Papers by Ono van der Hart
Journal of EMDR Practice and Research, 2015
Jak sugeruje poprzedni artykuł w niniejszym pis ´mie, znajomos ´c ´ i stosowanie teorii struktura... more Jak sugeruje poprzedni artykuł w niniejszym pis ´mie, znajomos ´c ´ i stosowanie teorii strukturalnej dysocjacji osobowos ´ci (TSDP) oraz towarzysza ˛cej jej psychologii czynnos ´ci moz ˙e przynies ´c ´ korzys ´ci lekarzom stosuja ˛cym terapie ˛ EMDR (odwraz ˙liwiania za pomoca ˛ ruchu gałek ocznych) w leczeniu pacjentów ze złoz ˙onymi zaburzeniami potraumatycznymi. Wg teorii TSDP, dysocjacja osobowos ´ci jest główna ˛ cecha ˛ traumatyzacji oraz szerokiej gamy zaburzen ´ zwia˛zanych z trauma˛, od prostego zespołu pourazowego (PSTD) pocza ˛wszy, a skon ´czywszy na dysocjacyjnym zaburzeniu toz ˙samos ´ci (DID). Wspomniana teoria moz ˙e stanowic ´ pomoc dla terapeutów EMDR w opracowywaniu dokładnego schematu ułatwiaja ˛cego zrozumienie problemów pacjentów oraz przy tworzeniu i wykonywaniu planu leczenia. Uzgodniony model ekspercki w przypadku traumy złoz ˙onej to leczenie odwołuja˛ce sie ˛ do faz, gdzie faza stabilizacji i przygotowania poprzedza leczenie traumatycznych wspomnien ´. Niniejszy artykuł koncentruje sie ˛ na pocza˛tkowej fazie stabilizacji i przygotowania, która jest niezwykle istotna dla bezpiecznego i efektywnego stosowania EMDR w leczeniu traumy złoz ˙onej. Najwaz ˙niejsze zagadnienia to (a) praca z nieadaptacyjnymi przekonaniami; (b) przezwycie ˛z ˙anie fobii dysocjacyjnych oraz (c) szerokie zastosowania uaktywniania zasobów (resourcing). Słowa kluczowe: dysocjacja, strukturalna dysocjacja osobowos ´ci, zaburzenia dysocjacyjne, EMDR, leczenie odwołuja ˛ce sie ˛ do faz, faza stabilizacji. etoda EMDR (odwraz ˙liwianie za po-moca˛ ruchu gałek ocznych), opracowana pocza˛tkowo w celu leczenia zespołu stresu pourazowego (PTSD), jest coraz cze˛s ´ciej stosowana w terapiach innych zaburzen ´ psychicznych, ła˛cznie z zaburzeniami be˛da˛cymi skutkiem traum złoz ˙onych, takimi jak złoz ˙one PTSD, pograniczne zaburzenie osobowos ´ci (BPD), jak równiez ˙ złoz ˙one zaburzenia dysocjacyjne, takie jak dysocjacyjne zaburzenie osobowos ´ci (DID) oraz zaburzenia dysocjacyjne gdzie
Directieve therapie, 2008
notities uit de praktijk De behandeling van een vrouw met recidiverend mutisme Marleen Tibben en ... more notities uit de praktijk De behandeling van een vrouw met recidiverend mutisme Marleen Tibben en Kees Hoogduin SAMENVATTING Gedragstherapie bij patiënten met een psychogene afonie is nogal succesvol. De meeste patiënten herstellen in één of twee zittingen. Recentelijk is deze strategie met succes toegepast bij een patiënt met mutisme. In deze gevalsbeschrijving wordt een replicatie hiervan gegeven. Inleiding Een patiënt met psychogene afonie ofwel conversieve fluisterspraak kan alleen nog maar fluisteren. Voor de behandeling van psychogene afonie is een succesvolle behandelstrategie bekend. Mulder en Hoogduin beschreven in 1986 al een behandeling van psychogene afonie bij een patiënte met een somatisatiestoornis (Mulder & Hoogduin, 1986). Na een behandeling van een uur had zij haar stem terug en was zij in staat om met normaal stemvolume te communiceren. Drost behandelde afoniepatiënten met een combinatie van suggestieve en gedragstherapeutische (shaping-)elementen. De resultaten van zijn behandeling zijn indrukwekkend te noemen: ruim 80% van de ongeveer 200 patiënten over wie hij rapporteerde, kreeg binnen één tot drie zittingen de stem weer terug (Drost, 1996). Naast de afonie bestaat er nog een tweede conversieve spraakstoornis waarbij de patiënt in het geheel niet meer kan spreken, zelfs niet meer fluisteren: conversief mutisme. Deze vorm van mutisme moet onderscheiden worden van mutisme dat voorkomt bij schizofrenie, depressieve M. TIBBEN is psycholoog en werkzaam als vestigingsmanager van de vestiging Delft van de HSK Groep. PROF. DR. C.A.L. HOOGDUIN, zenuwarts, is lid van de directie van de HSK Groep. Tevens is hij hoogleraar psychopathologie aan de Radboud Universiteit, Nijmegen, sectie Klinische Psychologie.
