Welcome to the winter edition of Blue Knot Review, an electronic journal chronicling recent developments and new perspectives around complex trauma and trauma-informed practice.
Jeni Haynes finds justice: a legal precedent in recognition of DID
In a landmark case believed to be the first in the world, Jeni Haynes, an Australian woman who was a victim of extreme protracted daily sexual abuse by her father, from a young age, took him to court. Richard Haynes was ultimately convicted by the testimony of her multiple self-states or personality `parts’ that had developed through the mechanism of dissociation. The provision of testimony by different dissociative parts is believed to be a legal first.
Persistent dissociation is often, but not always, trauma-related (as in Jeni’s case). It is a defence which protects the mind in the face of overwhelming unbearable trauma. While trauma-related dissociation can take many forms, when abuse and overwhelming experiences are severe and occur early in life, this can result in multiple compartmentalised self-states, i.e. Dissociative Identity Disorder (DID). Jeni’s mind created over 2,000 separate parts, some of which courageously testified in court and brought justice to Jeni and all of her parts.
Few diagnoses have met with the degree of disbelief and denial which DID still attracts. For Jeni, as for many other survivors, being believed is profound. Given the nature of her self-states, her different parts were able to provide rich testimony in relation to what had happened, with sufficient detail to provide the evidence needed to secure a conviction (and thereby her vindication). In so doing, Jeni Haynes has not only found justice for herself and all her parts. She has paved the way for greater understanding of dissociation and DID, as well as for trauma-informed justice processes for other victims of horror.
Read about and view the 60 Minutes portrayal of Jeni Haynes’ search for justice here.
A brief account of the nature of dissociation, DID, and why all clinicians need to know about it
Pam Stavropoulos PhD, Head of Research, Blue Knot Foundation
(*Detailed discussion of this topic will appear in the updated Blue Knot Foundation Practice Guidelines for Clinical Treatment of Complex Trauma, to be launched in the coming months)
Dissociation is a challenging mental process on which there are different views. Some argue that compartmentalisation is a normal human capacity and that the key issue is `not whether it occurs but the extent to which the compartments share information, emotion, worldview, and so on’.(1) Conceptualising dissociation as a continuum is helpful. This is because unconscious `quarantining’ of experience can be seen as a normal psychological process which can become problematic if it is persistently activated for defensive purposes (i.e. unresolved trauma, in which the dissociative response was initially protective but is regularly triggered and becomes the `default’ response). An initially adaptive dissociative response can become a form of maladaptive coping and a way of managing stress which becomes dysfunctional.
The core dissociative symptoms are depersonalisation (sense of estrangement from self), derealisation (alienation from surroundings), amnesia, identity confusion, and identity alteration. Symptoms can be mild, moderate, or severe, where `[t]he most important distinction…to make is between mild dissociative experiences that are normal and experiences that range from moderate to severe’.(2) American psychiatrist Marlene Steinberg says that she kept hearing about dissociative symptoms from her patients, and `saw that the psychiatric community and the public were labouring under the misperception that dissociation was an all-or-nothing matter - either you were a `Sybil’ or you were free and clear’.(3) What was missing, she said, `was the continuum of dissociation, the same mild to moderate to severe range that occurs in depression or anxiety’.(4)
Dissociation has not featured in the training of most clinicians which means it is frequently unidentified in their clients. (5) In contrast to the visible agitation of hyperarousal (e.g. trembling, dilated pupils, changed skin colour and voice pitch) the signs of hypoarousal are also harder to detect. While it is possible to be behaviourally active while dissociated, dissociation is correlated with the `shut-down’ response which is less visible in comparison. Dissociation may present as `spaciness’, being overly `chilled’, `on autopilot’, or `zoning out’. These responses are often dismissed or rationalised as hesitation, and are also confused with depression.
It is important for clinicians to be aware of dissociation and the various forms it can take. This is because trauma-related dissociation not only disrupts the capacity to be in the present moment, but can severely erode health. Combinations of the core dissociative symptoms can lead to various dissociative disorders which escape detection when underlying dissociation is unrecognised.(6) Different constellations of the five core symptoms define the particular type of dissociative disorder.(7) In DID all five symptoms are present.
