ESTD Newsletter Volume3 Number 6 March 2014

EDITORIAL BOARD/
GRAPHIC DESIGN/
FRANK MYKLESTAD
ESTD Newsletter
Volume 3, Number 6, March 2014
DOLORES MOSQUERA
ISABELLE SAILLOT
VALERIE SINASON
JOSEPH SCHWARTZ
WINJA LUTZ
ONNO VAN DER HART
ORIT BADOUK-EPSTEIN
MARTIN DORAHY
GIOVANNI TAGLIAVINI
EUROPEAN SOCIETY FOR TRAUMA AND DISSOCIATION

1STE HOGEWEGz 16-A, 3701 HK ZEIST THE NETHERLANDS
EMAIL: INFO@ESTD.ORG WEBSITE: WWW.ESTD.ORG
ESTD NEWSLETTER
Editors: Joseph Schwartz & Onno van der Hart
Table of contents
Quarterly Quote >
Letter From The President >
The Treatment Of Clients Reporting (Ritual) Abuse By Organised Perpetrator Networks >
A Note On An Unacknowledged Trauma >
Film Review >
Book Review >
On The Bright Side -Inspiring VignettesFromThe ConsultingRoom >
Hot Off The Press >
Dates For Your Diary In 2014/15 >
ESTD Contacts In Your Region >
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ESTD Newsletter
QUARTERLY QUOTE
Living in trauma-time
Even though we had moved on to other places, even though

we had built other worlds for ourselves, we all, in effect,
remained there, in the receding black smoke, in the terrible
silence that followed, mute, each of us alone.
Menachem Ansbacher (2003),
about his war experiences on the Golan Heights during the Yom Kippur War

LETTER FROM THE PRESIDENT

Dear Colleagues and fellow members of the ESTD,
A WARM WELCOME TO THE NEW ESTD

MEMBERS.
First, I wanted to address the issue of the effects of the
financial crisis and restrictions in the field of mental health
in Europe, affecting both the work of colleagues active in the
clinical sector and patients with chronic disorders amongst
others those related to chronic traumatization. It seems that the
volume of budget allocations for mental health is an indicator of the concept
man which prevails in a given society. The Fiscal policy of drastic restrictions in
funding mental health sector indicates a hard position against chronic mentally
troubled persons. This political culture, based on an economical current favouring
healthy people is opposed to a more humanist current both currents being signs of our modern
society. The effects are going in a direction that mental health care is becoming more difficult
for all citizens, instead of being users of mental health services, we become clients, consumers.
Manolle Hopchet
o f
ESTD President
Associations and societies like ours are often insufficiently heard or consulted or asked for
participation in decision making. Maybe the legislation in east and west European countries
regarding mental health policies does not argue enough about benefits to the quality of life. Perhaps
enough research concerning those benefits, above all financial ones, for our society, of promoting
better life quality, with the help of offering proper treatment to very traumatized persons would
lead to a change in this legislation. Even if we can observe that over the past 20 years some studies
concerning those financial benefits have been fulfilled, a lot of work still needs to be done.
With the upcoming conference in Denmark it is a big opportunity for our Society to emphasize the
importance of our work in the field of trauma and dissociation. The improvement of knowledge,
of results concerning specific treatment for this clinical traumatized population can help, over
time, in making overall people and legislators become aware about the advantages of having these
persons develop a better quality of life.
Next to this serious matter, our conference is also and above all a meeting place, where numerous
clinicians working in different fields related to trauma and dissociation, coming from different
cultures, can exchange about their different perspectives and share their experiences. ESTD wants
to offer the space to allow an abundance of information and knowledge to be exchanged, the
emergence of new collaborations and developing networks, all this despite the language barrier.
Even if it a fact that English is the language necessary to exchange and express as best as possible
our thoughts and ideas with most of the ESTD conference participants, it doesnt need to be the
only vehicle of communication in ESTD. As mentioned before, ESTD is realizing efforts and will do
more so in the future to make from this society a multilingual one. This can only be possible with
your help, we always need some people who are ready and have some time to translate.
If you have some questions or requests, please let us know or address them to the contact persons
of your country, mentioned on the website country pages or on the last pages of this Newsletter.
Manolle Hopchet
President, ESTD
ESTD Newsletter
Suzette Boon PhD Clinical psychologist/psychotherapist

Working as supervisor at Top Referent Trauma Centre (TRTC), Altrecht in Zeist (the Netherlands)
THE TREATMENT OF CLIENTS REPORTING (RITUAL) ABUSE BY ORGANISED

PERPETRATOR NETWORKS: A REFLECTION ON
NEARLY 30 YEARS OF EXPERIENCE AND IN PRIVATE PRACTICE
Introduction
In the past, the issue of satanic ritual abuse (SRA) has led only to heated controversy and media attention,
in the Netherlands as well as elsewhere in the world. This has not contributed to a better understanding of
clients who report such trauma histories. Clinicians in the Netherlands (myself included) were portrayed as
half-wits who were deceiving their clients into believing that they had been subject to this kind of abuse,
or who were foolish or over-involved enough to accept the validity of their clients' reports unquestioningly.
Indeed, in their editorial in the Dutch Journal of Psychotherapy, Van Daele and Lauteslager (2010) supported
Canadian philosopher Ian Hacking's proposition that a therapist should only take the fears of a client
seriously provided there is compelling legal evidence to support the client's reports of sexual or ritual abuse.
Without such evidence, the therapist would be engaging in the harmful and outrageous encouragement of
fears that are not actually based on facts. Since such a proposition is untenable and quite incompatible with
psychotherapy, this does not exactly encourage (more) public reflection on these complex treatments. On
the other hand, the treatment of clients who report abuse by organised networks is still a topical issue,
particularly at mental health care centres that have specialised in the treatment of severely traumatised
clients with a Complex Post-Traumatic Stress Disorder (CPTSD) or dissociative disorders. The dilemmas
encountered in the course of such treatments, as explained in more detail in this article, are not solved by
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silence but by sharing experiences with colleagues and by continuing to seek ways to assist these clients
to the best of our ability.
This article will not discuss detailed content of the reported events and cruelties, as I do not find such
details relevant to proper treatment. As a matter of fact, losing oneself in too many grisly details may
even be a pitfall to clinicians. The whole point is that clinicians must be able to keep sight of the larger
picture during treatment and not become bound up in such details or allow themselves to be distracted
by them. I will also refrain from making any attempt at establishing a "truth" or proving that "it really does
exist": those are matters for the judicial authorities. I sincerely doubt whether surveys based on detailed
questionnaires administered to clinicians and clients will contribute to a better treatment of this problem
(Marinkelle, 2013 Rutz et al, 2008). Such surveys offer a lot of (very) detailed information on trauma, but
they do not suggest ways for the therapist to deal with that kind of trauma.
This article will explain how and when I first encountered the phenomenon of organised abuse, followed by a
description of the clients reporting this type of abuse, the networks, the treatment and any pitfall involved.
1 Many thanks to Onno van der Hart for his valuable comments on this text and Jolanda Treffers for her excellent translation.
2 Published with permission, a slighly different version of this paper was published in 2013, Tijdschrift voor Psychotherapie, 39, 441-452[Dutch Journal of
Psychotherapy].
Background
It was in the mid-eighties that we, staff members of a social psychiatry department at a mental health
centre, were first confronted with the phenomenon of "ritual abuse." This happened during a workshop by an
American colleague on the diagnosis and treatment of DSM-III dissociative disorders; in themselves already
diagnostic categories that were considered controversial, particularly where it concerned the Dissociative
Identity Disorder (DID). We presented case histories of clients with symptoms and behaviour of which we
had little understanding. The clients concerned were all being treated for severe psychiatric symptoms,
including chronic dissociative symptoms and post-traumatic stress symptoms. In addition, they suffered
from problems such as serious eating problems, chronic suicidality and often severe forms of self-mutilation.
Beforehand, our questions mainly concerned the meaning of drawings, apparently made by dissociative
(child) parts, of bizarre-looking abuse involving much symbolism such as reversed crosses, the pentagram
and people with robes and hoods, as well as texts that were frequently written in inverted print. These
materials were given to us by clients in the course of their treatment. The clients, as a rule, insisted that they
had no memory of drawing or writing that which they presented to us and were very avoidant and anxious.
Once they realised that they must have created these materials themselves, they voiced opinions about
themselves in no uncertain terms: they had to be stark raving mad and their fantasies and thoughts must
be utterly bizarre. That American colleague then told us that some of the symptoms our clients exhibited,
including these drawings, may be an indication that the clients had experienced some form of ritual abuse.
Similar materials had also been presented during treatments in the United States and a number of European
countries, including Germany and England (Huber, 1995; Sinason, 1994, Tate, 1991). Incidentally, according
to some, such materials are precisely the reason for the emergence of a global pandemic of 'ritual abuse',
with clinicians from various continents influencing each other and subsequently influencing vulnerable
clients (who would then produce such materials in order to please their therapists or to receive attention).
In the years thereafter, the issue of ritual abuse gained increasing media attention, first and foremost in
the United States and England, in particular as a result of high-profile court cases and studies of large
groups of young children in nurseries or at schools of whom it was suspected that they suffered organised
ritual abuse. This suspicion was based on the many consistent stories and drawings by these (often very
young) children. This resulted in a fierce polarisation between so-called believers and non-believers. The
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non-believers, remaining unreservedly convinced of being right, spoke of mass hysteria involving parents,
researchers and care providers who had led the children to believe these cruelties through over-involvement
and unprofessional conduct. Colleagues from the United States who had fallen prey to this mass hysteria
would then delude suggestible clinicians around the world, such as ourselves, into accepting this nonsense.
The Netherlands was not spared from intense controversy about the issue either.
In the United States, a new syndrome was introduced: the so-called false memory syndrome (Pedzek
& Banks, 1996). Partly influenced by the existing "suing culture", this resulted in a long string of court
cases in which (mostly) adult clients accused their therapists of talking them into believing false
memories. They demanded (and often - but not always - received) enormous damages. The court cases
concerned supposed ritual abuse, but were certainly not limited to such extreme testimonies from clients.
False memory claims were also made in cases involving sexual abuse by a single perpetrator, such as
the father. The introduction of the so-called false memory syndrome and all of the subsequent court
cases involving false memories had a major impact on psychiatrists and psychotherapists in the United
States who were treating clients of this sort. Some of them stopped treating these clients altogether.
Others decided never again to speak about the issue in public - not even at scientific conferences.
Reports of organised abuse kept emerging, however, (also in the Netherlands) and sometimes these
reports were so convincing that they could not simply be dismissed as fabrications by suggestible children
or adults and their over-involved therapists. In 1993, a current affairs programme on Dutch national
television (entitled "NOVA") devoted two extensive episodes to the phenomenon following 11 reports to
the Dutch Inspectorate for Youth Care of suspected organised ritual abuse. I was invited to contribute
to the programme, I felt like I was definitely "risking my neck by doing so, since it was clear that such
a programme would add fuel to the fire of disbelief for those who thought that the existence of such
abuse was nonsense by definition or simply the fruit of the deranged minds of certain therapists and
their clients. Moreover, it seemed highly questionable whether this media attention would ultimately be
beneficial to the clients concerned and their therapists. The programme led to parliamentary questions
and the creation of a committee, chaired by Mr Hulsenbek LL M, that thoroughly investigated the issue
and questioned many people involved with regard to their experiences and ideas, ranging from clinicians
(myself included) and clients to members of the police, judicial authorities and critics. The conclusion of
the committee's final report was that there was (and, incidentally, there still is) no firm evidence for the
existence of such organised networks in the Netherlands. Consequently, and understandably, the credibility
of the witnesses is questioned to this day - over and over again. It is often already difficult enough for
the Public Prosecution Service to establish "simple" sexual abuse, let alone proving the extreme stories
about organised networks (see also Nierop & Van den Langeshof, 2010). I know that some of the vice
squad detectives in Amsterdam with whom I sometimes had contact at the time thoroughly investigated
a number of cases and found evidence that some statements were indeed accurate. They were therefore
convinced that not all stories were fabrications. Nevertheless, they were never able to find sufficient
legal evidence to prosecute the perpetrators. In fact, none of my own clients, and none of the clients of
therapists whom I have supervised, has ever filed a criminal complaint against the perpetrators. Personally,
I hold the opinion that therapists must maintain a strict boundary between their role as a clinician and the
responsibilities of the police and the Public Prosecution Service. Therefore, I believe that it is not a task of
therapists to encourage their clients to report the crimes to which they have been subjected to the police.
Even if the Hulsenbek committee concluded that there was no firm evidence for the existence of organised
networks in the Netherlands, it did not completely rule out that the testimonies that were given could - at
least in part - be true. The report therefore included recommendations for further research and increased
support for care providers. At the same time, however, it was evident that conducting such research would
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hardly be feasible. After all, time and again the testimonies are given by clients who often suffer from
serious psychiatric problems. The vast majority of them is unable or unwilling to file a criminal complaint,
while the stories they tell are often (still) inconsistent as a result of their fears and inner division.
I never participated in any work groups dedicated to this issue, but continued to focus on treating clients
and supervising colleagues who approached me with questions about this problem. I did, however, co-write
a chapter for a book that was edited by G. Fraser and published by the American Psychiatric Press (Van
der Hart, Boon, & Janssen Heijtmajer, 1997). The primary goal of this book, with contributions from many
clinicians who often already had years of experience with clients who reported organised (ritual) abuse in
the course of their treatment, was to provide guidelines for the treatment of such clients.
The clients
Since 1986, I have personally treated (and still treat) a significant number of clients who reported histories
of (frequently still ongoing) organised abuse in the course of their treatment. Some of them were in
treatment for a short while, others for a very long time. In addition, I acted as a supervisor to colleagues
who encountered such testimonies and met with many of their clients during consultations. At the moment,
I am working at a Top Referent Trauma Centre (TRTC). Of the 119 DID clients currently undergoing individual
treatment at this TRTC, nearly a quarter of them (28) report histories of organised abuse, and a number of
them still seem to be in contact with the perpetrator system or network. Many, but not all, reports concern
ritual abuse. Some of the perpetrator networks are primarily engaged in other criminal activities, such as
the systematic exploitation of children and adults for the purpose of the porn industry.
The clients concerned differ greatly in the degree to which they are able to function in their daily lives.
Some of them are attending university or hold jobs; others have been undergoing psychiatric treatment for
an extensive period of time and are functioning much less well. All of them were diagnosed with a severe
dissociative disorder and suffer from chronic post-traumatic stress symptoms. In addition, most of them
meet the criteria for a cluster C personality disorder, showing symptoms of extreme avoidance. On the
other hand, there is certainly also a group of clients with a cluster B personality disorder. In most cases,
testimonies about organised abuse emerged only in the course of treatment.
These clients are (often, but not always) different from other clients with a dissociative disorder in that
they more often suffer from the following symptoms: (pseudo) epileptic seizures; severe eating problems,
severe forms of self-mutilation, extreme anxieties, specific phobias, severe sleeping problems, flashbacks
with bizarre contents, paranoia, a recurring increase in symptoms, suicidality and self-harmful behaviour
during certain periods of the year. These periods coincide(d) with the reported gatherings of the network.
Some of these clients dissociate so severely during treatment that the therapist is unable to make contact
witht hem. Also, they often have a great fear of, and resistance to, using medication - or demonstrate an
adverse response to it. The reason for this can be found in their reports of the perpetrator networks' wide
use of drugs and medication, which increases their fear of losing control. Finally, these clients all have
similar, rigid and inflexible beliefs about themselves, others and the world. A remarkable element of this are
their grandiose ideas about the power and superiority of "their world" (the network), reaching far beyond
the world of "us ordinary souls". They have a great fear of the almost supernatural power of the network
over them. On the other hand, they hold consistent ideas about never being able to belong to "our world"
as they are "bad to the core" because of the things they did (or are still doing) within the network or group.
The perpetrator networks

