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DATES: June 18th, 19th, 20st 2021



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9:50 – 10:00 OPENING

10:00 – 11:30 FABIO VEGLIA: Semantic attachment traumas and the narrative Self-construction.

11:30 – 11:45 BREAK

11:45 – 13:15 CHRISTINE COURTOIS: Developments in the understanding of complex trauma and its treatment. *

13:15 – 14:15 LUNCH BREAK

14:15 – 15:45 BRUCE ECKER: Complex attachment trauma meets memory reconsolidation: facilitating the brain’s process of unlearning for transformational change.

15:45 – 16:00 BREAK

16:00 – 17:30 ELIZABETH HOWELL: The closed system, attachment and dissociation.

17:30 – 18:30 PANEL DISCUSSION (F. Veglia, C. Courtois, B. Ecker, E. Howell)




10:00 – 11:30 LIZ MULLINAR: Practical proven strategies to create a safe, empowering environment to enable permanent healing from complex trauma. *

11:30 – 11:45 BREAK

11:45 – 13:15 OFFER MAURER: Insidious trauma and love relationships.

13:15 – 14:15 LUNCH BREAK

14:15 – 15:45 ROGER SOLOMON: Eye movement Desensitization and Reprocessing (EMDR) and traumatic attachment.

15:45 – 16:00 BREAK

16:00 – 17:30 PAT OGDEN: Sensorimotor Psychotherapy in the context of attachment and trauma treatment. **

17:30 – 18:30 PANEL DISCUSSION (O. Maurer, R. Solomon, P. Ogden)




11:30 – 13:00 ALESSANDRO CARMELITA & MARINA CIRIO: Mindful Interbeing Mirror Therapy – Beyond the recovery from trauma.

13:00 – 14:00 LUNCH BREAK

14:00 – 15:30 DIANA FOSHA: The role of the neurobiological core Self and its felt sense in the treatment of trauma and dissociation.

15:30 – 15:45 BREAK

15:45 – 17:15 RUTH LANIUS: Healing the traumatized Self – How to manage complex clinical situations in trauma treatment.

17:15 – 18:15 PANEL DISCUSSION (A. Carmelita, M. Cirio, D. Fosha, R. Lanius)




DIANA FOSHA (United States)

Diana Fosha, Ph.D. is the developer of AEDP (Accelerated Experiential-Dynamic Psychotherapy), and founder and current director of the AEDP Institute, an internationally recognized school that specializes in training therapists in a healing-oriented transformational approach to the treatment of attachment trauma. For the last 20 years, she has been active in promoting a scientific basis for a healing-oriented, attachment-, emotion- and transformation-focused therapy. A leader in the field of transformational studies in trauma treatment, Fosha’s work on healing transformational processes focuses on integrating neuroplasticity, recognition science and developmental dyadic research into experiential clinical process work with patients. The author of numerous papers and book chapters, she is the author of The transforming power of affect: A model for accelerated change (Basic Books, 2000); senior editor, with Daniel Siegel and Marion Solomon, of The healing power of emotion: Affective neuroscience, development & clinical practice (Norton, 2009), and co-author, with Natasha Prenn, of Supervision essentials for Accelerated Experiential Dynamic Psychotherapy (APA, 2016). Described by psychoanalyst James Grotstein as a “prizefighter of intimacy,” and by David Malan as “the Winnicott of [accelerated experiential dynamic] psychotherapy,” Diana Fosha is known for her powerful, precise yet simultaneously poetic and evocative writing style. Her phrases, —“undoing aloneness,” “existing in the heart and mind of the other,” “True Other,” “make the implicit explicit and the explicit experiential,” “going beyond mirroring,” “stay with it and stay with me,” “rigor without shame” and “judicious self-disclosure” — capture the ethos of AEDP.



Diana Fosha, PhD, will focus her presentation on the dyadic moment-to-moment tracking of the felt sense of the neurobiological core self in the treatment of trauma and dissociation.  Drawing on research on neuroplasticity, affective neuroscience, attachment theory, developmental caregiver-infant interactions, and transformational studies, Diana developed AEDP’s fundamentally experiential, dyadic, healing-oriented practice. This workshop will show how to make clinical use of the important construct of the neurobiological core self, introduced by both Jaak Panksepp and Antonio Damasio. Clinical videotapes will illustrate experiential clinical work conducted at the upper limits of the window of tolerance in order to expand the patient’s relational, emotional and receptive affective capacities. The focus will be on techniques involving affirmation and recognition, making use of the therapist’s affective self.  The clinical work will demonstrate moment-to-moment tracking informed by Jaak Panksepp’s concept of the neurobiological core self. Manifestations of the neurobiological core self will be tracked from the earliest moment of the 1st session through the end of the treatment in a patient with complex PTSD. With clinical videotapes.


