R6 - Required Module Six - Shame and moral injury and their roles in complex trauma and dissociative disorders
R6 - Shame and moral injury and their roles in complex trauma and dissociative disorders
Content Level: Advanced
Contributors: Martin Dorahy, PhD; Su Baker, MEd and Joan Turkus, MD, (edited by John O’Neil)
This module focuses on the effect of shame in the understanding and treatment of Complex trauma and dissociative disorders. To understand shame clinically and theoretically it needs to be well differentiated from other closely related affects and emotions, such as guilt. For example, the cognitive elements of shame pertain to appraisals about the self, while for guilt, appraisals are associated with one’s actions. Like guilt, shame can manifest in healthy ways (e.g., the threat of shame arising helps us conform to social norms) and unhealthy ways (e.g., eroding self-esteem, as well as relationships). More pathological manifestations of shame have been shown to be particularly common in complex trauma and dissociative disorders, and have routinely been shown to disrupt therapy if not worked through. Part of the therapeutic understanding is to recognize different behavioral responses to experiencing shame or having it begin to rise. Nathanson (1992) has proposed fours scripted responses: withdrawing, avoiding, attacking oneself and attacking another. In DID for example, these different behavioral scripts may be dominant in the psychological make-up of different identities (Kluft, 2007).
This module will look for how shame is related to complex trauma and dissociation, and readings will allow a further understanding of the treatment process and related theoretical foundations. In addition, the newer concept of moral injury is introduced as a subset of shame and guilt, which impacts on spiritual and/or ethical beliefs.
1. Define the effect of shame and differentiate it from related but distinct emotions
2. Discuss the importance of shame for understanding the clinical presentation of complex posttraumatic and dissociative disorders
3. Discuss treatment issues associated with working through shame in the therapy of those with complex posttraumatic and dissociative disorders
4. Define and discuss the concept of moral injury and its effect on the traumatized person
Readings and Webinars
A. Dorahy, M. (2015). Shame and Dissociation in Complex Trauma Disorder. ISSTD webinar. (To be watched on student’s own time, before the class.)
B. Dorahy, M. J. (2017). Shame as a compromise for humiliation and rage in the internal representation of abuse by loved ones: Processes, motivations and the role of dissociation. Journal of Trauma and Dissociation, 18(3), 383-396.
C. Jinkerton, J.D. (2016) Defining and assessing moral injury: A syndrome perspective. Traumatology, 22(2), 122-130.
D. Kluft, R. (2008). The use of Tomkins' innate affect theory and Nathanson's compass of shame in facilitating the understanding and treatment of DID and DDNOS. ISSTD Webinar. (To be watched on student’s own time, before the class)
E. Platt, M. & Freyd, J. (2011). Trauma and negative underlying assumptions in feelings of shame: an exploratory study. Psychological Trauma: Theory, Research, Practice, and Policy, 4(4), 370–378
30 minutes: Discussion of Webinar A
30 minutes: Discussion of Reading B and E
30 minutes: Discussion of Webinar D
30 minutes: Discussion of Reading C
30 minutes: Discussion of student’s disguised cases, or further discussion of readings A, B, C, D and E if no case material available
- 2.50 APAThe International Society for the Study of Trauma and Dissociation is approved by the American Psychological Association to sponsor continuing education for psychologists. The International Society for the Study of Trauma and Dissociation maintains responsibility for this program and its content.