Most clients report that, as a child, they were taken to the groups where the abuse took place by one or
both parents, or a family member. A few were entrusted to neighbours or friends so frequently that it was
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possible for the child to be taken to the network of perpetrators quite regularly. We do not know of any
adults who report that they experienced this form of abuse at school only. The networks that are being
reported on differ in size, goals and motives, the degree of possible contact with other - even international
- networks, and the way in which children and adults are exploited and indoctrinated. The rituals that have
been reported to take place within some of these networks at times seem likely to be a sort of cover used
to bind those involved to the network and to force them to engage in criminal activities, such as activities
related to the porn industry, prostitution, child trafficking, arms and drug trafficking, and other matters that
enable criminal organisations to earn a lot of money (see also Van der Hart et al., 1997). The networks are
similar in the following ways: the abuse is systematic and there are multiple perpetrators; both men, women
and children are involved; the group or organisation knows a strict hierarchy; children are systematically
trained to be obedient. All clients report forms of sadistic torture aimed at teaching them to be obedient
and loyal to the group. Clients who (also) report ritual abuse, in particular, all have experiences of becoming
perpetrators themselves at a young age, committing acts of abuse and torture on other children, adults
or animals. The systematic indoctrination of the beliefs and ideas of the group are an important part of
the so-called training. And perhaps most importantly: early attachment relationships are systematically
manipulated and exploited as the children are neglected, abused and isolated by their primary caregivers,
only to be lovingly received and praised again when they have demonstrated "good" behaviour within the
group. Siblings are also systematically played off against one another to prevent them from forming an
alliance or confirming each other's testimonies later in life. Subsequently, children (and later: adults) are
continually intimidated with threats to their own lives or the lives of loved ones and with the possibility of
having movies and photographs distributed of the acts in which they have engaged. Moreover, wide use
seems to be made of deception and trickery in these "trainings", including the use of drugs and medication
that induce hallucinations. Memories seem to be systematically manipulated. Reality is manipulated and
distorted to such an extent that any testimonies given about the network and its activities will seem to
be inaccurate and therefore not pose a threat to the network.
The treatment
Together with some of my colleagues, I have published extensively on the treatment of complex dissociative
disorders (Boon, 1997; Boon & Van der Hart, 1995; Boon, Steele, & Van der Hart, 2011; Van der Hart &
Boon, 1997). During the intake phase, the client is subjected to a comprehensive diagnostic examination.
At this time, minimal attention is paid to the trauma history of the client. It is certainly never explored.
What is important, is the nature and severity of the symptoms at that time. Also, hypnosis is never used
in order to recover memories. Clients that are eligible for treatment at our TRTC meet the criteria for a
Complex Post-Traumatic Stress Disorder (CPTSD) or a Complex Dissociative Disorder (DID or DSNAO).
The treatment consists of three phases (1) stabilisation, symptom reduction, (2) treatment of traumatic
memories, and (3) further integration of the personality and rehabilitation (see also the guidelines developed
by the International Society for the Study of Trauma and Dissociation (ISSTD, 2011).
Phase 1 of the treatment focuses entirely on the present as clients learn to cope with their symptoms.
Traumatic memories are not at all explored during this phase. In addition to individual treatment, many
clients also participate in structured group programs during phase 1. One of the rules of such groups is
that the past is not discussed (Boon et al., 2011; Dorrepaal, Thomaes, & Draijer, 2008).
If the abuse has taken place within an organised network in the past, and provided that there is no evidence
that the client is still in contact with the perpetrators at the present time, traumatic memories will be
discussed only once a client is stable enough to proceed to the next treatment phase. Treatments such
as these can be complex and long lasting. Also, there is more risk of increasing self-destructiveness and
the undermining of the therapeutic relationship (Boon, 1997; Kluft, 1997; Van der Hart et al., 1997, 2006/10).
The main reason for this is that old network messages are re-activated, which will at first intensify the
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feeling of internal chaos and internal conflict experienced by these clients. Examples of such messages
include: you are not allowed to talk, you are not allowed to have treatment, you must end your life if you
start talking about the secrets, your therapist will send you away or run you into the ground if he or she
finds out all the things you have done and who you really are. Extremely serious attachment problems mean
that it sometimes takes years before a stable working relationship with the therapist can be established
and the client is sufficiently stabilised to start focussing on the integration of traumatic experiences. Daily
life is complicated by many intrusive memories of awful events as well as extremely negative convictions
about the self. Another aspect of these treatments is that it takes a lot of time to build up a working
relationship with those parts of the personality that are loyal to the network and that exert a great deal
of influence within the system of dissociative parts. For example, they can give orders to engage in selfdestructive acts or to undermine the therapeutic relationship. In general, the dissociative organisation of
the personality is much more complex and much more layered (i.e., divided into several distinct systems
of dissociative parts of the personality) than in clients who report other forms of abuse. Also, various
(systems of) dissociative parts of the personality seem to be systematically pit or played off against one
another internally. Some dissociative parts report that they are praised, considered "good", and have been
given a status within the network that comes with certain privileges (such as not being tortured or abused
anymore). These parts consider it their duty to keep an eye on the other parts within the person, to report
on their behaviour and to punish them in case of resistance. By sustaining the illusion of separateness,
they remain unaware that they are actually punishing and endangering themselves. The reluctance to
face reality is often quite extensive, however, as is the way in which the perpetrators have misled them.
When the abuse appears to be ongoing

