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In this comment to Paolo Stramba-Badiale’s description of his clinical case, I argue that the therapist’s acknowledgment of feelings of powerlessness both in self and in the patient, without surrendering to them and without untimely attempting to overcome them, is a major factor of therapeutic change in the treatment of dissociative adults who had been chronically traumatized since early childhood. Consideration of the dynamic tension between the motivational system engaged in coping with environmental threats (freezing-fight-flight-feigned death) and the care-seeking (attachment) system provides the background for the argument, together with the knowledge of the controlling interpersonal strategies that typically follow, during childhood, infant attachment trauma. [ABSTRACT FROM PUBLISHER]

For about a century clinical observations suggested the association between dissociative symptoms and developmental trauma. Retrospective and prospective studies confirmed that dissociation is the central pathogenic process of developmental trauma. Dissociative processes generate dissociative symptoms likely to dominate some clinical pictures such as Dissociative Disorders or Borderline personality disorder, or also surface, in different proportions, in practically all DSM-IV diagnostic categories as an index of negative outcome. This paper aims to review some crucial issues on dissociative phenomena and processes originated from traumatic experiences in childhood. The article also purposes the existence of a traumatic-dissociative psychopathological dimension, its clinical meaning and the treatment strategies to overcome the difficulties it causes during psychotherapy. [ABSTRACT FROM AUTHOR]

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The article offers an historical review of studies on the role played by attachment processes in dissociative psychopathology. The treatise proceeds from Bowlby's first insights, through Main and her collaborators' empirical studies on attachment disorganization, to the first formulation of the hypothesis linking disorganized early attachment to pathological dissociation. Recent research supporting the hypothesis is then reviewed. It is concluded that infant attachment disorganization is in itself a dissociative process, and predisposes the individual to respond with pathological dissociation to later traumas and life stressors. Four implications of this theory are interspersed in the re- view and are discussed in the final section: (I) pathological dissociation should be viewed as a primarily intersubjective reality hindering the integrative processes of consciousness, rather than as an intrapsychic defense against mental pain; (2) early defenses against attachment-related dissociation are based on interpersonal controlling strategies that inhibit the attachment system; (3) dissociative symptoms emerge as a consequence of the collapse of these defensive strategies in the face of events that powerfully activate the attachment system; (4) psychotherapy of pathological dissociation should be a phase-oriented process focused primarily on achieving attachment security, and only secondarily on [ABSTRACT FROM AUTHOR]