Participants finishing this course will have a comprehensive understanding of how to intervene with the traumatized child with dissociative symptoms in ways to promote healthy development.
This online course syllabus is the copyrighted property of the International Society for the Study of Trauma & Dissociation (ISSTD). Please do not copy or distribute without permission from the ISSTD. (Copyright 2011-2012, ISSTD)
Intended Participants: Licensed mental health professionals (psychiatrists, psychologists, clinical social workers, mental health counselors) who are personally treating a child or adolescent with Complex PTSD, a significant trauma history, or dissociative symptoms; educators in human services
Session Dates: Six months period from February 1 to July 19, 2011 covering 9 sessions/topics. Each session will begin with a week of reading followed by 10 days for online discussion.
Course Format: This course is designed in an online format to cover nine sessions of combined literature discussion and clinical case presentations/discussions by faculty and students.
Evaluations: At the conclusion of this course, an evaluation form will be provided. Please fill it out and send to Lynette Danylchuk, ISSTD Professional Training Director, l.danylchuk@usa.net. We count on you for your feedback.
24.5 Continuing Education Credits: CE/CME credits can be purchased for this course and are sponsored by the Institute for the Advancement of Human Behavior. Students who sign up for CE/CME credits will be required to take a test at the completion of the course and successfully pass the test to receive the credits. In addition, they will be required to complete the evaluation form at the end of the class. They will be expected to present a case study during the course and participate in discussions that demonstrate that they have read the materials and followed the discussions through postings.
Disclosure of Relevant Financial Relationships:
The Institute for the Advancement of Human Behavior, Inc. is responsible for the content, quality and scientific integrity of all CE/CME activities certified for credit.
In accordance with the Standards for Commercial Support established by the Accreditation Council for Continuing Medical Education, American Psychological Association (APA), and American Nurses Credentialing Center (ANCC), all those in a position to influence the content of an education activity are asked to disclose any relevant financial relationships that may establish a conflict of interest.
Joyanna Silberg, PhD, Frances Waters, LMSW, DCSW, LMFT, Sandra Wieland, PhD, and Annita Jones, PsyD have no relevant financial relationships.
Certificate of Completion Form: In order for participants to receive the certificate of completion form, they will be required to present a case study during the course and participate in discussions that demonstrate that they have read the materials and followed the discussions through postings.
About the Curriculum:. The course you are about to take represents the collaborative efforts of Dr. Joyanna Silberg, Frances Waters, LMSW, and Dr. Sandra Wieland with suggestions from the course directors from ISSTD, Dr. Richard Chefetz, Dr. Eli Somer, Dr. Elizabeth Howell, and Dr Steven Frankel.
Description: This course begins with a brief historical perspective of childhood dissociation, an explanation of the effect trauma can have on infant/child neurobiology, and an introduction to theories of dissociation. The course then covers methods of assessment, assessment tools, and differential diagnosis across the spectrum of dissociative pathology. Family dynamics that contribute to dissociative pathology in children and ways to work effectively with the family while building positive attachment between child and parents will be described. Ideas for helping to stabilize the child, promote emotional regulation, explain dissociation to both the child and the parents, and encourage communication between dissociative states will be given. Special attention will be given to working with the varied societal systems (schools, social services, legal system) with which the family is involved. A variety of treatment modalities and creative techniques will be presented for safely processing trauma and furthering integration of the child’s dissociative states. Extensive case studies and specific examples will be used throughout the course. Participants will present case studies from their own practices.
THE COURSE SYLLABUS
SESSION 1 - HISTORY, THEORY, AND NEUROBIOLOGY
This session presents a brief history of childhood dissociation together with the major theories that have been developed to help understand the dissociative process: vulnerability from disorganized attachment, complex developmental trauma, discrete behavioral states, and structural dissociation. The effects of trauma on the infant/child’s developing neurobiological systems will be reviewed.
Introductions and Session 1 Readings - Jan 29- Feb 2, Goldstein
Instruction: Feb 3- Feb 13, Jones
Session 1 Goals:
1. Participants will be able name three neurobiological impairments caused by trauma.
2. Participants will be able identify characteristics of disorganized attachment in children.
3. Participants will be able to compare two theories of dissociation and how they could explain dissociative symptomatology.
SESSION 2 - ASSESSMENT AND DIFFERENTIAL DIAGNOSIS
This session describes the many forms of trauma that can cause dissociative symptoms in children. How children’s dissociative presentation differs from that of adults will be highlighted. The course will describe assessment techniques, interview questions, and standardized questionnaires. The importance of being aware of co-morbid conditions but yet distinguishing between dissociation and other disorders (e.g., ADHD, bipolar disorder, reactive attachment disorder) will be emphasized. The ISSTD’s Guidelines for Evaluation & Treatment of Dissociation in Children and Adolescents will be introduced.
Readings: Feb 14- Feb 18
Instrucrtion: Feb 19- Feb 29, Silberg
Session 2 Goals:
1. Participants will describe dissociative symptoms in children covering the spectrum from dissociative processes to a disorder.
2. Participants will identify differential diagnoses commonly seen with traumatized and dissociative children, i.e. ADHD, Bipolar Disorder, Reactive Attachment Disorder, OCD.