The most severe forms of dissociation are associated with severe childhood trauma. This is another reason why dissociation in general and DID in particular are so challenging: `Dissociation is the ultimate form of human response to chronic developmental stress, because patients with dissociative disorders report the highest frequency of childhood abuse and/or neglect among all psychiatric disorders’.(8)
Depending on the age of the child and the duration and severity of the trauma, dissociative divisions can be many. They `can range from very simple to extremely complex divisions of the personality’.(9) The etiology of DID in severe early life trauma is confronting. It is one of the reasons why the DID diagnosis remains controversial despite the solid evidence base which attests to its legitimacy. (10)
DID sit at the extreme end of the dissociative continuum, commensurate with the severity of the trauma experienced. (11) Parts of the overwhelming experience/s generate internal states which serve to protect from unbearable overload (as for Jeni).
Clinicians need to be aware that `[m]ultiple lines of evidence support a powerful relationship between dissociation/DD [i.e. dissociative disorders] and psychological trauma, especially cumulative and/or early life trauma’.(12) This is important to know because in contrast to the `Trauma Model’, the so-called `Fantasy Model’ contends that dissociation leads to fantasies of trauma, even though `[a]lmost no research or clinical data support this view’.(13) In fact, neuropsychological studies of diagnosed DID and DID-simulating controls (14) `consistently support the TM [Trauma Model] of DID and challenge the core hypothesis of the FM [Fantasy Model].’(15)
Updated information on the nature of memory, and particularly traumatic memory is also necessary. (16) For example, the possibility of delayed recall of traumatic experience is contested by some. This is despite the fact that `[r]esearch during the past two decades has firmly established the reliability of the phenomenon of recovered memory’.(17) This mirrors the situation in which `even among professionals, beliefs about dissociation…often are not based on the scientific literature’.(18) Dispelling of myths and misinformation about dissociation and traumatic memory is critical in the interests of public health. It is also why the recent conviction and `legal first’ based on the testimony of DID survivor Jeni Haynes is so significant.
DID is more prevalent than is realised (official estimate is 1.5%) (19) and widely undetected for the reasons discussed. In attuning to the challenge of how early life trauma may generate multiple dissociated self-states, it is helpful to recognise that we all have internal states (as the well-known concept of `ego states’ attests). (20) It is also important to acknowledge that personality is influenced by the relationships we have and the diverse roles we perform.
Frank Putnam, a respected clinician and researcher of DID, has proposed a `state’ model of personality, according to which fluctuations occur depending on context and other factors (`we are all multiple to some degree’).(21) Self emerges in the context of relationships (`self’ is a task, not a given) and our dependence on primary caregivers in early childhood means that experience of caregivers has a formative (though not determining) (22) influence in shaping the people we become.
It is increasingly recognised that while `[o]ur mental life is full of discontinuities’, for some people `the cracks in identity are marked’.(23) Jeni Haynes illustrates the ingenuity - and simultaneous extremely high cost - of the myriad dissociative divisions of DID (i.e. `an adaptation that allows a child to survive betrayal, cruelty, suffering, torture and neglect’ by dividing `unimaginable suffering into manageable pieces’).(24) In the case of DID, self-states are comprehensively and severely compartmentalised, and `parts of the experience, the really awful bits, are sequestered in the overall personality so that literally the left-hand doesn’t know what the right-hand knows’.(25)
When utilised protectively, dissociation has been likened to `a circuit breaker for the nervous system’ whereby a person can `pull the plug’ and go `offline’ by separating sensation from consciousness.(26) This comes at the cost of disabling disconnection (`the person surrenders self-state coherence to protect self-continuity’).(27) Yet as the action and courage of Jeni Haynes shows, and as borne out by the verdict in her landmark court case, the `parts’ hold different aspects of the trauma experienced and their truth was spoken and belatedly validated. The court listened and found those truths compelling. In so doing, it has created a legal precedent which signals new hope both for trauma survivors in general and survivors of DID in particular.
