Dissociative Collusion: Reconnecting Clients with Histories of Trauma in Couple Therapy.

This paper introduces the concept of "dissociative collusion" as a helpful theoretical and clinical tool for understanding and working with clients with histories of trauma in couple therapy. The paper describes ways to diagnose and treat dissociative collusion based on the integration of an object relations approach, a relational approach, and a narrative approach. Dissociative collusion, a unique version of the well-documented "couple collusion," describes relational unconscious dynamics where split-off aspects of one or both partners are mutually dissociated in a complementary fashion that becomes a part of the shared unconscious and is reenacted in destructive ways. The dissociative collusion concept is especially relevant to couple therapists who work with clients with histories of trauma, who frequently use dissociation as a primary defense mechanism. We suggest that the challenge and goal for couple therapy with this population are to help them reconnect and better oscillate between dissociated self-other configurations. A case of couple therapy of a wife who had been a victim of childhood sexual abuse and her husband who displayed frequent use of dissociative defenses is presented.

Este artículo presenta el concepto de "colusión disociativa" como herramienta teórica y clínica útil para comprender y trabajar con pacientes con antecedentes de trauma en la terapia de pareja. El artículo describe maneras de diagnosticar y tratar la colusión disociativa basándose en la integración de un enfoque de la relación de objeto, un enfoque relacional y un enfoque narrativo. La colusión disociativa, una versión única de la bien documentada "colusión de pareja", describe una dinámica relacional inconsciente donde los aspectos de la separación de uno o ambos integrantes de la pareja están disociados mutuamente de una manera complementaria que se vuelve parte del inconsciente compartido y se restablece de maneras destructivas. El concepto de colusión disociativa es especialmente relevante para los terapeutas de pareja que trabajan con pacientes con antecedentes de trauma, quienes con frecuencia usan la disociación como mecanismo de defensa principal. Sugerimos que el desafío y el objetivo para la terapia de pareja con esta población es ayudarlos a reconectarse y a oscilar mejor entre configuraciones disociadas del otro yo. Se presenta un caso de terapia de pareja de una esposa que había sido víctima de abuso sexual en la infancia y su esposo que demostró el uso frecuente de defensas disociativas.

Couples therapy with childhood sexual abuse survivors (CSA) and their partners: establishing a context for witnessing.

This article proposes a clinical practice for therapy with couples in which one partner suffered sexual abuse in childhood. Such couples often encounter unique difficulties with physical contact, intimacy, sexuality, communication, and trust, and their relationship dynamic may be marked by reenactments of past traumatic relational patterns. This clinical practice is founded on the assumption that establishing the witnessing lacking during the traumatic event in childhood can break the traumatic reenactments in adulthood, and spur recovery. The suggested practice may facilitate twofold witnessing: the couple's therapist witnesses the reenactments of the trauma in the couple's relationship; and the survivor's partner witnesses the trauma's effect on the survivor's personal life and relationship. Twofold witnessing can help break the cycle of traumatic reenactment and help the survivor integrate the events of her life into a more coherent, continuous narrative. The partner's presence also facilitates acknowledgement of what happened to the survivor, and helps the survivor elaborate on her stories of resistance, survival, and strength. Finally, each of the partners is able to appear more wholly and fully, and together to tell the preferred stories of their life as a couple, replete with the multiple relational patterns they wish to live, which may contradict the characteristics of the original trauma.