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The new edition of the Attachment and Trauma congress will deal with dissociation and integration. When it comes to dissociation, one cannot fail to speak of trauma. The presence of traumatic events in the history of life affects the structuring of the individual personality to such an extent as to inhibit the development of integrative functions and lead to even extreme dissociative phenomena. The severity of the trauma seems to determine the severity of the level of dissociation, and a criterion for defining how much the trauma can weigh on an individual’s personality is, in addition to the entity of the event itself, the identity of the person acting on it. When the attachment figures become figures from which to protect themselves, the cardinal points within which to orient the construction of identity are lacking and the ability to integrate our experiences into a coherent and stable representation of ourselves and others is lost.
Dissociation is a complex phenomenon, the symptoms of which are present in different mental disorders, and it is not always easy to distinguish them from a clinical and therapeutic point of view, since they can be confused and overlapped with others. For this reason the interventions of the speakers will analyze dissociative symptoms from different perspectives, trying to identify common points and important distinctions in the complex mass of phenomenological data that psychopathology presents to us, and defining the guidelines to favor the reorganization of the dissociated personality. , towards a harmonious and coherent integration of the different parts. The neuroscientific, clinical aspects and the most effective intervention hypotheses will be studied in depth, as well as the diagnostic elements on which to direct the professional’s attention, in order to provide a wide-ranging vision, useful in the therapeutic work of typology.
so complex of disturbance.
so complex to disturb.
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Author of numerous articles and texts on the theory of emotional regulation. Currently, he teaches at the Department of Psychiatry and
Biobehavioral Sciences (UCLA).
RELATIONSHIP AND INTEGRATION IN MINDFUL INTERBEING MIRROR THERAPY
The study of personality uniquely underlines the role of attachment relationships, early traumatic experiences and consequent dissociation in the construction of the self. We can look at psychological suffering on the basis of two related dimensions: the level of integration of the Self and the individual's ability to relate to the outside world. In line with these assumptions, the definition of the parts of the personality in patients who have suffered trauma and who present serious symptoms is very important in the therapeutic field, and psychotherapy is increasingly characterized as an intervention aimed at integrating the dissociated parts into a Self cohesive. At the same time, the therapeutic relationship assumes a central role in the repair of the dissociated states resulting from more or less serious and early relational traumas.
Mindful Interbeing Mirror Therapy (MIMT) represents an absolutely innovative approach, in which patient and therapist are both placed in front of the mirror, and interact through their reflected image. This unique modality of intervention is based on the integration of the most recent research in the field of neuroscience, and of the clinical considerations of efficacy that support its validity.
The construction of the self and the construction of a relational world are processes that take shape in parallel during individual development, starting from the ability to recognize oneself in the mirror - a process that operates the construction of identity - and from the ability to recognize states emotions of the other in the relationship. The mirror
therefore it appears as a unique field of intervention in which to operate a reconstruction of a cohesive self, in relation to the other.
In the last five years of study and fine-tuning of the intervention procedure, the MIMT has made it possible to identify a new and extremely accelerated method of connection between patient and therapist, and of integration between the internal parts in which the patient
experience a profound form of self-compassion that is truly transformative. In addition to this, the theoretical and applicative cues that continually emerge in clinical practice offer new opportunities for intervention, to which research can give substance and support.
WHY IT IS NECESSARY FOR THE CLINICIAN TO DISTINGUISH DISSOCIATION FROM TRAUMATIC DISINTEGRATION
Despite more than one hundred years of studies it is still difficult to find a consensus on the meaning of dissociation. In fact, the term dissociation refers to a very heterogeneous category of disorders, to even more different psychopathological phenomena and finally to a pathogenetic process understood in an extremely discordant way by the various clinicians who have studied and defined it: just think of the difference that c 'is between the dissociation understood in the Freudian sense as the removal of a painful or unacceptable content from the Janetian one of the collapse of the integrative capacities submerged by the traumatic experience. On a clinical and therapeutic level, the consequences of these differences are evident in the multiplicity of approaches and therapeutic techniques proposed. The first aim of the paper is to summarize the repeated clinical observations and the growing number of experimental tests which lead us to consider dissociation only one of the consequences of a more general pathogenetic process caused by trauma which consists in the disintegration of higher mental functions. The second aim is to illustrate the clinical utility of this distinction and its therapeutic implications.
