Structural Dissociation Theory

• The Haunted Self (Nijenhuis, van der Hart & Steele, 2004)

• Apparently Normal Personality (ANP)
  • A person may have one or more
  • This part is generally high functioning and present oriented
• Emotional Parts (EPs)
  • Contain emotions, cognitions, body sensations and behaviors from the time of the experience
  • Are often temporally locked in the past, including age-wise
  • Take on specific roles or “jobs”
• Adaptive therapeutic tool
  • Conference Room / Dissociative Table / Gathering Place
    • Helps client develop awareness of different ego states / parts and the functions
    • George Fraser (1991)
    • Kathy Martin (http://kmccs.com)
      • Used to create and enhance resources for parts
      • Facilitates internal teamwork by understanding of roles of the parts
        • Each part exists for the greater good of the system
      • Facilitate communication and compassion
      • Grounding in present time orientation
      • Arousal reduction
      • Allows linkage of adaptive information

Military & First Responders

• Normal reactions to abnormal events
• Constant danger becomes dysfunctionally stored
• Earlier childhood events may form the foundation of maladaptive memory networks
• Follow EMDR standard procedures and protocols (eight phases and three prongs) unless specific modifications are indicated
• Some additional processing issues
  • Culture of the profession, e.g., self-sacrifice
  • Perception that emotion is a sign of weakness
  • Maladaptive self-soothing behaviors, e.g., substance use/abuse, addictive behaviors
  • Survivor guilt
  • Avoidance
  • Anger / explosiveness
  • Classified experiences
  • Secondary gain, e.g., disability compensation, legal issues, redeployment
  • Anniversary dates
  • Transitions
  • Sexual assault on-the-job
  • LGBT and race
  • Couple / family struggles
  • Time limits on treatment
• Processing considerations
  • May be triggered by the idea of relaxing state change exercises in Phase 2
    • Psychoeducation, e.g., stress reduction, affect tolerance, role of emotional numbing
    • Important to have a variety of state change tools in place
  • Client may under-report SUD due to emotional numbing
  • Don’t have to report details, brain is doing the processing
  • Remind client of stop signal
• EMD, Recent Event, or Inverted protocol (future, present, past) may be helpful
  • Reduces the possibility of over-accessing
  • Gives client a sense of control over the process
  • Remind client that emotional and physiological disturbances are the result of the brain processing the memory
    • Your brain is doing what it needs to do to get rid of the disturbance. You are here with me and the only place this (the memory) is actually happening is in your brain. Allow it to do its job. Once it’s been able to process all the ick, it will have
      much better access to the positive things again.
    • May need to remind client s/he can access resources to remain in the affective window of tolerance so s/he can continue to process
    • Remind client of importance of using stop signal if s/he needs it
• If needed, return to target more frequently and use shorter sets to limit potential of associative links flooding the client
• Possible cognitive interweaves
  • How does holding on to all of this help you/ him / her / them now?
  • If the roles were reversed and it had been you who died (was injured), what would you think about your brother / sister / partner? What would you want him / her to know?
  • What do you want to say to him / her that you haven’t been /weren’t able to say? Say it now. Have the conversation.
  • You’re home. It’s over. You’re safe now.
  • What can you do now to make things better – to make amends?
• Body Scan may activate unprocessed memory elements
  • Make sure there’s enough time to stabilize if that were to happen
  • Check for any discomfort the client may “live with,” e.g., headaches or physical pain due to injury