Phase 2 tackles trauma processing, but only once the patient has stabilized and a therapeutic alliance has developed and strengthened over time. There are many approaches that mental health clinicians use, including cognitive processing therapy,22 eye movement desensitization and reprocessing,23 and body-based treatments such as Somatic Experiencing24 or Sensorimotor Psychotherapy.25 The goal is for patients to come to process and come to terms with what has happened to them. It is a painful process, and difficult emotions such as rage, grief, terror, and helplessness are confronted with the support of a highly trained clinician.
It is important to note that hypnotherapy is not recommended for trauma processing, although it can be helpful in phase 1 treatment for increasing adaptive coping skills.26,27 Clinicians should receive specialized training in hypnosis to understand how to use it to manage symptoms, and not to uncover dissociated memories. It is very important to respect that dissociation occurs for important reasons of survival and to remove that way of coping without a proper foundation of adaptive coping skills can leave an individual in a serious crisis. For specialized training, I recommend the American Society for Clinical Hypnosis.
Phase 3 consists of reintegration,19 and is the culmination of the work done in the previous phases. This is a time that patients often begin to feel as they are “living for the first time.” It is also a time at which issues around intimacy are tackled.
Psychiatry Advisor: Do you have any additional insights to share?
I regard dissociation as a type of resilience, a way of coping that enables a person, especially a child, to survive an unbearable or traumatic set of circumstances. Part of educating a client is framing the dissociation as a manifestation of resilience, something that was useful and serviceable at a point when it was needed, but that can be relinquished when the trauma has ended. When dissociation is used over and again as a way of coping, it becomes automatic and detrimental to people’s lives, recreating a sense of out-of-control danger.
Working with individuals with complex PTSD and DDs is complex, difficult, and rewarding. It is important to receive proper training and consultation to do this work. What I have said in this interview is only the tip of the iceberg with regard to how much there is to understand about working with DDs.
For those interested in deepening their knowledge and skills, I recommend the International Society for the Study of Trauma and Dissociation for further information, training, and resources.
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