PSYCHOLOGICAL TRAUMAS AND ALTERED STATES OF CONSCIOUSNESS: TOWARDS A REBIRTH OF THE SELF
In this talk we will examine the neuroscientific basis - and the related mind-body-brain correlation - of the five dimensions of consciousness: time, thought, body, emotions and intersubjectivity. We will describe how the self emerges from the integrated experience of the five dimensions, and how this is then related to the development of important neural networks that takes place during childhood and adolescence through secure attachment relationships. We will also analyze the neuroscientific correlates of the alterations that are often observed in each of the five dimensions of consciousness in various forms of psychopathology of traumatic origin, and thus demonstrate the importance of these dimensions in therapeutic practice. The concepts expressed during the intervention will be illustrated by examples of clinical cases.
INTERVENING ON INTEGRATIONAL FAILURE IN BORDERLINE PERSONALITY DISORDER WITH CONCOMITANT DISSOCIATIVE DISORDERS
Patients with Borderline Personality Disorder (BPD) often have a history of childhood trauma and dissociative disorder. Furthermore, there was significant overlap between the symptoms experienced by individuals with complex post-traumatic stress disorder (PTSD) or a dissociative disorder (other specified dissociative disorder or dissociative identity disorder [DID]) and symptoms of BPD, e.g. example: self-mutilating behavior, suicidal tendency, auditory hallucinations (voices), alterations in self-perception and states of consciousness, amnesia, depersonalization, chronic dysregulation, relational instability and phobic avoidance of traumatic experience. Although many therapeutic approaches to BPD focus on symptom management, in some cases this is not enough. Throughout the intervention we will describe, and illustrate through case histories, a trauma-informed practical approach that highlights the need to identify the individual's non-integrated internal structural organization and intervene on it to address the root causes of symptoms.
“FROM ISOLATION TO INTEGRATION: THE JOURNEY OF THE PSYCHE OF A REFUGEE”
The intervention will present a new paradigm of treatment aimed at leading the psyche of refugees on a "journey" that will take them, precisely, from isolation to integration. Over the course of three years, the huge amount of data collected by mental health and by the volunteers who - after a special training - worked within the various refugee camps set up in the coastal areas of Greece, allowed to identify 4 different stages relating to the psychological condition of the refugees. These stages describe the psychological state in which each refugee is at each stage of their journey and, consequently, indicate the type of treatment that each of them should receive from the mental health professionals present on the ground. For example, the psychological condition of a woman who has just stepped off a boat that rescued her at sea after a terrible journey is very different from that of a person who remained in a refugee camp for a long time, awaiting a verdict on her state of asylum seeker. Similarly, the psychological condition of those who have managed to obtain the necessary documentation and are about to move to a new country is once again completely different from previous cases. The intervention will aim to underline the importance of a psychological support that is modeled and adapted according to the differences and peculiarities of each stage of the path taken by refugees.
TREATMENT OF SURVIVORS OF CHILDHOOD SEXUAL ABUSE AND ATTACHMENT TRAUMA
Recently, the media has devoted much attention to the issue of child sexual abuse (CSA), particularly when perpetrated by celebrities, members of the establishment, or within religious communities or in cases of exploitation juvenile sexual; yet, most childhood sexual abuse occurs within the family and is rarely reported. In fact, recent studies indicate that in these cases of abuse in the family context, only one survivor out of eight reports, and often does so after many years. Frequently, survivors and clinicians are also unable to recognize the link between a history of CSA and a range of mental and physical health problems, including: emotional dysregulation, addictions, self-harm and suicidal ideation, anxiety disorders, in the sexual and relational sphere, personality disorders, as well as persistent somatic symptoms, chronic pain, immune system disorders and chronic fatigue syndrome. The danger of this lack of recognition is that childhood sexual abuse goes undetected and it is therefore possible that the diagnosis is not made correctly and that the mental or physical problems manifested become pervasive. It is essential that professionals from the various fields of physical and mental health adequately understand the impact and long-term effects of CSA and its various clinical manifestations, so that they can provide an appropriate response. The purpose of this seminar is to raise awareness of CSA and the long-term effects it has on survivors, and to introduce the principles of trauma-informed practice to be employed in their treatment. Importance will be given to the contextualization of child sexual abuse in the context of attachment trauma from which relational fears derive >>>: every interpersonal relationship is considered as dangerous and a source of terror, including that with the therapist. This gives rise to a set of relationship difficulties and relationship "inhibitors", which can then affect personal and professional relationships. We will explore the dynamics of the traumatic bond - present in every aspect of CSA - and how to intervene on relational inhibitors to minimize social distance, to connect and create a bond within the therapeutic relationship, with the aim of re-establishing the value relationship and facilitate reciprocity. We will also explore the impact that working with CSA survivors has on professionals, as well as the use of strategies, such as self-care, to minimize secondary traumatization and secondary traumatic stress. By identifying a variety of therapeutic skills and the challenges posed by working with CSA survivors, therapists will feel better prepared and more able to experience the transformative effects of posttraumatic growth for both themselves and clients. Topics Covered • Nature and dynamics of CSA, including: grooming process, secrecy, reality distortion • CSA as attachment trauma and its neurobiological impact • Psychological impact and long-term effects of CSA • Role of shaming and self-blame • Principles of safe trauma therapy • Importance of the therapeutic relationship for restoring relational value • Challenges and impact of working with CSA survivors • Post-traumatic growth
DISORGANIZED ATTACHMENT, DEVELOPMENTAL TRAUMA, AND DISSOCIATION PSYCHOTHERAPY
Studies show that individuals with a history of disorganized attachment develop adaptive responses to the experience of terror experienced with their caregivers, which translate into significant difficulties in emotional regulation and in the development of mutually satisfying relationships, as well as in the appearance of dissociative phenomena in different clinical grades. Similar scientific results that have emerged in repeated studies show the world of psychotherapy the origins in the developmental age of at least one form of dissociation: the fragmentation of consciousness and a compromised integration of the sense of self, or of the individual's "personality". In this intervention we will deepen our knowledge on these developmental processes, and on how to deal with these forms of disorganized attachment within the psychotherapeutic relationship and move from an unresolved trauma linked to abuse and neglect in the developmental age to its complete resolution during the course of therapeutic healing process.
