Fine’s cognitive behavioral model for dissociative disorders

Fine’s cognitive behavioral model was designed specifically for the treatment of dissociative disorders and is based on Braun’s BASK model. In this article we present it to you.

a dissociative disorder involves mental fragmentation or disconnection. In any normal and healthy subject there should be continuity between thoughts, memories, emotions, actions and identity. But in dissociative disorder this continuity is broken.

Usually Dissociative disorders appear as a reaction to trauma. They represent a defense mechanism, a protection against the great pain experienced by the person. This generates that distressing memories are kept at bay and do not reach consciousness.

This way, the patient avoids having to face that stressful situation again – even if it is in the form of memories, nightmares or thoughts –. The problem is that, evidently, the meaning of his life remains disintegrated.

Symptoms can range from dissociative amnesias, in which the person completely forgets a painful part of their life as if it had not happened, to the development of new identities separate from the original identity.

Dissociative disorders generally They are chronic in nature, but can arise in waves, depending on whether the patient is in a more or less stressful period.

Being a complex mental disorder, intervention is not simple either. The therapist’s task is to bring to the surface everything that is hidden. For this objective, Fine’s cognitive behavioral model was developed. It is an integrative model that satisfies the exploration and stabilization requirements for treatment.

Objectives and principles of Fine’s cognitive behavioral model

In this model, promotes security, predictability and consistency. Therefore, it is a well-structured therapy. There are two ways to explain the goals of treatment to patients with a dissociative disorder: achieving congruence of purpose and motivation of the different parts of the mind and experiencing the integrity of events and the continuity of the story over time. , using the Braun model as a reference.

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Braun’s model, called BASK, states that, In a non-dissociative state they experience events almost simultaneously. This simultaneity takes place along four dimensions: having knowledge of the event, associating behaviors with those events, having sensations and also affects.

In people with dissociative disorder, some or all of these interconnections may be severed or capriciously recombined.

The ultimate goal of Fine’s cognitive behavioral model is, therefore, to reconnect the four dimensions of the BASK model for each event experienced. Their multiple realities are renegotiated with the patient and they are moved from a necessarily decontextualized life to one that is being progressively integrated.

Model stages

Fine’s cognitive behavioral model It is oriented towards phasic integration, where the initial suppression of the affect phase is followed by its dissolution.. It is made up of two very different stages:

The affect suppression stage

It favors the initial suppression of affect throughout most of the person’s states, at a time when the affect is overwhelming and unmanageable.

The cognitive strategies used help the patient focus on something other than affect. In this phase, personalities begin to be identified or the different ego states become known. Much of the cognitive restructuring takes place in this phase.

The patient also learns new ways of dealing with old problems. At this stage, the therapist introduces interventions aimed at strengthening the self. and hypnotic interventions are carried out aimed at security, modulation of affect and reconfiguration of the different parts of the psyche.

The patient learns the explicit and implicit rules of treatment, checks boundaries, and becomes familiar with the consequences for boundary violations.

The stage of dissolution of affection

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Once the patient has begun to unlearn old patterns and relearn currently more adaptive ones, the therapist will introduce abreactive work. This work dilutes the intensity of the affect without modifying the content of the patient’s experience.

A successive approach is carried out that includes the technique of systematic desensitization in the face of overwhelming affections, preferring fractional abreactions to total ones.

The development of therapy, sequenced in this way, results in the majority of patients with a dissociative disorder completing integration regardless of the content of their experiences.

In addition to these two stages, The patient can bring material to therapy. You can bring primary and secondary post-traumatic material, fantasies and confabulations to the session.

The primary constitutes the actual work with the original events that overwhelmed the patient. The secondary involves working with what they were forced to witness, visually or auditorily.

Confabulation is very relevant in the patient with a dissociative disorder, often feeling like a child forced to find an explanation in order to respond satisfactorily to an abuser or to himself. Finally, fantasy provides a welcome escape from harsh reality.