(no subject)

[pengke.livejournal.com]

Continuation of the previous article:

What do you foresee in the future of the dissociative disorders field?

Bowman: Critics of recovered memories are beginning to fade in prominence and this will slowly continue as mental health clinicians are now beginning to respond to these attacks in an organized manner. The burgeoning of research on memory, dissociation, and PTSD will continue to elucidate the nature of traumatic memory and dissociation. The recovered memory controversy will leave the dissociative disorders field permanently more cautious about memory veracity, but with a new wealth of research that will place it in a more scientifically sound position than it was before the controversy.
Increased concern with pacing of treatment and with memory veracity will continue and treatment of DID will become more mainstream. More therapists are now being trained to recognize DID, so the current trend toward more therapists treating it will continue. DID is being increasingly recognized on other continents; this trend will continue. The DD field in other countries is beginning to see some backlash by advocates for accused parents, but the DD field outside the US will benefit from American experience with memory and likely will not suffer the massive lawsuits seen in the USA.
Brain (PET and SPECT) scanning will further elucidate the neurological basis of dissociative amnesia and personality switching, and may enlighten us about the biological basis of dissociative amnesia. Research on DID will become more allied with physiologic research on PTSD and dynamic understanding of borderline personality disorder. EMDR or other novel techniques likely will come into more use.
The development of the dissociative disorders field will be wed to the acceptance of trauma as a major paradigm in the etiology of mental illness. Overall, the dissociative disorders field will unify more with the trauma/PTSD field and dissociative disorders will become even more mainstream than they are now. It is difficult to predict the role of spirituality in the future of the DD field except to say that it will mirror the increased awareness of the importance of spirituality in mainstream mental health and medical care.
Carlson/Wilfrid: Historically, the church is where many troubled people have come, and in the future, they will continue to come for help. How positive it could be if there were workshops, etc., where members of the religious community can dialogue with people in the fields of psychiatry, psychology, medicine, and where counselors, therapists, and recovering patients and families could participate.
Comstock: Knowledge about dissociation will be increasingly integrated into other fields and will be seen as a component of many disorders such as impulse disorders, eating disorders, borderline personality disorder, and posttraumatic stress disorder. I think the emphasis will shift from seeing dissociation as an end result or symptom to seeing dissociation as a coping process used when the ego cannot contain the feelings engendered by the event. As research results and outcome data support some forms of treatment and not others, we will be better able to help each patient understand and control his or her dissociative responses.
Friesen: To quote someone, "The more things change, the more they stay the same." I am a veteran in this field, and my hope for widespread improvement in the treatment of DID clients has been practically snuffed out altogether. There are so many DID people who need help who are not getting it because there are too few clinicians trained to treat them! Jesus was right when He had compassion on the crowds he saw. They were "harassed and helpless, like sheep without a shepherd. Then [Jesus] said to his disciples, 'The harvest is plentiful but the workers are few. Ask the Lord of the harvest, therefore, to send out workers into his harvest field'" (Matt. 9:36-38).
It looks to me as though the general public will continue to avoid pain and, therefore, people who have suffered severe abuse will not get the attention they need in order to recover. People would rather question their stories than listen to them. The prevailing attitude of the general public is very similar to how the general public feels about poverty-struck countries--"We don't want to think about it!" The popular method of handling reports of severe abuse is to shoot the messenger. It also looks to me as though most Christian clinicians are not willing to pay the price to get trained to treat DID clients, nor to risk being sued for helping people whose presenting problems are controversial. Perhaps there is a little more acceptance of working with DID clients today than there was 20 years ago, but not much. There seems to be little room for treating DID clients in the caseloads of most clinicians, and there seems to be little energy in most churches for helping people who have been seriously wounded. I se e that the future will be about the same as the present. There are some really good DID clinicians who are helping many people. The vast majority of therapists do not know how to treat DID clients, and probably will not learn how to do so. The harvest is plentiful but the workers are few. Ask the Lord to send out workers into this harvest field.
Mungadze: I foresee some good and perhaps bad things on the horizon in the treatment of dissociative disorders. Starting with the positive side, very good research on the treatment of DID, memory, and trauma keeps coming and confronting the false memory syndrome foundation's ideas that used to threaten the treatment of DID. Our treatment is getting better and there are more and more DID clients getting well. On the negative side, managed care continues to force some clinicians to document their treatment goals and procedures to fit their cost needs. If this continues, managed care will determine treatment instead of skilled, experienced clinicians that specialize in DID. Managed care will also influence what some doctors and clinicians conclude as diagnoses for their DID clients in fear of managed care's bias against the disorder. Some dissociative disorder specialty programs are already changing their names to trauma programs to avoid the dreaded DID term. This is sad because once again leadership in this fi eld needs to remain in the hands of the treating clinician rather than the managed care reviewer.