* See below for citations and references
Joe Tucci, CEO, Australian Childhood Foundation and Dr Cathy Kezelman AM, President, Blue Knot Foundation
Blue Knot Foundation launches a new publication for GPs and other primary care practitioners:
Talking about Trauma – Guide to Everyday Conversations, Screening and Treatment for Primary Care Providers
In a packed room, at the conference: Trauma Informed Care in General Practice, convened by the Royal Australian College of General Practitioners and the Australian Society of Psychological Medicine on June 1st in Melbourne, Joe Tucci, CEO of the Australian Childhood Foundation launched the latest Blue Knot publication in the Talking about Trauma series: Talking about Trauma – Guide to Everyday Conversations, Screening and Treatment for Primary Care Providers.
‘… what one sees, the presenting problem, is often only the marker for the real problem'
(Felitti & Anda, 2010:80)
Large numbers of people present to their primary care practitioners with diverse health issues, many of which are complex trauma-related, but which neither they nor their GPs identify as such. The physical, psychological, financial and social costs of failure to identify cumulative, underlying trauma in primary care consultations are substantial.
As primary health care plays a critical role in health promotion, prevention, screening, early intervention and treatment, primary care providers need to be able to confidently `talk about trauma’ in their daily practice. This includes intervening early and effectively with patients with a lived experience of trauma to promote better care and health and well-being outcomes.
Primary care practices work with patients who present with co-morbid mental health challenges, drug and alcohol issues, suicidality and self-harm, and sexual health issues. This is as well as `traditional’ areas of focus such as cardiovascular disease, asthma, diabetes, obesity, and cancer. All of these issues can be, and often are, associated with unresolved trauma. Not only does trauma literacy highlight the burden of trauma-related disease, morbidity and mortality, but it also provides opportunities for enhanced treatment outcomes when practitioners and practice personnel work from a trauma frame.
This report promotes awareness of trauma and ways to have safe conversations about trauma in primary care settings. It fills a critical gap in knowledge and understanding not generally provided in standard medical training and provides context-specific information for primary care practitioners.
While attuned interpersonal interactions are critical, so too are `trauma-informed’ primary care practices in which trauma-informed principles are embedded at all levels of service.
These initiatives will have substantial benefits. General practitioners and other primary health care providers and settings have a unique, rich, and often untapped opportunity to help large numbers of people recover from the impacts of trauma, respond to the public health issue of trauma, and intervene in the costly cycle of trauma-related disease and morbidity. The information contained in this Guide is critical to facilitate these outcomes.
Blue Knot also delivers a face-to-face category 2 training package which is available on request by contacting trainingandservices@blueknot.org.au, with an online category 2 training and Category 1 activity to be developed in the second half of 2019.
To enquire about this or other training please email trainingandservices@blueknot.org.au or call 02 8920 3611 and ask to speak with one of the training team.
To order your copy of this enlightening text visit our shop here
Humanising Mental Health Care in Australia: A Guide to Trauma-informed Approaches edited by Richard Benjamin, Joan Haliburn and Serena King Oxon: Routledge, 2019, 456pp, ISBN 978-0367076580
The ground-breaking Humanising Mental Health Care in Australia: A Guide to Trauma-informed Approaches was featured in the March edition of Blue Knot Review.
The main aim of this book is to draw attention to the all too often devastating effects of abuse and trauma on both children and adults, effects that are not always linked to the trauma by patient or clinician, particularly in those suffering with severe mental illness although it is clear that biological conditions such as Schizophrenia, Bipolar Disorder, and Depression, present frequently, and require biological treatments, it is also readily apparent that the relationship between child abuse, psychotic symptoms, dissociation, and psychosis is complex, and that there are multiple pathways to psychotic symptoms, and that in some cases abuse and trauma may explain all of a patient’s symptoms and they may be an important contributor to the presentation.
Blue Knot Professional Development Training
As you may be aware, Blue Knot Foundation runs an extensive professional development training process. As part of this process it invests in an ongoing quality assurance process, based on learner, client and trainer feedback. This feedback and current research inform enhancements to existing programs, tailored programs and new offerings.