As mentioned above, a number of these clients reports in the course of the treatment that their contact
with the perpetrators has not yet been severed. Essentially, they are travelling back and forth between
therapy and the perpetrators. Usually, the person entering into treatment has amnesia for this fact. It is
shocking to realise that the abuse is still continuing and this may result in persistent disbelief or avoidance
when this information is shared by another dissociative part (or parts) of the personality. In any event
where the client is still subject to (continuing) abuse, regardless of whether this involves abuse repetition
by a sadistic partner or parent, or ongoing abuse by a network of perpetrators, the primary goal of the
treatment must be to help the client end the abuse and sever any contact with the perpetrators.
To do so, a combination of the treatment phases 1 and 2 may be necessary in order to break some of
the fears that make people return to the perpetrator network over and over again. It is essential for the
therapist to stay grounded and not to be swept up by the vortex of intense stories and the strong emotions
that they invoke within both the client and the therapist. Clients can only save themselves, but to do so
they will need very consistent support. As soon as there are indications in the treatment that contact with
the perpetrators still exists, it is important to carefully and gradually explore how exactly that contact is
established. Many clients have dissociative parts that must telephone in to report on the content of the
therapy at the end of each treatment session. The focus of the treatment must be to determine which
dissociative parts are still returning to the network (or perpetrators) and what fears and/or rigid beliefs
play a role in this. Usually, it is a result of a fear of death - both one's own death and (especially) the death
of loved ones. In addition, once clients have become more attached to their therapist, they report that the
perpetrators are making threats to the therapist and his or her family as well. The clients nearly always
assign (irrational) supernatural powers and excessive influence to the group. The process of detachment
may take years because clients are constantly returning to the perpetrators, only to have their convictions
and fears confirmed through rituals or brutal abuse. It is important that the therapist puts the alleged
omnipotence of the network or group into perspective and that he or she helps the client to critically
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10
examine and correct these magical thoughts and associated fears. This can only be done step by step and
may lead to anger issues within the transference relationship, particularly on the part of the dissociative
parts that are still loyal to the network. A narcissistic collusion between these parts of the personality and
the perpetrators is often found, brought about at a young age as a way of surviving. To give up this collusion
means to become painfully aware of the extreme deception, pain and helplessness. These dissociative
parts in particular are often "storing" the most awful experiences and intense feelings of guilt and shame
to which the person as a whole is so resistant. The process of detachment from the network is by definition
accompanied by intense guilt, shame and mourning as the client must usually let go of people with whom
there is an intense, albeit ambivalent, connection (such as immediate family members). Detachment is only
possible if the client is at the same time entering into new meaningful relationships with other people, or
strengthening ties with people outside of the network. Messages like "if you leave us, you will remain alone
forever", "there is no life for you outside of the group", "if we turn you away, you will die a miserable painful
death", and "if people would really know who you are and what you have done, you would be locked up forever"
are constantly repeated internally and often stand in the way of new, meaningful attachment relationships.
Prognosis
A lot has been written already about the prognosis of clients with a Complex Dissociative Disorder (Boon,
1997; Boon & Van der Hart, 1995; Kluft 1997a, 1997b; Van der Hart et al., 2006). The treatment of clients
with a dissociative disorder who continue to be abused is complicated and lengthy. The prognosis is
determined in part by the extent to which the client is able to form a proper working relationship with
a therapist and treatment team, has good cognitive skills and a reasonable ego strength, is capable of
creating new meaningful relationships or strengthening existing (healthy) ties, and is able to develop a
good daily structure that includes activities that are meaningful as well as activities that are fun. Very
severe comorbidity on Axis II, particularly cluster B, and severe comorbid addiction problems, are factors
that adversely affect the prognosis.
Pitfalls and dilemmas during treatment

Obviously, the treatment of problems such as these knows many pitfalls. The most common dilemmas
encountered regularly by clinicians or treatment teams are listed below. All of these dilemmas require a
lot of attention, care and reflection:
Therapists may lose themselves in all kinds of details and thereby fail to keep sight of the larger picture.
The tremendous appeal made to the therapist may lead to a lack of boundaries. In other words: therapists
may start feeling that they should meet with this client more often and for a longer time than they would
in any other treatment.
Therapists may become anxious or paranoid themselves as a result of the stories told to them by the client
and be inclined to take literally everything the client tells them. This may cause a collusion of fears, which
is not beneficial to the therapeutic process.
A reverse reaction could be that therapists suddenly dismiss everything the client tells them as a fanciful
narrative that must be rejected or ignored as much as possible.
Therapists (even entire treatment teams) may be so swept up by a case that they run the risk of losing all
ability for sound reflection.
Therapists may become so overwhelmed that secondary traumatisation or a burnout can occur.
There may be confusion about the role of the therapist. Therapists may be tempted to take on the role
of the Public Prosecution Service and want to investigate or prove what is actually happening or identify
the perpetrators and report them to the police.
There may be disagreement and confusion about the need to file a criminal complaint against the
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11
perpetrators, especially when the client reports that minors are currently still being abused.
Therapists may become isolated; no longer daring to discuss the case with their colleagues for fear
of ridicule, disbelief or encountering rigid convictions with regard to the proper course of treatment
for their clients.
Finally, it is very important to avoid a split in the team and to keep an eye out for the parallel processes
that may occur in teams where such serious and violent problems are being treated. It is therefore
essential for the therapist to be embedded in a team of colleagues who understand the complexity
of such treatments and can support the therapist, but are also able to ask critical questions or help
guard boundaries if necessary.
In conclusion
I completely disagree with the proposition that the fears of clients related to reported abuse should
only be taken seriously once sufficient legal evidence has been provided. I do think, however, that
reports of such severe abuse require careful handling. Intervision is a prerequisite for the therapist
and should take place within a multidisciplinary team that will always leave room to seriously consider
alternative explanations for a particular report of abuse or for certain "facts". Such explanations could
include: (1) delusions or a psychotic episode, (2) pseudologic fantastica, or (3) pseudo-memories that
are functional because they are covering up other (emotional) pain, such as severe emotional neglect
or the feeling of being unseen as a child/adult. In the past 30 years, I have encountered several clients
to whom explanation 2 or 3 applied. In the cases of all other clients, I and the colleagues with whom I
work are convinced that they were indeed abused by a perpetrator network (and sometimes still are).
That does not mean, however, that all of their memories are factually accurate. As mentioned earlier, the
general impression is that the perpetrators use drugs and deception to intentionally distort memories
and induce pseudo-memories.
The aim of this short article was to describe my personal experience, as well as the experiences of
many of my colleagues, in treating clients who have reported organised (ritual) abuse by perpetrator
networks. Especially in centres that specialise in the treatment of long-term consequences of severe
early childhood trauma, therapists are regularly confronted with this problem. Discussions about
whether trauma histories should be considered fact or fiction (like those taking place in the Dutch
media in the nineties, as well as those among professionals) are quite pointless in my opinion and thus
make little sense. They have only resulted in a polarisation of views. What does make sense, is informing
a new generation of clinicians about the problems, treatment dilemmas and pitfalls in order to arrive at
a consistent, balanced approach towards this group of clients. I hope that this will ultimately contribute
to the further development of appropriate treatment services for this client group.
LITERATURE
Boon, S. (1997). The treatment of traumatic memories in DID: Indications and contraindications. Dissociation,
10, 65-79.
Boon, S., & Van der Hart, O. (1995). De behandeling van de multiple persoonlijkheidsstoornis [The treatment of
the multiple personality disorder]. In O. van der Hart (red.), Trauma, dissociatie en hypnose [Trauma, dissociation
and hypnosis] (3rd edition) (pp. 187-232). Lisse (the Netherlands): Swets & Zeitlinger.
Boon, S., Steele, K., & Van der Hart, O. (2011). Coping with trauma-related dissociation: Skills training for patients
and therapists. New York/London: W. W. Norton & Co. (Dutch edition: Omgaan met traumagerelateerde
dissociatie: Vaardigheidstraining voor patinten en hun therapeuten. Amsterdam: Pearson, 2012.) For further
information: www.celevt.nl
ESTD Newsletter
12
Van Daele, E., & Lauteslager, M. (2010). Editorial. Tijdschrift voor Psychotherapie [Dutch Journal of Psychotherapy],
36, 145.
Dorrepaal, E., Thomaes, K., & Draijer, N. (2008). Vroeger en verder: Cursus na een geschiedenis van misbruik of
mishandeling. [The past and beyond: training course following a history of sexual of physical abuse] Amsterdam:
Pearson.
Van der Hart, O., & Boon, S. (1997). Treatment strategies for complex dissociative disorders: Two Dutch case
examples. Dissociation, 9, 157-165.
Van der Hart, O., Boon, S., & Heijtmajer Jansen, O. (1997). Ritual abuse in European countries: A clinicians perspective.
In G.A. Fraser (Ed.), The dilemma of ritual abuse: Cautions and guides for therapists (pp. 137-163). Washington, DC:
American Psychiatric Press.
Van der Hart, O., Nijenhuis, E.R.S., & Steele, K. (2006). The haunted self: Structural dissociation and the treatment of
chronic traumatization. New York/London: Norton & Co. (Dutch edition: Het belaagde zelf: Structurele dissociatie
en de behandeling van chronische traumatisering. Amsterdam: Boom, 2010.)
Huber, M. (1995). Mltiple Persnlichkeiten: Uberlebenden extremer Gewalt. [Multiple personalities: survivors of
extreme violence] Frankfurt: Fisher Taschenbuch Verlag.
International Society for the Study of Trauma and Dissociation (2011). Guidelines for treating dissociative identity
disorder in adults (3rd rev.). Journal of Trauma & Dissociation, 12, 115-187.
Kluft, R.P. (1997a). On the treatment of the traumatic memories of DID patients: Always? Never? Now? Later?
Dissociation, 10, 80-90.
Kluft, R.P. (1997b). Overview of the treatment of patients alleging that they have suffered ritualized or sadistic
abuse. In G.A. Fraser (Ed.), The dilemma of ritual abuse: Cautions and guides for therapists (pp. 31-63). Washington,
DC: American Psychiatric Press.
Marinkelle, A.B (2013). Ritueel misbruik: per definitie fantasie of fictie? [Ritual abuse: fantasy or fiction by definition?]
Tijdschrift voor Psychotherapie, 39, 425-433. [Dutch Journal of Psychotherapy].
Nierop, N. & Van den Eshof, P. (2010). Herinneringen: Continu, sluimerend, hervonden of gelogen? Ervaringen van de
Landelijke Expertisegroep Bijzondere Zedenzaken [Memories: Constant, dormant, refound or untrue? Experiences
of the Dutch National Expert Group for Special Sexual Offenses]. Tijdschrift voor Psychotherapie [Dutch Journal of
Psychotherapy], 36, 148-170. Pezdek,
Pezdek, K., & Banks, W. P. (Eds.) (1996). The recovered memory/false memory debate. San Diego, CA: Academic Press.
Rutz, C., Becker, T., Overkamp, B., & Karriker, W. (2008). Exploring commonalities reported by adult survivors of
extreme abuse: Preliminary empirical findings. In R. Noblit & P. Perskin Noblit (Eds.), Ritual abuse in the twenty-first
century (pp. 31-85). Bandon: Reeds publishers.
Sinason, V. (Ed). (1994). Treating survivors of satanist abuse. London/New York: Routledge.
Tate, T. (1991). Children for the devil: Ritual abuse and satanic crime. Londen: Methuen.
ESTD Newsletter
13
2014 Suzette Misrachi, All Rights Reserved

