful and meaningful term that can and should be rescued from the theoretical morass in which it has been buried. Victim-blaming connotations stemming from its historical linkage to the motivational concept of pleasure in pain disappear when masochism is reframed as an outcome of dissociation rather than of volition. In concert with an ever-increasing understanding of the centrality of dissociation in various types of psychopathology (Ross, 1986; Beahrs, 1982; Davies & Frawley, 1994; Putnam, 1997; Waites, 1993; Watkins & Watkins, 1997), this article presents a view of masochism as dissociation-based. It also describes the emergence of masochism from attachment need (specifically, attachment to the abuser); and how the interaction of attachment need with dissociation is at the heart of the syndrome. It then shows how masochism contains the seeds of its own transcendence. Recent research (Dell, 1997) and theory (Blizard, 1997; Blizard & Bluhm,1994) suggest that Dissociative Identity Disorder (DID) and Dissociative Disorder NOS (DDNOS) are heavily laden with masochistic (self-defeating) psychopathology. Although masochism is not limited to these diagnoses, dissociative processes appear to be central to the development of masochistic psychopathology.
Open Access
Dissociation : Volume 10, No. 4, p. 223-229 : The origins of dissociative identity disorder from an object relations and attachment theory perspective
(Ridgeview Institute and the International Society for the Study of Dissociation, 1997-12) Blizard, Ruth A.
When a child is utterly dependent for survival on a parent or caregiver who is abusive, the child faces an extraordinary dilemma in finding a way to preserve the attachment to the caregiver while trying to survive terrifying abuse. Concepts from object relations and attachment theories will be integrated with current thinking about trauma and dissociation to develop a theory of why multiple identity states are created by the child to survive this paradox. According to this view, alter personalities may be understood as over-elaborations and personifications of internalized, split, self and object representations. Because of the severity of trauma, these were kept separate and dissociated in order to preserve both the self and the attachment to the "good" aspects of the caregivers while allowing the child to survive by maintaining functioning relationships with the "bad" aspects of the caregivers. Understanding the origins of these personality states in childhood object relations can help to elucidate the dynamics of the relationships within the system of personalities in adulthood. They can also clarify the purpose of reenactment of abuse, whether between two self states, or in external relationships. These principles are illustrated with a case example.
Open Access
Dissociation : Volume 10, No. 4, p. 214-222 : Dancing the dance with dissociatives: some thoughts on countertransference, projective identification and enactments in the treatment of dissociative disorders
(Ridgeview Institute and the International Society for the Study of Dissociation, 1997-12) Baker, Su
Therapists working with dissociative patients, with their complex, overlapping transferences, frequently encounter countertransference conundrums. Further complications arise as the dissociative patient frequently uses the defense of projective identification, whereby the therapist is left "holding the bag," experiencing the patient's unwanted feelings or unacceptable impulses. Patient and therapist become the inevitable participants in transference enactment, each unwittingly playing a role written from the patient's past. However, projective identification and enactment may both be viewed as a powerful type of communication, allowing the therapist to understand the experience of the patient in a uniquely empathic way. By creatively welcoming inevitable enactment, the playing out of the patient's unconscious dynamics in the therapy, the therapist and patient can work through otherwise uninterpretable clinical material. This paper proposes that in the transpersonal field of therapy with dissociative patients, therapist and patient, "dancing together," can rework old patterns and arrive at new, deeper understanding and change. Case material is presented to illustrate this thesis.
Open Access
Dissociation : Volume 10, No. 4, p. 203-213 : Abreaction: baby or bathwater?
(Ridgeview Institute and the International Society for the Study of Dissociation, 1997-12) Chefetz, Richard A.