Our quality assurance process in the first half of 2019 has informed updates for a number of the programs which are included in the July-December calendar here and in our in-house program.
This includes our updated programs:
- Trauma-Informed Care and Practice – Level 2
- Trauma-Informed Care and Practice in Domestic and Family Violence Services - Lvl 2
We are also excited to offer a new program:
- Working with Intergenerational and Collective Trauma – fostering healing and building resistance.
This new one-day professional development training will suit all staff who work with, or manage services for, people who may have experienced historical, collective or intergenerational trauma. This includes service managers, therapists, case workers, counsellors, social workers, psychologists, community, mental health and peer workers, primary care practitioners, policy makers, program managers and other professionals.
It has been scheduled for October in Sydney and Melbourne in November but can be delivered in-house as well. You will find more information here
In 2018 Blue Knot Foundation delivered more than 330 training days to more than 6,300 attendees. The following is feedback from one participant:
“The training was very relevant to my position as a DV counsellor for women survivors of DFV. The material…was well structured and presented. I never felt bored or overwhelmed. The day gave me lots of ideas to explore further, affirmed some of my practices and acknowledged some of my experiences as a long term DV worker. The exchanges with other training participants were an added bonus. Well-designed training. Thank you.”
Gaby, QLD.
Find comprehensive Training packages and Services information here and a schedule of dates and locations here.
Please note that our training can come to you and your organisation anywhere in Australia and can be tailored to suit your specific needs.
To find out more please email trainingandservices@blueknot.org.au or call 02 8920 3611 to speak to a member of our training team.
Supervision
Blue Knot Foundation runs a brokerage service whereby we match the needs of organisations/services seeking group/team based supervision with a suitably skilled supervisor.
Supervisors are able to facilitate the following: group clinical and non-clinical supervision, group case consultation and debriefing as well as group based support around vicarious trauma and self-care. Other consultation services are available on request.
To find out more, visit https://www.blueknot.org.au/Supervision
Organisational Consultancy
Blue Knot Foundation’s organisational consultancy supports organisations to design and/or modify their current culture, practices, policies and procedures around the core trauma-informed organising principles of safety, trustworthiness, choice, collaboration and empowerment.
To find out more, visit https://www.blueknot.org.au/Consultancy
Regional ISSTD Conference, Christchurch NZ
November 2019
The International Society for the Study of Trauma and Dissociation is holding a regional conference from 22nd-24th November 2019 in Christchurch, NZ.
The conference will feature pre-conference workshops, plenary and panel sessions, as well as a workshop presented by Pam Stavropoulos PhD, Head of Research and Dr. Cathy Kezelman AM, President, from Blue Knot Foundation.
Their presentations will focus on the soon-to-be-released updated Guidelines for Clinical Treatment of Complex Trauma. The Guidelines delineate the conceptual and treatment landscape in 2012 as compared to 2019, review the status of phased treatment for complex trauma in light of some current criticisms and outline emerging treatment approaches and their capacity to address dissociation.
This conference offers a unique opportunity to hear from international leaders in the field and acquire new knowledge, skills and tools for your clinical practice with complex trauma clients.
Further information about the Conference, including how to register, can be found here.
Vicarious Trauma – webinar
Hosted by the Australian Psychological Society, this webinar explores the importance of recognising the early signs of vicarious trauma and developing strategies to stay healthy and well when working with traumatised clients or traumatic material.
It is presented by Blue Knot Foundation President Dr Cathy Kezelman AM, National Helpline Manager, Tarja Malone and then, National Training and Services Manager, Elena Manning.
Recommended Reading -
A Recommendation for People Who Have Experienced Abuse in Childhood
Blue Knot Helpline telephone counsellors have a list of books to which they refer and sometimes suggest to callers. It Wasn’t Your Fault is one such recommendation.
This book review was inspired by a caller to the Blue Knot Helpline. 'It Wasn't Your Fault: Freeing Yourself From the Shame of Childhood Abuse with the Power of Self-Compassion', written by Beverly Engel. Our caller was keen to share it with us as “the best book” she has ever read. She found it immensely helpful for her recovery process.