suzette.misrachi@gmail.com
A NOTE ON AN UNACKNOWLEDGED
TRAUMA
In 2012 I wrote a thesis entitled: "Lives Unseen:Unacknowledged Trauma of Nondisordered, Competent Adult Children Of Parents with a Severe Mental Illness
(ACOPSMI)" (Misrachi, 2012). I wanted, among other things, to achieve clinicianfriendly understandings to capture the plight of individuals from this population
whom I refer to hereafter as survivors (the full thesis is available from link in
reference list). I did this research as a parallel process to my clinical practice. This
meant I was practicing with my clients in a relational/emotional way while researching
in a theoretical and conceptual manner.
It is important to realise that the legacy of trauma can facilitate a chameleon-like effect in the daily lives
of survivors. Research on survivors reflects just how possible it is socially to function as a citizen and still
be trauma-affected (e.g., see testimonies in Camden-Pratt, 2002, 2006; Nathiel, 2007). The community of
survivors include philosophers (Gaita, 1998), nurses (Blair & Cowling, 2004), psychologists, doctors (Nathiel,
2007), social workers (Burdekin, Guilfoyle, & Hall, 1993), authors and playwrights (Lachenmeyer, 2000), and
physicists (Blizard, 2008). Who then would think these people are traumatic stress-carrying individuals?
Australias 1993 National Inquiry into the Human Rights of People with Mental Illness (Burdekin,
et al., 1993) reports that the offspring of people with a mental illness live their lives acceptably
to society (p.498). Society may wonder what is the problem since [a]fter all, they survived, didnt
they? (Bloom, 2002, p.8).. My thesis highlights a variety of elements that can become obstacles
in preventing access to the clients psychological injury for treatment.I will outline a few here:
In my clinical practice I found that competent, non-disordered individuals come to therapy for reasons
other than trauma as such.
ESTD Newsletter
14
Clients may describe extraordinary and intrusive mental states that seem to pop up uninvited in their
ordinary day-to-day routines. Their dramatic, seemingly unsolvable, dilemmas in their daily interpersonal
exchanges may also work against them in their relationships. Yet their high functioning capacity serves
to conceal what lies beneath their skin but only up to a point. They may have tried hard to integrate their
relational and intrapsychic intrusions into their everyday world. But then this may have became too much,
too overwhelming somehow bubbling over. They may have started to lose a grip on their relationships,
their job or their identity in terms of self confidence and who they were and are becoming. Such individuals
come to me for different, somewhat socially acceptable, reasons such as marital difficulties or the death
of a pet or sibling.
Just by having been a child raised within a family where one or both parents had a severe mental illness a
(now adult) client is at risk of presenting with concealed trauma. In one case, a mental health practitioner
came to see me because of the death of his sibling. As a child and adolescent he was in and out of mental
hospitals even at one point suffering from conversion disorder. This client encountered psychiatrists, social
workers, psychologists, etc., over decades, but nobody was able to to recognise that he was suffering the
impact of trauma. Evidence of a relationship between childhood traumatisation and conversion disorder,
i.e., ICD-10s dissociative disorders of movement and sensation, was overlooked (Roelofs, Keijsers,
Hoogduin, Naring, & Moene, 2002). He became quintessentially their familys designated patient within
his family system. The mental health professionals he was surrounded by had the effect of colluding with
the mentally unwell parents. From my clients account, both his parents clearly displayed serious levels of
mental instability that were never attended to. Instead, they got away with soul murder (Shengold, 1989).
The severity, chronicity and overall extent of their parent(s) mental instability is often reflected in type and
nature of early abuse and neglect which the client experienced or witnessed. Their historical relationship
with mentally unstable parents is also informed by attachment theory, which acts like a compass to help
guide me as their therapist. The client is enabled to move towards creating at the very least a potential
understanding, if not an unofficial diagnosis, that their parent was to a certain degree unstable. For instance,
if the clients parent went against the natural instinct to protect and nurture them during childhood then
we can safely presume something was awry.
In taking a thorough history, one can often determine whether or not my clients parent had an undiagnosed
mental illness. Sometimes together we speculate what type of mental illness it might be. I allow the process
to unfold until I sense that the client feels safe enough to introduce the possibility that they [ Suzette
please clarify. As written it sounds like you are referring to grandparents being ill] were likely to have been
survivors of parents with some kind of a severe mental instability.
In my practice experience, the client expresses great relief when they realise that their parent was likely
to have been an undiagnosed, under diagnosed or even an un-diagnosable severely mentally-ill person
Boundaries become clearer and problem ownership more easily delineated. This process facilitates greater
control over the internal work to be done for the sake of recovery.
There are clear benefits in helping clients unofficially diagnose their parent. Conversely, there are distinct
risks in not identifying them as survivors. Since non-disordered, competent survivors are well-camouflaged,
they may be viewed as better off than parents with a severe mental illness by virtue of being competent
and not disordered. This adds to their risk of their needs remaining invisible and therefore forgotten.
Undetected trauma may stop or delay prevention of physical diseases and illnesses (Felitti et al., 1998).
ESTD Newsletter
15
There are social advantages in helping this population group become more visible both to themselves and
to others. Competent, non-disordered survivors could function as role models. Just as career-competent
and famous individuals have come forward, in Australias beyondblue initiative (beyondblue, 2012), declaring
they are or were depressed, survivors need a vehicle where they may feel safe to communicate their
trauma-based needs and similarly be helped. Raising the public profile of survivors may normalise (Gilbert,
2011) their fundamental needs. Strengthening and uniting them as a population group may serve to reduce
their sense of shame as a trauma-affected population because like trauma, shame shapes peoples lives
(Dearing & Tangney, 2011).
Authors Note:
I came to my research topic as a result of frustration over a shortage of literature addressing the grief
of this understudied population. Their sadness seemed mysteriously endless. So based on my practice
experience and knowledge of grief theories, I authored a resource website addressing their grief (Misrachi,
2008). This website is a resource accessed by clinicians in Australia by The Royal Melbourne Children's
Hospital, the Victoria VVCS - Veterans and Veterans Families Counselling Service Department of Veterans'
Affairs and internationally by other mental health teams and institutions including individuals (see link
in reference list). I welcome feedback on my thesis or resource website suzette.misrachi@gmail.com
About the author:
Suzette Misrachi is a psychotherapist and counsellor (since 1999) specialising in trauma, loss and grief,
children, adolescents and adults. She is also an educator and group facilitator designing and giving
professional and personal development programs (since 1992). Recently she presented on grief and trauma
to medical personnel in Japan, post tsunami and earthquake tragedies. She lives in Melbourne working in
private and institutional practice with traumatised individuals. She plans to move to the Netherlands to
seek professional opportunities with her husband (a Dutch national) in 2014. She welcomes correspondence
email: suzette.misrachi@gmail.com
REFERENCES
Beyondblue. (2012). From:
Blair, K., & Cowling, V. (2004). In a daughter's voice: A mental health nurse's experiences of being the daughter
of a mother with schizophrenia. In V. Cowling (Ed.), Children of parents with mental illness 2: personal and clinical
perspectives (pp. 85-98). Camberwell, Vic: ACER Press.
Blizard, R. A. (2008). The role of double binds, reality-testing and chronic relational trauma in the genesis and
treatment of borderline personality disorder. In A. Moskowitz, I. Schafer & M. J. Dorahy (Eds.), Psychosis Trauma and
Dissociation: Emerging Perspectives on Severe Psychopathology (pp. 295-306). Hoboken, NJ: John Wiley & Sons, Ltd.
Bloom, S., L. (2002). Beyond the beveled mirror: Mourning and recovery from childhood maltreatment. In J. Kauffman
(Ed.), Loss of the assumptive world. New York: Brunner-Routledge.
Burdekin, B., Guilfoyle, M., & Hall, D. (1993). National inquiry into human rights and mental illness. Canberra: Australian
Government Publishing Service.
ESTD Newsletter
16
Camden-Pratt, C. E. (2002). Daughters of Persephone: Legacies of maternal "madness". University of Western

