Towards reconnecting: creative formulation and understanding dissociation

Publication Date13 March 2017
AuthorSarah L. Parry,Mike Lloyd
SubjectHealth & social care,Mental health
Towards reconnecting: creative
formulation and understanding
Sarah L. Parry and Mike Lloyd
Purpose The term dissociation can describe a coping strategy to protect oneself against something
unwanted in the moment, a disconnection from sensations and experiences in the here and now. Although
the more severe experiences of dissociation have been the subject of intense study over the last two
decades, much less has been written about clients commonly seen in mental health services with mild to
moderate dissociative conditions. Specifically, the purpose of this paper is to attend to therapeutic work with
a client who experienced moderate dissociation, which caused disruptions to her autobiographical narrative
and sense-of-self.
Design/methodology/approach This single case design details the therapeutic journey of a Caucasian
woman in her early 40s, who experienced moderate dissociation. The report illustrates how the process of
creative artwork formulation helped address unwanted dissociative experiences whilst enhancing other
coping strategies.
Findings The clientspersonal resources combinedwith a creative and responsive approachto formulation
and reformulationfacilitatedthe process of reconnectingwith herself and othersthrough developing awareness
of her strengths and past meansof coping, finally developing a consistent self-narrative.
Practical implications The experiences of a creative approach to formulation are discussed in relation to
the clients past traumas and case relevant theory. These preliminary findings suggest creative artwork
formulation is an effective tool in terms of developing trust and shared understanding within the therapeutic
relationship and meaning making processes throughout therapy.
Originality/value This case study presents an account of creative artworkformulation used as a method of
formulation and reformulation specifically with a client experiencing moderate dissociative experiences
following interpersonal traumas. Further, the report discusses the ways in which creative artwork formulation
facilitated memory exploration and integration, as well as containing meaning making and healing.
Keywords Coping mechanisms, Therapeutic relationship, Artistic expression,
Creative artwork formulation, Detachment, Moderate dissociation, Therapeutic alliance
Paper type Case study
The term dissociation refers to a psychological process that is thought to be protective in nature
and usually develops in childhood as a response to interpersonal traumas, which often involve a
main carer (Brand et al., 2009; Lanius et al., 2014). When the extensive literature surrounding
the role of antecedent traumas for dissociation is considered (e.g. Dalenberg et al., 2012;
Schore, 2009), it is not surprising that many people who come to mental health services report
dissociative experiences in addition to more commonly identified conditions, such as anxiety or
low mood. Dissociation is often described as a collection of confusing and unknown experiences
associated with other psychological difficulties (Şar, 2014) such as anxiety, depression,
persistent pain or grief. Further, international epidemiological general population studies have
suggested that the prevalence of dissociative conditions, as defined by the Diagnostic and
Statistical Manual of Mental Disorders (DSM-5 Task Force and American Psychiatric Association,
2013) is as high as 8.6-18.3 per cent (Martinez-Taboas et al., 2013). Therefore, it is likely that
many practitioners will encounter clients experiencing dissociation, even in community and
non-specialist settings (e.g. Wilson, 2015).
Received 17 November 2015
Revised 21 May 2016
15 October 2016
15 November 2016
Accepted 21 November 2016
Sarah L. Parry is a Senior
Lecturer in Clinical Psychology
at the Faculty of Health,
Psychology and Social Care,
Manchester Metropolitan
University, Manchester, UK.
Mike Lloyd is a Clinical
Psychologist at Vale Royal
Adult Mental Health Service,
Vale House Resource Centre,
Winsford, UK.
PAG E 28
VOL. 22 NO. 1 2017, pp. 28-39, © Emerald Publishing Limited, ISSN 1361-9322 DOI 10.1108/MHRJ-11-2015-0033

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