By Igor Pietkiewicz, PhD and Radosław Tomalski, MD, PhD, ESTD representatives for Poland
Poland is a country in central Europe, with a population of more than 38 million people. According to the Central Statistical Office, in 2013, there were more than 1.6 million people (over 4 per cent of the population) treated in outpatient units for mental disorders (predominantly anxiety and mood disorders) or substance abuse. There is no information about the incidence or prevalence of various types of abuse. The number of licensed psychotherapists is relatively low in comparison to that of healthcare consumers. There are about 1000 psychotherapists holding a certificate of the Polish Psychiatric Association or the Polish Psychological Association (the two oldest and largest professional organisations in the country). It is difficult to estimate the number of therapists in training, because psychotherapy schools do not provide such information. There are currently only 5 ESTD members in Poland and our activities are closely linked to the SWPS University of Social Sciences & Humanities Faculty in Katowice.
HIGHLIGHTING THE SIGNIFICANCE OF TRAUMA
In 2015 and 2016, our work focused on the dissemination of knowledge about the diagnosis and treatment of trauma-related disorders among healthcare practitioners who attended numerous events we organised in Katowice: two conferences dedicated to the psychotherapy of psychosis and a few workshops on trauma. During the conferences, Trevor Eyles from Denmark delivered interesting presentations on the “Maastricht approach” and the “Aarhus model” followed by 3-day workshop for psychiatrists and voice-hearers on “Voices-led therapy”. Andrew Moskowitz also gave a pre-conference, whole-day workshop "Reconceptualizing trauma, dissociation and psychosis: Can ‘madness’ have a meaning?" There were also two intense and inspiring two-day workshops led by Suzette Boon: “Diagnosis and differential diagnosis of dissociative disorders and other trauma-related disorders” in October 2015, and “Long-term consequences of chronic traumatization: Assessment and phase 1 treatment of Complex PTSD and dissociative disorders” in September 2016. Suzette additionally agreed to give an interview about the effects of trauma, which was recorded and made available to students and the general public via the University page and social media: http://swps.pl/dysocjacja. In 2016, Giovanni Tagliavini, Antonio Onofri, and Giovanni Liotti were invited by a small group of therapists from Poznań and Katowice, to talk about dissociation, adverse childhood experiences, grief, and disorganized attachment. A number of valuable books about trauma and dissociation have also been published in Poland recently, but this is beyond the scope of this brief report to enumerate all of them. However, it is worth mentioning that a few these publications have been translated from Italian by Hanna Michalska, a Polish ESTD member.
To develop education in our field and attract new members to ESTD, a Trauma and Dissociation Seminar was also launched at the University, where professionals can meet and discuss practical aspects of diagnosis and treatment. This seminar is supported by ESTD members who agreed to participate online and share their experience. In November 2016, Anabel Gonzalez from Madrid gave an introductory talk about dissociative phenomena and disorders, and in March 2017, Giovanni Tagliavini from Milano will talk about treatment of dissociative disorders (http://badaniepsyche. pl/news/11). A Facebook interest group for trauma and dissociation has also been established, to share news and encourage discussion.
To support further research and therapeutic work, we prepared a cultural adaptation of several popular screening instruments: a revised version of the Dissociative Experience Scale (DES-R), Dissociative Symptoms Scale (DSS), Somatoform Dissociation Questionnaire (SDQ20), and Trauma Experiences Checklist (TEC). We are also planning to support Prof. Eli Somer in creating a Polish version of his instrument to measure maladaptive daydreaming. Two structured clinical interviews were also translated into Polish: Trauma and Dissociation Symptoms Interviews (TADS-I) and the Maastricht Interview to explore the experiences of people hearing voices.
TALKING TO THE DEVIL
In Poland, which is predominantly Catholic, many people are highly involved with religious communities, affecting practitioners’ values, social axioms, and illness-behaviour, including how they conceptualise symptoms and seek help. In many groups, individual and collective exorcisms are practised for those who experience changes in behaviour and identity, attributed to possession. At the beginning of 2016, we launched a pilot study to explore phenomena and symptoms associated with possession. We submitted a grant proposal to the National Research Centre, hoping to obtain the budget to continue this study. We submitted another one for research into depersonalisation and derealisation in clinical and non-clinical samples.
We received great support from Prof. Onno van der Hart and Dr. Suzette Boon in creating both projects and running a pilot study. Both grant proposals are undergoing an evaluation process. One of them has already received very good reviews from the Polish experts and qualified for phase two (review of international experts). Success in that would lead to establishing a Centre for the Study of Trauma & Dissociation at our University, employing research assistants and developing international co-operation.
We are extremely grateful for ESTD's warm reception and the continuous support we receive from the board and regular members who support us in these endeavours.
Alterations in consciousness are common experiences in healthy individuals and patients with a variety of mental disorders. Such states may also be natural reactions to traumatic experiences, and accompanied by dissociative symptoms, when the mind detaches itself from overwhelming feelings and one’s surroundings to survive. Depersonalization (a sense of detachment from one’s mind or body) and derealization (experiencing the external world as dreamlike or unreal) can be experienced with different intensity and in various contexts, for example, during meditation, religious practices or intense sports exhaustion.
Some forms of depersonalization and derealization are chronic, significantly dysfunctional, cause distress, and are regarded as pathological. Yet there are no empirical studies that compare normal and pathological depersonalization / derealization, how they relate to trauma, and how individuals subjectively experience them.
In this project, structured clinical interviews with trauma survivors are conducted, video-recorded and analysed by the research team to explore personal experiences of depersonalisation, derealisation, and dissociation. Such studies are necessary to help clinicians recognise and diagnose dissociation and alterations in consciousness characteristic of trauma-related disorders, subsequently leading to better diagnostics, referral, and treatment.
This project offers you: free-of-charge assessment of dissociative symptoms and diagnostics towards a dissociative disorder, a comprehensive report about your symptoms which you can share with your doctor or therapist, and an opportunity to discuss your problems and recommendations for treatment.
The project is financed by the National Science Centre in Poland, grant number: 2016/22/E/HS6/00306.
Igor Pietkiewicz, Ph.D.; Radosław Tomalski, M.D., Ph.D.; Suzette Boon, Ph.D.; Onno van der Hart, Ph.D.; Anna Bańbura, M.Sc.; Szymon Nęcki, M.Sc.; Anna Hełka, Ph.D.