NARM vs Structural Dissociation
A side-by-side comparison: mechanism, evidence, the conditions each treats, philosophical roots, and where they actually disagree clinically.
At a glance
NARM
- Tradition
- Somatic
- Founder
- Laurence Heller (2012)
- Evidence
- Emerging evidence
- Focus
- Developmental + Relational + Somatic
- Format
- Individual
- Duration
- Medium to long-term
Structural Dissociation
- Tradition
- Trauma-Focused
- Founder
- Onno van der Hart, Ellert Nijenhuis, Kathy Steele (2006)
- Evidence
- Guideline-recommended
- Focus
- Stabilization + Processing + Integration
- Format
- Individual
- Duration
- Long-term (years for complex presentations)
How they work
NARM
Core mechanism: Simultaneously tracking somatic experience, relational patterns, and identity-level beliefs reveals how developmental survival styles organized around early unmet needs are maintained in the present
Ontology: Early attachment failures create survival styles that organize identity, relationships, and somatic patterns into predictable configurations; the self-structure formed around deprivation, not the original events, is what maintains suffering
Structural Dissociation
Core mechanism: Phase-oriented treatment: (1) stabilize ANP functioning and reduce EP intrusions, (2) process traumatic memories to resolve phobia of trauma-related content, (3) integrate dissociated parts into a more unified personality
Ontology: Trauma structurally divides the personality into parts organized around incompatible action systems — daily life management (ANP) and survival defense (EP); healing requires phased integration of what was dissociated
Conditions treated
1 shared · 2 NARM-only · 2 Structural Dissociation-only
Both treat
Only NARM
Only Structural Dissociation
What each assumes — and misses
NARM
Philosophical roots: Heller (developmental trauma and identity); Reich (character armor — reimagined developmentally); Bowlby (attachment); Schore (affect regulation); Winnicott (true self/false self); Lowen (bioenergetics, reframed)
Blind spots: Limited empirical evidence; five survival styles risk becoming rigid typology; developmental focus may not address acute symptom presentations; less helpful for single-incident trauma
Therapeutic voice: You're telling me about this pattern of always taking care of others. As you say that, what do you notice happening in your body? And I'm curious — what happens inside when you imagine someone wanting to take care of you?
Structural Dissociation
Philosophical roots: Janet (dissociation, fixed ideas, action systems); Myers (shell shock, apparently normal/emotional personality); Bowlby (attachment); evolutionary psychology (action systems); van der Kolk (body keeps the score)
Blind spots: Phase-oriented approach can become indefinite stabilization that avoids processing; the model is complex and requires extensive training; may pathologize adaptive dissociation in some cultural contexts
Therapeutic voice: The part of you that goes to work and pays the bills — and the part that wakes up screaming — they're both you. Right now they don't know each other very well. Our work is to help them communicate.
Choosing between them
NARM (Somatic) and Structural Dissociation (Trauma-Focused) come from different traditions, which means they assume different things about what a person is, what causes suffering, and what the therapeutic relationship is for. The choice between them is often less about "which works better" and more about which set of assumptions fits the client and the therapist.
For deeper coverage: see the full NARM and Structural Dissociation pages, or use the interactive comparison tool to add more modalities to this comparison.