Fabio Veglia is a Psychologist, a Psychotherapist, as well as a Full Professor of Clinical Psychology at the Faculty of Psychology at the University of Turin. He is the Director of the Specialization Schools in Cognitive Psychotherapy of the Centro Clinico Crocetta, located in Turin, Genoa and Vercelli. Furthermore, he is the Director of the headquarter of MIND, in Novara, as well as the Scientific Coordinator of the Disability and Sexuality Service of the Department for Social and Health Services in Turin. He has been working in the field of research and education for over thirty years and he is the author of several scientific books, such as “Handicap e sessualità: il silenzio, la voce, la carezza” (Franco Angeli), “Storie di vita: narrazione e cura in psicoterapia cognitive” (Bollati Boringhieri) and “Manuale di educazione sessuale” (Erikson). In addition, he has co-authored the books “C’era una volta la prima volta”, together with Rossella Pellegrini, and “Narrazione e disabilità intellettiva”, together with Ciro Ruggerini, Sumire Manzotti and Giampiero Griffo.


A severe dysregulation of the archaic defense systems, characterized by a chronic activation of the alarm mechanisms, can be caused by the simultaneous activation of the interpersonal motivational systems or IMSs (i.e. caring, ranking and social sexuality) operated by the attachment figures, who are perceived as a source of danger and threat instead of a haven of safety and relational wellbeing. These interpersonal, traumatic experiences that often occur during the early stage of the child’s development can be only partially integrated within his/her body/feelings/memory/consciousness; furthermore, they severely compromise not only the organization of the attachment system, but also the structure of the internal working models, as well as the regulation mechanisms of emotional responses and the development of metacognitive abilities. When the brain is forced to work in such extreme conditions, dissociative disorders often show up and the individual starts using controlling strategies to manage interpersonal relationships through a compulsive activation of caring, ranking and sexuality. At the same time, as soon as the acute phase of the neurovegetative and behavioral responses mediated by the brain stem (fight, flight, freeze, faint) is over, the autobiographical component of human consciousness is biologically driven to make sense and make meaning of any fragmented, confusing and distressing experiences connected to traumatic memories; in addition, it inevitably integrates these experiences, as well as the controlling strategies, into the narrative that shapes Self-identity. Thus, complex relational traumas acquire the same characteristics as semantic traumas; the latter not only characterize personal identity, but also become ontologically connected to the Self through the use of radical, unassailable assumptions concerning some essential qualities of the individual. As a consequence, the attempt to develop a cohesive, consistent and continuous personal narrative is blocked, syntactically disorganized, deprived of any coherent contents, compartmentalized and made useless and chaotic by the need to reach an agreement between the different parts of the Self. Unlovability, unworthiness, powerlessness, a pervasive sense of shame, emptiness, Self-inconsistency and the lack of internal freedom become the sematic cores on which the individual builds the narrative of his/her own relational, traumatized history. These semantic cores and the dissociated parts of the Self to which they are connected create ongoing, dangerous opportunities of re-traumatization and activate mechanisms of emotional dysregulation, consciousness dissociation and sudden retrieval of fragments of traumatic memories. Therefore, often times therapists cannot treat these clients by focusing only on the regulation of the dysfunctional somatic, relational, emotional and metacognitive mechanisms or by simply reactivating the self-repairing mechanisms of the brain. When it comes to the treatment of attachment traumas, once the client has been stabilized and the therapeutic alliance is strong enough, it is often necessary to add – through relational and sensorimotor work – a narrative treatment aimed at working with parts, having a significant semantic connotation.

Bibliographic references:

Damasio A., Lo strano ordine delle cose, Adelphi, Milano, 2018.

Di Fini G and Veglia F (2019) Life Themes and Attachment System in the Narrative Self-Construc­tion: Direct and Indirect Indicators. In “Front. Psychol”,10:1393. doi: 10.3389/fpsyg. 2019.01393

Liotti G., Farina B., Sviluppi traumatici: eziopatogenesi, clinica e terapia della dimensione dissoci­ativa, Raffaello Cortina Editore, Milano, 2011.

