by Mike Fisher, Chair of TAG

 

 

One helpful model for treatment and recovery recognises three distinct stages or phases towards recovery. These can be identified as:

 

  1. Stabilisation and symptom reduction

  2. Processing traumatic memories and achieving change

  3. Resolution, integration and recovery

 

However in actuality no treatment process moves through this progression in simple linear fashion. There will, at times, be considerable overlap or movement between the stages. There will also be a wide range of tasks that will need to be undertaken in the progression towards recovery.

 

Elements of each of the stages or phases are likely to include the following.

 

Stabilisation

 

• Establishing a relationship and therapeutic alliance.
• Developing trust and setting boundaries.
• Assessment and mapping of the system (if DID)
• Developing effective support systems.
• Achieving a safe sense of physical and emotional being and environment.
• Developing strategies to enhance order and routine.
• Developing grounding techniques.
• Seeking to recognise and manage triggers.
• Develop sense of containment and coping skills.
• Assist with changes in cognition and behaviour.
• Promoting internal communication.
• Development of safety and internal safe place.

 

Processing trauma and achieving change

 

• Managing hyperarousal with cathartic expression of emerging emotions.
• Reducing trauma with the recovery of specific memories.
• Facilitating the association of behaviour, affect, senses and knowledge (BASK)
• Reframing understanding, thoughts and feelings.
• Processing traumatic disturbance to reduce avoidance and intrusion.
• Developing alternatives to self-harming, phobias and destructive behaviour.
• Increasing of comfort, self-nurture, reward and satisfaction.
• Containing of conflicts of attachment, dependency and abandonment.
• Reducing dependency on dissociation.
• Managed reduction of addictive tendencies and self-harming.
• Changing the patterns of fear, guilt, shame and self-blame.
• Promoting internal co-operation and collaboration.
• Development of crisis management skills.
• Supporting verbal and creative expression.

 

Resolution and recovery

 

• Achieving an increased sense of self and identity.
• Increase in independence and life choices.
• Achieving new, realistic life perspectives.
• Association of alters, parts and functions.
• Possible integration of alters.
• Resolution of significant conflicts.
• Expression of post-integration grief.
• Strategic planning of future life.
• Maintaining life functions within normal parameters.
• Reduction in the expressed need of dependency on therapist.
• A planned gradual reduction in therapy.

 

This list can only be a very basic guide to what can be a complex array of tasks that may need to be undertaken as part of the therapeutic journey. Every individual’s needs and circumstances will be different. Likewise the time involved in making the journey to recovery will vary a great deal. The only predictable factor is that it will be long term. Whilst the first phase can take a long time before survivors feel secure enough to work in depth, phase two is likely to be the longest phase of recovery. Pacing the therapeutic work and the rate that the survivor can manage is important, otherwise “flooding” and destabilisation will take place.

 

Some considerations for Counsellors

 

• Understanding different types of alter personalities and their function.
• Appreciating the dynamic between alter parts.
• Understand imitation DID distinguishing features.
• The implication of transference and counter-transference with dissociation.
• The importance of the somatic dimension of trauma & dissociation.
• The relationship between trauma, insecure attachment and dissociation.
• The value of creative methods and other adjunct therapies.
• Using Multiaxial Assessment and Global Assessment of Functioning scale
• Using the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)
• The importance of recognising patterns and trends.
• The need to cope with chaos, confusion and uncertainty.
• The need to deal with one’s own vicarious traumatisation.
• The importance of keeping one’s own defences at a minimal level.
• The value of finding the ways of working with each client that are the least traumatising.
• Appreciating that this area of work is both very simple and very complex.
• The necessity of supervision, support and therapy for counsellors.

 

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