Onno van der Hart

Kathy Steele

Ellert R. S. Nijenhuis

They typically have a wide array of symptoms, often classified under different combinations of comorbidity, which can make assessment and treatment complicated and confusing for the therapist. Many patients have substantial problems with daily living and relationships, including serious intrapsychic conflicts and maladaptive coping strategies. Their suffering essentially relates to a terrifying and painful past that haunts them. Even when survivors attempt to hide their distress beneath a facade of normality—a common strategy—therapists often feel besieged by their many symptoms and serious pain. Small wonder that many survivors of chronic traumatization have seen several therapists with little if any gains, and that quite a few have been labeled as untreatable or resistant. In this book, three leading researchers and clinicians share what they have learned from treating and studying chronically traumatized individuals across more than 65 years of collective experience. Based on the theory of structural dissociation of the personality in combination with a Janetian psychology of action, the authors have developed a model of phase-oriented treatment that focuses on the identification and treatment of structural dissociation and related maladaptive mental and behavioral actions. The foundation of this approach is to support patients in learning more effective mental and behavioral actions that will enable them to become more adaptive in life and to resolve their structural dissociation. This principle implies an overall therapeutic goal of raising the integrative capacity, in order to cope with the demands of daily life and deal with the haunting remnants of the past, with the “unfinished business” of traumatic memories. Of interest to clinicians, students of clinical psychology and psychiatry, as well as to researchers, all those interested in adult survivors of chronic child abuse and neglect will find helpful insights and tools that may make the treatment more effective and efficient, and more tolerable for the suffering patient.

Structural Dissociation and the Treatment of Chronic Traumatization

The Haunted Self

The Trinity of Trauma: Ignorance, Fragility, and Control is structured as a trilogy. This book includes the first two parts: Volume I, The Evolving Concept of Trauma, and Volume II, The Concept and Facts of Dissociation in Trauma, which are predominantly conceptual, theoretical, and empirical in nature. Volume I aims to overcome conceptual flaws that have plagued the trauma field to date. It proposes new definitions of trauma and derivative concepts as well as a dimension of trauma-related disorders. It suggests that individuals and their environment constitute, depend on, and are relative to each other. Volume I unites two groups of trauma-related disorders that were previously contrasted in psychiatric history under various names such as "melancholia" versus "hysteria", "traumatic neurosis" versus "traumatic hysteria", and "posttraumatic stress disorder" versus "dissociative disorders". It also mends the "dissociation" of dissociative and conversion disorders. Volume II analyzes and defines the concepts of "personality", "self", "dissociation in trauma", and "dissociative parts". It explores and documents the biopsychosocial features of different prototypical dissociative parts in traumatized individuals. Important features of these parts also characterize other players in traumatization, stretching from perpetrators to society at large.

Ignorance, Fragility, and Control

The Trinity of Trauma

The first comprehensive theory of somatoform dissociation. Expanding the definition of dissociation in psychiatry, Nijenhuis presents a summary of the somatoform components of dissociation-how sensory and motor functions are affected by dissociative disorders. Founded in the current view of mind-body integration, this book is essential reading for all mental health professionals engaged in the diagnosis, treatment, and study of dissociative disorders, PTSD, and other trauma-related psychiatric disorders.

Ellert R. S. Nijenhuis

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