Abreaction refers to the discharge of pent-up affect through spoken language that relieves pathogenic intrapsychic tensions which are residua of trauma (Laplanche, 1967; Moore, 1990). This definition is inadequate and mired in Freud's early models of the mind, both the hydraulic and topographic models, and nineteenth century models of hypnosis. Abreaction may more usefully be defined as the verbal or non-verbal expression of intense affect, which when associated with a coherent narrative of experience, may provide relief of chronic anxiety states. Affect is the centerpiece of experience. It is the prime contextualizer of meaning. Ego mechanisms of defense all alter the meaning of experience in an effort to reduce threats to psychological equilibrium. The destruction of context and meaning via dissociative adaptations is an effective and primitive mechanism of protection from both external impingement and internal conflict. Isolation of affect (Freud, 1955), is a dissociative process. It is important to understand that dissociative phenomena do not bypass ego functions. Post-traumatic adaptations may include a profound secondary alexithymic state. This may seem hidden in the wake of powerful affective storms. The affect-phobic nature of the person prone to abreaction is a major impediment to treatment. The primary task of treatment is stabilization of the patient prior to "working through" the sequelae of trauma. The mid-phase of treatment may involve continued psycho-educational efforts to identify and name affects, the use of "dream-rules" in the interpretation of abreactive narrative, and a utilization approach which welcomes affect into the treatment setting in a safe, skilled environment. Management of countertransference responses to avoid enactment which could lead to boundary violations is essential.
Open Access
Dissociation : Volume 10, No. 4, p. 246-254 : Therapeutic alliance with abuser alters in DID: the paradox of attachment to the abuser
(Ridgeview Institute and the International Society for the Study of Dissociation, 1997-12) Blizard, Ruth A.
Abuser alters present a dilemma in the treatment of adults with dissociative identity disorder, because they often undermine the therapy as well as re-abuse the patient. They are paradoxical because they were created to help the child survive abuse, but continue to do so by abusing the self. They were often modeled after an abusive primary caretaker to whom the child was attached. Object-relations and attachment theories clarify how creation of the abuser personality serves to preserve the attachment to the abusing caretaker. By understanding how abuser alters function to maintain attachment, contain overwhelming memories, and protect against abuse, therapists can better engage abuser alters in a therapeutic alliance. Empathy, cognitive reframing, and gentle paradoxical techniques can help host and abuser personalities become more empathic toward one another, develop common purpose, and begin integrating. By working through the transference, attachment to the internalized abusive caretaker is replaced by a healthy attachment to the therapist in the therapeutic alliance.
Open Access
Dissociation : Volume 10, No. 4, p. 000 : Cover, table of contents
(Ridgeview Institute and the International Society for the Study of Dissociation, 1997-12)
Open Access
Dissociation : Volume 10, No. 4, p. 255-265 : Special case transferences and countertransferences in the treatment of dissociative disorders
(Ridgeview Institute and the International Society for the Study of Dissociation, 1997-12) Chefetz, Richard A.
While transference paradigms tend to be unique to each patient's situation, there are repetitive themes in the treatment of survivors of severe abuse which manifest themselves relentlessly. These over-arching exemplars describe the erotic and traumatic nature of abusive experiences. A thorough understanding of these situations is necessary to facilitate a positive outcome in the treatment of persons with dissociative disorders. Non-dynamic approaches to psychotherapy may be especially vulnerable to mistakes and missteps when erotic and traumatic transference themes are robustly present. The vicissitudes of the erotic and traumatic transferences are explored from a psychoanalytic perspective and a vignette is provided for explication of the theoretical material presented.
