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Research suggests that dissociative disorders are among the most underdiagnosed and undertreated in psychiatry. The situation is similar in psychoanalysis, where ever since Freud's repudiation of the “seduction hypothesis,” dominant theories have favored fantasy and repression over considerations of trauma and split consciousness (recent countercurrents notwithstanding). The reasons for this “dissociation of dissociation” are fascinating to explore, but more pressing are its
practical consequences, which include the production of generations of clinicians comparatively few of whom have true expertise in understanding and treating dissociative pathology. Richard Chefetz is one of those few, and his new book is a goldmine for anyone struggling to understand this most perplexing and important of fields.
Intensive Psychotherapy for Persistent Dissociative Processes makes an immense contribution both theoretically and clinically. Theoretically, Chefetz weaves together cognitive and affective neuroscience, attachment theory, and relational psychoanalysis into a unified framework for understanding an array of complex clinical problems with dissociation at their core. If Chefetz is right, these include not only dissociative disorders and PTSD, but also many personality disorders and addictions. The breadth of that list will be unremarkable to readers who already think of the mind as “a conglomerate of self-states” (a theory of mind perhaps best characterized within psychoanalysis by Philip Bromberg, with whom Chefetz has previously collaborated). What sets Chefetz apart is his foregrounding of dissociative processes, with comparatively less emphasis on the structure and contents of self-states per se. It's not that configurations of self-states are unimportant for Chefetz; far from it. But he maintains that clinicians will recognize “more people with dissociative disorders by staying aware of dissociative processes than they will ever notice if they are intent on looking f