AEDP West Sunday Seminar
with AEDP Senior Faculty member Kari Gleiser, Ph.D.
March 22, 2009 | San Anselmo, CA
Working With Complex Trauma and Dissociative
Disorders with AEDP

REVIEW by Karen Pando-Mars

On March 22, 2009, AEDP West was fortunate to have AEDP Institute Senior Faculty member Kari Gleiser, Ph.D. present to us on “Working with Complex Trauma and Dissociation with AEDP.”

It was a lovely first day of spring and the room was full. Kari began by passing around a paper bag full of scraps of paper, asking each of us to take one. She then asked how many people in the room work with trauma. Nearly all the hands went up, at least three-fourths of the audience. Then she asked how many of us work with dissociation. A few hands went up. Kari was impressed with the discrepancy between the high number of those who work with trauma and the few who directly work with dissociation. Kari’s point is that when there is trauma, there is likely to be dissociation.

Before heading into her teaching, Kari wanted to sensitize us to the experience of living with dissociation. She asked each of us say out loud the words on our scrap of paper at the same time. Then she had us repeat the words, loudly, making sure that ours were heard above the others. As you can imagine, there was a cacophonous, resounding buzz in the room. Finally, she asked us to notice the number on our paper and to read our words in order this time, one-by-one. What emerged was a poignant poem, Fermata by Andrew Zawacki that took us inside one person’s world. This was an incredibly powerful depiction of having many disconnected parts and disparate voices clamoring for attention, demanding to be heard, and just how impossible the task. Yet, this experience clearly demonstrated how each part had an important piece of the whole.

The next section of her presentation was to familiarize the audience with the continuum of dissociation in order to help us to assess and recognize its occurrence. She proposed that the clients we find most challenging, in terms of gaining traction in the therapy process, might be struggling with dissociation. Being that the nature of dissociation is to “cut off” and “go away,” the terror of being found out contributes to the concealing of clues that would lead us to discover this very aspect of a client’s problems.

Here are some highlights from some of the distinguishing points of Kari’s talk. She gave three definitions of dissociation. The first is a disintegration of internal experience into isolated fragments. In this mode there are not enough cognitive schemas in which to fit the experiences and there is an overload of emotional experience. The second, the Bask model, notes a separation between behaviors, affect, sensation and knowledge. (Braun 1988) The third describes two varieties of dissociation: compartmentalization and detachment. In compartmentalization there is the development of separate selves. In detachment (Brown 2006) there is derealization, depersonalization, and dissociation from experience.

The continuum of dissociation ranges from normal, (which we will imagine on the far left side of a line) which is the kind of hypnosis, spacing out, deep absorption that can happen while driving, involved in a task, etc. We all have multiple selves and capacity for compartmentalization between them, meaning this level of dissociation has functionality. In the middle towards the right side there is PTSD and the dissociation here enters with flashbacks, usually avoided, suddenly intrusive symptoms. On the far right of the continuum is the “pathological” diagnosis such as DID, DID NOS, (Dissociative Identity Disorder) and can also be a part of Borderline Personality Disorder and other Personality Disorders.

Kari defined some of the core symptoms and the clarification between these is quite valuable. Amnesia refers to a barrier between parts of the self in which there is lost time, and a lack of memory or awareness of what took place during that time. The autobiographical narrative is incomplete. Depersonalization is a numb, “floating out of body” experience. Derealization is going on when a person is disengaged from what is happening in the moment, the world feels unreal: “this isn’t really happening.” Identity confusion is a partly developmental derailment in which a person is unclear about their likes/dislikes, sexuality etc. Identity alteration is the most common characteristic of dissociation where there is a shifted sense of self into fragmented separate parts that have different jobs/roles.

Another feature of Kari’s presentation was to name possible signs of DID such as lost time, changing voices in the session, hearing voices “inside one’s head” (which is often distinguished from psychosis when voices are heard “outside one’s head” (ie. God was talking to me etc.), shifting symptoms and functioning, finding items in one’s possession one didn’t remember buying, frequently being called a liar. All this is to acknowledge there are quite a few markers we can identify in assessing dissociative symptoms and disorders, which are very important to recognize since so many of us are dealing directly with clients who have experienced trauma.

Fortunately Kari also gave some application and theory about how AEDP can be a model of choice in treating people who are suffering with these symptoms since AEDP is so focused on working with emotion in transformative ways and in establishing safety and acknowledging fears. Not only does we need to attend to establishing our external relationship to support the client’s work, but, we need to establish an internal atmosphere of safety and relationship between parts which prior to treatment may have been quite exclusive.

Some of the important tips Kari offered to the AEDP therapist were just how careful we need to be to not play favorites when dealing with parts. Don’t assume “what you see is what you get.” She emphasized that there must always be time at the end of sessions to metaprocess: to check in and welcome reactions from other parts who may have been “listening in.” One of Kari’s observations is about how a distressed part may disappear, so that while you think you have been helping the client to regulate, in fact, the part went away.  This is all the more reason to develop a system of checks and balances at the end of sessions. And importantly, we as therapists need to realize how the symptom of dissociation has served a regulatory function for these clients. Kari beautifully states how clients become symptomatic because they cannot bear what is inside them. Our job is to down-regulate negative affect and to up-regulate positive affects. The goal is not just to help them become calm, but to develop ways to tolerate and bear distress so they can help it to resolve and to help each part really receive the help it needs.

Kari has a wealth of information about identifying and treating dissociative disorders and fortunately for us she has published a paper about this treatment, which is available on the AEDP website. If you want to learn more detail about how Kari (and Jerry Lamagna) developed an intra-relational model of AEDP please look up their article: “Building a Secure Internal Attachment: An Intra-relational Approach to Ego Strengthening and Emotional Processing with Chronically Traumatized Clients.”