By Manoëlle Hopchet and Serge Goffinet, ESTD representatives for Belgium
Manoëlle Hopchet, clinical psychologist. President of the Belgian Institute for Psychotrauma and EMDR, President elect ESTD
The field of knowledge about dissociative disorders has not developed in the same way in french-speaking and dutch-speaking communities in Belgium. In Flanders (Dutch-speaking area), interest in dissociative disorders had come from the U.S. in the 1990s and resulted in the founding of the former Dutch-Flemish Association for the study of Dissociative Disorders (NVDDS) in 1994. This organization originated in the Netherlands and was active for a period of ten years. The association organized conferences, seminars and various training courses on the diagnosis and treatment of dissociative disorders in the Netherlands and Flanders. In 2004 with interest waning and organizations being less prepared to free up money and time for their clinicians, the board of the NVDDS chose to wind up the Association. Finances were directed on one hand to the creation of the national center for early childhood chronic traumatization (LCVT) in the Netherlands and on the other to establishing the ESTD. The vision for the ESTD was to pursue a wider partnership within Europe.
In Flanders there is now little attention given to the field of dissociation and dissociative disorders. Only a few research articles written by our Flemish colleagues (e.g., Johan Vanderlinden, Dirk De Wachter, Walter Vandereycken , and colleagues) can be found along with several articles on related themes. Dissociative disorders remain the subject of controversy between ‘believers’ and ‘non believers’ and this debate has not changed in Belgium for more than twenty years.
In the psychiatric field, dissociative disorders are more often categorized as personality disorders, so the interest in psychiatric units, especially in acute hospital settings is very low. But there is also some hope: After discussion with several psychology colleagues, I can tell that today in mental health centers discussion on and interest in the dissociative disorders is alive and increasing. This is partly due to recent publications in Dutch by Onno van der Hart, Ellert Nijenhuis, and Eric Vermetten, Simultaneously, it is sad to announce that due to financial constraints, mental health centers are focusing more and more on short-term work, which becomes a real concern for the treatment of chronically traumatized patients. Furthermore, private therapists complain about the difficulty they have referring these patients to services that offer specialized treatment. An often negative treatment outcome for these ‘difficult’ clients and their acting out behavior indicate a general lack of knowledge and training in trauma and dissociative symptoms.
This brings us to the question of training in complex trauma and dissociative disorders. In 2002 we created with some colleagues in Belgium the Belgian Insititute for Psychotraumatology and EMDR and since 2006 we devote attention to the training of French-speaking and Dutch-speaking clinicians, psychotherapists and psychiatrist in chronic trauma issues. Our courses focus attention on various aspects and treatment possibilities related to the effects of psychological trauma. From the ever-growing interest in chronic psychological trauma, rather acute PTSD, including the establishment in 2006 of the Dutch (The Netherlands and Flanders) Association for Psychological Trauma (NtVP) we can slowly but surely notice an increasing and new interest about dissociative disorders and their treatment, especially among psychologists and psychotherapists.
Serge Goffinet, MD, psychiatrist, psychoanalyst, member of the International Lacanian School. Since 1997 he has been treating adolescents with dissociative disorders in both out-patient and in-patient settings.
French-speaking psychology and psychiatry in Belgium are grounded in the psychoanalytic traditions (mainly Lacanian, with some Freudian tendencies and some affiliation to Jungian and other schools). Very few psychologists were doing classical hypnosis and less than ten French-speaking Belgians were members of ISSTD before 1995. After 1995, trainings in hypnosis (e.g., Institut de la Nouvelle hypnose) and EMDR (e.g. Belgian Institute for Psychotrauma and EMDR, BIPE) were initiated. These techniques became more widely used in clinical practice and some people trained in traumatology also became knowledgeable about dissociative disorders. Bilingual foreigners or other multilingual Belgian (i.e., Flemish) gave workshops and trainings which at times addressed dissociative disorders
From 1996 to 2004 the countries around Belgium provided greater influences:
1. the Netherlands: Translations of the work of Van der Hart, Nijenhuis, and others, especially under the influence of Erik De Soir (bilingual traumatologist and member of the Association de Langue Française pour l’étude du stress et du trauma (ALFEST)) helped to disseminate a theoretical understanding of dissociative disorders.
2. Germany: Some bilingual or multilingual people, gave workshops about traumas and/or EMDR making dissociative disorders far less “north-American”;
3. France/French-speaking Switzerland: Interest for psychological trauma in French “psychotrauma” was growing hugely, along with the re-discovery of Pierre Janet’s work on dissociation. These factors had a great influence in the taking into account dissociative disorders, as a robust diagnosis.
In Belgium, the first publication – in one of our regional scientific journal - was completed by some friends of mine (the first author had his first contacts with psychiatric patients in my unit): Storms E., Vermeiren E., Bonvin E., Dubois V., Dissociation, hypnose et psychotraumatisme, Acta Psychiatrica Belgica, 2004, 104-1, 49-53. But in that same year (2004), in a popular newspaper, there was still skepticism with an article appearing about dissociative identity disorder as a psychiatrist’s fantasy.
Since 2000, I have published at least one article per year (alone or with colleagues) in national journals on this topic (in French, of course!). Another publication was made in 2007 by colleagues: Debecker N., Lesnicki N., VermorelRondreux M. “TROUBLES DISSOCIATIFS DE L’ IDENTITÉ: UN CONCEPT DISCUTÉ” Acta Psychiatrica Belgica, 126, 5: 133-140. In this article, the authors describe the different aspects of dissociative disorders and their comorbidity. The validity of the concept of dissociative identity disorder, the historical context of appearance and its links with hysteria are also discussed.
The US TV series “United States of Tara” was seen in Belgium in 2010. A Belgian psychoanalyst, Jacques Roisin, published a book on psychotrauma (De la survivance à la vie), edited by the famous ‘Presses Universitaires de France’, with some insights about splitting and denial. In 2011, the oldest society (Society for Mental Medicine) organized in Fond’roy (my) hospital – in Brussels - a whole day on dissociative disorders with several clinicians. There was an overview of clinics, therapy and theory on the subject of dissociation.
Despite these developments, for most psychotherapists, dissociative phenomena belong to hysteria or traumatic neurosis, rather than being syndromes or disorders in their own right. This is due to the traditional roots of psychology and psychiatry related to classical psychoanalysis and linked to the skepticism a priori toward new therapeutic approaches, especially coming from the United States and English-speaking countries. Dissociative disorders are still too controversial for most French-speaking Belgian professionals. It will take a lot to convince clinicians but there are encouraging signs of an opening door to the diagnosis and therapy of chronic complex trauma.
From ESTD Newsletter Volume 2, Number 3, June 2012