THE BAS K
MODEL O F
DISSOCIATION :
Part II- Treatmen
Bennett G . Braun, M .D.
Dr . Braun is Director of the Dissociative Disorders Program a t
the Sheridan Road Hospital .
For reprints write : Bennett G . Braun, M .D., Director, Dissocia-
tive Disorders Program and Inpatient Unit, Rush-Presbyterian -
St. Luk e's Medical Center, 1753 W . Congress Parkway, Chicago ,
Illinois 60612 .
ABSTRAC T
This article is a continuation of the BASK Model of Dissociation: Part
I, which discussed the phenomena and theory- of dissociation. It uses the
previously described BASK Model (Behavior,Affect,Sensation, Knowl-
edge levels within a time continuum) and applies it to treatment . Since
treatment is a dynamic concept and knowledge is a static term, BASK is
changed to BATS, wherein the active term "thought" is substituted for
"knowledge." The interrelationship of the various dimensions of th e
BATS model is demonstrated and described. The BASK format is used
to describe how a behavior, affect, thought and/or sensation clue is used
to track down and synthesize the BASK/BAT S components in psycho-
therapy through work with different personalities and/or fragments . A
main thesis is that congruence of the BASK/BATS levels across th e
space/time continuum is required for healthy functioning . It is hoped
from this discussion that the reader will gel a sufficient understandin g
of the practical use of the BASK model and that he/she might apply it to
her/his school and practice of psychotherapy.
The therapist's intention in treating a patient with a disso-
ciative disorder is to help the patient reshape the dissociativ e
experience and make it congruent with regard to Behavior ,
Affect, Sensation, and Knowledge (BASK), as well as space /
time (i .e., here and now vs then and there) . If this goal is to b e
achieved under therapeutic guidance, the patient should b e
able to restore the dissociated aspects to the ongoing flow o f
consciousness and reestablish its integrity . The purpose of thi s
paper is to use the BASK model of dissociation to propose a n
explanation of the dissociative process and offer illustrations o f
its application in therapy .
In the BASK model (Figure 1) the main stream of con-
sciousness is conceptualized as made up of four processes - -
Behavior, Affect, Sensation (including perception) and Knowl-
edge - functioning along a time continuum represented b y
arrows . When the integral BASK components are consistentl y
congruent over time, consciousness is stable and the menta l
processes are healthy . If dissociation is defined as the separa-
tion of an idea or thought process from the ongoing flow o f
Bask Mode l
BBehavior
A
Affec t
S
Sensation
K
Knowledge
Figure 1 : The BASK Model of Dissociation . Dissociation can occur at any level, i .e ., any BASK component may he seperated from an y
other(s) at a given point in time and congruent at others . The arrows represent the passage of time .
16
 
