Dissociation : Vol. 6, No. 2/3 (June/Sept. 1993)
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Item Open Access Dissociation : Vol. 6, No.2/3, p. 000 : Cover, table of contents(Ridgeview Institute and the International Society for the Study of Multiple Personality and Dissociation, 1993-06)Item Open Access Dissociation : Vol. 6, No.2/3, p. 077-078 : Guest Editorial(Ridgeview Institute and the International Society for the Study of Multiple Personality and Dissociation, 1993-06) Hart, Onno van der, 1941-Item Open Access Dissociation : Vol. 6, No.2/3, p. 079 : Editorial(Ridgeview Institute and the International Society for the Study of Multiple Personality and Dissociation, 1993-06) Kluft, Richard P., 1943-Item Open Access Dissociation : Vol. 6, No.2/3, p. 080-086 : Diagnosis and clinical phenomenology of multiple personality disorder: a North American perspective(Ridgeview Institute and the International Society for the Study of Multiple Personality and Dissociation, 1993-06) Putnam, Frank W., 1947-Item Open Access Dissociation : Vol. 6, No.2/3, p. 087-101 : The treatment of dissociative disorder patients: an overview of discoveries, successes, and failures(Ridgeview Institute and the International Society for the Study of Multiple Personality and Dissociation, 1993-06) Kluft, Richard P., 1943-The treatment of dissociative disorder (DD) patients with multiple personality disorder (MPD) and allied forms of dissociative disorder not otherwise specified (DDNOS) has advanced rapidly over the last two decades. It is clear that many patients with these conditions can be treated successfully, and several schematizations of the treatment process have been published. However, all studies to date have been open; controlled studies remain to be done. This presentation will review what is known about the treatment of these conditions, however flawed the state of our knowledge, as judged by the criterion of being associated with good clinical results. A number of relevant issues will be discussed.Item Open Access Dissociation : Vol. 6, No.2/3, p. 102-118 : Multiple personality disorder in Europe: impressions(Ridgeview Institute and the International Society for the Study of Multiple Personality and Dissociation, 1993-06) Hart, Onno van der, 1941-Based on his personal knowledge of the field in the Netherlands and on written reports from colleagues in other European countries, the author presents an impressionistic overview of the state of affairs in the field of diagnosis and treatment of MPD in Europe. His main impression is of the relatively advanced state of affairs in the Netherlands, although many problems are still encountered. In Britain a few serious developments take place, but mainstream psychiatry is unsupportive. In other European countries developments lag behind even more, but there are also signs that changes for the better will occur. Special attention is given to a systematic study regarding Swiss psychiatrists’ familiarity with MPD. Finally, a number of lessons for spreading knowledge about MPD and dissociation and for mutual support among MPD clinicians are presented.Item Open Access Dissociation : Vol. 6, No.2/3, p. 119-125 : Multiple personality disorder and the family physician(Ridgeview Institute and the International Society for the Study of Multiple Personality and Dissociation, 1993-06) Hunter, Marlene E. (Marlene Elva), 1931-Although a wealth of knowledge is being accumulated about the whole field of dissociative disorders, very little attention is being paid to relating this information with the role of the family physician. This is unfortunate. Because of his or her unique relationship with the patient, such physicians are in the best position to pick up the warning signals that herald the emergence of dissociative phenomena, and may thus play a significant role in helping the patient to enter appropriate therapy. Symptomatology and phenomenology indicative of a possible dissociative disorder are discussed with reference to complicating health issues and other concerns that may, from time to time, have to be addressed.Item Open Access Dissociation : Vol. 6, No.2/3, p. 126-135 : The differentiation of patients with MPD of DDNOS from patients with a cluster B personality disorder(Ridgeview Institute and the International Society for the Study of Multiple Personality and Dissociation, 1993-06) Boon, Suzette; Draijer, Nel, 1950-Because of similarities in presentation, multiple personality disorder (MPD) and dissociative disorder not otherwise specified (DDNOS) can be misdiagnosed as borderline personality disorder (BPD) or another cluster B personality disorder. In order to find distinguishing symptoms, four groups of patients are compared: DDNOS patients (N=24); MPD patients (N=49); patients with BPD or histrionic personality disorder, referred for evaluation of dissociative pathology (N=21); control patients with a cluster B personality disorder (N=19). All patients were interviewed with the Structured Clinical Interview for DSM-III-R Dissociative Disorders (SCID-D) and the Structured Trauma Interview (STI). Although there are many areas of overlap in the phenomenology of patients with MPD or DDNOS and patients with a "cluster B" personality disorder, we clearly found that these groups can be differentiated by the severity and cluster of dissociative symptoms, the prevalence of some Schneiderian symptoms, and the severity of childhood trauma.Item Open Access Dissociation : Vol. 6, No.2/3, p. 136-144 : Recognition and differential diagnosis of dissociative disorders in children and adolescents(Ridgeview Institute and the International Society for the Study of Multiple Personality and Dissociation, 1993-06) Hornstein, Nancy L.An overview of the literature on dissociative disorders in children and adolescents is presented in a way that highlights the emerging clinical profile of the highly complex behavioral and symptomatic presentation of these conditions in childhood. Developmental influences are recognized as playing a role in the diagnostic challenge of differentiating