Panksepp J., Biven L., Archeologia della mente, Raffaello Cortina Editore, Milano, 2014.

Porges S. W., La teoria polivagale. Giovanni Fioriti Editore, Roma, 2014

Veglia F., Di Fini G. (2017). Life Themes and Interpersonal Motivational Systems in the Narrative Self-construction. in “Frontiers in psychology”, 8, pp. 1897, 2017.


BRUCE ECKER (United States)

Bruce Ecker, LMFT is co-originator of Coherence Therapy, co-director and co-founder of the Coherence Psychology Institute, and coauthor of Unlocking the Emotional Brain: Eliminating Symptoms at Their Roots Using Memory Reconsolidation; the Coherence Therapy Practice Manual & Training Guide; and Depth Oriented Brief Therapy: How To Be Brief When You Were Trained To Be Deep and Vice Versa. Clarifying how transformational therapeutic change occurs is the central theme of his clinical career, and he has contributed many innovations in concepts and methods of experiential psychotherapy. Since 2006 he has driven the clinical field’s recognition of memory reconsolidation as the core process of transformational change, and he has developed the application of this brain research for the advancement of therapeutic effectiveness and psychotherapy unification. He lives in New York City.


In this presentation, video of therapy sessions will show how the emotional learnings created by severe attachment trauma can undergo profound unlearning through memory reconsolidation, thoroughly eliminating extreme post-traumatic symptoms and their underlying traumatic memory reactivation, a transformational change. Memory reconsolidation is the brain’s innate process for directly revising existing learnings down to their neural encoding. How that process works has been the focus of laboratory studies by neuroscientists during the last two decades. It is a process of experience-driven neurological change. Translation of the research findings into therapeutic methodology has been the presenter’s main work since 2006. The presentation will equip attendees with a clear map of the steps of process required by the brain for inducing reconsolidation and transformational change, as well as a vivid demonstration of those steps applied to severe complex attachment trauma. The emotional depth and empathetic quality of the facilitation will be strongly apparent. A fundamental distinction will be made between transformational change, which eliminates the very existence of the target learning and the possibility of relapse, and counteractive change, which builds up positive resources that compete against but do not actually replace the target learning, allowing relapse. This therapeutic methodology of reconsolidation is based entirely on empirical, trans-theoretical knowledge of the brain’s process of unlearning. The key steps are defined as internal experiences, not external procedures, so therapists are free to use any suitable experiential techniques to facilitate this process. For example, the steps have been detected in many different therapy systems’ published cases of transformational change, which suggests that these critical steps may be universal common factors that can serve as a framework of psychotherapy unification. This process represents a significant confirmation and sharpening of the corrective experience paradigm and a serious challenge to nonspecific common factors theory.


LIZ MULLINAR (Australia)

Liz Mullinar is the founder of Heal for Life Foundation (HFL).  The HFL centers in Australia, UK and the Philippines have helped over 8,500 adults and children heal from their childhood trauma through an affordable week-long residential program.  The program has developed a reputation as a powerful and unique intervention to aid the recovery of people experiencing severe and persistent mental illness who have background of trauma and abuse.  Over 69% of participants experience a reduction in symptoms of mental illness which is sustained beyond six months, and over 90% of program participants rating the program as life changing or very positive. Liz, a survivor of childhood trauma, developed the Heal for Life model in the mid-nineties in collaboration with other survivors of trauma who were health professionals, to develop a permanent way of healing from the impact of childhood trauma utilizing the unique knowledge of their own journey of healing. Through her work with HFL and her lived experience, Liz is a recognized leader in the field of Trauma Informed Practice (TIP). She is the author of two books published by Hodder Headline: “Breaking the Silence” and “The Liz Mullinar Story”. Her latest book “Heal for Life” will be released for the conference. It details the evidence underpinning the HFL model and provides practical strategies learned from her own healing journey and proven over twenty years of supporting survivors of trauma. Liz concentrates her time in the training and supervision of therapists in the use of the Heal for Life treatment model in their private practice, running TIP for organizations and in training teams in other countries to run the program. Liz is also working with remote Indigenous communities in the Kimberly (West Australia) to help them develop and train teams to run HFL programs in their communities. Liz has been recognized for her significant work in transforming the lives of people who have been severely debilitated by trauma by being awarded an order of Australia and in 2000 she was awarded the inaugural Australian Humanitarian of the Year Award.