1115SOC[ . I, No, 2: tune. 1988
consciousness, the BASK model may be used to illustrate disso-ciation occurring on any one or more of these four processes o
rlevels
. Automatism is an example of dissociation on a singl e
level, Behavior. Multiple personality disorder is the most ex-
treme example of dissociation and separate association acros s
all levels.
The BASK concept is placed in different perspective by a
brief discussion of the proposal made by Braun and Sach s
(1985) regarding the development of multiple personality dis-
order . A model for understanding the genesis of MPD wa s
established on the basis of predisposing, precipitating an d
perpetuating factors : the 3-P model (Figure 2). It takes account
of the theoretical proposal made in 1984 (Braun, 1984a) re-
garding the etiology of multiple personality and dissociatio n
and the apparent role played by state-dependent learning an d
neuropsychophysiologic (NPP) states - a view summarized i n
Part 1 of this paper (Braun, 1988) .
In brief summary, 1 proposed (Braun 1984a, 1985) tha t
multiple personality disorder (MPD) is the extreme end of a
continuum of dissociative phenomena that includes hypnosis ,
repression, ego states, and atypical dissociative disorder (se e
upper section of Figure 4, below) . The MPD patient and th e
easily hypnotized person share the characteristic of being disso-
ciationprone, but MPD is not explained merely by the ability to
dissociate. MPD is the result of repeated dissociative episode s
that occur under extreme stress - usually the stress of sever e
and inconsistently administered child abuse . Dissociation is a
defense mechanism for the dissociation drone victim who mus t
escape from some untenable conflict-e .g., severe, unpredict-
able abuse from an otherwise loving mother . The dissociative
episodes frequently have similar NPP affective states that pro -
mote the linking together of the episodes in a chaining o f
congruent, stable behavior patterns, memories, ranges of emotioand response patterns
. Over time, an alter personality/frag-
ment with its own behavioral repertoire, life history, and rang e
of affect is formed, shaped and expressed .
Although independently derived, the 3-P model (Braun &
Sachs 1985) bears significant similarity to Kluft's (1984) 4-factor
theory of MPD. In the 3-P proposal, the two major predisposing
factors for MPD are (1) a natural, inborn capacity to dissociate ,
and (2) exposure to severe, overwhelming trauma such as fre-
quent, unpredictable and inconsistently alternating abuse an d
love, especially during childhood . Both of the factors, take n
together, are hypothesized as a necessary cause of MPD, bu t
neither cause is sufficient to cause the disorder . There is docu-
mentation now in more than one thousand patients to demon-
strate that severe child abuse is a predisposing factor in 95% t o
98% of MPD (Putnam, Gurofl ; Silberman, Barban, & Post ,
1986; Schultz, Braun, & Kluft, 1985 ; Schultz, Kluft & Braun ,
1986; Braun & Gray, 1986 ; Braun, 1984b).
The most common events linked to precipitation of MPD i s
some form of abuse that triggers defensive dissociative epi-
sodes. When such events are related by a common NPP o r
adaptational theme, the dissociated elements begin to develo p
a life history and behavioral style of their own, and an alternat e
personality begins to develop .
Perpetuating factors are personal, interpersonal and situa-
tional . The personal perpetuating factor may be the patient' s
repeated use of dissociation as a defense against stress -
sonal factors usually relate to family dynamics and may include
ongoing abuse ; situational variables include societal attitudes ,
such as a family's literal interpretation of "spare the rod an d
spoil the child" .
MPD develops most easily when the fragments/segment s
that are lost were congruent for BASK. Polyfragmented atypical
dissociative disorder and polyfragmented multiple personalit y
disorder appear to develop when the incongruence is not onl y
on the time continuum, hut also in the levels of BAS K
(Figure 3). This usually occurs when the incident causing th e
Ps vOHOS,IC I.AL IN' L It Il L
 
RONIC
Sbaillc .deny
PRECIPITATING
EVENT
PERPETUATING
PHENOMENA
S any : n,e I'Iac4 . 4
MULTIPLE PERSONALIT Y
DISORDER
DissocarwE r pI5 I :,ie
Figure 2 : The influence of the three P' s
(Predisposing factors, Precipitating Events, Perpetuating Phenomena )
on the creation of Multiple Personality Dissorder . Solid arrowheads indicate a
greater degree of influence than do open arrowheads . (From page 53 i n
R . Kluft, M .D ., (Ed .) Childhood Antecedents of Multiple Personality .
American Psychiatric Press, Inc ., Washington D .C., 1985 . Reprinted wit h
permission .)
Polyfragmentatio n
P01 d
DieaocIatlan
M,1t y
Disorde
A
Behav
B   Cs  
ior
 
