Abstract

When working therapeutically with relational trauma (RT), shame and dissociation as  process and structure are ubiquitous, although not always recognized to the untrained  eye. Chronic, traumatic “shame states” and dissociation together make our work as  psychotherapists challenging. I have colloquially called shame and dissociation “estranged bedfellows”, as together they work 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 the primary  purpose of these phenomena 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?  

In this workshop, I describe the dynamic relationship between embodied shame states  and disembodied dissociative processes (e.g., detachment) and structural dissociation  from several vantage points. These include neurophysiological, intrarelational  (psychodynamic), interrelational (attachment), and meanings/beliefs about self, other,  and relationship. For each perspective, several therapeutic applications will be  identified. 

At the same time, there is the opposite of shame, pride. While there are maladaptive  forms of pride, as in hubristic pride and traumatic pride states where aspects of self, or  one’s entire being, are not able to “hold” pride, our focus here will be on adaptive forms  of pride. I will describe “good enough me pride”, the authentic pride of  accomplishment. Another form of adaptive pride, an enduring, transformative state  rather than emotion, is “pro-being pride” (PBP). PBP is the celebration of one’s unique  ways of being, in relation to oneself, others, and the world. PBP is the most powerful  antidote to shame states. From this perspective, successful psychotherapy with patients  living with RT entails working with life experiences that led to the development of  shame states and dissociation, with the aim of restoring the patient’s aliveness and PBP.  A clinical vignette, with transcribed excerpts from a Deep Brain Reorienting (DBR)  session, will document one patient’s movement from a shame state that inhibited his  creative self-expression, to “good enough pride”, and emerging pro-being pride. A  fifteen minute conversation with participants will follow the presentation.

Potential to Distress: Yes