As a self-help resource, it gives an empathetic and insightful account of the nature of shame arising from childhood abuse and also offers a pathway for healing from this most difficult and destructive emotion.
Beverley Engel, a practicing therapist in the USA and author of 22 books, writes in a very clear and engaging way about the different layers of shame that stem from childhood emotional, physical and sexual abuse and neglect and compounding traumas in later life.
This book works from an understanding that even when you know intellectually that your abuser was responsible for what happened to you, you can still feel and think that you are damaged, worthless or that something is wrong with you. This is an expression of shame that results directly from what your abuser did and said to you.
On top of this, many survivors feel bad about or repeatedly question themselves over how they responded to the abuse, the ways in which they coped and survived and the strategies they adopted to protect themselves from further shaming.
Engel presents the practice of self-compassion as an antidote to shame and harsh self-criticism. Each chapter offers guidance and experiential exercises for deepening your understanding of the origins of your shame, fostering a kinder, more accepting inner voice and moving towards a more nurturing relationship with yourself.
She emphasises the importance of working through the book at your own pace including options for skipping or re-reading sections which are triggering.
Our caller said:
“…reading the book was immensely helpful, but at times triggering, for example it lists all the ways that someone may be abused, and I found that I could relate to the whole list. Engel gives practical exercises for releasing anger and I liked the way she teaches you how to throw your shame back at the perpetrator.”
If you would like to read a few more reviews on this book pop over to
www.goodreads.com/book/show/20344352-it-wasn-t-your-fault
Blue Knot Review is an electronic journal chronicling recent developments and new perspectives around complex trauma and trauma-informed practice. Contact newsletter@blueknot.org.au for feedback or to contribute. Click here to subscribe or forward this email to anyone who may be interested
The Blue Knot Helpline has established a referral database of mental health practitioners, doctors,
service providers and support groups to provide referral options to callers of our Helpline. If you are a trauma-informed health professional you can apply to be included on this referral database here.
Citations and References for article: Jeni Haynes finds justice: a legal precedent in recognition of DID
[1] Richard Chefetz, Intensive Psychotherapy for Persistent Dissociative Processes (Norton, New York, 2015), p.129.
[2] Marlene Steinberg & Maxine Schnall, The Stranger in the Mirror (HarperCollins, New York,2003), p.33
[3] Steinberg & Schnall, The Stranger in the Mirror, ibid, p. xiv.
[4] Steinberg & Schnall, The Stranger in the Mirror, ibid.
[5] Lynette Danylchuck & Kevin Connors, Treating Complex Trauma and Dissociation (Routledge, New York, 2017), p.7.
[6] Note the diagnostic category `Other Specified Dissociative Disorder’ (i.e. OSDD) which has replaced the previous diagnostic category of Dissociative Disorders Not Otherwise Specified; DDNOS in DSM-5, and which `applies to presentations in which symptoms characteristic of a dissociative disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the dissociative disorders diagnostic class’ (`Other Specified Dissociative Disorder’ http://traumadissociation.com/osdd
[7] Steinberg & Schnall, The Stranger in the Mirror, ibid, p.32.
[8] Vedat Sar, `The Many Faces of Dissociation: Opportunities for Innovative Research in Psychiatry’, Clinical Psychopharmacology and Neuroscience (12, 3, 2014), p.171.
[9] Onno Van der Hart et al, The Haunted Self (Norton, New York, 2006), p.5.
[10] See, for example, Martin Dorahy et al, `Dissociative Identity Disorder: An empirical overview’, Australian and New Zealand Journal of Psychiatry (48, 5, 2014, pp. 402 – 417), and Bethany Brand et al, `Separating Fact from Fiction: An Empirical Examination of Six Myths about Dissociative Identity Disorder’ Harvard Review of Psychiatry (24, 4, 2016, pp. 257-270).
[11] `Scepticism about numbers of self-states is a potential intellectualization and deflection of the sad reality…an intolerance of the reality of severe abuse’ (Chefetz, Intensive Psychotherapy for Persistent Dissociative Processes, ibid, p.116).