Sydney, Sydney.
Camden-Pratt, C. E. (2006). Out of the shadows: Daughters growing up with a 'mad' mother. Sydney: Finch Publishing.
Dearing, R. L., & Tangney, J. P. (Eds.). (2011 ). Shame in the therapy hour (1st ed.). Washington, DC: American
Psychological Association.
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., & Edwards, V. (1998). Relationship of childhood
abuse and household dysfunction to many of the leading causes of death in adults: The adverse childhood
experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245-258.
Gaita, R. (1998). Romulus, my father. Melbourne Text Publishing.
Gilbert, P. (2011). Shame in psychotherapy and the role of compassion focused therapy. In R. L. Dearing & J. P. Tangney
(Eds.), Shame in the therapy hour (1st ed., pp. 325-354). Washington, DC: American Psychological Association.
Lachenmeyer, N. (2000). The outsider: A journey into my father's struggle with madness. New York: Broadway Books.
Misrachi, S. (2008). Surviving parents with mental illness.
survivingparentswithmentalillness
From: https://sites.google.com/site/workwithin/
Misrachi, S. (2012). Lives Unseen: Unacknowledged Trauma of Non-Disordered, Competent Adult Children of Parents
with a Severe Mental Illness (ACOPSMI). Department of Social Work Melbourne School of Health Sciences Faculty
of Medicine, Dentistry and Health Sciences. From: http://repository.unimelb.edu.au/10187/16566 Please note: For
tabulation reasons, please only use or forward the link never the actual thesis itself.
Nathiel, S. (2007). Daughters of madness: Growing up and older with a mentally ill mother Westport, CT: Praeger
Publishers.
Roelofs, K., Keijsers, G. P. J., Hoogduin, K. A. L., Naring, G. W. B., & Moene, F. C. (2002). Childhood abuse in patients
with conversion disorder. American Journal of Psychiatry, 159, 1908-1913.
Shengold, L. (1989). Soul murder: The effects of childhood abuse and deprivation. New Haven: Yale University Press.
ESTD Newsletter
17
FILM REVIEW
by Orit Badouk Epstein
Directors: Dani Menkin & Yonatan Nir, 2012
DOLPHIN BOY,
Morad, a 17 year old boy from an Arab village in
the north of Israel, sent an innocent text message
to a girl in his class who was already betrothed
to someone else. The girls older brother read the
message and, with his friends, kidnapped Morad
and savagely beat him up, leaving him badly injured
and unconscious. It took 11 days for him to regain
consciousness.
The film begins with a scene showing Morad in hospital, in a state
of catatonic shock. After two months he was still mute and not
responding to any conventional treatment for PTSD. Dr. Ilan Kutz
an unusual psychiatrist, whose sensitivity and ability to think
outside the box, surpassed any professional expertise, decided
to introduce him to Dolphin therapy in Eilat in Southern Israel.
Like horses and dogs, dolphins have an enhanced sensory
capacity which enables them to tune in on a non-verbal level to
the human need for affection. Dolphin therapy has been widely
recognised since the 1970s and helps alleviate symptoms of
children with autism, cerebral palsy, shell-shock, cancer and
other traumas. Although research has not yet determined what
it is that actually helps relieve these symptoms, we know that
swimming with dolphins changes hormone levels and increases
endorphins in the brain.
Morads fathers love and dedication for his son is palpably
moving. He quits his job; sells his properties and the two move
to Eilat where Morad is introduced to the dolphin reef and the
welcoming staff. When Morad finally dives into the blue water
of the Red Sea, a connection is instantly made and a bond is
created that feels deeper than any ocean. After five months
of swimming with dolphins, he begins to smile and starts to
speak but he has no memory of his past. When asked where he
was born: he shrugs: Here in Eilat. His bond with the dolphins
continues to intensify to the point where he mirrors and mimics
their behaviour. He learns to dive to a depth of 30 metres and
releases air bubbles through his eyes in the style of a bottlenose
dolphin. A part-self, featured as dolphin boy is now in charge.
Whats more, he refuses to reconnect with his mother and return

to his village. Instead he adapts to a new Israeli environment
where he loses all trace of his Arab accent and even falls in
love with a Jewish Israeli girl. As well as having a dolphin boy
part, he now has an Israeli young male part. Nevertheless, his
PTSD symptoms remain acute; he continues to have nightmares,
sudden rage outbursts and is incapable of crying.
For 4 years, while away from his village, the camera followed
Morads recovery process. The camera also works as a
therapeutic tool providing Morad with a new narrative that is
empowering and validating his experiences. We witness the
unwavering devotion of his father; his intense bond with the
dolphins; his intimate relationship to the Jewish Israeli female;
the dedication and creativity of treatment given by Dr. Kutz and
the supportive team at the reef. Eventually at the age of 21 he
is finally ready to return to his village. Morads phobic part that
couldnt cry is overcome and in a cathartic moment, when he
departs from Eilat and says goodbye to the dolphins, we see
ESTD Newsletter
tears rolling down his face. He also reunites with his mother.
This is a transformative and most humbling documentary, a
remarkable story that demonstrates the healing capacity of
mammals to overcome human cruelty.
My review could end here. Yet, as an attachment based
psychotherapist, I am left feeling slightly curious: why did
Morad so adamantly refuse to see his mother and why did it
take him so long to recover, for
someone who didnt seem to
have a history of vulnerability
with respect to his attachment
style?
18
behaviour and conclude that we have done wrong. It encompasses

the whole of ourselves; it generates a wish to hide, to disappear
or even to die (Lewis, 1992, p.2). One of the causes of shame is
the recognition of the selfs failure to conform to social norms
and expectations. (M. Dorahy, 2013). Shame and honour are
usually associated with something greater than the individual.
Honour shaming is almost always placed on a group. This can
be the immediate family, the extended tribe or in some cases,
it can be as large as an entire
nation. The fear of shame in
Arab culture is so powerful
because the identification
between the individual and the
group is far greater than in the
west. The importance of the
group weighs heavier than the
importance of any individual.
If an individual is in a position
of shame, he then loses his
influence and power; similarly
his entire group will suffer.
To find out more, please join

me, Dr. Ilan Kutz and Andrew
Moskowitz for a screening
of Dolphin Boy followed
by a discussion at the ESTD
bi-annual
conference
in
Copenhagen 2014.
The film is a humanitarian one

and its emphasis is on the power
of human and animal love. In
an interview the director was
reluctant to give the film any
political message that this was
about an Arab boy who erases
his Arab identity in Israeli society. Yonatan Nir said: regardless
of ones culture, we perceive this as a person who escaped
trauma and his change of identity is part of the escape. This
can happen to a rape victim from a kibbutz or a child that was
sexually abused in an orthodox community (2011).
We know dissociative amnesia is all too helpful for such an

escape. In his conceptualisation of the self, John Bowlby saw the
impact of external events on relationships as crucially important
to our understanding of our own sense of self-worth: During the
earliest years of our lives, indeed, emotional expression and its
reception are the only means of communications we have, so that
the foundations of our working models of self and attachment
figure are perforce laid using information from that source
alone.(Bowlby, p.157) We dont know much about Morads early
life or his relationship with his mother. We see her mainly in the
background, a religious woman looking sad and excluded from
the dominant male bonds in her family. We dont know much
about the familys status in the village and their blood relations.
We are told that his attack did not involve any sexual trauma.
The cultural context and recognition of some important cultural
and political issues seemed glossed over. As someone who grew
up in the Middle East, I think the importance of issues around
shame has been greatly overlooked. Shame can be defined as
the feeling we have when we evaluate our actions, feelings or
Wilson et al (2006) argue that States of post traumatic shame

and guilt form the pathological nucleus of simple and complex
PTSD, p.124. Could it be that Morads deeply rooted fear of
honour shaming his family might have played a major role in his
dissociative amnesia? - Recovery was possible only where the
spacious desert and the deep sea could facilitate the distance
he needed from his village and where dolphins could reach and
touch him without any prejudice or prior judgement to him.
To find out more, please join me, Dr. Ilan Kutz and Andrew
Moskowitz for a screening of Dolphin Boy followed by a
discussion at the ESTD bi-annual conference in Copenhagen
2014.
Bowlby J., A Secure Base, Routledge, 1998
De Hooge I.E, Zeelenberg M.B., Reugelmans S.M.2010
Dorahy M. (2013)
Lewis M. (1992) Shame: The exposed self. NY, Free Press.
Wilson J.P., Drozdek.B., Turkovic,S. 2006. Post traumatic Shame
& guilt. Trauma, violence & abuse, 7.122-141.
BOOK REVIEW
by Joseph Schwartz
ar, Vedat; Middleton, Warwick; Dorahy, Martin, eds. (2014).
GLOBAL
PERSPECTIVES
ON DISSOCIATIVE
DISORDERS:
Individual and Societal Oppression. London & New York: Routledge.
Psychotherapists have an occupational hazard

which this collection does much to correct. We
tend to work individually without the benefit of
daily collegial contacts and, when we are trauma
specialists, our practice tends to be intense,
challenging and consuming. We rarely are able to
lift our heads over the parapet to see just how
prevalent abuse is world-wide and even more
rarely are able to understand the epidemiology
and causes of abuse world-wide.
ar, Middleton and Dorahy in their powerful introduction to this
collection of articles from the Journal of Trauma and Dissociation,
the journal of the International Society for the Study of Trauma
and Dissociation (now in its 30th year) ask us to look at the global
pattern of abuse and its cause. ar, MIddleton and Dorahy are
distinguished clinicians and researchers in the field of trauma
and dissociation. ar is past president of the ISSTD and current
president of the European Society for Traumatic Stress Studies.
Middleton and Dorahy are on the Board of the ISSTD. Their
detailed description of the prevalence of abuse world-wide
concludes:
The chapters in this book demonstrate through a variety of
examples that oppression is part of the human condition in
democratic and undemocratic societies. And where oppression
resides, dissociation is by necessity a constant companion.
In the first paragraph of their introduction they say:
Even within established democracies there are frequently
groups or organizations that have power structures worthy
of the most totalitarian state, and, although such entries may
include orphanages, churches, cults and organized criminals,
globally the most commonly encountered abusive totalitarian
structure is based on the family.
In between the first and last paragraphs come the facts of the case.
In the scandal of the Catholic Church in the US, 6100 priests
were accused to have sexually abused 16,000 victims. Four
hundred priests were convicted and jailed. In 2012 the Church
paid $3 billion to settle out of court. Internationally 60 Catholic
bishops from 20 countries have been convicted or forced to
resign because of sexual offences. Other organisations have
similar records including the scouts, orphanages, old age homes
and special schools.
ar, MIddleton and Dorahy go on to build their case that because
the powerful are in a position to abuse the vunerable they do go
on to do so. Their view corresponds to the long-standing feminist
analysis of rape succinctly expressed by Andrea Dworkin: Why
do men rape women? Because they can.
Mental health is not immune from this power dynamic. In 1986, in
the case of Jules H. Masserman, a past president of the American
Psychiatric Association and the author of 20 books and 400
articles, Masserman settled out of court with four women who
testified that he had drugged and sexually molested them. The
APA Appeals Board suspended him for five years but did not
expel him - a global pattern of leniency, avoidance and bystanding
ESTD Newsletter
by the responsible authorities. I was forcefully reminded of the

