Elizabeth Howell - Trauma and Dissociation Informed Psychotherapy: Relational Healing and the Therapeutic Connection

Trauma and
Dissociation Informed
Psychotherapy

RELATIONAL HEALING AND
THE THERAPEUTIC CONNECTION

Elizabeth Howell

W.W. NORTON & COMPANY

Independent Publishers Since 1923

A Norton Professional Book

Advance Praise

Elizabeth Howells new book provides a masterful synthesis of the vital revolution in trauma theory and practice over the last 25 years. In this illuminating, indispensable guide she weaves together the powerful insights of multiple disciplines with those of her own personal transformation as a relational trauma therapist. Dedicated to exploring the painful and complex reality of her subject, Howells book is an invaluable guide to the newly hopeful field of trauma therapy.

Jessica Benjamin, psychoanalyst and author of
Beyond Doer and Done ToandThe Bonds of Love

Elizabeth Howell writes from her heart, guided by her deeply felt and valued relationships with her patients, clearly cherished as her most important collaborators. Her original thinking shines through as she adds her own views and creatively spells-out and interprets the work of both psychoanalytic thinkers and traumatologists, an integrative feat few writers have achieved. Sit down with Howell, as I have, and enjoy her company. You will be delighted!

Richard A. Chefetz, M.D.,
Private Practice of Psychiatry, Washington, D.C.

Howells distinctive blend of trauma-informed clinical compassion, academic and analytic questioning reaches a new peak here. She exposes the trauma caused by Freuds creation of the Oedipus complex and the damage of one-person psychology. At the same time she offers hope through comprehensive non-dissociative theorizing, backed as always by solid clinical evidence. Gently, authentically, and relationally argued this is a powerful seminal bombshell of a bookalbeit an elegant one.

Valerie Sinason, Ph.D., British psychoanalyst and author

At the heart of Elizabeth Howells courageous thesis is the question: can contemporary psychoanalysis adapt to trauma and dissociation informed psychotherapy? She pulls no punches in offering scholarly yet confronting responses to offer a belated resolution to the 100-year trauma debate raging between Freudian repression and Janetian dissociation. Therapists and patients alike will greatly benefit from Dr. Howells parsimonious definition of trauma as that which causes dissociation. This radical reconceptualization has powerfully reshaped the future direction of trauma therapy as her clinically based discussions amply illustrate.

Dr. George Halasz, Adjunct Senior Lecturer, Monash University,
Melbourne, Australia, and child and adolescent psychiatrist

Clear, well-written, engaging. Valuable for clinicians at all levels.

Lucie Grosvenor, LCSW, Executive Director,
Psychoanalytic Psychotherapy Study Center

Page numbers listed correspond to the print edition of this book. You can use your devices search function to locate particular terms in the text.

abreaction

remembrance and, 9

ABS. see alternating bilateral stimulation (ABS)

absence

dissociated experiences as, 95

abuse

attachment-based defenses against acknowledging, 1819

child sexual see child sexual abuse

deprivation related to, 17879

neglect related to, 17879

rejection related to, 17879

trauma resulting from, 27

traumatic, 129

abuser(s)

in Oedipal theory, 1920

ACEs. see adverse childhood experiences (ACEs)

Ackerly, R., 113

adverse childhood experiences (ACEs), 5155

physical health effects of, 5155

trauma and dissociationrelated, xxi

affect(s)

conveying of, 67

isolation of, xiv

reducing and controlling intensity of, 4142

regulation of, 9899

strangulated, 9

affective arousal, 33

agency

critical, 132

Freudian model and, xviii

personal, 138

in repressed unconscious, 82

aggressor(s)

case example, 12425

identification with, xv, 12125

Ainsworth, M., 99

alloplastic

defined, 122

Alpert, J., 32, 135

Al Qaeda terrorists

WTC attack by, 3637

alternating bilateral stimulation (ABS)

in fear extinction, 188

America by Day, 108

amnesia, 4, 33

amygdala, 33

Anda, R.F., 51

anger in connection, 166

Anna O. see Pappenheim, B.

ANP. see apparently normal personality (ANP)

ANS. see autonomic nervous system (ANS)

anti-libidinal ego, 143

anxious ambivalent attachment, 99

anxious avoidant attachment, 99

anxious resistant attachment, 99

apparently normal personality (ANP), 21, 136

described, 14852

in DID, 15154

arousal

affective, 33

emotional, 33

Assault on the Truth, 13

association

lack of, 17677

attachment

anxious ambivalent, 99

anxious avoidant, 99

anxious resistant, 99

Bowlbys theory of, 9798

described, 9799

developmental dynamics of fear and, 11920

disconnection and, 12021

disorganized see disorganized attachment (DA)

dissociation and, 12021

earned secure, 102

generative, 166

importance of, 11819

insecure, 99

learning theories on, 98

need for, xix, 128

in reducing fear, 98102, 1067

secure, 99

attachment-based defense(s)

against acknowledging abuse, 1819

attachment-based dissociation, 12021

neurosis vs., xviii

attachment dilemmas

in criticizing oneself, xxiixxiii

attachment patterns

types of, 99

attachment system, 16163

case example, 16163

described, 9899

attachment theory

Bowlbys, 9798

described, 9798

IWMs in, 98, 101

trauma theory and, 98

attack(s)

self- see self-attack

attractor(s)

in state space, 177

attunement

dissociative, 73

Auerhahn, N.C., 97, 128

authority roles

in psychotherapy, 6163

authority structure, 6163

autobiographical memory, 32

autonomic nervous system (ANS), 116

dorsal vagal parasympathetic response of, 114

autoplastic

defined, 122

baby-watchers

scientific, 17778

bad me, 144

Barrett, D.L., 182

battle fatigue, 22

behavior(s)

DArelated, 1001

behavioral-mental states of being, 17778

behavior state(s)

discrete, 17677

betrayal blindness, 119

betrayal trauma, 119

better to be a sinner in Gods world, 12528

biological states

posttraumatic, 11417

blame-other patterns of thinking, xix

blame-self patterns of thinking, xix

blank screen psychoanalysts, 166

blindness

betrayal, 119

body(ies)

dissociation effects on, 4557

trauma effects on, 25, 4557

body psychotherapy

Janet and, 7

body rhythms

affects conveyed by, 67

bonding

traumatic, 120

Boon, S., 41, 42

borderline

defined, 56

borderline personality disorder (BPD), 56

DA as precursor to, 1012

fragmentation of psyche in, 146

PTSD and, 56

splitting associated with, 5657, 146

stable instability of, 146

borderline personality organization

defenses of, 14647

bottom-up processing, 4951

described, 49

Boulanger, G., 82

Bowen, M., 90

Bowlby, J., 9799, 113, 11819, 130, 14344

attachment theory of, 9798