[12] Richard Loewenstein, `Dissociation Debates: everything you know is wrong’, Dialogues in Clinical Neuroscience (20, 3, 2018), p.229. A continuum of trauma-related symptom severity has been found across groups, `supporting the hypothesis that there is an association between the severity, intensity, as well as age at the onset of traumatisation, and the severity of trauma-related psychopathology’ (J.A. Rydberg, `Research and Clinical Issues in Trauma and Dissociation’, European Journal of Trauma and Dissociation (1, 2017, p. 95).
[13] Loewenstein, `Dissociation Debates: everything you know is wrong’, ibid.
[14] Schlumpf, Reinders et al. `Dissociative Part-Dependent Resting-State Activity in Dissociative Identity Disorder: A Controlled fMRI Perfusion Study’ PLoS One (9, 6, 2014); Brand, Vissia, et al `DID is Trauma-Based: Further Evidence Supporting the Trauma Model of DID’, Acta Psychiatrica Scandinavica (134, 6, 2016), pp.560-563.
[15] Rydberg, `Research and Clinical Issues in Trauma and Dissociation’, ibid, ref. Brand, Vissia et al, ibid.
[16] See The Truth of Memory and the Memory of Truth: Different Types of Memory and the Significance for Trauma (Blue Knot Foundation, 2018).
[17] Constance Dalenberg, `Recovered memory and the Daubert criteria: recovered memory as professionally tested, peer reviewed, and accepted in the relevant scientific community’, Trauma, Violence & Abuse (7, 4, 2006), pp.274.
[18] Loewenstein, `Dissociation Debates: everything you know is wrong’, ibid, p.229.
[19] Diagnostic and Statistical Manual of Mental Disorders, fifth edit; DSM 5 (American Psychological Association, Washington DC, 2013), p. 294
[20] An ego state is defined as `one of a group of personality states that is relatively stable across time’ and which `is distinguished by a specific role, emotion, behavioral, memory, and/or cognitive function’ (Phillips & Frederick, Empowering the Self through Ego-State Therapy E-book, 2010); `Every major school of psychology recognizes that people have subpersonalities and gives them different names’ (van der Kolk, The Body Keeps the Score, New York: Penguin, 2015). It is important to note, however, that the ego states of DID (typically called `alters’) differ from ego states more generally (`Ego states that are also alters generally have…characteristics that are not intrinsic to the ego state phenomenon per se’; Richard Kluft, `Dealing with Alters: A Pragmatic Clinical Perspective’, Psychiatric
Clinics of North America (29, 2006, p.284). For discussion of the differences, see Kluft, `Dealing with Alters’, ibid.
[21] Frank Putnam, The Way We Are (International Psychoanalytic Books, 2016), p.121. That what we call `self’ is not fixed or unified but rather consists of fluctuating states is now widely accepted: `The self is characterized by a complex multiplicity of subunits and subselves’ (Howell,2005); `We all have parts’ (van der Kolk, The Body Keeps the Score, ibid). Yet this recognition is not apparent in standard theories of personality which continue to emphasise `fixed, persistent, and globally defining traits’ (Putnam, The Way We Are, ibid).
[22] As in the phenomenon of `earned security’ by which initial attachment may be reworked and resolved.
[23] David Spiegel, `Integrating Dissociation’, American Journal of Psychiatry (175:1, 2018), p.4.
[24] May Benatar, Emma and Her Selves (IPBooks, New York, 2018), p.13.
[25] Benatar, Emma and Her Selves, ibid, p.7.
[26] Benatar, Emma and Her Selves, ibid, p.13.
[27] Philip Bromberg, Awakening the Dreamer (Routledge, New York, 2011), p.68.
References
Benatar, M. (2018) Emma and Her Selves: A Memoir of Treatment and a Therapist’s Self-Discovery New York, IPBooks.