Australian and New Zealand Journal of Psychiatry, Nov 1, 2004
Imprecise conceptualizations of dissociation hinder understanding of traumarelated dissociation. ... more Imprecise conceptualizations of dissociation hinder understanding of traumarelated dissociation. An heuristic resolution for research and clinical practice is proposed. Method: Current conceptualizations of dissociation are critically examined. They are compared with a new theory that incorporates classical views on dissociation with other contemporary theories related to traumatization, viewing dissociation as a lack of integration among psychobiological systems that constitute personality, that is, as a structural dissociation of the personality. Results: Most current views of dissociation are overinclusive and underinclusive. They embrace non-dissociative phenomena-rigid alterations in the level and field of consciousness-prevalent in non-traumatized populations, and which do not require structural dissociation. These views also largely disregard somatoform and positive symptoms of dissociation and underestimate integrative deficiencies, while emphasizing the psychological defensive function of dissociation. They do not offer a common psychobiological pathway for the spectrum of trauma-related disorders. Structural dissociation of the personality likely involves divisions among at least two psychobiological systems, each including a more or less distinct apperceptive centre, that is, a dissociative part of the personality. Three prototypical levels of structural dissociation are postulated to correlate with particular traumarelated disorders. Conclusions: Limitation of the concept of dissociation to structural dividedness of the personality sets it apart from related but non-dissociative phenomena and provides a taxonomy of dissociative symptoms. It postulates a common psychobiological pathway for all trauma-related disorders. Trauma-related dissociation is maintained by integrative deficits and phobic avoidance. This conceptualization advances diagnosis, classification, treatment and research of trauma-related disorders.
Dunod eBooks, Jan 25, 2017
European Journal of Trauma & Dissociation, Sep 1, 2021
Some World War I clinicians related the symptoms of traumatized servicemen to an underlying disso... more Some World War I clinicians related the symptoms of traumatized servicemen to an underlying dissociation of their personality, consisting of two prototypical conditions: one involving functioning in daily life (inspired by Myers, whose work is also discussed in this article, and which will be labeled apparently normal part of the personality [ANP]) and one involving fixation in the traumatic experience and related attempts at defense (emotional part of the personality [EP]). These authors described two dissociative patterns. As illustrated in this article, one pattern consisted in the presentation of a dominant ANP suffering from constant or frequent intrusions from EP. The other pattern consisted in repeated complete alternations between ANP and EP. Instead of the use of purely symptom-oriented approaches, for the dissociative symptoms to be really resolved, an integration of traumatic memory in the personality, that is, between EP and ANP had to take place. These clinicians used hypnosis to access the traumatic memory and EP and to foster such integration; they agreed on the importance of the quality of the therapeutic relationship in this regard. However, they differed in opinion and practice as to the need to assists patients in their expression of traumatic emotions during this process. When the trauma was related merely to war experiences, such therapeutic processes took place within a simple phase-oriented treatment model, while in the presence of a history of previous trauma and related dissociation of the personality, this model had more complex applications. This is similar to modern treatment approaches of the sequelae-such as a complex dissociative disorder-of chronic (childhood) traumatization.
