Trails in the Fog: Using Case Formulation to Map Interventions with Youth Who Dissociate

Abstract
Youth with trauma and dissociation often present with complex presentations involving interacting co-occurring disorders, high-risk behaviours, and challenging social circumstances. Identifying dissociative processes and matching treatment to diagnosis are crucial steps to initiating effective treatment with these youth. However, interventions with these youth and their caregivers can feel like playing whack-a-mole, with shifting symptoms and treatment priorities undermining the youth’s and caregivers’ confidence and motivation to continue the therapeutic work. In this case, a stable, collaborative and concrete treatment plan can serve as a map that provides hope and consistency throughout the treatment process. Traditional assessment and diagnosis is essential—but not sufficient—in informing an effective treatment plan when working with youth and families with complex trauma and dissociation. This workshop outlines an individualized and holistic approach to treatment planning with youth and their caregivers that integrates the assessment process, case formulation, developmental and intergenerational considerations, and best practices for treating the underlying mechanisms maintaining the youth’s instability within the context of treating complex trauma and dissociation.

This session opens with an overview of the assessment process and case formulation with youth. As part of this, the session briefly reviews trauma- and dissociation-specific assessment tools for use with youth and their caregivers, and highlights the ways in which the assessment process complements the assessment content. The focus then shifts to translating assessment results into an integrated, holistic and developmentally-sensitive case formulation. Emphasis is then placed on the direct application of case formulation to initial treatment planning, including: identifying and accentuating resources and protective factors; prioritizing treatment targets; selecting appropriate psychological, pharmacological and social interventions that address the mechanisms maintaining the youth’s challenge; and returning to the case formulation to guide treatment over time.

Rather than focusing on any particular therapeutic orientation or type of therapy for understanding and treating trauma and dissociation, this session emphasizes the intentional clinical thought processes underlying treatment planning and intervention implementation across treatment modalities. Composite case examples are used to illustrate these concepts. The session will end with an opportunity for attendees to ask questions, and discussions are encouraged.