Phase-Oriented Treatment of Structural Dissociation in Complex Traumatization: Overcoming Trauma-Related Phobias

• Published in: Journal of trauma & dissociation Vol. 6; no. 3; pp. 11 - 53
• Main Authors: Steele, Kathy, van der Hart, Onno, Nijenhuis, Ellert R. S.
• Format: Journal Article
• Language: English
• Published: Binghampton, NY Taylor & Francis Group 2005; Haworth Press
• Subjects: Adaptation, Psychological; Biological and medical sciences; complex trauma; Dissociation; dissociative disorders; Dissociative Disorders - complications; Humans; Individual psychotherapy; Medical sciences; Personality; phase-oriented treatment; Phobic Disorders - etiology; Phobic Disorders - therapy; Psychoanalytic Theory; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychotherapies. Psychological and clinical counseling; Psychotherapy - methods; Stress Disorders, Post-Traumatic - complications; Stress Disorders, Post-Traumatic - therapy; Transference (Psychology); Treatments; Affect affectivity; dissociative disorders; Posttraumatic syndrome; phase-oriented treatment; Anxiety disorder; complex trauma; Review; Therapeutic relation; Theoretical model; Affective attachment; Coping; Therapeutic schedule; Dissociation; Human; Dissociative disorder; Personality; Individual psychotherapy; Stress; Symptomatology; Split personality; Treatment; Treatment planning; Comparative study; Therapeutic role; Structural analysis
• ISSN: 1529-9732; 1529-9740
• DOI: 10.1300/J229v06n03_02

The theory of structural dissociation of the personality proposes that patients with complex trauma-related disorders are characterized by a division of their personality into different prototypical parts, each with its own psychobiological underpinnings. As one or more "apparently normal" parts (ANPs), patients have a propensity toward engaging in evolutionary prepared action systems for adaptation to daily living to guide their actions. Two or more "emotional" parts (EPs) are fixated in traumatic experience. As EPs, patients predominantly engage action systems related to physical defense and attachment cry. ANP and EP are insufficiently integrated, but interact and share a number of dispositions of the personality (e.g., speaking). All parts are stuck in maladaptive action tendencies that maintain dissociation, including a range of phobias, which is a major focus of this article. Phase-oriented treatment helps patients gradually develop adaptive mental and behavioral actions, thus overcoming their phobias and structural dissociation. Phase 1, "symptom reduction and stabilization," is geared toward overcoming phobias of mental contents, dissociative parts, and attachment and attachment loss with the therapist. Phase 2, "treatment of traumatic memories," is directed toward overcoming the phobia of traumatic memories, and phobias related to insecure attachment to the perpetrator(s), particularly in EPs. In Phase 3, "integration and rehabilitation," treatment is focused on overcoming phobias of normal life, healthy risk-taking and change, and intimacy. To the degree that the theory of structural dissociation serves as an integrative heuristic for treatment, it should be compatible with other theories that guide effective treatment of patients with complex dissociative disorders.