The greatest problem for survivors of childhood trauma is the inability to recognize triggers from childhood trauma and to know how to release these triggers so as to de-activate the fight/flight/freeze response. Neuroscience informs us that this response is automatic and that it is one of the prime causes of behavioral and emotional problems for survivors of trauma. Experts in the field have identified that healing must come from the dominant right brain hemisphere. The HFL model succeeds by safely accessing the right hemisphere to release emotions suppressed at the time of the trauma. The model also recognizes the importance of the client themselves in leading and controlling all processes of treatment. This presentation will explain the HFL model: trust, release, empower, nurture, educate.  The model is unique in that it was developed by survivors of trauma incorporating findings from neuroscience as well as their own innate knowledge and personal experiences. it has been refined over 20 years of service delivery by incorporating the experiences and feedback of survivors of childhood trauma. The HFL model empowers the participant to recognize that they have the knowledge and ability to heal; it promotes autonomy and self-efficacy. Clients are supported by peer support therapists who have themselves undergone the same healing process. These individuals are highly trained and professionally supervised to deliver psychoeducation and therapeutic supports. This practical and experiential presentation will provide a survivor’s perspective on effective treatment for complex trauma including a video presentation to reinforce this client-centered, peer-developed program for use in private practice. This will enable congress participants to extend their therapeutic modalities in order to more safely and effectively support clients of childhood trauma towards healing.


Ruth Lanius, MD, PhD, Professor of Psychiatry is the director of the posttraumatic stress disorder (PTSD) research unit at the University of Western Ontario. She established the Traumatic Stress Service and the Traumatic Stress Service Workplace Program, services that specialized in the treatment and research of Posttraumatic Stress Disorder (PTSD) and related comorbid disorders. She currently holds the Harris-Woodman Chair in Mind-Body Medicine at the Schulich School of Medicine & Dentistry at the University of Western Ontario. Her research interests focus on studying the neurobiology of PTSD and treatment outcome research examining various pharmacological and psychotherapeutic methods. She has authored more than 150 published papers and chapters in the field of traumatic stress and is currently funded by several federal funding agencies. She regularly lectures on the topic of PTSD nationally and internationally. She has recently published a book ‘Healing the traumatized self: consciousness, neuroscience, treatment’ with Paul Frewen.


This lecture will discuss complex clinical situations that regularly arise during trauma treatment. Integrative therapeutic interventions aimed at restoring the self through resolution of key symptoms, including dissociative flashbacks, tonic immobility, dissociative voice hearing, out-of-body experiences, fragmentation of the self, self-mutilation, affect dysregulation (high intensity emotional states, positive affect intolerance, and emotional numbing) will be discussed. Moreover, treatment approaches focusing on re-establishing interpersonal functioning and preventing the inter-generational transmission of trauma will be reviewed. Clinical case examples will be used throughout the lecture, and neurobiologically informed treatment strategies will be discussed. Recent advances in research focusing on the neurobiology of traumatic stress and its treatment will also be discussed throughout the lecture.


Alessandro Carmelita is a Psychologist and a Psychotherapist, as well as a Trainer and Supervisor in Schema Therapy certified by the ISST. After having been trained by some of the most important experts in the field of Psychotherapy and Interpersonal Neurobiology, he has created an innovative therapeutic approach named Mindful Interbeing Mirror Therapy (MIMT) and has developed it together with Marina Cirio. He has traveled around the world to train Psychologists and Psychotherapists in using this revolutionary approach with their clients. Besides this, Dr. Carmelita has conducted 56 editions of the international training program in Schema Therapy and has trained/supervised hundreds of therapists.

Marina Cirio is a Psychologist and a Psychotherapist. She has enriched her professional training with recent contributions in the field of Psychotherapy and Neuroscience. She has developed Mindful Interbeing Mirror Therapy (MIMT) together with Alessandro Carmelita, thus contributing to expand both the clinical implications and the research work on the therapeutic interventions that can be used with different types of patients. After using this innovative approach for years, Dr. Cirio is going to conduct – together with Dr. Carmelita – a new training course in MIMT that will allow many other therapists to learn and understand this new way of relating to clients, which can facilitate a real and profound change.