1111A    0  
Al
 
1111actS
 
(hi
Sensatio n
K DO   C) 'WVKnowledge
0 000 C
A O BO O
, 0
Figure 3 : Poly-fragmentation . When an event is so overwhelming that simpl e
dissociation is insufficient to handle it (A) then the individual not only drop s
the encoding from consciousness, but separates aspects of it from othe r
aspects of the same and different BASK levels, thus making it even les s
accessible to consciousness . This is compared with MPD (B)
B
17
DISSOCIATION, Vol . 1, No . 2:June, 1988
.BASK MODEL
dissociation is so traumatic as to severely, rapidly, and repeat-edly overwhelm not only the congruence iu time, but the con-
gruence between and within each of the BASK levels as well .
Such a situation will be illustrated in Case I - Behavioral Clue ,
below.ln Figure 4, the continuum of dissociation is adapted to
display aspects of treatment of MPD (Braun 1986) . issues 3
through 8 are adapted for the treatment of the patient wit h
atypical dissociative disorder, called Dissociative Disorder NO
in the new DSM-III-R (1987).
In the treatment of MPD, trust is the first and essential basis
for all that follows. Trust is the critical first step to establishing
contact, and trust is the critical bond that must be maintaine d
to make continuing therapy possible. If trust breaks down, reason
must be sought within the therapist, within the patient, o r
within the always tenuous therapist/patient relationship . Spe-
cifically, but certainly not exhaustively e
judged unworthy of trust because he is missing salient issues i n
the lives of the personalities; (2) the therapist may create actual
mistrust by his actions, words or omissions; (3) the patient ma y
be unable to trust himself enough to grant trust to the therapist ,
perhaps because the patient does not understand the switching
that occurs within himself ; and (4) the patient may be on th e
edge of taking a positive therapeutic step and/or about t o
reveal and work on a secret, so the reduction of trust serves as a
form of resistance. Also, (5) the patient may mobilize a negativ
transference .
Trust is not merely an initial first step . It is a first step that
must be made over and over again as therapy progresses wit h
the known personalities and as contact is made with the newl y
discovered personalities. Trust must never be taken for granted,
for it is constantly being tested and withdrawn and must . he
reestablished repeatedly .
After the foundation for trust is laid and the therapist ha s
made the diagnosis of MPD, he/she must share the diagnosi s
with the patient. Timing is crucial e
information at the beginning of therapy for too long, the pa-
tient will become restless and seek another therapist . If th e
diagnosis is shared too early, the patient will panic and bol t
from therapy . When the diagnosis is shared and accepted by th
patient, the patient may be overjoyed because finally thing s
make sense and she/he feels understood . However, the thera-
pist should be prepared to face a therapeutic crisis . Very soon
there will be significant acting out because the discovery of MPDalso is the discoverv of its psychic rationale, secrecy, and thereb
ythreatens to reveal past experiences of child abuse, which i
s
always a secret that must be kept from both the internal an d
external worlds.The discovery of the secret often causes psychic
chaos.
When trust is established and the diagnosis shared, the door
to the beginning of therapy for MPD is finally opened. Next, the
therapist must find out how this constellation of' personalitie s
works. He must establish communication with the personalitie s
and obtain a history of each . For issues 3 through 8 of Figure 4,
the following questions and concepts can help to gather th e
necessary information for treatment :
'Who are you? A personality may he defined as a set o f
thought processes with concomitant behavior and psy-
chophysiology. IVho or or descriptor is the address ,
in computer terms, where a specific set of thought proc-
esses with their concomitant neuropsychophysiology an d
behaviors may be accessed and called forth . Later, th e
therapist will return to this address to do psychotherap y
around specific issues - e .g., shoplifting behavior.
 14hercwere you created? an essential elite to the age
of the personality and how long it has existed ; Knowing
when also is a clue to the possibility of a significant trauma
at that time and to other personalities who may be relate d
in some way. If a personality does not know its age, it still
will have an earliest memory that may be retrieved; e.g., i
the earliest memory is of junior high school, the personal -
ity may have been created at the patient's biological age of
12 to 14 years.
  Miry were you created? In seeking why, the therapist i s
looking for precipitating and perpetuating events associ-
ated with this personality's development, and why thi s
alter is present at this specific time in life and/or in ther-
apy. Other personalities may be able to furnish importan t
why information about this personality that it is unable t o
provide.
  'here were you created? Where was the body when yo u
were created? Where are you in the power structure o f
personalities (who do you control and who controls you) ?
Where do you live in the patient ' a projective tech-
nique and obviously the therapist would not accept a s
reality the personality's response `behind the right eye " .
Nevertheless, the response is an important clue to loca-
tion of this personality in a system of personalities an d
their functions . As therapy progresses, the patient may he
asked to draw a map of his psyche, charting out the syste
of personalities. Over time the map will change and hel p
to document progress in therapy (Braun, 1986b ; Braun &
Sachs, 1986). Other special techniques serving simila r
uses include sand tray therapy (Sachs & Braun 1986) and
art therapy.
',What are your functions? What do you do that aids o r
balances the system of personalities? What are your issues
and problems ?
 How were you created? How were your elements put to-
gether? Are you an original, or do you believe you wer e
put together from parts of other previous personalities ?
Figure 4 : The treatment of MPD and ADD . The 13 issues need to he Belt with ,
but often one goes hack and fourth with or without skips during real t r t
as the theraputic situation dictates, (Adapted from page 19 in B . Braun, N1 .D .,
(Ed .) Treatment of Multiple Personality, American Psychiatric Press, inc .,
Washington, D .C ., 1986 . Reprinted with permission .
ih PTVe`
 
