Structure with Engagement: Toward an Integration of Trauma and Relational Psychoanalytic Models in the Treatment of Dissociative Disorders

Abstract

Trauma model approaches to the treatment of dissociative disorders may provide containment and direction and yet, these same approaches may be constricting and limit exploration. However, relational psychoanalytic approaches may allow for engagement and exploration while potentially failing to provide containment and structure. This article provides an overview of key elements of both models and considers the question of whether it is possible to creatively resolve theoretical and clinical tensions between trauma model and relational psychoanalytic responses to dissociation. A review of the history of the study of dissociation in the field of psychoanalysis and concerns about psychoanalytic practice in the context of dissociation is followed by comparing contrasting conceptualizations of the assumptions of normality, definitions of dissociation, theories of etiology, goals of treatment, and theorized mechanisms of action. The review ends with a discussion of potential possibilities for clinical integration.

KEYWORDS:

• trauma
• dissociation
• dissociative identity disorder
• psychoanalysis
• relational psychoanalysis

Notes

For a full discussion of these controversies, please see Gleaves, May, and Cardena, 2001, and Dalenberg et al., 2012.