Open Access
Dissociation : Volume 10, No. 4, p. 192-202 : Expanding the psychoanalytic view of the intrapsychic: psychic conflict in the inscape
(Ridgeview Institute and the International Society for the Study of Dissociation, 1997-12) O'Neil, John Allison
Dissociation theory and psychoanalysis have to some extent emerged as conflicting paradigms to explain mental illness, a conflict which perhaps reaches its peak over the Oedipus Complex . Psychoanalytic theory has generally been unable to accommodate itself to dissociation, and psychoanalysts have instead relegated it to the status of historical curiosity or mistake, tried to assimilate it into more conventional psychoanalytic theory, or neglected it altogether. There is thus a paucity of psychoanalytic accounts of many dissociative themes, and, when present, they are generally misrepresented . Dissociative pseudo-hallucinations and other inter-alter communications are generally misinterpreted as psychotic phenomena, flashbacks as conversion symptoms, and inscapes (internal landscapes) as the world of internal object relations . Two cases of DID illustrate classic oedipal conflict played out in the inscape. The paper concludes that traumatic etiology and oedipal conflict need not be contradictory; that multiplicity cannot be assimilated by current psychoanalytic theory; that current psychoanalytic theory remains pertinent to the treatment of all patients, including dissociative ones.
Open Access
Dissociation : Volume 10, No. 3, p. 139-140 : Editorial
(Ridgeview Institute and the International Society for the Study of Dissociation, 1997-09) Kluft, Richard P., 1943-
Open Access
Dissociation : Volume 10, No. 3, p. 000 : Cover, table of contents
(Ridgeview Institute and the International Society for the Study of Dissociation, 1997-09)
Open Access
Dissociation : Volume 10, No. 3, p. 141-147 : Case study of a Puerto Rican woman with dissociative identity disorder
(Ridgeview Institute and the International Society for the Study of Dissociation, 1997-09) Martinez-Taboas, Alfonso, 1953-; Rodriguez-Cay, Jose R.
In this case-study the authors present how a typical case of Dissociative Identity Disorder (DID) is treated by two clinicians working with Puerto Rican patients. In the following case, a 28-year-old female patient with DID was treated utilizing a three stage process treatment. In the first stage, the authors confirmed the diagnosis and tried to contact the principal alter identities. The aim here is to try to make a contract and commitment with the patient and her alters about the importance of the therapeutic process. In the second stage, a lot of work was done to debilitate her dissociative defenses and substitute them for more mature ones . Also, pharmacotherapy was initiated during this period. In the last stage, we mainly used cognitive, behavioral, and experiential therapies to consolidate her new self. The authors present clinical and social evidence that sustain their opinion that the patient made striking progress during and after treatment.
Open Access
Dissociation : Volume 10, No. 3, p. 174-181 : Paranormal and dissociative experiences in Middle-Eastern Jews in Israel: diagnostic and treatment dilemmas
(Ridgeview Institute and the International Society for the Study of Dissociation, 1997-09) Somer, Eliezer, 1951-
Four Israeli Jewish persons of Middle Eastern cultural heritage presented for consultation following unsuccessful helping attempts delivered by various folk and spiritual healers. The four patients suffered from the following DSM-IV defined problems: Post-traumatic Stress Disorder, Dissociative Disorder not Otherwise Specified, Schizophrenia-paranoid type, and Histrionic Personality Disorder coupled with a Conversion Disorder with Seizures. The patients construed their suffering in cultural idioms implicating supernatural experiences. Many of their symptoms resembled dissociative clinical pictures. However, unlike many dissociative disorder patients described in the Western scientific literature, these persons refused to accept any of their possession-like experiences as possible manifestations of their own dissociated ego-states. The paper describes the struggle to find common ground on which significant cross-cultural help could be offered to indigenous people manifesting dissociative and other symptomatology.
Open Access
Dissociation : Volume 10, No. 3, p. 182-189 : Successful integrated hypnotic and psychopharmacological treatment of war-related post-traumatic psychological and somatoform dissociative disorder of two years duration (psychogenic coma)
(Ridgeview Institute and the International Society for the Study of Dissociation, 1997-09) Cagiada, Silvana; Candido, Luigi; Pennati, Ambrogio
This report describes the treatment of Basile, a young African boy who slipped into what might best be described as a psychogenic coma with numerous additional dissociative features of two years' duration after having been kidnapped by bandits and witnessing the wounding and death of a friend who had been kidnapped with him. His treatment by a team of mental health professionals who used psychopharmacology, hypnosis in many forms, and a computer in connection with both hypnotic metaphors and the expressive potential of a graphics program is recounted. Despite profound and longstanding impairment, Basile was able to recover and resume his education. The authors conclude that such patients, despite their complexity and duration, may be accessible to a systematic and determined approach to therapy that mobilizes numerous resources and modalities on their behalf.
