Phase-Oriented Treatment for Dissociative Disorders
Trauma affects people’s memory. For example, they may experience periods in their life when they can remember little or nothing about their past life. It’s known as dissociative amnesia. You may also have heard of people who’ve turned up far away from their homes, with no memory of where they wanted to go or where they came from. This is called dissociative fugue. These are both examples of dissociative disorders. They’re clinical conditions for which intervention is complex. In this article, we’re going to examine phase-oriented treatment.
Everyone can dissociate. In fact, dissociating is normal. It protects you from events that are psychologically threatening. For example, have you ever felt ‘disconnected’ in the face of a situation that overwhelmed your coping capacity? If your answer is yes, you’ve probably experienced dissociation.
The border that separates these ‘normal’ experiences from the pathological kind is called ‘time and repercussions’. When dissociative experiences prevail over time and deteriorate an individual’s health, the possible existence of a clinical condition is considered.
Phase-oriented treatment
Imagine that a glass is thrown on the ground. It breaks into pieces. Something similar occurs with memories in dissociation. The impact of psychological trauma can split part of the psyche. It separates, creates different parts, and produces ruptures.
Moreover, the individual’s mind prevents them from being able to put the pieces together, thus protecting their mental health. In fact, if they could put them together, they’d experience deep pain.
The research available to date suggests that patients worsen if they don’t receive the kind of treatment where the therapist recognizes and works with each dissociated part. Therefore, the first step in any intervention must be the stabilization of the patient’s symptoms. Once this is achieved, they can move forward in the process of the ‘union’ of the parts that have been separated and were linked to the trauma.
1. Stabilization of the patient
The objective of the first phase is to strengthen and stabilize the patient. It focuses on them being able to regulate their emotions and their interpersonal relationships. Basically, it’s about promoting self-care, connection with the body, and understanding the symptoms.
Think back to the broken glass on the floor. It can’t be put back together without the pieces all being picked up. Then, before it’s glued back together, the pieces must be arranged, put on a smooth surface, and checked to see how they fit together.
In this phase, it’s advisable that the patient’s traumatic memories are contained to prevent their reactivation. That’s because they still lack the tools to avoid this happening. The first step is to create specific conditions so that the patient can remember with certainty.
At this stage, the patient has a phobia of their internal experience and of the dissociated parts. For this reason, the construction of their memory will probably be a progressive process, with certain points of lucidity.
“As a general rule, the part or parts of the person that function in everyday life will be responsible, and not the therapist, for taking care of the infant parts.”
-Fonseca-
2. Trauma Processing: Integrating Traumatic Memories
In this phase, the objective is to process the emotions, thoughts, and bodily sensations that have been linked to the trauma. It’s achieved by re-experiencing traumatic situations and by verbalizing the intense emotions felt by the patient. The exercise is more than an emotional release because it involves elaborating and integrating the experience.
“It implies a remembering, to process and heal.”
-Fonseca-
The objective is to confront, work on, and integrate traumatic memories. However, this phase can be dangerous. That’s because the patient has a phobia of their traumatic memories and re-experiencing them could lead to re-traumatization. Therefore, it’s essential that specialized approaches are used for this purpose, such as EMDR or sensorimotor psychotherapy.
3. Integration of personality and rehabilitation
Sometimes, it’s impossible to move past the first phase, let alone reach the last one. Nevertheless, the ultimate goal of therapy is to organize an identity that’s as stable and united as possible. That said, at this phase, it’s likely that the patient has a phobia of the implications of leading a daily life.
“At best, the dissociated parts will cohere.”
-Fonseca-
This final phase is one of mourning. Mourning for the patient’s past, present, and future losses. In addition, it’s essential that they learn to take the risks involved in leading a normal life. But, this can reactivate memories related to the trauma. If this happens, it’s recommended that they review with the therapist the tasks that they carried out in previous phases.
Finally, it’s recommended that individual intervention be conducted with people who suffer from dissociation. The therapy can last for years. In fact, it could even last the patient’s whole life. In these cases, validation and the therapeutic relationship become especially relevant.
All cited sources were thoroughly reviewed by our team to ensure their quality, reliability, currency, and validity. The bibliography of this article was considered reliable and of academic or scientific accuracy.
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van der Hart, O., Steele, K., Nijenhuis, E., & Assen, H. (2011). El Tratamiento de los Recuerdos Traumáticos en Pacientes con Trastornos Disociativos Complejos. Parte uno de dos. Revista Iberoamericana de Psicotraumatologia y Disociacion, 3, 1-22.
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Holgado, F. G. (2021). Tartamudez, trauma y bloqueo: Introducción al trabajo con partes. Revista de psicoterapia, 32(119), 95-111.
- Pedrero, F. E. (2020). Manual de Tratamientos Psicológicos. Pirámide