Pre-Conference Workshops

Thursday, 22 March 2018

P1 - THE IMAGE COMES FIRST: A GRAPHIC NARRATIVE TOOL FOR TREATMENT OF PTSD
Presenters: Tally Tripp and Linda Gantt

This workshop teaches an integrated set of techniques that can be used to bring about rapid and lasting treatment for post-traumatic stress disorder. The procedures can be applied individually and in groups. The first task of this method is to process and integrate the verbal and nonverbal trauma narratives without reliving the trauma. This is accomplished by doing a “graphic narrative” and then “re-presenting” it to the patient. The second task of reversing traumatic dissociation uses the externalized dialogue that involves using both the dominant and non-dominant hands. Participants will learn the essential tasks of trauma therapy and how to treat post-traumatic stress disorder. The training is appropriate for non- art therapists and will include a hands-on experience of working with art and narrative processes.

P2 - PRENATAL, PREVERBAL AND PRESCHOOL TRAUMA AND SUBSEQUENT DEVELOPMENT OF DISSOCIATION
Presenters: Fran Waters, Na'ama Yehuda, Renee Marks, and Laurie Parker

Prenatal and preverbal traumas, along with preschool trauma, are often unrecognized forms of trauma that nonetheless can profoundly impact the trajectory of a child's life in ways that continue into adulthood. Birth trauma, abuse, neglect, and early medical trauma—although often coded in sensory motor memory or implicit memory systems—remain largely unrecognized as the origins of dissociative responses and disorders that severely impair the child. Research increasingly recognizes how aversive conditions during pregnancy, such as malnutrition, domestic violence and maternal stress, can impact not only the mother but also the developing fetus, and predispose babies to exhibiting fear-based dysregulated patterns after birth.

Traumatized infants and very young children can only communicate their distress through crying, irregular and disrupted circadian rhythms, feeding disturbances, frequent and sudden startle reflexes, abnormal or erratic responses to eye contact and stimuli, developmental delays, and even dissociative shutdown marked by staring and non-responsiveness.

This workshop will review research on early trauma, and examine symptoms and warning signs of dissociative responses. Star Theoretical Model (Waters, 2016) which combines five theories—attachment, neurobiology, child development, family systems, and dissociation—will be delineated as a framework for evaluating and treating early trauma. Communication disorders, processing difficulties, somatic disturbances, and emotional dysregulation based in or complicated by traumatic origin will be illuminated. Clinical cases of dissociative infants, toddlers and preschoolers will be presented, utilizing various modalities (e.g. Sensorimotor psychotherapy, EMDR, art and play therapy) to illustrate the treatment process through to integration. Special attention will be given to repairing attachment disturbances. Artwork and videos will be shown.

P4 - EATING DISORDERS, TRAUMA AND TRAUMA-RELATED DISORDERS; A CASE OF DID AND OVERVIEW OF THE CLINICAL SCIENCE
Presenter: Tim Brewerton

This workshop begins by presenting a case of dissociative identity disorder (DID) and binge eating that spawned his clinical research interest in trauma and eating disorders (ED). Video clips taken at various stages during the course of treatment will illustrate the dissociative process and the various alters identified. He illustrate how these “alters” take on specific adaptive functions and separate identities, which protect the self and are often archetypal in nature. Evolving concepts from psychotherapy theory and neuroscience are highlighted during the presentation.

Next, the workshop = will present an overview of the current state of clinical science and practice regarding traumatized ED patients. Individuals with EDs report very high rates of lifetime traumatic events, and they are especially sensitive to stress/adversity. Participants will become familiar with literature describing the clinical characteristics of ED patients with comorbid posttraumatic sequelae, e.g., PTSD, Complex PTSD, and Dissociative Disorders. Important principles for treating traumatized individuals with EDs, including the necessity of moving beyond sequential treatment to the development of integrated treatment protocols, are discussed in detail using clinical vignettes. Integration of existing evidence-based treatments including CBT for EDs, DBT, Cognitive Processing Therapy (CPT) Prolonged Exposure (PE), and Eye Movement Desensitization Reprocessing (EMDR) are emphasized.

