Fractionated abreaction is a technique that was specifically created to process extreme abuse and memories that are so atrocious that other techniques fail because we get flooded and overwhelmed instantly when we remember what happened. An abreaction is a situation where we remember and re-experience a memory and when that happens accidentally and uncontrollably it is never therapeutic. In the early years of trauma therapy it was attempted to let survivors re-experience in a controlled setting but the more dissociation the less this will work. It is not a good tool. Most trauma therapy techniques try to solve the problem of how to make it possible to look at a memory that is utterly overwhelming and impossible to confront. In fractionated abreaction this is achieved by breaking it down into bite sized pieces and only looking at a fraction of it at a time. This technique highly benefits from tools used in hypnosis to achieve the titration. It doesn’t always have to be formal hypnosis. The self-hypnosis that often naturally happens to people with DID can be enough.
Time
One way to do that is to break the memory down into short periods of time. We might look at sequences that are no more than a few seconds long. One sequence will be processed after the other. Periods with less distress can be a bit longer. The really bad stuff is approached a moment at a time.
Intensity
Another level of our experience is the intensity of the memory. We will be taught how to dial it down so that we will only feel about 5% of the full intensity. If that isn’t manageable it can get even lower. Then we will be guided to face the trauma situation on this intensity level until we don’t feel overwhelmed anymore and intensity can be increased a tiny bit. The process is repeated many times until we can manage the full intensity of the memory.
BASK elements
In addition to that, we can break our experience down into the BASK elements (behavior, affect, sensation, knowledge) and look at them one at a time. That means that we might only look at the emotional response or the physical pain while we contain everything else for later. Hypnosis is often used to help us remove the other elements from our awareness for a while.
Dissociative parts
Fractionated abreaction works with one part at a time. Everyone who is not actively going through the process is brought to their Safe Place and hypnosis is used to help them enter a deep sleep. The number of parts present is limited to avoid a chain reaction of triggers.That makes it possible to work through trauma with single parts even before there is a lot of communication or cooperation within the system. When parts draw closer together, the trauma isn’t an overwhelming force anymore. One could argue that because it isn’t so overwhelming anymore, parts can finally get closer to each other. It is the trauma that perpetuates the dissociation. Modern approaches that insist that processing has to happen co-consciously at all times can fail the patient.
One of these interventions can be used by itself when the memory is moderately bad and manageable. For the worst of what can happen to a human being, the interventions get stacked. So one part will go through only one BASK element covering just a few moments at 5% intensity. The T might decide to go through the whole memory, moment by moment first and then raise the intensity and do it all over again. They could also guide us to stick to the first moment, slowly increase the intensity and when we reach 100% we move to the next moment. Eventually, we will put it all together.
It sounds like this will take forever, since we are going so slow. The truth is that we are working within an area of traumatization where we can’t go any faster without risking retraumatization. This technique was created to process the unspeakable horrors. If our Ts think we can cope, they will only use a slim version of this technique or they will use a different one altogether. Chances are that when we go through fractionated abreaction, there is no other way for us to approach the trauma.
With a skilled therapist, this technique is relatively safe and it can easily be combined with EMDR or other techniques for processing, if that is a wish. It is meant for outpatient treatment and private practice and patients can usually go on with their day after a bit of a break. Even though it uses controlled re-experiencing it is still relatively gentle, because intensity is slowly increased in a way that gives us agency and doesn’t overwhelm. Going slower ends up being faster, as Kluft often says. We save all the time we would otherwise spend in crisis.
You can read more about this in Shelter from the Storm by Richard Kluft (caution, highly triggering. Also funny)
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