broken crockery symbolising dissociation

 

Book Review by Lettica Banton, TR Together

Ahead of TR Together’s upcoming event Working with dissociative clients: theoretical and clinical insights we wanted to share our thoughts on traumatology expert Valerie Sinason’s pocket-sized book The Truth about Trauma and Dissociation (2020).

In a lively and conversational tone of voice, Valerie manages to provide a succinct yet rich overview of two related psychotherapeutic concepts: trauma and dissociation. While historically dissociation has been a stigmatising label applied to people perceived to have a constitutional weakness of mental functioning (see the work of Pierre Janet), Valerie illuminates how disconnecting from one’s mind, self or environment is a fundamental creative adaptation to managing trauma. Valerie emphasises that for small children and vulnerable adults, who are too traumatised to switch on their survival ‘fight, flight freeze’ instincts, dissociation might be the only potential answer in their “unconscious survival toolkit” (Sinason, 2020, p40).

‘Dissociation’ is a concept affiliated with much psychotherapeutic ‘jargon’ and in Chapter 5, Valerie provides brief definitions of related acronyms and terms that we might have heard of as clinicians but never fully digested, including ‘structural dissociation’ and ‘dissociative amnesia’. In Chapter 4, she provides more practical strategies and techniques for working clinically with trauma and dissociation through ‘A bunch of fives’ where she groups together theoretical concepts. For example, ‘Sinason’s Mnemonic’: Mad, Bad, Sad, Sick and Suck outlines the different paths a person may take in the face of trauma (Sinason, 2020, p45), which we will reprint here for your learning:

  1. "Go mad - and you get psychiatric services.
  2. Go bad, criminal - and you get forensic services
  3. Go sad, depressed - and you get medication
  4. Go sick, sometime - and you get medical treatment
  5. Go suck, addiction problems, drugs, drink, food, sex, relationships - and you get addiction services"

Contextualising itself in the collective trauma of the coronavirus pandemic, the book covers an array of different traumatic experiences, from adverse childhood experiences to relational traumas such as gaslighting. This highlights how frequently we might encounter dissociation as a coping mechanism in our clients from a wide array of backgrounds and life experiences. Valerie also includes a chapter on the extreme trauma of War and Atrocity. She considers the traumas for soldiers and civilians caught directly in its destruction, as well as the intergenerational impact of war, which is now very relevant and timely for clinicians, given unfolding world events.

Woven throughout the book are quotes from the arts, literature and poetry, which Valerie beautifully uses to illuminate the often unspeakable and timeless nature of trauma and dissociation. This adds an emotional experiential depth to her insightful commentary for the reader. For example, her inclusion of Joan Baez’s 1997 song ‘February ‘“shows the level of internal tragedy for people when objects lose their meaning and words are unrecognisable” (Sinason, 2020, p34):

You stopped and pointed and you said
‘That’s a crocus’
And I said ‘What’s a crocus?’ And you said
‘It’s a flower’
I tried to remember but I said
‘What’s a flower’

February by Joan Baez, 1997

A note on our upcoming event

Unfortunately, due to personal circumstances, Valerie is no longer able to lead our upcoming live webinar on this topic. Her colleague Mark Linington, CEO of the Clinic for Dissociative Studies in London UK and an attachment-based psychoanalytic psychotherapist at The Bowlby Centre, will be joining us instead. Mark’s talk will aim to define and identify trauma, explore the neurobiological basis of dissociation, assess attachment patterns and dissociation severity, and discuss therapeutic strategies for empowering clients. It promises to be a highly informative session. You can read more about the event and register here.

In addition to Valerie’s book, Mark has recommended two further texts which may be useful reading to accompany the conversation:

    • Boon, S, Steele, K and Van Der Hart (2011). Coping with Trauma-Related Dissociation: Skills Training for Patients and Therapists - a skills training manual for individuals with trauma-related dissociative disorders), Norton
    • Steinberg, M. (2023). The SCID-D Interview: Dissociation Assessment in Therapy, Forensics, and Research (Semi-structured Clinical Interview for Dissociative Symptoms and Disorders), American Psychiatric Association

The TR Together Team