More Alike Than Different: Treating Severely Dissociative Trauma Survivors

Sarah Robertson is an associate editor of the Canadian Book Review
Annual.

More Alike Than Different is a measured and gracefully written study of
a phenomenon that has been labeled multiple personality, severe
posttraumatic dissociation, and, most recently, dissociative identity
disorder (DID). The author, a practising psychologist affiliated with
Queen’s University and the Kingston Psychiatric Hospital, locates the
roots of dissociation in trauma, most commonly child sexual abuse.

In the book’s first two chapters, she draws upon feminist and
social-constructionist dis-course to arrive at its central premises:
first, that “the widespread sexual abuse of children is an inevitable
outcome of a patriarchal culture”; second, that “forms of
subjectivity, including extremely dissociative subjectivity, do not have
objective status that can be addressed in a transcendent and ahistorical
fashion”; and third, that multiplicity becomes problematic only when
the “defensive dissociative barriers between [personality] states are
rigid.”

Subsequent chapters address ways of learning the language of
dissociation within the therapeutic context, the assessment and healing
stages of therapy, boundaries in the therapy relationship, the social
and legal contexts of abuse and memory, ritual abuse, the treatment of
gay and lesbian survivors of abuse, and the politics of abuse and
dissociation.

The author’s refusal to adopt an “exclusionary and adversarial”
approach to these topics allows for a rich and nuanced exploration of
their complexities. Her support of feminist politics, for example, is
tempered by a recognition that “the spirit of fascism as it has
re-surfaced in today’s political climate it not confined to the
reactionary right.”

Rivera’s unflinching examination of the fiendish complexities of the
therapeutic relationship makes her book essential reading for
therapists, but theorists and interested laypersons will also benefit
from its lucidly expressed insights.