The study of human personality has shed light on the undeniable impact that attachment relationships, as well as early traumatic experiences – and the consequent dissociation – have on the construction of the Self. Psychological suffering can be analyzed from two different, but interrelated, perspectives: the level of integration of the Self, on the one side, and the individual’s ability to interact with the external world, on the other side. Starting from this premise, identifying and defining the various parts of the client’s personality – especially if the latter has experienced trauma and starts therapy with severe symptoms – is crucially important. As a matter of fact, Psychotherapy is more and more conceived as a series of interventions aimed at integrating the dissociative parts of the client’s personality, in order to support them building a unified Self. At the same time, the therapeutic relationship plays a central role in the treatment of the dissociation caused by early relational traumas, regardless from their seriousness. Mindful Interbeing Mirror Therapy (MIMT) is a completely innovative therapeutic approach based on the use of a mirror within the therapeutic setting, which is placed in front of both the client and the therapist, thus allowing them to interact through their reflected image. The validity of this unique modality of intervention is supported by its theoretical underpinnings, which include not only the most recent research studies in the field of Neuroscience, but also a series of effective clinical studies. The construction of the Self and the individual’s relational reality – starting from the very beginning of the identity construction process, that is the ability to identify themselves in front of a mirror, to the capacity to acknowledge the other’s emotional states – are two parallel processes characterizing each human being’s development. Therefore, Mirror Therapy can be seen as a unique combination of therapeutic interventions helping the client reconstructing an integrated Self, while at the same time working on the relationship with the other. Over the past five years, Mindful Interbeing Mirror Therapy has been studied in depth and a specific procedure of intervention has been created; additionally, thanks to MIMT, therapists have discovered a new and extremely accelerated way to connect with the client, as well as an effective approach to help the latter integrating their inner parts through a deep, transformative self-compassion. Finally, yet importantly, the theoretical and application aspects emerging from clinical practice offer new opportunities of intervention that Research can keep supporting and validating.



PAT OGDEN (United States)

Pat Ogden, PhD, is a pioneer in somatic psychology and the Founder and Education Director of the Sensorimotor Psychotherapy Institute, an internationally recognized school specializing in somatic–cognitive approaches for the treatment of posttraumatic stress disorder and attachment disturbances. Her Institute, based in Broomfield Colorado, has 19 certified trainers who conduct Sensorimotor Psychotherapy trainings of over 400 hours for mental health professionals throughout the US, Canada, Europe, and Australia. The Sensorimotor Psychotherapy Institute has certified hundreds of psychotherapists throughout the world in this method. She is co-founder of the Hakomi Institute, past faculty of Naropa University (1985-2005), a clinician, consultant, and sought-after international lecturer. Dr. Ogden is the first author of two groundbreaking books in somatic psychology: Trauma and the Body: A Sensorimotor Approach to Psychotherapy and Sensorimotor Psychotherapy: Interventions for Trauma and Attachment (2015), both published in the Interpersonal Neurobiology Series of W. W. Norton.

The Role of Body Sensation in Treating Dissociative Clients: Risks and Rewards

This keynote will explore how to increase dissociative clients’ confidence in their own body sensation as an avenue for self-knowledge and change.  The phobia of the body will be addressed, and several interventions to support overcoming this phobia will be explored.  Topics include: Risks and rewards of working with body sensation; interventions to use when clients become dysregulated by their sensations; tips to help clients befriend their body sensation and mitigate avoidance of somatic experience. The presenter will discuss the inherent risks and challenges of working with positive affect and “good” memories and what to do when these experiences are triggering. The potent impact of the client’s own self-touch will also be explored, including both the potential for positive outcome as well as for dysregulation and re-experiencing. Participants will learn how working with positive affect and self-touch can be used to change the body’s procedural tendencies and support integration of parts of the self.



Offer Maurer Ph.D. is a clinical psychologist, the director of The New Wave in Psychotherapy Program at the Hertzeliya Interdisciplinary Center (IDC) in Israel and the co-founder/co-director of the Israeli Institute for Schema Therapy. He is the Former chairperson of the Israeli Forum

for Relational Psychoanalysis and Psychotherapy. Dr. Maurer is a guest lecturer at various international programs on LGBT and sexuality issues, Schema Therapy and psychotherapy integration. He is the founding director of the ‘Gay-Friendly Therapists Team’ (2001), the first

gay-friendly psychotherapy institute in Israel. Based in New York and in Lisbon, he offers Schema-Therapy-informed Life Coaching for individuals and groups.




