Abstract
The College Special Interest Group on Psychological Trauma is currently celebrating its fourth anniversary having just supported the 3rd World Conference for the International Society for Traumatic Stress Studies (ISTSS), and having sponsored Professor Onno van der Hart's highly successful, Australia-wide lecture tour. I shall briefly report on the tour, summarise our group's achievements, and indicate our plans.
First, a few words to introduce Professor van der Hart. Among other positions, Professor van der Hart is currently Chief of Research at the Cats Polm Institute, The Netherlands; Professor, Department of Psychology, University of Utrecht; and Member of the Board of Directors, ISTSS. He trained as a clinical psychologist in The Netherlands, and then specialised in individual and family therapy in North America. By the early 1980s when he entered the field of psychological trauma, he was already the doyen of Dutch psychotherapists. I met Professor van der Hart in Jerusalem in the mid-1980s when he was on sabbatical leave, and I was directing psychiatric residency training at the Hebrew University Medical School. We continued to collaborate by Email.
In recognition of his contribution to the field (see selected publications), our Steering Committee agreed to sponsor his lecture tour, and to support the 3rd World Conference for the ISTSS where Professor van der Hart was invited to be keynote speaker. The antipodean venue had been selected in honor of the outgoing president, Professor Sandy Mac-Farlane. In addition to the Keynote oration, he gave two workshops and participated on several panels. Following this he delivered the prestigious Beatty-Smith lecture at Melbourne University, and several workshops under the joint aegis of the College Special Interest Group on Psychological Trauma, the Pierre Janet Centre, and three other participating organisations: the Albert Road Clinic, Melbourne; Belmont Hospital, Brisbane; and the Australian & New Zealand Association of Psychotherapists, Sydney.
Professor van der Hart presented scientific studies of complex PTSD, not only in adult survivors of child sexual abuse, but also in Holocaust survivors, War Veterans and victims of “incidental” trauma. His main contribution was detailed reportage of his novel and innovative structural model of dissociation. Some of its key tenets are as follows. The principal etiological contribution to dissociation is traumatic stress. All post-traumatic syndromes, most notably PTSD, somatoform disorder, borderline personality disorder and dissociative identity disorder, manifest dissociation. There are three levels of severity of dissociation, corresponding to the severity of the respective posttraumatic disorder. Professor van der Hart also outlined his studies of dissociative amnesia and spoke of integration in phenomenological and psychopathology areas of the sense of reality, of the present and of the self. He drew our attention to shortcomings of DSM-IV, vis-a-vis ICD-10 which covers somatoform dissociation. To Complement the DSM-based SCID-D, Nijenhuis & Van der Hart developed the Somatoform Dissociation Questionnaires (the SDQ-30, and a short form, the SDQ-5). He noted that ICD-10 contains out-dated notions of dissociative identity disorder.
Professor van der Hart is not only an experimental researcher; for example studying state-dependent responses to subliminal threat stimuli in dissociative identity disorder patients, but also a clinician researcher and psychiatric historian. He has provided particularly rich analyses of posttraumatic dissociation in WWI combatants. His historical studies are almost entirely based on an examination of the primary literature, drawing upon English, French, and German sources. They are some of the most comprehensive and innovative in the field.
Basing his views on the oeuvre of Pierre Janet, which he succinctly outlined, Professor van der Hart and his colleagues enunciated a three-stage model of posttraumatic stress, and a corresponding three-stage model of treatment. He made it clear that all three treatment levels—stabilisation of the mental state, neutralisation of trauma, and synthesis and rehabilitation of the personality—are essential to all trauma treatment, whatever the technical modalities employed.
Turning to the overall activities of the College Special Interest Group on Psychological Trauma, these have ranged from annual weekend meetings, symposia at the College Congress, to a steering committee think tank. As a result of the latter, the first of four papers proposing integrative empirical and ethical approaches to psychological trauma is about to be published. It is on diagnostic aspects. Others on treatment, service delivery, and training and research are at the final draft stage. Further conjoint publishing ventures are on the drawing board.
A further important Special Interest Group initiative is post-graduate specialist training in psychological trauma. The first venue will be in Perth. The Group also plans to carry out multi-centre collaborative research. Fields of investigation will include trauma and self-harm, and the relationship between post-traumatic intrusive symptomatology and impairment of attention and working memory. There is also significant interest in medico-legal and political aspects of traumatology, and in patient—and community advocacy.
The next meeting of the Special Interest Group will be held in October 2000, entitled “Trauma and self harm”. Further details will be announced shortly. Prior to this, the Special Interest Group presented a symposium at the Annual College Congress in Adelaide, April 2000, entitled, “The psychobiology of trauma”. At this symposium, Professor Sandy MacFarlane presented kindling models of trauma, Professor P. Morris, anti-kindling agents, Professor R. Meares, hierarchical approaches to trauma, and Paul Brown, dissociative hallucinosis and pseudohallucinations.
To date some 300–400 College Fellows have attended the Trauma Special Interest Group activities, and we hope to grow further. Trauma presents an integrative paradigm for psychiatry, in which the stress– diathesis model takes on a wider light. We invite all College Fellows to support the activities of the Special Interest Group on Psychological Trauma.