Working with Trauma, Dissociation, and Psychosis

Note that all the slides for the course are available here in one place, for your notes.

This video will make you familiar with the scope and the diversity of the evidence that indicates trauma and other childhood adversity can make later psychosis more likely, as well as more complex links such as psychosis possibly causing trauma which in turn contributes to more psychosis.

In this video you will learn how to conceptualize trauma as just one of what might be a number of interacting factors that can lead to psychosis. You will also become familiar with a functional definition for trauma, so that trauma can be related to as a process and not something that follows mechanically from certain types of events.

Is psychosis just an automatic reaction to adverse life events experienced by some people, or is it more complex, and perhaps related to attempts to solve trauma related problems which in turn backfire? This video will help you gain insights from research into how everyday people respond to problems that have no apparent solution, so you can conceptualize psychotic reactions as having roots in this "normal" response to certain difficulties.

This lecture reviews some of the ways the "mainstream" has and also continues to downplay any possibility of trauma causing psychosis, especially more extended psychotic reactions such as those diagnosed as "schizophrenia."

When attempting to address the link between trauma and psychosis, it can be helpful to understand the sources of resistance to recognizing that link. After watching this video, you will be familiar with a range of factors and social pressures which have led to so much "denial."

It's common for professionals to think that trauma leads to PTSD, while some sort of illness leads to psychosis. As you watch this video, you will see that there is often little difference between reactions to trauma that are obviously diagnosable as PTSD, and those which appear as "psychosis."

What are the effects on people when they enter a mental health system blind to the possibility that trauma may be at the root of a psychotic reaction? This video will introduce you to a number of real life examples, including the story of Peter Bulimore, who was treated for "schizophrenia" without any attention to the possible role of trauma.

The first step to insuring that trauma issues will be addressed is to ask about them. After watching this video, you will have a good overview of why this is important and how to go about it.

Learn some key elements of a therapeutic style likely to be successful with people who have experienced both trauma and psychosis.

Some of the trickiest aspects of trauma and distressing states of mind have to do with the way approaches that seem successful in the short term can lead to long term problems. After watching this video you will be more aware of these kinds of issues and have ideas about the type of approach more likely to succeed with them.

This video addresses the sometimes perplexing question of "where to start?" when people have a mix of unresolved trauma from the past, various vulnerability factors, and difficulties with psychotic experience in the present.

What might be the role of mindfulness practices in better handling traumatic memories and psychotic experiences? And on the other hand, what are the dangers and limitations of this kind of approach? This video provides some answers to those questions.

This video provides an example of an exercise that uses mindfulness and compassion to take an accepting and soothing attitude toward distressing experience.

A really key skill to support recovery is being able to accept the presence of intrusions, for example in the form of voices, while directing one's attention back to desired activities. This video describes one way of practicing this and then gives you a chance to practice it yourself, using prerecorded "voices"!

Psychosis and re-traumatization happens typically when a person is over-stressed, so one key to reducing vulnerability is helping people manage stress better. There's one important trick to it though that often throws people off; this video will some of the contradictions involved and give you ideas about how to help people manage them.

Learn how to help people form coherent narratives of their lives, framing both traumatic and psychotic experiences in ways that preserve and promote a sense of self worth. Being able to relate one's troubles in the form of a story fosters social connection, compared to simply framing them as "symptoms" which is more likely to promote isolation.

Rai Waddingham provides an extremely coherent account of how she first framed her story in a psychotic way, then in a mental illness/symptom sort of way, then learned to frame and understand her story in a very human way, leading to a sense of "becoming a person."

Helping people tell a coherent story is more difficult when some of what they are relating appears to be "delusional." After watching this video, you will have a few strategies to work with people when this seems to be the case.

This lecture will help you clearly identify how dissociation is a natural response to some of the conflicts arising out of response to traumatic threat and then the need to return to everyday life after the trauma. You will also be able to identify the most common type of dissociative split, or "structural dissociation."

Problems with dissociation come in two forms, one more having to do with "absence" of something, the other having to do with something that had been absent now "intruding" or creating a disturbance. This lecture will help you understand this dynamic and track what's happening with your clients as they struggle with these kinds of issues.

