A fresh look at the importance of dissociation in understanding trauma. A new model of therapeutic action, one that heals trauma and dissociation, is overtaking the mental health field. It is not just trauma, but the dissociation of the self, that causes emotional pain and difficulties in functioning. This book discusses how people are universally subject to trauma, what trauma is, and how to understand and work with normative as well as extreme dissociation. In this new model, the client and the practitioner are both traumatized and flawed human beings who affect each other in the mutual process that promotes the healing of the client—psychotherapy. Elizabeth Howell explains the dissociative, relational, and attachment reasons that people blame and punish themselves. She covers the difference between repression and dissociation, and how Freud’s exclusive focus on repression and the one-person fantasy Oedipal model impeded recognition of the serious consequences of external trauma, including child abuse. The book synthesizes trauma/dissociation perspectives and addresses new structural models.

"This read truly does have something for everyone who works with trauma and dissociative processes." --American Journal of Clinical Hypnosis "This volume, which takes a multi-perspective approach to the practice of EMDR and Ego State Therapy, presents a wide variety of ways to integrate these two therapies, both with each other and with other complementary methods in the treatment of trauma and dissociation." --European Association for Body Psychotherapy EMDRIA has approved this book for a Distance Learning Book Course for 8 EMDRIA credits. "This book pioneers the integration of EMDR with ego state techniques. and opens new and exciting vistas for the practitioners of each." --From the foreword by John G. Watkins, PhD, founder of ego state therapy "This read truly does have something for everyone who works with trauma and dissociative processes." --American Journal of Clinical Hypnosis "The editors have gathered many experts in the field who explain in clear informative ways how to expand the clinician's abilities to work with this terribly injured population. This book blends concepts from neurobiology, hypnosis, family systems theory and cognitive therapy to enhance treating this population. It is a well written book that the novice as well as the seasoned clinician can benefit from." --Mark Dworkin, author of EMDR and the Relational Imperative "[This book] conveys complex concepts that will be of interest to seasoned therapists... with a clarity that will appeal to the novice as well. This is really a wonderful text with many excellent ideas and I highly recommend it to anyone who treats trauma." --Sarah Chana Radcliffe, M.Ed.,C.Psych.Assoc. Author, Raise Your Kids without Raising Your Voice "I believe that this book is a significant contribution to the fields of psychology and EMDR. It is the first of its kind... anyone who reads this will gain greater confidence in using EMDR and ego state therapy witih highly dissociative and complicated clients." --Sara G. Gilman, in Journal of EMDR Practice and Research, Volume 3, 2009 "This is a book about polypsychism and trauma. It offers a number of creative syntheses of EMDR with several models of polypsychism. It also surveys and includes many other models of contemporary trauma theory and treatment techniques. The reader will appreciate its enrichment with case examples and very generous bibliographic material. If you are a therapist who works with patients who have been traumatized, you will want this book in your library." --Claire Frederick, MD, Distinguished Consulting Faculty, Saybrook Graduate School and Research Center "Training in EMDR seems to have spread rapidly among therapists in recent years. In the process, awareness is growing that basic EMDR training may not be adequate to prepare clinicians to effectively treat the many cases of complex trauma and dissociation that are likely to be encountered in general practice. By integrating it with ego state therapy, this book may just serve as a crucial turning point in the development of EMDR by providing a model for productively applying it to the treatment of this important and sizeable clinical population." --Steven N. Gold, PhD, President Elect, APA Division of Trauma The powerful benefits of EMDR in treating PTSD have been solidly validated. In this groundbreaking new work nine master clinicians show how complex PTSD involving dissociation and other challenging diagnoses can be treated safely and effectively. They stress the careful preparation of clients for EMDR and the inclusion of ego state therapy to target the dissociated ego states that arise in response to severe and prolonged trauma.

The Dissociative Mind in Psychoanalysis: Understanding and Working With Trauma is an invaluable and cutting edge resource providing the current theory, practice, and research on trauma and dissociation within psychoanalysis. Elizabeth Howell and Sheldon Itzkowitz bring together experts in the field of dissociation and psychoanalysis, providing a comprehensive and forward-looking overview of the current thinking on trauma and dissociation. The volume contains articles on the history of concepts of trauma and dissociation, the linkage of complex trauma and dissociative problems in living, different modalities of treatment and theoretical approaches based on a new understanding of this linkage, as well as reviews of important new research. Overarching all of these is a clear explanation of how pathological dissociation is caused by trauma, and how this affects psychological organization -- concepts which have often been largely misunderstood. The Dissociative Mind in Psychoanalysis will be essential reading for psychoanalysts, psychoanalytically oriented psychotherapists, trauma therapists, and students.

