On November 9th, 2023, Hope Roots hosted a 1-hour Free Discussion with Dorinna Ruh with tools to help therapists learn to assess clients for dissociation. This call, and other training resources are provided as part of Hope Roots' mission to increase access to trauma-informed care. For more resources like this, please subscribe on YouTube at https://www.youtube.com/@hoperoots and signup for email updates when new resources are posted.

Event Description

Discovering a client’s dissociative disorder is the first step toward their receiving proper treatment. Yet many therapists do not get adequate training regarding dissociation, specifically how to assess it. As a result, it takes between 5 - 12 years for someone in therapy to get diagnosed with a dissociative disorder (Brand BL, Loewenstein RJ, Spiegel D. Dispelling myths about dissociative identity disorder treatment: an empirically based approach. Psychiatry. 2014 Summer;77(2):169-89).

Dorinna Ruh has taught advanced EMDR Therapy skills since 2010 as an EMDRIA-approved consultant and specializes in dissociative disorders. Learn more about Dorinna’s work at https://advanced-emdr-education.com/ In this free call, Dorinna will review dissociation assessment for therapists who want to ensure they have the basic skills needed to identify clients who may have a dissociative disorder. No CEUs will be given.

Donations Appreciated

If you find this offering of value, please consider sending a donation to Hope Roots, so we can continue our mission of increasing access to trauma-informed care (including training opportunities like this!). You can also Venmo a donation (@hoperoots).

This list is not for diagnosis, but combines wisdom from multiple sources to help trauma therapists more quickly identify someone who may have a dissociative disorder. Click here to download a PDF of this handout.

• Three or more prior diagnoses (esp. BPD, Bipolar, mood disorders)

• Prior treatment failure

• Concurrent psychiatric and somatic symptoms

• A history of abuse as a child (esp. twisted, complex)

• An inability to recall childhood events from the years 6 to 11

• Severe headaches and other pain syndromes

• Impaired affect regulation

• Chronic destructive behavior

• Easily learning coping skills in session, inability to use them outside

• Distorted relationships with others

• Loss of one's system of meaning.(i.e. losing one's core beliefs, values, religious faith, or hope in the world and other people - https://www.verywellmind.com)

• Neglect in infancy

• Physical unavailability of primary caregiver in the first 2 years of life

• Childhood caregivers who were frightened or frightening

• Fluctuating symptoms and levels of function

• Time distortion, time lapses, or frank amnesia

• Being told of disremembered behaviors

• Others noting observable changes

• The discovery of objects, productions, or handwriting in one’s possession that one cannot account for or recognize

• Hearing voices (80% or more experienced as within the head) that are experienced as separate, often urging the patient toward some activity

• The patient’s use of “we” in a collective sense and/or making self-referential statements in the third person

• The eliciting of other entities through hypnosis or a drug-facilitated interview

• Traumatic medical history or childhood hospitalizations/procedures

• Refugee population

• Ability to block out pain, high pain tolerance Indications of disorganized attachment

• Client with lots of symptoms and report a history of a great childhood

• Therapist feels “floaty”, inexplicably tired or confused when the client is present .

Items in bold are ones we can usually learn very early in treatment or during intake questions

Compiled from Van der Kolk, 2001, Kluft, 1999, Twombly, 2013

In EMDR Therapy, clients reprocess not just a single traumatic memory, but any past memories and present triggers that are fueling their present symptoms. For instance, if the presenting problem is social anxiety the clinician will help the client explore the present triggers related to their symptoms (i.e. the grocery store is crowded) and then use a “floatback” technique to make a list of past memories that are connected to those thoughts, emotions, and sensations in the client’s memory network (i.e. age 5 - lost in store; age 27 - robbery). The client will also consider how they will feel and respond in the future after EMDR therapy (i.e. a calm trip to the store). An EMDR Therapy treatment plan is completed when a client has reprocessed any past memories, any present triggers, and can visualize themselves successfully navigating the future without distress. The worksheet below can be used by EMDR-trained clinicians to map out a plan for a client’s EMDR therapy.

Click here to download the PDF