exposure of TV star Jimmy Savile in the UK where everyone
stood by and let Savile abuse over 450 youngsters over a period
of 30 years with the response: Oh thats JImmy.
Although we all know from our practices that the connivance
of the authorities with the abusers is the rule rather than the
exception, we are reminded by ar, MIddleton and Dorahy
about the Holocaust where at the infamous Evian Conference in
1938, 32 countries wrung their hands at the plight of the Jews in
Germany and Austria while simultaneously slamming their doors
shut. And we are further reminded that genocide has become a
fact of international life as in Rwanda and Srebenica.
We get up-close to what we see in our consulting rooms in the
presentation of organised abuse. But I certainly had no idea of
the global extent of organised abuse and its invariable cover-up
when well connected people are involved - Belgium; Portugal;
North Wales; London; Pennsylvania; Argentina; Wollongong,
Australia; Jersey; Omaha, Nebraska. In March 2011, 184 suspects
of being members of an international child pornography ring
were arrested by police in 40 countries linked to an internet
address where police found 71,000 IP addresses in 109 countries.
As ar, MIddleton and Dorahy are at pains to emphasise, abuse
is not an exception it is a global fact of life.
Warfare is an additional factor leading to dissociation. ...the
populace is not only oppressed in their daily behavior by the
threat of unforseen mass violence, but also by governments
and agencies designed to protect them.
The appalling phenomenon of child soldiers receives attention
including examples from the Western democracies. The youngest
British soldier killed in WW1 was John Condon age 14. In WW2 the
youngest was Reginald Earnshaw also age 14. The Russians and
Germans are well known for their desperate use of youngsters
in the fighting on the Eastern Front. In our period, up to 95,000
child soldiers were killed in the Iran-Iraq war.
In limning the world in which we inhabit as one where oppression
is the norm rather than the exception, ar, MIddleton and
Dorahy offer a different and thought provoking way to view
dissociation, a different paradigm from the one most of us use
in our treatment of traumatised patients:
An alternative paradigm with which to view dissociative
disorders is to characterize them as a chronic human rights
20
abuse syndrome of childhood. Here various forms of oppression

operate, including oppression of the child by the abusive and
potentially colluding non-abusive caretaker, and the multiple
ways in which their lived experience is ignored or invalidated
by social, political and medical systems. Research from every
continent increasingly demonstrates the ubiquity of dissociative
defences and the universality of the sorts of traumas that
engender them. (Emphasis added)
ar, MIddleton and Dorahy call for an ending of the silencing that
can surround the perpetration of abuse whether in families or
institutions. But the task of ending the oppression that lies at
the root of abuse seems enormous. In my practice I am always
struck by how poorly we defend our children, how far we are
from the African ideal: It takes a whole village to raise a single
child. But it seems it is more than we dont protect our children
and the vulnerable in our society. We tolerate or support power
structures that make abuse inevitable. What role can clinicians
play in the political process to help limit the exploitation of the
power differences that lead to the ubiquity of dissociation? It
is an epidemiological challenge perhaps only equalled by the
ubiquity of cancer causing agents in our global environment. One
small thing might be for the ESTD to fund a press office that
can attempt to encourage the media to consult us as clinicians
whenever a story of abuse emerges. It was painfully obvious
to see that in the Jimmy Savile case no mention was made of
the difficulty of healing the children, now adults, damaged by
Saviles crimes. Action does seem urgent.
Note
Assuming that many readers of the Newsletter are members of
the ISSTD where they will have received the articles in volume
14 issues 2 and 3, I just list all the articles in this collection
below. For those who wish print copies, there is only bad news.
Routledge has set the price of the book at an eye watering 85.
I protested to Routledge and they wrote back:
Due to the book being both niche and high-level, it was positioned
as a library purchase. This decision was made based on the
performance of previous titles.
Sales of similar titles do show that there is a market for special

issues as books in libraries that do not take the journal.
Editorial will be keeping an eye on sales, and there is the

possibility that the book will be issued as a much cheaper
paperback after 18 months or so; and/or it may be issued as
ESTD Newsletter
21
an ebook after 2 years. Again, performance of previous titles

indicates that a book which does well in hardback will also do
well in paperback/ebook.
Well see. Things arent better if one tries to buy a copy of V.14,
#2 because the price of a single copy of the journal has been
set at 96. Although there is a new article by NIck Bryant on
the Franklin scandal and MIddletons article on adult abuse
of survivors is collected here instead of being in a separate
issue of of the journal, the price is daunting even with the Sar,
MIddleton, and Dorahy introduction only available in the 85
book version. I would hope that these authors would consider
publishing their important article elsewhere to reach the wider
audience it deserves. I suppose the library fax machine will have
to serve.
Introduction.
Global Perspectives on Dissociative Disorders: Individual and Societal Oppression Vedat Sar, Warwick Middleton and Martin Dorahy
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Stimulus Deprivation and Overstimulation as Dissociogenic Agents in Postmodern Oppressive Societies Vedat Sar and Erdinc
Ozturk
The Role of Abusive States of Being in Interrogation Frank W. Putnam
Parentchild Incest that Extends Into Adulthood: A Survey of International Press Reports, 20072011 Warwick Middleton
Ongoing Incestuous Abuse During Adulthood Warwick Middleton
Dissociation and Symptoms of Culture-Bound Syndromes in North America: A Preliminary Study Colin A. Ross, Elizabeth
Schroeder and Laura Ness
Ethnic Syndromes as Disguise for Protest Against Colonialism: Three Ethnographic Examples Elizabeth Hegeman
Dissociation and Identity Transformation in Female Survivors of the Genocide Against the Tutsi in Rwanda: A Qualitative
Research Study Denise H. Sandole and Carl F. Auerbach
Transference-Focused Psychotherapy with Former Child Soldiers: Meeting the Murderous Self Nel Draijer and Pauline Van Zon
Boundary Modifications in the Treatment of People with Dissociative Disorders: An International Perspective Adah Sachs
Seeking AsylumTrauma, Mental Health, and Human Rights: An Australian Perspective Louise Newman
The Franklin Scandal: The Cover-Up of a Child Abuse and its Analogues to Dissociative Identity Disorder Nick Bryant
ESTD Newsletter
22
ON THE BRIGHT SIDE
- Inspiring VignettesFromThe ConsultingRoom
By Winja Lutz
Our experience tells us that even in therapeutic work as challenging as

the work with complex trauma and dissociation many heartwarming, funny,
touching, and humorous situations occur and client's consent granted we
would like to invite you to share those with each other in this newsletter.
We do not mean to make light of our work in a dismissing way far
from it! but most of us have experienced humor as a very effective,
attachment fostering, and burden lightning thing in therapy. Research on
humor tells us that humor increases immunoglobulin A, thus making us
more resilient, it increases attention, lowers pain perception and buffers
burnout and PTSD especially through humor's social bonding feature and
its ability to combat the physiological impact of stressors (Sliter et al, 2013).
We should obviously not do without it in the therapy room (and outside of
it). Facing the difficult work that we do on both sides of the "couch"
we can only benefit from sharing our humorous therapy experiences with
one another. Please submit short descriptions of all the heartwarming,
hilarious, gratifying, funny, touching, and humorous situations you
have experienced in the therapy room be it as therapist or client! You
can send your submissions to: winja.lutz@gmail.com Please specify if you
want your story published anonymously. A submission implies consent of
all parties depicted.
2011
By Julie K. Bird
Ive always been funny. I would joke to save my life. When I felt uncertain I would
revert to being comical, witty and entertaining, it was the most reliable protective
trait I had. I used to be with a therapist who made a point of not laughing at any of my jokes because he
said I would hide behind my humorous exterior while there was certainly truth in that it also made me
feel very much out of my depth and downright scared which only served to drive me deeper into hiding. It
took me a while to figure this out. When I finally found a therapist who would laugh at my jokes while still
keeping me on board with the serious work a lot of sadness came seeping through the humor.
One day we were doing trauma processing work and I got pretty caught up, feeling dizzy and dissociative.
She started reorienting me, saying my full name, telling me how old I was at the present time, asking me
to focus on certain things in her office... then she said: Nothing bad can happen to you here, its 2007 you
are safe now. I felt a quick stab of bewilderment and then I burst out laughing it was 2011. She looked
a little taken aback until I giggled: Its 2011! She grinned: 2007 huh?! So, humor is a life-saver after all.
Nothing had ever brought me back from dissociative regression this effortlessly!
ESTD Newsletter
23
HOT OFF THE PRESS

Introducing the latest research
The behavior patterns of abused children as described in their testimonies

Katz, C. & Barnetz, Z. (2013). The behavior patterns of abused children as described in their testimonies. Child Abuse & Neglect.
Online [retrieved 1/25/2014]: http://www.sciencedirect.com/science/article/pii/S014521341300224X
Abstract
The aim of the current study is to identify how children describe their behavior during abuse and to explore their behavior further
with respect to the type of the abuse (physical or sexual), frequency of abuse (single or multiple incidents), familiarity with the
suspect, and children's age and gender, with the assumption that this information may have a significant effect on the children's
recovery process. The study involved 224 transcripts of interviews with alleged victims aged 514 in Israel. The sample was randomly
selected from all of the forensic investigations with children that were conducted in Israel in 2011. The results show that abuse
type has a strong effect on children's behavior, with children in the sexual abuse group reporting more fight and flight behavior
and children in the physical abuse group reporting more self-change behavior. This finding was interacted with the severity of
abuse variable, with children in the sexual abuse group reporting less flight behavior and an increase in the self-change behavior
with the highest level of severity of abuse (touch under the clothes and penetration). Investigative interviews with children can
be a significant source of information for practitioners within the clinical context. The current study stresses the consequences
that abuse can have on children's behavior during these incidents and the implications for the therapy process with the children.
The integrative power of dance/movement therapy: Implications for the treatment of dissociation
and developmental trauma
Pierce, L. (2014). The Arts in Psychotherapy, 41(1), pp 7-15.
Online [retrieved 1/25/2014]: http://www.sciencedirect.com/science/article/pii/S0197455613001652
Abstract
Chronic and compounding exposure to traumatic events, especially within the context of early attachment relationships, can result
in symptoms of dissociation commonly seen in dissociative disorders, personality disorders, and post-traumatic stress disorders.
This theoretical article proposes an application of dance/movement therapy as facilitative of right brain integration in adult clients
who present with trauma-related dissociative symptoms. Findings from trauma psychology, neuroscience, and dance/movement
therapy literature are used to create an attachment-oriented theoretical foundation for how dance/movement therapy might
support the integration of dissociated somatic, emotional, and psychological experiences. A model for case-conceptualization and
treatment planning is proposed according to a trauma treatment framework consisting of three phases: safety and stabilization,
integration of traumatic memory, and development of the relational self. Within this phase-oriented theoretical framework, dance/
movement therapy interventions such as body-to-body attunement, kinesthetic mirroring, interactive regulation, self-awareness,
symbolism and expression, and interactional movement are examined as applications that may support bottom-up integration
and resolution of psychological trauma. Limitations and suggestions for future research are also discussed.
ESTD Newsletter
24
Empirical Testing of Criteria for Dissociative Schizophrenia

