Dissociation : Vol. 2, No. 2 (June 1989)
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Item Open Access Dissociation : Vol. 2, No. 2, p. 116 : Book review(Ridgeview Institute and the International Society for the Study of Multiple Personality and Dissociation, 1989-06) Fink, David L.; Putnam, Frank W., 1947-Item Open Access Dissociation : Vol. 2, No. 2, p. 110-115 : Multiple personality disorder and homicide: professional and legal issues(Ridgeview Institute and the International Society for the Study of Multiple Personality and Dissociation, 1989-06) Hall, PamelaUnfortunate complexities encountered during the treatment of a 49 year old male with diagnosed multiple personality disorder (MPD) are described. Treatment sessions extending over a one year period were abruptly terminated after the patient's murder of his live-in girlfriend. Clinical hypotheses regarding the mechanism of the dissociation which occurred prior to and ensuing the killing are presented. The need for special attention to concealed aspects of the dissociation is addressed. The difficulties of case management on an out-patient basis in a large urban hospital are outlined, with implications for optimal treatment conditions. Skepticism among service providers regarding the diagnosis of MPD is also discussed.Item Open Access Dissociation : Vol. 2, No. 2, p. 105-109 : Integrating a dissociative disorders curriculum into residency training(Ridgeview Institute and the International Society for the Study of Multiple Personality and Dissociation, 1989-06) Batson, Ronald; Stephens, GeorgeThis paper will describe the complexities encountered in developing a dissociative disorders curriculum for psychiatric residents. A conceptualization of this educational process has been synthesized from the observational perspectives of both faculty and resident.Item Open Access Dissociation : Vol. 2, No. 2, p. 099-104 : Observations on the claim of iatrogenesis in the promulgation of MPD: A discussion(Ridgeview Institute and the International Society for the Study of Multiple Personality and Dissociation, 1989-06) Greaves, George B.The term "iatrogenesis" has both intensional and extensional (i.e., connotative and denotative) meanings which are frequently confused. While the four previous papers of the David Caul Memorial Symposium on iatrogenic issues in multiple personality disorder explore the extensional sense of the term, the discussant of this symposium focuses on the "iatrogenic debate" over MPD in its intensional form, augmenting the scope of the discussion considerably. His comments are based on extensive conversations with David Caul about the subject during the year preceding Dr. Caul's untimely death.Item Open Access Dissociation : Vol. 2, No. 2, p. 000 : Cover, Table of Contents(Ridgeview Institute and the International Society for the Study of Multiple Personality and Dissociation, 1989-06)Item Open Access Dissociation : Vol. 2, No. 2, p. 092-098 : Iatrogenic factors in the perpetuation of splitting and multiplicity(Ridgeview Institute and the International Society for the Study of Multiple Personality and Dissociation, 1989-06) Torem, Moshe S.The purpose of this paper is to increase the awareness of clinicians who treat multiple personality disorder patients to the possibility that misuse of treatment techniques may perpetuate splitting and multiplicity, and thus contribute to chronicity in MPD patients. Many MPD patients tend to have rapidly dissociative switching from one ego-state to another. These trance-like states make the patients highly suggestible to outside influences which include the therapists' verbal and non-verbal communication. Some therapists may have an overinvestment in more alter- personalities, and thus ignore the needs of the whole person. Treating an adult patient who is in an age regressed ego-state, or alter personality, presents a particular challenge as to the patient's boundaries since violating those boundaries may too perpetuate splitting and multiplicity. The paper reviews and discusses such issues as therapeutic limit setting, the issue of trust, and counter-transference elements as they may contribute to the perpetuation of splitting and multiplicity in MPD patients. Case vignettes are used to illustrate the above points, and suggest ways to avoid potential pitfalls so that therapy will promote progress towards integration and improved functioning of the whole person.Item Open Access Dissociation : Vol. 2, No. 2, p. 083-091 : Iatrongenic creation of new alter personalities(Ridgeview Institute and the International Society for the Study of Multiple Personality and Dissociation, 1989-06) Kluft, Richard P., 1943-The initial assessment of a