Life is an ongoing struggle for patients who have been chronically traumatized. They typically have a wide array of symptoms, often classified under different combinations of comorbidity, which can make assessment and treatment complicated and confusing for the therapist. Many patients have substantial problems with daily living and relationships, including serious intrapsychic conflicts and maladaptive coping strategies. Their suffering essentially relates to a terrifying and painful past that haunts them. Even when survivors attempt to hide their distress beneath a faÁade of normality—a common strategy—therapists often feel besieged by their many symptoms and serious pain. Small wonder that many survivors of chronic traumatization have seen several therapists with little if any gains, and that quite a few have been labeled as untreatable or resistant.
In this book, three leading researchers and clinicians share what they have learned from treating and studying chronically traumatized individuals across more than 65 years of collective experience. Based on the theory of structural dissociation of the personality in combination with a Janetian psychology of action, the authors have developed a model of phase-oriented treatment that focuses on the identification and treatment of structural dissociation and related maladaptive mental and behavioral actions. The foundation of this approach is to support patients in learning more effective mental and behavioral actions that will enable them to become more adaptive in life and to resolve their structural dissociation. This principle implies an overall therapeutic goal of raising the integrative capacity, in order to cope with the demands of daily life and deal with the haunting remnants of the past, with the “unfinished business” of traumatic memories.
Of interest to clinicians, students of clinical psychology and psychiatry, as well as to researchers, all those interested in adult survivors of chronic child abuse and neglect will find helpful insights and tools that may make the treatment more effective and efficient, and more tolerable for the suffering patient.
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Part 1 Structural Dissociation of the Personality
Chapter 1: Introduction
Chapter 2 Structural Dissociation of the Personality: Basics
Chapter 3 Primary Structural Dissociation: Prototypes of the Apparently Normal and the Emotional Parts of the Personality
Chapter 4 Secondary Structural Dissociation of the Personality
Chapter 5 Tertiary Structural Dissociation of the Personality
Chapter 6 Trauma-related Symptoms in Light of Structural Dissociation
Chapter 7 Structural Dissociation and the Spectrum of Trauma-related Disorders
Part II Chronic Traumatization and a Janetian Psychology of Action
Introduction Part II, A Janetian Psychology of Action
Chapter 8 Synthesis and Its Limitations in Trauma Survivors
Chapter 9 Traumatization as a Syndrome of Nonrealization
Chapter 10 The Hierarchy of Action Tendencies
Chapter 11 Phobic Maintenance of Structural Dissociation
Chapter 12 Assessment of the Traumatized Patient
Chapter 13 Promoting Adaptive Action: General Treatment Principles
Part III Treatment
Chapter 14 Phase 1 Treatment and Beyond: Overcoming the Phobia of the Attachment and Attachment Loss with the Therapist
Chapter 15 Phase 1 Treatment and Beyond: Overcoming the Phobia of Trauma-Derived Mental Actions
Chapter 16 Phase 1 Treatment and Beyond: Overcoming the Phobia of Dissociative Parts
Chapter 17 Phase 2 Treatment: Overcoming the Phobia of Traumatic Memory
Chapter 18 Phase 3 Treatment: Integration of the Personality and Overcoming the Phobias of Normal Life
About the Authors:
Onno van der Hart, PhD., is Professor of Psychopathology of Chronic Traumatization, Department of Clinical and Health Psychology, Utrecht University, Utrecht, the Netherlands, and a psychologist/psychotherapist at the Sinai Center for Mental Health, Amsterdam, the Netherlands. He is a Past President of the International Society for Traumatic Stress Studies (ISTSS).
Ellert R.S. Nijenhuis, Ph.D., is a clinical psychologist, psychotherapist, and researcher. He is affiliated with Mental Health Care Drenthe, The Netherlands and collaborates with various Universities. He is a former director of the Executive Council of the International Society for the Study of Dissociation (ISSD).
Kathy Steele, MN, CS , is Clinical Director of Metropolitan Counseling Services, a training and low cost psychotherapy center, and is in private practice with Metropolitan Psychotherapy Associates in Atlanta, Georgia. She serves on the Board of the International Society for the Study of Traumatic Stress, and is a former member of the Executive Council of the International Society for the Study of Dissociation.