Pre Conference Training Workshops

Timings - 9 am – 5 pm
Coffee – 11 – 11.30
Lunch – 13.00 – 14.00
Coffee – 15.00 – 15.30

Nel Draijer (Netherlands)
Transference Focused Psychotherapy (TFP) techniques in the treatment of DID

The treatment of Dissociative Identity Disorder is – depending on the severity of Axis II comorbidity - characterized by specific transference and countertransference phenomena.
Transference Focused Psychotherapy (TFP), based on object-relations theory, is an intensive (twice a week) psychodynamic psychotherapy, developed for patients with a borderline personality organization (BPO; Kernberg et.al., 2008). BPO is characterized by generally intact reality testing but primitive defenses (such as splitting, projective identification), identity diffusion (inner shifting of identity or self-states between ‘good’ versus ‘bad’, victim versus perpetrator, ‘well cared for child’ versus ‘totally neglected child’, etc.). TFP starts out with a contract to limit self-destructive acting-out such as suicidality, self-mutilation, attacking others, excessive drinking or binge eating, etc. TFP is an evidence based treatment which shows not only significant improvements at symptom level, but also structural changes, in terms of (more secure) attachment organization (Levy et al, 2006). 

TFP treatment techniques are particularly helpful in analysing and sustaining the severe transference and counter-transference forces active in the treatment of DID patients, including complicated cases with severe Axis II comorbidity.  This workshop presents the basic outlines and techniques of TFP, as well as ways in which TFP techniques can be used in the treatment of the so-called ‘impossible patient’. Participants are encouraged to bring clinical material for discussion.

Objectives:

Participants will be able to:
1. Identify the object-relational basis of Transference Focused Psychotherapy
2. Recognize the major transference and counter-transference forces in complex DID treatments in terms of object relational dynamics.
3. Handle negative transference and counter-transference reactions in complex DID treatments more effectively.

Joy Silberg (USA)
Treating Traumatized Children and Adolescents with Dissociative Symptoms and Disorders

This workshop begins with a look at trauma and dissociation in children and adolescents from a historical perspective and covers the physiological effects of trauma on the brain and related impairments in chronically traumatized children. The workshop then covers methods of assessment, assessment tools, and differential diagnosis across the spectrum of dissociative pathology.  The psychotherapy section presents a model that integrates child developmental theory, attachment theory and family systems theory with an understanding of how trauma affects the developing brain. Specific techniques that have been found to be helpful with dissociative children will be presented and demonstrated. The therapy enriches purely cognitive behavioral perspectives with an emphasis on processing emotions related to traumatic events through creative expression and sensitivity to attachment dilemmas in traumatized children. The workshop addresses techniques for looking at difficult symptoms such as self-injury, trance states, rage reactions and sexual acting out. The workshop ends with a review of techniques for intervening within the systems that affect the child and adolescent such as family dynamics, social services, schools, and the legal arena. Clinicians finishing this workshop will have an understanding of how to intervene with the traumatized child with dissociative symptoms to promote healthy development.

Christine Courtois (USA)
Integrative and Multimodal Treatment of Complex Traumatic Stress Disorders

Complex traumatic stress disorders develop in the aftermath of chronic cumulative trauma, particularly severe child abuse and neglect. They are also associated with relational insecurity and disorganization in primary attachment relationships that occur before the more overt traumatization. The objective of this workshop is to provide attendees with an increased understanding of the nature, diagnosis, and treatment of these conditions and disorders, drawing upon recent clinical consensus and research findings. Topics to be covered include: description of complex traumatic stress disorders in children and adults; preliminary treatment guidelines based on the growing clinical consensus and evidence base; and specific individual and group treatment strategies and approaches, especially those directed towards affect regulation, ego-enhancement, symptom stabilization, interpersonal skills, and the maintenance of the individual’s functioning. The importance of the therapeutic relationship to the treatment will be stressed. This overview is based on the presenter’s recently published book, Treating Complex Traumatic Stress Disorders: An Evidence Based Guide,co-edited with Dr. Julian Ford.   

Learning Objectives

Attendees will be able to identify the aftereffects of chronic cumulative trauma (particularly during childhood) as complex traumatic stress disorders and will be able to identify criteria of these disorders.

Attendees will gain an understanding of preliminary treatment guidelines for complex traumatic stress disorders.

Attendees will be able to identify a variety of evidence-based assessment and treatment strategies and techniques for complex traumatic stress disorders.

Remy Aquarone (UK), Suzette Boon (Netherlands), Andrew Moskowitz (UK)
Assessment and diagnosis of dissociation and the dissociative disorders

This workshop will focus on standard and developing approaches to the assessment and diagnosis of dissociation and the dissociative disorders, with particular emphasis on structured interviews and the consideration of realistic treatment goals.  In addition, attendees will be exposed to current debates about the definition of dissociation and the range of dissociative symptoms, and approaches to differentiating dissociative disorders from other psychiatric disorders

The morning session will consist of a workshop overview followed by a presentation of divergent approaches to defining dissociation (from narrow to broad), along with a consideration of dissociative symptoms (Andrew Moskowitz).  Next, Remy Aquarone will discuss the (traditionally-considered) ‘gold standard’ approach to assessing dissociative disorders, with emphasis on joint assessment, the combined use of the DES and SCID-D, and realistic treatment outcome considerations.  In the afternoon, Suzette Boon will present her new structured interview for the assessment of dissociative disorders (the Interview for Dissociative Disorders and Trauma-Related Symptoms), discuss the new interview’s capacity to detect ‘false positive’ cases of DID, and contrast it with the SCID-D.  The final session, with all three workshop presenters, will be on differential diagnosis, with particular emphasis on psychotic disorders, borderline personality disorder and bipolar disorder.  Case material and questions from participants will be welcome throughout the workshop, and particularly in the final portion.

Michael Paterson (UK)
EMDR and Ego State Therapy: Healing Complex Trauma and Dissociation

We all display particular patterns of thinking, feeling and acting, depending on the situation.  The transition is usually seamless in well-adjusted people, but where there has been disrupted attachment or sustained early life trauma the result is often the formation of particular ego states, also known as alters, parts, or schema modes.  These states perform roles usually geared towards survival, but in adulthood they can be dysfunctional.  Depending upon a client’s early life experiences some ego states can be malevolent, wanting bad things for the client such as willing them to suffer in some way.  These clients present us with the greatest challenges through what we know as complex trauma and dissociative disorders.

It is necessary for clients to remain stable during EMDR sessions and contained between sessions, particularly with complex trauma and dissociative disorders.  There is a need, therefore, to learn techniques to work in the Preparation Phase with more difficult clients so they too can benefit from the full EMDR protocol.  It is also helpful to know how to deal with blocked processing in the Desensitization Phase due to the interference of an ego-state.

This workshop initially provides an overview of dissociation and how it impacts on EMDR processing. There will be an explanation of Ego State Therapy (EST) and how it fits with EMDR to provide the stabilization clients need, as well as dealing with blocked processing.  Clinical case material is used throughout to illustrate learning points.  Through demonstration and practice participants will learn how to build resources for clients, access ego states in a controlled way and effect therapeutic change. In the latter part of the day, participants will see videos of live cases where EST is used effectively in the Preparation Phase of EMDR to: 1) identify the part-selves and 2) moderate the malevolence displayed by two difficult ego states.

Learning objectives

Understand how complex trauma and dissociative disorders impact EMDR processing

Understand the concept of working with part-selves as a way of preparing clients for the standard EMDR protocol.

Learn how to access ego states in a controlled way and effect therapeutic change and stability.

Learn techniques to deal with difficult ego states.