This video will help you grasp some of the functions of "hallucinations" and "delusions," and how that relates to what may be going on with underlying dissociative process. This will help you see these sorts of experiences as possibly understandably related to people's experience with difficult events, rather than just "symptoms of an illness."

Terror can be more intense when its source is unknown. This lecture will help you understand the way traumatic events can leave people with memories that are "decontextualized" and which, when activated, feel like something terrible happening in the moment - and you will better understand how this experience can easily be interpreted in a psychotic way.

One confusing thing about "psychosis" is that it involves not just one state, but a number of contrary states or polarities, and switching between those states. This video offers a map to put some of these possibilities into perspective and to relate the extremes to the more moderate or "middle way" approach where balance between extremes can be achieved.

What are some practical and collaborative ways to help people become more aware of the hazards of various extremes, and to help them reorient toward finding a balance? This video provides some basic tools for accomplishing this objective.

This is a guide to getting experience identifying polarities, and a middle ground, within a discussion.

When intrusions, in the form of trauma memories, voices, etc. are disturbing, it's natural to try to block them out. This video introduces the notion that healing requires something more complex: combining being able to set limits with intrusions along with ways to accept and integrate the disturbing content.

Become able to identify the problems associated with "threat based" responses to voices that involve "fight," "flight," and "submission," and learn to identify a balanced strategy that is more likely to be effective.

Eleanor Longden is a good example of someone who has learned more effective ways of responding to voices. Learn a bit about her story, and hear her highlight some of the most important parts of her journey in her own words.

Problems with voices often develop into a vicious circle, and people can be trapped by these dynamics for a very long time. Learn one way to help them escape, by mapping out exactly how the vicious circle works and how they might transition to a more constructive "virtuous" circle.

People who have experienced trauma and psychosis are often at high risk for self harm, and this risk is often worst when people experience commanding voices which they feel unable to resist. Learn how to understand this dynamic and help people shift the balance of power with these voices, so that dangerous forms of compliance are reduced or eliminated.

You might want to practice this role play first with a colleague.....

How can people learn to be compassionate toward not just themselves but also to dissociated parts of themselves which manifest as oppressive voices? This lecture links to a video which provides a clear overview of this process.

People often feel isolated with their voices, and stuck in an unproductive relationship with them. This video introduces a novel way to possibly overcome this pattern: having the therapist or other helper attempt a conversation directly with a voice! When this is successful, important changes can be initiated in how the person relates to the voice, leading to various kinds of breakthroughs.

While people with "psychosis" are often saying things which are literally untrue, there may be considerable truth or at least real meaning in what they are saying if they are understood as speaking metaphorically. Learn how to respond in a constructive way when it seems your client's communication may be more metaphorical and indirect rather than literal.

This lecture provides more detail on how to work when issues are expressed in a metaphorical way, and it presents interesting case examples drawn from the work of Bertram Karon, a psychodynamic therapist.

Trauma often causes people to question things very deeply, and some of the deepest questions are those which are often described as "spiritual." This questioning then often comes alive within psychotic experience, but people can flounder when there are too many questions, and inadequate support in finding constructive answers. Learn a way of conceptualizing this process of breakdown and attempts at "rebirth" in a way that doesn't pathologize it, but keeps alive the hope for a more constructive outcome.

"Magical thinking" is often just seen as a symptom of psychotic disorders, but in the right context, an applied use of imagination or "magic" can facilitate healing. "Rescripting" memories of past events is one such method. This video will help you understand the basics of how this method works.

In this case example, you will see how rescripting can be used alongside other methods of helping to facilitate recovery.

This lecture reviews some of what was already discussed about everyday mental states, dissociation, and psychosis, and introduces some new ways of looking at those same issues that may help you more deeply integrate an understanding of them.

In part 2 of this review and integration, some further ideas about how dissociation can lead into psychosis, and then about how healing can be facilitated, are explored.

A "capsule summary" of what was discussed, and some concluding words.....