~ ~nGM[n~[ n
VisVno[F
 
ViSn
 
Vso
18
 
DISSOCIATION . Vol I . No. 2: Jitnr, 1959
BRAUN
How may provide some early clues to possibilities for inte-
gration especially if the therapist also detects indication sof co-presence -i .e
. as one personality interacts with the
therapist, another one observes at the same time . Th e
given personality may not know the answers to the how
questions any more than one may know the reason fo r
her/his conception . However, someone else in the system
of personalities may know this, and the information wil l
yield a clue to the thinking process of the individual .
The question of integration must be approached with grea t
caution . Some personalities will sec integration as tantamoun t
to death . They need to be reassured that thev will not disappear,
but will continue to contribute to one, unified, whole person .A
useful analogy is that of red paint and white paint joining t o
make a greater amount of pink paint . The therapist also mus t
be absolutely sure regarding who to integrate . A meek and sub-
missive personality is probably not a good candidate for integra-
tion with a rageful one or a martial arts expert unless all individ-
ual issues and integration issues have been processed carefull y
and resolved .
Psychotherapy for MPD is a dynamic process . While th e
BASK model is useful in describing MPD, the understanding of
the therapeutic process requires a dynamic model . That model
is outlined in the next section .
BASK/BATS in Psychotherapy
The reason that knowledge in BASK is changed to though t
in BATS is that the BATS model is a dynamic one rather tha n
static and descriptive . Thought is an active term, as in therapy ,
and knowledge is a passive one . BATS attempts to look at th e
results of congruence or noncongruence of the BASK levels o fthe individual
's thought
processes.
Psychotherapy uses
the Test-Operate-Test -
Exit (TOTE) principl e
to bring the element s
of BASK into congru-
ence. We saw earlier, i
illustration of identit y
(Braun, 1988), tha t
when behavior, affec t
and thought are congru-
ent, we experience a
sensation of satisfactio
or calm that all is well .
When behavior, affect ,
thought and/or sensa-
tion are incongruent,we
suffer an error signal or
anxiety. I believe tha t
congruence is th e
major goal of psycho -
therapy especially in pa-
tients with dissociativ e
disorders .
The dynamic BATS
process model (Figur e
5) brings all BASK ele-
ments into active congruence . The congruence of some, bu t
not all, of the BATS elements may yield a variety of results, some
ofwhich may be desired and some not . Congruence of all of the
BATS elements, especially in continuous relation to space /
time, yields a healthy individual.
Congruence Sc Outcome :
 Behavior/Affect = Expressio n
 Behavior/Thought = Choic e
 Behavior/Sensation = Somatizatio n
 Affect/Thought = Ownershi p
 Affect/Sensation = Stimulus Augmentation (i .e., pain)
 Thought/Sensation = Stimulus Augmentation o r
Reductio n
 Sensation/Affect/Thought = Psychophysiologic o r
Somatic Memor y
 Sensation/Thought/ Behavior = Disorder of Feelin g
(i.e., alexithymia)
 Behavior/Affect/Thought . = Learning
 Behavior/Affect/Sensation = Automatism s
*Congruence (of all BATS over time) = Mental Healt h
Five illustrative uses of the BATS model involving patien t
material will be presented and should make its utility apparent .
In each of the following five cases, hypnotherapy was used t o
assist psychotherapy in (1) recovering lost material, and (2 )
chaining together the BASK/BATS elements that were no t
congruent . When congruence was achieved the episode wa s
brought to an end and suffering reduced .
The case examples below will be used to illustrate how on e
uses the BASK/BATS concepts to chain together informatio n
that was unavailable to
the consciousness o f
the host personality to
help gain congruenc e
of BASK/RATS on the
space/time contin-
uum . The patient i s
taught to use full knowl
edge of both similaritie
and differences to dif -
ferentiate here an d
now from then an d
there, and to brin g
present reality an d
thinking to bear on the
previously incongruent
BASK to modify it an
make a new, mor e
adaptive, congruen t
BASK In each of th e
examples, as in all psy-
chotherapy, informa-
tion known before the
clue was noted wa s
used as a basis for the
exploration and chain-
ed together with infor-