P5 - SHAME IN COMPLEX TRAUMA AND DISSOCATION: PSYCHOLOGY MEETS NEUROBIOLOGY 
Presenters: Ulrich Lanius, Frank Corrigan, Rick Hohfeler, Sarah Krakauer 

Shame can be understood as an emotional process and as a traumatic state of mind and body.  Shame lies at the heart of individual and collective human experience, and as such reveals much about our sense of self, other, and relationship.  Not surprisingly, then, those of us who work psychotherapeutically with complex, relational trauma and dissociation regularly encounter shame both directly, for example in our patient's self-loathing, and indirectly, when dissociation, both as process and state of mind and body, provides a partial escape from obliterating shame.  Shame as emotion and traumatic state reveal much not only about the nature of self and relationship, but also point toward powerful happenings in the brain and body. These shame-related happenings include dysregulating states of hyperarousal and hypoarousal, and further suggest we would be wise to give special attention to the Periaqueductal Gray (PAG) region of the midbrain. 

This workshop brings together two psychotherapists with expertise working with shame in complex trauma and DID in both inpatient and outpatient settings (Rick Hohfeler, PhD and Sarah Krakauer, PsyD), and two seasoned psychotherapists who will share their expertise in neurobiology and brain/behavior relationships as pertains to shame, complex trauma and dissociation (Frank Corrigan, MD and Ulrich Lanius, PhD).  Ken Benau, PhD, a psychotherapist with special interest in working with shame and pride in psychotherapy, will serve as moderator and facilitator of a conversation both between our four presenters, and between our presenters and workshop participants.  We hope to foster an exciting exchange of ideas illuminating different ways of understanding the psychology (including phenomenology) and neurobiology of shame with respect to complex trauma and dissociation.  Likewise, we hope our shared conversation will further highlight creative ways to apply these understandings of shame, as observed in the mind, brain and body, to our work as psychotherapists.  We intend to pay particular attention to those points of intersection between mind, brain, body and behavior as relates to shame and complex trauma, in order to inspire psychotherapists and researchers alike.

Friday, 23 March 2018

P3 - LEGAL AND PROFESSIONAL ISSUES IN THE ASSESSMENT AND TREATMENT OF CHILDHOOD ABUSE SURVIVORS (Moved from Thursday)
Presenter: A. Steven Frankel

This six hour program is concerned with the factors that make the treatment of child abuse survivors one of the higher risk domains within the mental health world.  We review the types of cases seen by trauma clinicians, the types of clinician functions most associated with ethico-legal problems, and examples of jurisdictional laws that clinicians should know about.  The program will emphasize the “standards of care” that bind clinicians both nationally and internationally, defining that concept with examples the role of that concept in ethics-legal expectations for clinicians.  Next, we turn to a discussion of the primary existing resources for standards of care, such that clinicians learn where to look for ethico-legal support as they engage with childhood trauma survivors. The program then moves to categories of survivor and clinician factors that are associated with risks and risk management.  This discussion will be based on the risk management chapter of the American Psychological Association’s Handbook of Trauma Therapy (2017), written by the presenter.  This section of the program will provide examples of specific categories of both patient and professional risk factors and how these are best managed.  Finally, we will discuss the critical role of consultation over the course of professional practice, and examples of different types and forms of such consultation, along with the ethics-legal requirements to inform patients of the consultation practices of their treating clinicians.     

P6 - DISSOCIATION 101: FOR STUDENTS AND EMERGING PROFESSIONALS
Presenter: Christine Forner

For many students and emerging professionals who first enter the field of dissociation and trauma, there is often not a great deal of information that describes the theoretical foundations and history of the dissociative field. This workshop is intended for students, emerging professionals and others who are interested in learning about the fundamentals of dissociation as a distinct response to trauma.  The premise of this workshop is to cover very basic fundamental information regarding dissociation and the dissociative disorders field. This course will cover 1) basic theories of trauma and dissociation, 2) the history of the dissociative field, including theories and treatment recommendations from the 1800's, through to the eighties, nineties and today, 3) The impact of the false memory "war", 4) finer details of current dissociative models (covering various theoretical foundations, e.g. Structural dissociation, dissociative symptoms/phenomena (the DSM), dissociative defenses 5) rate and prevalence 6) a breakdown of the dissociative disorders, 7) basic neurobiology of trauma and dissociation, 8) assessment and evaluation, and 9) current treatments. The basic goal of the pre-conference session is to equip those who attend with enough information to take into their scholarly or new professional practices as well as have a solid foundation for the rest of the conference.

