Excerpted from the February, 2001 NESTTD Newsletter
Dear NESTTD Members and Supporters:
I am happy to report that the study and treatment of dissociation is alive and well! I have just recently come back from the annual conference of ISSD, our parent organization, held this year in San Antonio. Attendance was even higher than last year, and an impressive number of NESTTD members either attended or presented. Deirdre Fay, Laurie Brown, and Lorna MacKenzie-Pollack were there; Jim Chu and Audrey Wagner were co-presenters at a day-long "basic training" in the conceptualization and treatment of dissociative disorders; Fran Grossman and a group of her doctoral students from Boston University presented a series of papers reporting findings of their research on resiliency; and I gave papers on EMDR treatment modifications and on substance abuse and trauma. The theme of this year’s conference was "Developmental Foundations of Dissociation," focusing attention on early attachment patterns and on the neurobiological sequelae of childhood abuse and trauma with a nice balance of clinical and research presentations. Many people mention that the ISSD annual conference is much more satisfying to attend than ISTSS because of the greater emphasis on clinical issues.
Since returning home from San Antonio, I find myself going back over and over to the presentations on attachment, especially in my day-to-day clinical work. The video tapes summarizing hours of research using the "Stranger" paradigm to study attachment showed chilling evidence of how maternal dissociative behavior or lack of attunement had already resulted in avoidance of or disorganized responses to the mother by toddlers of only 12-15 months of age. Watching the little boy who cried when the researcher (the "Stranger") left the room instead of crying after his mother left—watching the mothers who greeted their toddlers with indifference when they returned after the ten-minute "separation"—watching the mothers who, worse yet, offered a toy as a substitute and then withdrew as soon as they had distracted the child from direct connection with them: these are the images that keep coming back to me when I am sitting with my patients. I remember the young father of a 12-month-old son who had been videotaped with his own mother twenty-five years previously. The old, grainy black-and-white film from the 1970s showed a teenage mother whose toddler son was uncertain whether or not to approach her when she returned to the room: he toddled toward her as if to greet her, then froze for a moment as if in fear, and then backed up two steps and just watched her. She was not indifferent, just misattuned: she tried to play with him too loudly and too actively while he responded robotically as if in a dissociated state. Twenty-two years later, he sat slouched in his chair while his own two-year-old son seemed uncertain about whether to approach or avoid him. When he and the toddler were given a "task" that required parental help in order for the child to complete it, the father loudly gave instructions from a distance, made no effort to help, and then blamed the child for not being able to complete the task, calling him "stupid." Data from the longitudinal follow-up of children first seen as toddlers show elementary school and high school age children with marked dissociative symptoms, more difficulty with learning and peer relationships, more likelihood of needing educational or psychological intervention.
As I recall these images, it reminds me that the patient who sits opposite me may have been vulnerable long before she was abused, may have been fearful of those who were supposed to protect her long before they actually harmed her, may have felt invisible or worthless long before the abuse "confirmed" those feelings, and may have learned to dissociate long before it had to become a "fine art." It is profoundly sad but ultimately helpful to be reminded that traumatic events occur in the context of attachment and that, when those attachments are frightening or disorganizing from the outset, the abuse itself takes on entirely different meanings and generates even more distorted beliefs about the self. As much as I would wish not to have to know these things, I am grateful to our parent organization, ISSD, for deepening my understanding about what it means to be a small child in a dangerous world.
Janina
president@nesttd.org
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