patient suffering multiple personality disorder (MPD) rarely discloses the full complexity of that patient's system of personalities. Like most other mental disorders, MPD reveals its inner structure gradually, in the course of the uncovering process of therapy. This common sense observation, however, is often disregarded due to the widespread concern that the very procedures designed to alleviate and integrate MPD may augment rather than reduce its complexity. This paper will review factors inherent in the treatment, the patient, and the therapist that may contribute to an actual increment in the patient 's complexity or to the appearance that this has occurred. Most apparent creations of new alter personalities reflect the use of personality formation to cushion the traumatic impact of the treatment, which is inherently painful, or to protect against intercurrent traumata. Others (the majority) represent in fact the discovery of preexisting but previously unrecognized alters. Some alters emerge in response to therapists' errors in technique or inappropriate behaviors.Item Open Access Dissociation : Vol. 2, No. 2, p. 077-082 : Treatment errors and iatrogenesis across therapeutic modalities in MPD and allied dissociative disorders(Ridgeview Institute and the International Society for the Study of Multiple Personality and Dissociation, 1989-06) Fine, Catherine G., 1950-David Caul’s special interest in iatrogenesis became the opportunity to explore how treatment modalities may impact on the iatrogenic creation of alter personalities in patients who already have multiple personality disorder (MPD). This paper reviews basic transferences and countertransferences that can be monitored in the treatment of MPD which can, if unchecked, lead to the creation of new alters. It appears that these phenomena rather than treatment modalities per se provide the major impetus to iatrogenic increases in the complexity in MPD patients.Item Open Access Dissociation : Vol. 2, No. 2, p.070-076 : Iatrogenic factors in the misdiagnosis of multiple personality disorder(Ridgeview Institute and the International Society for the Study of Multiple Personality and Dissociation, 1989-06) Coons, Philip M.The diagnosis of multiple personality disorder (MPD) is fraught with difficulties leading to a frequent false negative diagnosis and an occasional false positive diagnosis. Proper diagnostic evaluation of a patient suspected of having MPD requires a familiarity with MPD, hypnotic phenomena, and a wide variety of other clinical syndromes. The clinician must use collateral data from old records and other individuals as well as provide sufficient time for the evaluation. Extreme caution is urged in forensic contexts. The use of extremely suggestive interviewing and/or hypnotic techniques is to be deplored. At times prolonged observation in the hospital or over the course of therapy is required. Clinicians should be patient, skilled in listening, and should keep an "open mind." Patient factors involved in producing misdiagnosis include distrust, fear of being labeled crazy, insistence on secrecy, amnesia, and conscious or unconscious deception.Item Open Access Dissociation : Vol. 2, No. 2, p. 066-069 : Iatrophilia and Iatrophobia in the diagnosis and treatment of MPD(Ridgeview Institute and the International Society for the Study of Multiple Personality and Dissociation, 1989-06) Braun, Bennett G.Item Open Access Dissociation : Vol. 2, No. 2, p. 061-065 : Evidence against the iatrogenesis of multiple personality disorder(Ridgeview Institute and the International Society for the Study of Multiple Personality and Dissociation, 1989-06) Ross, Colin A.The authors present data which argue against the iatrogenesis of multiple personality disorder (MPD). Twenty-two cases reported by one Canadian psychiatrist, 23 cases reported by a second Canadian psychiatrist, 48 cases seen by 44 American psychiatrists specializing in MPD, and 44 cases seen by 40 Canadian general psychiatrists without a special interest in MPD are compared. The Canadian general psychiatrists had seen an average of 2.2 cases of MPD, while the Americans had seen an average of 160. There were no differences between these groups on the diagnostic criteria, for MPD or the number of personalities identified. Specialists in MPD are not influencing their patients to create an increased number of personalities or to endorse more diagnostic criteria. Exposure to hypnosis does not appear to influence the phenomenology of MPD.Item Open Access Dissociation : Vol. 2, No. 2, p. 059-060 : Editorial(Ridgeview Institute and the International Society for the Study of Multiple Personality and Dissociation, 1989-06) Kluft, Richard P., 1943-