This workshop is designed to demystify dissociation and provide participants with a broad based understanding of it as a response to overwhelming stress.

P7 - SOMETHING OLD, SOMETHING NEW, SOMETHING BORROWED, AND SOMETHING BLUE: SELECTED TOPICS IN THE TREATMENT OF DISSOCIATIVE IDNTITY DISORDER
Presenter: Richard P. Kluft

This workshop is designed to prepare the therapist to make effective use of a number of models in conjunction. Although a combination of psychodynamic psychotherapy and hypnosis was used by the therapists in the most successful series of DID treatments on record, neither modality nor their combination is advocated or taught routinely. Consistent with its title, this workshop will begin by addressing some basic concepts in the psychotherapy of DID and the use of hypnosis in that process (Something Old), and proceed on to topics drawn from the director’s most recent contributions (Something New), a review of Basic Affect Theory and shame dynamics as developed by the late Donald Nathanson (Something Borrowed), and a specialized focus on addressing the heartbreaking dysfunctional sexual behavior demonstrated in a certain group of women suffering Dissociative Identity Disorder (Something Blue). Among the Something New topics is a challenge to the rifts between psychoanalysis and hypnosis that stem from Sigmund Freud’s rejection of hypnosis in 1895. Newer scholarship demonstrates that Freud’s decision was based on inaccurate and flawed reasoning. In fact, it is possible to enrich hypnosis with the contributions of psychoanalysis and to enrich psychoanalysis and psychoanalytic psychotherapy with the contributions of hypnosis without violating the basic frames and models of either modality. Basic affect theory helps bridge the two. Examples will be drawn from patients demonstrating severely dysfunctional sexual behaviors and reenactments.

P8 - TRACKING THE SOMATIC NARRATIVE OF MULTIPLICITY IN TRAUMA AND DISSOCATION
Presenter: Rochelle Sharpe Lohrasbe

Tracking, as a Sensorimotor Psychotherapy skill, is useful when working with dissociative clients. The client’s spoken narrative, the somatic narrative and the therapist experience are three sources of rich information in the multiplicity of dissociative experience that can be tracked. Developing attunement not only to the spoken word but also to the implicit expression that comes in the form of a somatic narrative, therapists can identify nuances in self states, indicators of dysregulated arousal, and opportunities for trauma and attachment reprocessing. Instruction and practice toward developing deeper observational capacities can support the therapeutic process during all phases of treatment for trauma survivors and clients with dissociative tendencies. This workshop will provide an overview of relevant theoretical foundations – drawing from literature and research in Interpersonal Neurobiology, the Polyvagal Theory, Attachment Theory, and Sensorimotor Psychotherapy. Participants will experience tracking first hand using video and live demonstration and brief learning exercises.  

P10 - EXTREME ABUSE: THE CRIME, THE VICTIMS, THE PERPETRATORS AND THE CLINICAL WORK
Presenters: Michael Salter, Ahad Sachs, and Lynette Danylcluk

Extreme abuse involves the deliberate, severe traumatization of victims, often in the context of organized abuse, criminal networks, cults and institutions. Although extreme abuse has been documented by clinicians for over thirty years, it remains a poorly understood and challenging area of clinical practice. This session will bring together three leading figures in the extreme abuse field.

The session will highlight the criminal  aspect of extreme abuse, and discuss the similarities and differences with other forms of trauma and dissociation. It will also examine very closely the process of devastation that extreme abuse has on both victims and perpetrators.

Victims and perpetrators both end up alienated from the rest of society, disbelieve their own humanity and feel unable to be understood or comforted by others. This dynamic, and others, present unique challenges to the therapeutic work.

Updated January 26, 2018

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