issues, and relational challenges brought to therapy. An understandi - PDF document

issues, and relational challenges brought to therapy. An understanding of the manifestations of structural dissociation helps the therapist make sense of paradoxical and contradictory symptoms and helps the patient to interpret their emotions, behavior, and physical reactions as information about the effects of trauma ratherthan proof of their expand their capacity to hemisphere-left hemisphere split. Though children are born with both hemispheres, they are right brain dominant for most of childhood. The slower developing left brain has spurts o irresolvable conflict between internal working models: biologically, the attachment figure elicits the cry for help response or proximity-seeking under stress, yet approaching abusive or threatening adults elicits fear, fight and flight responses. fragmentation can be more subtle and permeable or more dramatic and rigid: clients with diagnoses of Bipolar II Disorder might shift from irritable moods to depressive states to anxiety, while clients with Borderline Personality Disorder might sometimes present as regressed and clinging, then cold and angry, then hopeless and passively suicidal, while all the while with memory (for example, not clearly recalling the intense anger and aggressive behavior of their fight parts or the neediness of a young child part with separation anxiety). In clients with DID (Dissociative Identity Disorder), not only will the number of parts tend to be greater but they be more likely to have subparts serving the Going On with Normal Life self or its priorities, for example, a professional self, a parenting part, or a part with special talents or social skills. In addition, as the neural systems governing each part become more elaborated and autonomous, clients start to exhibit switching and time loss as they are ÒhighjackedÓ by parts who act or act out outside the conscious awareness of the Going On with Normal Life self. While updating her curriculum vita, Celia, a successful organizational consultant, was surprised to discover that she had won an award in 19 the needy but relational child parts? Treatment goals and interventions To address these challenges, there are some simple principles that can guide us in planning the treatment. Even in the midst of crisis and confusion, it is the therapistÕs job to keep the focus on the sequence of basic therapeutic tasks necessary to good treatment for trauma-related dissociation. Neuroscience research on traumatic remembering tells us that both spontaneous triggering and deliberate recollecting result in activation of the autonomic nervous system and de-activation of the prefrontal cortex in preparation for mobilizing (fight/flight responses) or immobilizing (freezing/submitting) forms of self protectionÑas if the danger were happening again. Not only do our clients suffer from the effects of each single traumatic incident but also from the repeated re-activation at a body level of the same non her life now clients have been normalizing their internal conflicts as ambivalence, the therapistÕs re-framing helps hold her.Ó As clients imagine the reactions of their younger selves, their internal states transform: they feel a sense of warmth, their bodies relax, they feel calmer. To ensure that these positive internal states are more than momentary, the therapist must continue focusing on what happens as the relationship to the part becomes deeper, more compassionate, and more committed. Sometimes, the therapist has to provide psychoeducation to make the point that change will come only through repetition of new patterns: ÒThe more you hold her, the safer she will feel, and then the calmer you will feel. She can let you feel calm and centered if sheÕs not terrified.ÓSometimes, the same message has to be framed even more empathically: ÒShe doesnÕt trust you ust ask them to notice ÒwhoÓ is upset and what has triggered that part. The assumption that upset is alwaysa communication from a part is not scientific fact, of courseÑit represents a leap of faith that naming compartmentalization and noticing it in a compassionate way is most likely to lead to positive change. However, it is a mindfulness-based. If we as therapists consistently LetÕs ask inside how old she is and just let a number come to mind.Ó Internal communication thus begins with conscious and present in the here-and-now, to tolerate the ups and downs and the highs emotions