More Alike Than Different

More Alike Than Different: Treating Severely Dissociative Trauma Survivors

MARGO RIVERA
Copyright Date: 1996
Pages: 248
https://www.jstor.org/stable/10.3138/j.ctt2ttmgg
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  • Book Info
    More Alike Than Different
    Book Description:

    Insightful and provocative, this important therapeutic guide will be of interest to professionals who treat trauma survivors as well as to their clients.

    eISBN: 978-1-4426-6484-5
    Subjects: Psychology, Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. Preface
    (pp. ix-xiv)
  4. Acknowledgments
    (pp. xv-2)
  5. 1 Introduction: Multiple Personality in Context
    (pp. 3-19)

    The issue of multiple personality is embedded in the issue of child abuse, particularly the sexual abuse of young girls. A number of independent studies drawing their cohorts from individuals in treatment with a wide variety of mental health practitioners found that nine out often people with multiple personalities seen in clinical settings are women (Putnam et al., 1986; Ross, Norton & Wozney, 1987; Rivera, 1991).

    There is some speculation that the high ratio of women to men with multiple personalities could be a sampling bias and that male multiples are more likely to be extremely violent and found in...

  6. 2 Multiplicity Is the Solution, Not the Problem
    (pp. 20-51)

    The telling of a story is shaped by the conventions available. I don’t believe there is such a thing as multiple personality. But then again, I do not believe there is such a thing as medical psychiatry, or academic psychology, or white male doctors either. These are all constructs, ways of framing consciousness, experience, and practice. They do not exist in some kind of reality outside of the terms that we have created to consider them. They are all categories that are unstable and suspect.

    They are not, however categories of equal power. Biological psychiatry is one of the most...

  7. 3 Learning the Language of Dissociation
    (pp. 52-66)

    The claim of many so-called sceptics regarding the existence or the utility of the diagnosis of dissociative identity disorder – that if you ignore the symptoms, they will go away – is true in a particular way. If you are not willing to talk to someone in their own language, they will either try to talk in your language or they will go away and not talk to you at all; often they will do both. The phenomenon of hypnosis bears this out. Individuals suffering from severe dissociative conditions are highly hypnotizable and therefore, by definition, highly suggestible when in a trance...

  8. 4 Assessment: A Joint Endeavour
    (pp. 67-94)

    In any therapy regimen, assessment is an ongoing process that begins before a therapist meets the client and continues until termination. When an assessment is requested of an individual displaying signs of a high level of dissociative behaviour, what is often sought is an opinion as to the degree of dissociation, usually asked in the form of, ‘Do you think this person is suffering from multiple personality disorder (dissociative identity disorder)?’

    What focus one takes in an assessment depends on the context in which the assessment is requested. I always want to know who wants the assessment and for what...

  9. 5 Constructing the Healing Process
    (pp. 95-125)

    There has been a great deal of optimism, both in clinical settings in which individuals suffering from dissociative conditions have been treated and in abuse survivor circles, about the prognosis for complete healing. The earliest outcome study (Kluft, 1988) found that more than 90 per cent of the individuals followed after a period of two years or more of stable integration did not relapse, and not only no longer suffered from multiple personality but showed substantial improvement in most areas of their functioning. Most clinicians who have treated a number of individuals suffering from severe dissociative symptoms have had the...

  10. 6 Boundaries in Psychotherapy
    (pp. 126-153)

    All psychotherapy occurs within the framework of the therapeutic relationship. There are many aspects of the recovery process that can take place without involving ongoing personal interaction between a therapist and client, such as reading self-help books or attending twelve-step groups. There are probably recovery computer programs for all I know; if there are, there is no reason why they should not be helpful. None of these resources and activities, however, are psychotherapy.

    The therapeutic relationship, the central vehicle through which therapy takes place, is a relationship like others in some ways and unique in other ways. It is a...

  11. 7 Abuse and Memory in the 1990s
    (pp. 154-171)

    The issues of memory has become central to the issue of trauma, particularly childhood sexual abuse. The ways in which we now think and talk about memory as it relates to trauma evolved from the late nineteenth century, when the word ‘trauma’ acquired a new meaning. Although it had always been in the medical lexicon as meaning lesion or wound, at this point in history the word acquired the meaning most common today: ‘a psychological hurt, a spiritual lesion, a wound to the soul’ (Hacking, 1995, p. 4).

    In the past fifteen years, we have seen the issue of memory...

  12. 8 Ritual Abuse
    (pp. 172-189)

    Just as therapy for people with severe dissociative conditions is the same as therapy for anyone else who wants in-depth dynamic therapy – only more so – so is ritual abuse like other abuse – only more so. More so is a significant qualifier. More so means a lot. What it does not mean, however, is freakish, qualitatively different, or ‘other.’

    This can be a hard point to keep in mind when a therapist is working with their first client who alleges a background of ritual abuse, but it is key. The horror that the therapist has to face and feel in order...

  13. 9 Treating the Lesbian and Gay Survivor of Abuse
    (pp. 190-208)

    Sexuality is often a key area of conflict for abuse survivors. People who were sexually abused and exploited from early in childhood often find sex an area of confusion and pain. They are the same in this regard as everyone else who is socialized in a society in which sex is simultaneously privileged and denigrated beyond reason. The difficulties experienced by anyone raised in an anti-sex and sex-preoccupied society in attempting to create a healthy, integrated sexuality are also experienced by survivors of sexual abuse, often only more so.

    Similarly, people – with sexual abuse histories or not – who are moved...

  14. 10 The Politics of Child Abuse and Dissociation
    (pp. 209-221)

    There is a lot of talk in the clinical community about the secondary PTSD (post-traumatic stress disorder) symptoms that often affect therapists treating individuals suffering from severe dissociation. This is generally attributed to the empathic connection with trauma survivors as they reveal and sometimes relive terrible experiences beyond the usual life experience of the therapist. Intrusive thoughts, sleep disturbance, numbing of emotions, hypervigilance, pervasive lack of trust, lability – all can be signs that the therapeutic work is taking a toll on the therapist as well as the client.

    In the first years of my work with severely dissociative individuals, I...

  15. Conclusion: Who Are You?
    (pp. 222-230)

    The dialogue between Alice and the caterpillar is evocative of the encounters many women suffering from severe posttraumatic dissociative symptomatology experience with mental health professionals. InMadness and Civilization(1972), Michel Foucault traces the changes in conceptualizations of illness – both physical and mental – throughout history. During the Middle Ages, lepers were scattered in colonies on the edges of European cities. They were considered dangerous and wicked, punished through their sickness by God. During the Renaissance, those who were considered mad were loaded onto ships and sent off to sail down Europe’s rivers in search of their sanity. The seventeenth century...

  16. References
    (pp. 231-246)
  17. Index
    (pp. 247-248)