Open Access
Dissociation : Volume 10, No. 3, p. 148-156 : Treatment of dissociative identity disorder in Turkey: a case study
(Ridgeview Institute and the International Society for the Study of Dissociation, 1997-09) Sar, Vedat; Tutkun, Hamdi
A 45-year-old housewife diagnosed with DID was treated for 27 months. This patient, one of the first DID cases diagnosed at Istanbul Medical Faculty Hospital, was initially treated mainly under inpatient conditions (six months total hospitalization in three successive admissions). She reached fusion in eight months. The initial presentation form of the patient raised important questions about the interrelationships of hysterical psychosis, childhood trauma, and DID.
Open Access
Dissociation : Volume 10, No. 3, p. 166-173 : Working with dissociative identity disorder in Stavanger, Norway
(Ridgeview Institute and the International Society for the Study of Dissociation, 1997-09) Hove, Ingunn; Langfeldt, Tone Sem; Boe, Tor; Haslerud, Jan; Stoerseth, Francoise
The article gives a short review of how knowledge and competence on dissociative disorders have developed in Stavanger, Norway. The main part of the article describes two patients with dissociative disorders. The first of these cases describes a middle-aged female patient with a long psychiatric history with different psychiatric diagnoses. She was the first among our patients to get the MPD diagnosis in 1992. The other case presents a young man diagnosed with DDNOS during his first stay in the psychiatric department in 1993. The diagnosis later on was changed to MPD. Their treatments within the Norwegian mental health system are illustrated.
Open Access
Dissociation : Volume 10, No. 3, p. 157-165 : Treatment strategies for complex dissociative disorders: two dutch case examples
(Ridgeview Institute and the International Society for the Study of Dissociation, 1997-09) Hart, Onno van der, 1941-; Boon, Suzette
In the Netherlands, the diagnosis of dissociative identity disorder (DID) is widely accepted, although skeptics also have made their opinions known. Dutch clinicians treating DID patients generally follow the common three-phase model for treatment of post-traumatic stress. Given the fact that they usually deal with complicated cases and enmeshed patients (cf. Horevitz E. Loewenstein, 1994), most often treatment is restricted to Phase 1: stabilization and symptom reduction. Treatment of higher functioning patients, on the other hand, usually aims at processing of traumatic memories and complete personality integration as well. In this article, two Dutch cases are described in detail, with a special emphasis on the clinical deliberations which, in the first case, led to the decision to proceed to trauma treatment, and which led in the second case to the decision to refrain from it.
Open Access
Dissociation : Volume 10, No. 2, p. 104-113 : The 19th century DID case of Louis Vivet: new findings and re-evaluation
(Ridgeview Institute and the International Society for the Study of Dissociation, 1997-06) Faure, Henri; Kersten, John; Koopman, Dinet; Hart, Onno van der, 1941-
Although not the first patient to be described as a multiple, the French patient Louis Vivet was the first to be explicitly named a multiple personality at the end of the 19th century. Recent critics have disputed the validity of the diagnosis or the number of alter personalities in this widely publicized case, by stating that his alter personalities were iatrogenically created, or by giving credit only to the first publication on Vivet, pertaining to his stay at the asylum of Bonneval during 1880-1881 (Camuset, 1882). The senior author of the present paper recently discovered Vivet's original medical file bearing on the same period. Comparing both sources, we conclude that Vivet manifested at least three personality states during this period and that there is no firm evidence that his situation was iatrogenic.