De Boeck Supérieur eBooks, Oct 12, 2021
International Handbook of Workplace Trauma Support, 2012
Dth, 1994
Het stress-begrip is onderdeel van ons alledaagse taalgebruik geworden. In veel gevallen dient he... more Het stress-begrip is onderdeel van ons alledaagse taalgebruik geworden. In veel gevallen dient het als een vervanging van uitdrukkingen als 'druk', 'gespannen', 'geı¨rriteerd', en 'angstig'. Iedereen weet waar het om gaat, maar wat er nu precies onder stress moet worden
To survey the number and characteristics ofDID and DDNOS patients treated at a Regional Institute... more To survey the number and characteristics ofDID and DDNOS patients treated at a Regional Institute for Ambulatory Mental Health Care in the Netherlands, their treatment goals and treatment course, and the organizational investment, semi-structured interviews were held with therapists about all patients diagnosed with D1D or DDNOS during a three-month period (May 31, 1993-August 31, 1993), and a study of these patients ' files took place. One hundred one patients received a dissociative disorder diagnosis, i.e., forty-one the diagnosis of DID and sixty the diagnosis of DDNOS. On average, these patients received the dissociative disorder diagnosis after a treatment period of over two years. Most therapists followed a basic stageoriented treatment model. In the majority of cases, hypnosis was an important adjunctive technique. For more than half of the patients (DID:53.7%; DDNOS:60.0%), therapists reported stabilization and symptom reduction as the treatment goal. For one-third (DID: 39.0%; DDNOS: 31.6%), the focus included treatment of traumatic memories as well as reintegration and rehabilitation. This objective was chosen within one to three years of stabilization and symptom reduction. Average treatment length was six years, most often with a frequency of one session a week. In 10% of all cases, a second therapist joined the treatment. Therapists reported concern with regard to: boundary issues, co-therapy, diagnostic issues, (contra) indications for treatment of traumatic memories, attachment problems, cooperation with other agencies, underdevelopment with regard to dissociative disorders in child and adolescent mental health care. The emphasis on supportive therapy only and the use of secondary therapists may perhaps be different from clinical approaches elsewhere.
In 1897 Pierre Janet (1859-1947) publicized his important contribution on the trauma patient's de... more In 1897 Pierre Janet (1859-1947) publicized his important contribution on the trauma patient's deep involvement with the therapist. The patient develops intense feelings toward the therapist, termed la passion somnambulique. During this period of passion the patient experiences intense need of and dependency on the therapist. Synthesizing Janet's work with contemporary treatment of trauma, an attachment paradigm is described in which the trauma patient suffers from the inability to tolerate aloneness, and the need for psychological and relational connection and guidance from the therapist is paramount. Issues of attachment, dependency, and intolerance of aloneness and their management throughout phase-oriented treatment will be discussed. Pierre Janet's meticulously recorded clinical and experimental observations serve as an extensive data base regarding the nature and course of the therapeutic relationship with traumatized patients. These notes documented his observations of dissociative and traumatized patients undergoing treatment at the
Australian and New Zealand Journal of Psychiatry, Aug 1, 1999
Objective: The primary aim of this study was to investigate the hypothesis that somatoform dissoc... more Objective: The primary aim of this study was to investigate the hypothesis that somatoform dissociation would differentiate among specific diagnostic categories after controlling for general psychopathology. Method: The Somatoform Dissocation Questionnaire (SDQ-20), the Dissociative Experiences Scale, and the Symptom Checklist-90-R were completed by patients w i t h DSM-IV diagnoses of dissociative disorders (n = 44), somatoform disorders (n = 47), eating disorders (n = 50), bipolar mood disorder (n = 23), and a group of consecutive psychiatric outpatients with other psychiatric disorders (n = 45), mainly including anxiety disorders, depression, and adjustment disorder. R e s u l t s : The SDQ-20 significantly differentiated among diagnostic groups in the hypothesised order of increasing somatoform dissociation, both before and after statistically controlling for general psychopathology. Somatoform dissociation was extreme in dissociative identity disorder, high in dissociative disorder, not otherwise specified, and increased in somatoform disorders, as well as in a subgroup of patients with eating disorders. In contrast with somatoform dissociation, psychological dissociation did not discriminate between bipolar mood disorder and somatoform disorders. C o n c l u s i o n s : Somatoform dissociation is a unique construct that discriminates among diagnostic categories. It is highly characteristic of dissociative disorder patients, a core feature in many patients with somatoform disorders, and an important symptom cluster in a subgroup of patients with eating disorders.
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Papers by Ono van der Hart