Laferrire-Simard, M.-C., Lecomte, T. & Ahoundova, L. (2014). Empirical Testing of Criteria for Dissociative Schizophrenia. Journal
of Trauma and Dissociation, 15(1), pp.91-107.
Online [retrieved 1/25/2014]: http://www.tandfonline.com/doi/abs/10.1080/15299732.2013.834860#.UuPgkHlZBaE
Abstract
This study examined the validity of dissociative schizophrenia diagnostic criteria. In the first phase, 50 participants with a psychotic
disorder were administered the Dissociative Experiences Scale and the Childhood Trauma Questionnaire to identify those with
dissociative characteristics. In the second phase, we selected those who had a score of 15 or above on the Dissociative Experiences
Scale. Fifteen of these participants were evaluated thoroughly with the Structured Clinical Interview for DSMIV Axis I, Structured
Clinical Interview for DSMIV Axis II, and Structured Clinical Interview for DSMIV Dissociative Disorders to determine whether
they met the criteria for dissociative schizophrenia and to generate a clinical description. Our results indicated that 24% of the
individuals we tested met these criteria. We propose making mandatory 1 of the 3 dissociative symptoms of the criteria to eliminate
people with only nonspecific symptoms (e.g., extensive comorbidity). According to this modified criterion, 14% of our sample would
receive a diagnosis of dissociative schizophrenia. However, a more comprehensive look at the clinical picture begs the question
of whether dissociative schizophrenia is truly present in every person meeting the criteria. We discuss the relevance of creating
a new schizophrenia subtype and offer recommendations for clinicians.
Trauma Group Therapy: The Role of Attachment and Therapeutic Alliance

Zorzella, K.P.M., Muller, R.T., & Classen, C.C. (2014). Trauma Group Therapy: The Role of Attachment and Therapeutic Alliance.
International Journal of Group Psychotherapy: Vol. 64, No. 1, pp. 24-47.
Online [retrieved 1/25/2014]: http://guilfordjournals.com/doi/abs/10.1521/ijgp.2014.64.1.24
Abstract
Attachment has increasingly been identified as central to therapy process and outcome. Attachment theory proposes that an
individual's prior interactions with attachment figures develop into templates that will guide the way they form connections and
perceive their relationships with others. This study examined clients' ratings of their relationship with the therapist as well as their
ratings of group climate at multiple discrete points during treatment. These variables were examined in relation to attachment
classification prior to therapy. Participants were 62 women attending the Women Recovering from Abuse Program (WRAP), a
primarily group-based day-treatment program for childhood interpersonal trauma, at Women's College Hospital in Toronto, Ontario,
Canada. Results demonstrated that clients' perceptions of relationships in group therapy varied as a function of attachment
classification.
Institutional abuse and societal silence: An emerging global problem

Middleton, W., Stravopoulos, P., Dorahy, M.J., Krger, C., Lewis-Fernndez, R., Martnez-Taboas, A., Sar, V. & Brand, B. (2014).
Institutional abuse and societal silence: An emerging global problem. Australian& New Zealand Journal of Psychiatry, 48(1), pp. 22-25.
Online [retrieved 1/25/2014]: http://anp.sagepub.com/content/48/1/22.short
Abstract
The Australian Royal Commission into Institutional Responses to Child Sexual Abuse was announced by Australian Prime Minister
Julia Gillard on 11 January 2013. Examining how institutions with a responsibility for children have managed and responded to
allegations and instances of child sexual abuse and related matters (Australian Government, 2013) argu- ably represents the
ESTD Newsletter
25
most wide-ranging attempt by any national government in history to examine the institutional processes (or lack thereof) for
addressing such abuse.
It is difficult to escape concluding that the single most pathogenic factor in the causation of mental illness is how we humans
mistreat each other. Yet abuse of children is frequently perpetrated or overlooked by the professionals whose core roles emphasize
the protection of children. These include teachers, health care professionals, police officers and judges, as well as clergymen.
Despite the lasting damage of childhood maltreatment, governments and societies have demonstrated an enduring reluctance to
investigate how trauma and abuse contribute so substantially to filling our mental health centres, prisons, drug and alcohol services
and medical wards. Partially and belatedly, society is attempting something that has never before been achieved progressive
exposure to public gaze of traumas that, despite earlier attempts to foster their recognition, have returned to or remained in
darkness.
As the full extent of institutional complicity in the sexual abuse of children becomes uncomfortably more obvious, it does not
signify that we are falling into an abyss. Rather, it suggests that for the first time in our history, such issues have reached a point
at which they have attained such significance that they have become the subject of a wide-ranging national Royal Commission.
Epigenetic Priming of Memory Updating during Reconsolidation to Attenuate Remote Fear Memories
Grff, J., Joseph, N.F., Horn, M.E., Samiei, A., Meng, J., Seo, J., Rei, D., Bero, A.W., Phan, T.X., Wagner, F., Holson, E., Xu, J., Sun,
J., Neve, R.L., Mach, R.L., Haggarty, S.J. & Tsai, L.-H. (2014). Epigenetic Priming of Memory Updating during Reconsolidation to
Attenuate Remote Fear Memories. Cell press, 156(12), pp. 261276.
Online [retrieved 1/25/2014]: http://www.sciencedirect.com/science/article/pii/S0092867413015894
http://news.sciencemag.org/biology/2014/01/modifying-dna-may-wipe-away-old-memories
Abstract
Traumatic events generate some of the most enduring forms of memories. Despite the elevatedlifetime prevalence of anxiety
disorders, effective strategies to attenuate long-term traumatic memories are scarce. The most efficacious treatments to
diminish recent (i.e., day-old) traumata capitalize on memory updating mechanisms during reconsolidation that are initiated upon
memory recall. Here, we show that, in mice, successful reconsolidation-updating paradigms for recent memories fail to attenuate
remote (i.e., month-old) ones. We find that, whereas recent memory recall induces alimited period of hippocampal neuroplasticity
mediated, in part, by S-nitrosylation of HDAC2 andhistone acetylation, such plasticity is absent for remote memories. However,
by using an HDAC2-targeting inhibitor (HDACi) during reconsolidation, even remote memories can be persistently attenuated. This
intervention epigenetically primes the expression of neuroplasticity-related genes, which is accompanied by higher metabolic,
synaptic, and structural plasticity. Thus, applying HDACis during memory reconsolidation might constitute a treatment option
for remote traumata.
Attention to eyes is present but in decline in 26-month-old infants later diagnosed with autism
Jones, W. & Klin, A. (2013). Attention to eyes is present but in decline in 26-month-old infants later diagnosed with autism.
Nature, International weekly journal of science.
Online [1/25/2014]: http://www.nature.com/nature/journal/vaop/ncurrent/full/nature12715.html
Abstract
Deficits in eye contact have been a hallmark of autism since the conditions initial description3. They are cited widely as a diagnostic
feature4and figure prominently in clinical instruments; however, the early onset of these deficits has not been known. Here we
show in a prospective longitudinal study that infants later diagnosed with autism spectrum disorders (ASDs) exhibit mean decline
ESTD Newsletter
26
in eye fixation from 2 to 6 months of age, a pattern not observed in infants who do not develop ASD. These observations mark
the earliest known indicators of social disability in infancy, but also falsify a prior hypothesis: in the first months of life, this basic
mechanism of social adaptive actioneye lookingis not immediately diminished in infants later diagnosed with ASD; instead, eye
looking appears to begin at normative levels prior to decline. The timing of decline highlights a narrow developmental window and
reveals the early derailment of processes that would otherwise have a key role in canalizing typical social development. Finally, the
observation of this decline in eye fixationrather than outright absenceoffers a promising opportunity for early intervention
that could build on the apparent preservation of mechanisms subserving reflexive initial orientation towards the eyes.
Epigenetic traces of childhood maltreatment in peripheral blood: a new strategy to explore geneenvironment interactions