dissociative disorders from more commonly diagnosed childhood conditions. A systematic approach to evaluation and differential diagnosis is described in detail, and misleading symptomatic manifestations of dissociative processes are identified.Item Open Access Dissociation : Vol. 6, No.2/3, p. 145-161 : The initial stages of psychotherapy in the treatment of multiple personality disorder patients(Ridgeview Institute and the International Society for the Study of Multiple Personality and Dissociation, 1993-06) Kluft, Richard P., 1943-The psychotherapeutic treatment of multiple personality disorder (MPD) places many burdens and demands upon a patient who is already beleaguered if not overwhelmed. Therefore it is useful if not essential to prepare the patient to manage the stresses that treatment may impose before beginning to deal with difficult material. The role of the first stages of the psychotherapy is to prepare a firm foundation for the more intense and draining work that will follow. The initial stages of establishing the psychotherapy and making preliminary interventions provide optimal opportunities to establish the therapeutic alliance, introduce the patient to techniques that will be essential components of the more difficult stages, clarify basic transferential patterns before they have become problematic, address anticipated problems regarding shame and secrecy, foresee likely causes of potential stalemates, and define and resolve problems in therapist-patient collaboration.Item Open Access Dissociation : Vol. 6, No.2/3, p. 162-180 : The treatment of traumatic memories: synthesis, realization, and integration(Ridgeview Institute and the International Society for the Study of Multiple Personality and Dissociation, 1993-06) Hart, Onno van der, 1941-; Steele, Katherine H.; Boon, Suzette; Brown, PaulThis paper is based on Pierre Janet's dissociation theory and his concept of the non-realization of a traumatic event. A model of treatment that integrates Janet's dissociation-integration theory with contemporary trauma-based models of therapy is delineated. The nature of traumatic memories is described, and a stage-oriented model for their treatment in patients with multiple personality disorder (MPD) is presented. Ideally a discrete phase in the overall treatment of MPD, this phase can itself be subdivided into the following stages: (1) preparation; (2) synthesis; and (3) realization/integration. Although a number of treatment recommendations are offered, the emphasis here is more on clarifying concepts than on the description of techniques.Item Open Access Dissociation : Vol. 6, No.2/3, p. 181-187 : Sadistic abuse: definition, recognition, and treatment(Ridgeview Institute and the International Society for the Study of Multiple Personality and Dissociation, 1993-06) Goodwin, Jean, 1946-The term "sadistic abuse" is proposed to designate extreme adverse experiences which include sadistic sexual and physical abuse, acts of torture, over-control, and terrorization, induction into violence, ritual involvements, and malevolent emotional abuse. Individuals with these extreme childhood histories may present with severe and multiple symptoms and a prolonged complicated treatment course. Adherence to basic principles of trauma-based treatment is recommended as is reference to relevant databases which include not only those materials concerning severe child abuse and family violence, but also literatures describing torture, the holocaust, prostitution, pornography and sex rings, cult abuse, and sadistic criminals.Item Open Access Dissociation : Vol. 6, No.2/3, p. 188-192 : The use, misuse, and abuse of art with dissociative/multiple personality disorder patients(Ridgeview Institute and the International Society for the Study of Multiple Personality and Dissociation, 1993-06) Frye, Becky; Gannon, LindaMany MPD patients draw or use expressive outlets either spontaneously or with minimal encouragement. The authors speculate that therapists from various professional orientations, regardless of formal knowledge of art as therapy, are being presented with art products and managing as best they can with little direction. This paper offers the combined perspective of an inpatient occupational therapist and an outpatient clinical social worker. It is a result of our collective professional experience and our reflections about being responsible within the limits of training. We will explore general uses of art by therapists not specifically trained in art as therapy. We will also examine areas in which therapists, whether from inexperience or their own needs, may complicate an already complex and frustrating treatment situation. Finally, we will outline some practical considerations and guidelines for managing art work as a part of therapy.Item Open Access Dissociation : Vol. 6, No.2/3, p. 193-198 : Special treatment techniques to access the inner personality system of multiple personality disorder patients(Ridgeview Institute and the International Society for the Study of Multiple Personality and Dissociation, 1993-06) Fraser, George A.In dealing with the inner personality states in dissociative state disorders, it is necessary to be able to effectively establish a communication bridge between these states and the therapist. For the new therapist this may present a completely foreign concept in therapeutic dialogue. The idea of speaking for the first time with alter personality states may cause some apprehension. But the expectation that the therapist must be able to access the inner personalities may present a major problem that requires guidance for colleagues. Beginning with a few examples of accessing techniques in past centuries, current accessing methods used by most therapists are then discussed. These include formal hypnosis, self-hypnosis, guided imagery, and chemical inductions of trance states such as those induced by the use of sodium amytal. These accessing methods are overviewed with an example of a technique used by the author to illustrate the process of accessing inner personality states.