Insidious trauma refers to the daily incidents of marginalization, objectification, dehumanization and intimidation that are experienced by members of groups targeted by racism, heterosexism, ageism, sexism, and other forms of oppression. In their daily clinical work, therapists come

across many forms of suffering (symptoms) which are often wrongly attributed to internal factors because insidious trauma is, oftentimes, unrecognized, under-articulated and mostly invisible. In this presentation the topic of insidious trauma will be elaborated upon with

a special focus on its various impacts on love relationships. A discussion of the specific dynamic of societal heterophilia and homophobia and their transmission through father-son relationships will be used as an example for the ways Insidious trauma gets played-out and

re-lived in love. Finally some clinical implications for clinical work with insidious trauma and its’ effects will be suggested.




Dr. Roger Solomon is a psychologist specializing in the areas of trauma and grief.  He is the Program Director and Senior Faculty with the EMDR Institute and teaches EMDR therapy internationally. He is a consultant with the US Senate, and has provided consultation to law enforcement and government agencies, including the FBI, Secret Service, NASA, US Attorneys Office, and US Army.  In Italy he consults with Polizia di Stato and University of Rome (La Sapienza), and is a visiting professor with Salesiana University in Rome.  For the past 15 years, he has focused on the utilization of EMDR therapy in the treatment of complex PTSD and trauma related dissociation, as guided by The Theory of Structural Dissociation of the Personality.  Dr. Solomon has authored or coauthored 45 articles and book chapters pertaining to EMDR therapy, grief, complex trauma, acute trauma and law enforcement stress.


Eye Movement Desensitization and Reprocessing (EMDR) and Traumatic Attachment


EMDR therapy is an evidence based therapeutic approach for treatment of trauma.  The Adaptive Information Processing Model, which guides EMDR therapy posits that present symptoms result from distressing experiences that are maladaptively stored in the brain, unable to be fully processed and integrate within the wider memory network (Shapiro, 1995, 2001, 2018). EMDR therapy is an eight phase method that involves processing the past memories underlying present problems, present triggers, and installing a future template for adaptive behavior.   EMDR can be utilized to not only treat major trauma but also the ubiquitous “seemingly small” but quite impactful memories (e.g. mother’s angry look, asking dad for help but he ignores me).  Such memories underlie negative beliefs such as “I am not good enough”, “I’m not loveable”, “I am powerless”, or “I am not safe”.


Disorganized attachment occurs when the caregiver is both the source of safety and terror, and underlies complex PTSD and dissociative disorders (Brown and Elliot, 2018).  Not only does the trauma (abuse or neglect) have to be treated, but also the traumatic attachment to the abuser.  EMDR can be utilized to treat both the trauma and the traumatic attachment


This workshop will present basic principles of EMDR therapy, and illustrate how traumatic attachment can be treated with clients who have been sexually abused.  Video presentations of sessions will illustrate treatment principles.



Dr. Elizabeth Howell is faculty and supervisor for Manhattan Institute for Psychoanalysis’s Program in Trauma Studies; on the faculty of the NYU Postdoctoral Program in Psychotherapy and Psychoanalysis; past Co-Director and Faculty, International Society for the Study of Trauma and Dissociation (ISSTD) Professional Training Program on Dissociative Disorders, and on the Editorial Board of the “Journal of Trauma and Dissociation”. In addition to many professional articles, her books include: “Trauma and Dissociation Informed Psychotherapy: Relational Healing and the Therapeutic Connection”; “The Dissociative Mind”; “Understanding and Treating Dissociative Identity Disorder: A Relational Approach”; “The Dissociative Mind in Psychoanalysis: Understanding and Working with Trauma” (Howell & Itzkowitz “Psychoanalysts, Psychologists & Psychiatrists Discuss Psychopathy and Human Evil” (Itzkowitz & Howell), and

“Women and Mental Health” (Howell & Bayes). Dr. Howell is the recipient, from ISSTD, of the Cornelia Wilber Award for outstanding clinical contributions in the field of dissociative disorders, and the Lifetime Achievement Award. She is the recipient, with Dr. Sheldon Itzkowitz of the Author’s Recognition Award from the National Institute for the Psychotherapies (NIP), and is a Gradiva Award nominee for “The Dissociative Mind in Psychoanalysis”. She has lectured nationally and internationally. She is in private practice in New York City, where she works with clients, does consultations, and runs consultation and study groups.


