Treating Trauma-Related Dissociation: A Practical, Integrative Approach (Norton Series on Interpersonal Neurobiology) by Steele Kathy & Boon Suzette & Hart Onno van der

Treating Trauma-Related Dissociation: A Practical, Integrative Approach (Norton Series on Interpersonal Neurobiology) by Steele Kathy & Boon Suzette & Hart Onno van der

Author:Steele, Kathy & Boon, Suzette & Hart, Onno van der [Steele, Kathy]
Language: eng
Format: azw3
Publisher: W. W. Norton & Company
Published: 2016-11-28T16:00:00+00:00


Ann was treating Colin, a male patient who was using cocaine on a regular basis and engaging in binge drinking that interfered with his ability to function at work. He eventually lost his job and became chronically suicidal. Colin refused to go to AA or to an emotional skills group, take medication for depression and anxiety, or stop using drugs and alcohol. He often canceled appointments, and Ann—worried about his suicidality—would pursue him and try to have therapy sessions on the phone. Stephen suffered from DID but was unwilling to acknowledge or work with parts and would not allow the therapist to access parts. However, parts of the patient were constantly switching in session, and e-mailing Ann about various issues which then could not be discussed in therapy. Therapy sessions devolved into Ann pleading for Colin to engage in some—any—therapeutic action, and Colin refusing. After consultation Ann was able to realize that she needed support to be less caretaking and more curious with the patient about his experience and what kept him from making changes. She needed to explore his motivation to make changes. She became clearer about what she required to continue treatment. As importantly, she realized that she and the patient needed to find at least one shared treatment goal that could be worked on consistently in therapy.

Anxious therapist, anxious patient. The anxious therapy dyad is the one most likely to end up with more serious boundary violations. Anxious therapists typically feel overwhelmed by the needs and suffering of the patient, and may feel guilty, overly responsible, and preoccupied with the patient’s well-being. They seek ways to actively take care of or help the patient. The caretaking serves to temporarily relieve the anxiety of both the therapist and the patient, and circumvents difficult work with the inner experience of either party. Anxious therapists have much more difficulty setting appropriate boundaries out of inability to tolerate discomfort and pain in either themselves or their patients. Such therapists often have learned to cope with relationships via controlling-caregiving strategies.

The anxious patient escalates in reaction to the anxiety of the therapist, becoming ever more dysregulated and distressed, in a spiral of mutually escalating arousal (Beebe, 2000; also cf. Chapter 4). The goal for the anxious patient and therapist is soothing of intense distress, rather than exploration of why they might be responding to each other this way and what could change. Anxious therapists often seek consultation after they are exhausted from contact and crisis, but feel the only option is to do still more. They may be highly reluctant to transfer the patient or change their patterns of response to the patient.


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