Attackment, Shame, and Dissociation

Chronic shame, an experience of being without value, is often at the center of the aftermath of traumatic experience accompanied by active dissociative processes. Infant attachment strategies are generated in the face of fear and seek proximity to a caretaker. Such seeking is compromised when the attachment relationship is itself a source of terror, horror, or other physical or psychic pain. Enlivenment, both longed for and feared, is hidden in the wish to heal from trauma and may become trapped in the tension between seeking safety by connection and seeking safety by maintaining distance from an abusive caretaker, an attackment relationship (Chefetz, 2015). In DID we see both of these dynamics playing out internally via dissociative states of self attempting to regulate via extinguishing enlivened affects before they become visible. Placing the search for enlivenment and the need for safe relating in the center of the therapeutic relationship allows prediction of clinical constellations of experience that can assist in safely navigating these complex treatments. An active combination of theory and case presentation is used to illustrate how to understand attackment relating and the search for enlivenment as being at the center of intensive psychotherapy for the treatment of trauma and dissociation.

This session was originally presented as a live conference session in May 2020.

Target Audience


Learning Objectives

At the conclusion of this session participants will be able to:

  • Identify how chronic shame prevents the enlivenment of felt experience
  • Develop strategies to engage with attackment presentations
  • Describe the internal interplay between dissociative and shame-based processes
  • Explain how shame defenses often facilitate negative treatment reactions
  • Explain internal psychodynamics between self states in DID as partly mediated by shame defenses
Course summary
Available credit: 
  • 3.00 ISSTD Certificate Program
    This program is eligible for 3.00 credits in the ISSTD Certificate Program.
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Presenter: Rick Hohfeler, PsyD
Presenter Bio: Dr. Richard Hohfeler received his doctorate in clinical psychology from Forest Institute of Professional Psychology in 1986. He is a clinical psychologist who has maintained a private practice in the Milwaukee, Wisconsin area for the past 30 years. Dr. Hohfeler has specialized in psychological trauma since 1988 as co-manager of an inpatient program treating survivors of abuse at Rogers Memorial Hospital where he also co-managed an inpatient program treating children and adolescents. He continues to treat adults, children, and adolescents suffering from disorders associated with severe developmental trauma in private practice, as well as with the Wisconsin Department of Corrections. Dr. Hohfeler is a faculty member of the Wisconsin School of Professional Psychology in Milwaukee, Wisconsin where he teaches courses in trauma and dissociation. He is a member of the International Society for the Study of Trauma and Dissociation (ISSTD), has presented at their annual conferences, and was elected to their Board of Directors in 2016. Since 2014 he has acted as moderator for the Virtual Book Club sponsored by ISSTD. Dr. Hohfeler has provided supervision and consultation to therapists and case managers from a variety of agencies in the Milwaukee area for the past 20 years. His consultation affiliations have expanded internationally through his active involvement with the ISSTD professional organization. In 2018 he published an article entitled “Relationally-Based Psychodynamic Psychotherapy in Prison: Processes of Control, Shame, and Dissociation.”

Presenter:  Richard A. Chefetz, MD
Presenter Bio: Richard A. Chefetz, M.D. is a psychiatrist in private practice in Washington, D.C. He was President of the International Society for the Study of Trauma and Dissociation (2002-3), Co-Founder and Chair of their Dissociative Disorders Psychotherapy Training Program (2000-8), and is a Distinguished Visiting Lecturer at the William Alanson White Institute of Psychiatry, Psychoanalysis, and Psychology. He is also a faculty member at the Washington School of Psychiatry, the Institute of Contemporary Psychotherapy & Psychoanalysis, and the Washington Baltimore Center for Psychoanalysis. He is a Certified Consultant at the American Society of Clinical Hypnosis and is trained in Level I and II EMDR. Dr. Chefetz was editor of “Dissociative Disorders: An Expanding Window into the Psychobiology of Mind” for the Psychiatric Clinics of North America, March 2006, “Neuroscientific and Therapeutic Advances in Dissociative Disorders,” Psychiatric Annals, August 2005, and “Multimodal Treatment of Complex Dissociative Disorders,” Psychoanalytic Inquiry, 20:2, 2000, as well as numerous journal articles on psychoanalytic perspectives on trauma and dissociation. In 2015 he published Intensive Psychotherapy for Persistent Dissociative Process: The Fear of Feeling Real, with W.W. Norton, in their Interpersonal Neurobiology series.

Available Credit

  • 3.00 ISSTD Certificate Program
    This program is eligible for 3.00 credits in the ISSTD Certificate Program.


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"Your Price" above reflects your final price based on your membership status and career level. 

  • ISSTD defines a student as those enrolled in a program of study leading to a degree or certification in the mental health field and who have an interest in trauma and dissociation. 
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