Brand, B., Sar, S. et al (2016) `Separating Fact from Fiction: An Empirical Examination of Six Myths about Dissociative Identity Disorder’ Harvard Review of Psychiatry (24, 4), pp. 257-270.
ttps://journals.lww.com/hrpjournal/Fulltext/2016/07000/Separating_Fact_from_Fiction___An_Empirical.2.aspx
Brand, B.L, Vissia, E.M. et al (2016) `DID is Trauma-Based: Further Evidence Supporting the Trauma Model of DID’, Acta Psychiatrica Scandinavica (134, 6), pp.560-563.
Bromberg, P. (2011) Awakening the Dreamer: Clinical Journeys New York: Routledge.
Chefetz, R. (2015) Intensive Psychotherapy for Persistent Dissociative Processes: The Fear of Feeling Real New York: Norton.
Diagnostic and Statistical Manual of Mental Disorders, fifth edit; DSM 5 (2013) Washington DC, American Psychological Association.
Dalenberg, C. J. (2006) `Recovered memory and the Daubert criteria: recovered memory as professionally tested, peer reviewed, and accepted in the relevant scientific community’, Trauma, Violence & Abuse (7, 4), pp.274-310 https://www.ncbi.nlm.nih.gov/pubmed/17065548
Danylchuck, L. & Connors, K. (2017) Treating Complex Trauma and Dissociation: A Practical Guide to Navigating Therapeutic Challenges New York: Routledge.
Dorahy, M., Brand, B. et al (2014) `Dissociative Identity Disorder: An empirical overview’, Australian and New Zealand Journal of Psychiatry (48, 5), pp. 402-417.https://www.researchgate.net/publication/262025048_Dissociative_identity_disorder_An_empirical_overview
Howell, E. (2005) The Dissociative Mind New York: Routledge.
Kluft, R.P. (2006) `Dealing with Alters: A Pragmatic Clinical Perspective’, Psychiatric Clinics of North America (29), pp.281-304.
Loewenstein, R.J. (2018) `Dissociation Debates: everything you know is wrong’, Dialogues in Clinical Neuroscience (20, 3), pp.229-242. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6296396/
Phillips, M. & Frederick, C. (2010) Empowering the Self through Ego-State Therapy E-book http://reversingchronicpain.com/EmpoweringSelfEgoStateTherapy/EST_ebook.pdf
Putnam, F.W. (2016) The Way We Are: How States of Mind Influence Our Identities, Personality and Potential for Change International Psychoanalytic Books.
Rydberg, J. A. (2017) `Research and Clinical Issues in Trauma and Dissociation: Ethical and Logical Fallacies, Myths, Misreports, and Misrepresentations’, European Journal of Trauma and Dissociation (1), pp.89-99.
Sar, V. (2014) `The Many Faces of Dissociation: Opportunities for Innovative Research in Psychiatry’, Clinical Psychopharmacology and Neuroscience (12, 3, 2014), pp. 171-179.
Schlumpf, Y. R., Reinders, A.T.S. et al. (2014) `Dissociative Part-Dependent Resting-State Activity in Dissociative Identity Disorder: A Controlled fMRI Perfusion Study’ PLoS One, 9(6) 10.1371/journal.pone.0098795
Spiegel, D. (2018) `Integrating Dissociation’, American Journal of Psychiatry, 175:1, pp.4-5.
Stavropoulos, P. & Kezelman, C. (2018) The Truth of Memory and the Memory of Truth: Different Types of Memory and the Significance for Trauma Sydney: Blue Knot Foundation. https://www.blueknot.org.au/resources/publications/trauma-and-memory
Steinberg, M. & Schnall, M. (2003) The Stranger in the Mirror Dissociation, The Hidden Epidemic New York: HarperCollins.
Van der Hart, O., Nijenhuis, E. & Steele, K. (2006) The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization New York: Norton.van der Kolk, B.A. (2015) The Body Keeps the Score: Brain, Mind and Body in the Healing of Trauma, New York: Penguin.
Audio recording – case study around working with dissociation The following is an audio recording of Pam Stavropoulos (Head of Research, Blue Knot Foundation) and Dragan Zan Wright (Blue Knot Foundation Trainer) discussing a case study around working with a client with dissociation. It was developed by the Mental Health Professionals Network as part of their recent online conference. https://www.mhpnconference.org.au/trauma-activity-two-content
