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• W156768427 abstract "The dramatic diagnostic shift from to the family of posttraumatic stress disorders (PTSD's) involved a major shift clinical formulations with accompanying needs for new theoretical and practical formulations. Women Who Hurt Themselves by Dusty Miller is among the flurry of new books that quite admirably address this new need for clinical guidance.Miller includes among these women all those who do damage to their bodies, which may include self-mutilation, substance abuse, eating disorders, smoking, excessive cosmetic surgery and other symptoms, thus a rather exhaustive category she calls Trauma Reenactment Syndrome (TRS). These women are at war with their bodies (p. 28), they live embedded secrecy, they lack an internalized protective presence (p. 30), and they are preoccupied with a struggle for control (p. 27). Most seriously, they have a fragmented triadic self (p. 31) that is split into victim, abuser, and self-protective by-stander (p. 31). Especially harmful is their tendency to dissociate that they had learned as a self-protective childhood mechanism but that creates chaos their adult lives. Indeed, Miller joins other PTSD clinicians who locate the origin of these a history of severe child abuse that may or may not be clearly remembered. The women's relationships are characterized by blurred boundaries and intense ambivalence combining desperate neediness with rageful rejection.These descriptions will evoke borderline syndromes for most clinical readers, but Miller rejects this diagnosis as having disrespectful and blaming connotations. She also differentiates TRS from the diagnosis of Multiple Personality or ordinary PTSD, although less passionately so, feeling that only her specific diagnosis will lead to the correct treatment that she has been able to elaborate after years of erring in the fog of not knowing (p. 184).Miller uses the image of Three Concentric Circles (p. 181) to represent her treatment model, which is also characterized by cautious timing and pacing (p. 181) and patient listening. The Outer Circle consists of historical information gathering and is meant to establish therapeutic trust and safety. Where are the client's hidden loyalties and deep identifications with both parents! The Middle Circle is devoted to current problems and symptoms (p. 182) and the establishment of a supportive network. It is the Middle Circle that the functions of the symptom are explored, such as helping the client to relieve pain, achieve numbness, contain rage, or mediate fear (p. …" @default.
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• W156768427 date "1994-10-01" @default.
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• W156768427 title "Book Reviews -- Women Who Hurt Themselves by Dusty Miller" @default.
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