mation obtained fro m
the various personali-
ties, fragments, etc.
Behavior Affect Thought Sensation
Figure 5 : Showes the dynamic model of BASK-BATS where thought as an activ e
process is substituted for knowledge, a static phenomena . It also shoves th e
interaction of 2, 3, and 4 of the BATS dimensions .
19
DISSOCIATION, vol . I, Au. 2: June, 15Sf
Case 1. BEHAVIORAL CLUE (Figure 6) :
The patient was a 32-year-old single white female with MPD
who was diagnosed as suffering from migraine headaches whic
were usually right-sided, often accompanied by an erythema-
tous area on the right temple, and preceded by flashing lights ,
tinnitus, and nausea . She was found staring into space an d
rocking (behavioral clue) shortly after a loud noise caused b y
another patient dropping a heavy book on the floor . When she
was able to talk she complained of a severe right-sided head -
ache. A quarter-size ervthematous area was noted above th e
lateral aspect of her right eye . She said that she had experi-
enced the usual aura for a very short duration as the rockin g
started . She said she had been terrified by the noise . It wa s
noted that she was again dissociated, staring into space, and wa
wringing her hands in an unusual manner . I asked her if he r
hands felt sticky, and she replied "Blood - blood, blood -- -
blood, blood, blood ." With some prodding, the following story
was pieced together from various alters using new informatio n
and previously known information .
When the patient was five years old, her father and uncle go
into a fight in her home . She was afraid and ran to hide unde r
the basement stairs . Shortly her father and uncle came tum-
bling down the stairs and landed near where she was hiding .
The two men separated ; her father picked up a revolver fro m
the workbench and shot her uncle six times, blowing off part of
his head and killing him . She crawled out and attempted to put
her uncle 's head back together . Her hands were covered wit h
blood and she froze . Her father put the hot gun to her head an d
snapped the trigger while she was staring at her uncle, causin g
further dissociation . Her father made her help him dismembe r
the uncle 's body with a hatchet, and when she struck the ches t
the corpse moaned due to air expelled from his lungs by th e
blow. Her father used this to prove to her that she had killed her
uncle, and thus assured her keeping of their mutually-hel d
secret. This prevented her from processing the incident unti l
she did so in psychotherapy. The polyfragmentation was frozen
in time and kept separate via multiple dissociation s
(see Figure 3 ).
The patient suffers polyfragmented MPD. This incident was
so traumatic that it was encoded or filed in many different spe-
cial purpose and memory trace fragments which had to contrib-
ute their pieces before the full chain of events and their mean-
ing could he appreciated . For example, one special purpos e
fragment just rocked, another wrung her sticky hands, whil e
other memory trace fragments knew about the fight, hiding ,
the gunshots, etc. When this was finally pieced together the hos
personality could understand, say "It's over," and relax . He r
behavior became normal, she felt calm, and her headache s
dissipated. It appears that the headaches were caused by rapi d
switching between fragments and special-purpose fragment s
that she created to cope with the panic and the overwhelmin g
experience . This was all reactivated through intrapsychic asso-
ciation which was stimulated by the loud noise .
From the above description one can see how symptoms o f
her migraine headaches were caused by her polydissociate d
memory . The aura of flashing lights were the flashes of th e
gunshots in the dark basement . The ringing in her ears wa s
originally created by the loud retorts of the gun's firing . Th e
nausea was secondary to the revulsion of looking at her uncle' s
dead body and what she was forced to do. The rocking behavior
was similar to what she had done under the stairs, and th e
erythematous area was a psychophysiologic memory of wher e
her father had pressed the hot gun to her head .
I have described this example in great detail to give th e
reader a feeling for the process . The following examples o f
affect, thought and sensation clues will be more brief .
Behavioral Clue
Cal m
S    Loud  Ringing   Pain in 
head
 
