Commentary on Takahashi's "Is MPD really rare in Japan?"

p. 066-06

Abreaction re-evaluated

p. 127-140Contemporary clinicians working in the field of multiple personality disorder (MPD) generally agree that pathogenic traumatic memories are at the root of this dissociative disorder. Examination of contemporary studies, however, shows that diagnostic and therapeutic conceptualization remains muddled and frequently contradictory. This confusion stems back to Breuer and Freud's "Studies of Hysteria," in which they used two contradictory models concerning the nature and treatment of traumatic memories. The first model was in terms of dissociation and integration, processes which already had a French pedigree (particularly with Pierre Janet), and the second was their own model which they developed in terms of the principle of psychological constancy and abreaction. In the literature on trauma since Breuer and Freud, e.g., studies on post-traumatic stress during and after World Wars I and II and the Vietnam war, different authors have emphasized either one or both models. The present authors critically re-evaluate abreaction and advocate the dissociation-integration model as the basis for further conceptualization, discussing the role of emotional expression within it

A reader's guide to Pierre Janet on Dissociation: A neglected intellectual heritage

p. 003-016A century ago there occurred a peak of interest in dissociation and the dissociative disorders, then labeled hysteria. The most important scientific and clinical investigator of this subject was Pierre Janet (1859-1947), whose early body of work is reviewed here. The evolution of his dissociation theory and its major principles are traced throughout his writings. Janet's introduction of the term "subconscious " and his concept of the existence of consciousness outside of personal awareness are explained. The viability and relevance of dissociation as the underlying phenomenon in a wide range of disorders is presented. It is proposed that, Janet's theory and methodology of psychological analysis and dynamic psychotherapy are cogent and relevant for today's students and practitioners

Treatment strategies for complex dissociative disorders: two dutch case examples

p. 157-165In the Netherlands, the diagnosis of dissociative identity disorder (DID) is widely accepted, although skeptics also have made their opinions known. Dutch clinicians treating DID patients generally follow the common three-phase model for treatment of post-traumatic stress. Given the fact that they usually deal with complicated cases and enmeshed patients (cf. Horevitz E. Loewenstein, 1994), most often treatment is restricted to Phase 1: stabilization and symptom reduction. Treatment of higher functioning patients, on the other hand, usually aims at processing of traumatic memories and complete personality integration as well. In this article, two Dutch cases are described in detail, with a special emphasis on the clinical deliberations which, in the first case, led to the decision to proceed to trauma treatment, and which led in the second case to the decision to refrain from it

Introduction to the Amsterdam Papers

p. 077-07

Ian Hacking on Pierre Janet: a critique with further observations

p. 080-08

Discussion of: "metaphors of agency and mechanisms in dissociation"

p. 164-16

Multiple personality disorder in Europe: impressions

p. 102-118Based on his personal knowledge of the field in the Netherlands and on written reports from colleagues in other European countries, the author presents an impressionistic overview of the state of affairs in the field of diagnosis and treatment of MPD in Europe. His main impression is of the relatively advanced state of affairs in the Netherlands, although many problems are still encountered. In Britain a few serious developments take place, but mainstream psychiatry is unsupportive. In other European countries developments lag behind even more, but there are also signs that changes for the better will occur. Special attention is given to a systematic study regarding Swiss psychiatrists’ familiarity with MPD. Finally, a number of lessons for spreading knowledge about MPD and dissociation and for mutual support among MPD clinicians are presented

Abreaction re-evaluated: author's reply to Peterson

p. 07

Treatment of DID and DDNOS patients in a regional institute for ambulatory mental health care in the Netherlands: a survey

p. 073-083To survey the number and characteristics of DID and DDNOS patients treated at a Regional Institute for Ambulatory Mental Health Care in the Netherlands, their treatment goals and treatment course, and the organizational investment, semi-structured interviews were held with therapists about all patients diagnosed with DID or DDNOS during a three-month period (May 31, 1993 - August 31, 1993), and a study of these patients' files took place. One hundred one patients received a dissociative disorder diagnosis, i.e., forty-one the diagnosis of DID and sixty the diagnosis of DDNOS. On average, these patients received the dissociative disorder diagnosis after a treatment period of over two years. Most therapists followed a basic stage-oriented treatment model. In the majority of cases, hypnosis was an important adjunctive technique. For more than half of the patients (DID:53.7%; DDNOS:60.0%), therapists reported stabilization and symptom reduction as the treatment goal. For one-third (DID: 39.0%; DDNOS: 31.6%), the focus included treatment of traumatic memories as well as reintegration and rehabilitation. This objective was chosen within one to three years of stabilization and symptom reduction. Average treatment length was six years, most often with a frequency of one session a week. In 10% of all cases, a second therapist joined the treatment. Therapists reported concern with regard to: boundary issues, co-therapy, diagnostic issues, (contra) indications for treatment of traumatic memories, attachment problems, cooperation with other agencies, underdevelopment with regard to dissociative disorders in child and adolescent mental health care. The emphasis on supportive therapy only and the use of secondary therapists may perhaps be different from clinical approaches elsewhere