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Working with dissociation

Dr Fiona Kennedy

Tuesday, 8 October 2024


In recent years, interest in dissociation has grown amongst psychological clinicians and researchers as the relevance of this process in psychological theory and therapy has been recognised and accepted. Dissociative responding is often a part of clinical presentations, from a simple ‘blanking’ during therapy all the way through to Dissociative Identity Disorder (DID). Few clinicians have training in understanding or handling these responses. Such clinical presentations can challenge a therapist’s skills in conceptualisation and treatment, undermine confidence and compromise client care. This workshop aims to address this challenge. It will be presented in an accessible format using video, case examples and role-play. It will emphasise practical application of the CBT theory of dissociation and provide a structure for using an integrated approach with ‘third wave’ components (CBT, plus DBT CFT and ACT). Fiona Kennedy is experienced in drawing on, and integrating, relevant psychological approaches, She co-wrote Integrating CBT and Third Wave Therapies: Distinctive Features (CBT Distinctive Features) for Routledge (2020) and co-edited CBT Approaches to the Understanding and Treatment of Dissociation (Routledge, 2013).

The workshop will introduce a novel and empirically-founded, 3-level CBT model of dissociation, and show how this can be used to formulate clinical presentations across multiple disorders. The workshop will illustrate how to intervene with symptoms occurring at all three ‘levels’ of dissociation, with practical, effective techniques drawn from ACT, DBT and CFT as well as CBT. There will be an emphasis on increasing the focus that clinicians place on conceptualising sense of self (level 3 in the model) in therapeutic work. The aim is to help clinicians to take clients from incoherent, dissociated, dysfunctional self-states towards a coherent self, where the client can be effective in the world according to their chosen values and within the systems they inhabit.

The event will be equivalent to 5.1/2hrs of CPD.


The Self in CBT and Third-Wave theories and Therapies
This section will briefly look at how concepts of identity, personality and the self have evolved.

What is dissociation?
Definition of dissociation as a set of psychological processes which can affect memory, consciousness/perception, somatic/bodily experience and sense of self.

The CBT model of dissociation and self-states
The CBT model of dissociation (Kennedy et al 2004, 2013) will be presented. This is based on Beck’s (1996) model of personality and psychopathology, involving three levels of information-processing. Dissociation at level 1 produces ‘spacing out’ as well as intrusive imagery; at level two various aspects of experience (thoughts, feelings, behaviours, bodily responses) can become inaccessible, as well as intrusions of experience. At level 3 ragmentation and lack of coherence of dissociated self states can cause distress and prevent the client being effective in the world. The roots of dissociation in trauma are also explored here.

Assessment of dissociation
A subset of assessments for dissociation are reviewed with emphasis on the WDS and the D-ISS which are based on the above ‘levels’ model. Clinical assessment of the client’s awareness, acceptance and choice/control of self-states.

Formulating dissociation
How to build in an understanding of how dissociative processes are part of the clinical presentation and make this part of the formulation of the development and maintenance of problems.

Explaining dissociation to the client
Simple narratives and metaphors to explain dissociation and narratives to normalise dissociative experiences.

Techniques for change
Drawing from DBT, ACT and CFT, specific techniques to address effects of dissociation at each level. How to work towards increased awareness, acceptance and control/choice (AAC) within a coherent self: developing a compassionate, observing self; integrating the client’s self-states by reducing dissociation and increasing AAC, using mindfulness, compassionate mind training, values work, and commitment strategies as well as specific DBT skills. Grounding, re-living and re-scripting and EMDR in the context of dissociative presentations.

Application to mental health problems across diagnoses:
From anxiety, depression, OCD and simple PTSD through complex PTSD, addictions, BPD, eating disorders, psychosis and dissociative disorders through to DID, dissociation can be present and cause a client and therapist to be ‘stuck’. There is not time in one day to cover all of these but some examples will be given, with general principles of what to look for and how to proceed.

Learning Objectives

• Understanding the concept of dissociation from a CBT perspective
• Knowing how to identify and assess for dissociation in any clinical presentation
• Being able to explain and normalise dissociation to the client
• Formulating dissociation as part of any clinical presentation
• Knowing strategies for treating dissociation and other trauma responses
• Being able to work with clients with incoherent identities to move towards coherence

Training Modalities

Didactic content, highly interactive training style with questions and comments welcome during the presentations, live role-plays, and video material.

Key References

Beck, A.T. (1996). Beyond belief: A theory of modes, personality, and psychopathology. In Salkovskis, P. M. (ed.). Frontiers of Cognitive Therap. London: Guilford.

Brewin, C. (2023) Identity – A critical but neglected construct in cognitive-behaviour therapy. Journal of Behavior Therapy and Experimental Psychiatry 78, 1-6 101808.

Holmes EA., Blackwell SE., Burnett Heyes S., Renner F., Raes F. (2016). Mental Imagery in Depression: Phenomenology, Potential Mechanisms, and Treatment Implications. Annual Review of Clinical Psychology 12, 249 – 280.

Kennedy, F.C., Clarke, S., Stopa, L., Bell, L., Rouse, H., Ainsworth, C., Fearon, P., & Waller, G. (2004). Towards a cognitive model and measure of dissociation. Journal of Behaviour Therapy and Experimental Psychiatry, 35, 25-48.

Lyssenko, L., Schmahl, C., Bockhacker, L., Vonderlin, R., Bohus, M., & Kleindienst, N. (2018). Dissociation in psychiatric disorders: a meta-analysis of studies using the dissociative experiences scale. American Journal of Psychiatry, 175(1), 37-46.

F. Kennedy, H. Kennerley and D. Pearson (Eds.). (2013). Cognitive Behavioural Approaches to the Understanding and Treatment of Dissociation. London; New York, NY: Routledge.

About the presenter

Fiona Kennedy is a respected and knowledgeable, fun trainer with a knack of making complex concepts accessible without losing their richness. She has many years’ experience in managing and delivering services in the NHS, as well as writing and researching especially on trauma and its consequences. She now runs her own training, supervision and therapy company, GreenWood Mentors Ltd.
She has written several books, including the self-help/guided therapy book Get Your Life Back: The Most Effective Therapies for a Better You, shortlisted for the BMA Popular Medical Book Of The Year 2018. In 2020 a therapist’s companion to this appeared as part of the Routledge CBT Distinctive Features series: Integrating CBT and Third Wave Therapies. She co-edited Cognitive Behavioural Approaches to the Understanding and Treatment of Dissociation and developed the CBT theory of dissociation. Fiona and her husband have volunteered in India for the past 14 years, enabling volunteers and NGO staff to work with children and young people from severe disadvantage as well as with tribal groups from rural areas.

Who should attend

This event is suitable for a wide range of delegates including (but not only) primary care low and high intensity practitioners, psychologists, nurse therapists, counsellors, psychiatrists, occupational therapists, and social workers. Practitioners working in adult primary or secondary care or with older adolescents. Specialist addiction, eating disorder, trauma, PD, psychosis and depersonalisation services.

Details coming soon

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