Thursday 14 April
9.30 - 17.00 (Lunch provided 12.30 – 14.00)
|Veiling zaal (C)||Mariëtte Groenendijk||How to plan and perform a structured trauma-treatment (including EMDR) with complex trauma-related disorders|
|Berlage zaal (B)||Janina Fisher||The Body as a Shared Whole: Integrating Sensorimotor Psychotherapy in the treatment of DID|
|Administratiezaal (A)||Suzette Boon||An Introduction to the Trauma and Dissociation Symptoms Interview (TADS-I): Assessment of Dissociative Disorders and Complex PTSD|
|Verwey kamer (D)||Renee Potgieter Marks||Assesment and treatment of dissociative children – Introduction to the guidelines|
|Mendes da Costa kamer (E)||Julian Ford||Complex Trauma in Childhood and Chronic Survival Adaptations in Adolescence: Pathways to Delinquency, and Doorways to Recovery|
How to plan and perform a structured trauma-treatment (including EMDR) with complex trauma-related disorders
Adult survivors of severe and chronic traumatization in early childhood can suffer from a wide range of symptoms and problems. Most of the clients with complex PTSD, structural dissociation of the personality and/or attachment-disorders, need a phase-oriented psychotherapeutic treatment in which the working alliance with the therapist is equally important as the schedule of the therapy ; that is the logical order of specific goals and interventions along the 3 phases of treatment (stabilization of the symptoms, integration of the traumatic memories, (re-)integration of the personality).
This workshop aims to give a kind of manual of how the therapist can build up such a treatment and how to work on the different themes and goals in 6 subphases, as presumed by the presenter. After a short explanation of the theory of structural dissociation of the personality (van der Hart, Nijenhuis and Steele) and some attention for assessment of trauma-related disorders and indication for trauma-treatment, we will structure the work that has to be done in each phase.
Most of the time of the workshop will be dedicated to the second phase of trauma-treatment ; the integration of traumatic memories. The goal is to learn to help the clients to overcome their phobia for the traumatic memories, how to use EMDR to get these memories integrated and how to combine this with the repairing of the attachment wounds using transformation within the therapeutic relationship. Trauma-treatment by using EMDR will be illustrated with a dvd of a client with DID.
Mariëtte Groenendijk is a licensed clinical psychologist / psychotherapist and EMDR-consultant. She has been working with patients who suffer from severe, early and complex traumatization since 1990 and throughout the years she became more specialized in the treatment of dissociative disorders. Till 2013 she was in charge of Top Referent Trauma Centre Transit in Ermelo and together with collegues she developed an one-day-group-treatmentprogramm for patients with DID. In the Netherlands she was one of the pioneers who treated dissociative patients in the second phase of treatment with EMDR. Since 2007 she tries to share those positive experiences by workshops with video-demonstration, lectures and consultation. Topics were assessment and treatment of CPTSS, DDNAO and DID, EMDR with dissociative disorders, inpatient multidisciplinair treatment of trauma-related disorders and treating the attachmentproblems in phase 2. She was co-author in two recent publications in the EMDR-Journal of Practice and Research about EMDR with dissociative disorders : van der Hart, Groenendijk, Gonzalez, Mosquera and Solomon : dissociation of the personality and EMDR therapy in complex trauma-related disorders : applications in the stabilizationphase (2013) and phases 2 and 3 treatment (2014). She now works in private practice (De Binnenkijk) as a therapist (also with children) and as a supervisor for collegues treating dissociative disorders.
The Body as a Shared Whole: Integrating Sensorimotor Psychotherapy in the treatment of DID
Childhood trauma and neglect leave survivors with a legacy of overwhelming memories and emotions but also a compromised nervous system that impairs their future capacity to tolerate the normal ups and downs of life. The survival responses that once preserved their safety under threat do not diminish once the danger is past. Instead, dysregulated arousal and trauma-related physical responses continue to re-evoke traumatic responses and implicit memories for decades after the events are over, interfering with functioning, relationships, and even the therapy.