The Closed System, Attachment, and Dissociation


Ronald Fairbairn wrote that he viewed the closed system of the patient’s inner world as the greatest source of all resistance: “It becomes [an] aim of psychoanalytic treatment to effect breaches in the closed system which constitutes the patient’s inner world, and thus to make this world accessible to the influence of outer reality” (1958, p. 84).

The psychotherapy dyad, like the infant-mother dyad and other intimate relationships, is ideally characterized by mutual regulation and is ideally an open system. An open system assumes interaction and influence from the outside. However, in traumatic attachments in which the attachment figure fails to provide a protective shield against perceived danger or threat, or is himself or herself dangerous or threatening, the attachment system becomes distorted in significant ways, causing the self to become increasingly self-sufficient (ironically so as to be able to maintain an affectional bond with the attachment figure). When affect is overwhelming and there is no outside source of safe support, then the psyche will of necessity become more and more self-referential and closed. As a result, the person becomes intensely hypervigilant to the twin dangers of outer threat and inner overwhelm. This means that self-regulation, especially affect regulation becomes a problem. In dissociative psychopathology the mutuality of relationships, both interpersonal and intrapersonal, has collapsed in significant ways. The closed system, then, precludes interpersonal intersubjectivity, the mutual recognition of separate others who have their own experiences and agency


Christine A. Courtois, PhD, ABPP, is a board-certified counseling psychologist who retired from 35 years in clinical practice in Washington, DC, and is now in semi-retirement as a consultant/trainer on trauma psychology and treatment. She continues to edit and write books on trauma responses and treatment. With Dr. Julian Ford, she has co-authored a book on the treatment of complex trauma and co-edited three books on complex trauma in adults and children/adolescents. The ten-year anniversary revision of their 2009 book on treating complex trauma was released by Guilford Press in February 2020. Dr. Courtois has also written numerous articles and chapters and is author of the consumer book It’s Not You, It’s What Happened to You, co-author of Posttraumatic Stress Disorder with Dr. Ford and others, co-editor of Spiritually Oriented Psychotherapy for Trauma, and author or Recollections of Sexual Abuse and Healing the Incest Wound.

Dr. Courtois was Chair of the Clinical Practice Guideline for the Treatment of PTSD in Adults for the American Psychological Association (2017). She is past president of APA Division 56 (Trauma Psychology) and has served two terms on the Board of Directors of the International Society for Traumatic Stress Studies (ISTSS). Dr. Courtois founded an inpatient and partial hospital treatment program, The CENTER: Posttraumatic Disorders Program and the Day CENTER, in DC for which she served as Clinical and Training Director for 16 years. She has received numerous professional awards including the APA Award for Distinguished Contributions to Psychology as a Professional Practice, the International Society for Traumatic Stress Studies Sarah Haley Award for Clinical Excellence, the American Board of Professional Psychology 2016 Distinguished Service Award to the Profession of Psychology, and most recently, the American Psychological Association Division 56 2018 Lifetime Achievement Award.


Complex Trauma, Its History, and Its Treatment: The PRISM Meta-Model


The term “complex trauma” and the diagnosis of Complex Posttraumatic Stress Disorder (CPTSD) have been quite controversial since they were first introduced in the early 1990s. Recently, there is growing acknowledgement that repetitive and entrapping forms of early life attachment and other forms of chronic interpersonal trauma often result in highly compounded, layered, and intertwined effects that impact and are impacted by maturation processes. These interfere with the traumatized child’s personal development in many domains and can literally last a lifetime. They can also cause developmental regression in adults who are traumatized in this way.


The decades since the 90s have seen the development of much more sophisticated understanding of these aftereffects with applications from a wide variety of fields, among them developmental, attachment, and affect studies and the neurosciences. Simultaneously, in Judith Herman’s words, the field has witnessed a “flowering of clinical innovation” that has led to new approaches and a wide range of treatment options applicable to the treatment of trauma. We now have a group of short-term evidence-based approaches that have received research support as effective in the treatment of posttraumatic symptoms. These findings have led some researchers and practitioners to regard them as applicable to all traumatized individuals, regardless of their clinical status. Yet, those who have specialized in the treatment of complexly traumatized and dissociative individuals have questioned this wholesale applicability on many counts. They have argued for sequenced and more nuanced approaches that attend to issues beyond posttraumatic symptoms, among them disorders of the self and relationships with others, in addition to the range of comorbidities that often result from complex trauma.




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