EXPLORING THE MOST SERIOUS BORDER OF POST-TRAUMATIC DISSOCIATION A PROPOSAL TO DISTINGUISH SCHIZOPHRENIA FROM DISSOCIATIVE DISORDERS, BASED ON QUALITY OF SYMPTOMS, RELATIONSHIP AND TYPE OF SELF DISORDER
Therapists who deal with dissociative disorders are well aware of the presence, in their patients, of symptoms generically definable as "psychotic" (disperceptions, hallucinations, "delusions", Schneider's first degree symptoms, severe derealizations and depersonalizations): these symptoms they aggregate in a variable way, creating a boundary that is often not easy to distinguish from that represented by schizophrenic syndromes. The situation of patients over 35 who arrive in therapy after having been largely misdiagnosed as part of a "schizophrenic spectrum" or as psychotics tout court, with consequent situations of mistreatment, sometimes lasting decades, is both historical and current evidence. On the contrary, a well-made and well-returned diagnosis not only orients the clinic effectively but also creates a powerful basis for alliance and future collaboration with the patient, often also giving him significant relief. The starting point of this presentation will be the reflections of Colin Ross, Andrew Moskowitz and Suzette Boon on the subject, integrated with the thought of some important exponents of the most recent psychopathological research on schizophrenia, including Wolfgang Blankenburg, Louis Sass and Josef Parnas. Through the illustration of specific clinical situations I will try to describe different types of disturbances, distortions and fragmentations of the Self that are very different between schizophrenia and dissociative disorders: these differences, if well observed, provide an excellent compass in the differential diagnosis, since they correlate to very different relational modalities and situations.
TRAUMATIC DISSOCIATION: FROM INTEGRATION FAILURE TO PERSONALITY INTEGRATION
In 1921, T. W. Mitchell - a British scholar interested in dissociative phenomena - declared: "Personality, as we know it on a phenomenal or empirical level, can be an integration, a structure that has been built and which, if subjected to excessive stress, it can shatter” (p. 231). Excessive stress, a traumatic experience, therefore leads to a breaking point in the psyche of the individual: this is what the integrative failure in traumatic dissociation consists of. However, this dissociation also provides for a certain reorganization of the personality, to be precise, into two different dynamic subsystems – the so-called dissociated parts of the personality – each endowed with a sense of self and a first-person perspective. We distinguish two dissociative prototypes: an apparently normal Part (ANP, Apparently Normal Part) and an emotional Part (EP, Emotional Part): the first deals with functioning in daily life, while the second is blocked in the period to which the traumatic event dates and is primarily focused on any dangers associated with the trauma. Ideally, the therapy consists of a series of phases aimed at the full/complete integration of the personality, and therefore with the development of more adaptive actions. From clinical practice we have learned that the greater the trauma and, consequently, the more complex the dissociation of the personality, the greater the duration of the therapeutic process and the more often it will be necessary to review the three phases of the treatment, which are:
1) stabilization, symptom reduction and skills training;
2) treatment of traumatic memories;
3) personality integration and rehabilitation
Training programs tend to emphasize the first two stages of treatment while the third, sadly, receives much less attention. Based on the differentiation between mental and behavioral integrative actions in terms of synthesis and realization (with the components of personification and presentification), concepts originally expressed by Pierre Janet, we will show how to promote these integrative actions in each phase of the treatment (and therefore how each of them is involved in the various phases). We point to the joy and pain that each stage towards integration brings, culminating (if possible) in the unification of the personality.
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