3. Participants will describe the therapeutic goals of the ISSTD’s Guidelines for Evaluation & Treatment of Dissociation in Children and Adolescents.
SESSION 3 - UNDERSTANDING FAMILY DYNAMICS
This session will describe dysfunctional family pathology and how this may influence the formation and/or persistence of dissociative symptoms. Participants will learn ways to help families shift these negative patterns, provide a sense of safety and structure for the child, and establish a more secure attachment pattern across the child’s dissociative states. Ways to engage the caregivers as partners in their children’s treatment will be presented.
Reading: Feb 29- Mar 3
Instruction: March 4- March 13, Jones
Session 3 Goals:
1. Participants will describe techniques for helping caregivers provide soothing and structure for dissociative children.
2. Participants will list 3 therapeutic exercises to do with caregivers in therapy sessions with dissociative children that help defeat dissociative barriers.
3. Participants will identify caregiver’s behaviors that can serve as traumatic triggers, and how to help them interrupt these.
SESSION 4 - STABILIZATION I
This session will focus on increasing sense of safety, stabilization and ego strengthening techniques using imagery, art therapy, cue words, visual prompts, and EMDR. Emphasis will be placed on how to explain both to the child and the parents about dissociation, how to help the child and parent start to recognize the dissociative states and behaviors, and how to develop cooperation between dissociated states. Ways to manage and reduce traumatic triggers will be discussed.
Reading: March 14- March 17
Instruction: March 18- March 28, Waters
Session 4 Goals:
1. Participants will explain stabilization techniques that enable the child to feel empowered, grounded, and safe.
2. Participants will describe psycho-educational methods for explaining dissociation and trauma with children.
3. Participants will describe strategies to build internal awareness across all dissociative states and break down amnesic barriers.
SESSION 5 - STABILIZATION II: SPECIAL PROBLEMS WITH DISSOCIATIVE CHILDREN AND ADOLESCENTS
Using participants’ case presentations, this session will focus on techniques for special management of problems encountered in working with dissociative children and adolescents. These problems include self-injury, sexually acting out, obsessive-compulsive behaviors, rage reactions and somatic symptoms.
Readings: March 29- April 2
Spring Break: April 3- April 10
Instruction: April 10- April 19, Wieland
Session 5 Goals:
1. Participants will identify psychoeducational, and cognitive-behavioral techniques for working with self-injury.
2. Participants will analyze how obsessive compulsive problems in children can overlap with dissociation.
3. Participants will identify techniques to decrease dissociative based sexual acting out behavior.
SESSION 6: COLLABORATIVE WORK WITH SYSTEMS
In this session, the presenters will discuss some of the political issues raised in interacting with systems such as the court, social services, school systems and health care when discussing a child’s dissociative symptoms. Focusing on normative developmental trajectories, pragmatic interventions for stabilization, and following current guidelines and standards of practice will help the practitioner to negotiate some of the difficult issues that arise.
Readings: April 20- April 24
Instruction: April 25- May 4, Waters
Session 6 Goals:
1. Participants will identify common barriers in mental health and school environments that present obstacles to assessment and treatment.
2. Participants will learn how to use common language to interface with professionals who may be skeptical of trauma-based pathology.
3. Participants will identify ways to balance ethical standards with legal requirements.
SESSIONS 7 & 8: TRAUMA PROCESSING I & II
The next two sessions will illustrate working with children and adolescents for safe processing of traumatic events across all sensory domains. Strategies, such as imagery, drawings, play therapy, ego state therapy, and EDMR will be discussed to help children safely process traumatic memories. Emphasis will be placed on the resolution of shame associated with their traumatic experiences.
Session 7:
Readings: May 4- May 8
Instruction: May 9- May 18, Silberg
Session 8:
Readings: May 19- May 22
Instruction: May 23- June 1, Wieland
Sessions 7 & 8 Goals:
1. Participants will be able to apply and use art activities for containment of traumatic memories and mastery.
2. Participants will be able to apply the use of variety of techniques to encourage internal communications between dissociative states for effective processing of traumatic memories.
3. Participants will be able to apply imagery techniques to help with processing memories.
SESSION 9 - INTEGRATION AND POST-INTEGRATION
This session will cover the final stages of work with traumatized and dissociative children. The presenters will discuss a variety of creative modalities and imagery techniques, and emphasize the treatment challenges at the final stages of treatment, including signs of a relapse, ongoing development of coping strategies, and resolution of attachment issues.
Readings: June 2- June 5
Instruction: June 6- June 15, All Faculty
Session 9 Goals:
1. Participants will be able to identify specific techniques to achieve integration
2. Participants will be able to recognize the types of triggers with child and/or family that may cause relapses.
3. Participants will be able to assess the ongoing development challenges faced by the traumatized child after integration.
Course Evaluations: June 15- June 18, All Faculty
Content Warning Statement:
PLEASE NOTE: This advanced workshop may include descriptions, videotapes, audiotapes, and/or reenactments of actual therapy sessions. Some of the case material may contain graphic descriptions of violence, sexual activity, or other content which could be disturbing, especially to participant who themselves have had similar experiences. The workshop is intended for healthy professionals and advanced students, who participate in at their own risk. If you find portions of the program upsetting, or if you need assistance for any other reason, please notify the instructor or program coordinator.
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