About the Workshop

Dissociative processes are most evident in the rapid shifts in self-states identified by the close tracking of ‘no-go zones’ - those places in our psyche which are too dangerous or painful to enter. These places frequently result from persistent early trauma, commonly as a consequence of growing up in an environment where the child’s caretaker(s) are either frightened or frightening, or both.

Working therapeutically with individuals with such disorganised attachments presents considerable difficulties since, by definition, the dissociative processes are designed to ‘hide’ both the fear and the longing for connection from both oneself and the Other. This can result in behaviours which fluctuate between angry attacks on the therapeutic relationship and a tenacious attachment to it. An intolerable dilemma arises from a longing to feel ‘real’ yet also desperately wanting to avoid the associated pain that comes with it. This requires the therapist to survive, detoxify, and metabolize the emotional turmoil that results from the internal shame and fear of humiliation, intolerable loss, intense dislike, disgust, and contempt that often underpin such ‘attackments’.

In this workshop, Dr Chefetz marries dissociation and its clinical manifestations with a wealth of extended case histories. Drawing on theories of self-states and their involvement in dissociative experiences, he demonstrates how to identify and work with persistent dissociative processes, and their related neurobiological and psychodynamic underpinnings.

Learning outcomes

• Recognising dissociative processes in your casework;
• Understanding memory processes in trauma patients; and
• Working with shame, repetition compulsions, enactments, addictive behaviours, depersonalisation, self-harm, and suicidality in the lives of adult survivors of childhood trauma.

Objectives

• Describe the normal tension between association and dissociation and how the balance between them contributes to mental coherence.
• Discuss why discerning depersonalisation is critically important in assessing dissociation.
• Describe how dissociative process influences memory and the questions that are important in discerning dissociative disturbances of memory
• Compare the basics of infant attachment behaviours and their adult manifestations in trauma treatment.
• Discuss the differences between emotions in the shame spectrum of experience and their personal and interpersonal correlates
• Explain the potential value and pitfalls of countertransference disclosure in psychotherapy with trauma survivors.
• Describe appropriate questions to discern depersonalisation, derealisation, amnesia, identity confusion, and identity alteration toward making a diagnosis of a dissociative disorder.
• Discuss and be able to apply the four basic patterns of infant attachment, secure, anxious-ambivalent, avoidant, and disorganised/disoriented to their adult cases and apply these to the clinical setting.
• Predict which patients in your practice are likely carrying hidden shame
• Describe the process from which shame and rage become welded together.
• Discuss how hippocampal and amygdala functions interact in trauma treatment.
• Discuss a strategy for pointed intervention to impact and reduce suicidality as an immediate threat.
• Explain how "attackment" describes a shift from proximity seeking in the attachment paradigm to guaranteeing distance when domination- submission, power and control, dynamics overwhelm the interpersonal world of a child
• Describe the difference between the words affect, feeling, and emotion as well as the clinical utility of distinguishing between them.
• Describe the general underlying cause of addictive behaviour as it relates to dissociative processes.
• Discuss a technique for specific psychotherapeutic exploration of addictions and their relief.
• Explain the likely sources of negative therapeutic reaction in the treatment of a person with a complex dissociative disorder.