Sticky
 
Headach e
Noise
 
in cars
 
Discontinue dSensation
 
\ 1,
Knowledge
Figure 6 : The use of an behavioral clue in psychotherapy . First behavior noticed was patient staring and rocking .
BBehavior
Affect
Trigger Clu e
 Paralysis, Rocking
Staring Wringin g
Hand   I . Norma l
K
 
Blood-Gun
 
"ft's over "Sho t
20
 
DISSOCIATION, Vol. No. 2
BRAUN
Affect Clue
  Appropriat e
Calme r
  } Muscle tensio n}"Sandy feeling "
} Pai n
That was the n
and this is no w
Clue
N Grab
 
cane
 
Breaks
 
Wanders &
Grabs cane
 
to staff
 
unit door ^
 
return s
pain in bac k
of head \
  Memory o f
M hitting he r
with can e
Congruenc e
Figure 7: The use of an affect clue in psychotherapy. Rage and agitation reported and observed
-
K
Knowledg e
S
 
Observes patient
hit with can eSensatio n
Trigge r
B
 
}
Behavio r
A
Affect
Contrac t
not to hur t
Case 2, AFFECTCLUE (Figure 7) :
The previous patient (Case 1), who walked with a cane, was
hospitalized at the same time and on the same unit as a 25 yea r
old single white female patienl . who also had MPD . The tw o
women became friends in the hospital . Both were standing i n
the dayr-oom when a manic patient took the first patient's can e
and hit her . This behavior was the trigger for this patient t o
become enraged ; she took the cane from the manic patient an d
drew it back to hit her . She then remembered her contract no t
to hurt herself or anyone else internal or external (Braun ,
1984c, 1986). She knew she had to leave the unit or she woul d
hurt someone, but was too upset to ask; she kicked out the door
of a locked psychiatric unit and left . She wandered the hospital
for a while, then returned to the unit and apologized for th e
damage .
She was still agitated when the incident was processed with
the aid of hypnotic relaxation . She commented that she had a
headache and a severe pain in the right occipital area. She then
was able to retrieve the memory of her mother hitting her in the
back of the head with a cane as she attempted to run from he r
mother . With some additional hypnotic work to stop the pai n
(somatic memory) she was able to realize the critical difference
between the incidents, and differentiate between then an d
now, allowing congruence of BATS . She became more calm ,
her muscle tension eased and the pain in her head significantl y
decreased.
Case 3. THOUGHT CLUE (Figure 8) :
The trigger for this young woman was a dream just prior t o
her discharge from the hospital . The dream image of a large,
dark shapehovering over her was accompanied by fear and anger
(affect) , trouble breathing and
pelvic pain (sensation), and she
was bent over in pain (behav-
ior) . This caused her to realize
that the dream was a memor y
of what had actually happene d
to her, and was causing th e
symptoms . The recovere d
memory was of her being orall
(clenched teeth) and vaginall y
(abdominal pain) raped by he r
father when she was a child e
had better control of her symp-
toms as an adult, but when a
trigger such as the dream re -
turned her to the behavior, affec
and sensation of the rape, sh e
lost the control .Under hypno-
therapy the memory could be
recovered of her father standing in her doorway before rapin g
her, allowing for congruence of BASK/BATS and resolution of
the symptoms.
Thought Clu e
Trigger Clu e
BBehavior Communicate s1" in Therap y
Fea r
Pain  Nausea  Abdominal pain   I  t -
in head
 