Because the body is a shared whole even for even our most challenging patients, integrating Sensorimotor Psychotherapy techniques with Structural Dissociation theory allows us to work more effectively with patients suffering from Complex Post-traumatic Stress, Borderline Personality Disorder, DDNOS or DID. Regardless of their symptoms or level of functioning, they can benefit from the Sensorimotor emphasis on mindfulness, present day focus, modulation of autonomic arousal, and resourcing. Sensorimotor techniques can also be used to increase the effectiveness of EMDR and other therapeutic modalities, prepare patients who are ready for processing memories, or it can be adapted to suit the special requirements of the most fragile unstable DID clients.
Using a combination of powerpoint presentation, video, case examples, and experiential exercises, this training will enable participants to integrate a neurobiologically-informed understanding of trauma into their work, increase their facility with the use of Sensorimotor Psychotherapy, and enable them to offer more effective treatments.
- Challenges to stabilization observed in complex trauma and dissociative disorder clients
- The Structural Dissociation model and its implications for treatment
- Animal defense-related inner conflicts that threaten stability or stall the treatment
- Increasing the capacity for mindfulness and co-consciousness
- Resourcing the ANP to increase top-down regulation of activation and behavior
- Interventions for working with attachment-seeking parts
- Interventions for working with hypervigilant and self-destructive parts
- Interventions for working with collapsed, immovable parts
- Developing somatic resources that speak to the differing needs of different parts
- Overcoming traumatic reactions through the practice of new actions
- Resolving inner conflicts that threaten safety and the capacity to live a normal life
Janina Fisher, PhD, is a licensed clinical psychologist and assistant educational director of the Sensorimotor Psychotherapy® Institute. An instructor since 1996 at the Trauma Center (a treatment/research center founded by Bessel van der Kolk), she is also past president of the N.E. Society for the Treatment of Trauma and Dissociation, an EMDR Consultant, former Instructor, Harvard Medical School, and a consultant to the Connecticut and Massachusetts Departments of Mental Health on trauma-informed care. Dr. Fisher is the author of a number of articles on trauma treatment and lectures nationally and internationally on the integration of neuroscience research into clinical practice. For more information about Dr. Fisher visit www.janinafisher.com.
An Introduction to the Trauma and Dissociation Symptoms Interview (TADS-I): Assessment of Dissociative Disorders and Complex PTSD
The Trauma and Dissociation Symptoms Interview (TADS-I) is a new clinician administered semi-structured interview to assess dissociative symptoms and disorders and other trauma-related problems. Dissociative disorders are often difficult to diagnose for the following reasons: (1) There is no clear agreement on the definition of dissociation, with some describing it on a continuum from normal to pathological, others as a physiological shut down, and others as a division of the personality; (2) Patients have a tendency to hide or dissimulate dissociative symptoms, so they may not be easy to identify; (3) There is overlap in some so-called dissociative symptoms with other disorders such as personality disorders; (4) DSM-5 and ICD-10 (and upcoming ICD-11) differ with respect to classification and criteria for dissociative disorders and for complex PTSD; and (4) Clinicians do not receive systematic education with regard to diagnosis and treatment of dissociative disorders. Thus both under- and over-diagnosis may occur. The TADS-I attempts to make a more clear distinction between complex dissociative disorders (DID and OSDD) and other psychiatric disorders. It includes sections of other trauma- related symptoms in order for the clinician to get a more clear picture of the complex comobidity of chronic traumatization. Participants will learn how to administer and score the TADS-I. Video clips of interviews will illustrate diagnostic complexities.
Suzette A. Boon PhD, 1949, is a clinical psychologist, and psychotherapist. Since the late eighties she specialized in the diagnosis and treatment of complex dissociative disorders. She translated and validated the Dutch version of the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D) and received a PhD for her thesis “Multiple Personality Disorder in the Netherlands” in 1993. She has developed a skills training manual for patients with a complex dissociative disorder Coping with Trauma-Related Dissociation. Skillstraining for Patients and Therapist (Boon, Steele & Van der Hart, 2011). The “Trauma and Dissociation Symptoms Questionaire (TADS-Q, Boon and Mathhess, 2014) is a semi-structured interview to assess dissociative and trauma-related symptoms which is currently being validated.