This book examines how drama therapists conceptualize and respond to relational and systemic trauma across systems of care including mental health clinics, schools, and communities burdened by historical and current wounds. This second edition of Trauma-Informed Drama Therapy: Transforming Clinics, Classrooms, and Communities offers a broad range of explorations in engaging with traumatic experience, across settings (clinical, educational, performance) and geographies (North America, Germany, Sri Lanka, South Africa, India, Belgium), and methodologies (Sesame, DvT, ethnography, performance, CANY, Self Rev). Each effort runs into obstacles, resistances, biases, and random events that highlight the authors’ passion and courage. No solutions are to be found. No grand schemes are proposed. Just hard work in the face of impenetrable truth: we are still at the beginning of understanding how to achieve an equitable, moral, accountable, healthy collective being-with. Confronting trauma, listening to victim testimonies, sitting with unsettling uncertainty, understanding the enormity of the problem, are difficult tasks, and over time wear people down. The chapters in this book belie this trend as they illustrate how the passion, creativity, faith, and perseverance of drama therapists the world over, each in their own limited way, can help. In each of these chapters you will read about people who have been pushed to the margins of existence, and then, how drama therapists have worked to remind them of their immutable, unique value that can transcend and transform those margins into spaces of care, power, and possibility. It will be useful for creative arts therapists, mental health professionals, educators, students and many others interested in the role of the drama and performance in the treatment of trauma.

Winner of the 2022 Gradiva® Award for Best Edited Book! Understanding shame as a relational problem, Shame Matters explores how people, with support, can gradually move away from the relentless cycle of shame and find new and more satisfying ways of relating. Orit Badouk Epstein brings together experts from across the world to explore different aspects of shame from an attachment perspective. The impact of racism and socio-economic factors on the development and experience of shame are discussed and illustrated with clinical narratives. Drawing upon the experience of infant researchers, trauma experts and therapists using somatic interventions, Shame Matters explores and develops understanding of the shameful deflations encountered in the consulting room and describes how new and empowered ways of relating can be nurtured. The book also details attachment-informed research into the experience of shame and outlines how it can be applied to clinical practice. Shame Matters will be an invaluable companion for psychotherapists, clinical psychologists, counsellors, social workers, nurses, and others in the helping professions.

Building on the comprehensive theoretical model of dissociation elegantly developed in The Dissociative Mind, Elizabeth Howell makes another invaluable contribution to the clinical understanding of dissociative states with Understanding and Treating Dissociative Identity Disorder. Howell, working within the realm of relational psychoanalysis, explicates a multifaceted approach to the treatment of this fascinating yet often misunderstood condition, which involves the partitioning of the personality into part-selves that remain unaware of one another, usually the result of severely traumatic experiences. Howell begins with an explication of dissociation theory and research that includes the dynamic unconscious, trauma theory, attachment, and neuroscience. She then discusses the identification and diagnosis of Dissociative Identity Disorder (DID) before moving on to outline a phase-oriented treatment plan, which includes facilitating a multileveled co-constructed therapeutic relationship, emphasizing the multiplicity of transferences, countertransferences, and kinds of potential enactments. She then expands the treatment possibilities to include dreamwork, before moving on to discuss the risks involved in the treatment of DID and how to mitigate them. All concepts and technical approaches are permeated with rich clinical examples.

Drawing on the pioneering work of Janet, Freud, Sullivan, and Fairbairn and making extensive use of recent literature, Elizabeth Howell develops a comprehensive model of the dissociative mind. Dissociation, for her, suffuses everyday life; it is a relationally structured survival strategy that arises out of the mind’s need to allow interaction with frightening but still urgently needed others. For therapists dissociated self-states are among the everyday fare of clinical work and gain expression in dreams, projective identifications, and enactments. Pathological dissociation, on the other hand, results when the psyche is overwhelmed by trauma and signals the collapse of relationality and an addictive clinging to dissociative solutions. Howell examines the relationship of segregated models of attachment, disorganized attachment, mentalization, and defensive exclusion to dissociative processes in general and to particular kinds of dissociative solutions. Enactments are reframed as unconscious procedural ways of being with others that often result in segregated systems of attachment. Clinical phenomena associated with splitting are assigned to a model of “attachment-based dissociation” in which alternating dissociated self-states develop along an axis of relational trauma. Later chapters of the book examine dissociation in relation to pathological narcissism; the creation and reproduction of gender; and psychopathy. Elegant in conception, thoughtful in tone, broad and deep in clinical applications, Howell takes the reader from neurophysiology to attachment theory to the clinical remediation of trauma states to the reality of evil. It provides a masterful overview of a literature that extends forward to the writings of Bromberg, Stern, Ryle, and others. The capstone of contemporary understandings of dissociation in relation to development and psychopathology, The Dissociative Mind will be an adventure and an education for its many clinical readers.