Re:bls/das

In response to the first issue of whether I meant exposure therapy "creating" or "uncovering" of an alter ego, I had the latter in mind when I wrote my post, but actually it doesn't matter, as I've not personally seen an alter emerge after an exposure session. I chose to focus on the possibility of seeing a alter emerge because at least that is something I can wrap my mind around. I have to admit my ignorance here, I really don't understand what is meant by this talk of boxes caving in. I think I have at least some understanding of the use of phrases referring to techniques that "lance dissociative barriers." In which case I can tell you that, on an obersavtion level (not making any deep inferences here) and only based on clinical experience (meaning I don't expect anyone to believe this to be true), some patients in exposure therapy report that they remember things that had previously forgotten. Now, I have no knowledge of whether the new details are true or false. I have no kowledge of whether they actually just "remembered it" or are only willing to report it to me for the first time. On the other hand, many patients go through exposure therapy with a continuing sense that something is missing. When this happens we just tell them that it's OK, they may or may not remember, and to just continue with the next thing that they do remember. In either case, the goal of exposure therapy is to achieve symptom reduction, it is not to recover memories or to break down dissociative barriers. Now, it may very well be that this is not the best way to handle things. The issue has not been addressed in research, so I can't make any claims about how important this strategy is to the overall effectiveness of the treatment. But on this point, we stand on the same level, as there is no evidence that the EMDR approach is any better with this issue.

Regarding your question about whether or not I was implying that alter egos were being created by clinicians, or were projections by clinicians, etc. The answer is, I was implying nothing about the nature or reality of alter egos. I was simply reporting my own personal observations about what I've seen in my cases and in group supervision about whehter or not alter egos appear during exposure therapy. Again, I readily acknowledge that other therapists may have different experiences and I don't afford any special standing to my particular set of experiences. Moreover, I think the best way to gain knowledge about the nature and reality of dissociative phenomenon will come from systematic research, not discussions of clinical experience.

You ask whether I'm challenging the existence of dissociation. I already answered that question, and I'll repeat my answer: NO. Rather, I am simply making the as yet unchallenged statement that there is no scientific evidence for the efficacy of the EMDR Dissociation Protocol compared to standard EMDR, or anything else for that matter. Moreover, the point I am trying to make about standards of evidence would be true whether or not I believe in dissociation. Whether or not there is evidence for an additive effect of some specific component of a treatment (whether it be Sandra's dissociation protocol or some aspect of eye movements, bilateral stimulation, dual task or what have you) is independent of my beliefs.

Now regarding my reference to BPD, why did I raise it? Now, I might be mistaken here, but I thought one of Sandra's comments made comment about the difficult nature of treating people with multiple traumas. Many people who meet criteria for BPD have experienced repeated instances of childhood physical and sexual abuse. As such, they are people with a history of multiple traumas. If I am mistaken in the content of Sandra's post and subsequently committed a non sequiter, then my mistake. In no way was I trying to equate BPD with DID. To the best of my knowledge, I've yet to see a case, either directly or through supervision, of DID. For anyone interested in research on exposure and `BPD, see Feeny et al. (2002). It is far from definitive, but it is a start.

Feeny, N. C., Zoellner, L. A., &Foa, E. B. (2002). Treatment outcome for chronic PTSD among female assault victims with borderline personality characteristics: A preliminary examination. Journal of Personality Disorders, 16, 30-40.

Replies:

No clinical observation of DID?, by Sandra Paulsen Inobe, PhD, 10/29/02 Re:No clinical observation of DID?, by Cahill, 10/29/02 Re:bls/das, by missusscarecrow@yahoo.com, 10/30/02

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