Assignment: Controversy Associated With Dissociative Disorders
- Review this week’s Learning Resources on dissociative disorders.
- Use the Walden Library to investigate the controversy regarding dissociative disorders. Locate at least three scholarly articles that you can use to support your Assignment.
The Assignment (2–3 pages)
- Explain the controversy that surrounds dissociative disorders.
- Explain your professional beliefs about dissociative disorders, supporting your rationale with at least three scholarly references from the literature.
- Explain strategies for maintaining the therapeutic relationship with a client that may present with a dissociative disorder.
- Finally, explain ethical and legal considerations related to dissociative disorders that you need to bring to your practice and why they are important.
Assignment: Controversy Associated With Dissociative Disorders To Prepare Review this week’s Learning Resources on dissociative disorders.Use the Walden Library to investigate the controversy regard
This study source was downloaded by 100000794395091 from CourseHero.com on 10-24-2022 10:58:11 GMT -05:00 https://www.coursehero.com/file/131530935/Wk-9-SfakiosLoridocx/ 1 Week 9: Controversies with Dissociative Disorders Lori Sfakios College of Nursing-PMHNP, Walden University PRAC 6665: PMHNP Care Across the Lifespan I Dr. Trace Yule January 24, 2021 This study source was downloaded by 100000794395091 from CourseHero.com on 10-24-2022 10:58:11 GMT -05:00 https://www.coursehero.com/file/131530935/Wk-9-SfakiosLoridocx/2 Dissociative Disorders Dissociative disorders (DD) are a group of disorders that often result from stressful situations, trauma, childhood trauma, or abuse. The disorders include dissociative amnesia, dissociative identity disorder, depersonalization or derealization disorder, and dissociative fugue (Mad Medicine, 2019). These disorders involve a disruption in mental functions such as memory, awareness, perception, consciousness, motor control, and identity, leading to feelings of being disconnected from oneself or disconnected from their environment (Sadock et al., 2015). Dissociating is the body’s physiological and psychological coping response to overwhelming, distressing, and painful trauma (Temple, 2019). There is a great deal of controversy, and ethical conflict regarding DD is due to the lack of scientific literature to support this group of disorders. The following paper will address the controversies with DD and my professional beliefs, strategies to maintain a therapeutic alliance with clients, and legal and ethical considerations. Controversy Associated with Dissociative Disorders Controversy with DD stems from the lack of scientific literature despite the evidence supporting a strong relationship between DD and trauma (Lowenstein, 2018). Lowenstein (2018) and Grande (2018) explain that the controversial debate focuses on whether dissociations result from psychological trauma or something a person has made up with their confabulated trauma memories or is it iatrogenic. Theorists such as Pierre Janet have studied dissociation. Janet described dissociation as an instinctive and adaptive process universal to everyone in traumatic situations (Temple, 2019). His theory was disregarded because of the shift to the psychoanalytic theory in the early 1900s. Many have disputed DD and the concept of dissociation through the years because of the lack of empirical evidence or the lack of ability to replicate previous findings (Lowenstein, 2018; Temple, 2019). Unfortunately, the controversies continue to lead to This study source was downloaded by 100000794395091 from CourseHero.com on 10-24-2022 10:58:11 GMT -05:00 https://www.coursehero.com/file/131530935/Wk-9-SfakiosLoridocx/3 a lack of knowledge and understanding essential to treat clients with DD. Evidence shows a strong prevalence of DD in those with post-traumatic stress disorder (PTSD), obsessive- compulsive disorder, and borderline personality disorder (Grande, 2018; Temple, 2019). Despite DD being one of the oldest groups of psychiatric disorders, skeptics remain. Dissociative identity disorder (DID)is the most controversial of the four primary DD. The media has portrayed very dramatic characteristics in people with DID, leading to a great misunderstanding. Professional beliefs must come from the evidence that does exist. Professional Beliefs of Dissociative Disorders The controversy of whether DD is caused by trauma or iatrogenic causes is irrelevant at this time in history. Those suffering from DD are highly underserved, leading to a large cost burden to the healthcare system and society (Lowenstein, 2018). Professionals need to put aside negative beliefs about DD and utilize the latest literature and clinical guidelines to treat it. DD has been listed in the Diagnostic and statistical manual of mental. My experience is limited, and I have only encountered one child, age 12, who has reported dissociative symptoms after witnessing her mother experience significant trauma. I believe that clients who have dissociative symptoms often have underlying co-occurring disorders. The reality is that clients with DD exist and dismissing them could lead to their demise. DD leads to severe symptoms, high utilization of psychiatric services, increased comorbidity, and increased suicidality (Lanius et al., 2018; Temple, 2019). It is paramount that providers develop strategies to maintain a therapeutic alliance with clients diagnosed with a DD. Strategies for Maintaining a Therapeutic Alliance This study source was downloaded by 100000794395091 from CourseHero.com on 10-24-2022 10:58:11 GMT -05:00 https://www.coursehero.com/file/131530935/Wk-9-SfakiosLoridocx/4 Treating clients diagnosed with DD is challenging as these clients often struggle with trust issues. The first step in caring for clients with DD is to develop professional competence with these disorders (Lawson et al., 2017). The first-line