Rosik: Treating dissociative disorders is not for the faint of heart! It is easy to be intimidated by experiences of patient rage, reports of therapists being litigated, and colleagues questioning your diagnostic acumen. As a result, many therapists who in years past treated DID because it seemed fascinating and garnered some professional notoriety have stopped treating these patients. Now that the societal climate surrounding DID treatment no longer promotes much secondary gain for therapists, those who remain in the trenches must have a sense of calling. For the Christian in this field, I believe the ingredients of such a calling are twofold, involving (a) a deep and mature faith in God and (b) an unyielding commitment to professional practice.
The field of dissociative disorders is here to stay. However, it is still in a period of relative adolescence and I anticipate we will witness as many new developments in the next decade as we have seen in the past one. Some of this evolution will stem from developments occurring within the field (i.e., new research data and clinical models) while some will be dictated by trends in the culture (i.e., those involving judicial decisions and health care funding). Prepare yourself for further adventure!
Finally, I also believe Christian theological and anthropological insights need to be represented in the future of this field. Jesus' own incarnational mandate (Is. 61:1-3; Luke 4:16-20) speaks to so many of the emotional and spiritual needs of DID patients: proclaiming freedom, releasing from darkness, binding up the brokenhearted, bringing comfort and gladness to the mourning, and enabling praise where once was only despair. Christian counselors, animated by God's Spirit and informed by modern scholarship, are clearly acting within this tradition when they treat persons suffering with DID. We, like the Lord before us, desire healing and wholeness for these individuals so that "they will be called oaks of righteousness, a planting of the Lord for the display of his splendor" (Is. 61:3b).
CONCLUSION
The responses solicited from this panel reflect some areas of general consensus and other issues where significantly divergent perspectives exist. The respondents appeared to agree on the need for caution when dealing with traumatic memories and the need for patients to determine for themselves the historical veracity of their recollections. Counter-transference concerns were frequently noted in the use of exorcism, with a suggestion of motives that included rescue fantasies (Bowman), seeking a short cut to difficult developmental tasks (Carlson/Wilfrid), ego gratification (Bowman, Rosik), and the avoidance of pain and suffering (Friesen). There was consensus on the beneficial impact of faith communities where positive social support is offered and a theological emphasis on God's love is provided. All panelists believed that the church has also been a place where religious and spiritual abuse can occur with potentially devastating consequences for DID parishioners. Finally, there was general agreement that th e DD field has seen significant evolution away from a treatment model that focuses primarily on abreaction of traumatic memories toward a greater clinical emphasis on ego-strengthening and the maintenance of adequate functioning in the present.
Despite these areas of concurrence, some topics evidenced continued sharp differences in understanding and approach. Perspectives on the utilization of exorcism varied widely, ranging from a strict prohibition (Bowman, Comstock) to an endorsement of its regular tactical application (Friesen), with others seeming to affirm its potential usefulness while maintaining that it should occur infrequently (Mungadze, Rosik). The veridicality of memories of satanic ritual abuse also appeared to be viewed quite differently, with Bowman suggesting that these recollections are almost always unreliable, whereas Friesen appears willing to grant them historicity as the patient develops a sense of this. Finally, in evaluating the future of the DD field, some respondents (Bowman, Comstock, Rosik) reported guarded optimism that the field is gaining greater acceptance and a more firm scientific foundation, whereas others (Friesen, Mungadze) expressed a mixed to pessimistic viewpoint due in part to managed care and a dearth of co unselors with specialized training.
It is quite possible that some of these differences in perspective can be explained by the dissimilar patient populations with which these panelists probably work. Many patients will seek out or be referred to therapists and clergy whose approach matches their own general worldview and specific theological expectations. This potential effect of selection bias is intensified when the practitioner has published literature in the field that can also serve as a vehicle for patient self-referral, as is the case for most of the respondents. Thus, the panelists' sentiments may diverge where they encounter clinical responses or therapeutic concerns that are more reflective of the unique subpopulation of patients to which they are exposed.
This article has intended to provide a venue for dialogue and understanding among a panel of religiously sensitive therapists and clergy, all of whom share a common concern for the well-being of those within the community of faith who struggle with DID and other dissociative and post-traumatic disorders. As our scientific and theological comprehension of this field continues to expand, it is sincerely hoped that many more opportunities for such professional interchange will occur.
(1.) Three significant exceptions to this rule arc a 1992 special issue of the Journal of Psychology and Theology (Vol. 20, No. 2) which focused on satanic ritual abuse, a 1993 issue of the now defunct journal Dissociation (Vol. 6, No. 4) examining possession and exorcism, and a 2000 special issue of the Journal of Psychology and Christianity (Vo. 19, No. 2) on Dissociative Identity Disorder.
(2.) These guidelines arc available electronically at: http:\\www.issd.org\isdguide.htm.


