Enhancing Methodology for Investigation of
Trauma and Dissociation: Findings from a
Randomised Control Trial Comparing Trauma
Therapies for Sexual Assault Victims
McDonald & Chichiniova, BACP 2015
WHAT IS DISSOCIATION?
• Definition: Dissociation is a
complex psychophysiological
process that alters the
accessibility of memory and
knowledge, integration of
behavior, and sense of self
(Putnam, 1994).
• Epidemiology: challenges in
documenting dissociation &
emerging international
patterns (Sar, 2010)
DISSOCIATION IN THERAPY
 Early: inhibiting working
alliance
 Middle: inhibiting
processing of key life
events & experiences
 Termination: inhibiting
decision-making around
termination
THE PRESENT ANALYSIS: RCT
EXAMINING THE EFFICACY OF
TREATMENTS FOR PTSD
 Sample 27 women
 137 women completed preliminary assessment
 74% did not meet the inclusion criteria
 Design
 Cross-over design
 6 observational points
 Cognitive Processing Therapy (CPT) x Observed and
Experiential Integration (OEI) x Control
THE IMPACT OF EVENT SCALE-REVISED (IESR) COMPLEX PTSDGROUPS
cPTSD 1
cPTSD 2
4
4
3.5
3.5
3
3
2.5
2.5
107: OEI 1
2
110: OEI 1
119: OEI 1
1.5
114: OEI 2
2
130: OEI 2
133: OEI 2
1.5
1
1
0.5
0.5
0
0
1
2
3
4
5
6
1
2
3
4
5
6
IES-R PTSD GROUP
4
3.5
3
2.5
103: OEI 3
2
123: OEI 3
1.5
1
0.5
0
1
2
3
4
5
6
METHODOLOGICAL RESEARCH INNOVATION
RECOMMENDATIONS
LIMITATIONS OF CURRENT RESEARCH
PRACTISES
Frequent invisibility [insensitivity] of cPTSD
 Client heterogeneity of presentation of dissociation
patterns
 High base rate of dissociation in therapy
 High rates of false negatives in standard assessment
protocols
 Frequent masking of dissociation patterns in group
statistics
 Screening & recruitment protocols
EXPANSION OF SCREENING PROTOCOLS
 Variety of instruments and modalities of assessments
 Self-report
 Observation
 Clinical interview
 Ideographic assessment protocols
 Tailored specifically to client history & presentation
 Frequent assessment over time of state & trait dissociation
THERAPY PROCESS AS A RESEARCH DESIGN
PRIORITY
 Triangulation of multiple data sources on therapy
process
 Repeating client & therapist observations over time
 Tracking clinical states & clinical processes via microattunement in addition to standard clinical protocols
 Idiographic profiles in presentation of dissociation
 E.g., discrepancy analysis betw. reports, obs., etc.
 Cross-case analysis to examine heterogeneity in response
to assessment, treatment interventions, and so forth
Hermeneutic Single-Case Efficacy
Design (Elliott, 2001)
 Rich case record
 Positive evidence: clear links between
therapy process and outcome
 Negative Evidence: evaluating
competing explanations for observed
pre-post change