Talking on trauma and dissociation

Working with Chronic Feelings of Shame. Therapists often feel that they do not have sufficient capacity to effectively address chronic shame, as it is particularly overwhelming, hidden, and alienating. We will explore the various functions of shame, both adaptive and maladaptive, as well as four common defenses against shame. We will discuss specific "antidotes" to shame for inclusion in treatment. A practical integration of cognitive, emotional, somatic, and relational interventions to decrease chronic shame will be discussed. The importance of pacing and acknowledging the experience of shame will be discussed. Most importantly, we will examine what it feels like to be with shame - our own and our patients' - with curiosity and compassion, finding ways to create a relational space in which shame can safely emerge. Finally, we will briefly discuss ways to help patients (and therapists) develop resilience to inevitable shame reactions.

Working with Chronic Feelings of Shame. Therapists often feel that they do not have sufficient capacity to effectively address chronic shame, as it is particularly overwhelming, hidden, and alienating. We will explore the various functions of shame, both adaptive and maladaptive, as well as four common defenses against shame. We will discuss specific "antidotes" to shame for inclusion in treatment. A practical integration of cognitive, emotional, somatic, and relational interventions to decrease chronic shame will be discussed. The importance of pacing and acknowledging the experience of shame will be discussed. Most importantly, we will examine what it feels like to be with shame - our own and our patients' - with curiosity and compassion, finding ways to create a relational space in which shame can safely emerge. Finally, we will briefly discuss ways to help patients (and therapists) develop resilience to inevitable shame reactions.

Ethical Indications in the Treatment of Complex Trauma Professional ethics is often seen as necessary and obvious, but not very interesting. This workshop will offer a lively discussion of the real clinical dilemmas that arise with patients with complex trauma. Ethical guidelines offered by professional organizations may provide basic guidance, but they generally do not address the highly complicated situations of trauma patients, nor the intense transference, behavioral problems, and chaotic relationships that therapists must sometimes manage. How do we deal with the patient's ongoing abuse and victimization? How do we maintain therapeutic boundaries? What is our responsibility in managing intense countertransference? How do we handle patients who refuse hospitalization but are self-injurious or suicidal? How far should we go to prevent someone from harming themselves? How do we deal with issues of faith and truth when patients report trauma and ask if we believe them? How do we handle a dissociative part of a patient when they tell us something that other parts don't know? These issues and more will be addressed. We will explore the importance of ethical principles that are as congruent as possible with our personal ethics, but we will also discuss times when our personal and professional ethics may differ, leaving us in a quandary.

Ethical Indications in the Treatment of Complex Trauma Professional ethics is often seen as necessary and obvious, but not very interesting. This workshop will offer a lively discussion of the real clinical dilemmas that arise with patients with complex trauma. Ethical guidelines offered by professional organizations may provide basic guidance, but they generally do not address the highly complicated situations of trauma patients, nor the intense transference, behavioral problems, and chaotic relationships that therapists must sometimes manage. How do we deal with the patient's ongoing abuse and victimization? How do we maintain therapeutic boundaries? What is our responsibility in managing intense countertransference? How do we handle patients who refuse hospitalization but are self-injurious or suicidal? How far should we go to prevent someone from harming themselves? How do we deal with issues of faith and truth when patients report trauma and ask if we believe them? How do we handle a dissociative part of a patient when they tell us something that other parts don't know? These issues and more will be addressed. We will explore the importance of ethical principles that are as congruent as possible with our personal ethics, but we will also discuss times when our personal and professional ethics may differ, leaving us in a quandary.

Working with Self-Harm and the Risk of Suicide in Complex Trauma Intentional self-injury and acute and chronic suicide risk are common issues in working with patients with complex trauma and dissociation. These behaviors may be hidden and the patient reluctant to talk about them or they may be a constant topic in therapy, leaving little room for therapeutic progress. How can we better respond to and understand the complex reasons for these behaviors and avoid power struggles with our patients? We will explore how to understand the many reasons for self-harm and suicide in a compassionate way, and how to help our patients discover more appropriate ways to address them. Specific interventions will be addressed, including how to approach the dissociative parts that are active in the dynamics of self-harm. We will discuss acute and chronic suicide, from suicidal thoughts, to ruminations, to plans. Finally, we will examine our countertransference process, from avoidance to chronic urgency to act.

Working with Self-Harm and the Risk of Suicide in Complex Trauma Intentional self-injury and acute and chronic suicide risk are common issues in working with patients with complex trauma and dissociation. These behaviors may be hidden and the patient reluctant to talk about them or they may be a constant topic in therapy, leaving little room for therapeutic progress. How can we better respond to and understand the complex reasons for these behaviors and avoid power struggles with our patients? We will explore how to understand the many reasons for self-harm and suicide in a compassionate way, and how to help our patients discover more appropriate ways to address them. Specific interventions will be addressed, including how to approach the dissociative parts that are active in the dynamics of self-harm. We will discuss acute and chronic suicide, from suicidal thoughts, to ruminations, to plans. Finally, we will examine our countertransference process, from avoidance to chronic urgency to act.

Working with Patient and Therapist Critical and Punitive Attitudes. This workshop will offer a practical and integrative approach to understanding and working with a wide range of inner criticism, punishment, and harshness in our patients, and also in ourselves as therapists. Everyone experiences an "inner critic," based on negative messages from authority figures and from ourselves in reaction to feeling inadequate in some way. In complex trauma this natural phenomenon often becomes more intense, overwhelming, and more dissociated. We will explore how these inner aspects develop and understand their different functions of protection, avoidance, and attempts to cope in daily life. At times, the simultaneous activation of the patient's and therapist's inner critic can lead to a therapeutic impasse. Our ability to reflect on our tendencies toward self-criticism as therapists will support our ability to work with these experiences in our patients.

Working with Patient and Therapist Critical and Punitive Attitudes. This workshop will offer a practical and integrative approach to understanding and working with a wide range of inner criticism, punishment, and harshness in our patients, and also in ourselves as therapists. Everyone experiences an "inner critic," based on negative messages from authority figures and from ourselves in reaction to feeling inadequate in some way. In complex trauma this natural phenomenon often becomes more intense, overwhelming, and more dissociated. We will explore how these inner aspects develop and understand their different functions of protection, avoidance, and attempts to cope in daily life. At times, the simultaneous activation of the patient's and therapist's inner critic can lead to a therapeutic impasse. Our ability to reflect on our tendencies toward self-criticism as therapists will support our ability to work with these experiences in our patients.