AUTHOR NOTES

BOWMAN, ELIZABETH, M.D., is Clinical Professor of Neurology and former Professor of Psychiatry at Indiana University School of Medicine and a Past President of she International Society for the Study of Dissociation. She received her M.D. from Indiana University and a Master of Sacred Theology degree from Christian Theological Seminary in Indianapolis, Indiana. She has professional interests in dissociative disorders, conversion seizures, and in religion and psychiatry.
Rev. Harry Carlson, retired Lutheran pastor, lives in Rio Linda, California. He received his M.Div. in 1953 from Wartburg Theological Seminary, Dubuque, Iowa. He has served for several years on the Sacramento County Mental Health and Alcohol/Drug Advisory Boards. He met and has consulted with Dr. Ralph Allison since 1979.
Christine M. Comstock received her Ph.D. in Clinical Psychology from The Fielding Institute. She specializes in treating survivors of abuse and has a research interest in the Rorsehach Ink Blot Test. She has published and presented extensively in the fields of child abuse, dissociation, and hypnosis, is a fellow of the International Society for the Study of Dissociation, and has won several awards for her work in the field of dissociation.
James G. Friesen, Ph.D., is a psychologist who has been working with dissociative disorders for 14 years. He is the author of four books, including Uncovering the Mystery of MPD, abest seller in the Christian community. He has spoken at more than 80 conferences worldwide.
Jerry Mungadze, Ph.D., specializes in the treatment of dissociative disorders. He is the founder and director of the Mungadze Association's nationally renowened outpatient and inpatient hospital unit in the Dallas/Fort Worth area. He is also an adjunct professor at Dallas Baptist University in Dallas, Texas, and much of his time is spent traveling both nationally and internationally presenting seminars, workshops, lectures, and case consultations.
Christopher H. Rosik received his Ph.D. in clinical psychology from the Graduate School of Psychology at Fuller Theological Seminary. He is currently a clinical psychologist working at the Link Care Center in Fresno, California. His professional interests include dissociative disorders, bereavement, and psychotherapy of missionaries and ministers.
Rev. Carl Wilfrid is Senior Pastor of Lutheran Church of the Good Shepherd in Reno, Nevada. He previously pastored Faith Lutheran Church in Chico, California. He received his M.Div. in 1969 from Luther Theological Seminary, Sr. Paul, Minnesota. He also received his S.T.M. in Pastoral Counseling from New York Theological Seminary in 1973. He has worked with several DID sufferers, some for an extended period of time.