Pelvic pain
 
I
& Asthma
 
I
F rap e
Figure 8: The use of a thought clue in psychotherapy .
Fear Calmer
Decreased Pain ,
Cleaner Breathin g
1-Present tim e
orientatio n
Congruence
Cowering,
Clenched Teeth
IncreasedA
Affec t
S
Sensatio n
K    Large. dark
ShapeKnowledge
(Dream)
2 1
I}1SSOCIATIO\, Vol . 2
Sensation Clue
(Somatic Memory)
Congruenc
Decreased
 
IncreaseTalking
 
in Therap y
Anger
 
Appropriat
Burn
 
Increased Decreased  I    NormaBlister,
pain
 
Burning
 
Burning
 
I
 
NoSymptoms )
 
\
 
/M burnedher
 
I
("Don't tell"
(History of Burns
Figure 9 : The use of a seperation chic, a somatic memory, in psychotherapy . Clue observed by the therapist :
Burn blister on left arm as well as blister on right arm without thermal injury .
Trigger
 
Clue
B Talkin
Behavior Talking
, Communicate
S
Sensatio n
K
Knowledge
Now 1 understand
Anxie
Affec
Case 4 E
(SOMATIC MEMORY)
(Figure 9)
This 23-year-old single
white female felt anxiety
(affect) and a burning sen-
sation on her right forearmShe then actually burne
d
her left forearm with a ciga-
rette. This caused a reduc-
tion in her anxiety, an d
significantly inhibited he
communication in psycho
therapy (behavior) n
she attempted to talk this
potentiated and increase
the sensation of burning i
her right arm, which re-
sulted in actual blister for-
mation in previously burne
areas on her right forearm )
yielded the memory recovered in hypnotherapy, of an abusiv
mother burning her with cigarettes and warning her l
Her work in psychotherapy was perceived as and trig-
gered her burning of herself, done by a maternal introject or
alter. Psychotherapeutic work with the hypnotically recovere
memory changed her thinking, decreased and finally ende
the symptoms and thus increased the patient
municate with the therapist y
after the revelation in therapy
Case 5. SENSATION CLUE (PSYCHOPHYSIOLOGI
[PSYCHOSOMATIC] ILLNESS) (Figure 10)
In this patient, a 30-year-old single white female, the trigge
for this episode was finding that her new roommate in the
hospital was a black woman d
nausea (sensation), avoidance (behavior), anxiety and fea
(affect) were made understandable by chaining with a factua
memory (knowledge) of an event in her childhood e
years old when her father had been put in jail for speeding and
driving without a license e
police holding area where the black inmates taunted her an
reached for her through the bars ,
and the fear was linked with the smell of the jail which cause
her to become nauseated in conjunction with the fear n
BASK elements were made congruent by therapy, and though
brought current reality to bear, her anxiety was decreased, th
symptoms ended, and she related well to the new roommate
Sensation CIue
(Psychosomatic Illness
Trigger
 