treatment is for clients with DD is psychotherapy. Psychotherapy modalities recommended for those who have experienced trauma are trauma-focused cognitive behavioral therapy (TF-CBT) (Lawson et al., 2017). Clinicians who take on clients with DD must be knowledgeable of DD and treatments. The client and the clinician should mutually agree upon case formulation and treatment plans. Selecting a treatment modality is just one piece of the puzzle. The clinicians must first develop a therapeutic alliance with the client, and secondly, the clinician must maintain that alliance with the client. Clinicians should avoid trying to dive right into a client’s troubling memories as this is anxiety-inducing and may cause the client to shut down (Ducharme, 2017). The clinicians must understand the client’s culture, which may impact the treatment and potential outcomes. The therapeutic alliance is a vital indicator of treatment outcomes. Victims of abuse and trauma often face challenges with interpersonal relationships because they are often abused by someone they trust. Victims of abuse develop feelings of mistrust and insecurities that they then apply to the general population, not just their assailants (Lawson et al., 2017). According to Lawson et al. (2017), clients who have dissociative symptoms are emotionally dysregulated, require long-term treatment, and often have less than optimal outcomes, which makes building a therapeutic alliance an even more significant challenge. Clinicians must have self-awareness, be mindful of their judgments and biases and avoid countertransference. It is important to continuously assess the therapeutic alliance, monitor for subtle changes in the client, and be aware of their own emotions when reacting to client changes (Lawson et al., 2017). Legal and Ethical Considerations This study source was downloaded by 100000794395091 from CourseHero.com on 10-24-2022 10:58:11 GMT -05:00 https://www.coursehero.com/file/131530935/Wk-9-SfakiosLoridocx/5 The treatment of DD comes with certain legal and ethical considerations. The treatment of clients with dissociative disorders is very complex and lengthy. Clinicians who take on clients with these disorders must be committed. Clinicians have an ethical obligation to remain knowledgeable of the disorders and competent to provide appropriate treatment to facilitate a positive outcome. Competency with this unique population often requires post-graduate work such as coursework, workshops, and supervisory guidance (Ducharme, 2017). Legal issues can arise when treating DD clients. Often those with dissociative identity disorder have two or more alters. Acquiring informed consent may be a challenge if the alter presents itself to the clinician. There may be concerns that the client may not fully understand the treatment they have consented to. Often, clinicians will facilitate a no-harm contract with the client; however, this is not legally binding and does not prevent suicide (Ducharme, 2017). DD clients often engage in self-injurious behaviors which makes them an even greater safety risk (Parry et al., 2017). Caring for clients who engage in self-injurious behaviors requires a safety assessment at each treatment session. Conclusion Treatment of clients with DD is a specialty. Only clinicians who have been appropriately trained should take on this unique population. Controversial beliefs continue to linger about DD. Clinicians must utilize the latest evidence-based treatment to help clients with DD. One of the most important aspects of caring for a client with DD is the therapeutic alliance. If there is no therapeutic alliance, there will be no positive outcomes. Positive relationships between clinicians and their clients can positively influence recovery from their past trauma and improve social connections, resilience, and safety (Parry et al., 2017). References This study source was downloaded by 100000794395091 from CourseHero.com on 10-24-2022 10:58:11 GMT -05:00 https://www.coursehero.com/file/131530935/Wk-9-SfakiosLoridocx/6 Ducharme, E. L. (2017). Best practices in working with complex trauma and dissociative identity disorder. Practice Innovations, 2 (3), 150–161. https://doi.org/10.1037/pri0000050 Lanius, R. A., Boyd, J. E., McKinnon, M. C., Nicholson, A. A., Frewen, P., Vermetten, E., Jetly, R., & Spiegel, D. (2018). A review of the neurobiological basis of trauma-related dissociation and Its relation to cannabinoid- and opioid-mediated stress response: A transdiagnostic, translational approach. Current Psychiatry Reports, 20( 12), 118. https://doi.org/10.1007/s11920-018-0983-y Lawson, D. M., Stulmaker, H., & Tinsley, K. (2017). Therapeutic Alliance, Interpersonal Relations, and Trauma Symptoms: Examining a Mediation Model of Women With Childhood Abuse Histories . Journal of Aggression, Maltreatment & Trauma , 26 (8), 861– 878. https://doi.org/10.1080/10926771.2017.1331941 Loewenstein, R. J. (2018). Dissociation debates: everything you know is wrong. Dialogues in Clinical Neuroscience , 20 (3), 229–242. O’Mahony, B., Milne, B., & Smith, K. (2018). Investigative interviewing, dissociative identity disorder and the role of the registered intermediary. Journal of Forensic Practice, 20 (1), 10-19. doi:http://dx.doi.org/10.1108/JFP-05-2017-0018 Parry, S., Lloyd, M., & Simpson, J. (2017). Experiences of therapeutic relationships on hospital wards, dissociation, and making connections. Journal of Trauma & Dissociation : The Official Journal of the International Society for the Study of Dissociation (ISSD), 18 (4), 544–558. https://doi.org/10.1080/15299732.2016.1241852 Temple, M. J. (2019). Understanding, identifying, and managing severe dissociative disorders in general psychiatric settings. BJPsych Advances, 25 (1), 14–25. This study source was downloaded by 100000794395091 from CourseHero.com on 10-24-2022 10:58:11 GMT -05:00 https://www.coursehero.com/file/131530935/Wk-9-SfakiosLoridocx/ Powered by TCPDF (www.tcpdf.org)7