Letter from the PresidentLetter from the PresidentRhonda Sabo, PsyD
Excerpted from the April, 2004 NESTTD Newsletter
Dear NESTTD Members and
Supporters,
As
I assume the presidency from Joanne Twombly, NESTTD has never been stronger.
This vitality is, in no small measure, the result of Joanne’s decisive
leadership and willingness to take on the risks involved in growth---as well as
the efforts of our indefatigable Steering Committee. During Joanne’s tenure,
NESTTD moved out of the
I have debated for a while about whether to write about my initiation into the world of trauma and dissociation in my first letter to you—and I have decided to do so. While stories from 1988 may seem irrelevant to 2004, there is surely a value to chronicling such history in a field, which even now in many places in the US and around the world, continues to evoke so much controversy.
In my clinical psychology graduate program I recall learning nothing about the treatment of PTSD, let alone its relation to childhood trauma. The word “dissociation” was never mentioned in a single class or training. Then in 1988, as a doctoral intern in a psychoanalytically informed adolescent inpatient unit, I was working with a 14-year-old girl hospitalized for a suicide attempt. I met with her in my office in the hospital unit; later that day I was perplexed when she seemed to have no memory of meeting with me. When I began to record her extensive amnesias and a list of other odd behaviors to my supervisors, I was cautioned not to “encourage” her histrionics. “Why,” they asked skeptically, “is she showing these behaviors only to you and to only one (newly graduated) nurse on the unit?” My own experience was that “encouragement” from a busy and tired intern (me) and a neophyte nurse had nothing to do with what was driving these behaviors. In fact, rather than colluding in “therapeutic misadventures” with me, my young patient spent most of our sessions expressing overt interest in only one thing—a 15-year-old male patient on the unit. And, truly, the only therapeutic misadventure being planned in our treatment room was her own plot to go AWOL from the unit with this boy! She did, by the way, succeed in eloping from our locked unit and was gone for days. Yet, in the midst of all of this, she was able to communicate something important about the workings of her mind to the two professionals whom she perceived as caring about her. I was frankly annoyed at my supervisors’ disinterest in her extensive symptom profile, and of course, at their implied distrust of me. After all, I had been schooled extensively in the analytic theories of Robert Langs! Whenever I would enter a session in those days, his admonishments about the sins of therapeutic indulgence would ring in my ears. So influenced was I toward analytic abstinence in those years, it was a wonder that I gave myself permission to say anything at all to my clients. But the fact was that my patient was acting quite a bit like Cornelia Wilbur’s Sybil (I had read the book years before). Since my little patient was still depressed and suicidal, I decided that I had to look at the dissociation literature, to see if there was something there that would help. (In the year 1988 the entire literature on dissociation could be crammed into my backpack!)! And there, in the library, I found my patient’s symptoms described in detail by Rick Kluft and others. When I turned to our adolescent inpatients, most reporting histories of abuse, and nearly every one diagnosed as BPD, I began to observe that a large subset of our kids were suffering from complex PTSD. This group had dissociative processes that were going unseen, somehow outside of the analytic, ego psychological, and object relations-informed radar screens through which we viewed human behavior. My new interest in dissociation led me to the First Regional Conference on Multiple Personality and Dissociation in Washington, where I attended a lecture by Professor Cornelia Wilber. Connie joked that, like her skeptical colleagues, she did not believe in “multiple personalities”—because, she said, dissociation was not a belief system. It was simply another set of phenomena, open to observation and study by scientists like herself. When I decided during that year to do my doctoral project on dissociation, I called my graduate program to ask if there was anyone who knew enough about the topic to act as my committee chair, “Only one professor—Margaret Warner”, they said. A graduate of the University of Chicago, with years spent in the U. of C. Counseling Center (where Carl Rogers did much of his work), she had a reputation for adhering to an orthodox Rogerian (client-centered or person-centered) approach. I had a great deal of respect for Margaret as a clinician, scholar and human being. But I also had to laugh. Because it meant that either structural dissociation was “real” or Margaret had managed to create iatrogenic dissociative disorders in her patients with reflective listening as her only tool! You may be curious about what happened to my young patient. In the two months that she was with us in the hospital, my young patient alleged parental abuse, then retracted her allegations in family therapy, and was returned to her family and school without receiving dissociation-informed treatment—or even trauma-focused psychoeducation. I recall that I started to write a dissociative diagnosis on her chart and then promptly crossed it out. I don’t know whatever happened to this child. But my pangs of guilt for not fighting harder to get her better treatment, and my anger at a mental health system to whom she remained essentially invisible, were what motivated me to continue to study trauma and dissociation. And, of course, strong emotions make powerful energy—they have propelled me on a journey that is going strong after 16 years. The same year my little patient appeared in our hospital unit, Jean Goodwin, MD wrote about her own strong emotional reactions to a debate organized at the 1988 Annual Meeting of the American Psychiatric Association concerning whether DID (then MPD) was “real”: “My patients don’t always believe fully that they exist, much less, that I do. This is made all the worse when my fellow psychiatrist treats me and my patients as though we don’t exist. This last is done subtly, without overt brutality. For example, a colleague may mention that in all his years of practice he had yet to see a patient. ….Might he sit in on a session? Certainly, I say, knowing that no such questioner ever yet has come to call. Then there are the new diagnoses that appear on patient’s charts each time they visit the ER. If it were only one time, I would not worry about being extinguished, but it is one hundred hundreds, one thousand tiny acts of erasure.” The trauma field has come a long way since 1988. We are now working in an age where the role of trauma and its sequelae are increasingly acknowledged and where, in many places, dissociation is actively studied and addressed in treatment. Our clinical work, after plenty of growing pains, has matured along with our understanding. As our search for more effective and humane treatment continues, the new “brain science” promises to provide heretofore missing pieces of the puzzle. A last word about Constance Dalenberg, Ph.D., who we have invited from California to teach our all-day program on May 1. She is a perfect example of a clinician-researcher, who, using a trauma lens, is making contributions to the area of transference/countertransference in psychotherapy that are important for clinicians of every orientation and specialty. So, like Jean Goodwin, think about inviting a colleague to “come to call” on us and learn what the New England Society for the Treatment of Trauma and Dissociation is about. We look forward to seeing you.
Goodwin,
J. (1988). At the Acropolis:
A disturbance of memory and imagination in a context of theoretical
debate. Unpublished paper.