Clue reported
 
Congruence
Relates well
to roommate
 
}
A
 
Anxiety
 
Fear Safe.
Affect
 
I
 
Decreased Anxiety
B
Behavior
to Therapist
 
f
Figure 10 : The use of a sensation clue, a psychosomatic illness, in psychotherapy . Clue reported to therapist : stuffy nose and nausea .
S
 
Vision Stuff
nosSensatio n
K
Knowledge
I
 
Present
rien c
toms
Jail
Memor
22
 
Il1SSOCIATION, WI . 2: June, 1988
DISCUSSION AND SUMMAR Y
After falling into disuse and nearly into disrepute for dec-
ades, today the concept of dissociation is increasingly seen as a
powerful tool to both describe and explain a broad range o f
mental phenomena that are observed in many psychiatric dis-
orders . In cognitive psychology, dissociation is seen as holdin g
important clues to the structure and function of the cognitiv e
unconscious (Kihlstrom, 1987) . Today 's renewed interest i n
dissociation may be attributed in some measure to its explana-
tory power in psychiatry as well as its compatibility with contem-
porary research in cognitive psychology . Waning interest in be-
haviorist psychology also opened the way for reconsideration o f
the dissociation, first proposed by Pierre Janet in 1889 (Janet ,
1889), to explain automatisms and other psychopathology tha t
we might today describe as dissociative . Also contributing to re -
kindling of interest in dissociation as a concept in mental dis-
ease is the declining force of Freud's dismissal of dissociation i n
favor of repression and the acknowledgement that incest an d
child abuse really do occur .
The therapist's understanding of dissociation may be en-
hanced by a two-dimensional model of behavior-affect-sensa-
don-knowledge (BASK) functioning along a time continuu m
(Figure 1) . If dissociation is defined as the separation of an ide a
or thought process from the ongoing flow of consciousness ,
then the BASK model of elements of consciousness may b e
used to illustrate that dissociation can occur on any or all BAS K
axes .
The BASK model (Braun, 1988) is shown to complemen t
the previously developed neuropsychophysiologic, state-depend -
cut learning model (Braun, 1984a) and the 3-P model (Brau n
&Sachs, 1985a) of multiple persormalitydisorder (MPD) ,whic h
postulated that predisposing, precipitating and perpetuatin g
factors are the necessary and sufficient causes of MPD . Th e
relationship between MPD and severe child abuse is mad e
apparent by the three theoretical presentations .
The major assumption of the 3-P model is that dissociatio n
is used defensively by the patient as a fragmentation/compart-
mentalization process . Personality fragmentation is a heav y
price to pay for the escape from pain and conflict ; however, i t
may be what allows for survival at the time . Therefore, th e
major goal of psychotherapy should be reassociation of frag-
mented thought processes and their eventual full integratio n
allowing for amgruenty of BASK/BATS on the space/tim e
continuum .
The goal of psychotherapy is to obtain congruence acros s
all the BASK/ BATS dimensions in space/time, thus yielding a
decrease of dissociated thought processes, a decreased nee d
for the defense of dissociation, and more control over interac-
tionswith the environment . The two-dimensional, passive BAS K
model is changed into a three-dimensional, dynamic behavior-
affect-thought-sensation (BATS) model to relate BASK to th e
therapeutic process . The outcomes of congruence of two, three ,
and four of the dimensions arc shown, and the BASK model i s
used to diagram the process of psychotherapy in achievin g
congruence at all levels on the space/ time continuum .
It appears that the BASK/BA'T'S Model is a useful too l
in the conceptualization of dissociative disorders and thei r
treatment, as well as in psychotherapy in general .
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Braun, B. (1984a). Towards a theory of multiple personality and other dissociativephenomena. In B.G. Braun (Ed
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Braun, B.(1984b) . Unpublished data - in (96%abused)
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Braun, .G. (1985). Dissociation . In B . Brau(Ed.).
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Braun, .G . (1988) BASK model 1. Dissociation,. 4-23.
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