Uher, R. & Weaver, I.C.G. (2014). Epigenetic traces of childhood maltreatment in peripheral blood: a new strategy to explore geneenvironment interactions. The British Journal of Psychiatry, 204: 3-5.
Online [retrieved 1/25/2014]: http://bjp.rcpsych.org/content/204/1/3.abstract
Abstract
Maltreatment in childhood affects mental health over the life course. New research shows that early life experiences alter the
genome in a way that can be measured in peripheral blood samples decades later. These findings suggest a new strategy for
exploring gene-environment interactions and open opportunities for translational epigenomic research.
Childhood Trauma and Coping through the Science of Physics: An Attachment Perspective
Lucabeche, V., Haney, J., & Quinn, P. Childhood Trauma and Coping through the Science of Physics: An Attachment Perspective.
Bulletin of the American Physical Society, APS Meeting 3/4/2014, 59(1).
Online [1/25/2014]: http://meetings.aps.org/Meeting/MAR14/Event/211254
Abstract
Trauma can be defined as stressful life events that disrupt and/or delay successful transition during childhood developmental
stages (Roberts, 2000). In this exploratory study, transitional stressors are defined as: childhood physical, sexual, or emotional
abuse; loss of a caregiver or significant relative due to death or abandonment; exposure to physical violence by non-family members
(e.g., bullying); or illness resulting in permanent physical disability. Trauma may produce disorganized attachments in childhood,
which may lead to emotional and to social impairment in adulthood (Siegel, 1999). Consequently, traumatized individuals, who
suffer from disorganized attachments, may seek to engage in activities which are emotionally predictable. An examination of the
personal childhood histories from a sample of Nobel Prize winners in the field of physics provides support for the hypothesis that
the study of physics may serve as an effective coping method for individuals who have experienced childhood trauma.
The co-occurrence of PTSD and dissociation: differentiating severe PTSD from dissociative-PTSD
Armour, C., Karstoft, K.I., Richardson, J.D. (2014). The co-occurrence of PTSD and dissociation: differentiating severe PTSD from
dissociative-PTSD. Social Psychiatry and Psychiatric Epidemiology.
Online [retrieved 1/25/2014]: http://link.springer.com/article/10.1007/s00127-014-0819-y
ESTD Newsletter
27
Abstract
A dissociative-posttraumatic stress disorder (PTSD) subtype has been included in the DSM-5. However, it is not yet clear whether
certain socio-demographic characteristics or psychological/clinical constructs such as comorbid psychopathology differentiate
between severe PTSD and dissociative-PTSD. The current study investigated the existence of a dissociative-PTSD subtype and
explored whether a number of trauma and clinical covariates could differentiate between severe PTSD alone and dissociative-PTSD.
The current study utilized a sample of 432 treatment seeking Canadian military veterans. Participants were assessed with the Clinician
Administered PTSD Scale (CAPS) and self-report measures of traumatic life events, depression, and anxiety. CAPS severity scores
were created reflecting the sum of the frequency and intensity items from each of the 17 PTSD and 3 dissociation items. The CAPS
severity scores were used as indicators in a latent profile analysis (LPA) to investigate the existence of a dissociative-PTSD subtype.
Subsequently, several covariates were added to the model to explore differences between severe PTSD alone and dissociative-PTSD.
The LPA identified five classes: one of which constituted a severe PTSD group (30.5%), and one of which constituted a dissociativePTSD group (13.7%). None of the included, demographic, trauma, or clinical covariates were significantly predictive of membership
in the dissociative-PTSD group compared to the severe PTSD group.
In conclusion, a significant proportion of individuals report high levels of dissociation alongside their PTSD, which constitutes a
dissociative-PTSD subtype. Further investigation is needed to identify which factors may increase or decrease the likelihood of
membership in a dissociative-PTSD subtype group compared to a severe PTSD only group.
Dissociation of the Personality and EMDR Therapy in Complex Trauma-Related Disorders: Applications
in Phases 2 and 3 Treatment.
Van der Hart, O., Groenendijk, M., Gonzalez, A., Mosquera, D. & Solomon, R. (2014). Dissociation of the Personality and EMDR Therapy in
Complex Trauma-Related Disorders: Applications in Phases 2 and 3 Treatment. Journal of EMDR Practice and Research, 8(1), pp. 33 48.
Abstract
Eye movement desensitization and reprocessing (EMDR) psychotherapy can play a major role in phase- oriented treatment of
complex trauma-related disorders. In terms of the theory of structural dissociation of the personality and its related psychology
of action, a previous article described Phase 1 treatment Stabilization, Symptom Reduction, and Skills Trainingemphasizing
the use of EMDR procedures in this phase. Phase 2 treatment mainly involves applications of EMDR processing in overcoming
the phobia of traumatic memories and their subsequent integration. Phase 3 treatment focuses on further integration of the
personality, which includes overcoming various phobias pertaining to adaptive functioning in daily life. This article emphasizes
treatment approaches that assist therapists in incorporating EMDR protocols in Phases 2 and 3 of phase-oriented treatment
without exceeding clients integrative capacity or window of tolerance.
ESTD Newsletter
28
DATES FOR YOUR DIARY IN
2014/15
TRAINING IN FINLAND
Assessment and treatment of complex trauma and dissociative disorders- training 2014/201518 lecture days by Onno van der Hart,
Suzette Boon, Kathy Steele, Ellert Nijenhuis and Sandra Wieland.
More information :www.traumaterapiakeskus.com
SYMPOSIUM NETHERLAND
Symposium for Dutch language adult survivors of chronic childhood trauma and those close to them: "Recent developments in
diagnosis and treatment," Amstelveen, the Netherlands, Friday, March 21 .2014, in the afternoon."
Registration now now open
27-29 March 2014 Denmark, Copenhagen

Trauma, Dissociation and Attachment in the 21st Century: Where are We Heading?
See more here: www.estd2014.org/
ESTD Newsletter
ESTD CONTACTS IN YOUR REGION

Austria Sonja Laure sonja.laure@nadua.at
Belgium
Manolle Hopchet manhopchet@scarlet.be
Serge Goffinet sergegoffinetpsy@msn.com
Czech Republik Jan Soukup honzasoukup@yahoo.com

Petr Bob petrbob@netscape.net
Denmark Helle Spindler hellesp@psy.au.dk

Andrew Moskowitz andrew@psy.au.dk
Estonia
Maire Riis maire@lastekriis.ee
Finland Pivi Saarinen paivi.saarinen@traumaterapiasarastus.fi

Elisabeth Helling
elisabeth.helling@gmail.com
France Hlne Delucci helene.dellucci@wanadoo.fr

Isabelle Saillot institut@pierre-janet.com
Bernard Mayer mayer@ietsp.fr
Georgia Manana Sharashidze manana@gamh.org.ge

Germany Bettina Overkamp bettina.overkamp@web.de
Michaela Huber Huber_Michaela@t-online.de
Greece Niki Nearchou fnearcho@psy.auth.gr

Iceland Gyda Eyjolfsdottir salarafl@gmail.com
Ireland Eileen Noonan eileennoonan1@ireland.com
Susan Cahill cahillsm@eircom.net
Toni Doherty tony.doherty@yahoo.co.uk
29
ESTD Newsletter
Isral Eli Somer somer@research.haifa.ac.il

Irit Ofri iritofri@gmail.com
Italy Giuseppe Miti giuseppe.miti@libero.it

Barbara Gallo babagallo@gmail.com
Giovanni Tagliavini giotagliavini@yahoo.it
Latvia Ilze Damberga lze.gerharde@lu.lv

Netherlands Marika Engel engel@cphogeweg.nl
Astrid Steenhuisen steenhuisen@cphogeweg.nl
Norway Ellen Jepsen ellen.jepsen@modum-bad.no

Arne Blindheim ar-blind@online.no
Poland
Agnieszka Widera-Wysoczanska
instytut@psychoterapia.wroclaw.pl
Romania Anca Sabau ancavsabau@yahoo.com

Serbia Vesna Bogdanovic vesnabgd@virgilio.it
Slovak Republic Hana Vojtova hanavojtova@seznam.cz
Spain Anabel Gonzalez anabel_gonzalezv@hotmail.com
Dolores Mosquera doloresmosquera@gmail.com
Sweden Doris Nilsson doris.nilsson@liu.se

Anna Gerge anna@insidan.se
Switzerland Eva Zimmermann eva.zimmermann@bluewin.ch

Jan Gysi jan.gysi@rs-e.ch
Turkey Vedat Sar sar@klinikpsikoterapi.com

Erdinc Ozturk erdincerdinc@hotmail.com
30
ESTD Newsletter
31
Country Contact person E-mail
Ukraine Oleh Romanchuk olerom@ukr.net

UK Scotland Remy Aquarone remyaquarone@dissociation.co.uk
Colin Howard colin@harrishoward.com
Mike Lloyd mike.lloyd@cwp.nhs.uk
Christopher Findlay christopher.findlay@btinternet.com
European Society for Trauma and Dissociation

E.S.T.D.
1ste Hogeweg 16-a
3701 HK Zeist
The Netherlands
Email: info@estd.org
Website: www.estd.org

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EDITORIAL BOARD/

Volume 3, Number 6, March 2014

EUROPEAN SOCIETY FOR TRAUMA AND DISSOCIATION

Volume 3, Number 6, March 2014

Volume 3, Number 6, March 2014

Even though we had moved on to other places, even though

LETTER FROM THE PRESIDENT

A WARM WELCOME TO THE NEW ESTD

Volume 3, Number 6, March 2014

Suzette Boon PhD Clinical psychologist/psychotherapist

THE TREATMENT OF CLIENTS REPORTING (RITUAL) ABUSE BY ORGANISED

Volume 3, Number 6, March 2014

Volume 3, Number 6, March 2014

Volume 3, Number 6, March 2014

The perpetrator networks

Volume 3, Number 6, March 2014

Volume 3, Number 6, March 2014

When the abuse appears to be ongoing

Volume 3, Number 6, March 2014

Pitfalls and dilemmas during treatment

Volume 3, Number 6, March 2014

Volume 3, Number 6, March 2014

Volume 3, Number 6, March 2014

2014 Suzette Misrachi, All Rights Reserved

Volume 3, Number 6, March 2014

Volume 3, Number 6, March 2014

Volume 3, Number 6, March 2014

Camden-Pratt, C. E. (2002). Daughters of Persephone: Legacies of maternal "madness". University of Western

Volume 3, Number 6, March 2014

by Orit Badouk Epstein

Directors: Dani Menkin & Yonatan Nir, 2012

Whats more, he refuses to reconnect with his mother and return

Volume 3, Number 6, March 2014

behaviour and conclude that we have done wrong. It encompasses

To find out more, please join

The film is a humanitarian one

We know dissociative amnesia is all too helpful for such an

Wilson et al (2006) argue that States of post traumatic shame

Psychotherapists have an occupational hazard

by the responsible authorities. I was forcefully reminded of the

Volume 3, Number 6, March 2014

abuse syndrome of childhood. Here various forms of oppression

Sales of similar titles do show that there is a market for special

Editorial will be keeping an eye on sales, and there is the

Volume 3, Number 6, March 2014

an ebook after 2 years. Again, performance of previous titles

Volume 3, Number 6, March 2014

ON THE BRIGHT SIDE

- Inspiring VignettesFromThe ConsultingRoom

Our experience tells us that even in therapeutic work as challenging as

Volume 3, Number 6, March 2014

HOT OFF THE PRESS

The behavior patterns of abused children as described in their testimonies

Volume 3, Number 6, March 2014

Empirical Testing of Criteria for Dissociative Schizophrenia

Trauma Group Therapy: The Role of Attachment and Therapeutic Alliance

Institutional abuse and societal silence: An emerging global problem

Volume 3, Number 6, March 2014

Volume 3, Number 6, March 2014

Volume 3, Number 6, March 2014

Volume 3, Number 6, March 2014

DATES FOR YOUR DIARY IN

Registration now now open

27-29 March 2014 Denmark, Copenhagen