Shame, Pride, and Dissociation: Inviting Conversations About Clinical Impasses

This session is available for 3.00 APA and ASWB credits.

Abstract
When working therapeutically with relational trauma (RT) and Dissociative Identity Disorder (DID), shame and dissociation both as process and structure are ubiquitous. At the same time, chronic, traumatic “shame states” and dissociation are what make our work so challenging. One of us (Benau) has colloquially called shame and dissociation “estranged bedfellows”, as they invariably work toward a similar “goal”, i.e., to keep out of the patient’s awareness thoughts/beliefs, feelings, somatic experience, and behavior that threaten internally and externally past and present trauma bonds. How do we understand the functions of shame and dissociation, and their relationships? How do we know when shame and dissociation “show up” in our work with trauma survivors, given that these phenomena’s primary purpose is to keep the patient from “showing up”, i.e., becoming aware of their fuller selves and that of others, and the meanings of what they have endured?

This workshop will explore relationships between shame and dissociation, the many challenges when working with these entrenched phenomena, and most especially where we get stuck and some ways to get unstuck. Dr. Benau will describe aspects of the psychodynamics of shame and dissociation, and how these guide therapy with RT survivors. A model to understand shame state reactivity between patient and therapist will be presented. Dr. Benau will also introduce the concept and phenomena of pro-being pride (PBP), i.e., the delight we take in being our true selves with ourselves and others, and in others doing the same with us, and will show how PBP can serve as a powerful antidote to shame states and dissociation.

In working with DID, there is a typically embattled dynamic between the need to visibly express imperative affects versus the equally imperative fear of becoming visible and known. While dissociation aids in the segregation of various self-states holding affects and attachment instincts, other self-states employ the invocation of acute shame to prevent the enlivenment of the former in an attempt to remain invisible. This ongoing intrapsychic dynamic often becomes relationally externalized creating psychotherapeutic impasses. Dr. Hohfeler will explain how this dynamic is created, maintained, and how it is manifested in psychotherapeutic work.

While the first half of our presentation will be mostly conceptual, the second half will be devoted to shame and dissociation-informed psychotherapy with trauma survivors. The co-presenters will briefly describe their own and others’ common clinical impasses as relates to chronic shame and dissociation, and some ways to effectively navigate this complex intrapersonal and interpersonal terrain. For the final hour, we invite participants to bring their clinical cases, tribulations and triumphs, so that together we can learn what shame and dissociation seek to keep out of awareness: the complexity of our patient’s and our own embodied aliveness.