Once again, Bramham Therapy was delighted to welcome Christiane Sanderson who presented a most informative and engaging seminar entitled Fragmented Minds: Understanding and Working with Dissociation and Complex Trauma.
Christiane is a senior lecturer in Psychology at the University of Roehampton, with 26 years’ of experience working with survivors of child sexual abuse, sexual violence, complex trauma and domestic abuse. She is heavily involved with the charity One in Four, which supports survivors of sexual violence and abuse, particularly in children. The charity’s most recent publication, Numbing the Pain, focuses on survivors’ personal accounts, and is reported and analysed by Christiane. The reports Numbing the Pain and Survivors’ Voices can be downloaded from their website.
The main aims of the seminar were fourfold:
- To understand the relationship between complex trauma, PTSD, complex PTSD and dissociation.
- To identify the signs and symptoms of clients in a dissociative state.
- To explore the lived experience of dissociation.
- To highlight effective interventions when working with this particular group of clients.
Complex Trauma is defined as prolonged, repeated and systematic abuse leading to fear without solution. The abused individual lives in a world of shame where reality is distorted, where silence and secrecy prevail and where there is no place of safety to reflect or process.
Dissociation as a result of complex trauma can be difficult to diagnose and the symptoms may be confused with certain personality disorders including BPD, psychotic disorders and
somatic symptom disorders. Dissociation becomes the coping mechanism, and an adaptive survival strategy of mental flight when physical flight is impossible. It is important to note that the younger the abused person, the more likely they are to dissociate.
Christiane describes dissociation as like having “a force field around you”, and survivors articulate it in a variety of similar ways including:
- Like having an out of body experience.
- Being numb, blank or frozen.
- Feeling like a cardboard cut out.
- Needing to be beaten to feel.
- Having one’s brain wiped clean,leaving a memory full of black holes.
- Being rigid and robotic to stay grounded.
There exists a continuum of dissociation ranging from the momentary lapses that we all experience, to situations where a person presents as separate identities.
Below is a brief summary of the main types of dissociation covered in the seminar:
Peri -Traumatic Dissociation – a horizontal mind/body split occurring at (or in the immediate aftermath of) a traumatic experience and seen as an activation of the biological survival system beyond conscious awareness. Also known as the ‘freeze response’ it is recognised as a predictor of PTSD.
Chronic and Recurrent Dissociation – in this state, the Self exists in isolation while all emotions are perceived as ‘the other, not me’. This default response to trauma cues can include emotional numbing, affective shutdown and a lack of embodiment where the individual lives in their head. Often some form of intense stimulation(e.g. self harm) is required to penetrate the dissociative state.
Structural Dissociation – a vertical split in personality between the ANP (apparently normal personality) and the EP (emotional personality). PTSD and Complex PTSD are included in this category. The person can often oscillate between being highly functioning /extremely cognitive or hyper-aroused, with rage and emotional outbursts.
Dissociative Identity Disorder (D.I.D)- with two or more personality states, the host is made up of many parts, each one unaware of the existence of the others. The parts can be male, female, adult or child and the host might refer to themselves as ‘we’. Someone suffering from D.I.D might find themselves in a location with no idea how they got there, and in extreme cases can even forget how to speak, read or walk. For example, American novelist,Mayo Angeloue,was raped as a small child and did not speak a word for five years after this traumatic event.
The hallmark signs of dissociation include:
- Lack of affect.
- Dichotomous and rigid thinking, eg darkness is safe or not safe; men are good or evil.
- Amnesia or fragmented memory.
- Self-harm and addictions.
- Lack of mentalisation or reflective functioning.
- Alterations in sensory-motor functioning, which could be robotic movement or even paralysis.
In therapy the dissociative client might appear unusually calm, but there may be somatic clues like a severe drop in body temperature or twitching/collapsing.They may be capable of prolonged silences, be rigid and physically tense, unable to speak the unspeakable or switch between self states e.g. submission and hostile aggression (as in BPD).
Triggers to dissociation are numerous but include:
- Trauma cues-like reacting to a particular colour. For example, children abused by priests can be traumatised by certain colours associated with religious clothing.
- Activation of the attachment system – intimacy or threat of abandonment.
- Somatosensory overload.
- Being looked at.
- Uncertainty or ambiguity.
Having identified the various forms of dissociation we then addressed the topic of working with clients who suffer from them. Christiane stated that ‘the aim of therapy is to enable the client to live in the present without being forever catapulted into the past, it is not about remembering’. She also emphasised that it was vitally important to recognise that a client who dissociates does so to keep safe.
Along with the various measurement scales which exist , Christiane also introduced The Trauma Informed Practice Model which consists of three stages, namely Stabilisation (to include psycho- education), Processing and Integration (a communication with all of the parts). Useful tools for treatment might be the human body jigsaw puzzle or Russian stacking dolls, whereby each piece of the puzzle or doll is a different part of the individual. It is important to focus on integrating mind, body and brain to encourage the client to re-connect with their body. In addition, grounding techniques, the therapist’s compassion, acceptance and disclosure of their own somatic counter-transference can also be useful.
Christiane’s seminars always seem to leave the participants wanting more. She encapsulates and addresses an enormous subject which she punctuates with relevant real life examples. Her presenting style is energetic and inclusive, and her sense of humour offers the opportunity for occasional moments of laughter in what is a serious and disturbing topic.
Average feedback scores from our Event:
Organisation of event: 4.9 out of 5
Speaker: 4.95 out of 5
Feedback from our Event:
“Excellent speaker and facilities. Difficult topic made easy to understand” – Sinead Gibson
“Christine was a treasure trove of info and was very engaging. It was enlightening, thought-provoking and gave me a myriad of ideas to take into my therapy room” – Liz, Eight Rivers Counselling, Blackthorn, Oxon
“Fantastic speaker, venue was not too big/crowded which is nice” – Anonymous
“Excellent – informative and inspiring” – Dido Denman
“Christiane Sanderson presented the topic in a clear, warm and experienced way” – Anonymous
“Well organised in all aspects, plenty of opportunity to talk to speaker, always well planned and followed up” – Vanessa, Newbury
“Excellent speaker and extremely knowledgeable and approachable. Also pleased about being sent a copy of the handouts prior to the workshop” – Ronald Zammit, NHS (Community Mental Health)
“The subject was very intense (I like this) but the organisation, venue, trainer made it alive and easier to digest” – Margaret Watson, London
“Extremely informative and offered a lot of new material to think about” – Anonymous