She is working as a supervisor at the Top Referent Trauma Center (TRTC), Altrecht in Zeist, The Netherlands and in private practice.
Renee Potgieter Marks
Assesment and treatment of dissociative children – Introduction to the guidelines
In July 2015 the Guidelines on the Assessment and Treatment of Dissociative Children and Adolescents was approved and published on the ESTD website. This document provides the most recent Child and Adolescent Guidelines in the world on assessment and treatment of dissociative children and adolescents.
During this pre-conference day, introducing the Guidelines, will be a unique opportunity to gain a better understanding on assessing and treating children and adolescents who are dissociative. The first part of the presentation will focus on the assessment of the dissociative child. A variety of child responses during assessments will be used to illustrate this information. “Typical” profiles will be discussed and complex cases will be presented where clinical information, history and questionnaires contradict each other and how to deal with this dilemma.
The second part of the presentation will focus on the treatment of the dissociative child. The latest theoretical concepts will be illustrated at the hand of drawings, sand trays, and DVD’s of children sharing their experiences with dissociation. The process of working with the dissociative child will be discussed from exploration of the child’s internal dissociative system, the dance between trauma processing and stabilisation as well as integration of the dissociative states
Renée Marks is working as Consultant Therapist and Clinical Lead at Integrate Families in the North of England. Integrate Families is a National Centre for Children with Complex Trauma and Dissociation. Renée is a national and international trainer on the topic of attachment, emotional regulation, complex trauma and dissociation in children and adolescents. She is a member of the Child and Adolescents Committee of the ISSTD and also an accredited trainer for their on-line training. Renée is the chair of the Child and Adolescent Committee of the European Society on Trauma and Dissociation (ESTD) and specialises in the more serious and complicated population of traumatised children and adolescents. Renée is also an expert witness and provides clinical supervision and consultation to different agencies and therapists.
Complex Trauma in Childhood and Chronic Survival Adaptations in Adolescence: Pathways to Delinquency, and Doorways to Recovery
Early childhood exposure to complex trauma sets into motion psychobiological survival adaptations that in later childhood and adolescence can become chronic emotional, relational, and cognitive patterns of coping involving alternating hyper- and hypo-arousal and psychoform and somatoform dissociation. Poly-victimized children are at risk for not only PTSD and internalizing psychopathology such as depression, but also for severe problems with impulsivity, aggression, defiance, substance abuse, and delinquency that often result in involvement in the juvenile justice system. This workshop will describe research (Finkelhor et al., 2009; Ford et al., 2012, 2013; Grasso et al., 2015; Milan et al., 2013) and clinical observations (Ford et al., 2006; Ford & Blaustein, 2013) on the trajectories from childhood complex trauma to severe behavior problems and delinquency, and on the challenges and outcomes of implementation of the Trauma Affect Regulation: Guide for Education and Therapy (TARGET) framework as an individual, group, family, and workforce/ organizational-culture intervention for traumatized youth in juvenile justice and cross-over (child protection, schools, public health, mental health) systems. Clinical and organizational case examples will be presented to illustrate key points for clinicians and policy-makers who are opening doorways to recovery for complexly traumatized adolescents.
Julian Ford, Ph.D., A.B.P.P. is a board certified clinical psychologist and tenured Professor of Psychiatry at the University of Connecticut School of Medicine where he is the Director of the Center for Trauma Recovery and Juvenile Justice in the National Child Traumatic Stress Network, the Center for Trauma Response, Recovery, and Prevention, and the Child Trauma Clinic. He Chairs two Institutional Review Board panels and is Director of the Regulatory Section of the Connecticut Institute for Clinical and Translational Science. Dr. Ford is Associate Editor of the Journal of Trauma and Dissociation and the European Journal of Psychotraumatology and serves on several peer review journal Editorial Boards. Dr. Ford has published more than 125 peer reviewed scientific and clinical reports and edited or authored 10 books including Treating Complex Trauma: A Sequenced, Relationship-Based Approach (2013, Guilford Press) and Treating Complex Traumatic Stress Disorders in Children and Adolescents: Scientific foundations and therapeutic models (2013, Guilford Press).